Nurse attrition as a process

Problems with attracting and retaining nurses during a tight labor market are exacerbated by the fundamental issues related to attrition from the field. Many individuals leave the field prior to graduation or between graduation and placement. Significant attrition occurs during the first 5 years in the profession. One out of every 3 hospital nurses under the age of 30 is planning to leave the current job in the next year [Nursing Shortage Fact Sheet (March 2002). American College of Nursing. Available at: www.aacn.nche.edu/media/backgrounders/shortagefacts.htmaacn.nche.edu. Accessed January 3, 2003]. In this situation, it is of concern that we have been unable to identify any research which takes a holistic approach to issues of attrition. Instead, research is fragmentary, anecdotal, and treats problems in isolation. In this article, we take a conceptual approach and attempt to consider what is being said in the literature about the forms which nurse attrition takes at varying stages in the nursing career. Specifically, we begin a step-by-step examination of the process through which the individual first considers nursing as a career, to the application and acceptance processes, through the educational process and the nursing curriculum in general, to graduation and initial placement, and finally, to the fifth year when the nurse is fully engaged as a practicing nurse. At each stage, we discuss potential issues which may lead to attrition and develop hypotheses to guide further research.