What newly licensed registered nurses have to say about their first experiences

      To understand factors that promote retention of Newly Licensed Registered Nurses (NLRNs) and those that contribute to turnover, a survey of a national sample of NLRNs was conducted. This article describes the content analysis of 612 NLRN comments about their work life. Using Krippendorff's1 technique, 5 themes were discovered. Colliding expectations describes conflicts between nurses' personal view of nursing and their lived experience. The need for speed describes the pressure related to a variety of temporal issues. You want too much expresses the pressure and stress NLRNs feel personally and professionally. How dare you describes unacceptable communication patterns between providers. Change is on the horizon suggests optimism for the future as NLRNs speak of transforming the systems where care is provided. This content analysis reveals that the working environment where NLRNs begin their career is in need of reform. Suggestions are offered from the nurses themselves.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Nursing Outlook
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Krippendorff K.
        Content Analysis: An Introduction to Its Methodology.
        Sage, Thousand Oaks, CA2004
        • National League for Nursing (NLN)
        Nursing Data Review, Academic Year 2005-2006 Executive Summary NLN: 2008.
        (Accessed October 18, 2008)
        • Squires A.
        New graduate orientation in the rural community hospital.
        J Contin Educ Nurs. 2002; 33: 203-209
        • Kovner C.T.
        • Brewer C.
        • Ying C.
        • Djukic M.
        Work Attitudes of Older RNs.
        Policy Polit Nurs Pract. 2007; 8: 107
        • Kovner C.T.
        • Brewer C.S.
        • Fairchild S.
        • Poornima S.
        • Kim H.
        • Djukic M.
        Newly licensed RNs' characteristics, work attitudes, and intentions to work.
        Am J Nurs. 2007; 107: 58-70
        • American Association of Colleges of Nursing (AACN)
        Enrollment growth slows at US nursing colleges and universities in 2007 despite calls for more registered nurses. 2007.
        (Accessed October 18, 2008)
        • Williams C.A.
        • Goode C.J.
        • Krsek C.
        • Bednash G.D.
        • Lynn M.R.
        Postbaccalaureate Nurse Residency 1-Year Outcomes.
        J Nurs Adm. 2007; 37: 357-365
        • Young C.M.
        • Albert N.M.
        • Paschke S.M.
        • Meyer K.H.
        The 'Parent Shift' program: Incentives for nurses, rewards for nursing teams.
        Nurs Econ. 2007; 25: 339
        • Schoessler M.
        • Waldo M.
        Organizational Infrastructure to Support Development of Newly Graduated Nurses.
        J Nurses Staff Dev. 2006; 22: 286-293
        • Tai T.W.
        • Bame S.I.
        • Robinson C.D.
        Review of nursing turnover research, 1977-1996.
        Soc Sci Med. 1998; 47: 1905-1924
        • Irvine D.M.
        • Evans M.G.
        Job satisfaction and turnover among nurses: Integrating research findings across studies.
        Nurs Res. 1995; 44: 246-253
        • Hayes L.J.
        • O'Brien-Pallas L.
        • Duffield C.
        • Shamian J.
        • Buchan J.
        • Hughes F.
        • et al.
        Nurse turnover: A literature review.
        Int J Nurs Stud. 2006; 43: 237-263
        • Lu H.
        • While A.E.
        • Barriball K.L.
        Job satisfaction among nurses: A literature review.
        Int J Nurs Stud. 2005; 42: 211-227
        • Coomber B.
        • Barriball K.L.
        Impact of job satisfaction components on intent to leave and turnover for hospital-based nurses: A review of the research literature.
        Int J Nurs Stud. 2007; 44: 297-314
        • Griffeth R.W.
        • Hom P.W.
        • Gaertner S.
        A Meta-analysis of antecedents and correlates of employee turnover: Update, moderator tests, and research implications for the next millennium.
        Journal of Management. 2000; 26: 463-488
        • Hom P.W.
        • Griffeth R.W.
        Employee Turnover.
        South-Western, Cincinnati, OH1995
        • Price J.L.
        Reflections on the determinants of voluntary turnover.
        International Journal of Manpower. 2001; 22: 600-624
        • Duchscher J.E.
        Out in the Real World: Newly Graduated Nurses in Acute-care Speak Out.
        J Nurs Adm. 2001; 31: 426-439
        • De Bellis A.
        • Longson D.
        • Glover P.
        • Hutton A.
        The enculturation of our nursing graduates.
        Contemp Nurse. 2001; 11: 84-94
        • Godinez G.
        • Schweiger J.
        • Gruver J.
        • Ryan P.
        Role transition from graduate to staff nurse: A qualitative analysis.
        J Nurses Staff Dev. 1999; 15: 97-110
        • Casey K.
        • Fink R.
        • Krugman M.
        • Propst J.
        The graduate nurse experience.
        J Nurs Adm. 2004; 34: 303-311
        • Halfer D.
        • Graf E.
        Graduate Nurse Perceptions of the Work Experience.
        Nurs Econ. 2006; 24: 150-155
        • Wilson B.
        • Squires M.
        • Widger K.
        • Cranley L.
        • Tourangeau A.
        Job satisfaction among a multigenerational nursing workforce.
        Journal of Nursing Management. 2008; 16: 716-722
        • Aiken L.H.
        • Clarke S.P.
        • Sloane D.M.
        • Sochalski J.
        • Silber J.H.
        Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction.
        JAMA. 2002; 288: 1987-1993
        • Bowles C.
        • Candela L.
        First job experiences of recent RN graduates: Improving the work environment.
        J Nurs Adm. 2005; 35: 130-137
        • Lynn M.R.
        • Redman R.W.
        Staff Nurses and Their Solutions to the Nursing Shortage.
        West J Nurs Res. 2006; 28: 678-693
        • Salmond S.
        • Ropis P.
        Research for practice.
        Medsurg Nurs. 2005; 14: 301-309
        • American Hospital Association
        The 2007 state of America's hospitals: Taking the pulse.
        (Accessed October 18, 2008)
        • Mathews J.J.
        • Nunley C.
        Rejuvenating orientation to increase nurse satisfaction and retention.
        J Nurs Staff Dev. 1992; 8: 159-164
        • Darling-Hammond L.
        • Sykes G.
        Wanted: A national teacher supply policy for education: The right way to meet the “Highly Qualified Teacher” challenge.
        Education Policy Analysis Archives. 2003; 11 (Accessed October 18, 2008): 1-57
        • Brunetti G.J.
        Resilience under fire: Perspectives on the work of experienced, inner city high school teachers in the United States.
        Teaching and Teacher Education. 2006; 22: 812-825
        • Ingersoll R.M.
        Teacher turnover and teacher shortages: An organizational analysis.
        Am Educ Res J. 2001; 38: 499-534
        • Kramer M.
        Reality Shock; Why Nurses Leave Nursing.
        C.V. Mosby Co, Saint Louis, MO1974
        • American Association of Critical-Care Nurses (AACN)
        AACN Standards for Establishing and Sustaining Healthy Work Environments: A journey to excellence. Washington, DC, 2005.
        (Accessed October 18, 2008)
        • Institute of Medicine
        Keeping Patients Safe: Transforming the Work Environment of Nurses.
        National Academies Press, Washington, DC2004
        • Joint Commission on Accreditation of Healthcare Organizations
        Health Care at the Crossroads: Strategies for Addressing the Evolving Nursing Crisis. 2002.
        (Accessed October 18, 2008)
        • Kimball B.
        • O'Neil E.
        Health care's human crisis: The American nursing shortage.
        The Robert Wood Johnson Foundation, Princeton NJ2002 (Accessed October 18, 2008)
        • Stanton M.
        • Rutherford M.K.
        Hospital nurse staffing and quality of care.
        Agency for Healthcare Research and Quality, Washington, DC2004 (Accessed October 18, 2008)
        • Maxfield D.
        • Grenny J.
        • McMillan R.
        • Patterson K.
        • Switzler A.
        Silence Kills: The Seven Crucial Conversations for Healthcare. 2005.
        (Accessed October 18, 2008)
        • Stanley K.M.
        • Martin M.M.
        • Michel Y.
        • Welton J.M.
        • Nemeth L.S.
        Examining lateral violence in the nursing workforce.
        Issues Ment Health Nurs. 2007; 28: 1247-1265
        • U.S. Department of Labor Occupational Safety and Health Administration (OSHA)
        Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers. Washington, DC: 2004.
        (Accessed October 18, 2008)
        • American Association of Critical-Care Nurses (AACN)
        Zero tolerance for abuse. 2004.
        (Accessed October 18, 2008)
        • International Council of Nurses (ICN)
        Abuse and violence against nursing personnel: ICN Position Statement. Geneva Switzerland, 2006.
        (Accessed October 18, 2008)
        • National Student Nurses Association (NSNA)
        Resolution in support of professional workplace culture and decreasing horizontal violence. 2006.
        (Accessed October 18, 2008)
        • The Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
        Root causes of Sentinel Events: September, 2007.
        (Accessed October 18, 2008)
        • Keller J.
        • Meekins K.
        • Summers B.L.
        Pearls and pitfalls of a new graduate academic residency program.
        J Nurs Adm. 2006; 36: 589-598
        • Phillips B.C.
        An education-service collaboration to address a perceived graduate RN readiness gap.
        Nurs Outlook. 2007; 55: 112-113
        • Sherman R.O.
        Leading a multigenerational nursing workforce: Issues, challenges and strategies.
        OJIN: The Online Journal of Issues in Nursing. 2006; 11 (Accessed October 18, 2008)
        • Kupperschmidt B.R.
        Understanding Generation X employees.
        J Nurs Adm. 1998; 28: 36-43


      Linda Honan Pellico, PhD, APRN, is an Assistant Professor, Yale University School of Nursing, New Haven, CT.


      Carol S. Brewer, RN, PhD, is a Professor, University at Buffalo School of Nursing, Buffalo, NY.


      Christine Tassone Kovner, RN, PhD, FAAN, is Professor and Acting Director of the Florence S. Downs PhD Program in Nursing Research and Theory Development, College of Nursing, New York University, New York, NY.