Changes in Nursing Students' Career Choices Following the COVID-19 Pandemic in China

Background: Health professionals including nurses have experienced heavy workload and great physical and mental health challenges during the coronavirus disease 19 (COVID-19) pandemic, which may affect nursing students' career choices. This study examined the changes in nursing students' career choices after the onset of the COVID-19 pandemic in China.

Methods: This study was conducted in five University nursing schools in China between September 14, 2020 and October 7, 2020. Career choices before and after the COVID-19 pandemic were collected and analyzed.

Results: In total, 1,070 nursing students participated in the study. The reported choice of nursing as future career increased from 50.9% [95% confidence interval (CI): 47.9–53.9%] before the COVID-19 pandemic to 62.7% (95%CI: 59.8–65.6%) after the onset of COVID-19 pandemic. Students who chose nursing as their future career following the COVID-19 outbreak had less severe depression and anxiety compared to those who did not choose nursing, but the associations of depression and anxiety with career choice disappeared in multivariable analyses. Binary logistic regression analysis revealed that male gender [odds ratio (OR) = 0.68, 95% CI: 0.50–0.91], rural residence (OR = 1.53, 95%CI: 1.17–2.00), fourth year students (OR = 0.50, 95%CI: 0.35–0.72), negative experiences during the COVID-19 pandemic (OR = 0.66, 95%CI: 0.47–0.92), and good health (OR = 4.6, 95%CI: 1.78–11.87) were significantly associated with the choice of nursing as future career after the onset of the COVID-19 pandemic.

Conclusions: The COVID-19 pandemic appeared to have a positive influence on the career choice of nursing among Chinese nursing students.

Introduction

The coronavirus disease (COVID-19) was first reported in China at the end of 2019, and was later declared as a public health emergency of international concern in late January 2020 and a worldwide pandemic on March 11, 2020 (1) by the World Health Organization (WHO) (2). By March 2020, the COVID-19 pandemic was well-controlled in some countries and territories, such as China (3).

Frontline health professionals, particularly nurses, played a key role in combating the COVID-19 pandemic (4). However, frequent exposure to COVID-19 cases, heavy workload and long working hours resulted in physical and mental burnout, emotional distress and psychiatric problems (5, 6) among healthcare workers including severe anxiety and depressive symptoms, and sleep disturbances (4, 7–10). An international study found that physical symptoms (i.e., headache and sore throat) were common in healthcare workers during the COVID-19 outbreak, which was associated with more severe anxiety, depression, stress, and post-traumatic stress disorder (11). Another study conducted in New York healthcare workers during the COVID-19 pandemic found that compared to attending physicians, nurses/advanced practice providers had more common mental health problems including acute stress, and depressive and anxiety symptoms (12). A meta-analysis revealed that the prevalence of anxiety, depressive, and insomnia symptoms in healthcare workers during the COVID-19 outbreak was 23.2, 22.8, and 38.9%, respectively (13). These consequences could affect nurses' quality of work and communication with patients and families, and even compromise workplace safety. A meta-analysis found that the overall prevalence of workplace violence was 62.4% in Chinese health professionals (14). Therefore, the cumulative stress placed on nursing staff may lead to job dissatisfaction and career changes during the COVID-19 pandemic. In Egypt, nurses in COVID-19 hospitals reported higher stress level (75.2%), heavier workload (98.6%), and lower satisfaction level (51.0%) compared to those working in the non-COVID-19 hospital (15). Only 4.8% of nurses in the COVID-19 hospital reported no intention to leave their job (15).

In a recent multicenter study involving 7,600 postdoctoral researchers worldwide regarding their work and career intentions (16), 61% of participants reported that the COVID-19 pandemic had negatively affected their career prospects. A study of 120 medical students in pediatric services (17) found no significant difference in students' career choices after the COVID-19 pandemic, but the proportion of choosing a medical career decreased from 72.6% to 68.3%, but 66.7% reported that the COVID-19 pandemic had strengthened their career choice to be pediatricians (17).

To date, no studies on the impact of the COVID-19 pandemic on nursing students' career choice have been published, which gave the impetus to examine the career choice of nursing students before and after after the onset of the COVID-19 pandemic, and explore the possible reasons for the change of career choice.

Participants and Methods

Participants and Study Settings

This was a multicenter, cross-sectional study conducted in five university nursing schools (Peking University, Capital Medical University, Jilin University, Lanzhou University, and Wuhan University) in China between September 14, 2020 and October 7, 2020. Participating universities are distributed in different regions of China, which enhanced the representativeness of the study sample. In order to avoid contagion, traditional face-to-face interviews were not adopted. Following other epidemiological studies (18, 19), the assessment was completed using the QuestionnaireStar application embedded with WeChat, which is a Smartphone-based social communication program with over 1 billion users in China. WeChat has been used in teaching activities in the participating universities, therefore all students are WeChat users. A Quick Response code (QR Code) linked to the assessment was distributed by WeChat among college students using the snowball sampling method. Inclusion criteria were: (1) undergraduate nursing students in universities, (2) aged between 15 and 28 years, and (3) able to understand Chinese and willing to provide electronical written informed consent. All nursing students in the participating nursing schools were consecutively invited to participate in the survey during the study period.

Data Collection

A standard data form for this study was used to collect basic sociodemographic characteristics and information related to career choice. The following COVID-19 related questions were asked: whether they served as a volunteer in clinical settings during the COVID-19 pandemic; whether they had negative experiences (such as physical or verbal abuse) during the COVID-19 pandemic; whether they frequently used social media during the COVID-19 pandemic.

The following questions on career choice were asked: whether they chose nursing as their future career before and after the COVID-19 pandemic; whether they were interested in medicine before and after the COVID-19 pandemic. The Chinese version of the 2-item Patient Health Questionnaire (PHQ-2) was used to measure severity of depressive symptoms (20, 21). The total score of PHQ-2 ranges from 0 to 6, with a higher score indicating more severe depressive symptoms. The 7-item Generalized Anxiety Disorder scale (GAD-7)—Chinese version assessed the severity of anxiety symptoms with a higher score representing more severe anxiety symptoms (22, 23).

This study was approved centrally by the participating nursing schools and their ethics committees [Approval No.: (2020) Keyan (No. 10)]. Written informed consent to participate in this study was provided by the participants or legal guardians of those younger than 18 years.

Statistical Analysis

All analyses were performed with SPSS, Version 24.0 (SPSS Inc., Chicago, Illinois, USA). Normal distribution of continuous variables was tested using P-P plots. Chi-square tests, independent two samples t-tests, and Mann–Whitney U-tests were conducted to compare socio-demographic and clinical variables between students who chose and those who did not choose nursing as future career after the COVID-19 pandemic. McNamar-test was used to compare nursing students' career choice before and after the COVID-19 pandemic. Binary logistic regression analysis was used to determine the independent correlates of career choice following the COVID-19 pandemic. Variables with significant differences in univariate analyses were included as independent variables, while career choice after COVID-19 pandemic was the dependent variable. Significance level was set at 0.05 (two-sided).

Results

Participant Characteristics

Of the 1,121 nursing students who were consecutively invited to participate in the survey, 1,070 met study entry criteria and completed the assessment, yielding a participation rate of 95.5%. About half of the students (50.9%; 95%CI: 47.9–53.9%) reported choosing nursing as their future career before the onset of the COVID-19 pandemic, while 62.7% (95%CI: 59.8–65.6%) chose nursing following the COVID-19 pandemic (OR = 5.85, 95% CI:4.05–8.44, p < 0.001). Table 1 shows the demographic and clinical characteristics and career choice of the sample after the COVID-19 pandemic. There were significant differences in terms of age, gender, residence, school grade, perceived health status, negative experiences during COVID-19 pandemic, being interested in medicine before COVID-19 pandemic, and choosing nursing as career before COVID-19 pandemic (all p-values < 0.05) between nursing students who chose and those who did not choose nursing as future career after COVID-19 pandemic. Students who did not choose nursing as their future career had more severe depressive (p = 0.005) and anxiety symptoms (p = 0.001) compared to those who chose nursing. Figure 1 summarizes the common reasons for career choice change in nursing students. The most common reason “for career change from” “not choosing nursing before the pandemic” to “choosing nursing after the onset of the COVID-19 pandemic” was the positive media reports on nurses, while the most common reason for change in the opposite direction was negative media reports and adverse experiences during the pandemic.

TABLE 1

Table 1. Sociodemographic and clinical characteristics of the participants.

FIGURE 1

Figure 1. Causes of career choice change. (A) Career choice change from “not choosing nursing before COVID-19 pandemic” to “choosing nursing after COVID-19 pandemic” (N = 152). (B) Career choice change from “choosing nursing before COVID-19 pandemic” to “not choosing nursing after COVID-19 pandemic” (N = 26).

Independent Correlates of Career Choice

Binary logistic regression analysis revealed that nursing students, who lived in rural areas, had perceived good health status, and chose nursing as future career before the COVID-19 pandemic, were more likely to choose nursing as future career after the onset of the COVID-19 pandemic. Compared to the first-year students, those in second, third, and fourth years were less likely to choose nursing as future career after the onset of the COVID-19 pandemic (all p-values < 0.05; Table 2).

TABLE 2

Table 2. Independent correlates of choosing nursing as future career after the COVID-19 pandemic (binary logistic regression analyses).

To clarify the contributions of other variables independent of choosing nursing as future career before COVID-19 pandemic, the binary logistic regression analysis was repeated after removing “choosing nursing as future career before COVID-19 pandemic.” The results show that nursing students who lived in rural areas and had perceived fair and good health status were more likely to choose nursing as future career after the COVID-19 pandemic. In addition, male students, fourth-year students and students who had negative experiences during the COVID-19 pandemic were less more likely to choose nursing as future career after the COVID-19 pandemic (all p-values < 0.05; Table 2).

Discussion

To the best of our knowledge, this was the first study that compared nursing students' career choice before and after the onset of the COVID-19 pandemic. Prior to the COVID-19 pandemic, 50.9% of Chinese nursing students reported choosing nursing as their future career, and the corresponding figure increased to 62.7% after the pandemic, both of which are higher than the previous finding in a study from Taiwan (34.6%) (24), but considerably lower than the corresponding figures from the USA (99.4%) and Turkey (81.1%) (25). Apart from the confounding effects owing to different demographic characteristics between studies, lower proportion of nursing students who chose nursing as their future career in this study compared to their Western counterparts could be due to the following reasons. First, workplace violence is common in clinical settings in China (14). Second, due to insufficient health resources in China, the nurse/patient ratio is low, resulting in heavy workload and long working hours (26, 27). Third, due to historical reasons, nurses have a relatively lower wages (28) and social status than other occupations, such as doctors, police officers and teachers (29). The increased proportion of nursing students choosing nursing as their future career after the COVID-19 pandemic could be associated with a number of reasons. Nurses who volunteered working at frontline hospitals during the pandemic were widely applauded by the public media. This conveyed a positive image of nurses and may have encouraged some nursing students to choose nursing as their future career. In addition, policies have been implemented to improve nurses' welfare following the COVID-19 pandemic (30–32).

Gender, residence, school grade, perceived health status, career choice before pandemic, and negative experiences during the COVID-19 pandemic, were associated with choosing nursing as future career after the COVID-19 pandemic. Compared with female students, male nursing students were less likely to choose nursing as their future career after the COVID-19 pandemic (OR = 0.68, 95% CI: 0.50–0.91), which is consistent with the data that nurses are predominantly females in most countries (33). In traditional Chinese societies, men are usually viewed as the “pillar” of families and are expected to have a higher income than women. Consequently, some male students did not choose nursing as their future career due to lower wages and social status in China. In this study, nursing students living in rural areas were more likely to choose nursing as their future career than their counterparts living in urban areas, which may be related to the poor economic status and fewer employment opportunities in rural areas of China. In contrast, due to the wider social network and connections, nursing students in urban areas usually have more job choices than those living in rural areas and may not choose nursing as their future career. This is similar to previous findings of a multicenter study that medical students brought up and educated in rural areas were less likely to work in rural areas (34).

Both depressive and anxiety symptoms were less severe in students who chose nursing as future career after the COVID-19 pandemic than students who did not choose nursing. Increased fear of COVID-19 was associated with higher likelihood of psychological distress and professional turnover intentions in frontline nurses (35). We hypothesize that nursing students who experienced depressive and anxiety symptoms or psychological distress due to fear of COVID-19 may have been influenced by such experiences in their career choice. However, the association of depressive and anxiety symptoms with career choice disappeared in multivariate analysis, probably because the association between mental health and career choice was moderated by other variables. In binary logistic regression analysis, students who had negative experiences during the COVID-19 pandemic were less likely to choose nursing as future career, while those who had good health status were more likely to choose nursing as future career after the COVID-19 pandemic. This could be explained by the following reasons. On one hand, negative experiences and relevant appraisals, such as fear of infection, uncertainty, stigmatization, discrimination from neighbors, unsafe workplace and risk of infection, are possible risk factors for psychological distress, particularly post-traumatic stress reactions, in healthcare workers (36, 37), which could have lowered the likelihood of choosing nursing as a future career. On the other hand, good personal health status and working in well-organized medical units, where protected environment is provided (38, 39) and precautionary measures are regularly taken (40), together with support from family, friends, supervisors, colleagues and society, have been proven to be important factors building up resilience against the development of distress (38–41), thereby increasing the likelihood of choosing nursing as future career.

Multivariate analysis also revealed that compared to first year students, those in senior grades were less likely to choose nursing as future career after the COVID-19 pandemic. Interestingly, the likelihood decreased with school grade: ORs = 0.44 (95% CIs: 0.27–0.74) in second year, ORs = 0.31 (95% CIs: 0.18–0.52) in third year, and ORs = 0.20 (95% CIs: 0.12–0.33) in fourth-year students. After removing the independent variable “choosing nursing as career before COVID-19 pandemic” which contributed the most to the model (OR = 66.9), fourth year students were still less likely to choose nursing as future career compared to the first grade students (OR = 0.50, 95% CI: 0.35–0.72), which is consistent with the findings in medical students (42). A recent study of Chinese medical students found that senior grade students were less likely to be volunteers combating the COVID-19 pandemic compared to junior and middle grade students (42), probably due to the risk of COVID-19 infection during the pandemic and relatively low income for junior doctors. Intention to be volunteers and career choice in medical or nursing students may be associated with workplace safety such as provision of personal protective equipment (43, 44). If the workplace is unsafe, many students may be unwilling to be volunteers, doctors or nurses. Therefore, we assume that higher grade nursing students were more aware of the potential risks and increased workload in clinical settings during the pandemic, therefore they were less likely to choose nursing as future career. Nursing students in good health status were more likely to choose nursing as future career, probably because these students felt they had the capacity to handle heavy clinical workload.

In this study, significantly more nursing students chose nursing as their future career after the pandemic than before the pandemic (p < 0.001). Of the 152 nursing students who changed their intention from “not choosing nursing before the pandemic” to “choosing nursing after the pandemic,” more than half mentioned that the reason was due to positive media reports on nurses. In China, many relevant policies have been released (30–32) to improve frontline health professionals' welfare during and after the COVID-19 pandemic, which probably increased the appeal of a nursing career. Of the 26 nursing students who changed their intention from “choosing nursing before the pandemic” to “not choosing nursing after the pandemic,” the most common reason was negative media reports and experiences. It is likely that negative factors as high risk of infection, heavy clinical workload (45), discrimination (46), sexual harassment (47) and workplace violence, discouraged nursing students to choose nursing career.

The strengths of this study are its large sample size, the representativeness of the study sample, and the comparisons of career choice before and after the onset of the COVID-19 pandemic. However, several limitations should be noted. First, due to the cross-sectional design, the causal relationships between career choice and other variables could not be determined. Second, the data on career choice prior to the COVID-19 pandemic were retrospectively collected, therefore, the possibility of recall bias could not be excluded. Third, a few factors relevant to career choice, such as social support, family members' career and students' negative experiences during the pandemic, were not recorded.

In conclusion, the COVID-19 pandemic appeared to have a positive influence on the choice of nursing as future career among Chinese nursing students. To increase the nursing workforce, effective measures should be implemented to promote nursing as a suitable career choice for nursing students.

Data Availability Statement

The Clinical Research Ethics Committee of Beijing Anding Hospital at Capital Medical University that centrally approved the study prohibits the authors from making the research data set publicly available. Readers and all interested researchers may contact Dr. Feng-Rong An (Email address: afrylm@sina.com) for details. Dr. An could apply to the Clinical Research Ethics Committee of Beijing Anding Hospital for the release of the data.

Ethics Statement

The studies involving human participants were reviewed and approved by the participating nursing schools (Peking University, Capital Medical University, Jilin University, Lanzhou University, and Wuhan University) and their Ethics Committees [Approval No.: (2020) Keyan (No. 10)]. Written informed consent to participate in this study was provided by the participants' legal guardian/next of kin.

Author Contributions

WB, H-TX, QZ, ZW, LH, and PC completed the data collection, analysis, interpretation, and drafted the manuscript. HC, Y-JZ, LC, Z-MG, MJ, HZ, B-XY, and SL completed the data collection, analysis, and interpretation. TC and GU finished the critical revision of the manuscript. FA and Y-TX completed study design, the data collection, analysis, interpretation, and drafted the manuscript. All the authors finished the approval of the final version for publication.

Funding

This study was supported by the National Science and Technology Major Project for investigational new drug (2018ZX09201-014), the Beijing Municipal Science and Technology Commission (No. Z181100001518005), the 2020 Higher Education Teaching Achievement Cultivation Project of Gansu Province, the Fundamental Research Funds for the Central Universities (2020YJ065) and the University of Macau (MYRG2019-00066-FHS).

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

1. Cucinotta D, Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Biomed. (2020) 91:157–60.

Google Scholar

2. World Health Organization. The Coronavirus Disease (COVID-19) Outbreak. (2020). Available online at: https://www.who.int (accessed March 30)

Google Scholar

3. Zheng Y, Lai W. Dermatology staff participate in fight against Covid-19 in China. J Eur Acad Dermatol Venereol. (2020) 34:e210–1. doi: 10.1111/jdv.16390

PubMed Abstract | CrossRef Full Text | Google Scholar

4. Li Z, Ge J, Yang M, Feng J, Qiao M, Jiang R, et al. Vicarious traumatization in the general public, members, and non-members of medical teams aiding in COVID-19 control. Brain Behav Immun. (2020) 88:916–9. doi: 10.1016/j.bbi.2020.03.007

PubMed Abstract | CrossRef Full Text | Google Scholar

5. Zhang Y, Xie S, Wang P, Wang G, Zhang L, Cao X, et al. Factors influencing mental health of medical workers during the COVID-19 outbreak. Front Public Health. (2020) 8:491. doi: 10.3389/fpubh.2020.00491

PubMed Abstract | CrossRef Full Text | Google Scholar

6. Zheng N, Zhang T, Liu Y, Zhu XQ. Investigation of the status of nurses returning to work after recovering from COVID-19 and influencing factors. J Nurs Care Qual. (2021) 36:E1–6. doi: 10.1097/NCQ.0000000000000521

PubMed Abstract | CrossRef Full Text | Google Scholar

7. An Y, Yang Y, Wang A, Li Y, Zhang Q, Cheung T, et al. Prevalence of depression and its impact on quality of life among frontline nurses in emergency departments during the COVID-19 outbreak. J Affect Disord. (2020) 276:312–5. doi: 10.1016/j.jad.2020.06.047

PubMed Abstract | CrossRef Full Text | Google Scholar

8. Cabarkapa S, Nadjidai SE, Murgier J, Ng CH. The psychological impact of COVID-19 and other viral epidemics on frontline healthcare workers and ways to address it: a rapid systematic review. Brain Behav Immun Health. (2020) 8:100144. doi: 10.1016/j.bbih.2020.100144

PubMed Abstract | CrossRef Full Text | Google Scholar

9. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. (2020) 3:e203976. doi: 10.1001/jamanetworkopen.2020.3976

PubMed Abstract | CrossRef Full Text | Google Scholar

10. Xiang YT, Jin Y, Wang Y, Zhang Q, Zhang L, Cheung T. Tribute to health workers in China: A group of respectable population during the outbreak of the COVID-19. Int J Biol Sci. (2020) 16:1739–40. doi: 10.7150/ijbs.45135

PubMed Abstract | CrossRef Full Text | Google Scholar

11. Chew NWS, Lee GKH, Tan BYQ, Jing M, Goh Y, Ngiam NJH, et al. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain Behav Immun. (2020) 88:559–65. doi: 10.1016/j.bbi.2020.04.049

PubMed Abstract | CrossRef Full Text | Google Scholar

12. Shechter A, Diaz F, Moise N, Anstey DE, Ye S, Agarwal S, et al. Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic. Gen Hosp Psychiatry. (2020) 66:1–8. doi: 10.1016/j.genhosppsych.2020.06.007

PubMed Abstract | CrossRef Full Text | Google Scholar

13. Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Brain Behav Immun. (2020) 88:901–7. doi: 10.1016/j.bbi.2020.05.026

PubMed Abstract | CrossRef Full Text | Google Scholar

14. Lu L, Dong M, Wang SB, Zhang L, Ng CH, Ungvari GS, et al. Prevalence of workplace violence against health-care professionals in China: a comprehensive meta-analysis of observational surveys. Trauma Violence Abuse. (2018) 21:498–509. doi: 10.1177/1524838018774429

PubMed Abstract | CrossRef Full Text | Google Scholar

15. Said RM, El-Shafei DA. Occupational stress, job satisfaction, and intent to leave: nurses working on front lines during COVID-19 pandemic in Zagazig City, Egypt. Environ Sci Pollut Res Int. (2020) 1–11. doi: 10.1007/s11356-020-11235-8

PubMed Abstract | CrossRef Full Text | Google Scholar

16. Woolston C. Pandemic darkens postdocs' work and career hopes. Nature. (2020) 585:309–12. doi: 10.1038/d41586-020-02548-2

PubMed Abstract | CrossRef Full Text | Google Scholar

17. Hu L, Wu H, Zhou W, Shen J, Qiu W, Zhang R, et al. Positive impact of COVID-19 on career choice in pediatric medical students: a longitudinal study. Environ Sci Pollut Res Int. (2020) 9:243–52. doi: 10.21037/tp-20-100

PubMed Abstract | CrossRef Full Text | Google Scholar

18. Wang X, Ouyang M, Carcel C, Chen C, Sun L, Yang J, et al. Impact of COVID-2019 on stroke services in China: survey from the Chinese Stroke Association. Stroke Vasc Neurol. (2020) 5:323–30. doi: 10.1136/svn-2020-000514

PubMed Abstract | CrossRef Full Text | Google Scholar

19. Yun D, Xiang Y, Liu Z, Lin D, Zhao L, Guo C, et al. Attitudes towards medical artificial intelligence talent cultivation: an online survey study. Ann Transl Med. (2020) 8:708. doi: 10.21037/atm.2019.12.149

PubMed Abstract | CrossRef Full Text | Google Scholar

20. Kroenke K, Spitzer RL, Williams JB. The patient health questionnaire-2: validity of a two-item depression screener. Med Care. (2003) 41:1284–92. doi: 10.1097/01.MLR.0000093487.78664.3C

PubMed Abstract | CrossRef Full Text | Google Scholar

21. Yang WH, Li L, Xiao LH, Peng F, Liu HH. Screening for depressive disorder in adolescents: validity of Chinese version of the Patients Health Questionnaire 2-Item (in Chinese). Chin J Clin Psychol. (2015) 23:937–43. doi: 10.16128/j.cnki.1005-3611.2015.05.042

CrossRef Full Text | Google Scholar

22. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. (2006) 166:1092–7. doi: 10.1001/archinte.166.10.1092

PubMed Abstract | CrossRef Full Text | Google Scholar

23. He XY, Li CB, Qian J, Cui HS, Wu WY. Reliability an dvalidity of a generalized anxiety disorder scale in general haspital outpatients (in Chinese). Shanghai Arch Psychiatry. (2010) 4:200–3.

Google Scholar

24. Yang R, Liu S, Chen G, Lai HL, Peng TC, Chang FM. Factors associated with career decision in Taiwanese nursing students: a questionnaire survey. Hum Resour Health. (2006) 43:581–8. doi: 10.1016/j.ijnurstu.2005.07.012

PubMed Abstract | CrossRef Full Text | Google Scholar

25. Alkaya SA, Yaman S, Simones J. Professional values and career choice of nursing students. Nurs Ethics. (2018) 25:243–52. doi: 10.1177/0969733017707007

PubMed Abstract | CrossRef Full Text | Google Scholar

26. Qi YK, Xiang YT, An FR, Wang J, Zeng JY, Ungvari GS, et al. Nurses' work-related stress in China: a comparison between psychiatric and general hospitals. Perspect Psychiatr Care. (2014) 50:27–32. doi: 10.1111/ppc.12020

PubMed Abstract | CrossRef Full Text | Google Scholar

27. An FR, Qi YK, Zeng JY, Ding YM, Chiu HF, Ungvari GS, et al. The prevalence of insomnia, its demographic correlates, and treatment in nurses working in Chinese psychiatric and general hospitals. Perspect Psychiatr Care. (2016) 52:88–94. doi: 10.1111/ppc.12103

PubMed Abstract | CrossRef Full Text | Google Scholar

28. Lyu L, Li G, Li J, Li M. Nurse turnover research in China: a bibliometric analysis from 2000 to 2015. Int J Nurs Sci. (2016) 3:208–12. doi: 10.1016/j.ijnss.2016.04.008

CrossRef Full Text | Google Scholar

29. Li C. Prestige stratification in the contemporary China: occupational prestige measures and socio-economic index (in Chinese). Sociol Res. (2005) (2):74–102. doi: 10.19934/j.cnki.shxyj.2005.02.004

CrossRef Full Text | Google Scholar

30. National Health Commission of the People's Republic of China. The Notification About Further Strengthening the Protection of Medical Personnel During the Pandemic Prevention and Control Period (in Chinese). (2020). Available online at: http://www.nhc.gov.cn/yzygj/s7659/202002/75c6e88ecbeb42a9a26acb538383e2fc.shtml (accessed February 19).

31. The State Council's Comprehensive Team for Joint Prevention and Control of COVID-19. The Notification About the Care of Elderly Relatives of Frontline Medical Personnel for COVID-19 Prevention and Control (in Chinese). (2020). Available online at: http://www.nhc.gov.cn/lljks/s7785/202002/080e205ea47649e99daa8d36d58d9dfe.shtml (accessed February 22)

32. The State Council's Comprehensive Team for Joint Prevention and Control of COVID-19. The Notification on Full Implementation Measures of Further Protection and Care for Medical Care Personnel (in Chinese). (2020). Available online at: http://www.nhc.gov.cn/renshi/s7759/202002/fb54d848898a4a709b25d8e060dd8cc7.shtml (accessed February 22)

33. Cilar L, Spevan M, Cuček Trifkovič K, Štiglic G. What motivates students to enter nursing? Findings from a cross-sectional study. Nurse Educ Today. (2020) 90:104463. doi: 10.1016/j.nedt.2020.104463

PubMed Abstract | CrossRef Full Text | Google Scholar

34. Chuenkongkaew WL, Negandhi H, Lumbiganon P, Wang W, Mahmud K, Cuong PV. Attitude towards working in rural area and self-assessment of competencies in last year medical students: a survey of five countries in Asia. BMC Med Educ. (2016) 16:238. doi: 10.1186/s12909-016-0719-9

PubMed Abstract | CrossRef Full Text | Google Scholar

35. Labrague LJ, de Los Santos JAA. Fear of COVID-19, psychological distress, work satisfaction and turnover intention among frontline nurses. J Nurs Manag. (2020). doi: 10.1111/jonm.13168. [Epub ahead of print].

PubMed Abstract | CrossRef Full Text | Google Scholar

36. Lee SM, Kang WS, Cho AR, Kim T, Park JK. Psychological impact of the 2015 MERS outbreak on hospital workers and quarantined hemodialysis patients. Compr Psychiatry. (2018) 87:123–7. doi: 10.1016/j.comppsych.2018.10.003

PubMed Abstract | CrossRef Full Text | Google Scholar

37. Carmassi C, Foghi C, Dell'Oste V, Cordone A, Bertelloni CA, Bui E, et al. PTSD symptoms in healthcare workers facing the three coronavirus outbreaks: what can we expect after the COVID-19 pandemic. Psychiatry Res. (2020) 292:113312. doi: 10.1016/j.psychres.2020.113312

PubMed Abstract | CrossRef Full Text | Google Scholar

38. Maunder RG, Lancee WJ, Balderson KE, Bennett JP, Borgundvaag B, Evans S, et al. Long-term psychological and occupational effects of providing hospital healthcare during SARS outbreak. Emerg Infect Dis. (2006) 12:1924–32. doi: 10.3201/eid1212.060584

PubMed Abstract | CrossRef Full Text | Google Scholar

39. Su TP, Lien TC, Yang CY, Su YL, Wang JH, Tsai SL, et al. Prevalence of psychiatric morbidity and psychological adaptation of the nurses in a structured SARS caring unit during outbreak: a prospective and periodic assessment study in Taiwan. J Psychiatr Res. (2007) 41:119–30. doi: 10.1016/j.jpsychires.2005.12.006

PubMed Abstract | CrossRef Full Text | Google Scholar

40. Chan AO, Huak CY. Psychological impact of the 2003 severe acute respiratory syndrome outbreak on health care workers in a medium size regional general hospital in Singapore. Occup Med (Lond). (2004) 54:190–6. doi: 10.1093/occmed/kqh027

PubMed Abstract | CrossRef Full Text | Google Scholar

41. Lancee WJ, Maunder RG, Goldbloom DS. Prevalence of psychiatric disorders among Toronto hospital workers one to two years after the SARS outbreak. Psychiatr Serv. (2008) 59:91–5. doi: 10.1176/ps.2008.59.1.91

PubMed Abstract | CrossRef Full Text | Google Scholar

42. Yu NZ, Li ZJ, Chong YM, Xu Y, Fan JP, Yang Y, et al. Chinese medical students' interest in COVID-19 pandemic. World J Virol. (2020) 9:38–46. doi: 10.5501/wjv.v9.i3.38

PubMed Abstract | CrossRef Full Text | Google Scholar

43. Gouda P. Attitudes of medical students toward volunteering in emergency situations. BMJ Open. (2019) 14:308–11. doi: 10.1017/dmp.2019.81

PubMed Abstract | CrossRef Full Text | Google Scholar

44. Astorp MS, Sørensen GVB, Rasmussen S, Emmersen J, Erbs AW, Andersen S. Support for mobilising medical students to join the COVID-19 pandemic emergency healthcare workforce: a cross-sectional questionnaire survey. BMJ Open. (2020) 10:e039082. doi: 10.1136/bmjopen-2020-039082

PubMed Abstract | CrossRef Full Text | Google Scholar

45. Wu Y, Wang J, Luo C, Hu S, Lin X, Anderson AE, et al. A comparison of burnout frequency among oncology physicians and nurses working on the frontline and usual wards during the COVID-19 epidemic in Wuhan, China. J Pain Symptom Manage. (2020) 60:e60–5. doi: 10.1016/j.jpainsymman.2020.04.008

PubMed Abstract | CrossRef Full Text | Google Scholar

46. Gennaro S. 2020: the year of the nurse, COVID-19, and systemic discrimination and racism. J Nurs Scholarsh. (2020) 52:597–8. doi: 10.1111/jnu.12606

PubMed Abstract | CrossRef Full Text | Google Scholar

47. Bronner G, Peretz C, Ehrenfeld M. Sexual harassment of nurses and nursing students. J Adv Nurs. (2003) 42:637–44. doi: 10.1046/j.1365-2648.2003.02667.x

PubMed Abstract | CrossRef Full Text | Google Scholar