A new research study published in the July/August issue of Nursing Outlook indicates changes that could reduce turnover among newly licensed nurses. The study, led by Yale University School of Nursing Assistant Professor Linda Honan Pellico, PhD, APRN, points to a divide between nurses' idealistic expectations upon entering school and the realities they face in their first jobs. The article recommends improvements for both nursing schools and the work environment.
The article comes at a time when about 18% of newly licensed RNs are leaving their first nursing employer within a year of starting work, and about 26% leave within two years. High turnover is an expense that can strain hospital budgets, exacerbate the nursing shortage, and negatively impact patient care.
Funded by the Robert Wood Johnson Foundation, the study surveyed 612 new nurses from 34 states and the District of Columbia. The researchers found that many novice nurses are dissatisfied with their first jobs due to a variety of unexpected situations they face in the primarily hospital-based environments where they begin their careers. Regardless of their negative perceptions, many of the nurses who responded to the survey felt hopeful that they could help reform work environments and patient care. Some suggested that improving the nurse-to-patient ratio was critical for improving professional satisfaction as well as patient safety.
"Nurses are on the front lines of an increasingly demanding hospital work environment," said Pellico. "Many feel they could be more effective caregivers to patients if they simply had more time to spend with them. Instead, they feel mounting pressure to rush through rounds and fill out paperwork, which is not why they chose to go into nursing," she added.
Among the findings: The nurses talked about the relentless pressure for speed and the difficulty of the many demands that are placed on them. Some nurses in the study told researchers that tasks in their first jobs do not reflect what they learned in nursing school. Many also expressed dissatisfaction with the lack of time they can spend with patients, while others felt their work was not appreciated by hospital physicians, administrators, and in some cases, more senior nurse managers. The nurses were particularly concerned with the communication patterns of those with whom they work.
The report also recommends that nursing schools help to reduce the number of nurses leaving the profession by giving students a more realistic idea of the pressures and workload they are likely to face in their first jobs. Rather than working four- or six-hour shifts, student nurses should be scheduled for eight-hour shifts and be given responsibility for more patients, the respondents said. When they get out of school, they are likely to face 12-hour shifts juggling four or more patients with complex medical conditions, the study noted.
The students also said they would have benefited from more practice on communications skills and conflict resolution so they could interact effectively with physicians, make proper notes in patients' charts, and handle shift changes.
"Nurses today are intellectually, emotionally, and physically drained," Pellico explained. The school teaches relaxation techniques like meditation and deep breathing, and encourages students to keep reflective journals. "Until you take care of yourself, you can't take care of someone else," she said. Several respondents stated that, in the face of these challenges, they love their work.
Despite the economic downturn and tightening job market, the U.S. health care system continues to face a projected shortfall of up to 260,000 full-time equivalent nurses by 2025. Understanding why nurses leave their jobs within the first 18 months of their careers could help hospital managers better direct resources and keep their workforces stable, while helping to improve hospital finances--and patient care--in the process.
Chronicle of Higher Education (July 27, 2009): Nursing Schools Should Warn Students About Grueling Hours, Article Says
NurseZone.com: RWJF Study Shows New Nurses Dissatisfied Yet Optimistic
"What newly licensed registered nurses have to say about their first experiences"
Linda Honan Pellico, Carol S. Brewer, Christine Tassone Kovner
Nursing Outlook, 1 July 2009 (Volume 57 Issue 4 Pages 194-203 DOI: 10.1016/j.outlook.2008.09.008)
Link to abstract