Exploring nurses' intentions to leave the profession


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  • At approx. 118.000 in U.S., Expected to grow to 300,000 Aging population, living longer with chronic illnesses, many nurses of retirement age, only 10% under age of 30 Lower nurse to patient ratios decrease surgical patient mortality, costly for org.11 & 50% have indicated an intention to leave92% of nurses are female, less than 11% identified themselves as non-white, Hispanic or Latino
  • Many studies have been conducted from the point of view of organizations and the relationship of job satisfaction to job turnover, but few studies have been conducted from the individual experiences of registered nurses. Few research studies conducted qualitatively on leaving nursing profession and none using feminist frameworks
  • with particular attention to the fact that the profession of nursing is predominantly female and analyzing whether the presence of gender was visible in the findings
  • Snowball sampling.
  • 11 participants (Interviews June-Aug. 2010), chose own pseudonymsAges from 29-59, years of experience from 3-33 Education in nursing: diploma (4), Associate degree (3), Baccalaureate degree (3), Master’s degree (1)4 participants had degrees in other fieldsWork Environment: various settings
  • Will discuss findings that most saliently deal with issues related to communication and briefly highlight their importance
  • Family influenced career choice and work choicesfelt guilty if obligation to care not met-”brunt of childcare on women”-women more compassionate caregivers-having responsibility for children as single momsMillie said, I always was told I was going to be a nurse. My mother told me that just as a little girl, that, you know, I was so caring, and I had such a compassion for little kids. So she thought, um, she-well, and I thought. But she just always said to me, ‘You’re going to make a great nurse.’ And so it was always in my mind that that’s what I was going to do. And that’s what I was going to be in life, was a nurse. “My mom always wanted to be a nurse. Maybe I thought I wanted to be a nurse all the time because it was my mom telling me I wanted to be a nurse.” -Supports lit on influence of gender role socialization and reason for entering nursing is desire to care for othersNursing situated in a discourse of care and the inability to accomplish this work is a source of dissatisfaction
  • Power dynamics were reflected through communicationThe participants shared many examples of feeling unsupported in the work environment, and they felt their voices were not heard when they attempted to address concerns, propose solutions, or verbalize their perspectives. Felt Positioned low on hierarchySuggestions “filtered”Power reflected as being overPresence of hierarchical observation=being watched which affected actions, particularly in respect to documentation and reporting overtimeLack of opportunities for advancement and education-excluded from developing knowledgeMen have more opportunities at work, more men would improve positionalityRose stated, “They want nurses to be more autonomous, more independent but then they run after us and tell us what to do.” Being positioned low on the hierarchy instilled a fear of repercussions and fear for job security among the participants. The current job market for nurses is not as open as it was a few years ago and some of the participants acknowledged that the current attitude amongst employers was “If you don’t like it, you can work somewhere else, but good luck getting a job.” she perceived that the low positionality of nursing influenced communication between physicians and nurses. She said, “Years ago, they treated us like handmaidens and you had to learn if something was wrong how to say it and let them think it was their idea.” “It’s now become if the patient says something negative about you, it doesn’t matter whether you’ve been doing the right thing, it’s that the patient said something bad about you. Now it’s customer service, customer service. You have to watch every word you say and exactly how you say it and the look on your face.”I just think, nursing doesn’t have a spokesperson anymore, they don’t have unions… there’s no, no one to really speak for us but the women that do the work....It’s kind of like they are not taken seriously. They’ll speak up to the nurse manager, but it gets filtered at that level what goes on to the rest it’s what. Nurses need to have a stronger voice. 2 participants had left previous nursing positions because they felt they were not listened to. Jewelrylady stated that a lack of voice leads to burnout.
  • Patient care is the “least that you do”Communication in healthcare has become electronic!!!Regardless of work environment, workload was reported as being high and difficult to accomplish—supports previous researchTechnology and physical environment new findings; more important that everything be documented even if you don’t do it.Creates a barrier between the patient and the nursehierarchical observation and normalizing judgment further reinforced with electronic documentationNursing in a caring discourse, objectiveness emphasized over subjective, emotional aspects of workYou spend all of your time like at the computer now. And it’s so important that everything be documented, documented, documented. It’s almost as important that you document it even if you don’t do it.” “There’s something that changed with the interaction and it puts a barrier there….It’s a symbol of where we are, we don’t interact.” Highlights that caring discourse not valued in work environment and caring practices are not supportedConformity to task/time imperatives
  • Lack of effective communicationSharing can be therapeutic—few opportunities to debrief.Need to have an understanding of other’s perspectivesSupports previous work on importance of collegiality and expands knowledge on role of stress in leaving professionMale nurses can mediate relationships, better communicatorsfelt that patients were sometimes judged unfairly for having different values and beliefs, which could negatively affect their care.Mary feels that her role with families is “to direct them to do things right” and “you can’t force your beliefs on how to do it on them.” Deedee finds it very “disappointing” that “people are very judgmental” It’s mean and hateful and you don’t know their story. And when you find out their story…I have not met a mother yet who was on drugs that said, ‘I’m really glad that my baby is off the wall. I’m really glad that I did this to my baby.’ Language influences discourse, which is socioculturally constructed—how are nurses socialized? Women?
  • The influence of gender was visible in conversations about family, career choice, communication patterns between womendecisions impacted by dominant structures in organizations
  • Include discussions of feminism and feminist theories in nursing education, discussion history of nursing; raise consciousness of how gender influences many aspects of workIncrease dialogue in the classroom—encourage the development of voice; teaching techniques are often passiveTeaching self-nurturance and providing opportunities to debrief More opportunities for education and professional developmentPSF: valuable framework for studying career turnover and workplace experiencesNormalizing judgementfeminist frameworks have not been extensively used to study issues related to human resource development (Bierema, Tisdell, Johnson-Bailey, & Gedro, 2002),Discussion of feminism theories in nursing education, organizational hierarchies, dialogue  Foundation to explore career turnover—organizational theories typically only discuss power as present in a hierarchy -useful to explore technology and power dynamics
  • Exploring nurses' intentions to leave the profession

    1. 1. An exploration of registered nurses’ intentions to leave the profession <br />Stacy Lutter, D.Ed., MSN, RN-BC<br />Assistant Professor of Nursing<br />York College of Pennsylvania<br />slutter@ycp.edu<br />
    2. 2. Background<br />What is the current shortage of registered nurses?<br />Shortage predictions<br />Impact on healthcare<br />Complicating factors<br />What is the current composition of the nursing workforce?<br />What are the reasons nurses leave nursing? <br />
    3. 3. Statement of the Problem<br /> “It is not a matter of looking harder or more closely, but of seeing what frames our seeing—spaces of constructed visibility and incitements to see which constitute power/knowledge.” <br /> (Lather, 1993)<br />
    4. 4. Study Purpose <br />To explore the perceptions of female registered nurses who have intentions to leave the profession. <br />
    5. 5. Research Questions<br />What factors have influenced a female registered nurse’s intentions to leave the profession?<br />How do female registered nurses who have intentions to leave the profession perceive their practice in a female dominated profession?<br />How do female registered nurses who have intentions to leave the profession perceive the influence of gender on their decision?<br />
    6. 6. Study Design<br />Basic interpretive <br />Semi-structured interviews<br />Participant criteria:<br />have a serious intention to leave the profession.<br />have actively searched for other jobs or have taken steps to prepare for another career that does not require a nursing qualification.<br />are not looking to exit the workforce completely.<br />are currently working in a patient care position. <br />have at least 3 years of experience in nursing.<br />
    7. 7.
    8. 8. Findings<br />Five Major Themes:<br />Feelings of duty and obligation<br />The power distribution in the hierarchy<br />Growing incongruity between working conditions and patient care<br />Interpersonal communication<br />Shifting perspectives on work and self<br />
    9. 9. Findings<br />Feelings of duty and obligation<br />In relation to family<br />In relation to others<br />
    10. 10. Findings<br />Power dynamics of the hierarchy<br />Positionality in the Hierarchy<br />Lack of Compensation (The Catch 22)<br />Lack of Opportunities (Feeling stuck)<br />Inaccessibility to Power structures <br /> (Lack of voice)<br />
    11. 11. Findings<br />Growing incongruity between working conditions and patient care<br />Workload<br />Physical environment<br />Technology<br />
    12. 12. Findings<br />Interpersonal communication<br />Communication between nurses<br />Negative behaviors related to stress<br />“cattiness”<br />“eating their young”<br />Approach to Diversity<br />
    13. 13. Findings<br />Shifting perspectives on work and self<br />Separating work from self<br />Finding Passion<br />Concerns about economic reality of leaving<br />
    14. 14. Discussion<br />Factors in the work environment influenced the decision to leave nursing.<br />Receiving mixed messages regarding patient care is a source of dissatisfaction.<br />Incidents of ineffective communication were not typically reported. <br />Not all reasons for leaving nursing are negative.<br />
    15. 15. Significance of the Study<br />Recommendations for Nursing Education:<br />Increase dialogue in the classroom to encourage the development of voice<br />Discuss organizational structures present in the healthcare workplace<br />Teach techniques of self-nurturance<br />Provide opportunities for debriefing and self-reflection<br />
    16. 16. Significance of Study<br />Recommendations for Workplace Education:<br />Create an environment that values participation in decision-making<br />Provide opportunities for professional development<br />Facilitate a collaborative approach to patient care among healthcare providers<br />Provide opportunities for debriefing<br />