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New Nurses Offer Insight into Retention

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By Debra Wood, RN, contributor

Newly licensed nurses seem reasonably satisfied with their jobs, yet more than 41 percent of them reported if they were free to choose any job, they would want a different one, according to a national comprehensive study, funded by the Robert Wood Johnson Foundation, exploring the nurses’ attitudes and experiences.

“We wanted to take the long view and have a better understanding of how we can retain new nurses,” said Sue Hassmiller, RN, FAAN, Ph.D., a senior program officer and team lead for human capital at the Robert Wood Johnson Foundation. “This study was part of our strategy to find out what was happening to nurses—if they were staying, if they were going, how many were going, why they were going, and what hospitals could do to do a better job of retaining these nurses.”

Co-principal investigator Carol S. Brewer, RN, Ph.D., associate professor in the School of Nursing at the University of Buffalo, New York, described the paper, published in the American Journal of Nursing, as “a first cut,” a 30,000-foot view of the situation. She said the study helps establish a baseline for further research.

A total of 3,266 nurses, licensed for 18 months or less, in 35 states completed the survey. More than 84 percent of respondents worked in a hospital inpatient setting, and 610 nurses had already left their first job.

Among those nurses who had changed positions, 41.8 percent cited poor management as a reason, 37.2 percent said stressful work conditions led to their departure, and 34 percent wanted experience in a different clinical area.

“The most troubling part to me was that people listed nursing management as the No.1 reason for leaving,” said lead author Christine T. Kovner, Ph.D., RN, FAAN, a professor at the New York University College of Nursing.

Hassmiller expressed no surprise at the findings, since management is often cited as a reason people leave jobs. Because hospital front-line managers frequently are promoted from the bedside, she said, they may lack the education and experience to lead.

Although a nurse is great at patient care, that doesn’t always translate to being a good manager, said Hassmiller, adding, “If hospitals have the resources, it’s probably a better idea to take people with advanced education, a bacheloriate and master’s degree, to fill the role of manager.”

New nurses consider their jobs difficult, with 62.5 percent saying they work hard three or more days per week. Nearly 13 percent of the respondents worked mandatory overtime and 51 percent voluntary overtime. About two thirds of the nurses said their work interfered with family life at least four days per month.

The authors noted that staff may hold accountable first-line managers or immediate supervisors for overtime requirements or the work environment.

“When they talk about stressful work conditions, they lay that at the door of management, even if it is beyond the capacity of their manager to fix,” Brewer said.

A quarter of the respondents found it difficult or impossible to do their jobs at least once per week due to inadequate supplies.

The new nurses experienced on-the-job physical injuries, with 25 percent reporting a needle stick, 39 percent at least one strain or sprain, 21 percent a cut or laceration, and 46 percent a bruise or contusion. Nearly two-thirds of respondents, 62 percent, reported experiencing verbal abuse.

“Another thing that was troubling was the level of verbal abuse they got,” Kovner said. “There are a lot of lessons for management. It’s everything from making sure verbal abuse doesn’t happen to making sure your people have the supplies and equipment they need to do the job.”

The researchers did not ask who perpetrated the abuse, so they do not know if it came from patients or colleagues. They will ask more about the verbal abuse in future surveys.

The research team will follow the nurse respondents for three more years to collect information on conditions responsible for turnover.

“We want to find out where are these nurses going to go in their career and what is going to happen to them over time,” Brewer said, “We’re hoping to get a better sense for new graduates how many choose to move out of the hospital setting but stay in nursing or reduce their effort in nursing.”

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