This letter, published in 2006 by the venerable newspaper advice columnist, sums up succinctly a primary problem in hospital human resources today – how to keep young nurses at the bedside long enough for them to love their job. According to research funded by the Robert Wood Johnson Foundation and published in the July/August issue of the journal Nursing Outlook, 18.1 percent of newly licensed registered nurses leave their first nursing employer within a year of starting their job, and 26.2 percent leave within two years. Three years ago, a similar study on newly minted Tennessee nurses found that 37 percent left their first job in the first year. While it's unclear how many of these disheartened nurses actually leave the profession altogether, the statistic is still alarming. "That's pretty huge …, and we're losing them in quick numbers," said Lois Wagner, executive director of the Tennessee Center for Nursing, a nonprofit organization founded to address nursing workforce issues. Wagner said about 80 percent of new nurses enter the field in a hospital setting.

 

Respondents of a survey at the heart of the RWJF study cited several reasons for their early-career dissatisfaction, including:

Wagner echoed those same types of concerns. "A lot of the factors are related to the work environment, which is very stressful, particularly for a new grad," she said. "You have these young, really unpracticed professionals entering the field with sicker patients who are in the hospital for shorter periods of time, and it's tremendously stressful." In particular, she noted that new graduates are many times placed in critical-care situations too soon, a situation that can be "anxiety provoking."

 

Wagner pointed to a lack of mentoring as a crux of the issue, and the mentoring problem has many facets. First, seasoned nurses are stressed, too, with unprecedented workloads. While they might desire to help a young nurse along, they just don't have the time. Wagner called this "a double-edged sword." There's also a shortage of veteran nurses, many of whom are leaving hospitals for calmer settings or are retiring. Finally, many nurses, including those with decades in the profession, have never been taught effective mentoring techniques. "Basically it comes down to, 'Look, I've been here 20 years. Follow me around, look at what I do, I'll tell you to do a few things and I'll check up on you,' " said Wagner, explaining what oftentimes passes for mentoring of young nurses today.

 

"There's a lot of work being done on how we can bridge that gap," she added. "Internship programs, residency programs, dedicated units for initiating new nurses. Those are scattered programs, but there is work being done." In fact, Vanderbilt University Medical Center boasts a popular, one-year nurse residency program. The fact that Vanderbilt enjoys extremely high retention rates for new nurses is no coincidence, she noted. "It takes time and effort and dedicated will to develop these evidence-based programs and implement the programs," she said. "It's not cheap, but do you want to be penny wise and pound foolish?" Wagner suggested that the nursing profession should learn from the physician process of residency, which introduces degreed professionals to patient care incrementally and with effective oversight.

 

Speaking of physicians, Wagner acknowledged that nurses still express frustration and anxiety when it comes to the relationship between doctors and nurses. In surveys asking nurses why they left a hospital position, "right up there will be management on the unit, and pretty far up there, in the top five or so, is physician relationships. That is an issue," she said.

 

Asked if she had any advice for long-time nurses who find themselves in a mentoring role, Wagner said, "Be open to the new grad. Understand that the new grad is still integrating all this knowledge they got while in school and learning how to apply that to clinical problems in the clinical setting. Be patient with them about that."

 

As for advice, here's what Dear Abby suggested to Susan in St. Louis: