WORKING LEARNER SERIES: NURSES

Transcription

1 WORKING LEARNER SERIES: NURSES Nursing Students Cope With Many Challenges on the Road to Earning Their Degrees It s no secret that this country is facing one of the largest nursing shortages in years. The American Health Care Association reported that there are over 135,000 registered nurse (RN) vacancies in the U.S. a national RN vacancy rate of 8.1%. 1 This shortage is expected to grow to 260,000 RNs by Compounding the problem is the fact that many RNs are in their 40s and 50s and will retire fairly soon: In 2012, the average age of an RN will be In a Nursing Management survey, 55% of nurses said they planned to retire between 2011 and The nursing shortage has serious implications for health care both now and in the future. It s already causing hospitals to increase the number of hours nurses work and the number of patients each has to care for, leading to stress, fatigue, and burnout. In a survey by Nursing Economic$ magazine, 98% of nurses said staffing shortages were the cause of increased stress 93% said these shortages lowered patient care quality, and 93% also claimed they caused nurses to leave the profession. 5 Furthermore, with baby boomers reaching their 60s, hospitals can soon expect to see sizeable increases in the number of both regular and acute-care patients. Between 2010 and 2030, the ratio of potential caregivers to elderly patients is expected to decrease by 40%. 6 Part of the solution to the nursing shortage lies in nursing schools. But to end the shortage, the Council on Physician and Nurse Supply estimates that 30,000 additional nurses will need to be graduated annually 30% more than are currently graduated. 7 The problem, however, isn t a lack of interest in nursing but a shortage of nursing faculty and resources to educate all the prospective students. In fact, in 2008, 49,948 qualified applicants were turned away from U.S. nursing schools due to a shortage of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints. 8 The New Face of the Nursing Student Today s nursing student is a far cry from the young, white-cap-and-dress-wearing woman of yore. In fact, more and more of today s nursing students meet the profile of the nontraditional student: Many are married, have children, and have achieved higher education prior to nursing school. 9 They also tend to be older: The average age of a new RN in 2003, for example, was Most nursing students work full-time, which can complicate their educational paths considerably. 11 As nontraditional students, nursing students are at higher risk for dropping out of their programs than typical students. Given the nursing shortage, it is crucial that institutions understand this cohort and provide the support they need to become the next generation of nurses. This article details some of the stressors and barriers nursing students face, and highlights ways colleges and universities can help them complete their education.

2 Barriers to Retention for Nursing Students In a study of minority nursing students in California, nursing educators Amaro, Abriam- Yago, and Yoder found that the most common personal problems students faced were: n lack of finances; n insufficient time; n family responsibilities; and n language difficulties. 12 The majority of students who these scholars interviewed worked either full- or part-time to support themselves and their families and pay for their education. Most also said that their family and work responsibilities interfered with the time they had for study. As one participant described it, During the day, we have to go to clinical all day... And then after school, after that, I have to go pick up my daughter and [do the] cooking and cleaning, and by the time I m done it s 10 or 11, and then I need to do... [a] care plan... It s like the whole family is going to school with you. 13 Arizona-based nurse Zanza Kruer had a similar experience to the women Amaro et al interviewed. She enrolled at University of Phoenix to earn her BSN while working as an LPN. My greatest obstacle [while returning to school] was time, she says. There was never enough time for everything and everyone. Kruer, in fact, chose to work for a nursing agency a company that hires out nurses on a per diem basis so that she could have greater flexibility and schedule work around her classroom and clinical hours. Many Nursing Students Must Cope with Job-Related Stress Nursing school in and of itself can be a significant source of stress: Not only do nursing students have to contend with the exams and papers that other students do, but many simultaneously work as nurses or nurse assistants both high-intensity, stressful jobs. As nurse and blogger Lois Turley puts it, Nurses are short-handed, understaffed, and overworked. We are only an accidental needlestick or body fluid splash injury away from exposure to deadly diseases. We get aches and pains from lifting and tugging on people bigger than we are. We watch people die. We see families grieve. Often we work double shifts to meet the needs when staffing is overstretched. We are tired. Yet we love nursing most days. 14 Nurses work long and often irregular hours: In a 2007 study of new nurses published in the American Journal of Nursing, for example, 51% of nurses said they had worked voluntary overtime, and 13% had worked mandatory overtime. The study also said 61% had been assigned to a night, evening, or rotating shift, and 63% claimed their work interfered with their family lives at least four days per month. 15 These nurses also reported significant amounts of job-related stress from other sources, such as verbal abuse on the job or injuries ranging from cuts and bruises to sprains and needle sticks. 16 Though none of the nurses in the survey had been working longer than 18 months, 29% of them had already left their first job, many citing stress and poor management as the reasons. 17 Stress is probably one factor contributing to the nursing shortage: According to a national study, 1 in 5 new nurses quits within his or her first year on the job. 18

3 Stressors Experienced by New Nurses (Working < 18 Months) Mandatory overtime Cut or laceration on the job Inadequate supplies making it impossible to do job Needlestick on the job Sprain or strain on the job Voluntary overtime Assigned nights, evenings, or rotating shifts Verbal abuse on the job Work interfering with family life more than 4x a month Percentage of Nurses Experiencing Each Stressor Source: Kovner, C. T., Brewer, C. S., Fairchild, S., Poornima, S, Kim, H., & Djukic M. (2007). Newly licensed RN s characteristics, work attitudes, and intentions to work. American Journal of Nursing 107 (9): Minority Nursing Students Face Their Own Set of Challenges Currently, the U.S nursing workforce does not have the same cultural diversity as the general population. Only 8-10% of RNs are minorities, compared with 22-25% of the country s population as a whole. 19 Minority students remain underrepresented in nursing schools, with only 17% identifying themselves as African-American, Hispanic, Native American, or Asian. 20 But their numbers do appear to be growing. At University of Phoenix, for example, minority enrollments in the LPN-to-BSN program rose from 24.6% in 2003 to 34.5% in Minority students in nursing school face a variety of obstacles not experienced by their Caucasian peers. Several students interviewed by nursing instructors Amaro, Abriam-Yago, and Yoder, for instance, said they had encountered racism or discrimination in their nursing programs, particularly in the hospital during practicum. 21 One Latina student, for example, said that during her practicum a male patient requested a Caucasian nurse instead of her, while a Vietnamese student was the target of comments about non-americans going on welfare. 23

4 Other problems that minority students reported were: speaking English as a second language (ESL) and/or having an accent, which caused classmates to become impatient with them; lacking ethnic role models or mentors; and cultural differences, such as emerging from a culture where women are not encouraged to be assertive. 24 Their most successful strategies for coping with these stressors, they said, were seeking support from peers and sympathetic instructors and joining ethnic nursing student groups like the Hispanic Nursing Student Association, where they could learn from the experiences of students who were further along in nursing programs than they were. 25 Growth in Minority Enrollments in the LPN-to-BSN Program at University of Phoenix, Percentage of All BSN Students Caucasian African-American Hispanic Asian Source: University of Phoenix research. (November 11, 2009). Source: Student Registration Survey (of those reporting) and Student Administrative Database (OSIRIS), University of Phoenix. What Colleges and Universities Can Do to Assist Nursing Students n Encourage mentoring. Both research and anecdotal evidence suggests that nursing students and new nurses perform better when they have mentors. The minority students in Amaro, Abriam-Yago, and Yoder s study, for example, said that instructors had an even greater effect on their educational success than did their families. Faculty singled out by students as mentors were described as patient, accommodating, encouraging, open to questions, and tolerant of mistakes and ESL students struggles with English. 26 Hospitals using RN residency programs in which new nurses are paired up with experienced mentors, such as Baptist Health South Florida in Miami, have found the programs reduce new nurse turnover. 27

5 Some organizations, such as the Oncology Nursing Society, run their own mentoring programs, which students could be encouraged to join. Nursing programs may also want to consider matching up younger students with more experienced ones who can give them advice and support. n Promote peer and social support groups. Nurses within a positive, supportive environment, nursing educators Milliken, Clements, and Tillman write, may experience reduced stress, fewer health-related problems, and greater adherence to self-care practices such as regular use of stress-reduction techniques. 28 The ethnic minority nursing students interviewed by Amaro, Abriam-Yago, and Yoder found both formal (minority nursing student organizations) and informal (study groups) peer organizations beneficial to their well-being while in nursing school, but all students can profit from sharing experiences with peers. Colleges and universities could facilitate such groups via online chatrooms or social networks dedicated solely to nursing students, or opening a lounge or computer lab where students could meet and study. n Provide flexibility in course scheduling. Nurses often work irregular hours, which can make it difficult for them to attend class or find time to study. They may benefit from online or hybrid-format classes that allow them to study and write papers around their work schedule. n Arrange for nursing-specific tutoring and/or study groups. Student nurses must digest a large body of information ranging from the Latin names for bones and muscles, to symptoms and treatments for numerous ailments, to the effects and interactions of medications. Students, especially those for whom English is a second language, could benefit from nursing-specific tutoring and study groups to help them manage the workload. n Incorporate stress management into nursing programs. Though many of the stressors nurses face are endemic to the profession itself, there are steps nurses can take to cope with stress, such as improving their time management, blocking out personal time for themselves, exercising, and holding venting sessions with peers. Relaxation training, which features such techniques as controlled breathing, guided imagery, muscle relaxation, and music therapy, has also been shown to relieve a variety of stress-related physical symptoms. 29 Nursing programs may want to make sure that student nurses are aware of the deleterious effects of stress and teach them some ways to cope with it, perhaps by holding workshops or special class sessions on the topic.

6 Profiles in Dedication: Zanza Kruer Nursing is much more than blood, guts, needles, and strange smells, says Zanza Kruer, RN. As she can well attest, becoming a nurse takes years of hard work and dedication. But Kruer s path to becoming an RN was even more challenging than most. The career path wasn t one she had ever considered even though, she says, strangers often approached me asking if I was a nurse, saying I looked like a nurse. But a series of life events led her to join the profession. At one point she was homeless and working three part-time jobs when she noticed there were five pages of open nursing positions and nursing school opportunities in the local newspaper. She enrolled in a practical nursing program, graduated, and was able to find a job, but knew she couldn t advance in her nursing career without an RN degree. So Kruer enrolled at University of Phoenix, receiving her Bachelor of Science in Nursing degree in While pursuing her BSN, Kruer overcame many obstacles, such as caring for a needy and handicapped elderly family member and coping with a benign tumor growing in her hand. Strapped for time, she joined a nursing agency so she could more easily schedule her employment around her course hours. My family and friends knew the importance of my degree and were patient when I had to prioritize classes or clinical time above everything else, Kruer relates. However, Kruer says, earning her degree was worth the effort: I love learning, research, and teaching, she says, and being able to effect change within my community. University of Phoenix is constantly innovating to help students balance education and life in a rapidly changing world. Through flexible schedules, challenging courses and interactive learning, students achieve personal and educational aspirations without putting their lives on hold. University of Phoenix is the largest private accredited university in North America. University of Phoenix serves a diverse student population, offering associate s, bachelor s, master s, and doctoral degree programs from campuses and learning centers across the U.S. as well as online throughout the world. Visit the University of Phoenix Knowledge Network at or [email protected]

7 1 (September 2009). Nursing shortage fact sheet. Retrieved November 11, 2009 from Billings, D. M. & Halstead. A. (2008). Teaching in nursing: A guide for faculty. Second edition. Fort Worth, TX: Saunders College Publishing. 10 Billings, D. M. & Halstead. A. 11 Heller, B. R., Oros, M. T., & Durney-Crowley, J. The future of nursing education: Ten trends to watch. Retrieved November 11, 2009, from 12 (2006). Perceived barriers for ethnically diverse students in nursing programs. Journal of Nursing Education 45(7): Many of the students this team surveyed were Latina or Asian-American Quoted in Milliken, T. F., Clements, P. T., & Tillman, H. J. (2007). The impact of stress management on nurse productivity and retention. Nursing Economic$ 25(4): Kovner, C. T., Brewer, C. S., Fairchild, S., Poornima, S, Kim, H., & Djukic M. (2007). Newly licensed RN s characteristics, work attitudes, and intentions to work. American Journal of Nursing 107 (9): Kovner, C. T., Brewer, C. S., Fairchild, S., Poornima, S, Kim, H., & Djukic M. 17 Kovner, C. T., Brewer, C. S., Fairchild, S., Poornima, S, Kim, H., & Djukic M. 18 Madkour, R. (February 19, 2009). Hospitals fight to stop new nurses from quitting. Retrieved November 11, 2009, from 19 (2006). 20 Billings, D. M. & Halstead. A. 21 University of Phoenix research. (November 11, 2009). Source: Student Registration Survey (of those reporting) and Student Administrative Database (OSIRIS), University of Phoenix Madkour, R. 28 Milliken, T. F., Clements, P. T., & Tillman, H. J. 29 Milliken, T. F., Clements, P. T., & Tillman, H. J University of Phoenix, Inc. All rights reserved. AY6270U