Study explores attitudes and experiences among newly-licensed RNs

A study, published in the September issue of the American Journal of Nursing (AJN), provides new insight into the work experiences of newly-licensed RNs that may help reduce the turnover rate of hospital nurses.

The national study is the first to explore attitudes and experiences among newly-licensed RNs (those who received their first or basic RN license by passing the NCLEX) in their first 18 months of employment.

“A shortage of 340,000 RNs is projected by 2020,” said Christine Kovner, PhD, RN, FAAN, professor at New York University College of Nursing and lead author of the study. “Therefore, it is vital that we understand the factors that promote the retention of newly-licensed RNs as well as factors that lead to the high turnover rates among them. We plan to continue surveying these RNs for two more years and develop predictive models of turnover, based on our findings.”

More than 84% of respondents worked in a hospital inpatient setting. Those whose first professional degree was an associate's degree (58.1%) were more intent on leaving their jobs than those whose first professional degree was a bachelor's degree (37.6%).

Among those newly-licensed RNs who had already left their first job (n=610), the most common reasons cited were poor management (41.8%), stressful work conditions (37.2%) and wanting to get experience in a different clinical area (34.1%).

More than half (51%) of respondents worked voluntary overtime and almost 13% worked mandatory overtime. The majority (61%) worked nights, evenings or rotating shifts. They also reported that (62.78%) of respondents said that work interfered with their family life at least one to four days a month. Twenty-nine percent of the respondents reported a change in supervisor, which can reduce the stability of management.

Among on-the-job injuries, 25% of respondents reported at least one needle-stick injury; 39% at least one strain or sprain; 21%, a cut or laceration; and 46%, a bruise or contusion. Sixty-two percent reported they experienced verbal abuse and 25.9% said it was difficult or impossible to do their jobs due to lack of supplies and equipment.

“This study helps to establish baseline data about a population that is particularly important both to the nursing profession and our health care system,” said Carol S. Brewer, PhD, RN, associate professor in the School of Nursing at the University at Buffalo, Buffalo, NY. “There are both costs and benefits when individuals leave organizations, as well as when they move within a health care system; however, as long as newly-licensed RNs stay in nursing, the nursing community will not have lost its invested human capital.”

The study included a survey that was mailed to a random sample of new RNs in 35 states and the District of Columbia. A total of 3,266 nurses completed the survey with a response rate of 56%. Data were gathered in four areas: respondent characteristics, work-setting characteristics, respondents' attitudes about work and job opportunities. Respondents who were not working were asked about their reasons for being unemployed, if applicable.

“We should pay equal attention to the emotional and practical aspects of being a nurse and this study provides initial insight about how we may achieve that goal,” said Diana Mason, PhD, RN, FAAN, editor-in-chief, AJN. “We know that some newly-licensed nurses are getting experience prior to assuming roles in other settings such as home care, school health or primary care. However, we also know that some hospitals are not doing what they can to retain valuable new graduates and need to invest more in front-line managers. We can not afford to remain passive about low retention rates as they are undermining our capacity to alleviate the nursing shortage.”

Support for this study was provided by a grant from the Robert Wood Johnson Foundation (RWJF) in Princeton, NJ, the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans. “We are committed to ensuring the highest quality of care for people in this country and nurses are critical to achieving that goal,” said Susan Hassmiller, RN, FAAN, PhD, leader of the foundation's Human Capital team which focuses on health care workforce issues. “This study provides invaluable insight into the challenges health care organizations must address to correct working conditions that undermine patient care, and cause nurses to leave their jobs – and sometimes leave the profession.”