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Nurses are experiencing overwhelming challenges and growing frustration in the practice arena. Staffing issues and other factors are causing many nurses to leave their positions in hospitals and some are even leaving the profession of nursing. Therefore, the purpose of this study was to discover the barriers and facilitators to the retention and recruitment of nurses.
Methodology
The study was conducted using a focus group approach. Data were collected from a convenience sample of Registered Nurses (RNs) recruited from the registrants of the Tennessee Nurses Association Convention in November 200o. To meet the criteria for participation, the RN had to be practicing a minimum of 20 hours per week. A total of 43 nurses participated in five different focus groups conducted at various times throughout the three-day convention. The number of participants in each group ranged from 5-12. Participants submitted a written consent form and a brief demographic survey prior to the beginning of each session. The focus groups were led by the same moderator who used a semi-structured interview tool. Participants were asked to respond to six major questions form their personal perspectives. The sessions were audiotaped and transcribed verbatim. Data were analyzed using SPSS and the QSR N5, a qualitative data management software package.
Findings
Demographically, the 43 participants were predominately white (91%), female (93%), and most were employed full-time (86%). About half (51%) held a master’s degree in nursing or higher. The nurses were employed in a variety of settings, although most were employed in acute care facilities on medical surgical units. Predominant themes from each of the six major questions follow. Question 1: What are the most positive aspects of nursing as a profession? In rank order, the nurses said that “personal reward”, “respect and trust”, and the “variety of opportunity” afforded them within the profession of nursing were the most positive aspects of nursing as a profession. Question 2: What are the least positive aspects of nursing as a profession? The most prevalent themes discussed included the “negative image nursing has as a career”; the “interpersonal hostility” and lack of support from “peers and administrators” in the work place; the “lack of resources”, particularly in relation to staffing but also in relation to supplies and equipment; and the “hazardous work environment” nurses must endure, the physical and emotional demand so the job, including risks of injury and infection. Question 3: What aspects of the job make you want to remain with your current organization? “benefits/salary” was the most frequent response, followed by the “respect” received in collaborative relationships in the work setting, and the “satisfaction” derived from their practice. Question 4: What aspects of your job make you want to leave your current position? Participant responses were grouped under two major themes: “tremendous workload demands” related to inadequate staffing and “lack of support” related to negative attitudes from peers and administrators. They spoke of “nurses eating their young” and of being “thrown to the wolves.” Question 5: What changes could be made in your current work environment to make it a better place to work, or more satisfying? The most prevalent theme was to “improve staffing” followed closely by the desire to have “more control and autonomy” over their practice, patient care, ancillary staff, rules and regulations, and over their professional lives. Other major themes included the need to “increase professionalism in the work place” e.g., having role models, mentors, and being able to quantify what they do; “reduce the time spent in doing paperwork and other non-nursing functions”; and “improve communication”, the desire for more positive feedback and less criticism. Question 6: What is your single greatest concern about nursing as a profession? The greatest concern expressed by the participants was for “patient safety and quality of care”. They expressed great concern over the current and future level of nursing staffing in their agencies. The second most prevalent concern was their “lack of control and power” over their own practice.
Summary and Recommendations
The findings document that the major stressors that RNs in Tennessee are experiencing relate to inadequate staffing, but others relate to the lack of supportive attitudes and behaviors by colleagues and administrators in the work place. Administrators must deal creatively and effectively with staffing issues, nurses should be given more power and control over their own practices and all must work to improve the image of nursing if we are to resolve these critical nursing workforce issues. Additional studies are needed to identify strategies to improve the retention and recruitment of nurses.
The study was sponsored by the Tennessee Center for Nursing, Inc. (formerly the Tennessee HealthCare Consortium for Nursing). The researchers gratefully acknowledge the contribution of the nurses who participated in the study.
Prepared by:  Nancy B. Moody, DSN, RN; Patricia L. Smith, EdD, RN; Joan L. Creasia, PhD, RN; Mona M. Shattell, MSN, RN; and Sharron Grindstaff, BSN, RN.
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