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What Makes New RNs Stay on the Job?

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By Linda Beattie, contributor

Nursing turnover is costly for hospitals and newly licensed nurses tend to leave their employers more frequently than any others. Can anything be done? Fortunately, yes. A new national study has shed some light on why these RNs may choose to leave and what hospitals can do to keep them on the job.

Keeping New RNs on the Job
A new national study has shed some light on why newly licensed nurses tend to leave their employers more frequently than others and what hospitals can do to keep them on the job.

“Our research was based on the model that if you can measure the intention of the nurse, you can predict whether they will stay or go,” said Carol Brewer, RN, Ph.D., professor at the University of Buffalo School of Nursing and co-author of the study. “So what influences the intention to leave or stay? We looked at several factors including nurse satisfaction, organizational commitment, job search rates, etc. There are a complicated number of predictors.” 

These predictors cover nurses’ perceptions of their working conditions, specific workplace attributes, as well as their personal characteristics and available job opportunities.

Researchers found that some of the specific job characteristics that increased a nurse’s satisfaction and commitment—which in turn increased their intent to stay—included variety, autonomy, supervisory support, workgroup cohesion, fair treatment, promotional opportunities and collegial nurse/doctor relations. 

“We found that if hospitals can focus on improving some of these variables, it is a kind of a ‘double whammy,’ impacting both nurse satisfaction and commitment to the organization,” Brewer said.  “Also, if you can intervene early enough to prevent nurses from forming a reason not to stay, you can impact their decision.  Hospitals need to impact satisfaction and organizational commitment before a nurse decides that he or she wants to leave.”

Funded by the Robert Wood Johnson Foundation, this comprehensive study was based on a sampling of nearly 2,000 newly-licensed nurses working in various sized communities across 34 states and Washington, D.C.  The results of the research have been published in the March/April issue of Nursing Economics.

The researchers also uncovered what factors might make these nurses more likely to leave their employer.

According to lead author Christine Kovner, RN, Ph.D, FAAN, a professor at New York University’s College of Nursing and faculty partner to NYU’s Langone Medical Center, their research confirmed that new nurses often find it difficult to deal with the heavy patient load and mandatory overtime required at many facilities.  These types of pressures decrease their organizational commitment, which in turn decreases their intent to stay.  Other dissatisfiers include systematic restraints (i.e., lack of supplies) and the lack of supervisory support.

“Hospitals really need to do something about their managers if they want to improve retention rates,” said Kovner, who explained that management issues have been cited in other studies, as well. “Anecdotally we have seen that the kinds of people that hospitals promote tend to be excellent clinicians, but the skills that make someone an excellent clinician are not the same as those that make them a good manager.  Hospitals need to invest more in management training and pay their staff to be better nurse managers.”

Kovner and Brewer pointed out that although colleges of nursing now use preceptor programs and other tools to prepare students for the real world, the bulk of the responsibility for getting new nurses up and running—and keeping them satisfied—still lies with their first employer.  This significant task also has important implications for the long-term nursing shortage, since these new nurses will be needed to replace the large number of older nurses who are nearing retirement.

“We don’t know exactly what impact the current economy will have on turnover in the short term,” said Brewer, “but nothing has changed in regards to the underlying causes of the nursing shortage. We still have an aging workforce, for instance, and those issues still have to be addressed.”

Improving retention rates can help individual hospitals as well as the larger health care system, according to the researchers.

“Turnover is extremely expensive, costing a hospital at least a year’s salary or more for each nurse who leaves,” said Kovner. “It is also very disruptive to the rest of the staff.” She noted that the disruption and inconsistency can also have a negative impact on patient care and safety.

Because each organization is unique, the authors recommend that hospitals take the time to review the factors that influence a nurse’s intention to stay or go, and recognize where they can make improvements.  “There are a lot of things hospitals have to address to impact nursing satisfaction and organizational commitment,” said Brewer.

“Even though Magnet status was not a noticeable difference in our particular study, these hospitals have the right idea,” she said.  “They are working to create an environment that is positive for nurses.”

 For more information on the study published in Nursing Economicsclick here

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