BACKGROUND: High levels of stress and the challenges of meeting the complex needs of critically ill children and their families can threaten job satisfaction and cause turnover in nurses. OBJECTIVE: To explore the influences of nurses' attributes, unit characteristics, and elements of the work environment on the job satisfaction of nurses in pediatric critical care units and to determine stressors that are unique to nurses working in pediatric critical care. METHOD: A cross-sectional survey design was used. The sample consisted of 1973 staff nurses in pediatric critical care units in 65 institutions in the United States and Canada. The following variables were measured: nurses' perceptions of group cohesion, job stress, nurse-physician collaboration, nursing leadership, professional job satisfaction, and organizational work satisfaction. RESULTS: Significant associations (r = -0.37 to r = -0.56) were found between job stress and group cohesion, professional job satisfaction, nurse-physician collaboration, nursing leadership behaviors, and organizational work satisfaction. Organizational work satisfaction was positively correlated (r = 0.35 to r = 0.56) with group cohesion, professional job satisfaction, nurse-physician collaboration, and nursing leadership behaviors. Job stress, group cohesion, job satisfaction, nurse-physician collaboration, and nursing leadership behaviors explained 52% of the variance in organizational work satisfaction. Dealing with patients' families was the most frequently cited job stressor. CONCLUSIONS: Job stress and nursing leadership are the most influential variables in the explanation of job satisfaction. Retention efforts targeted toward management strategies that empower staff to provide quality care along with focal interventions related to the diminishment of stress caused by nurse-family interactions are warranted.

New graduates are faced with significant challenges associated with transitioning from the role of student nurse to graduate nurse. Acute care environments are driven by complex systems and are technologically advanced. Coupled with extremely high acuity of patients, this setting places many demands on new graduates to develop competency in a relatively short period of time. Many new graduates feel unprepared for the demands of practice and struggle with mastery of clinical skills, time management, development of clinical judgment, and learning to manage a heavier patient care load. This steep learning curve can be overwhelming increasing new graduates' stress level and feelings of incompetence, thereby increasing the potential for turnover.Because the phenomenon of turnover is so costly and impacts quality of care, healthcare organizations have been challenged to design effective programs that offer support for new graduate nurses to ease their transition into practice (Beecroft, Kunzman & Krosek, 2002;Blanzola, Lindeman, & King, 2004; Krugman, Bretschneider, Horn, Krsek, Moutafis & Smith, 2006;Lindsey & Kleiner, 2005;Rosenfeld, Smith, Iervolino & Bowar-Ferres, 2004;Williams, Sims, Burkhead & Ward, 2002). These programs are intended to help new NOT THE PUBLISHED VERSION; this is the author's final, peer-reviewed manuscript. The published version may be accessed by following the link in the citation at the bottom of the page. Nursing, Vol. 40, No. 9 (September 2009): pg. 416-425. DOI. This article is © Slack Incorporated and permission has been granted for this version to appear in e-Publications@Marquette. Slack Incorporated does not grant permission for this article to be further copied/distributed or hosted elsewhere without the express permission from Slack Incorporated. Journal of Continuing Education in 2graduates quickly adapt to fast-paced environments and effectively respond to the challenging, dynamic situations encountered in daily practice.New graduate transitioning programs are particularly important because a large portion of new nurses leave the nursing profession within two years of graduating from nursing school (Kamphuis, 2004;McMahon, 2005). Turnover in the new graduate population is a documented phenomenon with reports indicating that during the first year of practice 30-61% of new graduates change their place of employment (Casey, Fink, Krugman, & Propst, 2004;Godinez, Schweiger, Gruver, & Ryan, 1999). New graduate turnover is very expensive for organizations, which report that a nurse with less than one year of experience who leaves, costs the organization almost $50,000 and can approximate a nurses' annual salary (Beecroft, Kunzman & Kroszek , 2001; WNRP Advisory Team, personal communication, 2005). Turnover costs can be as high as $145,000 (Colosi, 2002). Organizations face financial drains related to costs for advertising, recruitment, and temporary replacements. These costs are underestimated because they do not capture the tremendous consumption of resources required to orient and ...

Aim This study aimed to compare rural and urban nurse residency programme participants’ personal and job characteristics and perceptions of decision‐making, job satisfaction, job stress, nursing performance and organisational commitment over time. Background Nurse residency programmes are an evolving strategy to foster transition to practice for new nurses. However, there are limited data available for programme outcomes particularly for rural nurses. Method A longitudinal design sampled 382 urban and 86 rural newly licensed hospital nurses during a 12‐month nurse residency programme. Data were collected at the start of the programme, at 6 months and the end of the programme. Results At the end of the programme, rural nurses had significantly higher job satisfaction and lower job stress compared with urban nurses. Across all time‐periods rural nurses had significantly lower levels of stress caused by the physical work environment and at the end of the programme had less stress related to staffing compared with urban nurses. Perceptions of their organisational commitment and competency to make decisions and perform role elements were similar. Conclusions Differences in these outcomes may be result from unique characteristics of rural vs. urban nursing practice that need further exploration. Implications for nursing management Providing a nurse residency programme in rural and urban hospitals can be a useful recruitment and retention strategy.

New nurses continue to face challenging work environments and high expectations for professional competence as they enter practice. Nurse residency programs are gaining prominence as a mechanism to ease new graduates’ transition to practice. This study examined new graduates’ perceptions of their professional practice competence and work environment throughout a yearlong nurse residency program. Employing a repeated measures design, data were collected at baseline, at 6 months, and at 12 months. Results showed that job satisfaction was significantly lowest at 6 months and highest at 12 months. Job stress was found to be lowest at 12 months and organizational commitment was highest at baseline. Of the variables related to professional practice, clinical decision-making was highest at 12 months and quality of nursing performance significantly increased at each measurement point. These data add to the growing evidence supporting the efficacy of nurse residency programs.

Use of a consistent language and framework to evaluate competence acquisition in simulation is recommended, as is future research to test the constructs.