Desire to Work in Nursing Instrument (DeWoNu-I)

Abstract

The Desire to Work in Nursing Instrument (DeWoNu-I) is a standardized, self-report psychometric questionnaire developed by Talman et al. (2023) designed to measure prospective nursing students’ and applicants’ occupational desire, motivation, and vocational commitment toward entering the nursing profession. Nursing workforce shortages, student attrition, and early-career burnout pose substantial international healthcare challenges, making the accurate measurement of pre-entry vocational orientation critical for admissions, educational retention, and workforce planning. Developed to address the absence of targeted, empirically grounded instruments assessing vocational interest during student admissions, the DeWoNu-I was constructed using a rigorous multi-stage methodological approach. This included qualitative focus group interviews, an exhaustive literature review, and a meta-ethnographic synthesis following the framework of Munro et al. (2007), which yielded 27 foundational elements organized into four theoretical categories: Nature of the work, Career opportunities, Suitability for nursing, and Previous experiences.

Following iterative content validity evaluations by panels of senior educational and psychometric researchers, the instrument was refined to 14 items measured on a four-point Likert scale ranging from 1 (“agree”) to 4 (“disagree”). The psychometric properties were evaluated with a nationwide sample of nursing applicants across universities of applied sciences in Finland. Although conceptualized across four theoretical domains, principal component analysis (PCA) demonstrated that a robust unidimensional structure accounts for 76% of total variance, supporting a parsimonious single-factor model of “desire to work in nursing.” Reliability indices confirm high internal consistency, with theoretical subscale Cronbach’s alpha coefficients ranging from 0.83 to 0.95. The DeWoNu-I serves as a vital predictive and evaluative tool for higher education admissions committees, nursing faculty, and vocational researchers seeking to foster resilient, committed nursing cohorts.

Keywords

Desire to Work in Nursing Instrument, DeWoNu-I, Nursing Applicants, Vocational Motivation, Career Choice, Nursing Education, Psychometrics, Admissions Testing, Occupational Commitment, Principal Component Analysis

Authors

The DeWoNu-I was designed and psychometrically validated by a research group specializing in nursing education, admissions systems, and healthcare workforce development in Finland:

• Kirsi Talman, PhD, RN — Department of Nursing Science, University of Turku, Turku, Finland. (Corresponding author: [email protected])
• Henna Mäntylä, MNSc, RN — Department of Nursing Science, University of Turku, Turku, Finland.
• Maija Hupli, PhD, RN — Department of Nursing Science, University of Turku, Turku, Finland.
• Anne-Maria Kanerva, PhD, RN — Faculty of Health and Well-being, Turku University of Applied Sciences, Turku, Finland.
• Janne Engblom, DSc — Department of Mathematics and Statistics, University of Turku, Turku, Finland.
• Elina Haavisto, PhD, RN — Department of Nursing Science, University of Turku, Turku, Finland, and Wellbeing Services County of Southwest Finland.

Purpose

The primary purpose of the Desire to Work in Nursing Instrument (DeWoNu-I) is to systematically quantify and evaluate the multidimensional vocational interest, underlying motivation, and personal commitment of applicants seeking admission into undergraduate nursing degree programs. Globally, healthcare infrastructures confront profound nurse shortages compounded by high rates of academic attrition in undergraduate nursing education and premature career abandonment among early-career registered nurses. A major contributing factor to early departure is the misalignment between student expectations and the clinical reality of nursing practice. Traditional university admissions selection mechanisms frequently rely on academic achievement metrics—such as grade point averages or standardized general cognitive testing—which fail to evaluate vocational compatibility, intrinsic professional motivation, and realistic expectations regarding nursing labor.

The DeWoNu-I was constructed to remediate this assessment gap by offering an evidence-based, psychometrically sound instrument capable of measuring applicant dispositional commitment. In higher education admissions contexts, the instrument can be implemented within multi-stage entrance examination batteries to identify applicants whose motivational orientation aligns with professional role demands. Identifying candidates with authentic occupational interest supports student retention, as intrinsically motivated students demonstrate superior academic endurance, clinical resilience, and stress management under demanding educational conditions.

Beyond student selection, the DeWoNu-I provides significant clinical and educational research utility. It allows academic researchers and nurse educators to track shifts in vocational motivation longitudinally—from initial application through clinical placement sequences to post-graduation professional transition. This longitudinal data can elucidate how early vocational expectations interface with clinical realities, academic burnout, and subsequent intent to stay within the nursing workforce. Furthermore, the tool provides career guidance counselors and vocational psychologists with diagnostic data to assist prospective students in assessing their personal congruence with healthcare professions prior to making substantial academic commitments.

Psychological Construct

The psychological construct assessed by the DeWoNu-I is occupational desire and vocational motivation toward the nursing profession. Rather than viewing career choice as an isolated, impulsive decision, contemporary vocational psychology conceptualizes vocational desire as a dynamic constellation of intrinsic, prosocial, experiential, and instrumental orientations. Through meta-ethnographic analysis, Talman et al. identified four interrelated operational dimensions underpinning this construct:

1. Nature of the Work

This dimension captures the applicant’s cognitive perception of and affective attraction to the functional tasks, daily activities, and intrinsic mental demands of clinical nursing. It reflects an appreciation for the fast-paced, unpredictable, and varied aspects of patient care. Rather than seeking a static or monotonous administrative role, candidates with high scores on this domain value workplace versatility, dynamic task shifting, and intellectual stimulation. Key components include:

• Alternating work environments: Cognitive readiness to adapt to shifting clinical conditions, patient turnover, and non-routine workflows.
• Versatility of content: Attraction to a profession that merges biological sciences, psychosocial interventions, technical pharmacology, and emotional support.
• Mental reward: The intrinsic psychological satisfaction derived from resolving complex clinical problems and managing critical health events.

2. Career Opportunities

The career opportunities dimension assesses instrumental motivation, vocational utility, and long-term professional development goals. Nursing is increasingly recognized as an autonomous, academically grounded discipline with expanding scopes of practice. This subscale reflects an applicant’s forward-looking perspective on the structural advantages offered by a nursing credential, including:

• Educational progression: The degree’s utility as a stepping stone toward master’s and doctoral degrees in clinical nursing, nursing leadership, or health administration.
• Advanced specialization: Opportunities to train in specialized domains such as critical care, nurse anesthesia, emergency nursing, or advanced practice nursing.
• Employment security: Awareness of and attraction to high labor market demand, low unemployment risk, and geographical mobility.

3. Suitability to Nursing

This subscale evaluates the applicant’s perceived person-environment fit, prosocial orientation, and intrinsic calling. Rooted in self-concept theory, suitability reflects an individual’s evaluation of their personal values, affective traits, and interpersonal competencies in relation to the emotional and physical demands of nursing care. Key facets include:

• Prosocial altruism: A fundamental desire to alleviate human suffering, assist vulnerable populations, and advocate for patient well-being.
• Personality congruence: The self-assessed alignment of one’s disposition—such as empathy, conscientiousness, emotional stability, and patience—with the demands of patient interaction.
• Sense of calling: An internalized, meaningful identification with nursing as a personal life mission rather than merely a commercial job.

4. Previous Experiences

Vocational interests are rarely generated in a vacuum; they are catalyzed by direct and indirect environmental exposures. This domain measures the foundational biographical experiences that orient an individual toward healthcare settings, including:

• Direct healthcare exposure: Personal observations of high-quality nursing care during prior personal illness, family hospitalization, or service as a nursing assistant.
• Interest in the clinical milieu: Affective attraction to hospital systems, clinical technologies, and the multidisciplinary healthcare setting.
• Biographical socialization: Vicarious learning experiences shaped by stories, mentorship, and professional narratives shared by family members, peers, or close acquaintances working in healthcare.

Theoretical Framework

The conceptual architecture of the DeWoNu-I integrates multiple established theoretical frameworks within vocational psychology, personality-job fit, and human motivation.

Holland’s Theory of Vocational Personalities and Work Environments

The primary theoretical foundation rests upon John Holland’s RIASEC model (1997), which posits that career choice represents an expression of personality. Individuals seek vocational environments that permit them to exercise their skills, express their values, and undertake agreeable roles. Nursing predominantly occupies the Social (helping, teaching, caring) and Investigative (analytical, scientific, problem-solving) domains, with secondary elements of Realistic (hands-on technical operations) and Conventional (protocol adherence, systematic charting) orientations. The DeWoNu-I measures this person-environment fit by assessing whether an applicant’s self-concept aligns with the behavioral requirements of the Social-Investigative nursing milieu.

Social Cognitive Career Theory (SCCT)

Developed by Lent, Brown, and Hackett (1994), SCCT expands upon Albert Bandura’s social learning paradigm to explain how basic academic and career interests develop, how educational and career choices are made, and how academic and career success is achieved. SCCT highlights the interplay between self-efficacy beliefs, outcome expectations, and personal goals:

• Outcome Expectations: The DeWoNu-I items concerning career mobility, educational expansion, and mental rewards directly reflect an applicant’s beliefs regarding the positive consequences of earning a nursing qualification.
• Environmental and Social Influences: SCCT highlights proximal and distal contextual factors. The DeWoNu-I subscale on “Previous experiences” captures experiential learning, observational modeling, and vicarious reinforcement derived from family narratives and clinical exposures.

Self-Determination Theory (SDT)

Under Self-Determination Theory formulated by Edward L. Deci and Richard M. Ryan, human behavior is directed along a continuum from extrinsic to intrinsic motivation. The DeWoNu-I captures both autonomous and instrumental motivational factors:

• Autonomous / Intrinsic Motivation: Evidenced by items tapping personal calling, the inherent joy of human interaction, and the intellectual interest in health and human well-being. SDT predicts that applicants with predominantly autonomous motivation display superior conceptual learning, enhanced emotional regulation, and decreased burnout.
• Identified / Instrumental Regulation: Evidenced by items measuring the degree as a conduit for further specialization and secure employment. While extrinsic, these identified regulations are internalized and align with constructive vocational persistence.

Validity

The psychometric validity of the DeWoNu-I was established through rigorous, sequential methodological procedures addressing content, construct, and structural validity.

Content Validity

Content development followed a systematic meta-ethnographic synthesis (Munro et al., 2007) of qualitative literature and empirical data extracted from focus group interviews with clinical educators and nursing applicants. An initial pool of 27 distinct elements was synthesized into an operational 15-item prototype distributed across the four theoretical categories.

To establish formal content validity, the prototype underwent a three-round Delphi-style expert panel evaluation. The panel comprised four senior researchers with extensive publication records in entrance examinations, psychometrics, and instrument design. In the first round, panel feedback led to the deletion of one redundant item within the “Nature of the work” domain and the rewording of seven items to eliminate semantic ambiguity and double-barreled structures. In the second round, five items underwent structural linguistic clarification to optimize item comprehension for young adult and non-traditional adult applicants. The third round resulted in 100% expert consensus on the operational relevance and clarity of the remaining 14 items, confirming high content validity index (CVI) metrics.

Construct and Structural Validity

Construct validity was evaluated using exploratory multivariate techniques on empirical data gathered from university of applied sciences nursing applicants in Finland. A primary Principal Component Analysis (PCA) was conducted to investigate the latent structure of the 14 items. The analysis revealed a clear, dominant single component that accounted for 76% of the total variance, with all 14 items exhibiting substantial factor loadings on this general factor.

Although the initial theoretical design postulated four distinct sub-domains, analytical exploration of multidimensional alternatives (e.g., two-factor and four-factor orthogonal varimax rotations) confirmed that subscale partitions fragmented the underlying construct into psychometrically weak, under-identified components (some with only one or two items). The empirical evidence strongly verified that the DeWoNu-I operates most effectively as a unidimensional metric capturing an overarching, integrated construct of “desire to work in nursing.”

Reliability

The reliability of the DeWoNu-I has been evaluated using classical test theory indices of internal consistency across both its theoretical subscales and overall composite structure.

Internal Consistency Metrics

When evaluated across the four theoretical subscales, the instrument demonstrated high internal consistency reliability, with Cronbach’s alpha coefficients exceeding conventional psychometric thresholds (typically α ≥ 0.70):

• Nature of the work: α = 0.83 to 0.89
• Career opportunities: α = 0.85 to 0.91
• Suitability to nursing: α = 0.88 to 0.95
• Previous experiences: α = 0.84 to 0.92

Across item-deletion sensitivity analyses, alpha coefficients varied within a stable range from 0.65 to 0.98. The high composite reliability confirms that the 14 items possess minimal measurement error and reliably capture applicant sentiment.

Item Homogeneity

Item-total correlations across the validation cohort demonstrated high homogeneity. No individual item suppressed the overall scale reliability, verifying that each item reliably contributes to the measurement of the target construct without introducing substantial idiosyncratic noise.

Factor Analysis

The internal latent architecture of the DeWoNu-I was thoroughly investigated using Principal Component Analysis (PCA) to determine whether the empirical data reflected the four theoretical categories or a more unified construct.

Initial Unrotated Solution

In the primary PCA run, extraction criteria based on eigenvalues greater than 1.0 identified a single dominant component accounting for 76% of the total variance. An examination of the scree plot revealed pronounced inflection points below factor one and factor three, indicating that a unifactorial structure represented the most parsimonious and psychometrically sound explanation of applicant responses.

Exploration of Multidimensional Models

To rigorously test the theoretical viability of multidimensionality, the researchers modeled two-factor and four-factor structures using varimax orthogonal rotation:

• Two-Factor Solution: The varimax-rotated two-factor solution accounted for 82% of the cumulative variance. However, the second component was psychometrically compromised, retaining only two items with significant primary loadings: Item 4 (“Degree enables further education”, loading = 0.895) and Item 14 (“I have taken an interest in nursing via stories told by close ones”, loading = 0.628). Factors defined by fewer than three items are widely considered unstable and vulnerable to sample-specific variance.
• Four-Factor Solution: A four-factor rotation corresponding to the four original theoretical categories explained 89% of the cumulative variance. Nevertheless, factor distribution was markedly unbalanced: Factor 1 subsumed 10 items (explaining 51% of variance), Factor 2 retained 2 items (explaining 17%), Factor 3 was defined by only 1 item (explaining 12%), and Factor 4 was defined by a single item (explaining 10%).

Methodological Recommendation

Because retaining single-item or two-item factors violates structural equation modeling and classical psychometric standards for subscale viability, the test developers formally concluded that the one-factor unidimensional solution is the most valid, parsimonious, and reliable model for practical use and research scoring of the DeWoNu-I.

Instrument / Measurement Tool

• Test Name: Desire to Work in Nursing Instrument (DeWoNu-I)
• Authors: Kirsi Talman, Henna Mäntylä, Maija Hupli, Anne-Maria Kanerva, Janne Engblom, and Elina Haavisto (2023)
• Construct Assessed: Occupational desire, motivation, and vocational commitment toward the nursing profession
• Administration Format: Self-administered paper-and-pencil or computer-based questionnaire
• Target Population: Nursing school applicants, undergraduate prospective students, and adult vocational switchers (aged 18 years and older, spanning young adulthood through middle age)
• Item Count: 14 items
• Theoretical Subscales (for qualitative profiling):
  • Nature of the work (Items 1–3)
  • Career opportunities (Items 4–6)
  • Suitability to nursing (Items 7–10)
  • Previous experiences (Items 11–14)
• Response Scale: Four-point Likert scale formatted as:
  • 1 = Agree
  • 2 = Somewhat agree
  • 3 = Somewhat disagree
  • 4 = Disagree

  (Note: In the original validation paper, numerical 1 corresponds to “agree” and 4 corresponds to “disagree”.)

• Scoring Guidelines:
  • Direct Scoring: In its original coding, lower numerical composite scores indicate a stronger desire to work in nursing.
  • Standard Psychometric Inversion (Recommended for typical statistical reporting): Items may be reverse-coded (4 = Strongly Agree / Agree to 1 = Disagree) so that higher composite or mean scores reflect a higher desire to work in nursing.
  • Composite Score: Derived by calculating the mean or sum across all 14 completed items.
• Administration Time: Approximately 5 to 10 minutes.

Permissions & Fee and Test Year

The Desire to Work in Nursing Instrument (DeWoNu-I) was developed and published in 2023. The validation study was published in Contemporary Nurse:

• Copyright: © 2023 Informa UK Limited, trading as Taylor & Francis Group.
• User Fee: There is no fee required for academic non-commercial research or standard educational evaluation.
• Permissions and Usage: Researchers, institutional admissions committees, and educators wishing to utilize, translate, or incorporate the DeWoNu-I into formal selection processes should request authorization from the corresponding author (Kirsi Talman: [email protected]) and reference the primary source publication. Commercial licensing inquiries should be directed to Taylor & Francis.

References

Holland, J. L. (1997). Making vocational choices: A theory of vocational personalities and work environments (3rd ed.). Psychological Assessment Resources.

Lent, R. W., Brown, S. D., & Hackett, G. (1994). Toward a unifying social cognitive theory of career and academic interest, choice, and performance. Journal of Vocational Behavior, 45(1), 79–122. https://doi.org/10.1006/jvbe.1994.1027

Munro, S. A., Lewin, S. A., Smith, H. J., Engel, M. E., Fretheim, A., & Volmink, J. (2007). Patient adherence to tuberculosis treatment: A systematic review of qualitative studies. PLOS Medicine, 4(7), e238. https://doi.org/10.1371/journal.pmed.0040238

Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1), 68–78. https://doi.org/10.1037/0003-066X.55.1.68

Talman, K., Mäntylä, H., Hupli, M., Kanerva, A.-M., Engblom, J., & Haavisto, E. (2023). Development and psychometric testing of an instrument to measure applicants’ desire to work in nursing. Contemporary Nurse, 59(2), 153–172. https://doi.org/10.1080/10376178.2023.2200014

13. Items of the Scale (Questionnaire)