Health Care Workforce

Competing priorities, burnout, and collegial support all play a role in nursing career decisions

Significant staff shortages of registered nurses (RNs) have plagued hospitals for the past 10 years. The nurse shortage will worsen in the next 5 to 10 years, when a large part of the nursing workforce is expected to retire. Comments from 472 RNs who responded to a 2006 survey hint at factors that may impede nurse recruitment and retention.

Nurses recounted several factors that played a large role in their nursing career decisions. These included competing family and work priorities and the struggle to balance them, practice deterrents such as inadequate staffing and work overload, and collegial support.

Many nurses loved nursing as a career and took great pride in it, notes Carol S. Brewer, Ph.D., of the University of Buffalo School of Nursing. However, at certain family stages, family needs took precedent over professional needs. When nurses had young children, they either stopped nursing for a while or worked part-time. Many pursued advanced education in the hope of a better schedule, less shift work on holidays and weekends, increased opportunities for promotion, and salary increases. However, many felt that the advanced degrees did not pay off as they expected. As nurses aged, some chose retirement in response to intolerable working conditions.

Nurses cited practice deterrents such as pay inequity (for degree of responsibility and skills), lack of respect for hospital nurses, and safety concerns for themselves and patients. They also voiced concerns about exhaustion, stress, excessive work demands and work-related injuries, increasingly ill patients, mandatory overtime, and nurse shortages. These problems gave them more negative attitudes toward nursing. On the other hand, Suzanne S. Dickerson, D.N.S., reported that collegial support encouraged nurses to stay in practice. Most nurses generally enjoyed their fellow nurses and were encouraged to remain in the profession because of them. Employers of RNs must find creative ways to respond to RNs' concerns in order to retain this skilled group.

The study was supported by the Agency for Healthcare Research and Quality (HS11320).

See "Giving voice to registered nurses' decisions to work," by Suzanne S. Dickerson, D.N.S., R.N., Dr. Brewer, Christine Kovner, Ph.D., and Mary Way, M.S.N., in the July 2007 Nursing Forum 42(3), pp. 132-142.

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