Moving on, Up, or Out: Changing Work Needs of New RNs at Different Stages of their Beginning Nursing Practice

Linda Honan Pellico, PhD, APRN; Maja Djukic, PhD, RN; Christine Tassone Kovner, PhD, RN, FAAN; Carol S. Brewer, PhD, RN


Online J Issues Nurs. 2010;15(1) 

In This Article

Abstract and Introduction


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.


More than 40% of the currently working registered nurses (RNs) will begin to approach retirement age in the next 10 years (Norman et al., 2005). Nursing graduates, numbering about 92,000 in 2006 (National League for Nursing [NLN], 2008) represent a vital source of replacement for the retiring cohorts, especially in hospitals, the first job setting for over 80% of new nurses (Kovner et al., 2007). Retaining the new RNs in nursing is essential to help ameliorate the projected shortage of 260, 000 RNs by the year 2025 (Buerhaus, Auerbach, & Staiger, 2009). At the organizational level, RN retention is important for maintaining adequate nurse staffing that is critical for ensuring quality patient outcomes (Kane, Shamliyan, Mueller, Duval, & Wilt, 2007). Further, improved retention minimizes turnover costs that range from $82,000 to $88,000 per RN (Jones, 2008).

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% (PricewaterhouseCoopers' Health Research Institute, 2007), turnover rates for the RNs in the first year of practice range from about 18% in a nationally representative sample of new RNs (Brewer et al., 2009) to about 50% in less representative United States (U.S.) samples (Salt, Cummings, & Profetto-McGrath, 2008; Scott, Engelke, & Swanson, 2008). Structured residency programs, however, have been shown to reduce new nurses' turnover in the first year of practice from 20% to 12% in one study (Halfer, Graf, & Sullivan, 2008) and from between 20% and 54% to between 4% and 28% in a systematic review of 16 studies (Salt et al.).

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. 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; Coomber & Barriball, 2007; Garon & Ringl, 2004; Irvine & Evans, 1995; Kovner, Brewer, Wu, Cheng, & Suzuki, 2006; Zangaro & Soeken, 2007). However, research about the factors specific to new RN retention is less abundant.

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.


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