Elsevier

Nurse Education Today

Volume 36, January 2016, Pages 230-235
Nurse Education Today

Satisfaction with nursing education, job satisfaction, and work intentions of new graduate nurses

https://doi.org/10.1016/j.nedt.2015.10.023Get rights and content

Highlights

  • Principal components analysis revealed two job satisfaction dimensions.

  • Satisfaction with work environment predicted intention to leave the first job.

  • Satisfaction with nurse education had a small indirect effect on intention to leave.

  • Participation in a transition program substantially reduced intention to leave.

Summary

Background and Objective

In the context of predictions of future shortages of nurses, retaining new graduate nurses in the nursing workforce is essential to ensure sufficient nurses in the future. This paper investigates the links between satisfaction with nursing education and job satisfaction, and job dissatisfaction and intentions to leave a nursing job.

Design and Data Sources

It uses survey data from a cohort study of nursing students recruited through two Australian universities and followed after graduation and workforce entry.

Method

Structural equation modeling (SEM) was used to simultaneously estimate the impact of educational satisfaction (work preparation component) on job satisfaction and the impact of job satisfaction on the expectation of leaving the current job.

Results

Two job satisfaction sub-scales were identified: 1) work environment satisfaction and 2) work hours and wages satisfaction. Work preparation satisfaction was significantly and positively associated with both job satisfaction scales but only work environment satisfaction was significantly associated with the expectation to stay in the job; a one standard deviation increase in work environment satisfaction was associated with a 13.5 percentage point reduction in the probability of expecting to leave. The estimated effect of satisfaction with education on expecting to leave, occurring indirectly through job satisfaction, was small (reducing the probability by less than 3 percentage points for a 1 point increase in work preparation satisfaction). Participating in a graduate transition program had the largest effect, reducing the probability of expecting to leave by 26 percentage points, on average.

Conclusions

The study results suggest policies which focus on improving satisfaction with the work environment would be more effective at retaining nurses early in their career than improvements to conditions such as work hours and wages. Investment in new graduate transition programs would potentially have the largest impact on retention.

Introduction

The past two decades have seen a great deal of concern about the supply of nurses and projections for future shortages in the health care workforces of most developed countries including Australia (Buerhaus et al., 2009, Health Workforce Australia, 2012a, Oulton, 2006). The supply of appropriately qualified nurses is important for both the quality of healthcare (Aiken et al., 2012, Needleman et al., 2011, Needleman and Hassmiller, 2009) and for the sustainability of health systems where the expansion of nursing roles in primary care and preventive services is an important component of proposed reforms aimed at improving the efficiency and affordability of health systems (Productivity Commission, 2005, Rother and Lavizzo-Mourey, 2009). There is evidence that young and newly registered nurses are more likely to leave the profession than their more experienced counterparts (Barron and West, 2005, Doiron et al., 2008, Fochsen et al., 2006). As the nursing workforce is aging and increasing numbers of nurses are leaving the workforce due to retirement, retention of younger nurses is important to ensure the future supply of nurses.

The many reasons why nurses leave their job or intend to leave have been summarized in two literature reviews of the determinants of nurse turnover (Hayes et al., 2006, Hayes et al., 2012). These find consistent evidence supporting job dissatisfaction as an important factor contributing to nurse turnover and turnover intentions. In addition, expressed intent to leave was consistently associated with turnover, as was young age.

Studies of the experiences and job satisfaction of new graduate nurses have identified issues associated with the transition from student to registered nurse (Flinkman and Salanterä, 2014, Parker et al., 2014, Unruh and Nooney, 2011) and have associated work readiness with job satisfaction and intentions (Walker and Campbell, 2013). In Australia, registered nurses are educated at university, completing the bachelor of nursing (BN) degree in order to register. The BN program is 3 years fulltime and includes a clinical practice component where students complete placements in a hospital supported by a facilitator provided by the university. The design and quantity of clinical training received during the bachelor of nursing program varies throughout Australia, with the minimum requirement for registration being 800 hours of supervised clinical placement (a number of universities provide more than this) and the form the supervision takes is not prescribed (Mason, 2013).

Formal programs to facilitate the transition from student to registered nurse are widely used across many countries but vary considerably; even within Australia, programs vary considerably in size, content, and financial support (Levett-Jones, 2005). There is some evidence of transition program benefits in terms of graduate competence and retention, although the research regarding their successful features is inconclusive (Rush et al., 2013). In Australia, new graduate programs are provided by employers (mainly hospitals) and the availability of positions in these programs can vary depending on hospital budgets and the numbers of graduating students seeking positions. Recent Australian health workforce reviews have noted concerns about the capacity of new graduates to find employment (Mason, 2013) and the mismatch between the numbers of new graduates and the places in transition programs (Health Workforce Australia, 2012b).

Clinical practice experiences prior to graduation and the extent to which education prepares students for clinical nursing are also likely to contribute to the success of the transition, and there is some debate around the extent to which current educational programs in Australia produce work-ready graduates (Mason, 2013). Research from the United Kingdom and Ireland has also identified limitations in the clinical practice component of nurse education (Mooney, 2007, O’Driscoll et al., 2010). Previous research investigating satisfaction with nursing education (using baseline data from our study cohort) found that over one third of final-year students and new graduates were dissatisfied with their preparation for nursing work (Milton-Wildey et al., 2014). In the qualitative component of that study, students raised concerns regarding the adequacy of the clinical component of the bachelor of nursing course in terms of both the quantity of clinical hours and the level of support and supervision provided during the clinical placement. Some respondents referred explicitly to the impact of negative experiences during clinical placement on their career intentions (Milton-Wildey et al., 2014).

Although there is considerable evidence linking job satisfaction with nurse turnover, the evidence among new graduates is limited. In particular, there has been little investigation of the importance of the undergraduate educational program in preparing student nurses for the workforce and the extent to which this is related to job satisfaction and employment intentions in the early years following graduation. This paper reports an investigation of the degree to which graduates who were dissatisfied with their training and work preparation are also dissatisfied with their first job, and whether this flows on to intentions to leave the current employer and/or the nursing profession. The study examines satisfaction with different aspects of the job and the job overall, as well as participation in a new graduate transition program.

If there is an association between clinical education and an expectation of changing jobs after the first year of employment, it is unlikely to be a direct relationship; rather, it is anticipated that any relationship would be via the impact of education on job satisfaction, illustrated in Fig. 1. We would expect that graduates who are satisfied with the adequacy of their educational program in preparing them for their clinical role would have fewer problems with the transition from student to registered nurse. We expect this to be reflected in job satisfaction which would in turn impact on future work intentions.

Our hypotheses are therefore that:

  • Satisfaction with the educational program will be positively associated with job satisfaction

    • Specifically satisfaction with work preparation aspects of the educational program and satisfaction with aspects of the job which impact on coping at work

  • Job satisfaction will be negatively associated with the expectation of leaving the current job.

Section snippets

Sample and Data Collection

The sample included 204 registered nurses employed in their first job after graduating from the bachelor of nursing (BN) program at one of two Australian universities, a large metropolitan university (78%), and a smaller regional university (22%). The nurses were recruited to a longitudinal cohort study between 2008 and 2012 while undergraduate students and completed annual online surveys until 2014. The project was approved by the research ethics committees at both universities. The survey was

Results

The characteristics of the sample are reported in Table 3. The majority were female, aged between 20 and 30, spoke English at home, and were employed in a public hospital in a metropolitan area. For 68%, employment included a transition program for new graduates. Although most expected to continue working for the current employer in 1 year’s time, 28% expected to find different employment in nursing and 6% expected to find employment outside of nursing. In response to the question about

Discussion

The study examined the associations between satisfaction with nursing education, job satisfaction, and work intentions among new graduate nurses, expecting an indirect effect of satisfaction with education on job turnover intentions. We found this to be the case, although the effect was very small. We hypothesized that satisfaction with educational preparation for work would impact on the expectation of leaving the job through its effect on job satisfaction. We found work preparation

Conclusion

The study results suggest three main strategies to improve the retention of new graduates in nursing. First, policies which focus on improving satisfaction with the work environment, such as improving staffing levels, would be more effective at retaining early career nurses than improvements to conditions such as work hours and wages. The latter might be important at later career stages but does not appear to be the priority during the early stages. Second, improvements in work preparation

Acknowledgements

Other researchers made important contributions to the original cohort study which generated the data used in this analysis; Prof Denise Doiron and Prof Deborah Street were central to the design and conduct of the original cohort study, while Dr Kathleen Milton-Wildey and Dr Glenda Parmenter advised on survey content and facilitated student recruitment. The current analysis was supported by a University of Technology Sydney Business School Research Grant (Project code 2013001191). Cohort

References (33)

  • A.M. D'Ambra et al.

    Incivility, retention and new graduate nurses: an integrated review of the literature

    J. Nurs. Manag.

    (2014)
  • D. Doiron et al.

    Is there a crisis in nursing retention in New South Wales?

    Aust. N. Z. Health Policy

    (2008)
  • D. Doiron et al.

    Job preferences of students and new graduates in nursing

    Appl. Econ.

    (2014)
  • M. Flinkman et al.

    Early career experiences and perceptions – a qualitative exploration of the turnover of young registered nurses and intention to leave the nursing profession in Finland

    J. Nurs. Manag.

    (2014)
  • G. Fochsen et al.

    Predictors of leaving nursing care: a longitudinal study among Swedish nursing personnel

    Occup. Environ. Med.

    (2006)
  • J.F. Hair et al.

    Multivariate Data Analysis

    (2006)
  • Cited by (41)

    • Why nurses stay: Analysis of the registered nurse workforce and the relationship to work environments

      2020, Applied Nursing Research
      Citation Excerpt :

      Retention of these experienced nurses and their ability to mentor and nurture new nurses is very important to the healthcare profession and the patient population they serve. Unfortunately, new additions to the nursing workforce have shown rapid turnover rates, which escalate recruitment/orientation costs and lead to newly educated nurses leaving the profession (Bryant, 2017; Kenny, Reeve, & Hall, 2016; Samson, 2013; Silvestre, 2017). The financial components of recruitment and retention to replace these nurses have significant impact on health care systems and can leave staggering costs for what seems like little gains.

    • Determining the learning needs of new graduated nurses working in inpatient care institutions

      2020, Nurse Education Today
      Citation Excerpt :

      Studies show there is a correlation between competencies and work satisfaction. NGNs who define themselves as professionally incompetent have weak professional and occupational commitment and increased turnover rates (Parker et al., 2014; Lin et al., 2014; Numminen et al., 2015; Kenny et al., 2016). Communication is another aspect in which NGNs have difficulties and need to improve during the adaptation process.

    View all citing articles on Scopus
    1

    Tel.: + 61 2 8936 0922, + 61 2 8936 0920.

    2

    Tel.: + 61 2 95144718, + 61 2 95144730.

    View full text