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Hospital Management Is Key to Retaining New Nurses


NEW YORK -- Turnover rates as high as 70% could be improved with better orientation and management of newly licensed nurses, researchers said.

NEW YORK, Aug. 30 -- Turnover rates as high as 70% could be improved with better orientation and management of newly licensed nurses, researchers here said.

Newly licensed nurses who changed employers cited management problems (41.8%) or stressful work (37.2%) most often, reported Christine Kovner, Ph.D., R.N., of New York University, and colleagues, in a survey published in the September issue of the American Journal of Nursing.

"The negative attitudes expressed in response to some survey questions suggest that newly licensed registered nurses may not remain in the acute care settings where they start out," they wrote.

Most newly licensed nurses start their career at hospitals, where studies have documented highly variable turnover rates from 7.5% to 70%.

A shortage of 340,000 registered nurses has been projected by 2020, so retaining new nurses and understanding turnover is important, Dr. Kovner and colleagues said.

"Expectations of reducing turnover may be unrealistic," the researchers added, but "investing resources in better orientation and management of newly licensed registered nurses may be the key in the long term to retaining them at hospitals."

To get a national perspective on turnover, the researchers surveyed 3,266 randomly selected nurses who had received their first or basic RN license by examination, rather than by endorsement after moving to a new state, in the preceding 18 months.

The nurses were from 51 metropolitan and nine rural areas across the country (17.2% of respondents were in rural areas). Respondents typically worked in hospitals (87.3%), were married (55.9%), white (82.3%), and female (91.2%), with no children or none at home (55%).

About half of respondents worked voluntary overtime; more than 10% worked mandatory overtime; and 61% worked nights, evenings or rotating shifts.

The new nurses were fairly well satisfied with their jobs overall, which "is a key to retention," the researchers said. The mean satisfaction score was 5.2 out of seven.

However, a substantial proportion (41.5%) said they would want another job if they were free to go. Furthermore, 24% reported that they planned to leave their first job in the first two years of employment, and 37% said they intended to search for a new position in the next year.

"These are alarming figures, indicating that newly licensed registered nurses are not finding what they want in the first year of work," Dr. Kovner and colleagues wrote. "Yet these percentages may also reflect normal career development for young adults today."

The findings suggest a trend toward professional but not employer-specific loyalty in which nurses "may plan to change jobs to have the kinds of experiences they want rather than trying to get them from one employer," the investigators noted.

The respondents nurses were neutral overall in desire to leave their current employment (a mean score 3.4 on a five-point scale), but 10% had switched employers since getting their license and 13% had changed employers in their first year of work.

The top reason why new nurses left their first job was poor management (41.8%), followed by stressful work (37.2%).

A quarter of respondents said they found it difficult or impossible to do their job at least once a week because of lack of equipment or supplies. In one year of working, 62% had been verbally abused, 25% had been stuck by a needle, 39% sustained a strain or sprain, 21% had been cut or lacerated, and 46% had received a bruise or contusion.

The new nurses were "generally pleased with their work groups but felt they had inadequate support from supervisors," the researchers said.

They reported that they felt supported by their supervisors "to some extent" (a mean score of 3.6 on a five-point scale) overall, but 13.1% of respondents said their supervisors were "not at all" willing to listen to job-related difficulties or were only willing to do so "to a little extent."

Another role of managers -- ensuring the quality of orientation -- appeared to need some improvement as well, although "there is some evidence that employers have tried to help new nurses adjust to their work life," the researchers wrote.

Only 6% of the nurses had no formal orientation, but less than a third had extended learning opportunities, such as formal externships, "which have demonstrated benefits in other studies," the researchers noted.

Also, respondents overall reported that mentors were accessible only "sometimes" (a mean score of three on a five-point scale) whereas 12.7% said "never" and 27.5% said "seldom" did anyone show them how to work successfully within the organization.

Long-term studies, including the two-year follow-up of Dr. Kovner's study, may help explain what happens to newly licensed nurses over time, the investigators said.

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