Improving the Work Environment
Objective: To determine registered nurses' (RNs) perceptions of their first nursing position experience, and if they left the position, why.
Background: Little information is available regarding job perceptions of RNs in practice for 5 years or less. Nurses with negative perceptions of first job experiences may soon leave the position, thus doing little to alleviate staffing shortages and wasting precious recruitment and orientation resources. Therefore it is important to understand how recent RN graduates view their first job.
Methods: The Survey of Nurses' Perceptions of First Job Experience was mailed to 3,077 RNs licensed in Nevada who graduated from their basic nursing program within the last 5 years. Completed surveys were received from 352 respondents. Descriptive statistics were used to describe the sample and perception responses. ANOVA and t tests were used to compare total scores with selected demographic variables.
Results: Thirty percent of respondents left in 1 year and 57% left by 2 years. Patient care issues, such as unsafe nurse-patient ratios, were perceived as the most negative aspects and the most frequent reason for leaving. Conclusions: The endings have implications for nursing and hospital administrators for improving the work environment and retention rates of recent RN graduates.
The nursing shortage has reached a critical level with no relief in sight. One-third of the nursing work-force is over 50 and the average age of nurses is 43.3 years. It is anticipated that the registered nurse (RN) vacancy will be 20% by 2020 with a shortage of one million nurses by 2010.'3 Nursing programs have been unable to graduate adequate numbers of new nurses to meet demands. In addition, nurses are reporting increased stress and dissatisfaction with nursing.One in 5 nurses plans to leave the profession within the next 5 years.4
Although the literature is full of research, dialogue, and predictions regarding the nursing shortage, there is little discussion of whether or not increasing the output of new graduate nurses to deal with the shortage will solve the problem. Little is known about whether or not we are keeping new nurses in the hospital settings, or whether we are losing them as fast as they are corning out of the nursing schools. Is it possible that hospitals are acting as a revolving door? That as fast as new graduates enter as a hospital employee, they exit, choosing to work in other nonhospital environments, or leaving nursing altogether? The current study was designed to examine that question.
Background
The ongoing nursing shortage in the United States has resulted in numerous studies aimed at deter-mining causes and proposing solutions.5,6 The nursing shortage in hospitals is receiving widespread national publicity. The American Nurses Association (ANA)5 has called nurse staffing in this country a public health crisis.
The growing shortage of RNs is chronic and expected to worsen over the next 10 to 15 years.7 Many factors, such as an aging workforce, stress, lack of autonomy, low pay, and unsafe nurse-to-patient ratios, have been cited as contributing to the problem. Additionally,while nursing continues to be a female-dominated profession, women now have many more career choices.8,9 This current shortage is believed to be different from the past shortages and thus previous solutions will not be effective.6,7 Berliner and Ginzberg7 report that the shortage problem today is actually 3 separate but related problems: fewer new nurses entering the profession, inability of hospitals to attract and keep new nurses, and nurses who either retire or leave the workforce early.
Loquist8 also points out that the current shortage is fundamentally different, with the root causes linked to major changes in the financing of health-care. This has resulted in vast changes in the organization and delivery of healthcare at every level. As a result, the nursing profession has experienced significant changes in responsibilities, roles, and employment.
With all the national and even international at-tention directed toward the nursing shortage, few research efforts have focused on nurse retention. Nationally, there are no reliable data indicating how long nurses stay at their jobs. However, nurse educators and nurse administrators agree that retention, particularly among nurses new to the profession, may be a larger issue than is currently recognized.
Despite the abundance of information regarding the nursing shortage, there is a paucity of literature focusing on the newest members of the workforce- those who have been in practice 5 years or less. Yet this is the group entering the healthcare work-force at a time that can arguably be considered the most chaotic and unstable in memory. If new nurses have negative perceptions of their first job, they may be less likely to remain in that position. They may transfer to other units or leave the organization entirely, thus doing little to alleviate staffing shortages and wasting precious recruitment and orientation resources.
Most new nursing graduates choose a hospital as their first employment setting. Working conditions are stressful and demanding for those with beginning skill levels because of the illness severity as well as sheer number of assigned patients. Long shifts and mandatory overtime are physically and emotionally draining, offering limited opportunities to provide the quality patient care they were taught to give in nursing school.5
Recent graduates frequently indicate to nurse educators that they plan to leave hospital settings after 1 year of employment to take other non hospital nursing positions. Other anecdotal reports indicate that some recent graduates are disillusioned with nursing, even to the point of leaving the profession within the first 1 to 2 years.7
It is important to identify if a significant factor contributing to the nursing shortage is that new nursing graduates are leaving hospital staff positions after a short time because of poor working conditions. This knowledge could significantly help focus efforts to deal with the shortage.
Purpose
The purpose of this study was to determine what recent RN graduates chose for their first nursing position, perceptions of their first nursing position experience, and, if they left the position, why.
Research Design
A descriptive survey design was chosen for this study using a questionnaire developed by the researchers to examine perceptions of recent graduate nurses registered in the state of Nevada regarding their first nursing position. The research protocol was approved by the university office for the protection of research subjects. Data collection was conducted over a 3-month period.
Data Collection Method
The Survey of Nurses' Perception of First Job Ex-perience was developed by the researchers after a review of the literature failed to identify a suitable data-collection tool for the present study. Three sections of the survey tool are addressed in this report. The first section consists of 14 questions regarding the first position held by the RNs after completing their initial nursing education program and 3 questions regarding the second position held by those RNs no longer working in their first position.
The second section contains 31 items that assess the respondent's perception of their first job as RNs. In order to establish initial content validity, survey items were developed following an extensive exam-ination of literature relating to staff nurse job perceptions/job satisfaction. Additionally, several nurs-ing job survey tools were examined, including the ANA Survey on the Nurses' Working Environ-ment5 and the Nursing Job Satisfaction Scale.10 All items are scored in a Likert-type format ranging from (1) "strongly disagree" to (6) "strongly agree." The third section consists of questions regarding demographic information about the subjects and several questions regarding their current position of employment.
The survey tool was piloted on 12 students who were RNs in either graduate nursing or BSN completion programs. Feedback from these nurses was used to modify the survey for greater understanding and clarity. Reliability assessment for the current study sample revealed that the Chronbach a reliability for the 31 item section on perceptions of first RN job was .89.
Data Collection Procedure
