Study Recommends Increased Clinic Hours for Student Nurses
New Haven, CT — August 1, 2009A new research study published in the July/August issue of Nursing Outlook
indicates changes that could reduce turnover among newly licensed
nurses. The study, led by Yale University School of Nursing Assistant
Professor Linda Honan Pellico,
PhD, APRN, points to a divide between nurses' idealistic expectations
upon entering school and the realities they face in their first jobs.
The article recommends improvements for both nursing schools and the
work environment.
The article comes at a time when
about 18% of newly licensed RNs are leaving their first nursing
employer within a year of starting work, and about 26% leave within two
years. High turnover is an expense that can strain hospital budgets,
exacerbate the nursing shortage, and negatively impact patient care.
Funded
by the Robert Wood Johnson Foundation, the study surveyed 612 new
nurses from 34 states and the District of Columbia. The researchers
found that many novice nurses are dissatisfied with their first jobs
due to a variety of unexpected situations they face in the primarily
hospital-based environments where they begin their careers. Regardless
of their negative perceptions, many of the nurses who responded to the
survey felt hopeful that they could help reform work environments and
patient care. Some suggested that improving the nurse-to-patient ratio
was critical for improving professional satisfaction as well as patient
safety.
"Nurses are on the front lines of an
increasingly demanding hospital work environment," said Pellico. "Many
feel they could be more effective caregivers to patients if they simply
had more time to spend with them. Instead, they feel mounting pressure
to rush through rounds and fill out paperwork, which is not why they
chose to go into nursing," she added.
Among the
findings: The nurses talked about the relentless pressure for speed and
the difficulty of the many demands that are placed on them. Some nurses
in the study told researchers that tasks in their first jobs do not
reflect what they learned in nursing school. Many also expressed
dissatisfaction with the lack of time they can spend with patients,
while others felt their work was not appreciated by hospital
physicians, administrators, and in some cases, more senior nurse
managers. The nurses were particularly concerned with the communication
patterns of those with whom they work.
The report
also recommends that nursing schools help to reduce the number of
nurses leaving the profession by giving students a more realistic idea
of the pressures and workload they are likely to face in their first
jobs. Rather than working four- or six-hour shifts, student nurses
should be scheduled for eight-hour shifts and be given responsibility
for more patients, the respondents said. When they get out of school,
they are likely to face 12-hour shifts juggling four or more patients
with complex medical conditions, the study noted.
The
students also said they would have benefited from more practice on
communications skills and conflict resolution so they could interact
effectively with physicians, make proper notes in patients' charts, and
handle shift changes.
"Nurses today are
intellectually, emotionally, and physically drained," Pellico
explained. The school teaches relaxation techniques like meditation and
deep breathing, and encourages students to keep reflective journals.
"Until you take care of yourself, you can't take care of someone else,"
she said. Several respondents stated that, in the face of these
challenges, they love their work.
Despite the
economic downturn and tightening job market, the U.S. health care
system continues to face a projected shortfall of up to 260,000
full-time equivalent nurses by 2025. Understanding why nurses leave
their jobs within the first 18 months of their careers could help
hospital managers better direct resources and keep their workforces
stable, while helping to improve hospital finances--and patient
care--in the process.
Further coverage:
Chronicle of Higher Education (July 27, 2009): Nursing Schools Should Warn Students About Grueling Hours, Article Says
NurseZone.com: RWJF Study Shows New Nurses Dissatisfied Yet Optimistic
Reference:
"What newly licensed registered nurses have to say about their first experiences"
Linda Honan Pellico, Carol S. Brewer, Christine Tassone Kovner
Nursing Outlook, 1 July 2009 (Volume 57 Issue 4 Pages 194-203 DOI: 10.1016/j.outlook.2008.09.008)
Link to abstract
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