Registered Nurses' Perceptions of Nursing

Peter I. Buerhaus; Karen Donelan; Beth T. Ulrich; Leslie Kirby; Linda Norman; Robert Dittus

Disclosures

Nurs Econ. 2005;23(3):110-118. 

In This Article

Discussion

The results of two national random surveys of RNs are reported in this article. The first was conducted during the height of the current nursing shortage in late 2001 and early 2002, and the second national survey was conducted in 2004, after hospitals had increased wages significantly and employment of RNs had risen by nearly 185,000 during this 2-year period (Buerhaus, Staiger, & Auerbach, 2004). Comparing the results of the two national surveys suggests some favorable trends may be developing. Overall, findings show that from 2002 to 2004 both job satisfaction and satisfaction with a career in nursing increased substantially, and more RNs definitely would recommend a career in nursing to a qualified high school or college student. These results are encouraging and may indicate that efforts to improve the nursing workplace climate over the past few years are paying off.

Because studies have shown that job satisfaction is a strong predictor of intent to stay or leave a job (Bratt, Broom, Kelber, & Lostocco, 2000; Garrett & McDaniel, 2001; Larrabee, 2003), findings from this study provide good news for nurses, hospitals, nursing executives, and others concerned with the near-term labor force participation of nurses. Eighty-three percent of RNs in both surveys were very or somewhat satisfied with their jobs in both surveys, but the percent of RNs who were very satisfied with their jobs jumped from 21% in 2002 to 34% in 2004. As suggested by the results of multiple regression analysis, the rise in satisfaction is likely driven by an increase in RNs who reported their organizations emphasized patient care, management recognized the importance of their personal and family lives, satisfaction with salary and benefits, job security, and by the increase in RNs who perceived positive relationships with other nurses and with management — all notable improvements. Not only does the rise in job satisfaction suggest that efforts to improve the workplace may be having a positive effect, but also may partly explain two important findings reported earlier in Part 1 of this series (Buerhaus et al., 2005a): (a) the sharp decline in the percentage of RNs (from 29% in 2002 to 15% in 2004) who identified the negative work environment as one of the main reasons for the nursing shortage; and (b) the increase in the percent of RNs (from 56% in 2002 to 63% in 2004) who indicated they had no plans to leave the nursing profession in the next 3 years.

The increase in RNs' job satisfaction from 2002 to 2004 is particularly impressive when compared to job satisfaction as reported in surveys of other professions. For example, a survey of 906 health care executives (The American College of Healthcare Executives, 2000) found that 78% of women and 81% of men were satisfied or very satisfied with their positions; a survey of business executives reported that 82% of women and 84% of men were satisfied or very satisfied with their positions (The American College of Healthcare Executives, 2000); and, a 2000 survey of 842 lawyers (American Bar Association, 2000) found that 80% were satisfied with their positions. Indeed, the favorable comparison between nurses' job satisfaction (83%) and the job satisfaction ratings of other professions raises questions about the validity of the widespread perception that the major cause of the nursing shortage is low job satisfaction.

Turning to satisfaction with their nursing careers, previous national surveys of RNs (Buerhaus, Donelan, DesRoches, Lampkin, & Mallory, 2001; Kaiser Family Foundation and Harvard School of Public Opinion, 1997) reported that RNs were generally satisfied with being a nurse, and both the 2002 and 2004 national surveys of RNs also found that the vast majority (87%) were either very or somewhat satisfied with nursing. Moreover, the percent of RNs who reported they were very satisfied with being a nurse rose noticeably, from 37% in 2002 to 46% in 2004, and the rise in satisfaction occurred among RNs in both direct and non-direct care positions. In fact, compared to several other professions, RNs appear to be more satisfied with their career decision than doctors, teachers, and attorneys. A 1999 study of physicians found that 81% of primary care doctors and 79% of specialty physicians were either very or somewhat satisfied with their career decision (Landon, Reschovsky, & Blumenthal, 2003); a 2003 national survey of teachers reported that 61% would certainly or probably recommend a career in teaching (National Education Association, 2003); and a 2000 national survey of members of the American Bar Association Young Lawyers Division found that 75% were very or somewhat satisfied with the practice of law (American Bar Association, 2000).

Through multiple regression analysis, the same variables that predicted job satisfaction also predicted RNs satisfaction with their career, which suggests the two constructs — satisfaction with one's job and with one's career — are closely related. Satisfaction with a nursing career also was related to opportunities to influence decisions in the workplace, recognition of accomplishments, and overall physical health, factors that were not associated with job satisfaction.

Positive sentiments toward nursing also were revealed by the upswing in the percent of RNs who would definitely or probably advise a qualified high school or college student to pursue a career in nursing (60% in 2002 vs. 72% in 2004). In fact, the percentage of RNs who would definitely recommend nursing as a career nearly doubled, from 17% in 2002 to 33% in 2004. Moreover, compared to whites, RNs who are minorities were much more likely to recommend nursing in 2004. The high percentage of RNs who definitely or probably would recommend nursing as a career compares favorably to members of other professions. For example, a 2001 survey of a nationally representative sample of 1,467 public school teachers found that 61% said that if they could revisit their career-choice decision, they certainly (32%) or probably (29%) would choose teaching again (National Education Association, 2003).

RNs also agreed that nursing is a good career for men, and for those who want a secure job, do well in science, and rank in the upper fifth of their high school class. RNs, however, do not believe that nursing is a good career for those who want respect, despite the fact that surveys of the public (Buerhaus, Donelan, & Dittus, 2001) and of physicians (Buerhaus, Donelan, Norman, & Dittus, 2005c) found that the nursing profession is very much respected. Other results indicate that in 2004, few RNs have heard negative talk about nursing, particularly in front of nursing students and patients and their families. What hasn't shown a significant change in the two surveys is the percent of RNs who believe that unionization is positive for the nursing profession or for the quality of patient care.

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