Understanding What Drives Nursing Undergraduates to Pursue Postgraduate Entrance: Insights from a Qualitative Study

Introduction

The World Health Organization (WHO) has projected a global shortage of 5.7 million nursing professionals, highlighting the urgent need to increase the number of nursing graduates by 8% annually to address this deficit [1]. In response to this widespread shortfall, nursing postgraduate programs have emerged as a vital strategy for strengthening nursing capabilities worldwide [2]. The increasing demand for specialized expertise in nursing is further intensified by the ongoing transformation and complexity of healthcare systems, necessitating advanced education and focused knowledge [3]. Nursing graduate programs play a crucial role in preparing the next generation of nursing professionals by developing leaders, researchers, and expert practitioners. These academic paths enhance students’ skills in critical thinking, leadership, and specialized clinical areas, equipping them to tackle the evolving demands of modern healthcare settings [4]. Additionally, such programs prepare nurses to fulfill roles like advanced practice nursing, nurse education, administration, and research, all of which contribute to the innovation and progress of nursing practice and scholarly endeavors [5].

To address the ongoing global nursing shortage, it is crucial to take prompt action in attracting and educating prospective members of the nursing workforce. Within this context, pursuing graduate education has become an increasingly essential route to advancement. Graduate-entry nursing programs in countries like Australia, the United Kingdom (UK), and the United States (USA) are now firmly established, laying the groundwork for comprehensive nursing education and training [6–9]. Similarly, China has experienced a continuous annual increase in nursing postgraduate enrollments, significantly contributing to the cultivation of future nursing professionals. In China, nursing postgraduates are individuals who have earned a bachelor’s degree in nursing or a closely related field, passed the graduate entrance examination, and completed the necessary master’s-level coursework to attain a master’s degree, thereby advancing their professional development in nursing [10]. These graduate programs are designed for individuals who have already completed undergraduate nursing studies and seek to deepen their education and further specialize in the nursing discipline.

Undergraduate nursing students are often influenced by various motivations when considering whether to pursue graduate education. While some students are guided by clear career trajectories that require higher qualifications, others may be motivated by a desire for personal and professional development, improved employment prospects, or a commitment to advancing nursing knowledge and practice through research [2, 5]. Nevertheless, although pursuing further education is widely regarded as beneficial, the underlying reasons that drive individual students to enroll in postgraduate programs are not always clearly understood.

A previous review highlighted the limited research in countries such as the United States and Australia that specifically examines the barriers and facilitators influencing nursing undergraduates’ motivation to pursue postgraduate education [11–14]. In China, the nursing education system presents its distinctive challenges, among them an intensely competitive postgraduate entrance exam process and the rapidly shifting demands of the healthcare sector. These issues are further influenced by a strong cultural focus on academic achievement and prevailing societal expectations regarding nursing professionals [6]. Despite these complexities, no prior research has thoroughly examined the motivations of Chinese undergraduate nursing students to pursue graduate-level studies. This represents a significant gap in the literature, particularly concerning the diverse and complex factors that shape nursing undergraduates’ decision-making processes regarding postgraduate education.

Currently, Australia provides two simultaneous pathways for entry: one allows direct admission from high school, while the other permits enrollment through undergraduate or graduate programs without requiring an entrance examination [15]. In Norway, after completing their education, students tend to favor careers in home care rather than pursuing postgraduate education [16]. In some European universities, approximately half of the graduates pursue postgraduate studies, while the other half choose to enter the workforce [17]. These international variations in educational and career choices highlight the diverse factors that influence nursing students’ motivations to pursue postgraduate studies. Gaining insight into these influences is crucial for developing strategies that align with both students’ aspirations and the evolving demands of the healthcare sector.

This study aimed to use qualitative research methods to explore in-depth the barriers and facilitators affecting nursing undergraduates’ motivation for postgraduate entrance examinations. The findings aim to inform the improvement of current and future curricula, ensuring they meet the needs of learners while adhering to academic and regulatory expectations. Such insights can play a critical role in shaping curriculum design, guiding recruitment efforts, enhancing course development, and informing future research. Through this approach, the study aims not only to support nursing undergraduates in making informed decisions about their academic and career paths but also to contribute to enhanced educational outcomes and the ongoing advancement of nursing education and professional practice.

Materials and Methods

Study design

This research adopted a qualitative phenomenology approach.

Participants

Participants consisted of third- and fourth-year nursing students at Nantong University, all of whom were entering a year-long clinical internship that began in the second semester of their third year and continued through the fourth year. These students were either actively preparing for or contemplating taking the graduate school entrance examination, and their insights reflect their experiences before the exam. Nantong University’s nursing program is recognized for its high academic standards and national alignment, attracting students from diverse regions across China. As such, the study sample represents a broad spectrum of nursing student experiences across the nation. Upon completing their studies, these students will need to decide whether to enter the workforce or pursue postgraduate studies, making them an ideal group to examine regarding graduate education aspirations.

The study employed purposive sampling, targeting individuals who showed interest in participating. Those who agreed received detailed information and signed consent forms. Each participant took part in a single semi-structured interview conducted by the researcher. Interviews continued until data saturation was achieved, meaning that no new themes or insights were being generated. Of the 82 eligible undergraduate nursing students, 46 were unable to participate due to personal reasons, and 12 declined. A total of 24 students consented to participate in the interview. Data saturation was reached after interviewing 15 students, beyond which no additional meaningful information emerged. A comprehensive flowchart detailing participant selection is shown in Figure 1. The concept of data adequacy refers to the point at which the data collected are sufficient to address the study’s objectives or research questions comprehensively. This aligns closely with the principle of data saturation, where further data collection yields no new patterns, insights, or themes [18]. Some participants may not have significantly contributed to data adequacy if their responses lacked depth, varied perspectives, or did not introduce novel insights.

Data collection

Data were gathered through face-to-face semi-structured interviews carried out between October and December 2023 by two female researchers: a nursing professor (corresponding author) and a master’s student in nursing (first author). Each interview lasted between 30 and 45 minutes. Importantly, neither of these researchers had any role in grading the participants academically, which helped maintain objectivity and safeguard the confidentiality of the study—key factors in building participant trust. Although one researcher is a teacher to some of the participants, she did not conduct the interviews. Instead, interviews were conducted by the master’s student researcher, who held no grading authority over the students, thereby minimizing the risk of bias or coercion affecting participants’ responses. The teacher-researcher mainly supported the process by fostering trust and rapport, helping to create a recruitment and research environment that respected participant autonomy. This careful approach ensured that participation decisions were driven by genuine interest in the study rather than external pressure. Trust was established with participants before the interviews to reduce any potential anxiety.

In line with the research aims and after an extensive review of the literature, the research team jointly developed the interview guide. The teacher-researcher contributed to this process by ensuring the interview approach remained respectful and sensitive to participants’ viewpoints and experiences. The research team designed the interview guide based on the research objectives, insights from the literature, and team discussions. The main questions included in the interview guide are listed in Table 1.

Table 1. Summary of the semi-structured in-depth interview

The interviews were held either in a classroom or the teacher’s office, both of which were carefully selected to provide a private and neutral environment that prioritized participant comfort and independence. These quiet and undisturbed locations were usually used after classes or during breaks to minimize disruptions. This approach helped lessen any potential power dynamics and detached the interview setting from formal academic contexts, promoting a sense of equality and trust during the conversations. Only the participants and researchers were present. Before starting, the purpose and content of the interview were thoroughly explained, and with participants’ informed consent, the sessions were fully recorded. Both audio and video recordings captured the data, with researchers applying techniques such as prompting, restating, clarifying, and summarizing to encourage full expression of participants’ thoughts. Researchers also carefully observed and documented participants’ facial expressions and body language. Field notes were taken throughout.

Data analysis

Within one day after each interview, the recordings were transcribed into NVivo 12.2 by the two researchers. The coding was carried out by two independent coders who were not involved in conducting the interviews, ensuring impartiality and reducing bias. Each participant’s data was coded from S1 to S15, representing those who contributed sufficient data for analysis. The team applied Colaizzi’s seven-step method [19, 20] to analyze the phenomenological data as follows systematically: (1) immersing in the data through repeated readings for a deep understanding; (2) identifying and numbering key statements related to the nursing students’ motivations and obstacles regarding postgraduate study; (3) interpreting the significance of these statements and categorizing them into meaningful units; (4) clustering these meanings into thematic groups, organizing and comparing them against the original text to maintain consistency; (5) creating a rich description for each theme, supported by three to four representative participant quotes; (6) refining the overall thematic structure by comparing clusters and eliminating redundancies; (7) sharing the resulting thematic framework with participants to confirm that it accurately reflects their perspectives, as depicted in Figure 2.

Ethical considerations

The Ethics Committee of the Sixth People’s Hospital of Nantong approved this study (approval number: NTLYLL2023016). The research team fully complied with ethical standards, including securing written informed consent from all participants, ensuring confidentiality, maintaining participant privacy and anonymity, and honoring participants’ right to withdraw at any time. Participation was entirely voluntary, with all individuals providing informed consent before taking part.

Trustworthiness

To ensure the rigor and reliability of the qualitative research, the study addressed key criteria, including credibility, transferability, dependability, and confirmability [21]. Credibility was reinforced through conducting face-to-face, semi-structured interviews that provided participants with ample opportunity to express their personal experiences and feelings in depth. Data integrity was maintained through the use of double data entry and verification procedures. Researchers engaged in ongoing reflexivity and peer discussions to identify and mitigate possible biases. Consistency across interviews was achieved by using identical questions and thorough examination of findings. Member checking was performed by returning transcripts to participants for review, ensuring the accuracy of the data through their validation and minor corrections. To protect participant anonymity, transcripts were anonymized and assigned unique identifiers throughout the thematic analysis, preserving privacy and upholding the integrity of the research. The COREQ Checklist [22] was utilized to enhance the transparency and quality of the study’s reporting.

Results and Discussion

As detailed in Table 2, the sample consisted of 15 nursing students, comprising 13 females and 2 males. Their ages spanned from 20 to 22 years, with the youngest participant being 20 years old and the oldest 22 years old. Participants were enrolled in the nursing program’s third and fourth years, with 6 students in their third year and nine in their fourth year.

Table 2. Demographic characteristics of the participants (n = 15)

Barriers

Academic workload and internship-related fatigue

Nursing students face a heavy academic load that includes comprehensive theoretical coursework alongside demanding clinical practice. Their clinical duties often involve 8-hour shifts spread over multiple days weekly. Although this hands-on experience is crucial for translating classroom knowledge into practical skills, it can also cause significant fatigue. As a result, many students become too tired to consider pursuing postgraduate education.

“I have plans to pursue graduate studies, but the exhaustion from clinical rotations, sometimes even working night shifts, quickly dispels the idea of taking the entrance exam.” (S2).

“Every day, I have to juggle a multitude of coursework, internships, and other academic responsibilities. It seems challenging to carve out extra time for preparing for the postgraduate entrance exam.” (S7).

“Usually, I’m swamped with tasks. I need to prepare for the nursing licensure exam, which involves rotations in various departments with corresponding assessments, and I also must prepare for my graduation thesis. I simply don’t have the time to prepare for the graduate entrance exam.” (S9).

“Coming back to the dorm and feeling like sleeping every day after work, it’s too exhausting to even think about preparing for the postgraduate entrance exam. So, I don’t even have that thought in my mind.” (S12).

Self-doubt and fear of failure

While the decision to pursue postgraduate studies can be made quickly, preparing for the postgraduate entrance examination is a lengthy and demanding process that requires sustained effort and patience. Undergraduate nursing students who experience a lack of perseverance or harbor self-doubt may lose their drive and abandon their plans before completion. The entrance exam itself is known to be difficult, causing some students to worry that failing will prevent them from continuing to postgraduate studies, thereby delaying their academic and career goals. This mental state can act as a significant barrier to their motivation to advance academically.

“I see some classmates studying diligently for the entrance exams, but I always feel like I might not make it, like I’m not good enough. Ris’s self-doubt makes me feel like no matter how hard I try, it’s pointless. I often question my ability to handle the rigor of graduate studies, especially when I see how demanding my current coursework is.” (S1).

“I once had the idea of taking the postgraduate entrance examination, but after careful consideration, I chose to give up. I believe I am not well-suited for pursuing further studies. The thought of failing the entrance exam is daunting. It makes me hesitate to commit to the process.” (S10).

“I haven’t decided yet whether pursuing postgraduate studies aligns with my career goals, considering that the career development path in nursing is relatively clear. I’m still hesitant about whether postgraduate studies are necessary for our future, so I’m undecided about whether to pursue them. There’s too much to prepare for the entrance exams, and I feel like I can’t adapt. I’m afraid of failing, afraid of not being able to handle the complex study tasks, so I tend to stay within my comfort zone.” (S14).

Employment pressure

Undergraduate nursing students face significant challenges due to economic instability and a highly competitive job market. The increasing cost of living combined with fierce competition for jobs creates a strong sense of urgency for them to find stable employment and financial security.

“I want to put all my energy into finding a job. It’s too risky for me to take the entrance exam. I’m afraid I won’t pass. Because if I don’t pass the exam, I will miss a year, and it is difficult to find a job in the current environment.” (S7).

“I want to start working earlier, earn money sooner, become independent, and relieve my parents from too much hardship.” (S9).

Lack of information and resources

Various factors, such as limited access to information and resources, can make it difficult for some nursing undergraduate students to pursue graduate studies immediately after finishing their undergraduate program. This situation may temporarily restrict their chances for professional growth. Nevertheless, it is essential to recognize that many individuals choose to pursue graduate education at a later stage, influenced by their circumstances and evolving environmental factors.

“Compared to other disciplines, there’s relatively limited information available regarding postgraduate studies in nursing. Unlike some other fields, nursing students often lack access to abundant resources and guidance. Consequently, they often find themselves grappling with uncertainty when deciding whether to pursue postgraduate studies, lacking sufficient information to make informed decisions.” (S8).

 “In comparison, while students in other academic fields might have access to dedicated mentors or counselors who can guide them through the complexities of postgraduate education, undergraduate nursing students in China often face the challenge of navigating the path to advanced studies with limited financial support systems.” (S15).

Facilitators

Enhancing academic credentials and professional competencies

Nursing undergraduates decide to undertake graduate studies to strengthen their academic qualifications and advance their professional abilities in response to the increasingly sophisticated healthcare settings and rising occupational expectations.

“I believe that by pursuing a graduate degree, I will have the opportunity to engage with more cutting-edge nursing theories and practices, thereby continuously enhancing my professional competence and skill level.” (S3).

“My choice to pursue graduate studies is an investment in my professional development. I aim to enhance my expertise in the field of nursing through academic advancement, continuously elevating my professional competency, and contributing more to the healthcare sector.” (S6).

Career development and transition

Nursing undergraduate students seek to advance their careers and undergo professional transitions, aiming for a broader outlook and greater opportunities. Both personal career goals and prevailing trends within the healthcare industry typically shape these decisions.

“Going for grad studies is like investing in my future. I believe it’ll help me reach my career goals and make a bigger impact in the industry.” (S4).

“At present, there is a high probability that nursing undergraduates will enter clinical work after graduation. I want to do management or teaching, and I think I can have more job opportunities and choices after taking the postgraduate entrance exam.” (S11).

Escaping clinical work and delaying employment

Some nursing undergraduate students opt to continue their education to avoid immediate clinical work and delay entering the workforce, a choice often influenced by their career plans and individual preferences.

“I realized that clinical work might not be the field I always wanted to engage in, so I delayed entering the work, chose graduate school, and found a career direction that suited my interests and abilities, instead of rushing into the work.” (S6).

“Re clinical practice made me realize the hard work and fatigue of nursing clinical work, which made me feel afraid. However, the choice of nursing undergraduates after graduation is minimal, so I will choose to pursue graduate studies.” (S13).

The influence of role models and social support

Undergraduate nursing students view outstanding nursing professionals, whether peers or seniors, as motivating examples that encourage them to pursue further education, while support from society provides a strong foundation for their advancement.

“During my undergraduate years, I followed my teacher to conduct research in the research group, and he guided me to the road of entrance examination for postgraduate studies.” (S3).

“I have seen some senior students and predecessors in the nursing profession who have achieved better career development opportunities and higher social status through further education. Reading successful cases deeply convinces me that pursuing a graduate degree is an important pathway to achieving my career goals.” (S5).

“My family is very supportive of me and will provide me with all kinds of help. Several students in our dormitory are planning to take the postgraduate entrance exam. We prepare for the exam together and help each other.” (S6).

Figure 3 illustrates the barriers and facilitators that influence the motivation of undergraduate nursing students to pursue postgraduate studies.

This qualitative study explored the barriers and facilitators that affect the motivation of undergraduate nursing students to pursue postgraduate studies. Our findings showed that while several challenges limit students’ decisions to continue their education, there are also motivating factors that encourage them to seek further academic advancement. Various factors, including improving academic credentials, enhancing professional skills, career advancement, and the influence of role models, collectively inspire undergraduate nursing students to pursue postgraduate studies. These elements are interconnected and work together to drive students’ motivation for further education.

A key motivation for undergraduate nursing students to pursue postgraduate studies is the desire to strengthen their academic qualifications and professional competencies. With ongoing advancements in medical technology and evolving healthcare models, nursing professionals face increasing demands [23]. Obtaining a postgraduate degree allows students to deepen their specialized nursing knowledge and skills, expand their perspectives, and elevate their professional standards by improving patient care, competency, educational quality, work efficiency, and communication skills, enabling them to meet better the complexities of modern healthcare environments and job requirements [11, 24].

Postgraduate education also represents a crucial route for career growth and transition for undergraduate nursing students. In the nursing profession, holding a postgraduate degree is often regarded as a significant advantage for career progression, offering broader opportunities and a wider range of career options [14]. Through postgraduate studies, nursing students can move into diverse areas such as clinical practice, management, education, and research, aligning their careers more closely with their personal goals [12].

Additionally, some undergraduate nursing students may be motivated to pursue postgraduate studies as a means to avoid clinical work temporarily and delay entering the workforce. Nursing professionals often encounter substantial work-related stress and psychological burdens in clinical settings. By undertaking postgraduate education, students can temporarily distance themselves from frontline clinical duties, reduce work pressure, and gain more opportunities for learning and personal development. Furthermore, pursuing further studies provides additional time to decide and prepare for their future career paths before fully committing to the workforce [25].

The role of role models and social support plays a crucial part in motivating undergraduate nursing students to pursue postgraduate education. When students have role models already engaged in postgraduate studies and receive encouragement from family, friends, and society, their confidence and drive to continue their education significantly increase. The achievements of these role models, along with societal backing, lay a strong foundation that empowers nursing undergraduates with the determination and courage to seek advanced education and career growth.

In contrast, the decision-making process for enrolling in graduate-entry nursing programs in countries like the United States, New Zealand, and Australia largely depends on family support and financial resources [26]. Students in these regions often expect demanding intellectual challenges, rigorous workloads, and difficulties managing finances alongside work and life commitments [27, 28]. Unlike many Chinese nursing students who may view these challenges as obstacles, participants in D’Antonio et al.’s study tended to welcome them, seeing such difficulties as opportunities for personal and professional development. They anticipated gaining confidence, hands-on skills, and a solid professional identity by completing the program [26]. This distinction highlights differences between the motivations of Chinese nursing undergraduates and their counterparts abroad. Nevertheless, both groups share the goal of pushing themselves academically and attaining higher education through graduate entrance exams [29]. Therefore, the motivation to improve professional skills and secure better career opportunities via postgraduate study is common among nursing students worldwide.

Undergraduate nursing students frequently face high academic demands combined with practical training responsibilities. The pressure to maintain strong academic performance while managing clinical placements can be exhausting, leading to fatigue and burnout [30], which reduces their enthusiasm and drive to continue studying.

Additionally, many nursing students struggle with doubts about their academic abilities and preparedness for postgraduate education [31]. Concerns about whether they possess the necessary skills and knowledge to succeed at the graduate level [32] can lead to hesitation and uncertainty about pursuing further studies.

Facing challenging coursework and demanding research projects can be overwhelming for undergraduate nursing students considering postgraduate studies. The fear of not succeeding may discourage them from applying to graduate programs. Concerns about meeting academic expectations or managing study commitments alongside other responsibilities often create obstacles that hinder their progress. These difficulties play a crucial role in how nursing undergraduates decide whether to continue their education. Overcoming these barriers typically requires a blend of support from universities, mentors, peers, and the development of personal resilience [33, 34].

After completing their undergraduate degrees, many nursing students feel pressured to enter the workforce immediately. This pressure is often driven by financial responsibilities, family expectations, or societal views, emphasizing the need to earn a livelihood. Consequently, postgraduate education might be viewed as a postponement of financial independence or security [13, 35]. The concern about falling behind classmates who opt for immediate employment can also influence students’ choices and deter them from pursuing further studies.

Access to detailed information and resources regarding postgraduate opportunities is often limited for undergraduate nursing students [33]. They may struggle to navigate complex application procedures, comprehend funding options, or identify programs that closely align with their career aspirations. Insufficient guidance from academic advisors or mentors can further intensify uncertainty, making it more challenging for students to make informed decisions about their educational paths. A lack of awareness about scholarships, grants, or other support services designed for aspiring postgraduate students adds another layer of difficulty, creating significant barriers to entry into graduate programs.

Our research highlights several key considerations for policymakers and educators. Expanding financial aid and mentorship initiatives could significantly benefit nursing students pursuing postgraduate studies. Educators might enhance support by integrating discussions about graduate education into the curriculum and establishing formal mentorship programs. Additionally, policies and educational practices that address cultural and institutional obstacles could better encourage students to pursue higher education.

This study does have limitations. Firstly, participants were drawn exclusively from a single university in China, which may limit the generalizability of the findings to other universities both within China and internationally. Future studies should aim to include a broader and more diverse sample from different regions and types of institutions in China to provide a more representative understanding. Secondly, this research focused on the viewpoints of undergraduate nursing students regarding the factors that influence their decision to pursue graduate studies. Broader research comparing these factors across various cultural and educational settings would yield a more comprehensive insight into the multiple influences on nursing students’ educational choices. Thirdly, the involvement of a faculty member interviewing their students may have introduced an element of perceived coercion, potentially affecting how honestly participants responded. To address this, future research should also gather perspectives from nursing faculty and parents of students to provide a fuller picture.

Conclusion

The objective of this research was to examine the factors that either hinder or encourage nursing undergraduates in their motivation to take postgraduate entrance examinations. Our study highlights the multiple challenges these students face when making decisions about pursuing graduate education. It is vital to tackle these obstacles and harness supporting factors to build an environment that nurtures students through various stages of their academic and career progression. To facilitate postgraduate study pursuits, nursing programs should explore offering expanded counseling services, adaptable program formats, financial assistance, career-focused workshops, mentorship and internship opportunities, peer support systems, and chances for research involvement. Institutions are also advised to weave graduate education and career planning topics into the main curriculum to help students appreciate the lasting benefits of advanced qualifications and their role in career advancement. Significantly, opportunities for further education are not limited to the period immediately after graduation but remain accessible throughout different points in a nursing professional’s career.

Acknowledgments: We sincerely thank all participants who generously volunteered for this study.

Conflict of interest: None

Financial support: None

Ethics statement: The Ethics Committee of the Sixth People’s Hospital of Nantong approved this study (Approval Number: NTLYLL2023016). All procedures adhered to established guidelines and ethical standards (Declaration of Helsinki). Informed consent was obtained voluntarily from all participants.