DiversityNursing Blog

By Debra Wood

One out of every six newly licensed nurses (more than 17 percent) leave their first nursing job within the first year and one out of every three (33.5 percent) leave within two years. But not all nurse turnover is bad, according to a new study from the RN Work Project, funded by the Robert Wood Johnson Foundation.

“It seemed high,” said Carol S. Brewer, PhD, RN, FAAN, professor at the University at Buffalo School of Nursing and co-director of the RN Work Project, the only longitudinal study of registered nurses conducted in the United States. “Most of them take a new job in a hospital. We’ve emphasized who left their first job, but it doesn’t mean they have left hospital work necessarily.”

While many nursing leaders have voiced concern that high turnover among new nurses may result in a loss of those nurses to the profession, that’s not what the RN Work Project team has found. Most of those leaving move on to another job in health care.

“Not only are they staying in health care, they are staying in health care as nurses,” said Christine T. Kovner, PhD, RN, FAAN, professor at the New York University College of Nursing and co-director of the RN Work Project. “Very few leave. A tiny percent become a case manager or work for an insurance company, verifying people had the right treatment.”

Such outside jobs tend to offer better hours, with no nights or weekends. The nurses are still using their knowledge and skills but they are not providing hands-on care.

The RN Work Project looks at nurse turnover from the first job, and the majority of first jobs are in the hospital setting, Brewer explained. However, in the sample, nurses working in other settings had higher turnover rates than those working in acute care.

Kovner hypothesized that since new nurses are having a harder time finding first jobs in hospitals, they may begin their careers in a nursing home and leave when a hospital position opens up. On the other hand, those who succeed in landing a hospital job may feel the need to stay at least a year, because that’s what many nursing professors recommend. Hospitals also tend to offer better benefits, such as tuition reimbursement and child care, and hold an attraction for new nurses.

“Our students, if they could get a job in an ICU, they’d be happy, and the other place they want to work is the emergency room,” Kovner said. “They want to save lives, every day.”

The RN Work Project data excludes nurses who have left their first position at a hospital for another in the same facility, which is disruptive to the unit but may be a positive for the organization overall, since the nurse knows the culture and policies. The nurse may change to come off the night shift or to obtain a position in a specialty unit, such as pediatrics.

“That’s an example of the type of turnover an organization likes,” Kovner said. “You have an experienced nurse going to the ICU [or another unit].”

While nurse turnover represents a high cost for health care employers, as much as $6.4 million for a large acute care hospital, some departures of RNs is good for the workplace. Brewer, Kovner and colleagues describe the difference between dysfunctional and functional turnover in the paper, published in the journal Policy, Politics & Nursing Practice.

“Dysfunctional is when the good people leave,” Brewer said.

The RN Work Project has not differentiated between voluntary and involuntary departures, the latter of which may be due to poor performance or downsizing. And some nurse turnover is beneficial.

“If you never had turnover, the organization would become stagnant,” Kovner added. “It’s useful to have some people leave, particularly the people you want to leave. It offers the opportunity to have new blood come in.”

New nursing graduates might bring with them the latest knowledge, and more seasoned nurses may bring ideas proven successful at other organizations.

Once again, Brewer and Kovner report managers or direct supervisors play a big role in nurses leaving their jobs. Organizations hoping to reduce turnover could consider more management training for people in those roles.

“Leadership seems a big issue,” Brewer said. “The supervisor support piece has been consistent.”

Both nurse researchers cited the challenge of measuring nurse turnover accurately. Organizations and researchers often describe it differently, Brewer said. And hospitals often do not want to release information about their turnover rates, since nurses would most likely apply to those with lower rates, Kovner added. When assessing nurse turnover data, she advises looking at the response rate and the methodology used.

“There are huge inconsistencies in reports about turnover,” Kovner said. “It’s extremely important managers and policy makers understand where the data came from.”

Source: www.nursezone.com

A study in the current issue of Policy, Politics & Nursing Practice estimates 17.5% of newly licensed RNs leave their first nursing job within the first year and 33.5% leave within two years, according to a news release. The researchers found that turnover for this group is lower at hospitals than at other healthcare settings.

The study, which synthesized existing turnover data and reported turnover data from a nationally representative sample of RNs, was conducted by the RN Work Project, funded by the Robert Wood Johnson Foundation. The RN Work Project is a 10-year study of newly-licensed RNs that began in 2006. The study draws on data from nurses in 34 states, covering 51 metropolitan areas and nine rural areas. The RN Work Project is directed by Christine T. Kovner, PhD, RN, FAAN, professor at the College of Nursing, New York University, and Carol Brewer, PhD, RN, FAAN, professor at the School of Nursing, University at Buffalo. 

“One of the biggest problems we face in trying to assess the impact of nurse turnover on our healthcare system as a whole is that there’s not a single, agreed-upon definition of turnover,” Kovner said. “In order to make comparisons across organizations and geographical areas, researchers, policy makers and others need valid and reliable data based on consistent definitions of turnover. It makes sense to look at RNs across multiple organizations, as we did, rather than in a single organization or type of organization to get an accurate picture of RN turnover.”

According to the release, the research team noted that, in some cases, RN turnover can be helpful — as in the case of functional turnover, when a poorly functioning employee leaves, as opposed to dysfunctional turnover, when well-performing employees leave. The team recommends organizations pay attention to the kind of turnover occurring and point out their data indicate that when most RNs leave their jobs, they go to another healthcare job.

“Developing a standard definition of turnover would go a long way in helping identify the reasons for RN turnover and whether managers should be concerned about their institutions’ turnover rates,” Brewer said in the release. “A high rate of turnover at a hospital, if it’s voluntary, could be problematic, but if it’s involuntary or if nurses are moving within the hospital to another unit or position, that tells a very different story.” 

The RN Work Project’s data include all organizational turnover (voluntary and involuntary), but do not include position turnover if the RN stayed at the same healthcare organization, according to the release.

Source: http://news.nurse.com

By Megan Murdock Krischke

Why do new nurses often leave their jobs in the first year? And what can be done to keep their careers on track, improve nurse retention and keep the costly issue of turnover in check?

A new study published in the July-August issue of Nursing Economic$ may help to answer these questions.

A few years ago the North Shore-LIJ Health System (NSLIJ) in New York set out to identify some of the key reasons for nurse loss in the first year of employment and created a nurse residency program to counteract that loss. A team of nurses at NSLIJ monitored the before and after results in order to measure the efficacy of program.

“What we recognized was the way we were orienting new nurses wasn’t meeting the needs of this computer-minded generation,” said M. Isabel Friedman, DNP, MPA, RN, BC, CCRN, CNN, program director of nurse fellowship programs for the Center for Learning and Innovation at North Shore-LIJ Health System and the lead author on the study. “We created a program that met the needs of our new nurses and helped them transition from new graduate to functioning practitioner.”

This study looked particularly at the Pediatric Nurse Fellowship Program (PNFP) at Cohen Children’s Medical Center for pediatric critical care, pediatric emergency department and hematology/oncology specialties. This specialty orientation program was designed to bridge the gap between the novice nurse and the new high-acuity pediatric specialty while providing new graduate RNs with important mentoring and support tools.

“We found that when nurses feel supported, their loyalty to the hospital system increases,” Friedman explained. “Additionally, our new hires go through the fellowship program in cohorts of 5-10. The community and peer support offered by the cohort is a factor in increased retention.” 

The PNFP used a blended learning model. The core curriculum that nurses focused on during the initial weeks of the program was chosen from the curriculums offered by the national professional organization for each specialty. Each week had a theme, such as respiratory. Nurses then had seminars, skills and simulation labs, and clinical days that addressed that week’s topic. 

One of the key findings of the study was the effectiveness of having a senior nurse whose specific job it was to work with the cohort of fellows as they were transitioning to working in direct patient care.

“Study of our previous orientation showed that the transition from orientation to direct patient care in the six- to nine-month timeframe was when first year retention rates began to drop significantly. Having a senior nurse who could be by a nurse’s side as he or she did a new procedure, or easily available to ask questions, increased the confidence of our new nurses and the quality and safety of the care they provided.” Friedman stated. 

Friedman and her colleagues found that the nurse fellowship program decreased turnover significantly in the PICU and that general retention rates were statistically significant when comparing length of employment before and after the program was implemented. “As you can imagine this was good for the bottom line. When comparing expenses for the 2.5 years before instituting the PNFP and the 2.5 years following, there was a potential cost savings estimate of over $2 million.”

As an added bonus to increased nurse retention and cost savings, nurses who participated in the PNFP are showing a greater value for continuing their education through specialty certifications and pursuing master’s programs. 

“This program is easily adaptable for other specialties. We had our first residency program in adult critical care. In addition to the PNFP, we have fellowships in cardiac cath lab and labor and delivery nursing, as well as having a fellowship for nurse practitioners. Every fellowship cohort is altered to some degree in response to the feedback we receive from our fellows, preceptors and others involved in the program.” 

“One reason this particular manuscript was a good fit for Nursing Economic$ is because it addresses the measures, methods and metrics. If we are going to make a business case for caring we have to make sure that we have the data that supports nursing’s work. This article showed in black and white how what they were doing helped the bottom line,” remarked Donna M. Nickitas, PhD, RN, NEA-BC, CNE, editor of Nursing Economic$.

“It emphasizes what we have been saying all along: to have a healthy work environment, you have to have a healthy workforce,” Nickitas continued. “We need to make sure our nurses are more than adequately educated and trained. This study demonstrates that the PNRP is worth the investment in time, effort and finances.”

“I love the program and I love my fellows,” Friedman effused. “They are bright and capable young people and we owe it to ourselves to educate the next generation of people who are going to be taking care of us and our loved ones. It is a fabulous feeling to see their success and see them grow and become nurse managers and to see them continually aspire to bigger and better things.” 

For more information, see the Nursing Economic$ study:
“Specialized New Graduate RN Pediatric Orientation: A Strategy for Nursing Retention and Its Financial Impact”

Source: NurseZone.com