The Image and Profile of the Nursing Profession in Greece: Attitudes of High School Students, Nursing Students and Nurses

Introduction: Profile considered the different characteristics or mode of behavior by individuals or group of people which attracts public attention while image is the underlying mental representation which does not reflect the reality in all its dimensions. Aim: To identify and compare the attitude of high school students, nursing students and nurses regarding the image and profile of the nursing profession in Greece. Materials and Methods: Questionnaire was constructed with 15 questions for each group (high school students, nursing students, nurses). The above groups were selected because they have different philosophies and views about nursing. Expert panel was employed to analyze the structure and themes of the questionnaire. The sample (n = 350) collected by convenience sampling using three High Schools (n = 100), one university (n = 120), and four hospitals (n = 130) of the South-West region in Greece (Peloponnesus area). Letters were sent, asking permission to approach participants. Data analyzed using SPSS 21. Results: Most high school students (71.4%) knew nursing as a science, although the main source of information was the school (30.6%) and the family (24.5%). Interestingly, the majority of students (73.5%) will declare nursing in computerized form and will prefer military schools (30.6%), theoretical science (20.4%) and technical occupations (18.4%). It is noteworthy that the majority of students responded that nursing does not offer career prospects (71.4%), social recognition (65.3%) and job security (77.6%). The majority of nursing students chose nursing for job security (51%), while nursing has career prospects (84%) and offers social recognition (78%). Although students will practice the nursing profession (92%), the majority believes that nursing is undervalued profession (64%). Finally, the majority of nurses believes that nursing offers social recognition (53.7%), has career prospects (63.4%) and job security (58.6%). Most nurses (56.1%) did not participate in continuing education programs, considers nursing as a tiring profession (92.7%), are not autonomous practitioners (58%) and they will not propose their children to pursue nursing (68.3%). Conclusion: Although nursing as a profession has been characterized in the past with low social prestige, it seems that in recent years many efforts has made to detach itself from the image of the past and it appears that succeeds. The Image and Profile of the Nursing Profession in Greece: Attitudes of High School Students, Nursing Students and Nurses Publication History: Received: December 16, 2014 Accepted: April 02, 2015 Published: April 04, 2015


Introduction
Nursing is one of the main and most important sectors of the healthcare system. The profile is a crucial factor in the survival and development of nursing science. In recent years has gained attention of the international nursing community. Profile considered the different characteristics or mode of behavior by individuals or group of people which attracts public attention1 while others identified as the shape of something that is seen from the public view [1]. Instead, as an image defined the underlying mental representation which does not reflect the reality in all its dimensions [2,3]. In other words, profile is what people see while image is finally what constructed in mind. The literature indicates that as a profession, nurses do not have a very positive self-image nor do they think highly of themselves [4,5], while nursing on You Tube offered narratives that constructed three distinct nursing identity types, namely nurse as 'a skilled knower and doer' , nurse as 'a sexual plaything' and nurse as 'a witless incompetent' individual [6].
The social valuation of a profession is determined not only through the activity of the nurses, but also from the valuation of the society about the importance of the work [7]. It is time for our society to realize that nurses struggle and fight to provide quality of care. There are many cases that practice the debt with transgression.

Factors that Negatively Affect the Image and Profile of the Nursing Profession
Nursing is facing many problems in many countries and try to find its identity. The same happens in Greece. The main problems encountered by nursing in our country include the numerical shortage of nursing staff [8], the bad composition and inequalities of staff (large number of assistant nurses), lack of nurses autonomy [9], lack of a framework for specialized nursing responsibilities, difficult working conditions, low salaries and staff who are unsatisfied [10]. The literature distinguishes factors as out-professional and interprofessional [11].

The mode of socialization for women
Nursing is still considered a predominantly female profession. Mazdayasna and Tahririan [12] note that our society wants women passive and obedient personalities which most closely matches the role of follower than a leader.

Media (Media)
The media has great power since contribute significantly in transmitting messages. The way that media portray the healthcare system has created the public the belief that there are two groups of health professionals [13]. Medical doctors who have unlimited authority and power and all other health professionals which are intended to serve medical doctors and satisfy their orders [14]. These images affect the quality and the number of people who choose nursing as a profession.

The inter-professional factors are:
The history of the profession Nurses had charity actions and provided aid to poor people [15]. In the minds of most people, the main functions of nursing are to measure vital signs, to give medications or handling complex technology [16]. Thus, most people confused whether nursing profession having rights, demands better working conditions, gaining strength and higher salary [17]. Therefore, it is necessary to make clear the role of the nurse and given new impetus regarding the social prestige of the nursing profession.

Nurses behavior
Nursing profession is considered high intensity and very often leads to burnout [18], resulting in reduced efficiency, productivity and development of negative emotions [19].

Factors that Influence Positively the Image and Profile of the Nursing Profession
1. Orientation to Primary Health Care. This success is based on knowledge, expertise and the ability to work in groups and to influence people [20]. 2. The educational programs are constantly modified in order to provide better educational work in various sectors [21]. 3. The development of proper inter-personal relations between nurses and patients and the rest of the healthcare system which improve the image and profile of the nurse [22]. 4. The use of technology is a daily reality [23]. Nurses now during their studies acquire knowledge about computing and technology. So, nurses are acquired skills that offer for the benefit of the patient. 5. Last but not least, research has become a vital necessity for the survival of the profession, the validity of nursing [24] and the provision of better care (evidence based-practice).
Taking into consideration first the characteristics that helped in the development of nursing science and secondly the fact that Greece is already in economic crisis, affecting funding of education and health, we decided to conduct this research. It is worth noting that there has not been a similar research in Greece. The aim of the present study was to identify and compare the attitude of high school students, nursing students and nurses regarding the image and profile of the nursing profession in Greece.

Data collection
This research used quantitative method. Data were collected using a questionnaire, which was constructed by the researchers, with a total of 15 questions for each group (high school students, nursing students, nurses). The above groups were selected because they have different philosophies and thoughts about nursing in terms of definition, aims of nursing science, career prospects. After the construction, the questionnaire was given to expert panel in order to analyze the structure and themes. The expert panel consisted of two academics. They were nurse teachers with at least seven years teaching experience and a background of medical nursing. The expert panels were given written information about the study. The panel agreed to participate and the instrument was sent. The panel sent the instrument back with helpful comments. The panel agreed that the structure and themes were appropriate. The Chronbach's alpha (a) was 0.632. The fact that the questionnaire was used for a first time, the reliability analysis was considered satisfactory [25].
Particular attention was given to the construction of common questions. The purpose of the common questions between the groups was to determine and compare whether they change attitude in the following themes: -Nursing has career prospects.
-Nursing offers social recognition.
-Nursing offers job security.
-What do you believe is nursing?
We used close questions (yes-no) and four-point scale (very much, very, little, not at all). Additionally, the last question of the questionnaire was open-ended, giving the sample the opportunity to express their opinion about what is nursing. Finally, some demographic questions were also included.

Sample and procedure
This research was conducted during the months October 2013-March 2014. The sample (n = 350) collected by convenience sampling due to lack of financial resources. The research was performed in three High Schools (n = 100), one university (n = 120), and four hospitals (n = 130) of the South-West region in Greece (Peloponnesus area). Letters were sent to the Directors, the Chairman and the Nurse Managers of hospitals respectively, asking permission to approach high schools students, nursing students and nurses. Anonymity, confidentiality and voluntary participation included the letters. Since approvals were given for the conduct of the research, then those high school students, nursing students and nurses who wanted to participate were included in the sampling frame. The time to complete the questionnaires ranged from 5 to 10 minutes.

Demographic characteristics of the sample (table 1)
Most students (71.4%) knew nursing as a science, although the main source of information was the school (30.6%) and the family (24.5%). Interestingly, the majority of students (73.5%) will declare nursing in computerized form and will prefer military schools (30.6%), theoretical science (20.4%) and technical occupations (18.4%). Also, 34.7% of students said they appreciate the public image of nurses as moderate and 32.7% as good. It is noteworthy that the majority of students responded that nursing does not offer career prospects (71.4%), social recognition (65.3%) and job security (77.6%). Finally, 81.6% of students responded that it has been informed by the school about the prospects of the nursing profession. In open-ended question, "what do you believe is nursing;" the students wrote the following keywords: help, hospital, care, illness, health, treatment.

Nursing students
The majority of students (80%) changed his mind positively about A question that arises from the research is why high school students appreciate the public image of nurses as moderate? The media, particularly television, are forces which shape public opinion. Thus, with the wrong ideals of television for the nursing profession, high school students may believe that nurses are not the people who may have administrative, organizational, research or educational tasks. On the other hand, the research showed that the family would support the students' decision to declare nursing. It seems that parents play an important role in the decisions of candidates, and therefore it is a good idea to direct efforts to attract and to inform parents.
Encouraging are the results of our research since almost all of the nursing students will practice the nursing profession and also 80% of the nursing student had positive changed opinion during the study. We can therefore conclude that the students were positively affected during their studies at the nursing department. It appears that the new curriculum, the preoccupation with research and the information about what really is nursing and what are the prospects, influenced positively students thoughts. Noteworthy, however, is the fact that the majority of students consider nursing as undervalued profession. Perhaps this is due to the perception in society that nursing is a paramedical profession and simply follow doctors instructions (the nurse is the "eyes" and "ears" of doctors).
Nurses answered that nursing offers social recognition, career prospects and job security. It seems that the nursing profession goes beyond traditional and stereotypical perceptions of the past. It begins to take place in society more clearly the role of the nurse and what really is nursing. Since nurses have much higher level of education than in the past, it is increasing the quality of care at all levels, and thus improving the social status of nurses. Social status is usually connected with the financial status of the profession. However, in our research nurses believe that their salaries do not correspond to the offered work. According to Kotzampasaki [26] money is depending on social prestige and the acquisition of social prestige will be followed by an appropriate financial reward and the potential claim.
The fact that high school students have different opinion with nursing students and nurses in terms of social recognition, the career prospects and job security, is probably because they are not keen to study nursing. In addition, the nurses working environment (hospital) is hardly encouraging. On one hand, the lack of nursing staff and on the other hand, the reduced funding from the state, affects the image and profile of the nursing profession.
Finally, the fact that the Greek hospitals prevails the biomedical model8 causes the nursing profession lack of autonomy and selfreliance. In our research, a large percentage of nurses reported that they had no autonomy. In addition, directly related to the profile and image of the nursing profession is the continuing nursing education. Our research shows that many nurses do not participate in education nursing programs, due to increasing workload or economic reasons. According to Panoudaki [27] continuing education is a professional and moral obligation of every nurse since approximately 50% of our knowledge are considered obsolete after 10 years.

Limitations of Research
The first limitation of this study is the small sample size. Although research provides useful information for the image and profile of the nursing profession in Greece, it is necessary in the future to use a larger sample.
nursing during their studies. Interestingly, most students chose nursing for job security (51%), while nursing has career prospects (84%) and offers social recognition (78%). Although students will practice the nursing profession (92%), the majority believes that nursing is undervalued profession (64%). Also, a large number of students (58%) consider positive the reaction of the social environment about their choice of studying nursing. Students said that they were informed by the nursing department on the prospects of the nursing profession (60%). Finally, 62% of students are prepared to fulfill the nurses' role. In open-ended question, "what do you believed is nursing;" students wrote the following keywords: prevention, treatment, care, science, offering, profession.

Nurses
The majority of nurses (60%) considers the image of the nursing profession as good, while they believe that the profile of the nursing profession has positively changed (75.6%). It is noteworthy that the majority of the sample believes that nursing offers social recognition (53.7%), has career prospects (63.4%) and job security (58.6%). Also, the majority of the sample (56.1%) did not participate in continuing education programs, and considers nursing as a tiring profession (92.7%). The nurse responded that the salary does not meet the offered work (95.1%). Interestingly, nurses are not autonomous (58%), while 68.3% will not propose their children to pursue nursing. In openended question, "what do you believe is nursing;" nurses wrote the following keywords: care, stressful profession, workload, exhaustive working hours, poor working conditions, science-art and profession.

Discussion
The research showed that although high school students knew the nursing as a science, they would not stated in computerized form but prefer other schools. Probably because either there is no proper information from high school about the nursing profession, either they do not want to study nursing because the lack of social recognition and professional career. Therefore, it appears that fewer young people choose today the nursing profession in Greece and is something that should trouble us in the nursing sector (education, management).