A Study Examining Senior Nursing Students' Expectations of Work and the Workforce

Background: Nursing is considered fast-paced, labor intensive work with cyclical shortages. To ensure that patients receive a consistently high level of care, hospitals have increasingly relied on schools of nursing to rapidly prepare newly licensed registered nurses (NLRNs) to function with high competence. Educational pathways resulting in a BSN degree include traditional 4-year and shorter accelerated nursing programs. The accelerated program provides an expedited alternative (i.e., 11-18 months) to a BSN degree for students who have achieved a previous bachelor’s degree. Kramer (1974) described the stressful transition from nursing education to practice as “Reality Shock,” and Duchscher further defined the early student to RN period as “Transition Shock” (Duchscher 2009). This role transition difficulty is blamed for much of the 15-60% NLRN turnover in their first 3 years of employment.

Aim: This study explored traditional and accelerated Bachelor of Science in Nursing (BSN) students’ expectations of nursing work and the workforce.

Method: This qualitative study of 14 focus groups (N = 98) is phase 1 of a 3-phase longitudinal study comparing senior student expectations of the workforce and workplace to their perceptions as newly licensed nurses. Phase 1 examined student nurses expectations of the workforce and workplace.

Results: Participants included 98 (74.8%) BSN students enrolled in their final semester of school. Ages ranged from 20-57 in accelerated (n=39) and traditional (n=59) programs, representing members from the Baby Boomer, Generation X, and Millennial generations. Ages significantly differed between traditional (m=23.1; SD=3.5) and accelerated (m=27.9; SD =6.4; p<.001) students. Accelerated students were more likely to be married (16.9%) than traditional students (2.6%; p <.01).

Two overriding themes for accelerated and traditional students emerged: Stressors and Coping Strategies. Four Stressors were described: 1) "role transition" was the greatest stressor that students reported as they prepared to enter the workforce; 2) "contagion" concerns were expressed as students felt comfort in their knowledge of infectious processes and personal protective equipment (PPE) use, yet feared contamination with pathogens; 3) "personal life impact" concerns were expressed by traditional and accelerated students when nursing schedules, such as working holidays and weekends, long hours, and nights, were expected to impact their lives and require family support; and 4) "fear of violence" was expressed when students realized that the work environment would be socially and psychologically challenging with emotional, verbal, and physical abuse from physicians, coworkers, patients, and family members.

Student nurses were acutely aware of stressors in clinical environments and expressed fear and anxiety with transition to practice. To succeed as a NLRN in this challenging environment, students developed Coping Strategies. Four general categories of Coping Strategies were described: 1) "fitting in as a real nurse" was described as students discussed two common strategies to cope with role transition that included establishing and maintaining good working relationships, and finding a supportive environment for successful transition to the NLRN role. To improve the likelihood of support in the clinical environment, students planned to seek out a mentor, act exceptionally nice to people in the workplace (e.g., make coffee, buy gifts), and exhibit authentic willingness to help (e.g., help certified nurse aides [CNA]); 2) "taking precautions" was described as student nurses identified strategies to thwart risk from contagious diseases. They planned to wash their hands and take the highest precautions to protect themselves (e.g., always wear gloves with patient care). However, they expressed the importance of remaining compassionate to patients and ensuring these precautions do not impede patient care; 3) "taking care of myself" was described by both accelerated and traditional students as they discussed strategies for combating the anticipated stress to themselves, family, and friends caused by the NLRN role; and 4) "staying physically and psychologically safe" was described because violence was viewed as part of the job and students related strategies for self-protection while working. In dealing with colleague or physician violence, some students expressed a strong desire to advocate for themselves to curb any misuse or abuse. Others planned to keep quiet, respond kindly to a rude or discourteous colleague, walk away, or talk to the nurse manager.

Conclusion: This study suggests students have experienced stressors in the clinical environment and anticipate them in the NLRN role. During transition, strategies such as “fitting in” and “staying safe” will be employed to ensure work success.  

Implications for Nursing: For decades, there has been discussion of transition shock for students as they leave the educational system and join the workforce as NLRNs. Today, Generation Xers and Millennial students have access to an increased speed of communication within a healthcare environment with growing budgetary constraints, high acuity, advanced technology, and physiological dangers. Consequently, nursing students are keenly aware of the workplace challenges that consist of stress caused by a strained workforce, unique work schedules, families and patients experiencing the most fragile life experiences, and exposure to dangerous transmittable diseases. These students have observed the “real world” and are savvy; they have developed strategies to overcome transitional barriers and realize that they must actively participate in a successful transition process.

Kramer, M. (1974) Reality shock: Why nurses leave nursing. St. Louis, MO: C.V. Mosby.

Duchscher, J. E. B. (2009) Transition shock: the initial stage of role adaptation for newly graduated Registered Nurses. Journal of Advanced Nursing, 65 (5), 1103-1113.  doi:10.1111/j.1365-2648.2008.04898.x