Young Registered Nurses’ Intent to Leave the Profession in Finland - A Mixed-Method Study

The purpose of this study was to examine and expand understanding concerning young Finnish registered nurses (RN) with an intention to leave the profession and the related variables, specifically when that intention has emerged before the age of 30. The overall goal of the study was to develop a conceptual model in relation to young RNs’ intention to leave the profession. Suggestions for policymakers, nurse leaders and nurse managers are presented for how to retain more young RNs in the nursing workforce. Suggestions for future nursing research are also provided. Phase I consists of two sequential integrative literature reviews of 75 empirical articles concerning nurses’ intention to leave the profession. In phase II, data had been collected as part of the Nurses’ Early Exit (NEXT) study, using the BQ-12 structured postal questionnaire. A total of 147 young RNs participated in the study. The data were analysed with statistical methods. In phase III, firstly, an in-depth interpretive case study was conducted in order to understand how young RNs explain and make sense of their intention to leave the profession. The data in this study consisted of longitudinal career stories by three young RNs. The data was analysed by using narrative holistic-content and thematic methods. Secondly, a total of 15 young RNs were interviewed in order to explore in-depth their experiences concerning organizational turnover and their intent to leave the profession. The data was analysed using conventional content analysis. Based on earlier research, empirical research on the young RNs intention to leave the profession is scarce. Nurses’ intention to leave the profession has mainly been studied with quantitative descriptive studies, conducted with survey questionnaires. Furthermore, the quality of previous studies varies considerably. Moreover, nurses’ intention to leave the profession seems to be driven by a number of variables. According to the survey study, 26% of young RNs had often considered giving up nursing completely and starting a different kind of job during the course of the previous year. Many different variables were associated with an intention to leave the profession (e.g. personal burnout, job dissatisfaction). According to the in-depth inquiries, poor nursing practice environments and a nursing career as a ‘second-best’ or serendipitous career choice were themes associated with young RNs’ intention to leave the profession. In summary, young RNs intention to leave the profession is a complex phenomenon with multiple associated variables. These findings suggest that policymakers, nurse leaders and nurse managers should enable improvements in nursing practice environments in order to retain more young RNs. These improvements can include, for example, adequate staffing levels, balanced nursing workloads, measures to reduce work-related stress as well as possibilities for advancement and development. Young RNs’ requirements to provide high-quality and ethical nursing care must be recognized in society and health-care organizations. Moreover, sufficient mentoring and orientation programmes should be provided for all graduate RNs. Future research is needed into whether the motive for choosing a nursing career affects the length of the tenure in the profession. Both quantitative and in-depth research is needed for the comprehensive development of nursing-turnover research.Nuorten sairaanhoitajien aikomus lähteä ammatistaan Suomessa – monimenetelmällinen tutkimus Tutkimuksen tarkoituksena oli selvittää nuorten sairaanhoitajien aikomusta lähteä ammatistaan ja siihen yhteydessä olevia tekijöitä erityisesti silloin, kun lähtöaikomukset olivat alkaneet ennen 30 vuoden ikää. Tutkimuksessa kehitettiin käsitteellinen malli kuvaamaan nuorten sairaanhoitajien ammatista lähtöaikomuksia ja siihen yhteydessä olevia tekijöitä. Lisäksi tulosten perusteella annettiin suosituksia poliitikoille, hoitotyön johtajille ja esimiehille, jotta useampi nuori sairaanhoitaja voitaisiin saada jäämään ammattiinsa. Suosituksia annettiin myös jatkotutkimukselle. Ensimmäisessä vaiheessa toteutettiin kaksi integroitua kirjallisuuskatsausta. Katsaukset sisälsivät yhteensä 75 empiiristä artikkelia ja ne käsittelivät hoitajien ammatista lähtöaikomuksia. Tutkimuksen toisessa vaiheessa analysoitiin kyselytutkimuksen aineistoa, joka oli kerätty eurooppalaisessa Nurses Early Exit (NEXT) tutkimuksessa. Yhteensä 147 suomalaisen nuoren sairaanhoitajan aineisto oli kerätty BQ 12 lomakkeella. Tämä aineisto analysoitiin tilastollisin menetelmin. Kolmannessa vaiheessa toteutettiin kaksi haastattelututkimusta. Ensin toteutettiin laadullinen tapaustutkimus, jotta voitiin lisätä ymmärrystä kokemuksista ja merkityksistä ammatista lähtöaikomuksiin liittyen. Tämän tutkimuksen aiheisto koostui kolmen sairaanhoitajan uratarinoista. Aineisto analysoitiin narratiivisella holistisella sisällönanalyysillä sekä teemallisella menetelmällä. Toisessa laadullisista tutkimuksista haastateltiin 15 sairaanhoitajaa organisaatiosta lähtemiseen ja ammatista lähtöaikomuksiin liittyen. Tämän teemahaastattelun aineisto analysoitiin sisällönanalyysillä. Aikaisempi tutkimus on osoittanut että empiirinen tutkimus koskien nuorten sairaanhoitajien ammatista lähtöaikomuksia on erittäin vähäistä. Hoitajien ammatista lähtöaikomuksia on tutkittu pääsääntöisesti määrällisin menetelmin ja kyselytutkimuksin. Lisäksi tutkimusten laatu vaihtelee. Aikaisempien tutkimusten mukaan monet eri tekijät ovat yhteydessä ammatista lähtöaikomuksiin. Kyselytutkimuksen mukaan noin joka neljäs (26%) sairaanhoitajista oli ajatellut ammatistaan lähtemistä vähintään muutaman kerran kuukaudessa kyselyä edeltäneen vuoden aikana. Tässä tutkimuksessa esimerkiksi uupumus ja työtyytymättömyys olivat yhteydessä ammatista lähtöaikomuksiin. Haastatteluissa nuoret kuvasivat huonon hoitotyön toimintaympäristön ja ammatinvalinnan toissijaisena tai sattumanvaraisena valintana olevan yhteydessä ammatista lähtöaikomuksiin. Yhteenvetona voidaan todeta ammatista lähtöaikomusten olevan monimutkainen ilmiö, johon on yhteydessä monia eri tekijöitä. Poliittisten päätöksentekijöiden, hoitotyön johtajien ja esimiesten tulisi kehittää hoitotyön toimintaympäristöä. Riittävä henkilöstömitoitus, tasapainoinen työkuormitus, työstressin vähentäminen sekä mahdollisuudet kehittyä ja edetä uralla ovat hyvän hoitotyön toimintaympäristön ominaispiirteitä ja ne voivat edesauttaa nuorten sairaanhoitajien pysymistä ammatissaan. Nuorten sairaanhoitajien halu toteuttaa korkealaatuista ja eettisesti kestävää hoitotyötä on huomioitava niin yhteiskunnassa kuin terveydenhuollon organisaatioissa. Lisäksi kaikille vastavalmistuneille tulisi tarjota riittävästi perehdytystä ja mentorointia. Jatkotutkimusta tarvitaan, jotta voidaan selvittää, onko ammatinvalinnan motiiveilla vaikutusta ammatissa pysymiseen. Sekä määrällistä että laadullista tutkimusta tarvitaan, jotta sairaanhoitajien lähtöaikomusten tutkimus kehittyy monipuolisesti jatkossaSiirretty Doriast

New graduate registered nurses' professional competence and the impact of preceptors' education intervention : a quasi-experimental longitudinal intervention study

Aims and objectives: The aim of this quasi-experimental longitudinal intervention study was to investigate new graduate nurses' professional competence development after preceptors' participation in an education intervention.Background: New graduate registered nurses are expected to be competent in many areas of nursing. Expectations that are sometimes unrealistic may cause a sense of inadequacy and stress, and this may in turn prevent them from fully deploying their competencies. Competence development is related to practice environment, occupational commitment, empowerment, and work experience. Orientation or transition programs have been designed to ensure new graduate nurses' competence, and preceptors and preceptorship could also have significant influence on their competence development.Design: A quasi-experimental longitudinal intervention study.Methods: The data was collected from October 2015 to November 2017. Participating wards were randomized into intervention and control groups. The intervention group preceptors had an eight-hour education intervention that focused on new employees' orientation, particularly from new graduates' point of view. Wards in the control group continued to precept as before. The Nurse Competence Scale was used for new graduates' self-assessment at baseline and at three-month and nine-month follow-up. This study is reported in accordance with the TREND Statement Checklist.Results: The education intervention aimed at preceptors did not have impact on the intervention group NGRNs' competence development. There were no statistically significant differences between the groups and effect size remained small.Conclusions: The preceptors' education intervention was not effective enough to develop new graduates' professional competence so that it would have differed from that of the graduates receiving conventional orientation at the university hospital. This study confirmed that competence development is a complex and multidimensional phenomenon and organizations should invest in new graduate registered nurses' competence development during their early career. Preceptors' education and development of preceptorship and transition programs are an important part of overall competence development in complex health care environments.Peer reviewe

Young Registered Nurses’ Intention to Leave the Profession and Professional Turnover in Early Career: A Qualitative Case Study

Peer reviewe

Psychological capital, grit and organizational justice as positive strengths and resources among registered nurses: A path analysis

Abstract Aim To examine registered nurses' individual strengths (psychological capital and grit) and an organizational resource (organizational justice) as well as associated work‐related outcomes. In a time of a global nursing shortage, there is an urgent need to identify strengths and resources that can have a positive impact on the health, well‐being and retention of registered nurses. Design A cross‐sectional survey. Methods A nationwide convenience sample of 514 registered nurses responded to a survey. Data were collected using a self‐reported questionnaire between March and May 2018. Data were analysed using descriptive statistics and multivariate path analysis. Results Participants rated their psychological capital and grit moderately high. Grit and organizational justice were found to have significant direct effects on psychological capital. Furthermore, psychological capital had positive direct effects on engagement and the perception of well‐conducted everyday nursing as well as negative direct effects on burnout, the stress of conscience and the intent to leave the profession. Conclusion The results suggest that nurse leaders and managers could consider improving registered nurses' well‐being with two complementary approaches. It might be useful to reinforce positive, individual strengths, such as psychological capital, and at the same time create more favourable nursing work environments, for example by strengthening organizational justice. Implications for the Profession Psychological capital and grit are emerging concepts in nursing workforce research. Identifying registered nurses' positive strengths and resources is important for inventing interventions that enhance nurses' engagement and well‐being as well as reduce turnover intentions. Impact Nurse leaders and managers play crucial roles in managing and developing registered nurses' individual strengths and organizational resources. This has gained even more importance now as the COVID‐19 pandemic could have a long‐term negative impact on nurses' well‐being. Reporting Method The study is reported following STROBE guidelines. Patient or Public Contribution No patient or public contribution