Congratulations! You made it through nursing school and passed the NCLEX. Now what?  As a new graduate with no experience there is little hope of landing your dream job in the first year.

There are many popular jobs search sites that offer a variety of nursing opportunities. But beware, some of these opportunities come with a string or two. Staff nursing agencies can offer the new nurse a variety of opportunities which can include contracted jobs that are short term 13 week assignments or long term assignments spanning six months or longer.  These positions are a great way to gain some experience without being committed to that particular facility. Similarly, hospitals and major facilities may also offer contracted positions and while it may be advantageous at that time, caution yourself. Ask yourself in whose best interest does this contract benefit?

After some research, concerns were noted on both sides. The facility may request a contract as long as three years due to the cost of training a nurse in the position. Employers may be more secure with a nursing staff under contract because outwardly it may appear as if the staff wants to work there.  Nursing turnovers are costly to any medical facility. Benefit-cost and cost-effectiveness is a long time cause for concern.  According to Jones & Gates (2007), the average cost of nursing turnover results in $22,000 to over $64,000 per nurse. The estimated range is between 0.75 to 2.0 times the salary of the departing individual.   It is noted that the cost variations are due to the nurse tenure, education and experience.  These costs include but not limited to: advertising and recruitment, vacancy costs (such as paying for agency nurses), orientation and training.   A study was conducted using the mid-career population over the new nurses in the southwest.  This study resulted in an estimated “16.5% turnover rate of registered nurses costing from $44,380 – $63,400 per nurse an estimated $4.21 to $6.02 million financial loss annually for hospitals in the United States of America” (Yarbrough, Martin, Alfred, and McNeill, 2016).  Even though this particular study showed that nurses with experience (mid-career nurses) had higher job satisfaction and planned to stay at their present position, there are still a sizable percentage of nurses that leave.

Employers have spent a significant amount of time and resources training nurses into their chosen specialties while not realizing the fruits of their labor and expense. The nurse will get in-services and training such as IV certifications and PALS all at the cost of the facility. While all this sounds great for the new nurse looking to get that coveted first year experience, the contract must be carefully examined for any repercussions.  For example, one contract stated that if the contract was broken by the contracted, all fees and training expenses incurred by the facility will have to be paid back (sometimes with interest). This can be very costly and deter the individual from seeking another nursing position.  It has become more and more common for facilities to offer sign on bonuses to entice nurses to come and work for them but this does not come free of charge.  Contracts are put in place to ensure that the facility will keep that employee for a predetermined amount of time.  Nurses are asked to sign contracts from one to three years which has its benefits on both sides. The nurse is almost guaranteed their position for the duration of the contract but the facility does reserve the right to terminate under any guidelines that are outlined in the contract or the facilities rules and regulations. Most likely the facility retains the rights to terminate any employee without warning.  At the time of signing, it is beneficial to ask questions such as, “What if the working environment turns out to be too hostile such as enduring limited staffing, bullying, laissez faire management support? What options would I have under these conditions? How long is the preceptor program?  Is the time allotted acceptable and safe? Does the staff work in teams?”  These questions are valuable in making the decision to sign or not to sign.

The best path is the educated one.  Check out the facilities ratings, see if you can talk to the employees and ask them if they are happy there, what is the patient/nurse ratio, was there a high turnover rate prior to the inception of the contract program. While some individuals may feel comfortable with a long term commitment and bonuses such as paid tuition and training, others may not want to commit themselves enabling them to continue looking for their destination job.  It is a personal choice that only the individual can make. Good luck and stay informed. 

 

Reference

Jones, C. B., & Gates, M. (2007). The cost and benefits of nurse turnover: A business case for nurse retention. The Online Journal of Issues of Nursing, 12. http://dx.doi.org/10.3912/OJIN.Vol12No03Man04

Yarbrough, S., Martin, P., Alfred, D., & McNeill, C. (2016). Professional values, job satisfaction, career development, and intent to stay. Nursing Ethics. http://dx.doi.org/10.1177/0969733015623098

Tracy

Tracy

Tracy lives on Long Island and was inspired to became a registered nurse in 2013 after her son was diagnosed with PDD-NOS. She is a substitute school nurse but her specialty is performing assessments for clients requiring long term care. Tracy previously was a journalist for a small paper covering the local government news and has now merged her love of medicine and writing.
Tracy

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