Moving On

This article describes the work experience of a national cohort of 229 RNs who participated in a survey on work environment at two different time periods. Survey results of the RNs' experience within two and a half years of their initial RN licensure (time period two) are described in detail, and comparisons are made to their experiences one year earlier (time period one). Using Krippendorff's technique for content analysis, six inter-related themes emerged at time period two. Findings indicate that the working environment of RNs impacts both nurses' satisfaction and their dissatisfaction. Factors associated with dissatisfaction center on the lack of nurse manager leadership, persistent verbal abuse, high patient-to-nurse ratios, and the physical demands of bedside nursing that result in injuries. Suggestions from the nurses themselves are used to guide strategies to improve the work environment and retain nurses. Citation: Pellico, L., Djukic, M., Kovner, C., Brewer C., (Nov. 2, 2009) Key words: Work environment, registered nurses, nurse retention, nursing, leadership, management, professional practice, qualitative research, content analysis, turnover, job satisfaction, nurses' work perception, workload More than 40% of the currently working registered nurses (RNs) will begin to approach retirement age in the next 10 years Improving retention of new RNs can be particularly cost effective, given the evidence suggesting that higher turnover exists among new RNs compared to all RNs. While average yearly turnover rates of all RNs range from about 5% to 21% In order to optimize new RNs' retention, organizational leaders must be sensitive to the RNs' perceptions of their work environment and to evolving needs in the initial years of practice. Substantial evidence exists about the factors that are generally associated with RN retention. These factors include job opportunities (local and non-local job opportunities), personal characteristics (work motivation, positive and negative affectivity, and education), work attitudes (job satisfaction, autonomy, and organizational commitment), and work attributes (shift type and unit type) (Aiken, Clarke, Sloane, Lake, & Cheney, 2008; Blegen 1993; The purpose of this study was to identify work experiences in a cohort of nurses within two and a half years of their initial RN licensure. These findings were compared with findings from this same cohort when they were surveyed about their work experiences one year earlier. Nurse leaders can use the findings of this study to guide development of retention strategies to effectively retain new nurses who are at different stages of their beginning nursing practice. Several quantitative studies have illuminated factors linked to new nurses' actual turnover and turnover intentions within the first two years of practice (Beecroft, Dorey, & Wenten, 2008; This current study adds to the literature presented above by revealing work experiences of RNs who were in practice for up to two and a half years. Further, the study offers a valuable insight about the evolving work needs of new nurses in their initial years of practice based on a comparison of nurses' work experiences over time. Design This qualitative study is a secondary data analysis of comments about work experiences that new RNs provided to an open-response question at the end of two specifically timed surveys that are part of a multi-year study. The first survey (time period one) was completed by Newly Licensed Registered Nurses (NLRNs) between the 6 th and 18 th month of licensure and the subsequent survey was completed by the same RNs one year later, i.e. between 18 and 30 months of employment (time period two). The nurses responded specifically to the question, "If you would like to make any other comments about the survey, please feel free to write below or on the back of this booklet," on both surveys. Responses described in this article came from nurses who responded to the question on both the time period one survey and the time period two survey. The first wave of data collection for the full study occurred from January to March of 2006 and resulted in a sample of 3,380 RNs for a response rate of 58%. Seventy-one percent of the RNs from the first data collection wave (N = 2,395) completed the survey during the second wave of data collection that occurred from January to March of 2007. A total of 271 RNs responded with comments on both surveys about their work experiences. The qualitative analysis of these comments from time period one is described in detail elsewhere The design of the original quantitative study was to use a longitudinal survey design to follow career trajectories of NLRNs randomly selected from 34 states and the District of Columbia over a period of 10 years. To date the survey instrument has been administered during the years of 2006 and 2007 to collect data using valid and reliable Likert-type scales in four main areas: (a) work setting (hospital, community) and position (staff RN, nurse manager), (b) demographics (age, gender), (c) work-related attitudes (autonomy, job satisfaction) and attributes (unit type, shift type), and (d) market-level variables (non-employment rate). Methods, sampling, and measures used in the original study are described in detail elsewhere Sample Permission to conduct the study was granted by the New York University and University of Buffalo Institutional Review Boards. The sample for this segment of the longitudinal study was comprised of a national sample of 271 RNs who provided comments about their work experiences in surveys at two separate intervals (time period one being the first 6-18 months of practice for the NLRNs, and time period two being one year later). We analyzed comments from a sample of 271 RNs; 42 comments unrelated to the research (e.g. comments related to address or name changes) were removed, resulting in an analytic sample of 229 RNs. The RNs who provided comments had a mean age of 35 years, with a range of 23 to 60 years of age. They were primarily White (83%), women (89%) whose entry into practice was an associate degree (AD) (54%), baccalaureate degree (BS) (39%), diploma (6%), and master's or doctoral degree (1%). Almost 77% of the RNs at time period two were employed in inpatient hospitals settings compared to 82% at time period one. The overall turnover rate for the RNs in hospitals settings at time period two was 8.8%. Almost 93% of the hospitals were non-magnet institutions. The majority of RNs were employed full time (76%), while 24% worked part time