2015 Manitoba New Nursing Graduates: A 6 and 12 Month Post-Graduate Survey

Transcription

1 2015 Manitoba New Nursing Graduates: A and Post-Graduate Survey Undergraduate Programs Report Prepared by: Manitoba Centre for Nursing and Health Research Contributors: Beverley Temple, RN, PhD Associate Dean of Research College of Nursing Faculty of Health Sciences James Plohman, MSc Research Coordinator, MCNHR Diane Cepanec, MA Senior Research Manager College of Nursing & MCNHR Sandra Ragheb and Rosemary Densmore, BEd Research Assistants, MCNHR 1

2 Table of Contents Highlights... 1 Background... 2 Introduction... 2 Procedures... 2 Survey Administration... 3 Response Rate... 3 Demographics... 4 Employed Graduates... Employment Location... 7 Practice Setting... 7 Work Hours... 8 Employment Status... 8 Transition to the Workplace... 9 Ideal EFT and Reasons Why Intent in the Next Year Intent to Leave Employed Outside Manitoba... Unemployed Graduates Seeking Employment Graduates Seeking Employment Outside of Manitoba Length of Employment Search Outside Manitoba Location of Employment Search Influences and Motivational Factors for Seeking Employment Outside Manitoba... 1 Remaining in Manitoba... 1 Workplace Experiences Transition into the Workplace Bullying References Acknowledgements Funded by the Nurses Retention and Recruitment Fund, Manitoba Health. Assistance with gathering graduate contact information from staff of the following organizations: o Nursing Regulatory Colleges (College of Registered Nurses of Manitoba, College of Licensed Practical Nurses of Manitoba, College of Registered Psychiatric Nurses of Manitoba o Nursing Programs (University College of the North, Brandon University, Red River College, University of Manitoba, Assiniboine Community College, Université de St Boniface) Research Assistants who conducted data collection: o Sandra Ragheb, Rosemary Densmore, Julie Navea, Meghan Conrad and Chioma Ogbumuo

3 Highlights Ninety four percent of all nursing graduates surveyed reported being currently employed in a nursing position at both and months after graduation. While still over 90%, the employment rate was the lowest for the RN graduates compared to LPN and RPN graduates (RNs n=248, 93%; LPNs n=7, 97%; RPNs 44, 98%) with the majority of the unemployed experiencing difficulty in passing the NCLEX examination (13 of 20 at months and 13 of 17 at months after graduation). Two thirds of RN graduates were employed in the WRHA (n=18; 8%). LPN graduates were employed more frequently in the Prairie Mountain Health Region (n=42; 55%) and to a lesser extent in the WRHA (n=22; 29%). Half of the RPN graduates were employed more so in the WRHA (n=22; 50%) with a significant number also working in the Prairie Mountain Health Region (n=; 27%) at months after graduation. The distribution was similar at months after graduation for the 3 groups. LPNs were more likely to report being born outside of Canada (RNs n=49, 19%; LPNs n=24, 31%; RPNs n=1; 2%) and more frequently report English as their second language (RNs n=51, 19%; LPNs n=24, 31%; RPNs n=3, 7%). Few of the nurses surveyed, reported being employed outside of Manitoba (RNs n=4, 2%; LPNs n=1, 1%; RPNs n=2, 5%) at months after graduation with similar results at months after graduation. Only 17 of the graduates at months after graduation indicated they were currently seeking employment outside of Manitoba. Of these 17, 13 also participated in the survey at months after graduation. All 13 reported they were still working in Manitoba and only 3 were still seeking employment outside of Manitoba. The incidence of bullying experienced by graduates in the past months ranged from 21-25% of employed graduates and did not vary significantly between the 3 groups of graduates surveyed or time periods. At months after graduation, the RN and LPN graduates overall level of dissatisfaction with their current nursing employment position was significantly related to the number and frequency of negative acts they had experienced in the last months as measured by the Negative Acts Questionnaire which is designed to measure perceived exposure to bullying and victimization at work. There was no significant relationship between these variables for the RPNs. Few surveyed graduates who had reported being a victim of bullying, reported the incidence of bullying to their employer at months after graduation (13 of 51 RNs; 3 of 18 LPNs; 2 of 10 RPNs). Of the 18 graduates who had reported bullying at months after graduation, 1 described what action was taken. Seven indicated that their employer had taken some action that they were aware of (5 of 11 RNs, 2 No Response; 0 of 3 LPNs; 2 of 2 RPNs). 1

4 Background Introduction In 2015, Manitoba nursing education programs graduated a total of 40 new nurses from the Bachelor of Nursing (BN), Bachelor of Science in Psychiatric Nursing (B.Sc.P.N) and Diploma Program in Licensed Practical Nursing programs combined. These graduates are a valuable resource that must be effectively utilized by the Manitoba health care system. We must have an accurate picture about where these new nursing graduates are finding employment, what type of employment they want to find, and where they intend to seek employment. The rate of migration of new graduates outside of the province and the reasons for their departure must also be monitored to ensure there are no systematic problems in Manitoba that are leading them to leave the province. The goal of this project was to survey all graduates from BN, B.Sc.P.N and Diploma Programs in Licensed Practical Nursing in the Manitoba, and months after they have graduated from their respective nursing education programs to gather valuable information about their employment status, location and types of positions held. It is also important to understand what challenges they encounter in finding employment and what type of employment they prefer to hold. Finally, we must ensure that new nurses are being adequately supported as they transition into the workplace and are not being subjected to undue stressors such as workplace bullying. This data will contribute important information for ongoing monitoring of nursing human resources in Manitoba to ensure that new graduates are being optimally utilized and supported. Procedures With funding from the Nurses Retention and Recruitment Fund (NRRF) of Manitoba Health and project assistance from each of the nursing education programs and the nursing licensing bodies in the province, the Manitoba Centre for Nursing and Health Research (MCNHR) conducted a survey of all 2015 graduates from all Bachelor of Nursing programs in Manitoba (Brandon University, University of Manitoba, Red River College and Université de St Boniface), the Diploma Program in Licensed Practical Nursing (Assiniboine Community College, UCN and Université de St. Boniface) and the Bachelor of Science in Psychiatric Nursing Program (B.Sc.P.N) at Brandon University. The study design was a repeated measures cross-sectional survey to examine employment and other characteristics of new graduates and to explore changes over time. In most cases, results from all survey participants are reported. However, in some cases where noted, analysis is presented involving only those individuals that participated in the survey at both and months after graduation. The MCNHR conducted the data collection, analysis and reporting. A site coordinator at each participating nursing program gathered contact information forms from all potential graduates of their program prior to graduation. On the form, in addition to asking for their current contact information, the future graduates were also asked for consent to authorize their respective nursing regulatory bodies (College of Registered Nurses of Manitoba, College of Licensed Practical Nurses of Manitoba or the College of Registered Psychiatric Nurses of Manitoba) to provide the MCNHR with their address 2

5 and phone number at the times the surveys were conducted. Copies of the signed contact information forms were provided to these regulatory bodies as proof of consent to release the information to the MCNHR. Contact information obtained from the regulatory bodies, assisted in ensuring up-to-date contact information was available for contacting the graduates at the time of the survey. For the month follow-up survey, graduates were contacted in August and November 2015 and April, 201. The month follow-up survey was conducted in February, May and October, 201. Survey Administration The survey of new nursing graduates was administered through the use of a secure online survey provider called Fluidsurvey.com. All graduates were sent a survey invitation containing a web-link to the online survey. Two reminder s sent one week apart were sent to graduates who did not respond. All three s sent to potential participants contained a web-link they could follow to complete the survey or opt-out of participating. No one chose to use this opt-out link. Graduates who did not respond to the survey request were contacted by telephone to remind them that they could complete the survey online and to ask them if they would prefer to complete the survey over the phone. Graduates were called at varying times of the day and evening in an effort to encourage survey completion. Presented in this report is the data collected from 2015 new nursing graduates from all Manitoba Bachelor of Nursing, Diploma in Practical Nursing and Bachelor of Science in Psychiatric Nursing programs that completed the survey at month and months post-graduation. Response Rate Table 1 summarizes the response rate of the entire population of Manitoba graduates from each of the three nursing programs involved in this survey. Table 1 - Response rate of entire population of 2015 nursing graduates at and months after graduation including those who could not be contacted. Nursing Category # of Participants at s # of Participants at s # of Grads Contacted Total # of Grads Population Response Rate Population Response Rate RN % 57% LPN % 3% RPN % 77% A total of 218 of the RN graduates participated in both the and month surveys, 53 LPN graduates participated at both time points and 42 RPN graduates participated in both surveys. The results are presented by the three groups of nursing graduates (RN, LPN, RPN). The findings in this report are limited to the graduates that completed the survey and findings may not be generalizable to all Manitoba nursing graduates. 3

6 Demographics The demographic profiles were very similar between the nursing graduates who completed the survey at months after graduation compared to those who completed the survey at months after graduation, owing to the significant number of participants that completed the survey at both time points. Of the 28 RN graduates who participated at months after graduation, 218 (81%) of them participated in the survey at months after graduation. Also, 53 of the 78 LPN graduates (8%) and 43 of the 45 RPNs (93%) that participated at months, also participated at months. A detailed breakdown of the demographic data frequencies can be found in the Appendix A. The mean age for all 3 groups of nursing graduates combined at months was 27.5 ±.1(SD) (Range 20-55) and at months was 28.5 ±.4 (SD) (Range 21-55). No significant difference in mean age was observed among nursing graduate categories (p > 0.05). The gender breakdown was similar across the 3 groups with an overall distribution of 91% being female and 9% males in the month survey. At the month survey, the percentage of graduates born outside Canada was higher among LPNs (n=24; 31%) compared with the other nursing groups (RN n=49; 19% & RPN n=1; 2%)(Figure 1). Consequently, the percentage of graduates with English as a second language was also higher in the month survey among LPN graduates (n=24; 31%) compared to the RN (n=51; 19%) and RPN (n=3; 7%) graduates. Similar results were found in the month survey. Percent age (%) n=44 n=21 n=53 n=24 n=49 n=1* RN BN LPN RPN Nursing Category No Yes Figure 1 Nursing graduates born inside and outside of Canada ( month survey) 4

7 70 n=171 0 n=25 n=42 50 RN BN Percent (%) n=23 n=13 LPN RPN WRHA n= n=1 n=1 Northern RHA n=37 Prairie Mountain RHA n=27 n=8 0 Southern RHA n=13 n=2 n=4 Interlake RHA n=4 n=1 n=2 Outside Manitoba n=2 0 0 Outside Canada Figure 2- Health Regions of residence of all nursing graduates ( month survey) As shown in Figure 2, the majority of graduates resided in the WRHA (5% of total sample at months and 59% of total sample at months). RN graduates were heavily clustered in the WRHA (4%) compared with 30% of LPN graduates and 5% of RPN graduates at months. An opposite trend was seen in the Prairie Mountain Regional Health Authority where a significant proportion of LPN graduates (55%) resided while only 14% of RN graduates and 29% of RPN graduates resided at months. Similar results were found in the months survey (Appendix A2). 5

8 Employed Graduates The employment rate was high across all nursing graduate groups with more than 90% reporting being currently employed at both and months after graduation (Figure 3). Decreases in employment rate at month post-graduation for the RPNs were related to 3 nurses going on maternity leave. The RNs reported the lowest employment rate with the majority of the unemployed experiencing difficulty in passing the NCLEX exam which persisted through months post-graduation. RN n=248 n=23 Nursing Group LPN n=7 n=78 s Post-Grad s Post-Grad RPN n=47 n= % Employed Figure 3 Employment rate at and months after graduation by nursing group Most of the employed nurses were able to find employment as soon as they wanted with 91% (n=22) of RNs, 91% (n=8) of LPNs and 82% (n=3) of RPNs finding employment promptly. RPN graduates showed significantly more movement between positions in the first year after graduation with 73% (n=32) reporting having held more than 1 position since graduation. By comparison 57% (n=139) of the RNs and 59% (n=41) of the LPN graduates reported having held more than one position at 1 year after graduation.

9 Employment Location As shown in Figure 4, the majority of the RN graduates were employed in the WRHA (n=18, 8%), LPNs were mostly employed in the Prairie Mountain RHA (n=42, 55%) and WRHA (n=22, 29%) and the RPNs were predominantly employed in the WRHA (n=22, 50%) and Prairie Mountain RHAs (n=, 27%) n=18 Percent (%) n=22 n=22 n=34 n=42 n= n=9 n=3 n=7 n=21 n=8 n=11 n=1 n=1 n=3 n=2 n=1 RN (n=247) LPN (n=7) RPN (n=44) 0 WRHA Prairie Mountain RHA Interlake Eastern RHA 0 Southern Health RHA Northern RHA 0 Another Province 0 0 Outside of Canada Employment Locations by RHA Figure 4 Employment locations by Health Regions Practice Setting At months after graduation, most of the employed RNs surveyed were employed in acute care (n=211; 8%). Just under half of the employed LPNs were employed in long term care / personal care home settings (n=32; 4%) with one third also in acute care (n=25; 33%). Almost half of the RPNs were employed in acute care (n=20; 4%) and just over one-quarter were in long term care/personal care homes (n=; 27%). The specific areas of practice are shown in Appendix B3. When asked if they were currently employed in the area of practice that they were seeking upon graduation, 81% (n=199) of the RNs, 70% (n=52) of the LPNs and 77% of the RPNs answered yes at months after graduation. RNs that were not employed in the area of practice they had originally been seeking were asked in which practice area they had been seeking employment. The most popular areas for the RNs were medicine, surgery and emergency care with 7 (15%) seeking employment in each of these areas of practice. LPNs were most commonly seeking in medicine (n=9; 40.9%). RPNs were most commonly searching for employment in acute adult psychiatric care (n=4; 40%). 7

10 When only those who completed the survey at both and months after graduation are examined, 23% of the RNs, 28% of the LPNs had changed their areas of practice. Considerably more RPNs had changed their area of practice with 4% employed in a different area of practice at months compared to months after graduation. Work Hours New graduates were asked to identify their primary hours of work per shift. At months after graduation, more of the RNs surveyed were working hour shifts (n=13; 55%) than 8 hour shifts (n=107; 45%). The LPNs reported working predominantly 8 hour shifts (n=51; 8%). An even greater majority of the RPNs were working 8 hour shifts (n=38; 8%). These percentages did not differ significant at months after graduation. For more details see Appendix B4. Employment Status The majority of the new graduates in all 3 groups were employed in part-time positions at months after graduation and this did not differ significantly at months after graduation n=133 n=47 Percent (%) n=93 n=17 n=13 n=18 n=8 n=4 n=13 n=11 n=9 RN (n = 247) LPN (n = 75) RPN (n = 44) 0 Full Time (Perm and Term) Part Time (Perm and Term) Position Type 0 Casual Multiple Concurrent Positions Figure 5 Types of positions of new nursing graduates at months When asked to rate how satisfied they were with the employment type they currently hold, at months after graduation, 79% (n=100) of the RNs working part-time and 85% of the RNs working full-time were satisfied to very satisfied with their current employment type. For the LPNs, 74% (n=43) of the parttime and 100% of the full-time LPNs were satisfied to very satisfied with their employment type. The RPNs were also mostly satisfied with 89% (n=1) of the part-time RPNs and 92% of the full-time RPNs satisfied to very satisfied with their current employment type. For more details see appendix B5. 8

11 Transition to the Workplace The employed graduates were asked to select from a list, what their primary factors were in accepting their first nursing position. At months after graduation, the most commonly selected reasons for the RNs were that they had their senior clinical practicum there (n=139; 57%), it was the practice area they wanted to work in (n=9; 51%) and it was the first place to offer employment (n=4; 50%). The LPN graduates most commonly selected that it was the first place to offer employment (n=40; 53%), position was close to home (n=3; 48%) and they had their senior clinical practicum there (n=3; 48%). The RPNs provided the same top 3 reasons as the LPNs with 1% (n=27) saying it was the first place to offer employment, 50% (n=22) selecting that the position was in the practice area in which they wanted to work, and 43% (n=19) selecting that the position is close to home. Senior practicum played an important role in where many of the new graduates found employment. Most of the RNs (n=187; 7%) indicated that their senior practicum assisted them in finding their first nursing position. Sixty five percent (n=49) of the LPNs and a lower percentage (n=25; 57%) of the RPNs agreed to this statement. When asked if their first nursing position was in the same facility as their senior practicum, 73% (n=187) of the RNs, 5% (n=49) of the LPNs and 57% (n=25) of the RPNs answered yes. When asked if their first nursing position was in the same unit as their senior practicum, 5% (n=137) of the RNs, 43% (n=32) of the LPNs and 34% (n=15) of the RPNs answered yes. When employed graduates were asked where they had sought employment, their answers mirrored the profile of which health regions they were employed. The majority of the RNs had sought employment in the WRHA (n=175; 71%), the LPNs had sought employment the most in the Prairie Mountain Regional Health Authority (n=43; 59%) and WRHA (n=25; 34%) and the RPNs reported seeking employment most commonly in the WRHA (n=2; 1%) and Prairie Mountain Regional Health Authority (n=13; 30%). Very few of the employed graduates surveyed acknowledged that had been seeking employment outside of Manitoba with only 8 of the RNs, none of the LPNs and only 3 of the RPNs reporting employment searches outside the province at months after graduation. At months after graduation, the new graduates were asked if the employment type (PT, FT, casual etc.) of their current position was their first choice. Most of the RNs (n=18; 75%), LPNs (n=47; 3%) and RPNs (n=32; 73%) indicated that they were working in their employment type of 1 st choice. At months after graduation, this percentage increased significantly for the LPN graduates (n=57; 78%) but remained similar for the RNs (n=193; 79%) and RPNs (n=31; 70%). Nurses who were not working in the employment type of 1 st choice were asked to provide which employment type they would prefer. Most of the RNs and RPNs preferred part-time positions with % (n=38) of the RNs and 58% (n=7) of the RPNs preferring this employment type at months after graduation. In contrast, the LPNs who were not employed in their employment type of first choice preferred full-time employment at months (n=1; 58%) and months (n=13; 81%) after graduation. 9

12 When new graduates who were not employed in their area of practice of first choice were asked to select from a list of reasons why they think that is the case, the most common reason selected for all nursing groups was that the employment of choice was not available. At months after graduation, 48% (n=29) of the RNs, 57% (n=1) of the LPNs and 58% of the RPNs provided this reason. For more details see Appendix B7. Ideal EFTs and Reasons Why The mean preferred EFT did not differ significantly between programs and survey time points equaling an ideal EFT of 0.8 for all nursing groups. This agrees with the predominance of part-time employment in which these new graduates are actually working. Working part-time allows new nurses the flexibility to take some time off from work that they would not necessarily be able to do as new full-time nurses who lack seniority. For more details see Appendix B7. Table 2 Preferred EFTs of surveyed nurses at months after graduation. RN LPN RPN Mean SD Range Mean SD Range Mean SD Range Reasons for Part-Time Preference: The nursing graduates were asked to provide reasons for why they preferred at part-time position. Their responses were coded into themes. A work/life balance and the ability to pick up more shifts were the two most commonly cited reason provided by all 3 nursing categories. Reasons for Full-Time Preference: A majority of the graduates employed full-time preferred this employment type to gain the maximum amount of income and experience. 10

13 Intent in the Next Year Employed graduates were asked what their primary intention is in the next year in regard to location of employment. They could select all categories that apply from a list but their responses were further categorized into the exclusive categories shown in the figure below. Percent (%) n=170 n=45 n=2 Stay with Current Employer n=42 n=17 n=17 May Stay with or Leave Current Employer n=33 n= n=1 Leave Current Employer Employed Graduates Intent in the Next Year BN (n=245) LPN (n=75) RPN (n=44) Figure Intentions of nursing graduates for employment in the next year ( month survey) Most of the graduates were either interested in staying with their current employer or were undecided between staying or leaving their employer. The LPNs had the higher proportion of individuals that had only selected that they were interested in leaving their current employer. For more details see Appendix B10. Intent to Leave Graduates were asked to select on a 5 point likert scale, how often in the last months they had considered leaving their current nursing position. At months after graduation, 15% (n=38) of RNs, 8% (n=) of LPNs and 9% (n=4) of RPNs indicated they had considered leaving quite often to very often. Graduates were also asked to select on a 5 point likert scale, how often in the last months they had considered leaving the nursing profession. At months after graduation, 7% (n=18) of the RNs, none of the LPNs and none of the RPNs had considered this quite often to very often in the last months. For more details see Appendix B9. 11

14 Employed Outside Manitoba Few new graduates surveyed were employed outside of Manitoba. At months after graduation, four RN graduates (2%) were employed outside of Manitoba (1 in the US and 3 in other provinces). One LPN graduate (1%) was also employed outside of Manitoba but did not specify a location. Two RPN graduates (5%) reported being employed outside of Manitoba in another Canadian province. These graduates were asked to select from a list of factors that influenced their decision to leave Manitoba. Personal reasons was the most commonly selected factor. Similar results were found in the months survey (See Appendix C1).

15 Unemployed Graduates Seeking Employment At months after graduation, 15 RN graduates (8%), 2 LPN graduates (3%) and 1 RPN graduate were unemployed. At months after graduation, 17 RN graduates (%), 3 LPN graduates (4%) and 3 RPNs were unemployed. Some were currently seeking employment and others were planning to seek employment in the future as indicate in Figure 7 below Percent (%) RN LPN RPN Not employed but WILL BE seeking nursing emplyment in the future Not employed but seeking nursing employment Figure 7: Unemployed nursing graduates and whether they are seeking or WILL BE seeking nursing employment. (Note: Numbers in the center of the bars indicate sample size in each category) At months, 2 of the RN graduates were not seeking employment due to maternity leave and 13 were not seeking due to difficulty passing the NCLEX exam. At s, these problems persisted with 13 of 14 working on passing the NCLEX and 1 indicating she was just finishing maternity leave. At months, 1 of the LPNs was on maternity leave and 1 had failed the licensing exam. At months after graduation, the 1 LPN was still trying to pass the licensing exam. The 3 unemployed and not seeking RPNs at months were all on maternity leave. Unemployed but Seeking Graduates Unemployed graduates seeking nursing employment were asked about the length of time they had been actively seeking employment. At months, the majority of RN graduates (n=4; 80%) had actively sought employment for less than a month, while at months the majority of graduates (n=2; 7%) had sought employment for 1- months. One RPN graduate had sought employment for less than a month at the months survey. No response was obtained for the two unemployed LPN graduates at months. 13

16 Of the unemployed graduates who were currently seeking employment at months after graduation, the majority (n=4; 7%) were not previously employed as a nurse. At months, of the 5 unemployed graduates currently seeking employment, 2 (40%) were not previously employed as a nurse. At months after graduation, the majority of graduates seeking employment (n=4; 7%) preferred part time permanent employment while at months the majority of graduates (n=3; 0%) preferred full time permanent employment. Most of the unemployed RN graduates had been seeking employment in acute care at and months. Surgery (n=5; 100% of RN graduates) and Operating/Recovery Room (n= 3; 0%) were the two most common areas of practice in which RN graduates were seeking employment. Both LPN graduates (n=2) were seeking employment in Long-term care/pch and one graduate was seeking employment in Medicine. One unemployed RPN graduate (100%) was seeking employment in Acute Adult Psychiatric Care, Long-term care/pch, and Penitentiary/Detention Centre. Most of the unemployed graduates were seeking employment in the WRHA at months after graduation (n=4, 7%). In total, one unemployed graduate (17%) was seeking employment outside Manitoba at months, compared with two graduates (40%) who were seeking employment outside Manitoba at months. 14

17 Graduates Seeking Employment Outside of Manitoba Few new graduates reported that they are seeking employment outside of Manitoba as summarized in Table 3. In total only 17 new graduates were seeking employment outside of Manitoba at months after graduation and only 22 were doing so at months after graduation. The table below shows the number that reported they are seeking employment in each of the 3 groups and 2 time points. Table 3 Number of employed and unemployed graduates seeking employment outside of Manitoba by nursing category. RN LPN RPN s s s s s s Employed Graduates Seeking Outside MB Unemployed Graduates Seeking Outside MB Length of Employment Search Outside Manitoba None of the new graduates who were seeking employment outside of Manitoba at months after graduation and that also participated in the survey at months after graduation, reported they were employed outside of Manitoba at months after graduation. Most of these had also stopped searching for employment outside of Manitoba with only 3 still seeking employment in another province. Eight of the 11 RN graduates who had indicated they were seeking employment outside of Manitoba at months after graduation, also participated in the survey at months after graduation. All 8 reported they were currently working in Manitoba and only 1 of the 8 was still seeking employment outside of Manitoba. Three of the 4 LPN graduates that reported they were seeking employment outside of Manitoba at months after graduation participated in the survey at months after graduation. Two of these 3 were no longer seeking employment outside of Manitoba and the remaining 1 was still seeking employment outside of Manitoba. Both of the RPN graduates who had indicated they were seeking employment outside of Manitoba at months after graduation also participated in the survey at months after graduation. Both were still working in Manitoba and 1 was still seeking employment outside of Manitoba in another province. Location of Employment Search Graduates were asked to provide the location of where they were searching for employment outside of Manitoba. Some indicated they were searching for employment in more than one location. The RN 15

18 graduates were searching for employment in a mix of other provinces and the United States with 2 seeking employment outside of North America at months after graduation. The LPN graduates were only searching for employment in other provinces and not in other countries. The RPN graduates were searching for employment in other provinces and other countries with one searching for employment at months after graduation even though the BScPN degree is not recognized in the country. Influences and Motivational Factors for Seeking Employment Outside Manitoba Some of the strongest influences for new graduates seeking employment outside of Manitoba included professional opportunities, and better pay/benefits (n=29, 78%), followed closely by travel and weather considerations (n=27, 71%), and family/personal influences (n=24, 3%). Workload and work conditions (n=22, 58%); cost of living (n=21, 55%); and recruitment strategies (n=18, 47%) were also selected as influential or very influential factors for graduates seeking employment outside Manitoba. Some of the challenges that new graduates identify as presenting a challenge to them as they seek employment outside Manitoba include weather (n=24, 3%); family or personal issues (n=22, 58%); and lack of employment in a specialty area (n=21, 55%). Lack of employment in specialty areas was seen as a large challenge in graduates from the month survey (n=15, 7%). Other challenges identified as influential or very influential included: lack of permanent employment (n=20); cost of living (n=19, 50%); not feeling valued (n=18, 47%); lack of full time employment and lack of employment in certain locations (n=17, 45%); work conditions/workload and lack of education opportunities (n=1, 42%). (Appendix C2) Remaining in Manitoba At months after graduation, the nurses who were working outside of Manitoba were asked if they would stay in Manitoba if the employment type they were seeking was offered to them in Manitoba. Seven of the 11 RNs, 2 of the 4 LPNs and 1 of the 2 RPNS said they would stay in Manitoba in this circumstance. 1

19 Workplace Experiences Transition into the Workplace At months after graduation, employed graduates were asked select from a list, what workplace supports they had received that helped to ease their transition into the workplace and were also asked to rate how helpful each was to them. Table 4 Employed new nursing graduates that found the following workplace transition supports to be somewhat helpful to very helpful. Workplace Supports RN (n=248) n (%) LPN (n=78) n (%) RPN (n=45) n (%) Orientation to the unit/area 222(91%) 73(99%) 42(97%) Orientation to the facility/agency 215(88%) 9(95%) 39(98%) Preceptor/buddy system on the unit/area 205(84%) 3(8%) 34(78%) Opportunity to be mentored by a staff member 172(72%) 1(84%) 24(55%) General policy and procedure manual 198(82%) 7(92%) 3(82%) Respectful workplace policy and procedure manual 13(7%) 7(92%) 34(78%) Respectful workplace education session 139(58%) 59(82%) 30(9%) A reasonable progression of responsibility 184(7%) 52(72%) 21(47%) An initial reduced workload 157(5%) 52(72%) 21(47%) New Grad Day for Nurses 97(42%) 38(53%) (13%) At months after graduation, the graduates were also asked to indicate which workplace supports they had not received that they felt would have been helpful. One hundred and twenty six of the employed RNs, 22 of the LPNs and 20 of the employed RPNs answered the question. This question was posed as an open text response. Their answers were categorized into themes summarized in Table 5. The most common theme related to feeling sufficiently supported. A desire for better orientation was the most common specific suggestion for improved support for all 3 nursing groups. For more details see Appendices D1, D2, D3. Table 5 Workplace transition supports employed graduates did not receive that they felt would have been helpful to aid their transition to the workplace. Some participants mentioned more than 1. Workplace Supports Not Received 17 RN (n=) n (%) LPN (n=22) n (%) RPN (n=20) n (%) Felt Sufficiently Supported 42(33) 17(77) (30) Other 38(30) 5(23) 5(25) Better Orientation to the Unit 32(25) (27) (30) Having a Mentor 20(1) 1(5) 7(35) More Training and Orientation on Job Duties 1(13) 1(5) 3(15) Training on Documentation 15() 1(5) 3(15) Regular Feedback from Managers 14(11) 1(5) 2(10) Having a Support Group / Supportive Management 11(9) 7(32) 3(15) Orientation to the Unit not Received 4(3) 2(9) 0 *Many respondents cited more than one support that they had not received that would have been beneficial.

20 Bullying Bullying was defined as the persistent act of demeaning and downgrading another person through cruel words and negative actions that undermine another person s self-confidence and negative actions that undermine another s self-confidence and self-esteem. A power disparity exists between the bully and the victim (Vogelpohl et al, 2013). Bullying has been identified as a problem that significantly affects the workplace environment, contributes to the likelihood of making an error affecting patient care (Longo & Hain, 2014; Rosenstein & O Daniel, 2008) and increases staff turnover. 30 Percent (%) n=55 n=51 n=18 n=10 n=11 n=15 s s 5 0 RN LPN RPN Nursing Group Figure 8 Employed new nursing graduates who indicated they had been bullied at their workplace in the last months ( month and month surveys) When asked if they had been bullied at their workplace in the last months, 20-25% of the graduates indicated they had experienced bullying in the workplace depending on the nursing category and survey time point (Figure 8). In another study conducted with nurses in the Northwestern United States, 4% of nurses reported they had been bullied in the last months (Etienne, 2014) (Appendix E1). Bullying Sources For the RN graduates, the two most common sources of frequent bullying (daily to weekly occurrence) were from patients (24%; n=) and patient s family members/visitors (20%; n=10). LPNs also reported that patients were the most frequent source of bullying with 17% (n=3) reporting daily to weekly occurrence from this group. RPN graduates were bullied most frequently by patients with 40% (n=4) of bullied individuals experiencing bullying from this group daily to weekly. For more details see appendices E1, E2. 18

21 NAQ Scores by Program Type The Negative Acts Questionnaire Revised (NAQ-R) is a 22 item tool designed to measure perceived exposure to bullying and victimization at work (Einarsen et al, 1994). Each item is scored from 1 (never) to 5 (daily) based on the frequency of experience of each behaviour. A total scale score is calculated along with 3 subscales; work related bullying, person related bullying and physical intimidating bullying Each (Appendix F). The Cronbach s alpha of this scale in this study for all data collected is indicating a high degree of internal consistency between scale items. A higher NAQ Score indicates the number and frequency of negative acts experienced is greater. Comparing the NAQ Total Scores between nursing groups at months after graduation (Table 5), shows that the RNs had the highest degree of negative experience followed by the RPNs and then LPNs. However, the NAQ scores varied a lot between individuals and were not significant different between nursing groups. Total NAQ score was also not related to age, gender, Born in Canada, or ESL status. The mean NAQ scores and subscale scores were similar to those measured by Einarsen et al (2014) who surveyed,350 individuals from a range of private, public and voluntary sectors in Great Britian. Mean work related bullying score in this noted study was 13.78, person related bullying score was 14.51, mean physical intimidating bullying score was 3.88 and mean NAQ total score was Table 5 Negative Acts Questionnaire mean total scores and mean subscale scores ( months). RN LPN RPN n Mean SD n Mean SD n Mean SD Work Related Bullying Person Related Bullying Physical Intimidating Bullying Total NAQ Bullying Score There was a significant moderate correlation between the overall level of job dissatisfaction and the NAQ Score for all nursing groups except the RPNs meaning graduates who had higher NAQ Scores were more likely to have experienced a higher number and frequency of negative acts. Work Related Bullying Scores were the most highly correlated with a higher level of overall job dissatisfaction. Table Spearman s Correlations of Negative Acts Questionnaire total scores and subscales with "Overall, how satisfied are you with your current nursing employment position?" Satisfaction was on a 5 point likert scale from very satisfied (scored 1) to very dissatisfied (scored 5). RN LPN RPN n r s p n r s p n r s p Work Related Bullying 241 *0.29 < * * Person Related Bullying 239 * * * Physical Intimidating Bullying 240 * Total Bullying Score 23 *0.233 < * *Significant correlations at p <

22 Workplace Reporting and Follow-up of Bullying A majority of the graduates who reported they had been bullied indicated they had not reported any cases of bullying to their employer. Of the nurses who had reported being bullied in the last months, only 13 of 51 RNs, 3 of 18 LPNs and 2 of 10 RPNs indicated they had reported any incidents of bullying to their employer # of Nurses RN BN LPN RPN Nursing Category Did Not Report Bullying Incident Reported Bullying Figure 9 Number of graduates who had been bullied and whether they reported the incident to their employer ( month survey) There was no common method used to report incidents of workplace bullying for the RN and LPN groups but the most common method for the RNs was through in-person communication (7 of 13) or an incident report (3 of 13). The 3 LPNs who reported bullying did so through through in-person communication, to manager and incident report. All RPNs who reported bullying did so through in-person communication. (Appendix E3) Employer Response When asked what action was taken by their employer after bullying was reported at months after graduation, of the 11 RN graduates who answered this question reported that their employer had indicated they would take action to address the bullying incident. The other 5 indicated that they either didn t know what action was taken (n=3), or said no action was taken (n=2). The 3 LPNs who reported bullying act months after graduation said no action was taken with 1 saying the incident was recorded and the 2 RPNs said their employer had plans to deal with the bullying incident with 1 saying the bully was spoken to by the manager. 20

23 At months after graduation, few of the employers followed-up with the graduates who had been bullied after action was taken with 3 of the 13 RNs, none of the 3 LPNs and 1 of the 2 RPNs receiving follow-up from their employer. Similar results were recorded in the survey at months after graduation. For more details see Appendix E3. Respectful Workplace Employed new graduates were asked what strategies their employer utilizes to foster a respectful workplace. Their responses were coded into themes. At months after graduation, the RNs that answered the question (n=173) most commonly mentioned that they did not know of any strategies utilized 53 (31%), but those that knew of strategies mentioned a zero tolerance policy (n=2; 15%) and 2 answered that they had been told to use open communication / open-door policy with their managers (15%). When the question was posed to the LPNs at months after graduation, the 4 who answered provided similar responses with 15 (33%) indicating they were not aware of any strategies utilized by their employer, 8 (17%) mentioning being educated on Respectful Workplace Policy and 7 (15%) being told about what actions were expected of them as an employee. For the 35 RPNS who answered this question, 13 (37%) mentioned the policies that were in place such as zero tolerance/open door policies, (17%) mentioned they were unaware of any strategies utilized by their employer and an equal number (n=; 17%) recalled receiving training on Respectful Workplace Policies. For more details see Appendix E4. Effect of Negative Behaviours on Intention to Leave At months after graduation, those graduates who had indicated they experienced bullying were asked if over the past months, negative behaviours experienced at work have made them consider leaving a nursing position. Sixty percent (n=31) of the RNs and a similar percentage of the LPNs (n=11; 1.1%) and RPNs (n=7; 70%) answered yes to this question at months after graduation. When these same nurses were asked if negative behaviours experienced at work in the last months had made them consider leaving the nursing profession, 28% (n=14) of the RNs, 28% (n=5) of the LPNs and only 1 of the 10 RPNs answered yes (Appendix F5). Relationship between NAQ Scores and Intention to Leave Those individuals who had indicated that negative behaviours experienced at work had made them consider leaving a nursing position also experienced a greater frequency and number of negative acts as measured by the NAQ Scores. As shown in Table 7, the NAQ score and subscale scores were all significantly higher in the group that had considered leaving their position compared to those who said the bullying had not made them want to leave except for the physical intimidating bullying scores which were not significantly different between the two groups. 21

24 Table 7 Negative Acts Questionnaire mean total scores and mean subscale scores ( months survey) for those who had and had not considered leaving a nursing position in the last months due to negative behaviours experienced at work. Considered Leaving Nursing Position All Nursing Graduates Who Were Bullied Did Not Consider Leaving Nursing Position n Mean SD n Mean SD Work Related Bullying 47 * * Person Related Bullying 47 * * Physical Intimidating Bullying Total NAQ Bullying Score 4 * * *Significant differences between those that considered leaving nursing position and those that didn t at p < 0.05 The same relationships existed between the NAQ scores and subscale scores of those who indicated that negative behaviours had made them consider leaving the nursing profession (Table 8). With all scores significantly higher in the group who had considered leaving the nursing profession compared to those who had not considered leaving as a result of the bullying they had experienced. However, again the physical intimidating bullying scores were not significantly different between these two groups. Table 8 Negative Acts Questionnaire mean total scores and mean subscale scores ( months survey) for those who had and had not considered leaving the nursing profession in the last months due to negative behaviours experienced at work. Considered Leaving Nursing the Nursing Profession All Nursing Graduates Who Were Bullied Did Not Consider Leaving Nursing the Nursing Profession n Mean SD n Mean SD Work Related Bullying 18 * * Person Related Bullying 18 * * Physical Intimidating Bullying Total NAQ Bullying Score 18 * * *Significant differences between those that considered leaving nursing position and those that didn t at p < 0.05 These relationships were true for the RN graduates at and months after graduation and for the entire nursing graduate population as a whole. There were insufficient numbers to determine with confidence if this was true for the RPN and LPN graduates alone. 22

25 References Einarsen, S., Hoel, H. & Notelaers, G. (2009). Measuring exposure to bullying and harassment at work: Validity, factor structure and psychometric properties of the negative acts questionnaire-revised. Work and Stress, 23(1), Etienne, E. (2014). Exploring workplace bullying in nursing. Professional Practice, 2(1), -11. Longo, J., Hain, D. (2014). Bullying: A hidden threat to patient safety. Nephrology nursing journal: Journal of the American Nephrology Nurses Association. 41(2), Rosenstein, A.H. & O Daniel, M. (2008). A survey of the impact of disruptive behaviours and communication defects on patient safety. Joint Commission Journal on Quality and Patient Safety, 34(8), Vogelpohl, D.A., Rise, R.K., Edwards, M.E. & Bork, C.E. (2013). New graduates nurses perception of the workplace: Have they experienced bullying? Journal of Professional Nursing, 29(),

26 Appendix A: Comparison Table of 2015 RN, LPN, RPN Graduate Demographics RN LPN RPN Total n(%) n(%) n(%) n(%) n(%) n(%) n(%) n(%) Total Sample n=28 n=23 n=78 n=7 n=45 n=47 n=391 n=38 What is your gender? n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n=25 n=22 n=77 n=73 n=45 n=47 n=387 n=382 Female 241 (91) 235(90) 8 (88) 3 (8) 42 (93) 44 (94) 351(91) 342(90) Male 24 (9) 27(10) 9 () 10 (14) 3 (7) 3 () 3(9) 40(10) Were you born in Canada? n=25 n=20 n=77 n=73 n=45 n=47 n=387 n=380 Yes 21 (81.5) 2(82) 53 (9) 45 (2) 44 (98) 4 (98) 313(81) 303(80) No 49 (18.5) 48(18) 24 (31) 28 (38) 1 (2) 1 (2) 74(19) 77(20) Is English your second/additional language? n=24 n=21 n=77 n=73 n=44 n=47 n=385 n=381 Yes 51 (19) 50(19) 24 (31) 30 (41) 3 (7) 2 (4) 78(20) 82(22) No 213 (81) 211(81) 53 (9) 43 (59) 41 (93) 45 (9) 307(80) 299(78) Do you self-identify as First Nations, Métis or Inuit? n=22 n=22 n=7 n=73 n=45 n=47 n=383 n=382 Yes 19 (7) 22(8) 8 (10.5) 7 (10) 8 (18) 8 (17) 35(9) 37(10) No 243 (93) 240(92) 8 (89.5) (90) 37 (82) 39 (83) 348(91) 345(90) What is your marital status? n=2 n=22 n=77 n=73 n=45 n=47 n=388 n=382 Single/never married 11(1) 150(57) 44 (57) 34 (47) 24 (53) 21 (45) 229(59) 205(54) Married/commonlaw 91 (34) 100(38) 29 (38) 34 (47) 20 (44) 24 (51 ) 140(3) 158(41) Separated/divorced 10 (4) 10(4) 3 (4) 3 (4) 1 (2) 1 (2) 14(4) 14(4) Other 4 (1) 2 (1) 1 (1.3) 2 (2.7) 0 1 (2) 5(1) 5(1) A1

27 RN RPN RPN Total n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) What is your region of residence? n=2 n=21 n=77 n=73 n=45 n=47 n=388 n=381 WRHA 171(4 ) 179(7) 23(30) 23(32) 25(5) 23(49) 219(5) 25(59) Northern RHA (4.5) (5) 1(1) 1(1) 1(2) 0 14(4) 13(3) Prairie Mountain RHA 37(14) 32() 42(55) 38(52) 13(29) 15(32) 92(24) 85(22) Southern RHA 27(10) 21(8) 8(10) 7(10) (9) 28(7) Interlake RHA 13(5) 11(4) 2(2.) 2(2.7) 4(9) (13) 19(5) 19(5) Outside Manitoba 4(2) 4(2) 1(1) 2(2.7) 2(4) 3() 7(2) 9(2) Outside Canada 2(10) 2 (1) (0.5) 2(0.5) Mean Age n=24 n=21 n=77 n=72 n=45 n=47 n=38 n= ± 28.4 ± 28.1 ± 29.8 ± 2.5 ± 27.1 ± 27.5 ± 28.5 ± Range A2

28 Appendix B: Comparison Table of 2015 RN, LPN, RPN Employed Graduates Mont RN LPN RPN Total n(%) n(%) n(%) n(%) n(%) n(%) n(%) n(%) Employment Rate n=28 n=23 n=78 n=7 n=45 n=47 n=391 n=38 Total Employed 248(93) 245(93) 7(97) 73(9) 44(98) 44(94) 38(94) 32(94) The following questions were answered by employed graduates on nursing positions held Were you able to find work as a nurse as soon as you wanted? n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n=247 N/A n=75 N/A n=44 N/A n=3 N/A Yes 22(91) - 8(91) - 3(82) - 330(90) - No 21(9) - 7(9) - 8(18) - 3(10) - How many nursing positions have you held since you graduated? n=24 n=245 n=75 n=9 n=44 n=44 n=35 n=358 One 147(0) 10(43) 45(0) 28(41) 22(50) (27) 214(59) 14(41) Two 84(34) 87(3) 20(27) 21(30) 18(41) 24(55) 2(33) 132(37) Three or more 15() 52(21) 10(13) 20(29) 4(9) 8(18) 29(8) 80(22) B1