Second Career Nurses' First Year of Nursing Practice Experiences

Sunday, 30 July 2017

Jessica G. Rainbow, BSN, BA
School of Nursing, University of Wisconsin-Madison, Madison, WI, USA

Purpose: There continues to be a global nursing shortage and high turnover among new nurses (Oulton, 2006). Nurses are key in providing quality patient care (Aiken et al., 2013). One strategy to increase the number of nurses in the workforce is to attract individuals to pursue nursing as a second career. This has led to innovative new educational programs and approaches for these learners, but little is known about the transition to nursing practice experiences and turnover among second career nurses (Auerbach, Staiger, Muench, & Buerhaus, 2013). In order to discover potential differences in experiences during the transition to practice of second career nurses, exploration of both first and second career new graduate nurses in the same setting is needed. The purpose of this mixed method study was to explore the experiences of first and second career nurses as they transitioned to nursing practice.

Methods: The study approach included semi-structured interviews and a longitudinal survey of both first career and second career nurses during their first year of practice. For the interviews, fifteen nurses with between one and two years of nursing experience who either had or did not have a career prior to nursing were recruited through a residency program listserv at an Academic Medical Center. Participants took part in hour-long semi-structured interviews. Interview questions queried prior work experiences, experiences with stress and coping during the transition to practice, and future career plans. Interview transcripts were analyzed using latent inductive thematic analysis (Braun & Clarke, 2006).

Survey participants were recruited in the month prior to their graduation from nursing school from a nursing program in the Midwestern United States, and completed follow-up surveys at 6 and 12 months following their graduation. The initial survey had 115 respondents, at 6 months there were 50 respondents and at 12 months there were 30 respondents. Survey respondents answered questions about prior career experiences, demographics, and future plans, in addition to validated scales on coping skills, stress and burnout levels.

Results: Themes identified during analysis of interview transcripts included: Difficulty defining nursing, improved coping with second career, and prevalence of burnout and presenteeism among nurses. All participants were unable to define nursing as a career and describe their days at work. They expressed how this made it difficult to relate to other non-nurses, which hindered coping. Second career nurses had developed coping strategies and support systems, and did not feel the need for support from coworkers. All participants relayed experiences of coworkers exhibiting presenteeism, physical presence at work when impaired, and burnout behaviors on their units and the consequences of these behaviors. However, first career nurses discussed how these experiences with coworkers made them question how long they would stay in their current position. Survey data analysis of the longitudinal descriptive correlation data is ongoing, but initial results indicate that lack of coping skills is a predictor of burnout. In particular, self-blame is a predictor of the emotional exhaustion component of burnout. Positive coping strategies, like positive reframing and active coping, are significantly correlated with self-compassion. Further analysis of the difference between first and second career respondents over the entire first year is in progress.

Conclusion: There were differences in the transition to practice experiences of second and first career nurses identified in the interviews. The difficulty that participants discussed in describing nursing reflects an ongoing challenge in defining nursing’s professional identity (Öhlén & Segesten, 1998). Multiple participants stated that they did not understand what nursing was when they chose to become nurses and still struggle to define it, which could be a factor in recruitment and retention. First career nurses often lacked the coping strategies and social support of second career nurses, and turned to their coworkers for support. Prior work on coping within nurses has highlighted the importance of developing these skills early in a nursing career (Crary, 2013). However, their coworkers were often burned out, and leaving their positions. Further analysis of all of the time points in the longitudinal survey data, which will be completed in Spring 2017, has potential to reveal differences in how first career and second career students cope with the transition to nursing practices. Findings from this study can offer important insight and recommendations for nursing education and transition programs on future interventions aimed at each of these groups.