University of Alberta LETTING GO: HOW NEWLY-GRADUATED REGISTERED NURSES IN WESTERN CANADA DECIDE TO EXIT THE NURSING PROFESSION by Kathryn Michelle Chachula A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Master of Nursing Faculty of Nursing © Kathryn Michelle Chachula Spring 2014 Edmonton, Alberta Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author’s prior written permission. DEDICATION For nurses everywhere, never cease to persevere & To new graduates entering the nursing profession who could not find their way, this work is for you You can be the change you wish to see in the world Mahatma Gandhi ABSTRACT The Canadian Nurses Association predicts the nursing shortage will rise to an estimated 60,000 Registered Nurses (RNs) by the year 2022. Further compounding this issue is the approximate 14-61% of nursing graduates who will change nursing roles or exit the profession within two years of practice. Using the Glaserian grounded theory method, the purpose of this study was to examine the basic psychosocial process labelled Letting Go involved in how newly-graduated RNs in western Canada arrive at the decision to exit the nursing profession within five years of entry into the workforce through semi-structured interviews. The study findings revealed the following themes: Navigating Constraints of the Healthcare System and Workplace; Negotiating Social Relationships, Hierarchies, and Troublesome Behaviours; Facing Fears, Traumas and Challenges; and Weighing Competing Rewards and Tensions. This study adds to a growing body of knowledge to understand new RN attrition from the profession. ACKNOWLEDGEMENT I would like to acknowledge numerous individuals who guided and supported me throughout my Master’s studies at the University of Alberta. Firstly, I offer my sincerest gratitude to my thesis supervisor, Dr. Florence Myrick, who continuously pushed the boundaries of my thinking and writing. Also, your enthusiasm for teaching, mentoring, and scholarship is infectious and invigorating. I feel privileged having worked with you and to have received your guidance during my studies. I would also like to extend my gratitude to my thesis committee members Dr. Olive Yonge and Dr. Randolph Wimmer, without you, this study would not be possible. Thank you sincerely for your warm and thoughtful direction. For my classmates, mentors and professors, I will not forget our discussions, both inside and out of the classroom, as well as in the corridors and hallways of the Edmonton Clinic Health Academy. You made my experiences remarkable at the University of Alberta. I acknowledge the financial support received throughout my Master’s studies: The Foundation for Registered Nurses of Manitoba, University Hospital Foundation - Ruth A. Van Dusen Nursing Scholarship, Olive Yonge Teaching and Learning Scholarship, Queen Elizabeth II Graduate Scholarship, Dr. Rene McElroy Day Scholarship in Nursing, The University of Alberta Faculty of Nursing, Alberta Enterprise and Advanced Education, UAH Class of September 1959, and the Mu Sigma Chapter of Sigma Theta Tau International. A special thank you is in order for my family who cheered me on in many different ways. Matt, your unwavering support, encouragement, and technological prowess significantly contributed to my success while studying afar in Alberta. To my parents, Terry and Brenda, you instilled in me an appreciation for education and nursing work, to which both pose a lifetime of limitless opportunity. Table of Contents CHAPTER 1: INTRODUCTION AND BACKGROUND ................................................ 1 Problem and Significance ............................................................................................... 3 Motivation ....................................................................................................................... 5 Research Objective ......................................................................................................... 7 Guiding Research Questions ........................................................................................... 7 Thesis Structure .............................................................................................................. 7 CHAPTER 2: CURRENT STATE OF KNOWLEDGE ..................................................... 8 Level of Job Satisfaction ................................................................................................. 9 Exhaustion and Burnout .................................................................................................. 9 Quality of Practice Environment ................................................................................... 12 CHAPTER 3: STUDY DESIGN ...................................................................................... 15 Historical Foundations of Grounded Theory ................................................................ 15 Symbolic Interactionism ............................................................................................... 16 Purpose of Study ........................................................................................................... 17 Guiding Research Questions ......................................................................................... 17 Sample Selection ........................................................................................................... 18 Recruitment of Participants ........................................................................................... 18 Demographic Description of Participants ..................................................................... 19 Concurrent Data Collection and Analysis ..................................................................... 21 Substantive Coding ................................................................................................... 22 Open coding. ......................................................................................................... 22 Selective coding. ................................................................................................... 23 Theoretical coding................................................................................................. 24 Memoing ................................................................................................................... 24 Journaling .................................................................................................................. 26 Mechanisms to Ensure for Rigour ................................................................................ 27 Ethical Considerations .................................................................................................. 28 Limitations .................................................................................................................... 30 Dissemination Strategies ............................................................................................... 30 CHAPTER 4: FINDINGS AND DISCUSSION: LETTING GO ..................................... 32 Negotiating Social Relationships, Hierarchies and Troublesome Behaviours .............. 55 Abiding Student-Teacher Relationships ................................................................... 57 Dampening the spirit. ............................................................................................ 57 Fanning the flame.................................................................................................. 60 Being Confronted with Paternalism .......................................................................... 61 Dampening the spirit. ............................................................................................ 61 Fanning the flame.................................................................................................. 64 Encountering Hierarchal and Horizontal Violence ................................................... 65 Dampening the spirit. ............................................................................................ 65 Feeling unwelcome and undervalued. ............................................................... 65 Yielding to humiliation and hostility. ................................................................ 71 Fanning the flame.................................................................................................. 76 Facing Fears, Traumas and Challenges ......................................................................... 78 Persevering ................................................................................................................ 79 Dampening the spirit. ............................................................................................ 79 Not feeling prepared. ........................................................................................ 81 Context Based Learning