Report: Changes Needed in Nurses’ Education and Work Environments

A new study led by a Yale School of Nursing researcher recommends changes in nursing schools and the work environment to reduce the number of novice nurses who opt to leave the profession.

The article comes at a time when about 18% of newly licensed registered nurses are leaving their first nursing employer within a year of starting work, and about 26% leave within two years. High turnover is an expense that can strain hospital budgets, exacerbate the nursing shortage, and negatively impact patient care.

The study, led Linda Honan Pellico, assistant professor at the School of Nursing, points to a divide between nurses’ idealistic expectations upon entering school and the realities they face in their first jobs. The report was published in the July/August issue of Nursing Outlook.

The researchers surveyed 612 new nurses from 34 states and the District of Columbia. They found that many novice nurses are dissatisfied with their first jobs due to a variety of unexpected situations they face in the primarily hospital-based environments where they begin their careers.

“Nurses are on the front lines of an increasingly demanding hospital work environment,” says Pellico. “Many feel they could be more effective caregivers to patients if they simply had more time to spend with them. Instead, they feel mounting pressure to rush through rounds and fill out paperwork, which is not why they chose to go into nursing.”

The nurses in the survey talked about the relentless pressure for speed and the difficulty of the many demands that are placed on them. They said that tasks in their first jobs do not reflect what they learned in nursing school. Many also expressed dissatisfaction with the lack of time they can spend with patients, while others felt their work was not appreciated by hospital physicians, administrators, and in some cases, more senior nurse managers. The nurses were particularly concerned with the communication patterns of those with whom they work.

The report also recommends that nursing schools give students a more realistic idea of the pressures and workload they are likely to face in their first jobs. Rather than working four- or six-hour shifts, student nurses should be scheduled for eight-hour shifts and be given responsibility for more patients, recommended the report, noting that once nurses get out of school, they are likely to face 12-hour shifts juggling four or more patients with complex medical conditions.

The students also say they would have benefited from more practice on communications skills and conflict resolution so they could interact effectively with physicians, make proper notes in patients’ charts, and handle shift changes.

Regardless of their negative perceptions, many of the nurses who responded to the survey felt hopeful that they could help reform work environments and patient care. Some suggested that improving the nurse-to-patient ratio was critical for improving professional satisfaction as well as patient safety. Several respondents stated that, in the face of these challenges, they love their work.

Despite the economic downturn and tightening job market, the U.S. health care system continues to face a projected shortfall of up to 260,000 full-time equivalent nurses by 2025. Understanding why nurses leave their jobs within the first 18 months of their careers could help hospital managers better direct resources and keep their workforces stable, while helping to improve hospital finances — and patient care — in the process, says Pellico.

The study was funded by the Robert Wood Johnson Foundation.

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