Without support young nurses won’t stay


Attracting and retaining new nurses is crucial to solving the chronic nursing shortage in the NSW health system. Yet, hundreds of young and less experienced nurses are leaving the system every year because they are burnt out due to heavy workloads and lack of clinical support, or they decide the pay is simply not worth the pressure and hassle.

So how do we attract and retain younger nurses?

NSWNA research reveals that better pay and conditions and more clinical support from experienced nurses are key to getting less experienced nurses to stay in the system.

We currently have an advertised shortage of 1,000 nurses in NSW public hospitals, not counting shortages in the private sector.

According to NSWNA Assistant General Secretary, Judith Kiejda, the severe shortage of experienced nurses is likely to worsen as nearly half of the profession, who are aged over 45, retire in the next 10 to 15 years.

‘We just don’t have enough graduate nurses entering the profession and staying on. Every year, hundreds of new nurses leave the profession because they are burnt out from the relentless pressure and heavy workloads. Or they decide it’s just not worth it for the minimal pay increases along the clinical career path,’ said Judith.

Research conducted by the NSWNA reveals that heavy workloads, pressure from patients and colleagues, lack of support and recognition, and inadequate compensation for the hassles of night shift leads many of our less experienced nurses to consider leaving the profession.

Independent research was conducted with nurses from health facilities across NSW. Discussion groups were held with nursing students, new graduates, more experienced RNs, and nurses who have recently left the system.

The Association also conducted an online survey of new NSWNA members to gain a snapshot of current workplace practices and issues.

In the focus groups of younger nurses, respondents at the beginning of their careers said they loved nursing and found it immensely rewarding. But, looking ahead 30 years with current workplace pressures, intense workloads, night shifts, an ageing population and the departure of experienced nurses, they wondered whether they would last the distance.

One respondent said, ‘I have worked in such a stressful environment, doing shiftwork, in ED you get abused, stuff gets put back on nurses, which is unfair. I don’t intend to stay in nursing but will stay in health.’

Nursing students expected they would have to work hard but did not expect such a stressful workplace, and heavy workloads drove many students away from the profession.

‘I knew I would have to work hard but this is beyond anything I imagined. I have to work harder, be more adaptable, the parameters change constantly. The expectations are huge,’ said one nurse.

Another said, ‘Due to heavy workloads, breaks are used to catch up [with work], not to actually have a break or eat.’

A concern for many new graduates and students was the lack of available support and backup from experienced nurses.

‘I get really tired. There sometimes are not enough nursing staff and I get left by myself. I have to keep saying I am a student. I love it but sometimes I think, is it worth it?’

The feedback from focus groups of more experienced RNs reveals that RNs are feeling overloaded and stressed – and are too busy to help less experienced nurses. RNs are concerned that the lack of CNSs and CNEs in our hospitals means junior nurses are feeling pressured about making decisions on their own and are not adequately supported.

Groups of TENs and AINs raised concern about the high workloads and poor skills mix. They said the lack of experienced nurses meant their supervision was haphazard or they were left to do things they couldn’t or shouldn’t be doing on their own.

TENs spoke about how they rotate monthly through the wards to learn yet, due to the workloads and the pressure on nurses, if someone calls in sick they are immediately used to fill gaps, sacrificing their education to prepare patients.

RNs spoke about how quickly they became ‘senior’. ‘I’m the more senior staff and I have only been here three years,’ said one.

RNs said they were responsible for more and more junior staff. As experienced nurses were spread thin, they were forced to leave junior staff with more responsibility, increasing risks.

One resigned nurse said: ‘In ICU, there may be one experienced staff member, the rest are agency, new grads and I’m having to leave inexperienced people with really sick patients.’

Other respondents commented about this pressure causing hostility from senior nurses towards new graduates: ‘So many people are angry against everyone who is new or inexperienced. You are expected to know everything straight away,’ said one.

‘The support is not there. Not even from colleagues,’ said another.

So what improvements would make the nursing profession more attractive and encourage nurses to stay? Better pay and conditions, reduced workloads, better staffing practices, more support from senior staff was the feedback the NSWNA received from the focus groups.

Challenges and all …

We love our job
Rachael Allen (right) and Tamara MacDonald (left) are two young nurses who responded to the NSWNA online survey – and the lucky winners of the NSWNA survey competition. Along with all members who filled in the survey, Tamara and Rachel went into the survey competition draw and won two fabulous iPods for their efforts.

Rachael is a 4th year RN working at Prince of Wales ED. She loves her job but points out that ‘nursing is difficult in today’s world’.

‘There’s increasing demand from patients and families, and higher patient acuity. I’d say it’s more challenging than in past,’ she said.

‘There’s also more responsibility. You feel like you’re carrying decision making because there’s no one around to check things with.

That’s pretty scary.’

Rachael said there are not enough senior nurses. ‘The CNE is not available after hours and we need more senior nurses on the wards.

’I think it’s OK [the pay] but it’s not really much when you consider what we do,’ she said.

Tamara, a 2nd year RN at Royal Hospital for Women, also loves her job. ‘I like helping and caring for people so it’s perfect for me.’

However, she finds shiftwork a difficult aspect of the job. ‘It affects your relationships with family and friends. It’s hard to have a social life,’ said Tamara.

Nurses at work
In December 2007 NSWNA conducted an online survey to better understand current workplace practices and issues for younger nurses. Half the respondents were under 25 and nearly all were under 30. The results paint a picture of inexperienced nurses struggling with heavy workloads and responsibility, without adequate support and guidance.

Here’s a snapshot of the survey results:

  • 88% worked on a rotating roster;
  • 95% started work on a new graduate transition program;
  • Of the respondents who had done an ‘in charge’ shift, 31% had received no guidance prior to doing it;
  • Only 4% said they felt very equipped to be in charge, 31% reasonably equipped, and 10% not equipped;
  • 67% said they often or sometimes worked through meal breaks or past rostered finishing time;
  • 6% always worked through meal breaks;
  • 25% said they hated night shift and can’t see themselves doing it much longer;
  • 34% had experienced aggression from family members of patients;
  • 28% had experienced violence from patients;
  • 75% had accessed support from a preceptor/mentor;
  • 63% rated access to CNE as ‘very useful’, 23% ‘useful’, and 9.3% ‘somewhat useful’, 4.3% ‘not at all useful’;
  • The most important aspects of working conditions were: workload (15%), team you work with (14%), pay (14%), and support and mentoring (13%);
  • 52% occasionally thought about leaving the profession. Only 11% loved their job and did not think about leaving;
  • What improvements would make the profession more attractive and keep younger nurses in the profession? Reducing workloads, better pay and conditions, better staffing practices, better recruitment strategies, better support from management and more recognition of the role nurses play.

Matt’s on board to help new NSWNA members

Meet Matthew Kelly, the NSWNA’s new Recruitment Liaison Officer.

It’s a new role at the NSWNA to help us gain an understanding of the issues facing new graduate nurses and TENs moving into the nursing workforce. Matthew also works to introduce the role of Association to young nurses.

‘An important part of my job is introducing to new grads the idea of a collective voice, to the idea of all nurses working for nurses to improve nursing.

‘Many students and new grads don’t have experience or knowledge about industrial issues. I’m trying to raise awareness that current good conditions were only achieved through a collective voice,’ he said.

The role is also a new career direction for Matthew but with recent experience as an RN at RNSH and in intensive care at John Hunter Hospital, he is well placed to understand issues for young nurses.

From talking to young nurses at work, Matthew said there is a lot of trepidation hitting the nursing workforce.

‘There is concern about levels of support. This is why we need to campaign for adequate numbers of CNSs and CNEs.

‘There is also pressure from heavy workloads and rising acuity levels. Many new nurses feel they can’t provide adequate levels of care.

They feel under pressure because they are not adequately supported and do not have proper back up,’ he said. ‘Nurses won’t stay if these pressures get too great.’

Pay claim responds to nurses’ concerns
Feedback from the focus groups form the cornerstone of the NSWNA’s claim for a new four-year wages and conditions agreement for NSW public health system nurses.

The Fair Conditions – Fair pay, Nurses Stay. It’s that simple campaign is currently being negotiated with NSW Health.

According to NSWNA Assistant General Secretary, Judith Kiejda, a key objective of the claim is to keep experienced nurses in the profession because their clinical skills are irreplaceable and because they also play a vital role in mentoring new nurses.

The claim includes:

  • A 5% per year pay rise for all public health system nurses and midwives, bringing nurses’ pay into line with other health professionals with similar experience, such as physiotherapists, diversional therapists, orthoptists and exercise physiologists;
  • Extra increases for nurses and midwives who have more than seven years’ experience and who are working permanent full-time or part-time in classifications RN8 and above;
  • A new classification at higher pay for experienced enrolled nurses;
  • An increase in the penalty loading for night work from 15% to 25%;
  • A 1% increase, per year of the agreement, in employer superannuation contributions, taking the current rate from 9% to 13%;
  • 225 more Clinical Nurse Educators to provide more support for junior staff and new graduates;
  • Easier pathways for casual and temporary employees to convert to permanent positions.