Academic and Employment Preferences of Nursing Students at the University of Las Palmas of Gran Canaria: A Cross-Sectional Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The structure and writing style of the entire article were excellent, but there were still some minor suggestions.

Ø   In the introduction, the importance of training registered nurses was mentioned. It also stated that most of the registered nurses trained in Spain emigrated to countries with more stable employment and better economic incentives. However, the primary focus of the article was to explore the academic and employment preferences of college nursing students, which did not align with the statements made in the introduction.

Ø   The research results were consistent with the general perception of the employment preferences of nursing graduates. My question was whether the academic and employment preferences of nursing students were shaped by their environment. For instance, there is generally a high demand for nurses in General Nursing, and male nurses are not typically accepted in maternity wards or delivery rooms. Alternatively, was it because nursing instructors instilled in them the idea that starting a career in General Nursing or Emergency Nursing would be more beneficial for their future career planning?

Author Response

Comments: The structure and writing style of the entire article were excellent, but there were still some minor suggestions

Response:Thank you to the reviewer for his time and kind comments, which allow us to improve our manuscript.

Comments: In the introduction, the importance of training registered nurses was mentioned. It also stated that most of the registered nurses trained in Spain emigrated to countries with more stable employment and better economic incentives. However, the primary focus of the article was to explore the academic and employment preferences of college nursing students, which did not align with the statements made in the introduction.

Response: Thank you very much. In the introduction we wanted to state that there is currently a high demand for nurses in our country, but that a high number of Spanish nurses often emigrate to get better working conditions, but also because we think that they cannot develop their professional career in a satisfactory way, as the Spanish system is quite rigid and does not allow flexibility to newly graduated nurses to work in their preferred areas. We have introduced an explanation of this aspect in the introduction to try to highlight this idea. We hope we have succeeded.

Comments: The research results were consistent with the general perception of the employment preferences of nursing graduates. My question was whether the academic and employment preferences of nursing students were shaped by their environment. For instance, there is generally a high demand for nurses in General Nursing, and male nurses are not typically accepted in maternity wards or delivery rooms. Alternatively, was it because nursing instructors instilled in them the idea that starting a career in General Nursing or Emergency Nursing would be more beneficial for their future career planning?

Response: This seems to us to be a very pertinent comment. We have not explored this possible connection between preferences and the ideas that nursing instructors may convey. It is known that the clinical rotations undertaken by the students have a strong influence (either by the environment, by the teachers or by the experiences the students have with the patients), but we have not found any studies where a direct influence by the instructors is reported. However, our intention in future studies is to explore the reasons for these preferences in our students, as the problem is that certain areas with high demand are not preferred. It is true that the Spanish system restricts the nurses' choice of job-area, but this leads to an additional problem, which is the leaving of the job and the profession in many cases. We have introduced this idea into the discussion as a future line of research.   

Reviewer 2 Report

Comments and Suggestions for Authors

Peer Review: Academic and Employment Preferences of Nursing Students at the University of Las
Palmas of Gran Canaria: A Cross-sectional Study

Dear Authors,

First of all, I would like to thank you for the opportunity to enhance my knowledge with your interesting manuscript. I believe this is a second version, and therefore I assume it has already been improved compared to the original version. In my opinion, there are areas that could be worked on to improve readability and appeal to readers and the scientific community:

Abstract: In my opinion, it should be improved in terms of results and potential future implications (this point is also weak in other parts of the manuscript); Introduction: It would be better if divided into sections and further elaborated from an epidemiological perspective, both locally and internationally. The reference to the demand for 13 million nurses is unclear (in the world? Europe? How many are there today? How many are missing?);

Methods: The manuscript lacks a scientific reference for reporting an observational study (e.g., STROBE, others...) and the relevant checklist (e.g., Supplementary Material); Results: The overall population of the study is unclear, as well as the corresponding participation rate (response rate missing);

Discussion: I apologize, but the discussions appear redundant and too lengthy for an “average reading.” Dear authors, I would suggest making the necessary considerations to significantly reduce them (six pages are unreadable...). Moreover, they lack a fundamental aspect: what could be the practical applications of the presented study in clinical practice (or perhaps I missed it because the text is too lengthy...). If so, I apologize, but the possible confusion arises
from reading mainly descriptive points that do not provide substantial suggestions for the relevant scientific  community.

Limitations: I suggest creating a specific section and removing the reference numbering. Best of luck with your work and kind regards.

Author Response

Comments 1:

Dear Authors,

First of all, I would like to thank you for the opportunity to enhance my knowledge with your interesting manuscript. I believe this is a second version, and therefore I assume it has already been improved compared to the original version. In my opinion, there are areas that could be worked on to improve readability and appeal to readers and the scientific community:

Response 1: Thank you for your time and effort. We believe that your comments will help us to improve this work. This is really the first version of the manuscript that has been reviewed by reviewers. The editor asked us to make a minor change before passing the manuscript to reviewers.

Comments 2

Abstract: In my opinion, it should be improved in terms of results and potential future implications (this point is also weak in other parts of the manuscript);

Response 2: Thank you. We have tried to improve the abstract in the results and implications sections.

Comments 3

Introduction: It would be better if divided into sections and further elaborated from an epidemiological perspective, both locally and internationally. The reference to the demand for 13 million nurses is unclear (in the world? Europe? How many are there today? How many are missing?);

Response 3: Thank you. We understand that it may cause confusion as drafted, confusing national and international needs. We have reworded this part.

Comments 4

Methods: The manuscript lacks a scientific reference for reporting an observational study (e.g., STROBE, others...) and the relevant checklist (e.g., Supplementary Material);

Response 4: We point this out in the Guidelines and Standards Statement. We have also included it in the design and added the checklist in Supplementary material .

Comments 5

Results: The overall population of the study is unclear, as well as the corresponding participation rate (response rate missing);

Response 5: Thank you. We have reformulated this section in the results (Descriptive analysis of the sample). We hope for a better understanding

Comments 6

Discussion: I apologize, but the discussions appear redundant and too lengthy for an “average reading.” Dear authors, I would suggest making the necessary considerations to significantly reduce them (six pages are unreadable...). Moreover, they lack a fundamental aspect: what could be the practical applications of the presented study in clinical practice (or perhaps I missed it because the text is too lengthy...). If so, I apologize, but the possible confusion arises from reading mainly descriptive points that do not provide substantial suggestions for the relevant scientific community.

Response 6: We apologize to the reviewer for the length of the discussion. We wanted to discuss the results in depth, but we may have overdone it. We have revised the discussion and shortened (4 pages) it by deleting some paragraphs and restructuring others. We still recognize that it is a bit long, but in our opinion it addresses important issues, as requested by another reviewer. We hope that the changes we have made have mitigated the problem and highlighted the practical applications.

Comments 7

Limitations: I suggest creating a specific section and removing the reference numbering.

Response 7: We have followed your suggestion. Done

Comments 8

Best of luck with your work and kind regards.

Response 8: Thank you for your time and comments. Best regards

Reviewer 3 Report

Comments and Suggestions for Authors

It was judged to be a very interesting and helpful paper for nursing education. However, due to the abundance of content in the main text, the delivery of important information was insufficient. Please make the following revisions. 

1. Introduction

Please explain the quality control measures for nursing education in Spain and the clinical experience required for nursing students to obtain licenses.

Please describe the necessity of conducting this research along with the research objectives. The research objectives should be articulated in connection with data analysis. It is deemed that the significance of this study will be evident if the necessity of using a heat map is demonstrated.

 2. Materials and Methods

2.4. Variables to study

Delete the ward definition section: These areas were defined as follows: ~~ lines 143-167.

 3. Results

I recommend revising '(r=0.510/p=<0.001)' to '(r=.510, p<.001)' and making similar revisions to other correlation analyses.

 Table 4. Correlation matrix for the preference of thematic areas

- I recommend revising '0,435' to '0.435' and changing the comma to a period. Please make similar revisions to other numbers. I also recommend changing the bold numbers in the table to regular font.

 I would like the paper to explain the significance of cluster .30. Please also discuss in the paper why the second and third can be considered as clustering. Please describe the analytical validity by citing previous research to determine whether the current sample size (n=179) was adequate for conducting an EFA.

 The discussion should be based on the research results. Please revise the discussion to effectively convey its meaning and align it with the specific research objectives. The current discussion contains a lot of descriptive information about the state of nursing education in Spain, but lacks discussion based on the results of this study. A discussion of the results table is also needed.

 I hope you can revise the review comments and publish a quality paper.

Comments on the Quality of English Language

I have no specific comments to make.

Author Response

Comment 1: It was judged to be a very interesting and helpful paper for nursing education. However, due to the abundance of content in the main text, the delivery of important information was insufficient. Please make the following revisions. 

Response 1: Thank you for your time. We have tried to improve the information we have provided based on your valuable feedback.

Comments 2.

1.Introduction

Please explain the quality control measures for nursing education in Spain and the clinical experience required for nursing students to obtain licenses. Please describe the necessity of conducting this research along with the research objectives. The research objectives should be articulated in connection with data analysis. It is deemed that the significance of this study will be evident if the necessity of using a heat map is demonstrated.

Response 2: We have added in the introduction an explanation of the quality control system of the nursing degree and the clinical experience required for nursing student in Spain. We agree that the introduction did not reflect well the aims of the study in relation to part of the analysis carried out (correlation analysis to establish relationships between areas). Therefore, we have added a secondary aim that we believe helps to improve the coherence of the manuscript and the research.

Comments 3 

2. Materials and Methods

2.4. Variables to study

Delete the ward definition section: These areas were defined as follows: ~~ lines 143-167.

Response 3: Done. We have added it as supplementary material.

Comments 4

3. 3. Results

I recommend revising '(r=0.510/p=<0.001)' to '(r=.510, p<.001)' and making similar revisions to other correlation analyses.

Response 4: Done. Thanks

 Comments 5

Table 4. Correlation matrix for the preference of thematic areas

- I recommend revising '0,435' to '0.435' and changing the comma to a period. Please make similar revisions to other numbers. I also recommend changing the bold numbers in the table to regular font.

Response 5: Done.

 Comments 6

I would like the paper to explain the significance of cluster .30. Please also discuss in the paper why the second and third can be considered as clustering.

Response 6: Thank you very much for this comment. We have analysed the results of our cluster analysis and considered that we had neglected the analysis in the discussion of clusters 2 and 3. Therefore we have introduced in the discussion a paragraph where an explanation is provided in reference to the rest of the clusters, as well as giving us the opportunity to introduce a quote to support the method used (reference 38. Factor Analysis-Principal Components-Clusters). We hope you will be pleased with it.

Comments 7

Please describe the analytical validity by citing previous research to determine whether the current sample size (n=179) was adequate for conducting an EFA.

Response 7: A reference (reference number 23) has been added to justify the adequacy of the sample size for the factor analysis based on the subject-variable ratio. Given that 10 areas have been analyzed, a n=100 would be sufficient.

Comments 8 

The discussion should be based on the research results. Please revise the discussion to effectively convey its meaning and align it with the specific research objectives. The current discussion contains a lot of descriptive information about the state of nursing education in Spain, but lacks discussion based on the results of this study. A discussion of the results table is also needed.

I hope you can revise the review comments and publish a quality paper.

Response 8: Thank you very much for your comments. Based on this comment and that of another reviewer we have revised and modified the discussion, shortening it substantially and eliminating a lot of descriptive information. A large amount of information about the state of nursing education in Spain was presented because we believe it is important to know this information in order to understand the context that influences the preferences of nursing students in Spain. For example, in many European countries it is not necessary to complete the nursing degree to become a midwife; in our country it is necessary to first complete the nursing degree and then access the midwifery residency program.

On the other hand, we sincerely believe that we discussed the most relevant results: most preferred versus least preferred areas in reference to those already studied in other settings, influence of variables on preferences towards certain areas (gender, having children: where the highest effect sizes were obtained for the associations) and correlations between areas (areas of high complexity, related areas). We hope that the re-reading of the new version will improve your opinion. Kind regards

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors,

the file in the annex file.

Best

Comments for author File: Comments.pdf

Author Response

Comment 1:Dear Authors,
I am pleased that you appreciated the comments, which in my humble opinion have positively transformed the work and made it certainly more appealing to the relevant scientific community. Just two final considerations: please reduce again the discussion (four page are still important for the reader), and add the citations of the Strobe checklist in the text and the bibliography so:
Strengthening the reporting of observational studies in epidemiology, Strobe. Available on: https:// www.strobe-statement.org/
Skrivankova, V.W.; Richmond, R.C.; Woolf, B.A.R.; Yarmolinsky, J.; Davies, N.M.; Swanson, S.A.; et al. Strengthening the Reporting of Observational Studies in Epidemiology Using Mendelian Randomization: The STROBE-MR Statement. JAMA, 2021 Oct 26;326(16):1614-1621. doi: 10.1001/jama.2021 

Response 1:

Dear reviewer
 Thank you for your comments. We have added the reference to the STROBE standards (reference number 20) and made further changes to the discussion, shortening it even more, but trying to keep the general sense. We believe it is now more readable and enjoyable for readers. Consequently, some references have been removed and the bibliography has been adjusted. We hope that the changes will allow the publication of this research. Thanks again and best regards