Predictors of registered nurses' willingness to remain in nursing

A major question about the adequacy of the future supply of nurses is how many will stay in the profession. The relationship between scheduling and propensity to stay or leave the nursing profession was examined in this study. This analysis suggests there are definite characteristics of the work schedules that can influence a nurse's inclination to stay or leave the profession. This is not simply a question of "overwork," but of matching work schedules and hours as closely as possible to employee expectations. This suggests management needs to find a way to pay attention when nurses request changes in hours. The mere fact of changing schedules will not solve the nursing shortage, but it is one action within the management control of any organization employing nurses that could have a positive effect on retention.     

Enhancing nursing as a career choice with fifth-grade students

The purpose of this study was to explore the influence of a career education program on children's interest in nursing as a career choice, especially related to gender in fifth-grade students. A within-subjects design compared interest in nursing as a career of 70 fifth-grade students before and after participation in a 4-week career education program about nursing. There was a 61% (N = 70, p < 0.001) increase of students expressing they would consider nursing as a career after participating in the career education program. This positive effect was discovered among both male and female students. Further results provided a pre and post-career assessment of the students' development that was congruent with findings from previous vocational studies. The results underscore the positive effect career education can have on children's career interests and substantiate the importance of exposing students to practicing nurses as a key strategy to stimulate interest in nursing to help maintain a steady recruitment of young people into the future nursing workforce.     

How should we collect data on the nursing workforce?

R esearchers who study the nursing workforce use data about nurses and data about nursing jobs. Diifferent approaches - sample surveys and relicensure surveys - used to collect data on RNs, and the benefits and weaknesses of these approaches, are reviewed. Predicting the future supply of nurses is more complex than estimating the current supply, as factors that affect future supply must be considered. Simple forecasts can be created with relatively few variables, which could be collected through relicensure surveys. However, more detailed assessments of potential retirement patterns, changing family norms regarding childcare and household work, and movements into higher education require the rich data more often found in sample surveys.     

Job preferences of students and new graduates in nursing

This article investigates the preferences of student and newly graduated nurses for pecuniary and nonpecuniary aspects of nursing jobs. It is the first study applying methods based on discrete choice experiments to a developed country nursing workforce. It is also the first to focus on the transition through university training and into work. This is particularly important as junior nurses have the lowest retention levels in the profession. We sample 526 individuals from nursing programmes in two Australian universities. Flexible and newly developed models combining heteroscedasticity with unobserved heterogeneity in scale and preference weights are estimated. Overall, salary remains the most important feature in increasing the probability that a job will be selected. ‘Supportive management/staff’ and ‘quality of care’ follow as the most important attributes from a list of 11 nonpecuniary characteristics. However, the subset of new graduates rank ‘supportive management/staff’ above salary increases, emphasizing the importance of a supportive workplace in the transition from university to the workplace. We find substantial preference heterogeneity and some attributes, such as the opportunity for clinical rotations, are found to be attractive to some nurses while seen as negative by others. Nursing retention could be improved by designing different employment packages to appeal to these different tastes.     

Registered nurses' perceptions of nursing

In Part II of this six part series on the state of the registered nurse (RN) workforce in the United States, the focus is on RNs' perceptions of nursing including RNs' satisfaction with their jobs in general and on specific elements of their work experiences, such as the quality of professional relationships. Satisfaction with a nursing career and whether RNs would recommend nursing to others are also examined. The improvements in nursing found in this analysis of two national surveys in 2002 and 2004 should be broadly communicated not only to energize individuals and organizations to continue their efforts to improve the workplace environment, but to challenge the many individuals in the nursing profession who hold onto a sense that nothing will ever improve in their organizations.     

When nursing takes ownership of financial outcomes: achieving exceptional financial performance through leadership, strategy, and execution

With nurses and unlicensed supportive personnel composing the greatest percentage of the workforce at any hospital, it is not surprising nursing leadership plays an increasing role in the attainment of financial goals. The nursing leadership team at one academic medical center reduced costs by more than $10 million over 4 years while outperforming national benchmarks on nurse-sensitive quality indicators. The most critical success factor in attaining exceptional financial performance is a personal and collective accountability to achieving outcomes. Whether it is financial improvement, advancing patient safety, or ensuring a highly engaged workforce, success will not be attained without thoughtful, focused leadership. The accountability model ensures there is a culture built around financial performance where nurses and leaders think and act, on a daily basis, in a manner necessary to understand opportunities, find answers, and overcome obstacles. While structures, processes, and tools may serve as the means to achieve a target, it is leadership's responsibility to set the right goal and motivate others.     

Navajo nation public health nurses inspire thoughts on health care reform

The wisdom and experience of pubic health nurses serving on a Navajo Reservation, who work far from the typical hospital setting, may well hold some of the keys to how we can successfully plan for and navigate the future of our shifting health care system. As more of the nursing workforce moves outside the walls of the hospital, competencies in autonomy, clinical judgment, decision making, and communication will increase in importance. long with safety and quality implications, this may also influence changes in nursing education, job requirements, hiring, and measuring performance. In addition, there may be implications around how new nurses are oriented and how they get the experience needed to function in more independent roles. Within their routine days, the conditions they work in, the situations they face, and the many ways public health nurses find to meet the needs of the people they serve, is a wealth of knowledge that may well translate into solutions for some of the challenges our nation's health care system is facing.     

Occupational commitment, education, and experience as a predictor of intent to leave the nursing profession

This national Internet-based study tested occupational commitment in predicting RN intent to leave the nursing profession. Results showed that occupational commitment was increased by educational level and experience. Findings suggest opportunities for policy changes that may increase retention of registered nurses.     

Nurses who do not nurse: factors that predict non-nursing work in the U.S. registered nursing labor market

Registered nurses (RNs) who work outside of nursing have seldom been examined. This aim of this study was to compare the 122,178 (4%) of RNs who are employed outside of nursing to those who work in nursing jobs in terms of sociodemographic, market, and political variables to determine if these groups are substantively different from one another. Using a logit regression model, wages were a significant predictor of working outside of nursing for unmarried nurses but not for married nurses. Married and unmarried male nurses were more likely to work outside of nursing. Baccalaureate education, children under age 6, higher family income, and years since graduation increased the odds of working outside of nursing for married nurses. Ultimately, identifying characteristics on which these groups differ may inform future policy directions that could target nurses who may leave nursing at a time when retention efforts might be effective to alter their trajectory away from the profession.     

Registered nurses' perspectives on health care and the 2008 presidential election

As this historic presidential election draws near, what do RNs think of our nation's priorities? Which candidates do they think will be most effective in shaping our health care system and addressing the most pressing issues of our time? The results of this survey show that RNs do not identify overwhelmingly with one political ideology or party and, in fact, they closely resemble the public on these political dimensions. The data also show that RNs identify health care issues as the most important problem facing the nation. RNs who believe that it is the responsibility of the government to provide health insurance to those without it, have more confidence in the government to achieve this outcome, and are more likely to be Democrats than Republicans. The presidential election is expected to be highly contested and could be determined by a relatively small margin of votes and, thus, nurses should recognize their chances of influencing the outcome of the election. The data from this survey provide baseline information potentially useful to increasing the political influence of the nursing profession, informing other organizations about where they might align with nurses, and helping candidates and the political parties compete more effectively in seeking the support of roughly 3 million RN voters.     

The nursing shortage continues as faculty shortage grows

To combat the nursing shortage, efforts to promote nursing as a career have been successful. However, academic nursing institutions are not adequately prepared for this new influx of applicants. The lack of faculty to educate the growing demand for baccalaureate-prepared RNs directly impacts the nursing shortage. The nursing shortage thus directly impacts safe patient care. The main reasons for the lack of faculty to meet the demand for more nurses include the increased age of the current faculty and the declining number of years left to teach, expected increases in faculty retirements, less compensation for academic teaching than positions in clinical areas for master's-prepared nurses, and finally, not enough master's and doctoral-prepared nurses to fill the needed nurse educator positions It is in the best interest of the nursing profession to do what it does best by incorporating the nursing process to solve the faculty shortage and secure its future in order to protect the lives of patients.     

Transition programs for internationally educated nurses: what can the United States learn from the United Kingdom, Australia, and Canada?

It is critical to conduct competency assessments of internationally educated nurses (IENs) to ensure public safety, as well as uphold accountability to nursing as a regulated profession. Transition programs are needed because of the required proficiency of the working language, as well as differences in nursing education, national health care systems, nursing practice and culture, etc. Transition programs in the United States are grossly under-developed because of lack of recognition of their importance, lack of funding and standardization, and decentralized regulation in nursing. United States can learn from the United Kingdom, Australia, and Canada regarding how to best transition IENs. Its current hit-and-miss approach is inadequate and inconsistent with the emerging global trend to systematically deal with the transitional challenges of IENs at the national level.     

Trends in the experiences of hospital-employed registered nurses: results from three national surveys

The comparative results of three national surveys provide the only known source of data describing the evolving state of the nursing workforce over time in this country. These national random sample surveys expose the harmful effects of a lingering shortage of nurses and make plain that much work remains to be done to improve the experiences of hospital-employed RNs. At the same time, nurses and others involved in hospital patient care should be encouraged by the improvements that have been made in recent years, despite the presence of a nursing shortage.     

Educational innovation: nursing's leadership challenge

Hospitals are increasingly looking for the best graduates, but as this competitive environment increases, little focus is on collaboration and innovation in changing the education system so there will be more "best nurses." In universities today we find numerous barriers to investment in innovation and risk, which hampers the ability to address national workforce needs and compete in a global marketplace. Academic institutions need to become more creative, and begin to look at nursing as a partnership between those who essentially purchase our product and those who develop the product. Nursing leadership needs to collaborate quickly with integration and innovation in developing, improving, and maintaining the skill set of the nursing workforce and assuring competent practitioners from our educational system going forward. We need to share our valuable resources and move out of our silos and begin to look at the big picture, and we need to reach inside and find that creative child that works within us.     

Impact of disease management programs on hospital and community nursing practice

The impact of disease management progrmms on the role of the nursing profession in the evolving U.S. health care system is reviewed. Needed changes in educational and training programs are discussed in relation to demands for changing clinical and administrative skills in nursing with an emphasis on increasing demand for advanced practice nurses.     

The 'Parent Shift' program: incentives for nurses, rewards for nursing teams

To create new opportunities for nurses to reenter the workforce, a RN p.r.n. program must meet the needs of nurses who wish to make dual commitments to home and work. The Parent Shift program provides an innovative model of attracting and retaining nurses in a hospital workforce. Many nurses who joined the program were away from the field of nursing for many years and were drawn to the program because of the promise of flexible shifts and minimal requirements for participation. In this study, flexible shifts not only encouraged program entry, they were also a powerful motivator for continued program participation over time. Parent Shift nurse presence was perceived by nurse managers to decrease stressors and improve time efficiency of full-shift staff.     

Six-part series on the state of the RN workforce in the United States

This series on the state of the nursing workforce focuses on describing the results of the national surveys of RNs. The series begins with an analysis of RNs' perceptions of the current nursing shortage and whether they perceive the shortage has gotten better or worse over the past few years. Future topics will include RNs' perceptions of being a nurse and how they perceive certain aspects of their jobs; RNs' awareness of the J&J Campaign and whether they think it has been effective; RNs' perceptions of the impact of the shortage on the quality of patient care in hospitals; and various issues related to the age and diversity of the nursing profession.     

A transparency and accountability framework for high-value inpatient nursing care

Transparency and accountability are terms that typically refer to activities aimed at measuring and holding providers responsible for their performance through such vehicles as public disclosure of comparative results. Today, transparency and accountability policies are widely accepted strategies to drive quality improvement and stimulate consumer choice. Yet nursing, the single largest health care profession, has not yet been engaged in these policy directions nor considered in their design or implementation. The framework reported here offers nurses and their professional organizations a model for which to advocate for policy change. Hospital and health system executives who have the freedom to establish institutional policies might implement this framework to achieve higher value. This framework provides both the context and components of a system that, if implemented, would measure, report, and reward hospital nursing's contributions to high value.     

Factors influencing work productivity and intent to stay in nursing

The researchers document the individual and workplace characteristics associated with decreased work productivity and intent to stay in nursing for nurses employed in direct patient care in the hospital setting. Factors associated with decreased work productivity were age, total years worked as a RN, quality of care provided, job stress score, having had a job injury, and having a health problem. Nurse leaders must place additional efforts on changes needed to improve the hospital workplace environment to decrease job stress, improve RNs' ability to provide quality care, and to assure the health and safety of nurses. Reducing job stress and providing adequate staffing so quality of care can be provided will enhance job satisfaction which will also encourage RNs to stay at the bedside. Improved work environments may delay older RNs' retirement from the workforce.     

Validation of a taxonomy of ambulatory nursing practice

Ambulatory care is a complex and challenging nursing specialty. This survey of 33 ambulatory nursing administrators addressed the roles and responsibilities of nurses in ambulatory care settings.