Reading activities of registered nurses

The Journal of Continuing Education in the Health Professions, Volume 10, pp. 245-256. Printed in the U.S.A. All rights reserved. Copyright 0 1990 The Alliance for Continuing Medical Education and the Society of Medical College Directors of Continuing Medical Education.

Nursing

Reading Activities of Registered Nurses BARBARA A. GESSNER, PH.D., R.N. Professor, University of Wisconsin-Madison School of Nursing 600 Highland Avenue Madison, Wisconsin 53705

MYRNA L. ARMSTRONG, ED.D., R.N. Assistant Professor, University of Texas at Arlington School of Nursing P.O. Box 19407 Arlington, Texas 76019

AUDREY S. CHANG, PH.D. Senior Scientist, University of Wisconsin-Madison School of Nursing 600 Highland Avenue Madison, Wisconsin 53705

Funded in part, by the University of Wisconsin-Madison School of Nursing

Contact Author: Barbara A. Gessner, Ph.D., R.N. Professor, School of Nursing University of Wisconsin-Madison 600 Highland Avenue Madison, Wisconsin 53705

Abstract: This national study was designed to gather baseline data about the reading activities of registered nurses. Question- naires were administered by nurse continuing educators to subjects (N=1406) at 44 sites in 25 states and the District of Colum- bia. In a week, the mean amount of time devoted to professional literature was four hours, 48 minutes (SD=3.88) plus eight hours, I 2 minutes (SD=5.1.5) to general material. This translated to reading one hour and 51 minutes per day, slightly more than the average adult. Educational level, position, and memberships were the best predictors of how much time was spent reading job-related material that might lead to self-development and enhancement of nursing practice.

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Gessner, Armstrong, and Chang

Key Words: Reading, continuing education, lifelong learning, professional education, registered nurses, adult education.

Reading Activities of Registered Nurses Reading is used to gain information or seek pleasure in everyday living. It is part of most aspects of life at home, work, or play, and is done in such diverse activities as cooking, shopping, commuting, or attending a concert. Professional and general literature is readily available, at relatively inex- pensive costs, containing subject matter that addresses a myriad of topics'. Although it takes time in one's busy schedule, when and where to read is controlled by the individual. These characteristics of reading make it use- ful for continued learning, self-development, and practice enhancement.

Reading practices of adults and other professionals like physicians and teachers have been explored, but little is known about the reading activities of registered nurses. Therefore, the present study was designed to pro- vide baseline data on the amount of time registered nurses spend reading general and professional literature. The specific purposes were to 1) determine the amount of time spent reading professional and general literature, 2) identify the demographic variables that influence the amount of reading done, and 3) describe the types of materials nurses read. For this study, reading was defined as gaining meaning from written messages.

Review of the Literature The most recent national published survey of the reading habits of adult Americans indicated the greatest amount of time was spent reading newspapers, magazines, books, and job-related materials. An average of one hour and 46 minutes was devoted to reading these types of information in a typical day. The range varied widely from under five minutes to over eight hours. According to Sharon, males read slightly more than females, and since more males were employed, their total time reflected the exten- sive reading done at work2.

One of the best predictors of the amount of time spent reading was level of education; the more education, the more time spent reading2.3-4. Likewise, in other adult education activities, more education correlated positively with greater participation rates.

Since gaining information was one of the primary motivators of read- ing3v5, it can be an important avenue for learning. The work of Tough, the Canadian educator, substantiated this. He found that almost every adult participated in learning projects, and reading was one way to obtain the knowled e needed to successfully complete this self-directed learning

Richards7 summarized 16 published studies of reported reading time of physicians during the period between 1955 to 1981. Two to six hours

exercise % .

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Reading Activities of Registered Nurses

per week was the range of average time devoted to reading job-related material. Physicians consistently reported reading as their preferred method of life-long learning to maintain professional competency. Specialty, type of practice, age, and teachin responsibilities had the greatest influence on

The teaching profession is concerned that its members meet expected standards. Concerns related to whether elementary and secondary teachers belonged to professional associations, subscribed to journals, and continued with life-long learning, includin reading, to gain additional knowl-

55% of teachers read professional literature 30 minutes or less in a typical week. A wide variance in amount of time devoted to this activity existed - from five percent with no professional reading to ten percent who read more than two hours each week.

Several factors increased the amount of time teachers read, including age (older teachers read more), availability of materials, and content directly applicable in the classroom l29l3. Educators in Canada suggested strategies to encourage reading among teachers: recognizing its value to professional development, selecting appropriate materials, lr iding con- venient places to read, and scheduling time for this activity .

Nursing leaders have long been advocates for professional development, including using reading as a strategy to remain current. For exam- ple, Florence Nightingale encouraged continuing professional growth; and Doyle15 in 1933 wrote an article for the American Journal of Nursing enti- tled “Reading Maketh a Full Nurse”. Others also encouraged reading as a means of continued learning for nurses16*17v18.

While these leaders promoted it, not all nurses saw reading as the primary method to confirm, maintain, and expand knowledge. While a study of nursing service directors in California indicated reading professional journals was perceived as necessary to maintain their positions19, other research findings reported that reading was not the preferred learning method for nursing education program directors20 and chief nurse administra- tors21. Conferences were the preferred continued learning activity with reading the second choice for those two groups of nurses.

For staff nurses, reading journals was the third choice for life-long learning21. Early studies of British nurses concluded that readin was lim-

more recent study, Skinner and Miller found American staff nurses value nursing literature as a means to stay updated profe~sionally~~.

reading time of physicians7* 8 .

edge to maintain their e x p e r t i ~ e ~ , ~ ~ , ~ Ei . In a study by George and Ray,12

ited after they graduated from their educational programs2*. 4 3*24. In a

Methodology Forty-six faculty and staff development coordinators volunteered to ad- minister the study instrument to registered nurses. Data were collected at 44 sites (two volunteers withdrew for work-related reasons) in 25 states

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plus the District of Columbia, representing 30 hospitals, 12 colleges and universities, one public health department, and one entrepreneur.

The number of questionnaires mailed to the designated sites was equal to the number of subjects the volunteer educator estimated could be obtained in a six-week period. Most subjects completed the research tool while attending continuing education classes. Instructions regarding administration of the tool included asking nurses not to participate in the study if they were currently taking credit classes as this might influence the amount and type of reading normally done.

Participation was voluntary, and those completing the questionnaire gave their consent to serve as subjects. The number of subjects at each site varied from one to 169, with the median number of 24. A total of 1,406 usable responses was generated. Usable was defined as having more than 90% of the questions answered. The response rate was not calculated be- cause the volunteer educators who administered the tool did not report the actual number of questionnaires distributed.

Instrument A self-reporting tool was adopted from the Reading Activity Inventory originally designed by Kirsch and Guthrie5. Subjects provided demographic information: gender, marital status, employment status, work setting, position, area of clinical interest, educational background, memberships in professional associations, age, and place of residence and work. Also, information was obtained about other factors that influenced reading such as journal and magazine subscriptions; books purchased; library usage; reading speed and comprehension; encouragement to read as a child, in nursing school, or by current supervisor; and learning style preference.

A section of the tool was devoted to time spent reading. Subjects were asked to estimate the amount of time devoted to both professional and general literature. Examples of activities to include as reading were described as skimming to locate information, perusing a small section of a document or article, studying, scanning material, or reading an entire book or article to learn new information. Data about use and benefit of reading were obtained also, but that information is not reported in this article.

The instrument was designed to examine the entire scope of reading done by nurses so major subject areas were identified rather than specific titles. The broad spectrum of all literature was classified into 18 distinct subject areas. The nine professional areas were clinical, research, administrative, and educational journals; clinical, research, administrative, and educational books, plus newsletters and papers from nursing and other medicalhealth care organizations and groups. General material was also divided into nine sections: news, entertainment, family, health and other magazines; fiction and non-fiction books; newsletters and papers from non-health related organizations and groups; and newspapers. Sample ti-

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tles or descriptions were used to define the groups. For each of the 18 areas of literature, subjects indicated whether they

expended no time, less than 30 minutes, 30 to 59 minutes, one to three hours, or more than three hours reading in an average week. In data analysis, to calculate the approximate amount of time spent reading, no time was coded as zero, less than 30 minutes was coded as 15 minutes, 45 minutes was used to code 30 to 59 minutes, two hours was set for the one to three hour category, and four hours was the code used for the answer of more than three hours.

Content validity was established in two ways. During pre-testing of the instrument, pilot subjects were asked to identify types of literature not included in the questionnaire. Also, several nurse experts were asked to review and critique the tool. In both instances, the tool was judged to be complete and literature areas understood.

No psychometric measures of instrument reliability were conducted; however there was internal consistency within the tool. When two questions referred to similar topics, the answers were in agreement. For exam- ple, respondents who indicated that the highest percentage of their total reading was devoted to professional development also had the greatest average time for reading occupation-related literature.

Another factor related to reliability was how consistent subjects were in their responses to the time, use, and benefit questions for each area of literature. In the nine professional areas, the consistency percentage ranged from 70% to 96%. The range for the nine general material areas was 85% to 97%.

The statistical package, SPSS/PC+, was used for data analysis. Demo- graphic data were described with descriptive statistics, such as percentage, mean, median, and standard deviation. To determine the relationship of demographic variables with time spent reading, one-way analysis of variance (ANOVA) was used. The level of significance was set at p =.05. When significance occurred, the Tukey post-hoc analysis was performed to determine differences between groups.

Descriptive data about the demographic variables of participants at each site were mailed to the volunteer coordinators, giving a composite picture of the subjects who were at their site.

Results Sample The majority of subjects were married (69%), women (95%), between the ages of 30-39 (42%), and employed full-time (80%). Sixty percent of the sample were staff nurses, 55% were on medical/surgical units and 68% were employed in urban hospitals. For their basic education, 25% of the sample had associate degrees, 36% baccalaureate degrees, and 36% diplo-

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mas, while the remaining 3% reported graduate degrees as their entry into nursing. The highest education attained was 24% diploma, 20% associate degree, 38% baccalaureate degree, and 18% graduate degrees, indicating that many of the nurses had additional formal schooling beyond their ini- tial preparation.

While general literature was purchased more than professional resources, a substantial number of registered nurses did invest in nursing related information with 77% subscribing to professional journals and 65% purchasing nursing books. Lack of time (61%) was the major deterrent to reading, although comparatively little time, less than ten hours per week (67%), was spent watching television. Ninety-three percent rated their reading comprehension as good to excellent, 89% reported their reading speed as average to rapid. Over half of the participants indicated they were frequently encouraged to read as children and in nursing school, but only 20% said they received frequent encouragement to read by their supervi- sors. Although 82% had health sciences libraries at work, only 46% used them.

Time The average time spent reading all areas of professional literature was four hours, 48 minutes (SD=3.88) per week and eight hours, 12 minutes (SD=5.15) per week were devoted to general information. The one-to-two ratio of professional to general reading was consistent when median reading time was calculated. Only five of the 1406 subjects indicated no professional reading, but 394 nurses (28%) read occupation-related literature less than two and one-half hours per week. The top quartile reported reading job-related material over six hours per week.

Everyone reported reading general literary resources from at least one subject area: the range was from 15 minutes to 36 hours per week. The fig- ures for the lowest quartile in general reading were from 15 minutes to four hours and 15 minutes while the top readers spent over 25 hours a week with the popular choices of magazines, books, and newspapers.

Demographic Variables Influencing Reading Table 1 summarizes the amount of total professional and general reading by nurses’ demographic variables. The variables having a significant impact on the amount of professional reading were highest education, position, and number of memberships in nursing organizations. Gender, age, marital status, clinical interest, basic education, hours worked, employment setting, and location of work and residence had no significant impact on time spent with nursing and other medicalhealth literature.

Education. One of the best predictors of the amount of time spent reading professional literature was educational level. The one-way ANOVA

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Reading Activities of Registered Nurses Table 1

Mean and standard deviation (SD) of hours of total professional and general reading time spent per week by nurse subjects (N=1406) according to demographic variables

Variables Gender Female Male Marital status Single Mamed Single parent Employment Full time 20 hourstweek & less Over 20 hours/week

Setting Hospital/nursing home Public health School/clinic Other

Position Administrator/manager Educator Staff Other

Clinical area Medical/surgical Maternallchild Public health Psychiatric Other

Basic education Diploma Associate degree Baccalaureate M.S./Ph.D. Highest education Diploma Associate degree Baccalaureate M.S.Ph.D.

Memberships None 1 or2 3 or more

Age 29 & under 30 to 39 40 to 49 50 & over Residence Rural Urban

Place of Work Rural Urban

Professional- - 1328

78

336 966 104

1114 204 46

1116 119 90 53

288 162 843 80

770 230 135 44

224

504 342 505 46

337 280 53 1 238

644 614 147

289 5 86 345 187

614 781

54 1

4.9 3.9 4.5 3.4

4.77 3.7 4.80 3.9 5.43 4.5

5.02 3.9 3.94 3.0 4.55 4.0

4.81 3.9 4.83 3.6 5.06 3.2 5.76 4.0

5.55 4.0 6.85 4.0 4.15 3.5 5.46 5.1

4.80 3.8 4.86 4.1 4.75 3.9 5.26 4.1 4.94 3.9

4.71 3.8 4.73 3.2 4.79 4.2 7.10 4.8

4.23 3.6 4.67 3.3 4.62 4.1 6.21 4.1

3.77 3.0 5.31 4.0 7.53 5.0

4.12 3.6 4.69 3.6 5.08 4.0 5.94 4.5

4.77 3.8 4.85 3.8

5.01 4.2 941 4.73 3.6

8.18 5.2 7.78 4.9

8.29 5.1 7.92 5.0 9.91 5.9

8.12 5.2 8.34 4.6 7.80 4.9

8.17 5.2 8.00 4.6 5.31 5.3 7.77 4.0

7.78 4.9 6.82 3.4 8.59 5.4 8.22 5.4

8.11 5.3 7.87 4.8 8.11 5.0 9.26 5.4 8.42 5.0

8.18 5.0 8.59 5.1 7.91 5.4 7.40 4.7

8.45 5.3 8.85 5.4 8.06 5.2 7.20 4.3

8.21 5.2 8.06 5.0 8.30 5.8

7.87 5.5 7.68 4.9 8.94 5.2 8.72 5.1

8.04 5.2 8.28 5.2

8.08 5.1 8.17 5.1


(F=13.9, pc.001) showed nurses with the most formal schooling devoted significantly more time to professional development via reading than nurses prepared at the diploma, associate degree, or baccalaureate levels. The reverse was noted for non-nursing reading (F=4.95, pc.01). Nurses with diplomas and associate degrees spent more time perusing general material than those with higher levels of education.

Data from masters and doctorally prepared nurses showed other significant differences from those who held baccalaureate, diploma and associate degrees. A greater percentage of their professional reading was done at work (F=5.0, pc.01); they subscribed to more professional journals (F=45.2, pc.0001) and general magazines (F=7.6, pc.001); purchased more nursing (F=23.3, pc.0001) and general books (F=8.3, pc.001); and made more trips to the medical library in a typical month (F=61.9, pc.0001). Nurses who had baccalaureate degrees as their highest education visited the library more often than those with diploma and associate degree education.

Position. Sixty percent of the sample were staff nurses, 20% held administrative positions, 1 1 % were educators, and 9% classified themselves in the “other” category. The overall F-test showed that position was a significant factor in amount of job-related reading time of nurses (F=44.1, pc.000 1). Tukey ’s post hoc test indicated educators devoted significantly more time to professional reading than other groups of nurses and that administrators read more than staff nurses. When general literature was considered (F=9.3, p<.001), another reversal occurred with staff nurses doing more pleasure reading than educators.

Membershius. Members of nursing organizations were readers. The polynomial analysis from the one-way ANOVA showed a significant linear relationship between the number of memberships and the amount of work-related reading a nurse did (F=49.0, pc.0001). Nurses who belonged to three or more professional associations read more than those with zero, one, or two memberships. They also subscribed to more nursing journals (F=109.6, p<.OOOl), purchased more nursing books (F=50.6, pc.OOOl), made more trips to the library (F=36.4, pc.OOOl), and spent less time watching television (F=6.7, pc.01). They read as much general literature as those who were not members of nursing organizations.

&. There was no significant difference in job-related reading by age, although a linear relationship was apparent in the data. As nurses become older, they read more. This same finding held for general reading. When total time for nursing and general reading was calculated, nurses 40 and over read significantly more than those 39 and under.

Types of Content Read Professional. Table 2 provides the statistics related to the differences in

25 2


professional reading between groups of nurses. The most prolific readers of professional literature were educators who read significantly more clinical, research, administrative, and education journals and books than staff nurses. The only area in which there were no differences between the reading of those two groups was health-related newsletters.

A similar relationship existed between educators and administrators. Again, educators read more in clinical and education books and journals, as well as research journals. Administrators, however, read significantly more managerial literature. They also read more work-related material than staff nurses in the areas of research journals and administration journals and books.

Clinical journals were the favorite choice of staff nurses. It was the only professional literature category where over 20% of staff nurses devoted two or more hours per week to reading. Clinical books and health- related newsletters were the other materials of interest. Staff nurses devoted very little or no time to reading education, research, and administrative books and journals. Only 34% of the staff nurses made one or more trips to the library in a month, but 72% personally subscribed to at least one or more professional journals.

General Material. There were few significant differences in general information read; those differences were in reverse order to reading work- related literature. Staff nurses read the most general literature, and they read more than the educators in four of the five categories of general magazines: entertainment (F=10.0, p<.OOl); home and family (F=l 1.1, p<.OOl); health or nutrition (F=12.7, p<.OOl); and the “other” category

Table 2 Overall F-test and the significant differences in professional reading between groups of nurses

mt Type of Educators Educators Administrators Administrators Professional More Than More Than More Than More Than

Differences between Groups of Nurses

Literature Read Staff Administrators Staff Educators F P

Clinical Journals X X

Research Journals X X

Administration Journals x Education Journals X X

Clinical Books X X

Research Books X

Administration Books x Education Books X X

Newsletters

13.4 <.OOO1 20.0 <.OOOl

X 112.3 <.OOO1 60.7 <.OOO1 21.7 <.OOO1 4.6 <.01

X 70.8 <.OOO1 13.1 <.OOOl

.1 =.888

Note: x indicates statistically significant group differences by Tukey’s test.

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(F=13, p<.OOl). The exception was news magazines. All categories of nurses reported reading fiction, non-fiction books, and newspapers, and no significant relationship existed among groups.

Another difference related to the amount of time spent reading (F=7.2, pc.01). Single parents devoted more time to reading general literature than either married or single nurses.

Discussion Nurses spent a total of 13 hours a week reading all types of material, ap- proximately the same amount as the general public. Most groups of nurses spent about the same amount of time reading, but what they read differed. Educators read the most professional literature, while staff nurses devoted more of their reading time to general information. The professional reading by staff nurses was in clinical journals they subscribed to at home. Other demographic variables that impacted on professional reading were education and memberships.

When compared to professional groups, nurses spent more time reading work-related literature per week than teachers and were in the mid- range of the average amount documented for physicians. Another similari- ty between nurses and physicians was that their professional reading increased when they were also educators. Differences also existed between those two professional groups. Reading was the first choice for continued learning for physicians but not for nurses. Clinical interest and place of practice did not influence reading by nurses.

While older teachers and physicians read more professional literature, the difference by age among nurses was only apparent when total time spent reading was considered. Nurses, like teachers, preferred reading material directly applicable to their work. This seemed to explain why staff nurses devoted most of their professional reading time to clinical material.

The convenience sample, although large and national in scope, consist- ed primarily of nurses who were attending continuing education classes. According to the literature the preferred learning style of nurses was conferences, so whether the sample was biased against reading is unknown. Another unanswered question was whether only those who read the most self-selected to participate in the study. Also, it was recognized that self- reporting may be subject to inaccurate recall, inflation, and bias in the di- rection of socially acceptable answers. These factors were the limitations of the study.

An obvious need was easy access to reading materials. Ideas to be considered are things like unit-based lending libraries and journal exchanges that can be facilitated by librarians or staff development educators. If staff nurses had reading materials applicable to their practice readily available on units and beyond the scope of the journals they subscribed to, their ho- rizons might be greatly expanded.

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Another factor affecting time spent reading professional literature may be external motivation. Head nurses could capitalize on this factor by en- couraging staff nurses to read and by providing suitable recognition for their efforts. One reward system to consider would be to tie reading to clinical ladder progression.

Summary Almost all registered nurses are reading professional literature, but what they read differs. Overall, nurses who hold advanced degrees, are members of nursing organizations, and are employed as educators and administrators read the most work-related material. An important element to ex- plore in future studies is whether nurses use information gleaned from reading to improve their nursing practice.

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Reading activities of registered nurses