Giving voice to registered nurses' decisions to work

Sep 18 2007

"We are the bouncers, the bodyguards, the 'shotgun' riders, the overseers, the maitre d's, the stewards, the organizers, the managers and leaders for the patient .. Often we are the only thing between them and a sentinel event. See us, hear us, feel us."

Welcome to the nurse's world, through the words of those who live there.

This telling reflection on the profession appears in a paper published in the current issue of Nursing Forum (July-September 2007) titled appropriately “Giving Voice to Registered Nurses' Decisions to Work.”

Suzanne S. Dickerson, D.N.S., associate professor in the University at Buffalo School of Nursing, is first author. The paper presents results of an analysis of written responses to an open-ended question contained in a survey that assessed work satisfaction of registered nurses. The study's quantitative results were published in 2006.

Analysis of the comments identified four major themes: competing priorities, balancing priorities, practice deterrents and collegiate support, which encourages nurses to stay in practice.

“Listening to the nurses' voices, it was amazing that in spite of the volume of deterrents to working, they continued to care for their patients,” Dickerson said. “One emphasis that was newly apparent was that nurses repeatedly told about their work patterns or trajectory that reflected the need for flexibility to fit family needs.”

Demographically, the respondents were mostly female (97.2 percent), mostly white (89.9 percent) and the majority, 66.7 percent, were married. Those currently working as nurses were divided fairly evenly between full-time and part-time positions (38 percent versus 32 percent). Of the 332 who indicated their current position, two-thirds were involved in direct care of patients, and more than half (53 percent) did so in hospitals. Another 18 percent worked in ambulatory care settings. The average age of respondents was 50, and they had an average of 20 years of experience. Comments categorized into the “Competing Priorities” theme centered on dedication to nursing as a career and pride in the work, as well as remarks stating the need to place family needs above professional needs at certain stages, particularly when there are small children or aging parents to care for.

In the related theme of “Balancing Priorities,” nurses commented on the need to interrupt their job trajectory to care for family, described returning to school in their middle years and their wish for a better work schedule, less shift work on holidays and weekends, increased opportunity for promotion and for salary increases. Some nurses described switching positions to lessen stress and lower the pace, and taking part-time positions for more personal time and to avoid work-place politics.

As one nurse commented: “I have found as I age…my time off is more important than most all other aspects.” A major theme under “Practice Deterrents” was pay inequity. Commented one participant: “Money is a major issue with many nurses. Although people say money is not a motivator, almost every nurse I know would be much more motivated if we were paid well enough so that we are not forced to work two jobs and if our advanced degrees were compensated.”

Another common deterrent was lack of respect, which is the reason one respondent is leaving the profession: “We have demanding stressful roles. Yet our employers see us as expendable, replaceable and interchangeable with a variety of lesser-trained support staff.

Other comments echoed this concern: “The voice of experience is not respected; the older nurse is not valued,” comment one respondent.

Work demands -- “My heart is at the bedside, the rest of my body couldn't do it”-- and safety issues -- “I left hospital nursing after 20 years because I became horrified and disgusted at the mistakes being made” -- also were mentioned frequently as a deterrent.

The final theme covered comments on why nurses stay in practice, and collegial support loomed large. “My coworkers are the reason I stay,” wrote one nurse. “I am grateful for the people I work with,” wrote another. “…I could never do my job without them.”

Dickerson noted, “The fact that collegial support was the most important factor to continue working demonstrates that ‘nurses-supporting-nurses' could be developed into a strong network to promote a solidarity that could be operationalized through nursing organizations.

“It would behoove employers to listen to the nurses voices to improve quality and at the same time promote retention.”