Satisfaction with nursing education, job satisfaction, and work intentions of new graduate nurses
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:
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Satisfaction with the educational program will be positively associated with job satisfaction
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Specifically satisfaction with work preparation aspects of the educational program and satisfaction with aspects of the job which impact on coping at work
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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
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