Original Investigation
Emergency Medicine
April 9, 2024
Emergency Nurses’ Reasons for Not Recommending Their Hospital to Clinicians as a Good Place to Work
K. Jane Muir, Raina M. Merchant, Karen B. Lasater, et al
JAMA Netw Open. 2024;7(4):e244087. doi:10.1001/jamanetworkopen.2024.4087
Question Why do emergency nurses not recommend their hospital to clinicians as a good place to work?
Findings This qualitative study was a directed content analysis of 142 open-text responses from emergency nurses describing why they indicated “probably not” or “definitely not” to the survey question, “Would you recommend your place of employment as a good place to work?” Nurses reported insufficient staffing, nonresponsive unit administration, unsafe working conditions, workplace violence, and a sense of being undervalued as reasons for not recommending their workplace to clinicians.
Meaning These findings provide opportunities for health care administrators to improve emergency departments for clinician retention.
Abstract
Importance Half of emergency nurses report high burnout and intend to leave their job in the next year. Whether emergency nurses would recommend their workplace to other clinicians may be an important indicator of a hospital’s ability to recruit clinicians.
Objective To examine why emergency nurses do not recommend their hospital to other clinicians as a good place to work.
Design, Setting, and Participants This qualitative study used directed content analysis of open-text responses (n = 142) from the RN4CAST-NY/IL survey of registered nurses licensed in New York and Illinois between April 13 and June 22, 2021. Inductive and deductive analytic approaches guided study theme development informed by the Social Ecological Model. The collected data were analyzed from April to June 2023.
Main Outcomes and Measures Nurses who answered “probably not” or “definitely not” to the survey question, “Would you recommend your place of employment as a good place to work?” were prompted to provide a rationale in an open-text response.
Results In this qualitative study of 142 emergency nurses (mean [SD] age, 43.5 [12.5] years; 113 [79.6%] female; mean [SD] experience, 14.0 [12.2] years), 94 (66.2%) were licensed to work in New York and the other 48 (33.8%) in Illinois. Five themes and associated subthemes emerged from the data. Themes conveyed understaffing of nurses and ancillary support (theme 1: unlimited patients with limited support); inadequate responsiveness from unit management to work environment safety concerns (theme 2: unanswered calls for help); perceptions that nurses’ licenses were in jeopardy given unsafe working conditions and compromised care quality (theme 3: license always on the line); workplace violence on a patient-to-nurse, clinician-to-nurse, and systems level (theme 4: multidimensional workplace violence); and nurse reports of being undervalued by hospital management and unfulfilled at work in delivering suboptimal care to patients in unsafe working conditions (theme 5: undervalued and unfulfilled).
Conclusions and Relevance This study found that emergency department nurses did not recommend their workplace to other clinicians as a good place to work because of poor nurse and ancillary staffing, nonresponsive hospital leadership, unsafe working conditions, workplace violence, and a lack of feeling valued. These findings inform aspects of the work environment that employers can address to improve nurse recruitment and retention.
