Factors Influencing Nursing Students’ Decision to Choose the Nursing Education Program in Bulgaria

The aim of this study was to establish the factors influencing nursing students’ decision to choose the nursing education program in Bulgaria. Methodology: An anonymous survey was carried out among 160 nursing students in March of 2016, using self-administered questionnaire. The questionnaire was prepared in order to achieve the aim of the study and asked for information about the demographic characteristics of the respondents, and 10 questions that asked students to evaluate on the scale of 1 to 5 (from “Completely agree” to “Completely disagree”) their choice and satisfaction with the decision to study Nursing. These questions were arrived at in brainstorming sessions with groups of 7 9 students and secondary information from numerous studies. Results were analyzed by descriptive statistics of the data, non-parametric and factor analysis, using the SPSS 17.0. Results: The results of the analysis showed that student motivation to enroll in this particular university program depends on four types of factors, which account for 59,30% of the studied variable. The motivating factors are interconnected, and have been grouped in the following way: F1 – Social and economic determinants, F2 – Quality of education, F3 – Market situation in the country, F4 – Opportunity to work abroad. The Kaiser-Meyer-Olkin (KMO) test was 0.601 (i.e. >0.5) and the Bartlett's test of sphericity was Sig.=0.00, which demonstrates the suitability of the factor analysis. Conclusion: The findings of this study provided valuable information regarding motivating factors which attract the current generation to join the nursing education program.


Introduction
Worldwide the process of choosing a nursing program can seem easy. According to the World community of nurses, few careers offer the same advantages as nursing: registered nurses earn high salaries, work with interesting people, andperhaps most importantly -significantly affect people's lives, often even saving their lives (25 Reasons to Choose a Career in Nursing).
But the situation in Bulgaria is not so good. They work in unfavorable conditions and receive low salaries, being exposed to higher mental, physiological and cognitive requirements. The labor of nurses has long been pointed at as among the most stressful in Bulgaria and among the few jobs where employees have to cope with different situations under stress. High levels of stress are connected with the basic characteristics of their activities: extremely dangerous, fast and intensive (Stoyanova, 2018). These employees have to approach their professional duties with the required attention and responsibility because there is a direct threat or clear and present life threat. They often work in teams, which require good collaboration between team members. Given the continuous 24-h work process, they work in shifts (Bakker et. al 2006;Schaufeli et al, 1998).
The aim of this study was to establish the factors influencing nursing students' decision to choose the nursing education program in Bulgaria.

Methods
An anonymous survey was carried out among 160 nursing students, using self-administered questionnaire. The questionnaire was prepared in order to achieve the aim of the study and asked for information about the demographic characteristics of the respondents, and 10 questions that asked students to evaluate on the scale of 1 to 5 (from "Completely agree" to "Completely disagree") their choice and satisfaction with the decision to study Nursing. These questions were arrived at in brainstorming sessions with groups of 7 -9 students and secondary information from numerous studies (Neill, 2009;Denny, 2014;Padlee et al., 2010).
The study was conducted between 01-30 March 2016. Results were analyzed by descriptive statistics of the data (mean, standard deviation, number and percentage), and presented in the form of tables, using the SPSS 17.0 program. Other statistical analysis method that was used is factor analysis.

Results and Discussion
The mean age of the respondents was 23.58 ±6,459. The decision to choose the nursing education program typically depends on various factors, prominent among them being the ones that have to do with a student's intrinsic motivation to pursue the major in question. In our initial sessions with groups (of 7 to 9 students each), we relied on brainstorming to deduce the main motivating factors. Table 1 shows the distribution of the answers of all participants in the study. They had to evaluate the influence of each of the given factors. In order to highlight the main motivating factors and reduce their number, we performed a factor analysis following the Principle Component Method. After applying the factor analysis, we removed the components weighing less than 0.5 and p ≥ 0.05. This component was "Q4: This is my childhood dream".
The rest of the items underwent a Varimax rotation in order to increase their factor weight at the expense of the removed items. In this way the observed variable could be better assessed using a minimum number of leading factors. The results of our analysis showed that student motivation to enroll in this particular university program depends on four types of factors, which account for 59,30% of the studies variable. The motivating factors are interconnected, and have been grouped in the following way: F1 -Social and economic determinants, F2 -Quality of education, F3 -Market situation in the country, F4 -Opportunity to work abroad (see Table 2). Having a factor weight of 0.408, Q4 was left out of the analysis. The Kaiser-Meyer-Olkin measure of sampling adequacy is 0.601 (i.e. > 0.5) and Bartlett's Test of sphericity is Sig. = 0.00, which proves that the use of factor analysis is acceptable.

Conclusion
Based on the survey data, it appears that four primary areas have importance for those who choose to study the nursing profession in Bulgaria: (1) Social and economic factors as the prestige of the profession, distance to the University and relatively low tuition fee; (2) quality of education; (3) future employment-related aspects of job security and a low competition among the applicants; and (4) the travel opportunities available to those with a nursing qualification. This suggests that for those who are highly motivated by such factors, this profession can provide returns in line with their expectations. The findings of this study provided valuable information regarding motivating factors which attract the current generation to join the nursing education program.

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