Career Intentions of Nursing Students and New Nurse Graduates: A Review of the Literature

Career Preferences among Nursing Students: A Cross-Sessional Study

Introduction

It is estimated that mores nurses are needed in the future, nursing students’ career preferences are important to contribute the shortage of nursing manpower in Macao. Little is known regarding the preferences for nursing students’ career preferences and related factors among nursing students.

Objective

To explore and investigate the career preferences and related factors among nursing students in Macao.

Methods

A descriptive, cross-sectional survey study design was adopted to assess career preferences and related factors among nursing students in Macao.

Results

In total, 217 nursing students completed surveys. The most favorite career preferences among nursing students were community health nursing, paediatric nursing, medical surgical nursing, and obstetric & gynecological nursing; while the least career preferences among nursing students were oncology and hospice nursing, mental health nursing, and ER nursing. Factors were related to “gender”, “education”, and “nursing is my first study preference” among Macao nursing students for career preferences.

Conclusion

The senior nursing students prefer working in community health nursing and the junior and female nursing students prefer working in pediatric nursing and obstetric and gynecological nursing. The more understandings of nursing students’ career preferences, the better nursing curriculum design and implication to promote nursing students’ intention for working in the least career preferences work.

Attracting Israeli nursing students to community nursing

BACKGROUND

The shift from inpatient care to community patient care has had an essential impact on the nursing profession. Despite the growing demand for community nurses in many countries, their number remains relatively low and many students do not perceive this field as an interesting career to pursue. In this review we aimed to understand if exposure of undergraduate nursing students to various nursing work settings during their studies affects their work setting choices after graduation.

METHODS

A literature search of papers relating to work setting preferences of nursing students in Israel and other countries was performed. Israel Ministry of Health, Nursing Administration documents and other related documents were also reviewed, with a focus on the nursing training program in Israel.

FINDINGS

While most first-year nursing students have limited knowledge regarding the profession, in later years, their preferences for post-graduation work settings are affected by their exposure to the various clinical fields through knowledge gained in courses together with clinical practice placements. In Israel, specific classroom courses in community nursing are allocated only 6% of the total time allocated to all classroom courses in nursing, and a single clinical placement in community nursing takes place during the third or fourth year of the nursing program, exposing students to a single aspect of community nursing during their nursing training. Studies in other countries have reported that students' experience during clinical placement contributes to shaping students' opinions of nurses' roles within that field. Nursing students who had a primary healthcare placement showed greater intention for working in this setting after graduation.

CONCLUSIONS

The lack of exposure to the various aspects of community nursing during undergraduate studies contributes to a lack of motivation for entering this field. Therefore, a profound change is needed in nursing training programs' curricula to prepare graduates to face future challenges in community nursing. Whilst both hospital and community nursing are equally important, nursing leaders and policy makers must be made aware of the various factors that contribute to new registered nurses' preferences of hospital over community nursing and build strategies for directing nurses to work in the community in order to respond to the expected nurse shortage in this setting.

Work-life interface and intention to stay in the midwifery profession among pre- and post-clinical placement students in Canada

BACKGROUND

Midwifery students' intention to stay in the profession can be influenced by how the interface of their work and personal life is affected by their clinical placement experience. The purpose of this study is to compare the intention to stay in the midwifery profession and its association with three work/personal life interface constructs among pre- and post-clinical placement midwifery students in Canada. The constructs investigated are work interference with personal life, personal life interference with work, and work/personal life enhancement.

METHODS

Quantitative cross-sectional data were collected through two separate online surveys completed by pre- and post-clinical placement students. In total, 456 midwifery students attending six different midwifery education programs responded to the surveys.

RESULTS

Compared to pre-clinical placement students, post-clinical placement students had significantly lower intention to stay in the profession. For pre-clinical placement students, higher personal life interference with work was significantly associated with lower intention to stay in the profession. For post-clinical placement students, higher work interference with personal life was associated with lower intention to stay in the profession. We did not find any significant relationships between work/personal life enhancement and intention to stay in the profession in pre- or post-clinical placement students.

CONCLUSION

Pre- and post-clinical placement students have different intentions to stay in the profession. For pre-clinical placement students, those who report that their personal lives highly interfere with work are less likely to want to stay in the midwifery profession. Post-clinical placement students reported that when working interfered with their personal lives they were less likely to want to stay in the profession. Our findings highlight the importance of offering students a realistic preview of the required commitment, workload, and personal involvement in the midwifery profession prior to applying or accepting a spot in a midwifery education program. Furthermore, facilitating the development of skills to better manage the expectations in midwifery work and personal lives might help with maintaining positive intentions to stay in the profession.

A cross-sectional study on preferred employment settings of final-year nursing students in Israel

BACKGROUND

Despite the growing demand for community nurses, their number remains relatively low. We examined perceptions of final-year nursing students regarding their preferred work setting after graduation and the factors affecting their choice.

METHODS

A cross-sectional survey using a structured questionnaire was developed specifically for this study. The questionnaire was distributed among fourth-year students from all nursing training frameworks across Israel.

RESULTS

Of 281 respondents (76.6% women, average age, 29.3 years), most (80.9%) preferred working in hospitals, while 5% preferred community settings; 14% were undecided. Students' knowledge on hospital nurses' tasks was greater compared to their knowledge on community nurses' tasks. Moreover, hospital nurses' tasks were perceived as more important than those of community nurses. The contribution of clinical placement in hospital nursing was perceived as significantly more meaningful than the contribution of clinical placement in community nursing. The vast majority of students (94.3%) stated that they would prefer to undergo a hospital nursing internship. A significant correlation was noted between students' clinical placement, the exposure to community nursing roles, and the perception of the community nurse's role: clinical placements that were perceived as a positive experience led to a more positive perception of community nurses' roles.

CONCLUSIONS

Nursing students' perception of community nursing is based upon limited information which does not reflect community nurses' actual role and work.

Preferences of nursing and medical students for working with older adults and people with dementia: a systematic review

BACKGROUND

A current issue in workforce planning is ensuring healthcare professionals are both competent and willing to work with older adults with complex needs. This includes dementia care, which is widely recognised as a priority. Yet research suggests that working with older people is unattractive to undergraduate healthcare students.

METHODS

The aim of this systematic review and narrative synthesis is to explore the factors related to healthcare (medical and nursing) student preferences' for working with older people and people with dementia. Searches were conducted in five databases: MEDLINE, PsycINFO, CINHAL, BNI, ERIC. Screening, data extraction and quality appraisal were conducted by two independent reviewers. A narrative, data-based convergent synthesis was conducted.

RESULTS

One thousand twenty-four papers were screened (139 full texts) and 62 papers were included for a narrative synthesis. Factors were grouped into seven categories; student characteristics, experiences of students, course characteristics, career characteristics, patient characteristics, work characteristics and the theory of planned behaviour.

CONCLUSION

Health educators should review their role in cultivating student interest in working with older adults, with consideration of student preparation and the perceived value of this work. There is a lack of evidence about the career preferences of students in relation to dementia, and this warrants further research.

Career interests of undergraduate nursing students: A ten-year longitudinal study

An understanding of students' career interests at entry and exit from undergraduate nursing programmes could inform decisions regarding curricula and clinical placements. Since 2006, the University of Auckland has surveyed healthcare students at entry to and exit from their respective programmes, collecting information on a range of demographic, and career-related factors. This article describes career interests of over 500 undergraduate nursing students in New Zealand over a ten-year period. All Bachelor of Nursing cohorts commencing between 2006 and 2016 were invited to complete a questionnaire which included questions about their career interests. In total 1875 questionnaires were completed (89% response rate). Among the overall cohort at entry, there was strongest interest for emergency care and child health, and least interest in older person's health. At exit, child health and surgery (general) were of strongest interest to the cohort, while older person's health remained of least interest. The analysis of the paired data (n = 564) identified decreases in interest for mental health and child health over the course of the programme, while there was an increased interest in primary health care. Changes in career interests indicate that education and clinical exposure to specialty areas during the programme may influence career interests.

Nursing students' experiences with clinical placement in residential aged care facilities: a systematic review protocol of qualitative evidence

REVIEW QUESTION/OBJECTIVE

The objective of this review is to analyze and synthesize the best available evidence on nursing students' experiences with clinical placement in residential aged care facilities.The specific review questions are.

Perceptions of community care and placement preferences in first-year nursing students: A multicentre, cross-sectional study

BACKGROUND

Despite increasing shortages of highly educated community nurses, far too few nursing students choose community care. This means that a strong societal problem is emerging that desperately needs resolution.

OBJECTIVES

To acquire a solid understanding of the causes for the low popularity of community care by exploring first-year baccalaureate nursing students' perceptions of community care, their placement preferences, and the assumptions underlying these preferences.

DESIGN

A quantitative cross-sectional design.

SETTINGS

Six universities of applied sciences in the Netherlands.

PARTICIPANTS

Nursing students in the first semester of their 4-year programme (n=1058).

METHODS

Data were collected in September-December 2014. The students completed the 'Scale on Community Care Perceptions' (SCOPE), consisting of demographic data and three subscales measuring the affective component of community care perception, perceptions of a placement and a profession in community care, and students' current placement preferences. Descriptive statistics were used.

RESULTS

For a practice placement, 71.2% of first-year students prefer the general hospital and 5.4% community care, whereas 23.4% opt for another healthcare area. Students consider opportunities for advancement and enjoyable relationships with patients as most important for choosing a placement. Community care is perceived as a 'low-status-field' with many elderly patients, where students expect to find little variety in caregiving and few opportunities for advancement. Students' perceptions of the field are at odds with things they believe to be important for their placement.

CONCLUSION

Due to misconceptions, students perceive community care as offering them few challenges. Strategies to positively influence students' perceptions of community nursing are urgently required to halt the dissonance between students' preference for the hospital and society's need for highly educated community nurses.

Graduate entry students' early perceptions of their future nursing careers

Graduate entry nursing programs designed for individuals with prior degrees in other disciplines are becoming increasingly popular internationally. They provide entry into nursing for people with unique skill-sets. Yet, little is known about why these individuals choose career change into nursing and what they expect from their new careers. This component of a larger study sought to explore graduate entry nursing students' short and longer term career intentions on commencement of their courses. A cross-sectional survey was used. Descriptive frequencies were used to analyse demographic data, while summative content analysis was used with the open-ended questions. Participants were drawn from eight cohorts of commencing students from enrolled in one graduate entry masters program in Australia between 2009 and 2015. Content analysis identified three main categories: professional role, work location, and work context. Longer term responses were categorised under four categories: professional role, work location, work context and personal and professional goals. Many students had clear directions about their future nursing careers. On graduation, many envisioned working in advanced roles or in clinical specialty areas, primarily in hospital settings. However, in the longer term, there was diversity among with many envisaging work outside traditional hospital settings, and some in other health disciplines.

Nurses' attitudes towards older people care: An integrative review

AIMS AND OBJECTIVES

To examine hospital nurses' attitudes towards caring for older adults and delineate associated factors contributing to their attitudes.

BACKGROUND

Population ageing is of international significance. A nursing workforce able to care for the ageing population is critical for ensuring quality older adult care. A synthesis of research related to nurses' attitudes towards older adult care is important for informing care quality and the nursing workforce issues.

METHODS

A systematic integrative review process guided the review. Cumulative Index of Nursing and Allied Health Literature and Medline databases were searched for primary research published between 2005-2017. A total of 1,690 papers were screened with 67 papers read in-depth and eight selected for this review that met the inclusion/exclusion criteria.

RESULTS

Nurses' held coexisting positive and negative attitudes towards generic and specific aspects of older adult care. Negative attitudes, in particular, were directed at the characteristics of older adults, their care demands or reflected in nurses' approaches to care. Across jurisdictions, work environment, education, experience and demographics emerged as influences on nurses' attitudes.

CONCLUSION

There is a paucity of research examining nurses' attitudes towards older adult care. The limited evidence indicates that attitudes towards older people care are complex and contradictory. Influences on nurses' attitudes need further study individually and collectively to build a strong evidence base. Interventional studies are needed as are the development of valid and reliable instruments for measuring nurses' attitudes towards older adult care.

RELEVANCE TO CLINICAL PRACTICE

Bolstering postgraduate gerontological preparation is critical for promoting nurses' attitudes towards older adult care. Creating age-friendly work environments, including appropriate resource allocation, is important to support older people care and facilitate positive nursing attitudes.

Nurses' Burnout: The Influence of Leader Empowering Behaviors, Work Conditions, and Demographic Traits

Nurse burnout is a widespread phenomenon characterized by a reduction in nurses' energy that manifests in emotional exhaustion, lack of motivation, and feelings of frustration and may lead to reductions in work efficacy. This study was conducted to assess the level of burnout among Jordanian nurses and to investigate the influence of leader empowering behaviors (LEBs) on nurses' feelings of burnout in an endeavor to improve nursing work outcomes. A cross-sectional and correlational design was used. Leader Empowering Behaviors Scale and the Maslach Burnout Inventory (MBI) were employed to collect data from 407 registered nurses, recruited from 11 hospitals in Jordan. The Jordanian nurses exhibited high levels of burnout as demonstrated by their high scores for Emotional Exhaustion (EE) and Depersonalization (DP) and moderate scores for Personal Accomplishment (PA). Factors related to work conditions, nurses' demographic traits, and LEBs were significantly correlated with the burnout categories. A stepwise regression model-exposed 4 factors predicted EE: hospital type, nurses' work shift, providing autonomy, and fostering participation in decision making. Gender, fostering participation in decision making, and department type were responsible for 5.9% of the DP variance, whereas facilitating goal attainment and nursing experience accounted for 8.3% of the PA variance. This study highlights the importance of the role of nurse leaders in improving work conditions and empowering and motivating nurses to decrease nurses' feelings of burnout, reduce turnover rates, and improve the quality of nursing care.

Factors associated with the choice of public health service among nursing students in Thailand

Background

Despite the fact that public and private nursing schools have contributed significantly to the Thai health system, it is not clear whether and to what extent there was difference in job preferences between types of training institutions.

This study aimed to examine attitudes towards rural practice, intention to work in public service after graduation, and factors affecting workplace selection among nursing students in both public and private institutions.

Methods

A descriptive comparative cross-sectional survey was conducted among 3349 students from 36 nursing schools (26 public and 10 private) during February-March 2012, using a questionnaire to assess the association between training institution characteristics and students’ attitudes, job choices, and intention to work in the public sector upon graduation. Comparisons between school types were done using ANOVA, and Bonferroni-adjusted multiple comparisons tests. Principal component analysis (PCA) was used to construct a composite rural attitude index (14 questions). Cronbach’s alpha was used to examine the internal consistency of the scales, and ANOVA was then used to determine the differences. These relationships were further investigated through multiple regression.

Results

A higher proportion of public nursing students (86.4% from the Ministry of Public Health and 74.1% from the Ministry of Education) preferred working in the public sector, compared to 32.4% of students from the private sector (p = <0.001). Rural upbringing and entering a nursing education program by local recruitment were positively associated with rural attitude. Students who were trained in public nursing schools were less motivated by financial incentive regarding workplace choices relative to students trained by private institutions.

Conclusions

To increase nursing workforce in the public sector, the following policy options should be promoted: 1) recruiting more students with a rural upbringing, 2) nurturing good attitudes towards working in rural areas through appropriate training at schools, 3) providing government scholarships for private students in exchange for compulsory work in rural areas, and 4) providing a non-financial incentive package (e.g. increased social benefits) in addition to financial incentives for subsequent years of work.

Music Therapy Training for Undergraduate Nursing Students: A Modality to Foster Interest in Gerontological Nursing

HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Music Therapy Training for Undergraduate Nursing Students: A Modality to Foster Interest in Gerontological Nursing" found on pages 25-31, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until May 31, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Identify the worldwide shortage of nurses specializing in gerontological nursing. 2. Describe the results of using music therapy to create positive attitudes toward older adults. DISCLOSURE STATEMENT Neither the planners nor the authors have any conflicts of interest to disclose. Nursing students generally have a negative attitude toward older adults. Preparing nurses to meet the care needs of an expanding aging population is a challenge for nursing educators. The purpose of the current study was to explore whether incorporating music therapy into a practical geriatric nursing course at a nursing home cultivates positive attitudes toward older adults, raises students' willingness to work with older adults, and increases their interest in specializing in gerontological nursing after graduation. Focus groups were conducted to collect data from three participant groups (N = 20). Verbatim transcripts of audiorecorded interviews were analyzed using content analysis, which revealed four themes: (a) better appreciation and understanding of music therapy, (b) role modeling instructors' successful experience and positive attitude toward older adults, (c) changing attitudes toward older adults, and (d) improving interaction skills with older adults. Results suggested music can be integrated into a gerontological nursing course to enhance students' motivation to learn, empathize, and approach older adults. [Journal of Gerontological Nursing, 42(6), 25-31.].

Nurses' attitudes towards older people and working with older patients: an explanatory model

AIM

To establish an explanatory model of registered nurses' attitudes towards older people and working with older patients.

BACKGROUND

Increasing demands for health-care from an ageing population will require a higher proportion of nurses who have positive attitudes towards older people and like working with older patients.

METHOD

A convenience sample of registered nurses (n = 579; 79.3% response rate) attending continuing professional education courses within a large university in London was surveyed from October to December 2011.

RESULTS

Registered nurses expressed positive attitudes towards older people and 89.7% reported positive attitudes towards working with older patients. The variables of self-ageing anxiety, attitudes towards health-care resource allocation, knowledge of ageing, ethnic group, job title, attitudes towards older patients and interaction between ethnic group and attitudes towards working with older patients explained 42.6% of the variance in attitudes towards older people. Factors, including attitudes towards older people, self-ageing anxiety, commitment to nursing, attitudes towards health-care resources allocation among older people and clinical specialty explained 16.7-34.3% of the variance in attitudes towards older patients.

CONCLUSION

The models identified several related factors that may help in the selection and management of nurses for caring older people.

IMPLICATIONS FOR NURSING MANAGEMENT

Our findings highlight the importance of investing in continuing education related to gerontological nursing and the ageing process so that there is a growing pool of registered nurses who wish to care for older patients.

The uniqueness of elderly care: registered nurses' experience as preceptors during clinical practice in nursing homes and home-based care

The expected shortage of registered nurses with an advanced degree as specialists in geriatric care or gerontology is imminent. Previous studies report that clinical practice where student nurses are supervised by registered nurses has a direct impact on how students perceive nursing as a profession and future career choice. Considering the anticipated need for well-educated and specialised nurses it is therefore, relevant as well as necessary to describe clinical learning with a focus on preceptorship in geriatric nursing care. This paper is a report of a study describing registered nurses' experience of precepting undergraduate student nurses during clinical practice in nursing homes and home-based care. A qualitative design, based on seven focus group interviews, was employed with 30 registered nurses with preceptor experience from nursing homes and home-based care for the elderly. Our findings present three precepting strategies that are unique to elderly care: preparing students for end of life care, facilitating a respectful approach to the older person and promoting creativity and independent work. The findings are discussed using a socio-cultural perspective and illustrate how communities of elderly practice can be valuable learning environments.

The influence of empowerment and incivility on the mental health of new graduate nurses

AIM

To test a model based on Kanter's theory of structural empowerment, which examines the relationships between new graduate nurses' perceptions of structural empowerment, workplace incivility and mental health symptoms.

BACKGROUND

The initial years of practice can be particularly stressful for new graduate nurses, who may be particularly vulnerable to uncivil behaviour as a result of their status in the work environment. Disempowerment and incivility in the workplace may compound the mental health symptoms experienced by new graduate nurses.

METHOD

A predictive, non-experimental design was used to examine the relationship between structural empowerment, workplace incivility and mental health symptoms in a sample of new graduate nurses working in hospital settings in Ontario (n = 394).

RESULT

High levels of structural empowerment were significantly associated with fewer negative mental health symptoms in new graduates. However, co-worker incivility and supervisor incivility partially mediated the effect of structural empowerment on new graduate nurses' mental health symptoms.

CONCLUSION

The findings suggest that empowering workplaces contribute to lower mental health symptoms in new graduate nurses, an effect that is diminished by incivility.

IMPLICATIONS FOR NURSING MANAGEMENT

Strategies that foster empowering work conditions and reduce uncivil behaviour are needed to promote positive mental health in new graduate nurses.

A prospective study of nurses' intentions to leave the profession during their first five years of practice in Sweden

BACKGROUND

Nursing turnover continues to be a problem for healthcare organizations. Longitudinal research is needed in order to monitor the development of turnover intentions to leave the profession over time.

OBJECTIVE

The objectives were: (1) to investigate the prevalence of new graduates' intentions to leave the nursing profession, (2) to prospectively monitor the development of intention to leave during the first five years of professional life, and (3) to study the impact of sex, age, occupational preparedness and burnout (i.e. exhaustion and disengagement) on the development of intention to leave the profession.

DESIGN

Longitudinal observational study.

PARTICIPANTS

Participants were recruited from first-year nursing students at any of the 26 universities in Sweden offering nursing education. Of the 2331 student nurses who were invited to participate in the study, 1702 (73%) gave informed consent and thus constituted the cohort. This cohort was prospectively followed yearly (three times during education and five times post graduation) from late autumn 2002 to spring 2010. Of the 1501 respondents who continued to participate after graduating, 1417 worked as nurses at the time of data collection and responded to the items regarding intention to leave the nursing profession during at least one wave of measurement; these constituted the sample of the present longitudinal study.

METHODS

The outcome variable was intention to leave the nursing profession. This was measured using a scale of three items, covering thoughts of leaving the profession. The main predictor was burnout, and this was measured by the exhaustion and disengagement scale from the Oldenburg Burnout Inventory. Data were analysed using latent growth curve modelling.

RESULTS

After five years, every fifth nurse strongly intended to leave the profession. The longitudinal analysis of change in intention to leave showed that levels increased during the first years of employment. High levels of burnout were related to an increase in intention to leave.

CONCLUSION

It is important for organizations employing new graduates to pay attention to nurses who show early signs of burnout, and provide a resourceful work environment with a suitable workload, sufficient introduction, management support, satisfactory collaboration with colleagues, and role clarity.

Workplace empowerment and nurses' job satisfaction: a systematic literature review

AIMS

This systematic review aimed to synthesize and analyse the studies that examined the relationship between nurse empowerment and job satisfaction in the nursing work environment.

BACKGROUND

Job dissatisfaction in the nursing work environment is the primary cause of nursing turnover. Job satisfaction has been linked to a high level of empowerment in nurses.

EVALUATION

We reviewed 596 articles, written in English, that examined the relationship between structural empowerment, psychological empowerment and nurses' job satisfaction. Twelve articles were included in the final analysis.

KEY ISSUE

A significant positive relation was found between empowerment and nurses' job satisfaction. Structural empowerment and psychological empowerment affect job satisfaction differently.

CONCLUSION

A satisfying work environment for nurses is related to structural and psychological empowerment in the workplace. Structural empowerment is an antecedent of psychological empowerment and this relationship culminates in positive retention outcomes such as job satisfaction.

IMPLICATION FOR NURSING MANAGEMENT

This review could be useful for guiding leaders' strategies to develop and maintain an empowering work environment that enhances job satisfaction. This could lead to nurse retention and positive organisational and patient outcomes.

Ageism among health care providers and interventions to improve their attitudes toward older adults: an integrative review

The purpose of this study was to review relevant literature on ageism among health care providers and assess interventions used to improve their attitudes toward older adults. Literature published between 1983 and 2011 was reviewed using the keywords attitudes, older adults, nursing, and nursing students using CINAHL, MEDLINE, and the Education Resources Information Center. Previous relevant research is discussed and includes studies categorized according to health care provider populations: (a) nurses, (b) nursing students, (c) medical students, and (d) direct care workers. Studies in nursing and medical professions that highlight ageism have been conducted; however, there is a gap in the literature concerning ageism among direct care workers. This often neglected, yet critical population of health care providers is essential to the care of older adults; recommendations regarding their training and mentoring are emphasized.

Graduating nursing students' perceived preparedness for working in critical care areas

AIMS

This article reports a study examining the relationships between undergraduate students' demographics, educational preparation and clinical experience and their self reported preparedness for employment in critical care.

BACKGROUND

Increasing demand for critical care services internationally, creates a need to grow the critical care nursing workforce. Limited data are available on factors affecting new graduate nurses' career choices.

METHODS

Final year nursing students from a multi-campus Australian University were surveyed during 2009.

RESULTS

Over half of the participants were interested in seeking employment in critical care following graduation. Main reasons for choosing critical care nursing were: (i) like varied and challenging work; (ii) opportunities for professional development; and (iii) like working one-on-one with patients. The main barriers identified by participants were related to the lack of knowledge and clinical skills required to work in critical care. Using the 9-item confidence and interest in critical care nursing scale, the study revealed that male participants and those who spent more than 1 week clinical placement in critical care were significantly more likely to report greater confidence and interest in seeking employment in critical care areas.

CONCLUSIONS

The value of placing nursing students in critical care areas for more than 1 week during undergraduate clinical placements is affirmed. Whilst most final year students report feeling prepared to work in critical care areas, the next step is to explore the transition of students as new graduates in critical care to identify professional and educational issues that impact on their retention.

Workplace empowerment, incivility, and burnout: impact on staff nurse recruitment and retention outcomes

AIM

The aim of this study was to examine the influence of empowering work conditions and workplace incivility on nurses' experiences of burnout and important nurse retention factors identified in the literature.

BACKGROUND

A major cause of turnover among nurses is related to unsatisfying workplaces. Recently, there have been numerous anecdotal reports of uncivil behaviour in health care settings.

METHOD

We examined the impact of workplace empowerment, supervisor and coworker incivility, and burnout on three employee retention outcomes: job satisfaction, organizational commitment, and turnover intentions in a sample of 612 Canadian staff nurses.

RESULTS

Hierarchical multiple linear regression analyses revealed that empowerment, workplace incivility, and burnout explained significant variance in all three retention factors: job satisfaction (R(2) = 0.46), organizational commitment (R(2) = 0.29) and turnover intentions (R(2) = 0.28). Empowerment, supervisor incivility, and cynicism most strongly predicted job dissatisfaction and low commitment (P < 0.001), whereas emotional exhaustion, cynicism, and supervisor incivility most strongly predicted turnover intentions.

CONCLUSIONS

In our study, nurses' perceptions of empowerment, supervisor incivility, and cynicism were strongly related to job satisfaction, organizational commitment, and turnover intentions.

IMPLICATIONS FOR NURSING MANAGEMENT

Managerial strategies that empower nurses for professional practice may be helpful in preventing workplace incivility, and ultimately, burnout.

Journal writing: a teaching strategy for gerontology nursing courses

Journal writing, recognized as a valuable method to augment and enrich learning, has been used in adult education, higher education, and in the health care professions. Journal writing promotes reflective thought and increases awareness. This article describes how journal writing was used in the gerontology rotation of an associate degree nursing program to engage students in the content, encourage examination of personal beliefs, recognize biases, and reflect on perceptions about older adults.

The impact on nurses and nurse managers of introducing PEPFAR clinical services in urban government clinics in Uganda

BACKGROUND

Improving provider performance is central to strengthening health services in developing countries. Because of critical shortages of physicians, many clinics in sub-Saharan Africa are led by nurses. In addition to clinical skills, nurse managers need practical managerial skills and adequate resources to ensure procurement of essential supplies, quality assurance implementation, and productive work environment. Giving nurses more autonomy in their work empowers them in the workplace and has shown to create positive influence on work attitudes and behaviors. The Infectious Disease Institute, an affiliate of Makerere University College of Health Science, in an effort to expand the needed HIV services in the Ugandan capital, established a community-university partnership with the Ministry of Health to implement an innovative model to build capacity in HIV service delivery. This paper evaluates the impact on the nurses from this innovative program to provide more health care in six nurse managed Kampala City Council (KCC) Clinics.

METHODS

A mixed method approach was used. The descriptive study collected key informant interviews from the six nurse managers, and administered a questionnaire to 20 staff nurses between September and December 2009. Key themes were manually identified from the interviews, and the questionnaire data were analyzed using SPSS.

RESULTS

Introducing new HIV services into six KCC clinics was positive for the nurses. They identified the project as successful because of perceived improved environment, increase in useful in-service training, new competence to manage patients and staff, improved physical infrastructure, provision of more direct patient care, motivation to improve the clinic because the project acted on their suggestions, and involvement in role expansion. All of these helped empower the nurses, improving quality of care and increasing job satisfaction.

CONCLUSIONS

This community-university HIV innovative model was successful from the point of view of the nurses and nurse managers. This model shows promise in increasing effective, quality health service; HIV and other programs can build capacity and empower nurses and nurse managers to directly implement such services. It also demonstrates how MakCHS can be instrumental through partnerships in designing and testing effective strategies, building human health resources and improving Ugandan health outcomes.

Learning pathways in contemporary primary care settings - student nurses's views

Workforce planning to address nursing supply along with curriculum change affecting practice placements has acted as key drivers shaping learning resources for student nurses within Aberdeen Community Health Partnership. As part of their learning, students are afforded the opportunity to visit a range of contemporary primary care settings such as public health, specialist nurses and NHS 24 on what are known as 'pathway experiences'. This research adopted a qualitative approach using focus group interviews to discover students' learning as a result of this initiative. Two main themes emerged, these being 'Healthcare contexts' and 'Nursing know-how'. Students developed a greater awareness and understanding about the delivery of healthcare in primary care settings and they expanded their nursing knowledge and skills. While students valued the experience, they also thought pathways fragmented their time at the base placement and detracted from gaining the practical nursing skills they considered of prime importance in their transit towards qualifying and working within a clinical setting. Implications for the future development of the pathway initiative are discussed.

Turnover intention in new graduate nurses: a multivariate analysis

Title

Turnover intention in new graduate nurses: a multivariate analysis

Aim

This paper is a report of a study to determine the relationship of new nurse turnover intent with individual characteristics, work environment variables and organizational factors and to compare new nurse turnover with actual turnover in the 18 months of employment following completion of a residency.

Background

Because of their influence on patient safety and health outcomes nurse turnover and turnover intent have received considerable attention worldwide. When nurse staffing is inadequate, especially during nursing shortages, unfavourable clinical outcomes have been documented.

Method

Prospective data collection took place from 1999 to 2006 with 889 new paediatric nurses who completed the same residency. Scores on study instruments were related to likelihood of turnover intent using logistic regression analysis models. Relationships between turnover intent and actual turnover were compared using Kaplan–Meier survivorship.

Results

The final model demonstrated that older respondents were more likely to have turnover intent if they did not get their ward choice. Also higher scores on work environment and organizational characteristics contributed to likelihood that the new nurse would not be in the turnover intent group. These factors distinguish a new nurse with turnover intent from one without 79% of the time. Increased seeking of social support was related to turnover intent and older new graduates were more likely to be in the turnover intent group if they did not get their ward choice.

Conclusion

When new graduate nurses are satisfied with their jobs and pay and feel committed to the organization, the odds against turnover intent decrease.

What is already known about this topic

There is concern in many countries about nurse turnover and the resulting effects on patient safety and quality of care.

Decreasing ability to recruit experienced nurses has increased the emphasis on recruitment of new graduate nurses, particularly in the United States of America.

Historically, new graduate nurses have a high turnover rate within the first year of employment.

What this paper adds

When new graduate nurses are satisfied with their jobs and pay and feel committed to the organization, the odds of turnover intent decrease.

Increased seeking social support to cope with the transition from student to competent Registered Nurse is related to turnover intent.

Older graduates (>30) are 4·5 times more likely to have turnover intent if they do not get their ward of choice.

Newly licensed RNs' characteristics, work attitudes, and intentions to work

OBJECTIVE

In an effort to better understand turnover rates in hospitals and the effect of new nurses on them, this study sought to describe the characteristics and attitudes toward work of newly licensed RNs, a population important to both the nursing profession and the health care system.

METHODS

A survey was mailed to a random sample of new RNs in 35 states and the District of Columbia. A total of 3,266 returned surveys met the inclusion criteria, for a response rate of 56%. RNs who qualified had completed the licensing examination and obtained a first license between August 1, 2004, and July 31, 2005. Data pertaining to four areas were collected: respondent characteristics, work-setting characteristics, respondents' attitudes toward work, and job opportunities. Respondents who were not working were asked to specify why.

RESULTS

Of the eligible newly licensed RNs, 58.1% had an associate's degree, 37.6% had a bachelor's degree, and 4.3% had a diploma or a master's or higher degree as their first professional degree. They were generally pleased with their work groups but felt they had only moderate support from supervisors. About 13% had changed principal jobs after one year, and 37% reported that they felt ready to change jobs. More than half of the respondents (51%) worked voluntary overtime, and almost 13% worked mandatory overtime. Also, 25% reported at least one on-the-job needlestick in a year; 39%, at least one strain or sprain; 21%, a cut or laceration; and 46%, a bruise or contusion; 62% reported experiencing verbal abuse. A quarter of them found it "difficult or impossible" to do their jobs at least once per week because of inadequate supplies.

CONCLUSIONS

This study provides descriptive evidence that a majority of newly licensed RNs are reasonably satisfied and have no plans to change jobs, but the group is not homogeneous. The negative attitudes expressed in response to some survey questions suggest that newly licensed RNs may not remain in the acute care settings where they start out. Investing in better orientation and management may be the key to retaining them in hospitals. The authors will be following these RNs for two years and will develop predictive models of turnover rates.