College students' perceptions of nursing: a GEE approach

The nursing shortage has stimulated renewed attention to understanding factors that may enhance the recruitment of students into nursing programs and the retention of registered nurses in the workforce. Many activities have been initiated to address the shortage of nurses, including increasing recruitment of students to study nursing. This paper has two major goals: (1) to answer the research question, "To what extent do college students' characteristics explain the differences in their attitudes towards four service occupations (nursing, medicine, physical therapy and high school teaching)?" and (2) to demonstrate statistical methods appropriate for performing multivariate analyses of clustered data and merging independent survey items into a clustered, multivariate analysis for direct comparison of the different items. Results indicate that the more favourable rating of nursing as an occupation relative to physical therapy is due to the sample, including a large number of students majoring in nursing. Students who are not nursing majors do not appear to hold a more favourable attitude towards nurses relative to physical therapists. The lower rating of high school teachers and higher rating of physicians on most items persists even after adjusting for all the control variables, including whether or not students are nursing majors. Additionally, results support the need for a statistical method such as generalized estimating equations (GEE) to account for individual and interaction confounders, repeated measures, clustering and correlated data.