JournalMcEwen

10.1177/0898010105282511
Prater, of Holistic
/ Called
Nursing
to Nursing

Journal of Holistic Nursing

Volume 24 Number 1
March 2006 63-69

Called to Nursing © 2006 American Holistic

Nurses’ Association
10.1177/0898010105282511
http://jhn.sagepub.com
Perceptions of Student Nurses hosted at
http://online.sagepub.com

Lyn Prater, PhD, RN

Louise Herrington School of Nursing, Baylor University
Melanie McEwen, PhD, RN
University of Texas Health Science Center at Houston

Purpose: This study uncovers reasons students report for wanting to become nurses, to quantify those who feel that
they are called to nursing, and to learn what “being called” means to them. Method: A descriptive, cross-sectional sur-
vey was conducted with all students enrolled in nursing courses at one program in a private, faith-based university.
Findings: Most students decided to go to nursing school while in high school or college and chose nursing because they
had a desire to help others. The most common personal characteristics they identified that will be helpful in nursing
were being caring or compassionate. Almost two thirds of the students indicated they were “called” by God to become
nurses. Conclusion and Implications: Findings can help nursing educators and leaders determine how to better recruit
and retain individuals into the nursing profession and how to support and encourage caring and compassionate qualities
in all nurses.

Keywords: called; calling; vocation; nursing students

citations date to the mid-1990s. Several aspects of the

M en and women enter the nursing profession for
any number of reasons. Sometimes, it is because
a mother or close family member is a nurse or they
have always wanted to help sick people. However,
many nurses, and presumably many nursing students,
stated that they wanted to become a nurse because they
feel “called.” Although this has been recognized in the
past, little effort has been made to learn how many
nursing students feel they are called to pursue nursing
as a career and to identify what can be done to support
this perception. This project was designed to uncover
reasons students reported for wanting to become
nurses, to quantify those who feel that they are called
to nursing, and to learn what “being called” means to
them.
The Concept of “Calling”
The terms vocation and calling are often used syn-
onymously and generally refer to a spiritual or divine
predisposition to undertake a certain work or occupa-
tion. Indeed, the word vocation comes from the Latin
vocare that means “to call” (Hansen, 1994; Raatikainen,
1997; Widerquist, 1995). The nursing literature con-
tains very minimal discussion of the concept of nurs-
ing as a calling or vocation. Indeed, the most recent
concept found in the literature will be described here.
Christopherson (1994) defines a calling as “a task
set by God with a sense of obligation to work for pur-
poses other than one’s own” (p. 219). A “call” exhorts
a person to pursue a task or a role; it means that the per-
son is chosen to perform certain services or tasks com-
monly aimed at helping others. Historically, the notion
of a calling is linked to religion and divine inspiration.
In contrast, career or occupation refers to work that is
chosen rather than inspired or imposed. Individuals
select a career path and/or a job that they believe is best
for them (Christopherson, 1994; Raatikainen, 1997).
Historical Overview of Nursing as a Calling
Throughout history, nursing has been rooted in the
ideal of service and includes a commitment to helping
humanity (Bradshaw, 1998). Modern nursing has fre-
quently been traced to the work of Florence Nightin-
gale; the notion of nursing as a calling can also be
traced to her. In 1837, Nightingale experienced what
she determined was a call from God, and she wrote
Authors’ Note: During article preparation, Dr. McEwen was an
associate professor in the Louise Herrington School of Nursing at
Baylor University, Dallas, TX.

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64 Journal of Holistic Nursing
several times that she became a nurse in answer to a
divine call (Gaydos, 2001; Widerquist, 1992).
Beginning in the second half of the 20th century,
nursing education moved from hospitals to colleges
and universities, and values and beliefs shifted. Empha-
sis moved away from serving humanity as nurses were
taught to view their role as a psychodynamic care pro-
vider rather than a nurturer. They learned to view the
nurse-patient relationship objectively and use a prob-
lem-solving process to provide nursing care. As nurs-
ing education evolved, nursing moved away from the
conceptualization of vocation and calling and toward
the conceptualization of profession.
The Concept of Calling and Nursing Practice
Despite the move to enhance professionalism, dur-
ing the past two decades, nursing scholars have reem-
phasized that the essence or nature of nursing involves
caring for and about others. This theme of caring about
others ties nursing to its past and the idea of calling
(Hawkins, 1999). Although little has been described in
the literature, when compared with other nurses,
called nurses place greater emphasis on showing con-
cern and providing comfort, assisting the patient and
family to find meaning in an illness, facilitating
expression of feelings, responding to spiritual distress,
and promoting actions aimed at seeking forgiveness
(Widerquist & Davidhizar, 1994).
Nurses who are called typically have deep personal,
religious beliefs or embrace humanitarian values.
They are aware of the meaning and importance of sup-
porting the spiritual needs of patients (i.e., through
prayer or reading scripture; Lane, 1987). Jeffries (1998)
described several characteristics of a calling as it
relates to nurses. She stated that each calling is unique
and creates a passion for the work, and the calling
requires special talents and expresses itself in enthusi-
asm and energy for work. Jeffries also noted that
sometimes a calling is quite clear and may be inter-
preted as an order from God; however, other times a
calling may be subtle, manifested by a series of steps
that leads the individual to pursue nursing.
Research Studies That Examine
Nursing as a Calling
No research studies specifically addressing the con-
cept of nursing as a calling were identified in the litera-
ture; however, two references were found that men-
tioned the concept within the realm of another, larger
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study, and one small survey was located that described
the notion of nursing as a vocation. Bloom, O’Reilly,
and Parlette (1979) examined professionalism among
public health nurses, focusing on the nurses’ intent to
organize into labor unions. Among the findings, the
researchers reported that older nurses were more
likely to view nursing as a calling than young nurses
were. They compared the sense of calling to “Nightin-
galeism” (p. 45), which was described as the belief that
one should be dutiful and deferential, contrasting it
with “professionalism.”
Raatikainen (1997) conducted a study examining
characteristics of proficient nurses. Among the vari-
ables she considered was the concept of calling. She
performed an analysis to see how a calling influences
professionalism and found that nurses who experi-
enced a calling worked at a high professional level. In
addition, she determined that nurses who experienced
a calling had better knowledge about patients’ needs
than nurses who did not experience a calling and con-
cluded that a calling is a strong resource that fosters
proficiency among nurses.
Siccardi (1995) performed a “minisurvey” on nurs-
ing as a vocation. She questioned several nurses from
South America on their views of nursing and vocation.
The nurses in this survey defined vocation as a “natu-
ral gift in people that have a tendency to service or
ministry” and “being called by God to ministry” (p. 9).
The nurses overwhelmingly believed that nursing is a
vocation, and most reported that they became nurses to
help those who suffer and to serve.
Purpose of the Study
Because of the critical shortage of nurses that exist
in many areas, it is important to encourage and nurture
those who view nursing as a calling and to learn how
best to support them in their studies and practice. The
following questions were addressed by the current
study:
• What reasons do nursing students give for choosing to
pursue nursing as a career?
• What percentage of nursing students feel they were
“called” to become nurses?
• What does being “called” mean to those students?
• Do students who believe they are called differ from
students not called in such areas as self-reported per-
sonality traits, future practice preferences, and demo-
graphic characteristics (e.g., age, race and/or ethnic-
ity, gender)?

Method
Study Design and Sample
Because very little has been published in the nurs-
ing literature concerning the concept of “called to
nursing,” a descriptive, cross-sectional population sur-
vey design was deemed appropriate for the current
project. The sample comprised all students (N = 212)
enrolled in upper division nursing courses (their final 2
years of study) at one medium-sized nursing program
in a private, faith-based university in the south-central
part of the United States.
Instrument
The questionnaire was developed by the research-
ers following an in-depth review of the literature
related to the concept of called to nursing. The ques-
tionnaire consisted of a group of open-ended questions
designed to gather information on motivations,
beliefs, and feelings students have about why they
chose nursing and related issues. The original form
was circulated to five nursing school faculty for evalu-
ation of readability and content validity. Their sugges-
tions and feedback were incorporated into the question-
naire, which was then given to five graduate students for
additional comments related to content validity. Minor
modifications were made, and the final survey form
comprised six open-ended questions and several
demographic questions (i.e. age range, race and/or
ethnic group, gender) to be used for comparisons.
Procedure
The University’s Institutional Review Board
approved the study and questionnaire. A cover letter
explained the purpose of the project and ensured
respondents that participation was voluntary and
answers would be confidential.
To guarantee possible inclusion of all students,
instructors teaching in each of the four semesters of
the nursing program agreed to allow class time for data
collection. In agreement with each course instructor,
during one of the final class periods for the course, the
researchers distributed survey forms and consent letters
and explained the study. Those students who were will-
ing to participate were allowed 20 minutes at the end
of the class period to complete the survey. The students
were instructed not to include any form of identifica-
tion on the questionnaire and to place completed forms
in a covered box at the rear of the room as they exited.
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Prater, McEwen / Called to Nursing 65
Data Analysis
Responses to each question were transcribed verba-
tim, listing all responses by question; the responses
were then analyzed, categorized and summarized. A
content analysis was performed, and themes for
responses to each question were identified and coded.
A series of chi-square analyses were performed to try
to determine if there were any correlations between
whether a student answered “yes” to Question 6 (Do
you feel that you were called by God to become a
nurse?) and other variables (e.g., demographic data,
when they chose nursing, personal characteristics).
Findings
A total of 205 questionnaires were distributed (not
all students were present on the day the surveys were
administered), and 131 were returned completed for a
response rate of 63.9%. As a group, the students at the
school of nursing were young, female, White, and
unmarried. Indeed, an overwhelming majority of the
participating students (85%) were aged 20 to 24 years,
12% were aged 25 to 40 years, and 3% stated that they
were older than age 40 years. Most of the students
indicated that they were White (83.2%). Other race
and/or ethnic groups and percentages were Black
(8.4%), Hispanic (4.6%), and Asian (3.1%); 1 student
did not answer.
Analysis of Responses
to Individual Questions
Analyses and exemplars for each survey question
are described here.
Question 1: “When did you decide you wanted to be a
nurse?”
The responses were coded based on whether the stu-
dent reported becoming interested in nursing as a
young child or early adolescent (before high school),
during high school or college, or as an adult. Based on
these categories, 17.5% stated that they were younger
(grade school or middle school), and 9.2% indicated
that they were adults or that nursing was a second
career. Thus, almost three fourths (73.3%) were in
high school or college when they decided to pursue
nursing as a career.
The most common response to when the students
decided on nursing was during their freshman or soph-
omore year in college. A number of the students indi-
66 Journal of Holistic Nursing
cated that they changed their major to nursing from
other areas of study. For example, one student stated “I
was . . . getting a Spanish degree and my dad [a physi-
cian] told me he could see me in the field. I enrolled
after graduation.” One of the most frequently men-
tioned changes of major was students reporting mov-
ing from premed to nursing. Specific responses were
“last semester of my senior year . . . while completing a
biology/pre-med degree,” and “sophomore year in col-
lege when I couldn’t decide if I wanted to be an MD
[physician], PA [physician’s assistant] or NP [nurse
practitioner].”
Of those who answered that they decided to be a
nurse as a child, several responses were similar to
these: “When I was 6 or 7 years old, I wanted to work
with the babies” and “When I was probably about 5
years old, I began to play nurse with my dolls.”
Another student wrote that she became interested in
nursing during the first grade because “my carpool
mom was a neonatal nurse and I got to visit the NICU
[neonatal intensive care unit] where she worked. I
loved the babies and I was hooked.”
Some of the respondents were more practical in
their rationale. For example, one of those who entered
nursing school as an adult wrote that she became inter-
ested “while working full-time after high school. I
realized I needed to go to college and chose nursing.”
Another answered “after my last layoff from my engi-
neering job.”
Question 2: “Why do you want to be a nurse?”
The responses to this question were reviewed and then
grouped according to several major categories: (a) to
help or care for people, (b) because they felt “called” or
“led,” (c) because they wanted to work in health care or
medicine, (d) to make a difference or contribute to
society, and (e) for practical reasons (i.e., job security,
did not make it into medical school). Percentages for
each group are summarized in Table 1.
Almost one half of the students’ statements indi-
cated that the main reason they wanted to become a
nurse was to help or care for people or “to serve.”
Typical responses were “to serve and help others,” “I
love people and I love helping and giving to others,”
and “I want to help people when they are the most
vulnerable.”
A desire to work in health care or in the medical
field was the second most common response, as more
than one fourth of students indicated this was the reason
they chose nursing. One student wrote “I’ve always
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Table 1
Primary Reason Students Report
for Wanting to Become a Nurse
Percentage
Reason for Choosing Nursing of Responses
To serve or help others 46.6
Desire to work in health care and/or medicine 26.0
Believe to be called or led 11.5
Practical reasons (e.g., flexibility, job security) 6.9
To make a difference 4.6
Other (i.e., excitement, love for a specific group 4.4
[e.g., babies])
wanted to be in the medical field, although I thought
that it would be as an MD.” Another wrote “I love
studying medicine and human health . . . I wanted to
help people . . . and wanted a flexible career.”
In this open-ended question, more than 11% stated
that they chose nursing because they were called or
“led” to choose it as a career. Typical responses were “I
feel a calling to help people,” “I want to serve people
and I truly feel called to it,” and “I feel this is where
God is calling me.” Several indicated that they want to
become medical missionaries.
The remainder of the students cited more practical
reasons they wanted to become a nurse. For example,
one stated “I like flexibility—I get bored easily and I
like that there are so many different areas to go into.”
Another stated that “I didn’t want to go to medical
school and then residency and then specialty train-
ing . . . too old to have a family and didn’t want to be on
call all the time.” Several mentioned job security, and
one wrote “to have a career option if something
happens to my husband.”
Question 3: “Do you have a close family member, friend,
or role model who is a nurse? If yes, who is it, and how
did they influence you?”
While more than one half of the students (52.7%)
responded that there was no one in their family or a
specific role model who interested them in nursing,
16.8% reported that their mothers were nurses, and 1
said that her mother and father were nurses. Another
24 students (18%) reported that their grandmother,
aunt, or sister was a nurse. Specific comments on how
these nurses influenced the students were “My mother
and all my aunts are nurses. I want to be as compas-
sionate as they are,” “My mom is a nurse. I basically

grew up in a hospital,” “Mom’s caring nature was a
huge influence in what I will strive for as a nurse,” and
“My mom and grandmother showed me how to care
for people.”
Question 4: “Prior to nursing school have you had experi-
ence helping care for someone who was ill or have
you been a hospitalized patient yourself?”
Thirty-two of the respondents (24.4%) mentioned that
they had experience caring for an ill family member.
Response examples were “My grandma was wheelchair-
dependent my whole life with bipolar/Alzheimer’s and I
took care of her since I was 12,” “My brother and my
mother needed constant care; my brother is doing well
but my mother is still under my care,” and “I cared for
my ill mother . . . until her passing.”
Many students (23%) indicated that they had
worked or volunteered in health care in some capacity.
For example, one wrote “I worked with special educa-
tion children—mostly autism,” and another said “I
was a hospital volunteer for 3 years prior to nursing
school.” Several stated that they were paramedics or
emergency medical technicians, and 4 were also certi-
fied nursing assistants.
A number of the students reported having experi-
ence in health care from a patient’s perspective.
Indeed, 3 noted that they were cancer survivors (2 had
childhood leukemia and 1 had breast cancer). The stu-
dent who had breast cancer wrote that “diagnosis and
treatment was ‘a wake up call’ to do the things in life
that are important.” One student answered “I have had
19 major surgeries and a few minor surgeries,” and
another wrote “I was in a car accident and in the hospi-
tal for 17 days. It was the nurses that I connected with.”
Question 5: “Describe characteristics, talents or person-
ality traits you have that you believe will help you in
nursing.”
Most students listed several characteristics or traits.
The first response of each student was grouped into
categories of characteristics; these are listed in Table 2.
As shown in Table 2, by far the most common
responses were related to caring and compassion.
Indeed, 56.6% listed this characteristic first, and fully
75% of the students specifically used the words car-
ing, compassion, love, or empathy/empathetic to
describe themselves in their written answers. Specific
responses were “compassion, always willing to help,”
“I genuinely love people, love to teach/educate,”
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Prater, McEwen / Called to Nursing 67
Table 2
Students’ Primary Reported Characteristics,
Talents, and Traits
Percentage
of Students
Characteristic, Talent, or Trait Responding
Caring or compassionate 56.6
Good communication skills and/or good listener 17.3
Organized and/or highly motivated 13.4
People oriented and/or love people 9.4
Other 3.2
“strongly empathetic to others,” and “caring, nurtur-
ing, sympathetic.”
More than 17% of the students indicated that their
good communication skills, including ability to listen,
would help them as nurses. Typical responses were “I
am a good listener—patients can vent to me,” “I com-
municate well with others, and they tend to open up
and share information,” and “I love to listen to people
and what they have to say.”
A third grouping related to more concrete or practi-
cal characteristics reported by the students included
intelligence, critical thinking ability, common sense,
and being a hard worker. Although most students
listed these characteristics second or third, 27.5%
mentioned at least one of them. For example, one stu-
dent wrote “I think very logically and use common
sense and instinct.” Another stated that she is “orga-
nized; able to multi-task and good under pressure.”
Other characteristics that were mentioned less com-
monly were humor, patience, calm, driven, and “easy
going.” Two students noted they were bilingual, and
one wrote “Blood and vomit do not affect me . . . I think
of the person’s need for help before thinking of how
gross what I am cleaning up is.”
Question 6 specifically addressed the concept of calling:
“Do you feel that you were called by God to become a
nurse? What does that mean to you?”
This question was intentionally placed at the end of the
survey to draw out responses regarding why they chose
nursing without “leading” the students to respond that
they were called. In response, almost exactly two
thirds (65.5%) of the students turning in the surveys
indicated that “yes” they felt called to nursing.
When describing the meaning of being called, stu-
dents’ thoughts fell among three main categories: (a)
68 Journal of Holistic Nursing
what the call is, (b) how the call is felt or perceived,
and (c) the purpose of the calling. In the first group
(what a call is), many students used words like “plan,”
“purpose,” “direction,” “passion,” “ministry,” and
“reason.” Other terms were “a life mission,” “feeling a
sense that you are needed,” and “following God’s will.”
In the second grouping (how the call was per-
ceived), several statements were similar to these:
“doors were opened” or “barriers were removed.”
Also, “God led me down this path,” and “God facili-
tated money, grants and other help received.” Another
fairly common theme related to the process of being
called was “given strength.” For example one student
wrote “He gave me strength to go on,” and another said
“God gives me strength to take care of others.”
In describing the purpose of the calling, 11 students
specifically wrote they were called to care or serve oth-
ers. A similar response was to “minister to those in
need.” Some students specifically cited use of the call-
ing to reach others for God. Examples included “car-
ing for the ill . . . to teach the Gospel,” “to be a witness
to others,” and “to demonstrate God’s love in the
world.” A few students were very specific, as one said
“to help other people with cancer,” and another “feeling
the need to serve others in under-developed countries.”
Some students were specific in describing the
meaning of calling. Examples included “Being called
means responding to God’s desire to work through
me,” “It means knowing that becoming a nurse is one
of God’s purposes for my life,” and “This is what God
intends for me to do.” One eloquent student wrote “I
feel that everybody has a ‘calling’ . . . it depends on
whether you are listening. God made me for such a
time as this.”
Analysis of the Theme of Calling and
Relationships With Other Variables
Several interesting findings were discovered when
comparing those who described themselves as
“called” and those who did not. For example, females
were more likely to report being called (66.4%) than
males (54.5%); however, chi-square analysis showed
that the difference was not statistically significant (p =
.430, df = 1). Age did not appear to be a factor as the
groups were very similar, although it was difficult to
compare as very few were in the older age groups.
Findings related to race were interesting, as being
called was more common among students from racial
and/or ethnic minority groups. Indeed, while 60% of
White students reported being called, percentages were
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72% for Black students, 75% for Asian students, and
100% of Hispanic students (6 of 6 students); however,
this was not statistically significant (p = .258, df = 3).
Discussion
Although after many years of teaching in a faith-
based school of nursing, we understood that many of
our students perceived a calling to the nursing profes-
sion; we were nonetheless surprised with the findings.
Based on the responses, a very significant majority of
our students felt that they were led by God or that their
being in nursing was within a divine plan. The stu-
dents’ descriptions of their perception of calling were
very closely tied to what was discovered in the litera-
ture. For example, the call to nursing gave them pur-
pose, direction, and reason for their choice, which is
consistent with Chrisopherson’s (1994) definition of
calling. Furthermore, as Jeffries (1998) observed in
discussing a sometimes stepwise path that leads to rec-
ognition of a calling, the called students frequently
described coming to nursing as a process of “closing”
and/or “opening doors” in which they moved from one
idea or direction to another while in high school or
college.
Another important, although not particularly sur-
prising, finding was that almost one half of the stu-
dents indicated that the primary reason they wanted to
become a nurse was to help and/or care for people.
Because 75% of students described themselves as
wanting to be nurses because they were caring, com-
passionate, and empathetic, it is clear the underlying
motivators for being a nurse are more likely to be inter-
nal rather than external. Aptitude tests and other for-
mats have been used to assist young people in search-
ing for a career that will fit their personality. Those
who possess a strong desire to help and serve should be
encouraged and sponsored by nursing faculty when-
ever possible. Other, perhaps less altruistic reasons
(e.g., did not want the time commitment of medical
school or job security) should be recognized, and
recruitment activities can include attention to those
individuals who have lost jobs or who are at risk for
losing jobs.
Several other findings hold significant implications
for those involved in recruitment of individuals into
the nursing profession. For example, almost three
fourths of the respondents were in high school or col-
lege when they decided on going to nursing school.
Previous experience with the health care system,

either as a patient or as a provider, appears to have been
an influence on many individuals in the current study,
although generalizations are very difficult.
Students’ perception of being called to nursing has
several implications for schools of nursing and faculty.
Among others, these implications relate to curricular
issues, support and encouragement of students, and
career counseling. Nursing faculty can affirm students
personally, with one-on-one interactions and small
group meetings and seminars. Faculty can affirm stu-
dents’ perception of being called by ensuring that cur-
ricula include spiritual care and address the value of
compassionate care. Extracurricular activities to
enhance the students’ spiritual life are also vital to
providing a holistic education.
Limitation and Ideas for Future Study
The most significant limitation to the current study
was that it was conducted at one school of nursing at a
faith-based university, thus limiting its general-
izability. A follow-up, expanded study is currently
being planned to perform a similar survey in other
faith-based schools of nursing and in nursing schools
in public colleges and universities across the United
States. There are plans to expand the research further
to examine nursing students internationally. Compari-
son of the responses from students from faith-based
and secular schools from different geographic regions
could be used to identify similarities and differences
among students.
Conclusions
Findings from the current study can be used as a
baseline to examine the same or related concepts
within nursing education and practice. For example,
does recognition of nursing as a calling influence a
nurse’s choice of practice area or specialization (i.e.,
are “called” nurses more likely to work with the
patients who are terminally ill, with cancer, or are
underserved)? and do nurses who view nursing as a
calling experience greater job satisfaction or less burn-
out than those who view nursing as a job or occupa-
tion? This information can help faculty and nursing
leaders determine how to better recruit and retain indi-
viduals into the nursing profession and how to support
and encourage caring and compassionate qualities in
all nurses.
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Prater, McEwen / Called to Nursing 69
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Widerquist, J. G. (1992). The spirituality of Florence Nightingale.
Nursing Research, 41(1), 49-55.
Lyn Prater, PhD, RN, has been a nursing instructor for more than
20 years and is currently senior lecturer and clinical coordinator
in the Louise Herrington School of Nursing at Baylor University.
She received her BS from Texas Woman’s University, her MS in
maternal-child nursing from Texas Woman’s University, and her
PhD from the University of North Texas in adult and continuing
education. She currently teaches Professional Development:
Foundations for Practice, Maternal-Newborn Clinical and
Women’s Health Care in Great Britain. Her research has focused
on nurse staffing, continuing education, and nursing as vocation.
She has been a faculty sponsor of the annual medical mission trip to
Mexico at Baylor University School of Nursing for 14 years and
has participated in several University-wide international delega-
tions to Iraq, Argentina, and the United Arab Emirates.
Melanie McEwen, PhD, RN, has been a nursing instructor for
more than 16 years and is currently an associate professor at the
University of Texas Health Science Center at Houston, School of
Nursing. She received a BSN from the University of Texas School
of Nursing in Austin, master’s in community and public health
nursing from Louisiana State University Medical Center in New
Orleans, and PhD in nursing from Texas Woman’s University. She
is the author of three nursing textbooks and numerous articles in
nursing journals. Her research interests include issues related to
spiritual nursing care, immunizations and immunization policy,
disparities in diagnosis and management of attention-deficit/
hyperactivity disorder, and school-based management of asthma.