The learning environment shapes many aspects of nursing students’ knowledge about their future career choices [1]. This environment has been described as the perceived (circumstantial) events that take place within the teaching setting, whether a classroom, a laboratory, clinical area, or a department [2]. It also includes all activities experienced by both students and their teachers. Three components usually establish the basis for these perceptions: the physical environment, the emotional climate, and the intellectual climate [3]. These components strongly determine the outcomes of the learning process among students. They influence how, when, and where students engage effectively with their environment, and thus determine many aspects of the teaching and learning process, including learning outcomes and future career plans [4]. As each nursing course teaches students about a specific area of nursing care, students’ future career choices might be significantly influenced by these experiences [5]. If students’ experiences in a pediatric course are positive, it is more likely they will consider pediatric nursing units as their work area after graduation [6]. Hence, studying both the nature and the impact of the learning experience of nursing students on their career choices after graduation is important, as it might improve students’ ideation toward nursing specializations that have workforce shortages [7]. While other studies have addressed students’ perceptions of the learning environment from a purely academic standpoint [8], this study also examined the effects of these perceptions on students’ future career choices.

The learning environment is an interactive network of forces within teaching and learning activities. This network influences students’ learning outcomes, which include academic achievements, experiences, and perceptions regarding the educators of the course and the specialization that the course covers [9]. In nursing education, teachers have paid particular attention to students’ perceptions of the learning environment as a key factor determining their career choices to avoid further shortages in some areas of nursing [10], which might also shape the behavior of nursing students, their confidence, and their academic progress [11]. An effective learning program provides students with a variety of educational experiences, engages them in the real teaching process, respects the needs of the learners, and encourages their participation, which then results in a positive learning experience [12].

Career planning is an ongoing process through which an individual sets career goals and identifies the means to achieve them [13]. It is a process of systematically matching career goals and individual capabilities with opportunities for their fulfillment [14]. Career planning is not a one-time event but is rather a process that becomes part of the repertoire of skills and experiences that enables graduate nursing students to develop as professionals [5]. Educators, among other important key stakeholders such as employers and professional organizations, are challenged to guide students and incorporate career planning during their study [15]. As educators communicate with students, it is essential to consider students’ values, interests, goals, needs, desires, and perceptions of different nursing specializations, all of which guide choices of the area of nursing work after the completion of education [16]. The clinical learning environment of each nursing course has been shown to have a direct impact on nursing students’ perceptions of their profession and to facilitate professional grounding [17]. Certain areas, such as pediatric nursing, have been identified as popular and enjoyable for students, while others lacked popularity for students’ future career plans, including aged care and psychiatric nursing [16]. Students tended to search for other areas to work after graduation, creating further shortages in these areas. Therefore, positive perceptions of students about courses on pediatric nursing, perceived well-being, and academic achievements could be used to increase the number of students who choose pediatric units after graduation [17]. In addition, these factors guide educators when measuring the quality of learning that occurs within this serious setting [18]. Therefore, this study addressed areas of limited knowledge about the effect of students’ experiences in a clinical course on their career planning.

The present study explored students’ preferences regarding the area, position, and department where they would work after graduation, and their career planning and choices in the future. Understanding students’ knowledge and attitudes toward the educational environment is essential as it influences students’ preferences after graduation. As pediatric nursing has a considerable shortage, it is necessary for undergraduate nursing students to develop positive attitudes based on logical knowledge about pediatric nursing. Therefore, the present study explored issues concerning how students perceived the clinical pediatric course educational environment and career planning. The information obtained through this part of the study showed whether there was a need for students to be oriented to career planning. This study examined the perceived educational environment among students enrolled in pediatric nursing course. Students did not report how satisfied they were with all elements of the pediatric course. Many students in this study reported that they were having positive experiences in their pediatric course; however, a considerable percentage of students reported dissatisfaction with the course and that the academic atmosphere was not conducive to learning. In addition, we found that students’ perceptions of the educational environment of the clinical pediatric course had a significant effect on their career planning after graduation.

In the present study, one-fourth of the students stated that they wanted to work as a faculty member at a college. A reason for this perception may be students’ observations of the hard-working conditions of nurses in hospitals and nurses’ low position relative to the work that they accomplish. This finding agrees with that of another study [14], which reported that 26.2% of students wanted to become academics, and a third study reporting that 38% of Turkish students wanted to become academics in the future [24]. A reason for this preference may be that nurses in the clinical setting engage in hard work and have a less favorable work atmosphere [25].

Many students also reported that they would like to work as head nurses or shift supervisors. Similarly, a study [24] reported that 21% of students wanted to become head nurses. Again, students favored managerial or supervisory roles over field work. Although this study did not address reasons for these choices, it is worthwhile to consider this issue in subsequent research.

Approximately 15% of students stated that they would like to work in pediatric areas, and this result may reflect negative experiences of academic pediatric courses, both theoretical and clinical. A reason for this may be that students perceived the pediatric course to be more difficult than other courses, with extra required assignments. In contrast to this finding, a study [14] found that most nursing students preferred pediatric units, which was explained by the positive experiences of students in the academic courses and with the educators.

We found that most of the students in this study thought about pursuing further or higher education. This finding agrees with an earlier study [25] reporting that 70% of Norwegian students wanted to enroll in further education, considering it as a professional step forwards that would improve their economic and career standing. Further education in nursing is very important because of the unprecedented growth in professional knowledge, rapid changes in the health care system, and the consequent changes in nurses’ roles. Higher education for nurses might resemble the achievement of a professional goal, for which it is important to have role models in the form of peer support and mentorship [26]. This view also emphasizes that nurses usually seek higher education to become involved with clinical education and minimize clinical work [27]. Students reported planning to seek graduate degrees to upgrade their competencies, which might contribute to the improvement of the profession [28].

The present study revealed that more than one-third of students had knowledge about career planning, while just below half of the students (41.3%) knew how to develop a professional portfolio and compose a curriculum vitae. These results are consistent with previous research [14] emphasizing that many students were trapped in their nursing scope and did not engage in further professional development due to a lack of experience or the absence of a solid opportunity to improve these skills during their study. Therefore, educators and clinicians can help students to develop appropriate and marketable skills, and to position students for future job and career opportunities.

The DREEM scores showed that the pediatric nursing course at Menoufia University could be classified as more positive than negative (Table 3). This result suggests that many students perceived many areas within the program as positive. However, there were areas that required attention, such providing electronically equipped facilities to facilitate watching appropriate videos and other educational requirements. The main concern in this study was the low mean scores of the total DREEM and subscales as compared to the scores reported in the literature. These findings further indicate that students in this study perceived their learning environment as missing some components, such as e-learning facilities and well-prepared educational classes, which could make the environment more conducive to learning and promote better learning in a less restrictive or stressful manner. Furthermore, there was an insufficient number of children in the pediatric clinical area with different diagnoses and over-crowding of healthcare workers, such as nurses, physicians, and other healthcare professionals in the unit or department.

In comparison, the overall DREEM scores reported from diverse nursing and health institutions were 115/200 and 110.3/200 [18], 114.3/200 [7], and 104.39/200 [21]. Despite differences in these studies, the mean score fell well within the range of 101-115, suggesting that perceptions of the environment were more positive than negative. However, the results of the current study are in contrast with those of other studies, which reported DREEM scores of 89/200 [29] and 92.6/200 [1].

Furthermore, the mean scores of the DREEM subscales were lower than those reported by many studies [30]. It is possible that these relatively low mean scores, although they reflected a more positive than negative environment in total, were influenced by students’ choice of workplace, especially choices concerning working in pediatric units. Students viewed learning in the pediatric course as relatively unsatisfactory relative to their expectations, and this corresponded with the negative learning experiences. However, this study did not ask students to clarify their expectations of the “ideal” situation. This can be interpreted as showing that students in the pediatric course perceived educational environment as more stressful when compared with other courses due to extra assignments and the difficult scientific material or topics of the pediatric course that were covered in a short period of time. Comparing areas of preference chosen by students for their future careers, pediatric nursing was selected as a specialization by nearly one-sixth of the students. This percentage would not be adequate to improve the numbers of nurses working in pediatric units, whether in hospitals, specialized centers, or community centers, if students keep their choices unchanged. Similar findings were reported by many studies [20], which reported relatively higher mean scores than found in this study, with a range of scores of 133-145 across health sciences students. For instance, in a study that assessed healthcare professions, midwifery students had a mean score of 135, pharmacy students had a mean score of 133, physiotherapy students had a mean score of 140, and dietetics and nutrition students had a mean score of 145 [20]. All subscales in the current study had mean scores that were lower than those reported by former study [17]. The source of dissatisfaction could have been certain incidents or the difficulties that students encountered in the course knowledge component. Dissatisfaction could also be attributed to the large number of assignments and the difficulty of exams. However, this cross-sectional study is limited in its ability to explore and explain its findings based on students’ and instructors’ experiences. Therefore, it was not clear whether students’ negative views were related to previous clinical experiences, specific situations, or other factors not related to the course. This point requires further investigation or follow-up in later studies.

The effects of students’ gender on the DREEM scores and career planning were tested, and we found no statistically significant difference between men and women (Table 3). Although this finding indicates that students’ gender did not influence their career planning, it is in disagreement with another study reporting that female students perceived the educational environment to be significantly more positive than male students [20]. We also found a statistically significant positive effect of the perceived educational environment on career planning (Table 4), which appeared in their choices of future work after graduation. In other words, if students perceived the educational environment of a specific clinical area more positively and viewed it as less stressful, they tended to choose it for future career planning.

Based on the findings of this study, we suggest improving the educational environment by providing information to students about career planning, how to develop a professional portfolio, and how to choose their future career pathway before graduating. It is also equally important that nurse educators be aware of the importance of the educational environment in nurturing and developing positive attitudes toward each nursing specialization. Future studies with larger samples are needed. An additional exploration of nursing students’ attitudes and knowledge toward career planning is recommended, especially in nursing specializations with personnel shortages, such as pediatric and neonatal nursing.

In summary, continuing quality improvement and innovation are essential for any educational institution. More emphasis should be given to students’ perceptions of the learning environment, which can be used to initiate change and improvements.

This study provided information on students’ perceptions of their career planning and the learning environment of a pediatric nursing course. Students perceived the educational environment as more positive than negative, but one-third indicated the presence of “plenty of problems.” The present study revealed that nearly one-fourth of students wanted to work as an academic at a college or university. Furthermore, pediatric nursing was only selected as a future specialization by 15.3% of students. No statistically significant differences were found between male and female students regarding their perceptions of the educational environment. In addition, many students did not report knowledge about career planning, which included building a curriculum vitae. In light of the findings of this study, it is recommended that further efforts should be made to stimulate students’ interest in pediatric nursing, to integrate theoretical content with practice, and to improve their planning activities early during their study. It is important to engage students in discussions concerning their ideas and worries about factors they perceive as less enhancing and more threatening in clinical settings.