COMMENTARY

Why New Graduate Nurses Quit Their First Jobs

Laurie E. Scudder, DNP, NP

Disclosures

May 13, 2011

Understanding Intention to Leave Amongst New Graduate Canadian Nurses: A Repeated Cross Sectional Survey

Rhéaume A, Clément L, LeBel N
Intl J Nurs Stud. 2011;48:490-500

Study Summary

Background. The first few years of nursing are stressful on many levels: fear of errors, lack of support, interpersonal conflict, and complex work environments. Many factors can lead to a decision by a new graduate nurse to leave a job, causing high rates of turnover, a costly outcome for both the nurse and the workplace. Although a number of studies have looked at individual factors, the goal of this study was to examine the relationship between transition programs, empowerment, work environment, and intent to leave.

Methodology. Data were collected over a 5-year period by surveying nurses practicing in New Brunswick, Canada (a primarily rural area) following the first 12-16 months of practice. In 2003, a mentorship program for new graduate nurses was implemented throughout the province, 2 years before data collection for this study began. The survey asked about employment status, orientation, mentorship, work environment, and demographics. Additional questions assessed empowerment, which was defined as a sense of control, competence, and goal internalization. Finally, intent to leave current employment was determined by an answer to a single Likert question asking participants to describe their intentions for work in the upcoming year. The survey also contained a qualitative section that allowed participants to add more anecdotal data.

Results. Surveys were mailed to approximately 1300 nurses and returned by 348, a 27% response rate. More than 90% worked in hospital settings, and 95% of participants were women. Two thirds (66.4%) were employed full time, although 86% indicated that they would choose full-time employment if it was available. Of interest, about half reported that they had previously worked in the healthcare system, although types of experience were not specified. The respondents were primarily young, with 205 (59.1%) being 20-24 years of age and an additional 83 (23.9%) were under the age of 30. The duration of orientation programs and the availability of mentorship varied widely, although most respondents (64%) agreed that the orientation period was of adequate duration, and a somewhat larger percentage (69%) agreed that their orientation assisted them with workplace integration. Even more (80%) participated in an employer-based mentorship program that ranged from 1-7 months in duration.

With respect to intention to leave, 49.6% of the new graduate nurses did not intend to leave their current employer, and only a small fraction (4.9%) reported definite plans to leave. The remainder (45.5%) expressed uncertainty about intent to leave. Those percentages were relatively stable over the 5-year study period.

Rhéaume and coworkers conducted correlation analyses to explore the relationships among the main study variables, characteristics of the transition programs, empowerment, work environment, and intent to leave. No significant correlations were found between any transition program characteristics and intent to leave. Overall empowerment score and intent to leave were moderately correlated, and higher empowerment levels were linked to lower intent to leave. However, a significant relationship was found between overall work environment scores and intent to leave. New graduate nurses who identified with the goals of their organization, as reflected by higher scores in the area of nursing participation in hospital affairs, and perceived the use of a nursing model (vs medical model) in care were less likely to leave.

Viewpoint

This study adds weight to earlier research documenting the importance of empowerment and a strong nursing model in the satisfaction of new graduate nurses, but these variables combined accounted for only 24% of the variance in intent to leave. This finding held true across sociodemographic groups, with older and younger nurses equally likely to value a sense of belonging to the organization and a work environment that supports their vision of nursing. Whereas the lack of impact of orientation and mentoring programs on intent to leave is initially surprising, the researchers noted significant variation in these programs. Treating these programs as dichotomous variables may have masked the effect of more successful programs. Although this study creates as many questions as it answers, it illustrates the inherently personal nature of these career decisions.

Abstract

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