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Perspectives from the RNABE new graduate nursing survey

As Canada begins to come to grip with the realities of a nursing shortage, questions are being asked by administrators, government, nursing associations, unions and nurses themselves. What can be done to retain and recruit nurses? Of particular importance, how can new graduates in nursing be retained and integrated into the health care system?

Health care restructuring has not been easy for British Columbia's registered nurses. It has been particularly difficult for new graduate nurses.

New graduate nurses are major contributors to Canada's supply of registered nurses (Park & Hughes, 1997). Graduates from B.C.'s nursing education programs account for approximately 55% of the province's annual supply of new registered nurses while 45% of B.C.'s new registered nurses come from other provinces and countries (RNABC, 1998). With the nurse shortage continuing to spread worldwide, foreign countries will increase their efforts to recruit registered nurses from B.C., leaving the province with even fewer registered nurses. Understanding how to integrate and retain new graduate nurses is a significant factor in maintaining the supply of registered nurses in British Columbia.

Anecdotal information about the employment profiles and patterns of new nursing graduates, in conjunction with the predicted nursing shortage in the foreseeable future, prompted RNABC to commission a provincial survey of new graduates in 1998.

Methods and in Results

The new graduate nursing survey was designed to capture employment information from new graduates of nursing schools in British Columbia who registered as practicing members with RNABC in 1997. The purpose of the survey was twofold: to identify the employment profile of newly graduated nurses in B.C.; and to identify self-perceived level of preparedness of new graduates for the workplace. Questionnaires were mailed in May 1998 to all new graduate nurses from approved nursing programs in B.C. who registered with RNABC from January 1, 1997 to December 31, 1997. Demographic characteristics of both the population of new graduates and the sample are presented in Table 1.

The questionnaire contained 35 forced choice questions and an opportunity for respondents to write comments, or clarify or explain their specific responses. One hundred and forty-five distinct narrative comments were collated from the survey and grouped within three categories: ability to meet job expectations; educational experience; and experience seeking employment. Subsequent analysis yielded themes within each category.

Ability to Meet Job Expectations

Respondents perceived that their ability to meet job expectations was about the same (62%) or better (25%) than they expected. However, written comments from new graduates focussed on the challenges of beginning a nursing career in today's health care system. They are concerned about delivering safe care when presented with what were called "dangerous" patient loads. One new graduate noted that being a "fairly new RN" is challenging, but her colleagues, who are experienced, are also facing difficulties with patient loads. "Full-time nurses with years of experience are finding that nursing is very stressful and so demanding that many are frustrated and burned out."

Some new graduates have felt the barner of not having experience. "How can one get the experience you require to be hired, if (no one will) give you a chance?"

Educational Experience

Although new graduates perceived difficulties meeting job expectations, most felt that education programs prepared them to meet job expectations satisfactorily (44%), quite well (35%) or very well (11%). However, many of their written comments indicated a need for increased clinical time in their education programs. "Lack of clinical hours places new grads at a disadvantage." "I feel more clinical time would have prepared me better for when I became employed."

Others spoke of meeting the expectations of the profession. "I have found that there were too many things we were not allowed to do as students, but are expected to do as RNs." "Clinical time should be increased; night shifts should be included."

On the other hand, there was the perspective that nursing programs educated the new graduate "extremely well for my profession. Upon graduation, I was amazed at the amount of knowledge I had and that I was able and expected to use it on the job."

Experience Seeking Employment

An overwhelming majority of the new graduate respondents worked casual (90%) with 65 % of those working in casual on call positions. More than one-third (35%) worked in two or three agencies. Seventy-eight per cent of respondents who are not satisfied with their employment status said they would prefer a full-time position.

Many written comments (44 out of 89) related to casualization. Some nurses expressed concern that they would be working casual for a number of years due to difficulty getting consolidated experience (hours) in one agency. "The major problem I encounter is the union environment and casual call-in process. Living life with a pager attached and never knowing when I might work again are the most difficult. Because I do not have enough hours yet, my chances of getting a regular position are nil, although I do continue to apply for everything that interests me."

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