Canadian Journal of Sociology Online May-June 2000

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Robert D. Hiscott.
Career Paths of Nursing Professionals: A Study of Employment Mobility.
Ottawa: Carleton University Press, 1998, 227 pp. $24.95 paper (0886293537), $49.95 cloth (0886293421)

In Career Paths of Nursing Professionals, Robert Hiscott sets out to examine the patterns of employment mobility among nurses through research undertaken while he was Principal Investigator at the Ontario Nursing Human Resources Data Centre.

The primary source of data for the book consists of telephone surveys conducted in 1992 and 1993 of 1056 Registered Nurses (RNs) and 633 Registered Practical Nurses (RPNs) in Ontario. Employment history data includes both quantitative and qualitative information on the characteristics of every position the respondent had (such as area of nursing responsibility, salary and the length and timing of shift work), changes in employment status (both voluntary and involuntary), and the reasons for these changes. By examining both short-term work experiences and long term career paths of nurses, Hiscott argues, “it is possible to gain a greater understanding of the dynamics of the nursing labour market and how the dramatic changes to this labour market at the present time will probably effect employment outcomes for nursing professionals in the future.”(p.2)

Hiscott begins his analysis by first situating this study within the broader context of the nursing labour force literature highlighting the problems nurses increasingly face such as rising job dissatisfaction, job turnover and employment mobility (Chapter 1). He then moves to a description of his data, beginning first with a statistical portrait of the respondents (Chapter 2), followed by an overview of the internal and external employment mobility they experienced (Chapter 3). Here Hiscott reports that overall, nurses, and most notably RNs, experience more movement between than within jobs.

In Chapter 4, Hiscott evaluates the family life cycle argument by examining the reasons nurses give for leaving their jobs. Contrary to this thesis, however, he finds that family transitions such as marriage, pregnancy and caring for children separately or combined did not account for as much employment mobility as did relocation. Another interesting finding is the higher attribution of health problems as the primary reason for employment mobility by RPNs. Changes in vertical employment mobility, such as position type and occupational status are examined in Chapter 5. The main findings here point to increased diversification of employment in the nursing profession as careers progress, particularly amongst RNs.

In the final two results chapters, Hiscott examines career interruptions amongst nursing professionals including periods of unemployment (Chapter 6), and the reasons why some nurses choose to leave the nursing profession (Chapter 7). In both chapters, the findings reflect substitution among nursing professionals (i.e., RPNs for RNs) and a move away from traditional full-time employment in hospital settings. In the conclusion, Hiscott summarizes the overall findings of his research.

The strength of the analysis Hiscott undertakes in Career Paths lies first, in his inclusion of the two key groups of nursing professionals - RNs and RPNs. As he accurately describes in his introduction, much of the nursing labour force literature is based on the examination of only the former group - RNs. To capture a more accurate picture of changes to nursing labour, particularly in light of health care reform and the move toward substitution, it is essential to examine the changes occurring in both of these groups. In addition to including these two important groups of nursing professionals, Hiscott also includes in his analysis the many and varied forms of employment mobility that nurses’ experience. Another notable strength of Career Paths is the time series analyses Hiscott uses to examine employment mobility across nurses’ careers. This make for a very thorough analysis of nursing labour force dynamics.

There are, however, two main weaknesses of Career Paths: first in its failure to move beyond descriptive statistics; and second, in its incomplete contextualization in some key areas of nursing labour force issues. With respect to the first issue, it is interesting to note the differences between the two groups of RNs and RPNs, but this analysis would have been much stronger if the statistical significance of these differences would have been analyzed, noted and discussed. With respect to the second weakness, sociologists who study nursing will find that there is very little recent research cited or discussed on the deskilling of nursing labour or on the impact of new management strategies on nursing. This is unfortunate as the data reinforce the substitution and the move away from traditional forms of nursing employment so often explored in this literature.

Overall, Career Paths is a good source of descriptive data on nursing employment status and mobility in Ontario, and as such is a useful background text for nursing labour force scholars and students. However, because of the minimal contextualization in the recent sociological literature on nursing work, its contribution to sociological research and teaching is modest.

Ivy Lynn Bourgeault, Ph.D.
University of Western Ontario
June 2000
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