Predictors of RNs' Willingness to Remain in Nursing

Abstract and Introduction

Introduction

The evolving nursing shortage in the United States and globally is a subject of considerable attention from researchers, the health care industry, higher education, and policy makers, both at the federal and state levels. Unlike past shortages, this one involves both the demand and supply parts of the equation. Consequently, multiple strategies must be put into place to offset the projected shortage of over 260,000 registered nurses (RNs) in 2025 (Buerhaus, Auerbach, & Staiger, 2009).

Retaining members of the current nursing workforce and increasing the number of new graduates are major strategies being addressed across the health care industry and higher education. In relation to retention, one of the short-term strategies that 34% of the 32 hospitals in the Community Tracking Studies are using is flexible scheduling, which includes a "broader range of shift types and self-scheduling" (May, Bazzoli, & Gerland, 2006, p. w319). Although the national trend is toward 12-hour shifts in acute care, there is evidence that older nurses prefer 8-hour shifts (Hoffman & Scott, 2003; Mion, Hazel, Cap, Fusilero, Podmore, & Szweda, 2006). However, Shullanberger (2000), in an integrative review of the literature, found that 12-hour shifts, in contrast to 8-hour shifts, were less fatiguing.

According to Norman and colleagues (2005), based on their national survey of 1,783 nurses:

Beyond focusing on retaining older RNs, it is important that employers initiate strategies to retain RNs who are approaching their 40s. Data in this survey showed that, as RNs enter their 4th decade, there is a strong tendency to shift employment into non-acute care settings. Strategies should be developed and tested that encourage retention in direct patient-care positions in acute care environments (p. 289).

Using a national sample to explore the impact of flexible scheduling on RNs who "intend to leave their current positions in the next 3 years," Ulrich, Buerhaus, Donelan, Norman, and Dittus (2005) found "more flexible scheduling would be very likely (29%) or somewhat likely (24%) to cause them to reconsider leaving" (p. 393).

In this study, responses from 8,038 nurses in Maine are used to elaborate on these previous studies by examining in some detail the relationship between scheduling and propensity to stay or leave the nursing profession as this relationship is mediated by a number of factors. Maine has been fortunate to date in maintaining its RN workforce, but this is not expected to continue. In 2000, there were 1,023 RNs per 100,000 population (national average 780) and the projected vacancy rate was 12% and was expected to grow to 31% in 2020, according to federal forecasts (U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Health Profes sions, 2001, 2000). Maine's Department of Labor projects the following employment growth in the health care sector between 2002-2012: ambulatory health-care services 32% (net 7,542), nursing and residential care facilities 29% (net 6,427), and hospitals 21% (net 5,405) (Maine Department of Labor, 2004). In addition, they project 3,469 additional jobs for RNs, which reflects 27% growth, and that annually there will be 1,097 openings (Maine Department of Labor, 2005).

Maine's 13 nursing programs produced 610 graduates in 2004-2005, up from a low of 392 in 2001-2002 (Kirschling, 2006a). It is important to note that the Maine State Board of Nursing has historically licensed to another jurisdiction the same number of out-of-state nurses that it licenses to the State of Maine. What this means for Maine is that retention of the existing workforce is an essential part of the solution, as well as increasing capacity in Maine's nursing programs.

A major question, therefore, about the adequacy of the future supply of nurses is how many will stay in the profession. Of course, this is partly a question about considerations common to any job such as when will people retire. For the baby-boom generation (those born between 1946 and 1964), which composed 65% of the nursing profession at the time of the survey reported here, this is a particularly critical question, since 84% of the nursing profession (at the time of the survey) was either in the baby-boom generation or older.

There are other aspects peculiar to the nursing profession that increase the urgency of identifying the factors affecting the decision to remain in the profession as part of the response to nursing shortages. These include the high-stress nature of many nursing duties and the ability to respond to the rapidly changing technological and organizational context of the nursing profession.

Table 1. Descriptive Information: Combined Sample, RNs Actively Seeking to Change Number of Hours Worked, and RNs Not Actively Seeking to Change Number of Hours Worked
	Combined Sample (8038)	Actively Seeking to Change number of hours Worked (1831).	Not Actively Seeking to change Number of Hours Worked (6,207)
Average Age (in years)	46.2	45.9	46.3
Age Categories
% 21–30 years	7.1	7.5	7.0
% 31–40 years	21.2	20.8	21.3
% 41–50 years	35.9	37.6	35.4
% 51–60 years	30.0	28.8	30.3
% 61+ years	5.9	5.2	6.1
Gender
% Female	92.7	91.8	93.0
% Male	7.3	8.2	7.0
Highest Education Nursing
% Diploma	22.5	21.0	23.0
% Associate degree	33.1	35.7	32.3
% Baccalaureate degree	34.8	33.2	35.3
% Master's degree	9.0	9.7	8.8
% Doctoral degree any field	0.6	0.4	0.7
Nursing Employment Setting
% Hospital	57.8	59.1	57.4
% Ambulatory care	8.6	8.9	8.5
% Public/Community health	3.0	2.5	3.1
% Occupational health	1.2	1.2	1.2
% Insurance company	1.9	2.0	1.8
% Long-term care	9.0	9.1	8.9
% Home health care	5.5	5.7	5.4
% Nursing education	1.4	0.9	1.6
% School health	3.4	2.6	3.7
% Other	8.4	8.0	8.4
Role with Primary Employer
% Staff/Direct care nurse	60.2	59.9	60.5
% Quality assurance/Infection control	1.0	0.7	1.0
% Discharge planner	2.3	2.1	2.4
% Utilization review/Outcome management/Other insurance related role	2.2	2.4	2.1
% Staff development	1.2	1.4	1.1
% Facility/Nursing department administrator or supervisor	6.9	6.6	7.0
% Team leader/Charge nurse, nurse manager, head nurse	11.1	12.0	10.7
% Educator (college/university)	1.2	0.7	1.4
% Researcher/Consultant	1.1	1.1	1.0
% Nurse practitioner, certified nurse midwife, clinical nurse specialist, nurse anesthetists	8.6	9.6	8.3
% Other	4.5	4.5	4.5
Plan to Be Working in Nursing in 5 Years
% Yes	93.4	92.9	93.5
% No	6.6	7.1	6.5
Average Hours for Typical Week
Hired	34.1	33.5	34.2
Worked	37.2	37.9	37.0
Worked minus hired = contract gap	3.1	4.3	2.8
Preferred (if seeking to change hours)	n/a	31.1	n/a
Worked minus preferred = schedule gap	n/a	6.7	n/a
Spent providing direct care	24.6	25.1	24.4
Spent providing non-direct care = direct care gap	12.6	12.7	12.6

Table 1. Descriptive Information: Combined Sample, RNs Actively Seeking to Change Number of Hours Worked, and RNs Not Actively Seeking to Change Number of Hours Worked

Combined Sample (8038)

Actively Seeking to Change number of hours Worked (1831).

Not Actively Seeking to change Number of Hours Worked (6,207)

Average Age (in years)

46.2

45.9

46.3

Age Categories

% 21–30 years

7.1

7.5

7.0

% 31–40 years

21.2

20.8

21.3

% 41–50 years

35.9

37.6

35.4

% 51–60 years

30.0

28.8

30.3

% 61+ years

5.9

5.2

6.1

Gender

% Female

92.7

91.8

93.0

% Male

7.3

8.2

7.0

Highest Education Nursing

% Diploma

22.5

21.0

23.0

% Associate degree

33.1

35.7

32.3

% Baccalaureate degree

34.8

33.2

35.3

% Master's degree

9.0

9.7

8.8

% Doctoral degree any field

0.6

0.4

0.7

Nursing Employment Setting

% Hospital

57.8

59.1

57.4

% Ambulatory care

8.6

8.9

8.5

% Public/Community health

3.0

2.5

3.1

% Occupational health

1.2

% Insurance company

1.9

2.0

1.8

% Long-term care

9.0

9.1

8.9

% Home health care

5.5

5.7

5.4

% Nursing education

1.4

0.9

1.6

% School health

3.4

2.6

3.7

% Other

8.4

8.0

8.4

Role with Primary Employer

% Staff/Direct care nurse

60.2

59.9

60.5

% Quality assurance/Infection control

1.0

0.7

1.0

% Discharge planner

2.3

2.1

2.4

% Utilization review/Outcome management/Other insurance related role

2.2

2.4

2.1

% Staff development

1.2

1.4

1.1

% Facility/Nursing department administrator or supervisor

6.9

6.6

7.0

% Team leader/Charge nurse, nurse manager, head nurse

11.1

12.0

10.7

% Educator (college/university)

1.2

0.7

1.4

% Researcher/Consultant

1.1

1.0

% Nurse practitioner, certified nurse midwife, clinical nurse specialist, nurse anesthetists

8.6

9.6

8.3

% Other

4.5

Plan to Be Working in Nursing in 5 Years

% Yes

93.4

92.9

93.5

% No

6.6

7.1

6.5

Average Hours for Typical Week

Hired

34.1

33.5

34.2

Worked

37.2

37.9

37.0

Worked minus hired = contract gap

3.1

4.3

2.8

Preferred (if seeking to change hours)

n/a

31.1

n/a

Worked minus preferred = schedule gap

n/a

6.7

n/a

Spent providing direct care

24.6

25.1

24.4

Spent providing non-direct care = direct care gap

12.6

12.7

12.6

Table 2. The Age Effect
Age	Seeking to change hours p = <0.0001	Not seeking to Change hours p = <0.0001
	1.14 times less likely to stay	1.16 times less likely to stay

Table 3. The Education Effect
Highest Nursing Degree ref: Master's or Doctorate	Seeking to change hours p = 0.0121	Not Seeking to change hours p = 0.0007
RN diploma	3.32 times less likely to stay	1.95 times less likely to stay
Associate	2.83 times more likely to stay	Ns
Baccalaureate	ns	Ns
ns = not significant (p = 0.05)

Table 4. The Contract Gap Effect (Hours Worked-Hours Hired)
Hours worked – Hours Hired ref: 0	Seeking to change hours p = <0.0001	Not Seeking to change hours p = 0.0044
≤ -1	ns	ns
[1, 5]	2.29 times more likely to stay	1.37 times more likely to stay
[6, 10]	2.83 times more likely to stay	1.71 times more likely to stay
≥ 11	3.05 times more likely to stay	ns

Table 5. The Schedule Gap Effect (Hours Worked-Hours Preferred)
Hours worked – Hours Preferred ref: 0	Seeking to change hours p = value <0.0001
≤ -1	ns
[1, 10]	ns
[11, 20]	5.85 times less likely to stay
≥ 21	10.99 times less likely to stay

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Predictors of Registered Nurses' Willingness to Remain in Nursing

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