5 takeaways on RN work habits and education

Hospitals are increasingly looking to hire nurses with bachelor's degrees, and recently licensed RNs are less likely to be employed by a hospital than their older counterparts — these are just some of the findings from the RN Work Project, a 10-year-long study of registered nurses.

The study began in 2006 and has surveyed a nationally representative sample of nurses six times in 10 years. In addition, the study surveyed new groups in 2009 and 2012, and will survey a new cohort of nurses in January 2016. Survey topics include nursing turnover rates, intentions and attitudes about work over the 10-year period. The most recent information the project released compares the responses of nurses licensed in 2004-2005 with those licensed in 2010-2011.

The study, supported by the Robert Wood Johnson Foundation, is directed by Christine Kovner PhD, RN, FAAN, Mathy Mezey Professor of Geriatric Nursing at the New York University College of Nursing in New York City; and Carol S. Brewer, PhD, RN, a professor emerita at the University of Buffalo (N.Y.) School of Nursing.

Here are five takeaways on trends the study has identified so far, as presented by Dr. Kovner and Dr. Brewer.

1. RNs are less likely to work in hospitals. The research team for the RN Work Project found that 77.4 percent of nurses in the 2010-11 cohort work in a hospital compared to 88.8 percent in the 2004-05 cohort. Those in the later cohort who did work in a hospital were more likely to work in a Magnet hospital (13.5 percent of the 2010-11 cohort, compared with 10.3 percent of the 2004-05 cohort). They are also less likely to work in intensive care units (18 percent of those in the 2004-05 cohort, compared with 11.6 percent in the 2010-2011 cohort).

2. RNs are less likely to work in special care units. The newly licensed RNs in the 2010-11 cohort were also much less likely to work in special care units, partly because they were less likely to work in hospitals, according to the study. When asked which unit they spent the most time working, 43.9 percent of RNs in the 2004-05 cohort chose specialty unit, compared to 35.8 percent in the 2010-11 cohort. "We suspect that hospitals can be more selective in hiring and prefer to hire experienced RNs in special care units," Dr. Kovner and Dr. Brewer wrote in a paper about the study. "Because hospitals can be more selective, they also suspect that even if the new nurses were able to get hospital jobs, they were likely unable to obtain jobs in these specialty units."

3. Hospitals are preferentially hiring RNs with a bachelor's degree in nursing. Hospitals are also preferentially hiring RNs with a bachelor's degree in nursing, according to the study. And if hospitals do hire associate degree grad­uates, they often are requiring those nurses to get a bachelor's degree within a specified time period.

According to Dr. Kovner and Dr. Brewer's unpub­lished calculations (using data acquired on nurses who left their jobs and what they were doing two years later), bachelor's degree graduates are significantly more likely to work in hospitals within six to 18 months of graduation than associate degree gradu­ates (82.9 percent compared to 67.1 percent), and associate degree graduates in the 2010-11 cohort were much less likely to work in hospitals than those in the 2004-05 cohort (67.1 percent compared to 83.1 percent).

This trend also seems to be in line with findings that the later cohort was also more likely to be enrolled in a formal education program (16.6 percent, compared with 11.4 percent in the earlier cohort).

"There have been several changes in the years between when these nurses passed their licensing exams, and those changes appear to have had animportantimpact on nurses' behaviors and goals," Dr. Kovner said in a prepared statement. "It's possible that the increase in newly licensed RNs holding BSNs and who are enrolled in formal education programs is a function of the recommendation that 80 percent of nurses have BSNs by the year 2020 in the Institute of Medicine report 'The Future of Nursing: Leading Change, Advancing Health.'"

4. Most RNs are happy with their shift. In the study, RNs were asked what shift they worked and if that was the shift they wanted to work. Only about 25 percent worked on a shift or schedule that was not their preference. Dr. Kovner and Dr. Brewer say this could be partly because the RNs work a shift that is conducive to their home situation. For instance, an RN may want to work the night shift so they can be with their children during today and their partner can be with their children at night.

5. RNs cited work-life balance as top reason for taking their first nurse job. When newly licensed RNs in the 2010-11 cohort were asked why they took their first RN job, the most common reasons given were the work hours were good for work-life balance (44.3 percent), the commute was short (42 percent), the organization had a good reputation (39.9 percent), it was the only RN position that offered full-time em­ployment (38.3 percent), the RN had clinical experience there as a student (34.4 percent) and a friend was at the organization (31 percent). Newly licensed registered nurses in the later cohort were much more likely than those in the earlier cohort to have left their first RN job within one year (16 percent compared to 10.4 percent), although not all RNs had worked for a full year at the time of the study.

Of those who had already left their first job and answered the question about the one thing their employer could have done to keep them at that job, by far the greatest percentage (42 percent) said there was nothing that could have kept them there. Other factors that might have kept them in their jobs were an increase in pay, a change in shift or hours or improvements in manage­ment.

When considering taking any new RN job, Dr. Kovner and Dr. Brewer encouraged applicants to carefully consider the character and behavior of the nurse manager. After all, the pointed out, the nurse manager typically has a lot of influence on the work environment such as shifts. "I think that young nurses don't think about that a lot. They think about, 'I hope I can get a job at X place.' I don't think they spend enough time thinking about what the manger of their unit is like," Dr. Kovner says.


More articles on workforce and labor management:

Hospitals and unions: 9 recent conflicts, agreements
Union voices concerns over proposed Crozer-Keystone acquisition: 4 things to know
Mich. hospitals, health systems outsource nurse anesthetists, continue US trend: 3 things to know


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