New Nurses Report Significant Job Stress, Need for Better Management

BUFFALO, N.Y. -- What keeps a newly licensed nurse on the job? Answers to that question are important to hospitals across the U.S., many of which are confronting serious nursing shortages.

Based on results of a study to be published in the May 2007 issue of American Journal of Nursing, the top two priorities for hospitals to address the retention issue are improving nursing management and taking steps to reduce on-the-job stress.

The study surveyed the work experience of nurses from 35 states who obtained their first license between Aug. 1, 2004, and July 31, 2005, and had been employed for up to 18 months. Of the 3,226 respondents, 610 had already left their first job -- 41.8 percent due to poor management, and 37.2 percent because of stressful work conditions. Another 34 percent changed jobs because they wanted to get experience in a different clinical area.

Carol S. Brewer, Ph.D., associate professor in the School of Nursing at the University at Buffalo, was co-principal investigator on the study. Christine T. Kovner, Ph.D., professor at New York University's College of Nursing and senior fellow at the Hartford Institute for Geriatric Nursing, was first author and principal investigator.

"This study helps to establish baseline data about a population that is particularly important both to the nursing profession and our health-care system," said Brewer. "There is much conventional wisdom about the experiences of newly licensed nurses, but little fact. This study helps to fill that void, and provide insight into their career choices."

The nurses who responded will be followed for three more years to collect more information on conditions responsible for turnover.

Susan Hassmiller, Ph.D., leader of the team that focuses on health-care workforce issues at the Robert Wood Johnson Foundation in Princeton, N.J., which funded the study, said: "This study provides invaluable insight into the challenges health-care organizations must address to correct working conditions that undermine patient care, and cause nurses to leave their jobs -- and sometimes leave the profession.

"We are committed to ensuring the highest quality of care for people in this country, and nurses are critical to achieving that goal."

Results showed that the nurse-respondents generally were pleased with their jobs, and reported positive work-group cohesion. They reported not having enough support from their supervisors, however. More than one-third indicated they intended to search for a new position in one year, but not necessarily outside of nursing.

Newly licensed nurses considered their jobs difficult, and they worked long hours: 51 percent worked voluntary overtime, 13 percent mandatory overtime. Sixty-one percent were assigned to nights, evenings or rotating shifts. Nearly two-thirds -- 62.78 percent -- said their work interfered with family life on at least four days a month, according to the results.

Survey participants also reported a somewhat hazardous working environment: a quarter of respondents sustained at least one needle-stick in a year; 39 percent at least one strain or sprain; 21 percent a cut or laceration, 46 percent a bruise or contusion, and 62 percent reported experiencing verbal abuse on the job. A quarter found it "difficult or impossible" to do their jobs at least once a week due to inadequate supplies, the study showed.

"Findings have shown that the work environment for newly licensed RNs has both positive and negative aspects," said Brewer. "Future analyses will focus on evaluating these factors' contributions to the new RNs' longevity in their workplace and nursing."

Additional contributors to the study were Susan Fairchild, M.P.H., project director in the NYU College of Nursing; Shakthi Poornima, doctoral student in the UB Department of Linguistics; Hongsoo Kim, Ph.D., assistant professor, and Maja Djukic, research assistant, both at NYU's College of Nursing.

The University at Buffalo is a premier research-intensive public university, the largest and most comprehensive campus in the State University of New York. The School of Nursing is one of five schools that constitute UB's Academic Health Center. UB's more than 27,000 students pursue their academic interests through more than 300 undergraduate, graduate and professional degree programs. Founded in 1846, the University at Buffalo is a member of the Association of American Universities.