From Nursing to Courtroom: A Qualitative Descriptive Study of the Preparations, Motivations, and Barriers of Nurses Becoming Lawyers

Corresponding Author: Homelo Valenzuela Estoque Institute of Nursing, Far Eastern University, Manila, Philippines Email: hestoque@feu.edu.ph Background: Transitioning is a common phenomenon that happens such as in a career shift provoked by either internal or external factors. This phenomenon also occurs to nurses becoming lawyers. Considering its complexity, such transition entails a process. Purpose: This study aimed to describe and uncover the preparations, motivations, ad barriers of nurses who transitioned into nurse-lawyers in the Philippines. Methods: The study employed descriptive-qualitative research design utilizing twenty participants selected through purposive and snowball or referral sampling techniques. A semi-structured interview guide was used for the data collection using Google form. Braun and Clarke’s thematic analysis was utilized as the primary treatment of the transcribed data. Strict observance of ethical standards in conducting research was ensured. Results: The study found out several themes and subcategories from the thematic analysis conducted. These included (1) “pre-planning emotive expressions”; (2) “motivations of career shift”; (3) “support mechanisms to afford career shift”; (4) “barriers to career shift”; (5) “the interconnectedness of law and nursing”; and (6) “impacts of the career shift.” Conclusion: Generally, the career shift of the nurse-lawyers presented significant themes pertinent to their preparations, motivations, and barriers in becoming lawyers. Apparently, these are all primordial in the career transition of the nurse-lawyers. Essentially, the study provides preliminary findings that may become springboard in the construction of a grounded theory that would explicate the transition of the nurse-lawyers as a phenomenon uniting and expanding nursing and the practice of law as complementary sciences.


Introduction
Transition is described as the passage from one life phase, condition, or status to another as periods in between fairly stable states (Lindmark et al., 2019). As a concept, transition is based on the response to change. Transition is also touted to be a dynamic process necessitating transformation and adjustment occurring over time and requires a reconstruction of self-identity (Chamberlain et al., 2019). The phenomenon of transition occurs anytime within the life span that entails significant implications in various aspects of life. Nurses, in this regard, are no exemptions.
Nursing is a profession intertwined with caring (Blasdell, 2017), while lawyering is a profession that can be associated with feistiness (Salerno et al., 2018). This fact leaves one to ask why nurses would suddenly become lawyers. Deciding to take law is a result of a process (Garcia, 2013). Most often than not, the Bachelor of Science in Nursing (BSN) program is commonly used as a prerequisite for nurses to enroll in the Doctor of Medicine program (Batongbakal Jr, 2020). If a student considers to become a medical doctor someday, a BSN program would probably be among his or her choices (Makino, 2020). Conversely, while the admission to law school does not specify a certain bachelor's degree, only a few would select the BSN program as their pre-law. In this regard, a student would probably take a degree in business or perhaps in political science. However, regardless of the preparatory law degrees taken, in the end, all pre-bar degrees are equal

Setting and participants
This study was conducted in April, 2020. Due to the current COVID-19 pandemic, a combined purposive and referral sampling techniques were employed in the selection of the study participants. Certain criteria were observed in the selection process. Firstly, they have to be both registered nurses and lawyers in the Philippines. Secondly, the participants should be with or without hospital/community work experience. Lastly, they are currently in the practice of law in either private or public agencies.

Data collection
Initially, a letter of invitation to participate was sent through email to twenty-five prospective participants giving them a week to decide. Out of the twenty-five purposively sampled and referred by the prospective study participants, twenty participants sent their approval to participate in the study. Within a week, a validated structured interview protocol, embedded in Google form, was deployed to them to obtain the data required. The researchers maximized the mentioned online platform because face-to-face interview was not possible to be conducted due to the strict community quarantine measures imposed by the Philippine government. Nonetheless, the researchers took this as a challenge to complete the data collection despite said limitation.
The interview protocol contained questions focusing on the transitional experiences of the twenty RN-JD such as, "What were your motivations of transitioning your career from being a nurse to being a lawyer?", "What were the barriers to entry in your current career considering your first profession as a nurse? How did you work through them?", "Between being a nurse and being a lawyer, which one exactly manifested your vision for your life?" among other relevant questions. All responses collected were written in English language. The average time to finish the structured interview was 45 minutes.
The researchers transcribed the data, treated, and presented back to the participants for validation purposes hence, to establish the rigor and trustworthiness of the treated data. Common themes emerged during the thematic analysis where data saturation was also ensured.

Data analysis
Thematic analysis was done using the method introduced by Braun and Clarke (2011). The thematic analysis conducted involved the process of coding in six phases to create and establish meaningful patterns. The steps included familiarization of data, generating initial codes, searching for themes among codes, reviewing themes, defining and naming themes, and producing the final report. In the familiarization of data, the transcribing of data, reading and rereading the data as well as the noting down of initial ideas was made. Then generating initial code follows where the coding of interesting features of the data in a systematic fashion across the entire data set and collating data relevant to each code was made. Then the searching for themes follows if the themes work in relation to the coded extracts and the entire data set as well generating a thematic map of the analysis. Defining and naming themes were also made where ongoing analysis to refine the specifics of each theme and the overall story the analysis tells, generating clear definitions and names for each theme was made. Lastly, producing the report. The final opportunity for analysis was made where the selection of vivid compelling extract examples, final analysis of selected extract, relating back of the analysis to the research question and literature thus producing a scholarly report of the analysis. The thematic analysis was done manually.

Trustworthiness
The researchers ensured the trustworthiness of this study. Trustworthiness is considered a more appropriate criterion for evaluating qualitative studies than rigor (Maher et al., 2018). Four criteria must be satisfied (Maher et al., 2018;Guba, 1978), and these include credibility, transferability, dependability, and confirmability. Credibility ensures the study measures what is intended and is a true reflection of the social reality of the participants (Maher et al., 2018;Guba, 1978). Researchers in this study ensured credibility through triangulation. Researcher's invested sufficient time during interview and investigation of its participants. Persistent observation was made by identifying characteristics and elements that are relevant to this study. Transferability relates to the ability of the findings to be transferred to other contexts or settings (Maher et al., 2018;Guba, 1978). Researchers in this study used the strategy of thick description where the widest possible range of information was provided. Dependability ensures the process is described in sufficient detail to facilitate another researcher to repeat the work (Maher et al., 2018;Guba, 1978). The practice of systematically documenting the processes and products of the study allows the auditors for further verification. Confirmability is comparable to objectivity in quantitative studies (Maher et al., 2018;Guba, 1978). To ensure confirmability, the researchers affirm that the findings of the study were confidently derived from the participants' responses and were free from any researchers' biases. In addition, the researchers ensured that their positionality was observed to be able to objectively treat and analyze the collected data of the participants.

Ethical considerations
Informed consent was obtained from the participants. The Ethics Review Committee (ERC) of the José Rizal University approved the conduct of the study with reference details JRUREC2020-003. The participants were oriented that they can freely withdraw anytime when they wish not to continue to participate anymore because of some constraints. Informed consent was also obtained from the participants. To ensure confidentiality and anonymity, the researchers assigned pseudonyms for each of the research participants such as P1, P2, P3, to P20. Table 1 presents the characteristics of the twenty nurse-lawyers who were recruited as research participants. They were selected through purposive and referral sampling techniques. Interestingly, majority of the participants did not have any clinical experience (n=12; 60%), while others ranged from 1 to 15 years. The mean age was 32.13 years and most of them were single, and never been married (n=17; 85%).

Emerging themes
The study found out several themes and subcategories from the thematic analysis conducted. These include: (1) Pre-planning emotive expressions (i.e., spur of the moment, personal goal/dream, inspiration from others, and self-empowerment/self-regulation); (2) Motivations of career shift (i.e., childhood dream, family as a source of inspiration, triggering painful circumstances, unjust-work-related experiences, and monetary gains); (3) Support mechanisms to afford career shift (i.e., familial support, self-sufficiency and determination, and academic competence); (4) Barriers to career shift (i.e., personal biases towards non-nursing preparatory courses, lack of experience at court, conflicting value-belief system, work-family-life balance, and null curriculum experiences); (5) The interconnectedness of law and nursing (i.e., a helical relationship of nursing and law in medical-related cases at court, critical thinking, problemsolving, decision-making, and therapeutic nurse lawyer-client interaction); (6) Impact of the career shift (i.e., service to society (impact to society), respect, pride, and admiration (impact to self), joy and fulfilment (impact to others), improved quality of life (Impact to self and family).

Pre-planning emotive expressions
The pre-planning emotive expressions, as a theme, refers to the multiple emotional responses regarding the visions of the nurses prior to becoming nurse-lawyers. This theme has sub-categories namely, "spur of the moment", "personal goal/dream", "inspiration from others", and "self-empowerment/self-regulation". "Spur of the moment" refers to sudden inclination that affected the disposition of one registered nurse in becoming a lawyer. "Personal goal/dream" pertains to deliberate intention to pursue one's goal or dream of becoming a lawyer. "Inspiration from others" refers to gaining motivation from someone who models desired goal. "Self-empowerment or self-regulation" refers to one's level of emancipation to become independent or autonomous in directing one's career.

Motivations of career shift
Motivations of career shift pertains to the internal and external drivers that inspired the nurses to becoming juris doctors. The theme explicates the sub-categories of being a juris doctors as a "childhood dream", "family as a source of inspiration", "triggering painful circumstances", "unjust RN work-related experiences", and "monetary gains".
"Since childhood, I always look up to my brother to the extent that I always wanted to follow his way of life -even hairstyle, fashion, and the way he laughs -. Such that when he studied law and eventually became a lawyer, I learned to love lawyering as well. To be able to have our own law firm then became our dream which, by God's grace, did come true as we manage our own firm now. The practice of law became our avenue to be able to lend legal assistance to the oppressed." (P7) "Too many labor laws violations in the company I worked with. I realized that the world is cruel and unjust to those who do not know their rights and I refused to be victimized by such system." (P12) "My parents wanted me to try a semester to see if I would like it. Also, the hospital setting for nurses was/is tremendously stressful and I could not see myself committing to it long term, so I thought might as well make the career shift early while I was young and capable." (P14) "I tried to practice my nursing profession but then I got scammed with the placement agency I enrolled in. From there my working abroad dreams were put to an end and I thought I should go into law school to secure a bright future locally." (P19) "It is too difficult to earn when you are a nurse in a hospital. So, I decided to take law. Being a lawyer in the Philippines is financially rewarding." (P1)

Support mechanisms to afford career shift
The support mechanisms to afford career shift refers to the support system and other mechanisms that helped in the transitioning from being nurses to juris doctors. The theme includes sub-categories such as "familial support", "self-sufficiency and determination", and "academic competence".

Barriers to career shift
Barriers to career shift refers to the challenges encountered in the transitioning of nurses into juris doctors that include the sub-categories like "personal biases towards non-nursing preparatory courses", "lack of experience at court", "conflicting value-belief system", "workfamily-life balance", and "null curriculum experiences".
"Lack of knowledge as to how to interact in court and other practical application of law such as drafting contracts due to lack to exposure at courts which was dealt with by observing court hearings and following pieces of advice of other lawyers." (P2)

The interconnectedness of law and nursing
The interconnectedness of law and nursing pertains to the intimate relationship or connection of law and nursing as perceived by the RN-JD. This theme has several sub-categories like "a helical relationship of nursing and law in medical-related cases at court", "critical thinking, problem-solving, decision-making", and "therapeutic nurse lawyer-client interaction".

"There is interconnectedness in being emphatic to the situation of clients which can be further elaborated to communication techniques and also the awareness of injustices experienced by some nurses in the field which can be addressed through law." (P2) "Nurses are trained to have critical thinking skills in every situation, which helps us to understand the complexity of the law better. We were trained to look on every angle of every situation and not just be contented on what is presented or what majority sees. We dig deep.
We were trained to remain calm in life threatening situations and emergencies. Thus, with this, sometimes in law, I am not easily perturbed with deadlines and crash times. We are also trained to have a clinical eye, such that we would know if someone is exhibiting physical manifestation of lying and uneasiness. We easily build rapport with people which helps in getting information from everyone and building a good PR." (P3) "Having to always find the best solution to a situation. There is no outright right or wrong answer, in both careers knowing more makes you able to better address concerns, among others." (P6)

"Even though nursing wasn't really a choice, the values I learned during that 4-year course have become an integral part of my being (like building rapport, sympathizing and empathizing with others, dealing with persons who are in grief or denial, building therapeutic communication, etc.). So being a lawyer for me goes beyond the legal works by actually connecting with the client and seeing things from their perspective. This way, I can better understand their needs and offer the appropriate help. I must admit, though, this can be stressful at times given our line of work and the clients we have to deal with (victims of human rights abuses). Because by going deep into the client's thoughts and feelings, you are in a way evaluating your own feelings about the situation and making yourself vulnerable to the surge of emotions like pain, anger, and frustration." (P8)
"Knowledge in both medical and legal field makes me eligible to be appointed in significant designations. It affords me the luxury to choose." (P11)

Impact of the career shift
The impact of the career shift refers to the implications of the career shift or transitional experiences of the RN-JD. This involves some sub-categories such as "service to society (impact Nurse Media Journal of Nursing, 11(1), 2021, 17 Copyright © 2021, NMJN, e-ISSN 2406-8799, p-ISSN 2087-7811 to society)", "respect, pride, and admiration (impact to self)", "joy and fulfilment (impact to others), and "improved quality of life" (impact to self and family).

"Nobody believed in me from the start except my sisters. And when I finally signed the Roll of Attorneys, everyone became proud of me. Nevertheless, i have given my family a chance to be recognized in our place as a family with a lawyer daughter/sister. I am still working as a clinical coordinator, and my school depends on my legal opinion on matters that
pertain to our department and school. I am at the same time the legal consultant of our school and a private law practitioner. My friends said they are happy because they can easily come and ask for legal advice anytime (pro bono)." (P5) "After becoming a lawyer, modesty aside, I felt like my status in the community was somehow raised to a significant level. All the people I come in contact with hold me in high regard which I do not even feel worthy of. My significant others also felt the same as they use to express that they have been afforded respect already by people in the community who do not even care to notice them before." (

Discussion
This study aimed to describe and uncover the preparations, motivations, and barriers of registered nurses who transitioned into being lawyers in the Philippines. The study found out several themes and subcategories from the thematic analysis conducted. These include (1 ) "Preplanning emotive expressions"; (2) "Motivations of career shift"; (3) "Support mechanisms to afford career shift"; (4) "Barriers to career shift"; (5) "The interconnectedness of law and nursing"; and (6) "Impacts of the career shift".
Nurses are considered the heart of healthcare organizations and keeping them remains a challenge for nurse administrators (Labrague et al., 2018). Nurse leaders can enhance their own resilience and then recruit, hire and retain resilient staff nurses in an effort to improve nurses' intent to retain (Hudgins, 2015). Improving the work environment for nurses, according to Nantsupawat et al., 2016), may lead to lower levels of job dissatisfaction, intention to leave, and burnout. However, professional turnover is a complex, ongoing, multidimensional process (Valizadeh et al., 2016). The shortage of health care providers is a major concern worldwide (Mudallal et al., 2017).
The results detailed above depict the findings of registered nurses experience in their career transition from being a nurse to becoming lawyers. It can be gleaned from the result that each participant had different reasons why they entered law school. For some, it was their childhood dream, a spur of a moment and for some, because they have been inspired by others and to empower themselves. However, it all boils down to one theme, leaving the nursing profession to becoming a lawyer. In one study, young nurses leave the nursing profession because of demanding work content as well as poor environment and the inability to identify with stereotypical images of nurses were main themes that emerged from these career (Flinkman et al., 2013). Novice nurses expressed that they had high levels of stress in their first months of employment (Hezaveh et al., 2014). Additionally, Labrague et al. (2017) found out that workplace stress and job satisfaction had a significant impact on nurses' decision to leave. A favorable work environment significantly reduces job burnout and job stress (Falguera et al., 2020). The formulation of programs for nurses such as incentives and professional development can help foster and sustain a positive practice environment and job satisfaction (Berandino & Soriano, 2019).
Nurses' experiences in their practice of profession have contributed to their intention of leaving the nursing profession as well. This concluded in a study where it was found out that nurses leaving the profession is determined by their general satisfaction with management and leadership quality, their satisfaction with pay and benefits, their job satisfaction and work-tohome interference issues they have to deal with, but not by career development opportunities (Homburg et al., 2013). One of the participants in this study decided to become a lawyer because of some unjust work experience. According to the participant, there are too many labor law violations in the company he used to work for. Further, the hospital setting for nurses was tremendously stressful. This experience was also true in a study where an examination of the experiences of recent graduates of nursing revealed that the intention to leave the nursing profession was because of having poor working environment (Lavoie-Tremblay et al., 2010). Comfortable work environments are vital in any healthcare settings (Atefi et al., 2014). When new nurses are well supported in the clinical environment, retention occurs (Leong & Crossman, 2016). Moreover, nurse managers and hospital administrators should establish an effective management system to cultivate a healthy workplace and adopt positive attitudes and harmonious relationships (Guo et al., 2017). Furthermore, supportive nurse managers reduce coworker incivility (Smith et al., 2017). Educational intervention through social network had a positive effect on oncology nurses' job stress and job self-efficacy (Bozorgnejad et al., 2020).
In a study conducted by Lorenzo et al. (2007), one out of every five employed workers is underemployed, underpaid, or employed below their full potential. This correlates to the study findings of the current research where monetary gains was one of the reported reasons why nurses transitioned to becoming a lawyer. A satisfactory wage is a significant factor in job-seeking behavior and is especially important in keeping workers in their current positions (McHugh & Ma, 2014). The Philippines has been reported as one of the countries where factors of low wages, increased workload, and poor benefits encourage Filipino nurses to exit their home country (Marcus et al., 2014). For some, they tend to change or shift career like the nurse-lawyers. In a general sense, these reverberate the need for policy improvements. Considering the factors cited, it is vital for nurse leaders to continuously act and lobby for the welfare of the nurses to keep them in the profession.
Social and academic support are influential factors in student resilience (Thomas & Revell, 2016). Participants in their career transition has cited familial support. Family function is considered to be a critical component of academic success (Rezaei-Dehaghani et al., 2018). Throughout their career transition process, these nurses had the possibility to make financial and personal sacrifices for a new education, and they were supported by their families (Flinkman et al., 2013). In the same aforementioned research, it has been said that several factors affect the academic performance of students and one identified significant factor is parenting style. Further, it stated that supporting family warmth and independent motivation directly affects academic achievement. This includes family emotional atmosphere, family member's communication, and interactions and parenting styles influence member's performance in different fields. For some participants their determination and academic competence has afforded them career shift. In one study, to understand the factors that facilitate career success, it has been cited that personal factors that facilitated success include persistence and resilience, initiative, autonomy, and personal and professional balance (Robinson et al., 2016). Research reported that a lack of professional opportunities and restricted professional autonomy were central reasons for leaving (Fochsen et al., 2005).
Transitioning from one profession or another is about handling the complexity of the process and ever-present barriers. Several factors are related to young RNs' intentions to leave the profession, including an imbalance of effort and reward, high psychological demands, and higher job strain, which all influence young nurses' intention to resign from their nursing careers (Lavoie-Tremblay et al., 2010). Furthermore, the same aforementioned study revealed that nurses who intended to quit their positions perceived a significant effort/reward imbalance as well as a lack of social support.
The nurses who intended to quit the profession perceived a significant effort/reward imbalance (Derycke et al., 2010), high psychological demands (Dall'Ora et al., 2020) and elevated Nurse Media Journal of Nursing, 11(1), 2021, 19 job strain (Riedl & Thomas, 2019). In the current study, the participants have identified "personal biases towards non-nursing preparatory courses", "lack of experience at court", "conflicting valuebelief system", "work-family-life balance", and "null curriculum experiences" as barriers in their career shift. However, despite these, participants were able to successfully overcome the barriers and eventually became lawyers. It has been said that in the business of life, the journey is as important as the destination. Time does not stop so one can achieve a goal, and our responsibility to our families does not pause for our careers. This shows that nurses are resilient to whatever endeavor they are facing on. Being resilient is about being able to withstand setbacks, frustrations and personal tragedies. One of the participants is a solo parent and a full time clinical coordinator in one nursing school, who despite her busy schedule, was able to pull it through. According to Hasselhorn et al. (2003), a proportion of nurses with an intention to leave the profession are young, highly qualified, and seeking a new challenge.
Among the themes that emerged, one of the most significant is the "interconnectedness of law and nursing". Considering the transition, nurses who became lawyers have seen the complementary blend of nursing and law as sciences. The knowledge, skills, and attributes acquired in formal nursing education and practice of the profession are vital in finding resolutions of medical-related cases that nurse-lawyers help resolve. Participants have reported that nursing profession and the legal profession is interconnected in some unique ways. While there is no vast wealth of research made on this matter, this study has found that there is interconnectedness in both mentioned professions. For one, the use of therapeutic communication has been cited as helpful. Also, being knowledgeable in both medical and legal fields makes one eligible for significant designations. This makes gives one more choices and opportunities. A nursing background is extremely helpful in working in legal practice areas (Brent, 2020). Nurse-lawyers can work in family law, elder law, representing nurses in professional negligence cases, and representing nurses in professional disciplinary cases. Brent (2020) also highlighted nursing as a noble, trusted and respected profession. Considering this finding, nurse-lawyers may contribute significantly in policy development to uphold the general welfare of the profession ensuring healthcare equity and equality for all.
Data collated from the participants also showed that their career transition has given them self-respect, pride, admiration, joy and fulfilment and most of all improved quality of life. In one study it was reported that one year after career change, individuals reported higher job satisfaction, improved job security and a reduction in the number of hours worked (Carless & Arnup, 2011). Furthermore, changing workplace, and even career, can provide nurses with the opportunity to move to positions better suited to their motives, ambitions, skills, and career goals. Job satisfaction is indispensable in the daily life of the workforce (Akinwale & George, 2020). Managers of nurses should strengthen the areas that contribute to higher employee satisfaction (Brayer & Marcinowicz, 2018).

Implication and limitation
The study provides preliminary findings vital to understanding the phenomenon of transition among nurse-lawyers. While the study is limited to a number of nurse-lawyers, the study significantly contributes to the body of knowledge. The dearth of related literature may provoke further exploration of any related topics relevant to the transitioning experience of nurse-lawyers. Since the study is descriptive-qualitative in nature, it is suggested that other researchers should delve into more intensive or comprehensive research undertaking to capture the lived experiences of nurse-lawyers. Such research has direct implications to both nursing as a practice and profession.

Conclusion
Any career transition involves tedious preparations, motivations, and challenges influenced by a number of factors. Nurses becoming lawyers are no exemptions in experiencing career shift. With the career shift, the challenge is set to combine nursing and law as equally noble and respected professions capable to emancipate clients across the lifespan regardless of race, creed, gender, and other socio-demographic indicators.
Exhumed from the results of this study are the nurse-lawyers pre-planning emotive expressions that help them attain and endure their career shift. Their motivations ranging from personal, familial and other enablers have expanded their capacity to decide to undergo the career transition. Interestingly, the identification of exemplars made them more inspired to become nurse-lawyers. However, the career shift of the nurse-lawyers was not without any challenges related to their family, work and studies, and life dimensions. These challenges have tested their perseverance, resilience, mental acuity and agility. These soft skills are but a few of the much needed skills required of being good nurse-lawyers. Apart from these findings, the nurse-lawyers have identified the strong interrelationship of law and nursing, which influence their chosen career path. Nurse-lawyers both uphold and protect the combined professions of nursing and law.
While the study was limited to the aspects of transitioning in terms of preparations, motivations, and challenges of the nurse-lawyers, the uniqueness of this transitioning experience suggests the need to further examine the extent of how nurse-lawyers forge the complementary blend of nursing and law for the welfare of individuals, families, and communities under their care.