Predictors of Registered Nurses' Willingness to Remain in Nursing

Jane Marie Kirschling, DNS, RN, FAAN; Charles Colgan, PhD; Bruce Andrews, PhD

Disclosures

Nurs Econ. 2011;29(3):111-117. 

In This Article

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.

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