Factors that influence early career nurse employment outcomes, settings and intention to remain in the workforce: a prospective cohort study

Abstract

A shortage of nurses currently exists both globally and in Australia, as attested to by the literature and the Australian government. In Australia, this shortage is felt more acutely in out-of-hospital settings. Ineffective recruitment processes and poor retention rates of Early Career Nurses (ECNs) have contributed to the shortage. Strategies to improve the supply of ECNs to the hospital and out-of-hospital settings have been implemented. However, little research has been conducted on the factors that impact on ECN employment outcomes and effective retention strategies. This study aimed to identify the factors influencing initial employment outcomes and settings for ECNs, and to clarify which factors attributed to ECNs’ intention to remain in their position and the profession over their first year post-graduation. This study employed a prospective cohort design guided by transition theories. The target population was final-year students enrolled in undergraduate nursing programs in Australia. Non-probability convenience sampling was used to recruit students graduating from two universities in different states. An online survey tool, the Early Career Nurse Employment Experience Survey (ECNEES), was developed and data were collected across three time points over 12 months, commencing in November 2016.The initial response rate was 64.2% ( = 374) with 81 responses ineligible due to duplicates ( = 12) and incomplete responses ( = 69), leaving a sample population of 293 participants. Overall loss to follow-up was 33.8% and the final sample retained from Phase Three ( = 194) was used in data analysis. After 12 months the professional turnover rate in the sample was 6.7% in total, comprising 3.1% leaving a Registered Nurse (RN) job and not taking another, plus 3.6% never beginning RN work post-graduation. Logistic regression was used to analyse the data. Analysis showed English as a first language was a predictor of employment as an RN. Analysis identified different factors that impact on employment in different settings. For ECNs previous healthcare experience or a preference for the out-of-hospital setting predicted employment in the out-of-hospital setting. Undergraduate employment, Grade Point Average (GPA) > 5.51 or previous relationships with employers were predictors of working in the hospital setting. Logistic regression showed higher Work Environment, Support and Encouragement (WESE) scores and stress in personal life were the only predictors of ECNs intending to remain in the profession. Statistical modelling could not predict ECNs’ intention to remain in their current position.Success in employment is impacted by ECNs having English as a Second Language (ESL). This may be due to a misalignment between English language requirements enforced by the regulatory board prior to registration and industry standards during recruitment, leading to a bias against ECNs with ESL. Different factors impact on securing employment in the hospital versus out-of-hospital setting. Relationships with industry and preferences play a large role in the employment setting for ECNs. Improving recruitment to the priority out-of-hospital areas may require workforce policy that creates dedicated supported positions for ECNs in these settings. Differences were apparent between ECNs’ intention to remain in their position and their intention to remain in the profession. Today’s ECNs desire job mobility within nursing, which may be leading to superior career outcomes in the profession.The National Health Workforce Dataset collected by the Department of Health should collect demographic information on languages spoken by nurses. It may also be timely for a review of the healthcare industry’s English language expectations. Longitudinal research that reviews current transition theories in the out-of-hospital setting and ECN populations with ESL will strengthen the theoretical basis needed to develop evidence-based retention strategies for these groups. Finally, all stakeholders should focus on facilitating ECN career progression through flexible working contracts and flexible career pathways that facilitate transfer between departments, organisations, and sectors. These strategies will assist in the effective recruitment and retention of the ECN population required to combat the nursing shortage.