NURSING HAS a retention problem. The National Academy of Medicine (formerly the Institute of Medicine) recommends advancing practice, engaging in lifelong learning, and transitioning into leadership roles to advance healthcare and the nursing profession in the US. These areas provide a framework, along with policy and legislative involvement, in which nurses are expected to participate. Sadly, many nurses will leave the profession after their first year. A 2017 study revealed that an estimated 17% of new nurses leave their first job within 1 year.1,2
Professional nursing associations have a vested interest in promoting membership, supporting nursing, and addressing the issues of professional engagement. The New Jersey State Nurses Association (NJSNA) recently took steps to assess, plan, and implement outreach to nurses, specifically those new to the profession. The NJSNA is a professional nursing organization that recognizes the need to promote, advocate for, and advance the nursing profession in an ever-changing healthcare climate through participation in professional activities. In 2017, it formed the ad hoc New to Practice Nurse Professional Committee to help the NJSNA address the needs of new nurses, be a resource to meet their needs, and promote the importance of belonging to a professional organization.
A key part of that effort was an online survey that was distributed to new nurses. It asked respondents to identify activities that would best align with their priorities and solicited their feedback on how the organization could increase membership interest and engagement. This article outlines the NJSNA's efforts to solicit feedback from new nurses with the survey and describes the committee's findings and recommendations.
In a time of healthcare challenges, nursing has been recognized as the largest segment of the healthcare industry. Of the nearly 3 million RNs employed in the US, 80,560 work in New Jersey alone.3 In New Jersey, demand for nurses is expected to increase to 102,000 by 2030.4
Nurses entering the profession after 2000 were older than the traditional post-high school student.5 A growing number of adults entering nursing programs are second-degree or second-career students who may be responding to the impending nursing shortage or choosing to enter the nursing profession from a healthcare-related field. In 2014, New Jersey had a reported 3,077 prelicensure nursing graduates.6 Along the trajectory of a nurse's journey, successfully completing an educational program is often the first exposure to the challenges of a nursing career and available support systems.
Various educational opportunities are available to prepare the nursing student for practice. For example, some educational institutions in collaboration with healthcare facilities have a dedicated educational unit (DEU), which encourages nursing students to interact and become part of the team in a clinical setting.7 Although limited in availability, DEUs offer students education, support, and patient-care experiences alongside a clinical instructor and an experienced nurse employed at the healthcare facility.
In the academic setting, patient-care simulation offers hands-on education in a safe environment.8 Another important development is the inter-collaborative learning model, which combines educational experiences across different disciplines to enhance communication and learning.9 For the graduate nurse entering the workforce, some employers have developed the nurse residency program to address needs for leadership and professional development.10 (For more information on nurse residency programs, see “How to land a job in a nurse residency program,” Student Voices, in the November issue of Nursing2019.)
However, according to the literature, new nurses have described feeling that their educational experience prepared them better for the licensure exam than for performing duties as a nurse.11 Nurses felt the demands of employment were beyond what they already felt would be a demanding professional choice, citing large caseloads and increasingly challenging patient morbidity and comorbidities.11-13 Nurses also reported feeling challenged by poor communication among their peers and colleagues, including horizontal violence, as well as difficulties in feeling confident to advocate for themselves and in dealing with death and dying.14
A study published in 2017 found an increased chance of retention if a nurse feels strongly toward his or her organization.15 However, nurses still describe stresses in the first years of practice that include poor nursing practice environments, lack of support, and work that is demanding, strenuous, and out of control.12
NJSNA takes action
The NJSNA recognizes the importance of reaching out to new nurses. Its mission is to promote the profession of nursing, advance the practice of nursing, and advocate for nurses through the activities of its members in education, policy development, leadership, professional representation, and workplace advocacy. As it worked to form the ad hoc committee, the NJSNA reached out to the Pennsylvania Nurses Association (PNA), which provided support and documentation to the NJSNA on engaging new nurses. Resources provided by the PSA included the Young Professionals Framework for State Associations, which the NJSNA referred to during the development of the ad hoc committee.16 The committee, voluntarily chaired by the NJSNA's vice president, held conference calls on a regular basis from September 2017 to May 2018. Discussions included actions the association could and should take to reach, support, and engage RNs in practice for 5 years or less. Overall, the committee aimed to meet on a regular basis to focus efforts on attracting, meeting the needs of, and retaining new nurses, as well as facilitate outreach to new nurses. The committee also referred to webinars from the American Nurses Association during its efforts.
The committee's survey aimed to see if the NJSNA's activities aligned with the responses from new nurses. The committee asked various groups and individuals to distribute a link to the survey, including the NJSNA, the New Jersey Consortium of Nurse Educators, the National Association of Hispanic Nurses of New Jersey, the Philippine Nurses Association of New Jersey, nurse educators, hospital supervisors, and individual nurses who forwarded the survey link to their colleagues. Not all respondents were NJSNA members, which broadened the survey's scope.
The committee collected the results of the survey from February to May 2018. The results were reviewed, compiled, and shared with the NJSNA Board of Directors at the March and May meetings of 2018. Over 400 nurses had responded by the time the survey closed in December 2018. The survey was designed to automatically exclude respondents who had practiced for longer than 5 years, providing a message of thanks for those responding nurses. (See Who responded to the survey?)
The nature of the survey responses was informative, energizing, and in some ways disheartening. Two questions asked respondents to identify their educational degree, the types of events in which they would like to participate, and their interest in their scope of practice. Nurses reported having an associate degree (35.9%), a baccalaureate degree (47%), diploma (0.08%), and a master's degree (0.05%) in nursing, results that were similar to state averages.5 To help the NJSNA improve its slate of local events for members and prospective members, the respondents were also asked to choose from a list of suggestions for holding “just for fun” networking or downtime activities.
In the next question, the respondents were asked to rate examples of activities to gauge respondents' priorities. (See Gauging priorities for activities.) When asked about their priorities relating to the mission and vision of the association, the respondents expressed interest in continuing education, professional resources, benefits, networking, and community service. Respondents expressed little interest in legislative issues.
When asked about communication, email (96%) and Facebook (41%) were favored by far. In order of preference, Instagram, snail mail, and Twitter were not as favored.
In their own words
The survey also included an open-ended question asking respondents to share what they felt membership in the NJSNA should offer (see Considering a career change). We took away four main themes from the responses: mentoring (48 times), networking (21 times), education (19 times), and social events (13 times). The six state regions that make up the NJSNA offer events that address these themes, but they operate independently in terms of what activities are offered, how often, and how they are promoted. For most NJSNA regions, connection and communication within the regions is exclusively available to members. However, networking activities and social events are available to all nurses and are communicated to non-members in various ways to increase engagement, such as printed flyers, mailed and online newsletters, email, and social media.
The activities may include community service, continuing-education offerings, and general informational meetings about association happenings (with particular attention given to feedback from the membership). There was also opportunity to gain from attending the state level events, such as the multiday convention, one-day education summits, and quarterly board meetings.
As a result of the survey, regions have expressed their commitment to reach out to nurses new to practice. The development of specific events by individual regions has also been promoted through the Membership Committee, which is comprised of the NJSNA's vice president and membership committee representatives from each region. At the state level, the NJSNA's president-elect and other NJSNA colleagues are promoting the message of organizational support to new nurses at in-person functions such as academic events and new hire orientations and in NJ Nurse, the official publication of NJSNA which is received by every nurse in New Jersey.
Challenges and barriers
One of the challenges of learning about the experiences of new nurses was the energy and time it took to personally engage organizations and colleagues who had access to the desired population. While addressing groups and colleagues in person garnered a lot of support for the survey, there were limitations to the number of potential respondents reached. Collecting information inexpensively and utilizing a free online survey format also may have limited the responses to those who were purely willing or had opinion they felt compelled to voice.17 Web-based surveys do not allow for body language, intent of the information, or follow-up questions. This might have skewed the results and limited the numbers. Compared with average sizes of graduating nursing classes each year (there were 3,077 graduates in 2014 alone, according to the New Jersey Collaborating Center for Nursing), the small sample size could not be representative or generalizable.6
However, the initiative generated a lot of positives. Membership to the state nurses association has benefits for all nurses, seasoned and new. Moving toward engagement, support, and understanding of the importance in joining was something members were consistently willing to share. The committee's efforts helped improve the NJSNA's understanding of new nurses' experiences through contact with them.
Considering a career change
In an open-ended question asking nurses to share what they felt membership in the NJSNA should offer, some nurses told chilling stories about first jobs. For instance, one nurse stated, “I had a really bad experience at my first hospital job. It was my dream job, and I was bullied and humiliated to the point it made me ill. I quit and I feel so lost in the profession that I dreamed and worked so hard for.”
Another nurse asked the association to provide a sounding board to discuss experiences on the job, saying, “I've only been in practice for 5 months. Some days I feel like I made the wrong career decision.” These comments brought to light the plight of a new nurse dealing with situations difficult for any new employee wondering where to turn to receive support or guidance.
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5. New Jersey Collaborating Center for Nursing. Chapter 2: educational capacity. http://www.njccn.org/wp-content/uploads/2018/01/Chapter-2-Educational-Capacity.pdf
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