1. The Leader’s role in retaining staff: A study of the decisions of early career nurses Describe the purposes of the project Present the findings, especially those related to the role of managers Share some recommendations about what managers and organisations can do to improve staff retention This research project was supported through an Australian Research Council SPIRT Grant. The research team was Carlene Boucher, Megan-Jane Johnston, Helen Hughes and Terry Gliddon. The Partner Organisations were St Vincent’s Hospital, RDNS and the Austin and Repatriation Medical Centre.

2. cboucher dec 042 Purpose of the study At the time that the project brief was developed (mid 2001) Australian health services were experiencing considerable difficulty in recruiting and retaining registered nurses. There have been few studies exploring the problem of nurse retention from the viewpoint of early career nurses even though the literature suggests that most professionals who leave do so in the first 5 years. There had also been little opportunity for nurses to comment on what they saw as the solutions to the Australian health care sectors’ poor nurse retention and recruitment. The project aimed to explore factors that led to early career nurses (ie. in their first five years of nursing) choosing to stay with or leave their employer organisations. It was hoped that by identifying the factors that influenced their choices to remain with or leave an employer it would be possible to develop recommendations for initiatives that the industry partners and other health organisations could adopt that would encourage new nurses to stay with them.

3. cboucher dec 043 Research questions 1.What professional, organisational, personal, social and economic processes are described by nurses as being important in their decisions about joining, leaving and staying with an employer? 2.What do nurses identify as being the key choice points in their early careers? 3.How do health industry policies, procedures and practices impinge on the decisions registered nurses make? 4.What strategies could health industry employers use to retain early career nurses?

4. cboucher dec 044 Methodology Interviews with 60 early career nurses/former nurses with a broad range of post-qualification experience Six focus groups to discuss the interview findings. Participants included nurses, nurse managers, HR professionals Thematic analysis based on extensive review of existing nursing and HRM literature

5. cboucher dec 045 What professional, organisational, personal, social and economic processes are described by nurses as being important in their decisions about joining, leaving and staying with an employer? New nurses’ experience a number of workplace characteristics as being difficult to cope with and these impact on their willingness to continue nursing. Heavy workload, acuity of patients and workforce issues such as staff skill mix, number of part time and agency staff. Shiftwork was a major issue especially in grad year Consistent with literature on general job- shock

6. cboucher dec 046 What professional, organisational, personal, social and economic processes are described by nurses as being important in their decisions about joining, leaving and staying with an employer? New nurses reported that their early experiences are particularly negatively impacted upon if the following were present: Perceived lack of support from NUM and other senior ward staff Poor management practices Perceived poor preceptorship Horizontal violence or bullying Lack of teamwork

7. cboucher dec 047 What professional, organisational, personal, social and economic processes are described by nurses as being important in their decisions about joining, leaving and staying with an employer? Remuneration was mentioned, but there appeared to be an acceptance that if a person went into nursing they accepted that the salary would be low in comparison to many other professionals. They also reported that it was difficult to get to know the culture of the organisation.

8. cboucher dec 048 What do nurses identify as being the key choice points in their early careers? Placements during their undergraduate program and first year experiences were the most vivid in people’s minds and appear to be important to people’s later career decisions. There do not appear to be any other specific choice points that led to nurses deciding to stay or leave, rather the process was incremental and cumulative. There was little evidence of any career planning amongst the nurses.

9. cboucher dec 049 How do health industry policies, procedures and practices impinge on the decisions registered nurses make? The nurses seemed to have little knowledge or understanding of policy at an industry level. They generally believed decision making occurred at the NUM level and had little understanding of how the decisions of NUM’s were based on hospital and other policy and practices. They appeared to vest an enormous amount of authority in the NUM’s and had some unrealistic notions about the NUM’s capacity to employ more staff, control patient numbers and vary working conditions.

10. cboucher dec 0410 Recommendations for practice – NUM’s There is a need for training and development for NUMS and other senior staff in day to day contact with new nurses (eg ANUM’s, CNE’s). They require general management training and people management and team building skills in particular. Recruitment of NUM’s needs to focus on their management rather than their clinical skills.

11. cboucher dec 0411 Recommendations for practice – HRM issues The processes that exist to support new nurses be reviewed to see if these can be done better (eg preceptorship, orientation). Additional measures could be put in place to help new nurses deal with work reality shock issues (eg access to peer support). It is important that nurse managers are also aware that this is a normal part of the transition into a full-time working role. Processes that help to alleviate loss of scheduling control (eg self rostering) should be used if possible. New nurses need to be helped to understand the policy and decision making structures of the organisation so they have a better idea of who they can access as a resource and also be more realistic about the limits on the power of the NUM to change things.

12. cboucher dec 0412 Recommendations for practice – HRM issues The research suggested that there was an important role to be played by ‘neutral’ people (maybe Human Resources staff or specially trained nurses) who new nurses could go to discuss and get advice about a range of issues from reality shock, through to personality conflicts and bullying. Whilst it is important that NUM’s and other staff on wards address these matters, new nurses appeared to want to be able to talk with competent staff who did not work in the area. New nurses need to be able to access ongoing career counselling to help them manage difficulties in their careers and to make career choices. Previous work undertaken on the principles of good work design could inform the way the Graduate year is constructed and in particular focus more attention on the need for social support for new nurses.

13. cboucher dec 0413 Conclusion In summary this research found that the adoption of progressive human resource management practices, (especially in the areas of management development and human resource management) were critical to both improving the experience of early career nurses and increasing their perceptions of the likelihood of them staying with a particular organisation.