Leaving from and returning to nursing practice: contributing factors.
Many nurses leave nursing and never return. Others return after a
period of time. Given the global shortage of nurses a better
understanding of these movements is needed. The present study focused on
nurses who had been out of nursing for more than five years, and
explored factors that influenced their leaving and return to practice.
All the nurses who had undertaken a Competency Assessment Programme at a
given New Zealand tertiary institution during 2005 were invited to
participate. Of the 70 questionnaires mailed out 32 (44.5%) were
completed and returned. Quantitative data were analysed using Microsoft
Excel, and the qualitative data were coded and analysed by means of
content analysis. For each, leaving and returning, three key issues
emerged. Nurses left for personal reasons, to seek a career change, or
because of poor working conditions. They returned when they had the
personal freedom to do so, for fiscal reasons, or because they were
motivated by some sense of unfinished business. These findings indicate
that it is important for educators involved with Competency Assessment
Programmes to collaborate with employers in ensuring that there are
opportunities for re-entry to positive work environments, with a degree
of flexibility that suits the demographic characteristics of those
nurses returning to practice.
Key Words: Registered nurse, career break, exiting, re-entry, workforce, returning to practice.
Registered nurses (Practice)
Registered nurses (Surveys)
|Publication:||Name: Nursing Praxis in New Zealand Publisher: Nursing Praxis in New Zealand Audience: Academic Format: Magazine/Journal Subject: Health care industry Copyright: COPYRIGHT 2009 Nursing Praxis in New Zealand ISSN: 0112-7438|
|Issue:||Date: July, 2009 Source Volume: 25 Source Issue: 2|
|Topic:||Event Code: 200 Management dynamics|
|Product:||Product Code: 9918560 Career Planning; 8043110 Nurses, Registered NAICS Code: 621399 Offices of All Other Miscellaneous Health Practitioners|
|Geographic:||Geographic Scope: New Zealand Geographic Code: 8NEWZ New Zealand|
Introduction and Background
Since the introduction in New Zealand of the Health Practitioners Competence Assurance Act (2003) all nurses who have been out of practice for five or more years must successfully complete a Nursing Council of New Zealand approved Competency Assessment Programme. They then become eligible for issue of an Annual Practising Certificate prior to re-employment as a New Zealand Registered Nurse. Given the workforce shortage of registered nurses (RNs) both globally (turn, Dolea, & Stilwell, 2005) and locally (New Zealand Nurses Organisation, 2007) knowing why nurses leave and choose to return is important information for Competency Assessment Programme educators so that they can offer appropriate support to nurses as they re-enter the workforce. Furthermore, it is important that employers have current information so that they are able to address workplace factors that influence nurse retention. This article discusses the results of a survey designed to elicit from RNs who had been out of practice for more than five years, reasons as to why they had left and were later considering return.
Traditional beliefs about nurses and a nursing career held that female health professionals were likely to take leave from nursing due to the pressures of balancing clinical workloads and the demands of family life (Mark & Gupta, 2005). Other authors maintain similar reasons, citing pregnancy or child care as reasons for leaving (Cobden-Grainge & Walker, 2002; Palumbo, Murray, & Gray, 2003; Yancy & Heanley, 2004). Additional reasons given for leaving include burnout, compassion fatigue, a desire for a career change, personal issues, political influences and lifestyle issues (Bakker, Le Blanc, & Schaufeli, 2006; Daniels, 2004; Nordam, Torjuul, & Sorlie, 2005; Watson & Feld, 1996; Worley, 2005).
Miles (1996) studied 10 RNs who intended to leave the profession permanently to move to new careers of medicine or law. Reasons given for leaving included "lack of commitment (no vocation), need for challenge (academic extension) [and] ... need for power and autonomy (dissatisfaction with the profession)" (p. iii). The New Zealand Health Information Service (2000) survey of over 2,000 RNs and midwives found that child care responsibilities were a common reason for RNs leaving, as well as the demands of shift work, and poor salary. Carryer (2001, p. 10) suggested that "many nurses escaped from nursing with a sigh of relief" as a result of the NZ health reforms during the 1990s. Cobden-Grainge and Walker's (2002) New Zealand study of 300 RNs noted factors related to job satisfaction, income and lifestyle as those prompting nurses to leave.
Durand and Randhawa (2002) interviewed 52 nurses who were on a career break, or had recently returned, and found for over half the return was either part time or as pool nurses--so enabling them to 'self roster' around family needs. One North American report of a re-entry programme for American RNs noted reasons for returning such as financial issues, missing nursing, new legislative requirements, a desire to update, the need for professional contact and absence of dependant children (Palumbo et al. 2003). Pinkerton (2006) added that being an 'empty nester' (parents whose children have left home) was a primary reason that nurses returned to practice. Langan, Tadych and Kao (2007) state that while some nurses may exit nursing due to early retirement there may be a time in their life when they reconsider this decision, due to a change of circumstances and look to return to practice.
There is little research identifying length of time out of the workforce. A recent survey of 402 Australian RNs in the state of Victoria revealed that on average the nurses had been out of the nursing workforce for approximately nine and a half years (Department of Human Services, 2005). O'Connor's (2001) interview with one RN noted that returning to clinical practice was challenging, especially after a gap of 20 years.
The aim of this research was to identify the factors that have influenced New Zealand Registered Nurses to leave, and then return, to nursing practice.
A survey approach using a mailed questionnaire was used. These were sent to a designated population as stated below.
Potential participants included all those registered nurses who had undertaken a Competency Assessment Programme at one tertiary institution. The names were accessed through the institution's database.
The study was approved by the Christchurch Polytechnic Institute of Technology Research Ethics Committee. An information sheet was included in the mail out which outlined the study and provided the researchers details. Participants were ensured of their anonymity as they were not required to provide their names or contact details. This was an important consideration as both researchers had been involved in course delivery of one of the 2005 Competency Assessment Programmes and although no longer involved in this teaching, some potential respondents may have been enrolled in their course. To further ensure anonymity a research assistant, who had signed a confidentially agreement, mailed out and received the survey forms. A separate form was provided for nurses who identified that they wished to receive the results of the study. This form was detached from the questionnaires by a research assistant before they were returned to the researchers. Return of the questionnaire was taken as consent. Of the 70 mailed, 32 (44.5%) were returned.
The survey tool had already been developed, piloted and administered in Texas, USA by White, Monacelli, Stone and Cannon (2006). Their study was undertaken with 28 nurses who had embarked on a distance learning re entry nursing update course. The development of the White et al. survey was funded through the State of Texas Higher Education Leadership Board between 2003 and 2005. Permission was sought and granted by them for the present authors to adapt the survey tool to suit the New Zealand nursing and cultural context. Adaptations included changes to the names of clinical areas and ethnic categories to match those used by the Nursing Council of New Zealand on the Annual Practising Certificate application form. Following this adaptation, six senior nurse academics critiqued the tool for reliability and content validity and recommended minor adjustments, which were made. The final version of the survey was then sent to all eligible participants.
The 22 item survey was divided into four sections. Section A consisted of questions related to the demographics of the participants while Section B was designed to elicit data about their work prior to exit. It required participants to reflect on their reasons for leaving and returning. Section C pertained to their employment since completing the Competency Assessment Programme, and Section D gathered data about the programme. Results from Section D will not be discussed in this article. The survey consisted of a combination of closed and open ended questions. Closed questions, which allowed only one response, were used to elicit the demographic data with the open ended questions providing an opportunity for the respondents to voice their opinion and express themselves freely.
Quantitative data were analysed using Microsoft Excel software to calculate the descriptive statistics. A content analysis approach was utilised to analyse the responses to open ended questions. This technique provides a systematic method to measure the frequency of specific words and phrases (Burns & Grove, 2009). Downe-Wamboldt (1992) insists that content analysis is more than just counting words it is about the meanings and context of the words. Burns and Grove argue that to perform content analysis, text must be categorised into units of meaning. A preliminary analysis was therefore undertaken to read the responses before key words and phrases were extracted using a coding frame to assemble the comments thematically. Both researchers used the same coding frame independently to test reliability and ensure an acceptable and appropriate level of agreement between them. Any areas of disagreement were discussed by the researchers and any vague or redundant themes re-analysed. The final themes were correlated with the aims of this study; that is factors that influenced RNs to leave and return to practice.
Of 70 questionnaires mailed out, 44.5% (n=32) were returned. The demographics of respondents are summarised in Table 1. All but one were female. With respect to ethnicity, there was a predominance (90%) of nurses identifying as New Zealand European. Length of the period nurses were out of practice ranged from five to 33 years (M=13.28 years, SD=6.7). For the majority 66 % (n=21) it had been more than 10 years since they had last practised. The length of time nurses had been nursing, before they left also varied, ranging from less than two years to more than 20 years, with a mean of 11.53 years (SD=6.9). The mean age of the nurses was 47.9 years (SD=6.6) (Figure 1). Areas where the nurses worked before leaving the profession and where they returned to are shown in Table 2 with the majority identifying a medical/ surgical type setting both pre exit and on return. Almost 50% (n=15) returned to the same or similar area of practice.
Nurses who returned to the same area of practice cited enjoyment and passion for their previous work area as reasons for returning to the area. Feeling familiar with the work was important as well as having the support from colleagues and the opportunity to work in a senior role in an area where they felt more confident and were already known.
[FIGURE 1 OMITTED]
Of the nurses who returned to a different area of practice a small number highlighted friendly hours with weekends off and more opportunities for casual work. However the foremost reason stated, was that it was the support offered during their Competency Assessment Programme placement which prompted their confidence and a desire to work there. Several nurses from both groups cited car parking and being close to home as the primary reason for their area of choice.
Very few nurses returned to their previous working hours/ conditions with data (refer Figure 2) showing that of the 71% (n=23) who had worked full time prior to exit only 0.9% (n=3) returned to fulltime work. None of the nurses identified casual work prior to exit yet 31% (n=10) now prefer this.
[FIGURE 2 OMITTED]
Reasons for Leaving Nursing
Three themes: personal life, working conditions and career change emerged in regard to leaving. These are listed in Table 3. Several nurses provided more than one reason for leaving, no hierarchy of reasons was provided as this had not been a survey instruction.
Twenty one (66%) said that they left nursing due to personal circumstances such as a move overseas to live ... or the distance from a rural area to the hospital made it difficult ... Three were motivated to leave due to family related business matters such as ... helping to manage the farm [and my] husband had [surgery] and more input was required on my behalf into the dairy farm. Another noted that the benefits of glide time in the family business enabled a fit around children's activities.
Ten (31.4%) of the respondents mentioned working conditions and disillusionment/ disenchantment as primary reason/ s for leaving. Factors such as didn't enjoy shift work ... unreasonable expectations [citing rest home nursing] and low pay were indicated. Other factors included found the environment unsupportive, ... stress, depression ..., dissatisfaction with nursing--pay conditions, lack of leadership ..., disillusioned at not being able to provide care at the level I wished ... Many of these nurses alluded to the Health Reforms of the 1990s suggesting these had altered the nursing profession. One nurse declared this outright stating they were disaffected with the health changes in early 90s. Another nurse stated that their previous move to a health management position had meant that they were now ... out of touch with nursing.
Six (19%) respondents left nursing as they wanted a career change. One ... went to midwifery training, another to become a chef ... Two sought teaching as a new career with one explaining that she went to teaching as the hours were more friendly ... The other two did not elaborate.
Returning to Nursing
Three key themes arose in relation to their return to nursing; freedom to return, salary and unfinished business. Again some respondents noted more than one reason for returning with no hierarchy identified.
For a minority, 29% (n=9) of the respondents, salary was a motivating factor for return. Four noted that, due to the Multi-Employer Nursing/ Midwifery Collective Agreement (MECA) which had included a significant salary increase of 20% (New Zealand Nurses Organisation, 2004), nursing salaries were higher than when they had left. Five highlighted their need for an independent salary linking this to their current family context. One declared that she was able to earn more than [her] husband, another noted a need to get an income after a divorce, while one wished to support four children through their university education.
Freedom to return
Almost half of the respondents (46%, n=14) noted that they now had the freedom to return. This freedom was related to their personal life and appeared to be influenced by their current family context; children now at university, sold the family business and children now grown up ... don't have the same family responsibilities.
The third theme 'unfinished business' cited by 56% (n=18) included more personal comments such as I need to work in a fulfilling environment. Nurses alluded to more intrinsic feelings and self awareness, in statements such as I have always been a nurse ... my enthusiasm for nursing [has been] rediscovered ... I need to get back for my personal self worth ... I felt that I had unfinished business with nursing ... and I had not worked for ten years and wanted personal satisfaction of a career before retirement. Another stated ... I just didn't give nursing a fair go.
This study has revealed a number of findings that reinforce much of the existing literature suggesting that nurses leave the profession due to the demands of family life (child care/ partners needs), working conditions (salary/shift work/burnout/policy changes) or the need for a career change (Bakker et al., 2006; Pinkerton, 2006). The dual demands of trying to balance the needs of a career and the needs of their own children were shown to be the strongest motivators for participants to leave. The results of this research echo these themes with the demands of personal (family) life being the overwhelming factor for the majority of the participants to leave. Palumbo et al. (2003) mention the lessening of family demands (lack of dependent children) providing a freedom to return, as well as the desire to earn an income. However, even though more than 50% of participants cited personal demands as the greatest motivator for leaving less than half stated they returned when their personal circumstances allowed them to.
Working conditions was the next theme. Since the majority of these participants left, nursing has become increasingly technologically focused with an increased emphasis on administrative requirements. However, despite the numerous reasons for leaving in regard to poor or stressful working conditions none of the participants referred to this, in their comments about returning. Only a minority of the participants cited the introduction of the MECA and its associated salary increase as a significant reason for them to return to practice.
This research also revealed several important issues to be considered in both how Competency Assessment Programmes are developed to suit the needs of the cohort and considerations for employers of nurses who return after a gap of five years or more. Of particular significance is that many of the participants in this study have been out of practice for more than 10 years. To return after a long period means many may potentially face multiple challenges in updating their knowledge and skills to a level that will allow them to function confidently in the fast-paced high-tech clinical environment of today's health care environment. This was a particular consideration also noted by White et al. (2006) for their re entry nursing update programme. They found that some of the nurses in their study were not able to meet the demands of the work environment; other nurses found that healthcare facilities were not willing to accept or assist the nurses to transition back into practice. A further important consideration of transitioning back into practice is the ability to work casually or part time (Durand & Randhawa, 2002).
It remains to be seen how long these nurses who have returned to practice will remain in the nursing workforce. Several participants noted that they were now ready to return to nursing and indeed felt passionate about this. However, workplace factors that influenced them to initially leave, such as the stress of the job and shift work remain today. Current practice issues, such as increased patient acuity, mean that contemporary nursing practice is at times both more demanding and complex than in the past. The introduction of the Health Practitioners Competence Assurance Act (2003) compels today's nurses to demonstrate their clinical competence by maintaining prescribed levels of hours worked as well as providing evidence of ongoing professional development placing increasing pressure on the nurses. Shift work is still a key feature of the nursing profession while the nursing workforce shortage as well as increasing workloads and high staff turnover contribute to stressful workplaces (Ministry of Health, 2006).
On a positive note there have been recent changes affecting nursing that may contribute to retention. Firstly, the significant salary increase for nurses employed within District Health Boards (New Zealand Nurses Organisation, 2004). Secondly, the recent establishment of a New Zealand Safe Staffing/ Healthy Workplace Unit (District Health Boards New Zealand, 2008) which may address workplace issues. Thirdly, the recent introduction of workplace based Profession Developed Recognition Programmes (Nursing Council of New Zealand, 2005) designed to recognise nurses professional development thus creating career pathways.
A particular consideration for both Competency Assessment Programme educators and employers is the extended length of time that some returning nurses have had out of practice, that is, 20 years or more. Durand and Randhawa (2002) and White et al. (2006) suggest that nursing has evolved via social, technological, educational, and political transformation to expand the contemporary nursing role considerably. As noted earlier these changes pose significant challenges for returning nurses.
A theme that arose in this study and which was not widespread in the literature was the notion of 'unfinished business'. While the majority cited more extrinsic personal reasons such as family commitments as their reason for leaving, their return was often driven more by intrinsic personal reasons such as the desire to complete what they had started and enhance self worth. Durand and Randhawa's (2002) research also noted this aspect, suggesting that nurses who left had always intended to return at some point in their lives when personal circumstances would allow. They also reported that nurses felt they needed to get back to nursing to do something for themselves, sentiments which reflect the theme of 'unfinished business'.
As with all survey-based research, there are limitations to the interpretation of the results. Generalisability implies that the findings of one study can be applicable to other settings (LoBiondo-Wood & Haber, 2006). However, this study was undertaken with a group of nurses from one region who had undertaken a Competency Assessment Programme and therefore it is not possible to assume that the same results could be generalised to a broader population. Given that the intent of this survey was to gain insight from a small group of nurses, the response rate of 44.5 % is adequate. However, generalisability is limited because the data represent the opinions of only 32 nurses. Another consideration is the disproportionate gender distribution. There is only one male respondent and that could distort some of the results leading, for example, to overstatement with respect to the need to attend to child rearing. As the format of some questions allowed for only one response this may have limited free expression of opinion by respondents. Lastly, as in all qualitative research, other researchers may have interpreted some of the data differently.
Conclusions and Recommendations
The survey tool included both quantitative and qualitative components. The quantitative component related to the participants' demographic characteristics and years in and out of the workforce. Open ended questions were designed to elicit qualitative data about why nurses had left and what issues they faced in re-entering nursing. The dual approach yielded a deeper set of insights with regard to the issues faced by the nurses, as well as future potential workforce planning concerns.
The primary aim of this research was to uncover contributing factors for nurses leaving and returning to nursing practice. Data about the length of time the nurses remained out of practice prior to re-entry and the type of healthcare environments they worked in prior to exit and on return were also explored. Nurses left for issues related to personal life and working conditions as well as a desire for career change. It has been revealed that those who returned did so when their personal circumstances allowed. Many returned as casual nurses in order to work flexible, family-friendly hours and respond to their fiscal needs. An important factor was that the majority returned to meet an intrinsic personal need to continue nursing. This indicates that there may always be nurses who will want to return and therefore the transition back to practice remains an important consideration. Both educators and employers need to work collaboratively with the Nursing Council to ensure the ongoing needs of these cohorts are met.
As the average age of nurses in the workforce continues to increase, keeping nurses in practice for as long as possible is as important as educating new graduates. Recommendations from this research are towards ensuring positive work environments, with a degree of flexibility that suits the demographic characteristics of nurses in this country.
Further research is recommended to examine retention and re-entry of RNs. Areas to be considered include the working environment, work life balance and coping with the demands of a challenging role. Given the increasing complexity of health care it is likely that re-entry nurses will find the workplace more stressful and demanding than when they left. Therefore there is a need for research to explore factors that will ensure retention of these nurses.
Bakker, A. B., Le Blanc, P. M., & Schaufeli, W. B. (2006). Burnout contagion among intensive care nurses. Neonatal Intensive Care, 19(1), 41-46.
Burns, N., & Grove, S. K. (2009). The practice of nursing research Appraisal, synthesis, and generation of evidence (6 ed.). St. Louis, MI: Saunders, Elsevier.
Carryer, J. (2001). A current perspective on the New Zealand nursing workforce. Health Management, 8(1),9-13.
Cobden-Grainge, F., & Walker, J. (2002). New Zealand nurses' career plans. Christchurch, New Zealand: Christchurch Polytechnic Institute of Technology.
Daniels, A. (2004). Listening to New Zealand nurses. A survey of intent to leave, job satisfaction, job stress and burnout. Auckland University of Technology, Auckland, New Zealand.
Department of Human Services. (2005). Nurses refresher re-entry supervised practice program survey. Melbourne: Nurse Policy Branch State Government Victoria.
District Health Boards New Zealand. (2008). Safe staffing healthy workplaces unit. Wellington, New Zealand: Author.
Downe-Wamboltd, B. (1992). Qualitative content analysis in nursing research: Concepts, procedures and measures to achive trustworthiness. Nurse Education Today, 24(2), 105-112.
Durand, M., & Randhawa, G. (2002). Nurses' views about returning to practice after a career break. British Journal of Nursing, 11(7), 477-485.
Health Practitioners Competence Assurance Act. (2003). New Zealand Government: Wellington.
Langan, J., Tadych, R., & Kao, C. (2007). Exploring incentives for RNs to return to practice: A partial solution to the nursing shortage Journal of Professional Nursing, 23(1), 13-20.
LoBiondo-Wood, G., & Haber, J. (2006). Nursing research Methods, critical appraisal for evidence-based practice St. Louis, Mo: Elsevier Mosby.
Mark, S., & Gupta, J. (2005). Reentry into clinical practice. JAMA, 288(9), 1091-1096.
Miles, M. (1996). Why they leave: A Heideggerian hermeneutic study of the reasons why ten registered nurses left nursing practice to enter the professions of medicine and law. Unpublished Masters thesis, University of Otago, Dunedin, New Zealand.
Ministry of Health. (2006). Health workforce development: An overview. Wellington, New Zealand: Author.
New Zealand Health Information Service. (2000). Non practising nurses and midwives. Wellington, New Zealand: Author.
New Zealand Nurses Organisation. (2004). Media Releae: Historic fair pay settlement for nurses and midwives. Wellington, New Zealand: Author.
New Zealand Nurses Organisation. (2007). Impending nursing shortage must be addressed. Retrieved 18 February, 2008, from www.nzno.org.nz
Nordam, A., Torjuul, K., & Sorlie, V. (2005). Ethical challenges in the care of older people and risk of being burned out among male nurses. Journal of Clinical Nursing, 14, 1248-1256.
Nursing Council of New Zealand. (2005). Framework for the approval of professional development and recognition programmes to meet the continuing competence requirements for nurses. Wellington, New Zealand: Author.
O'Connor, T. (2001). Returning to practice from education. Kai Tiaki Nursing New Zealand, 7(11), 12-13.
Palumbo, M. V., Murray, B., & Gray, J. G. (2003). The process of R.N. re-entry into the nursing workforce in the state of Vermont. Vermont: Vermont Department of Health, Office of Rural Health.
Pinkerton, S. (2006). A successful re-entry program. Nursing Economics, 24(1), 50-51.
Watson, P., & Feld, A. (1996). Factors in stress and burnout among paediatric nurses in a general hospital. Nursing Praxis in New Zealand, 11(3), 38-46.
White, K., Monacelli, A., Stone, P., & Leslie A. Cannon. (2006). Distance learning re-entry nursing update project [Electronic version]. Retrieved 7 April 2006 from http:/nurserefresher.austincc. edu.
Worley, C. A. (2005). The art of caring: Compassion fatigue. Dermatology Nursing, 17(6), 416.
Yancy, P., & Heanley, A. (2004). Can everyone be refreshed? The Journal of Continuing Education in Nursing, 35(2), 80-83.
Zurn, P., Dolea, C., & Stilwell, B. (2005). Nurse retention and recruitment: Developing a motivated workforce. Geneva, Switzerland: International Council of Nurses.
Isabel Jamieson, RN, MNurs(Melb), Senior Lecturer, School of Nursing and Human Services, Christchurch Polytechnic Institute of Technology
Chris Taua, RN, MN (Dist.), Principal Lecturer, School of Nursing and Human Services, Christchurch Polytechnic Institute of Technology
Table 1. Characteristics/Demographics of Respondents (n=32) n % Total survey population (number of surveys sent) 70 Response Rate (number of surveys returned) 32 44.5 Sex Male 1 03.12 Female 31 96.87 Ethnicity NZ European 29 90.62 English/ European 2 06.25 Maori 1 03.12 Other 0 -- Residence Rural 15 46.87 Urban 17 53.12 Years working in nursing (pre exit) <2 years 2 06.25 2-5 years 5 15.62 6-9 years 6 18.75 10-20 years 16 50.00 >20 years 3 09.37 Mean 11.53 Years since last worked as a nurse (pre course) 5-9 years 11 34.37 10-20 years 18 56.25 >20 years 3 09.37 Mean 13.28 Highest Education Level [+ or -] School Cert 1 03.12 6th Form/Higher School Cert 7 21.87 UE 15 46.87 International (e.g. A levels) 2 06.25 Graduate tertiary 5 15.62 Postgraduate Tertiary 1 03.12 Not stated 1 03.12 Note. [+ or -] Does not include Nursing qualification Table 2. Pre Exit and On Return Work Areas Med/ Aged Mental Pre Exiting (n) Surgical Care Health Medical/Surgical 17 11 4 Aged Care 2 1 1 Mental Health 6 1 1 3 Community 1 1 Practice Nurse 5 2 2 Psychopaedic 1 Totals 32 14 9 4 Practice Not Pre Exiting Community Nurse Other Employed Medical/Surgical 1 1 Aged Care Mental Health 1 Community Practice Nurse 1 Psychopaedic 1 Totals -- 2 -- 3 Table 3. Reasons for Leaving Nursing Personal life Child care responsibilities Lived overseas with husband (no work permits for wives) Distance to hospital prohibitive To work on the family farm/business Working conditions Low salary Changes in nursing late 1980s / early 1990s Dislike of shift work Understaffing Lack of support for a new grad Lack of support for a rural part time nurse Lack of personal area of speciality in a rural area Unreasonable expectations of an employer Stress Lack of leadership Rosters not convenient for child care Disillusioned with personal ability to provide care Career change Teaching Chef Midwifery
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