November 6, 2019

PhD graduate focused on how to retain nurses in the workforce

Registered Nurse Dr Jane Douglas discovers disconnect between expectation and reality of the job

Dr Jane Douglas remembers her early years as a Registered Nurse.

“I remember those first few months on the job, they were really difficult,” she said.

Those memories and her future work in nursing were the catalyst for Dr Douglas to undertake a PhD from the School of Nursing, in the Faculty of Science, Medicine and Health at the University of Wollongong, completing a thesis titled Early Career Registered Nurses: How and why they stay? Exploring their disorienting dilemmas.

“Nurses constitute the most significant number of health care workers globally and in Australia, but they continue to leave the system for various reasons,” she said.

“I worked as an RN for several years in numerous clinical areas and during that time I witnessed firsthand the effects of nursing shortages and the impacts on nurses, patients and clients. Added to this, I was hearing stories from the early career registered nurses (ECRN) as they spoke of the challenges they faced as new professionals.”

Dr Douglas said she wanted to take a strength-based approach to her research, and find out why ECRNs chose to stay rather than the reasons they may have left the profession. What she found was a disconnect between nursing students expectations of being RNs and the realities they faced once working in the field.

“What I found when working with new graduate nurses is that they take a little while to come up to speed but they do it really quickly and really well,” Dr Douglas said.

“We [as colleagues and teachers] have to remember that we are developing ECRNs to be future leaders and critical thinkers; people who think about what they do and that is important for our profession.

“In terms of how we approach education what we have to remember is that no new graduate will walk into a job and know exactly what to do as every area is different; people need to learn the role by doing it. It’s not just in nursing. No matter what the profession [a graduate enters], you will always lose some on the way.

“One of the misconceptions we have is that the inclusion of more workplace learning in pre-registration curriculums will make it easier for ECRNs to adjust [to their new career]. Workplace learning certainly helps, but as participants in this study suggested, no matter how many experiences you have, you can never understand what it is to be an RN until you are one, and that is where the disorientation happens – that chasm between what is expected and what it is actually like.”

Dr Douglas said she hopes her research will help highlight changes that need to occur within the nursing profession to ensure ECRNs feel supported and valued in those vital first five years of their career.

“There are already things happening in regards to this,” she said.

“Groups like the Australian College of Nursing are looking at retention rates and mentorship programs. Personally, I think it should be a multi-pronged approach. In my thesis I said it was about removing bullying from the workplace and implementing policies mandating relational learning approaches such as mentorship or clinical supervision, for early career registered nurses.

“I also think educators and supervisors in the workplace can help to manage what is expected of ECRNs – making sure that others have realistic expectations that align with the RN standards for practice. In the university sector, curriculums could be ensuring new graduates understand the disorientation they may experience upon commencing a new career and facilitating approaches and networks for working through it.

“As a profession, we need to realise new ECRNs are new on their first day of work and need time to grow into that role. To do that they need support, education and understanding from the organisations that employ them; learning does not stop with pre-registration education and ECRNs deserve the time and support to grow into their new role as they learn from and make sense of their experiences.

“It is good for people to remember that nurses are human beings too. People look at a nurse and only see a registered nurse, not someone who is in their first week of nursing, and the expectation from others, including patients is that the person caring for them has been doing this for 20 years, not a few weeks.”

For the past 12 years, Dr Douglas has been involved in academia but has recently re-entered the health industry, working as an RN in a community setting.

“I still love nursing. I’m now working in aged and community care and it is just lovely. Of course, there are days where you go ‘this is exhausting’, but I love talking to people and connecting.”