Career persistence in baccalaureate-prepared acute care nurses.

Purpose: To explain how baccalaureate-prepared acute care nurses understand, adapt to, and negotiate challenge and change in acute care settings in the context of social and structural features and consequently develop career persistence there.

Design: Grounded theory method based on the research of Strauss and Corbin.

Methods: A research team conducted open-ended interviews with a theoretic sample of 19 new and experienced baccalaureate-prepared (BSN) nurses in the southeast United States during 2007 and 2008 until saturation was achieved. Interviews were audiotaped and transcribed verbatim. Constant comparative method was used to analyze data to three increasingly abstract levels culminating in theory emergence. A diagram was developed to better understand relationships and processes.

Findings: A central category, building professional resilience, emerged as the central social process with three core processes of verifying fit, stage setting, and optimizing the environment contributing to career persistence in acute care. Core processes include skills and practices nurses have learned to negotiate changing acute care environments while sustaining patient advocacy. Definitions, properties, and dimensions of each were established.

Conclusions: The study offers a systematic framework for understanding and promoting career persistence for acute care nurses. Findings broaden theories of resilience to the unique settings of acute care nursing and further extend theoretical understanding of the nursing shortage and market issues of supply and demand.

Clinical Relevance: A middle range theory of professional resilience and career persistence makes visible skills and practices acute-care nurses use to weather continuous change and challenge in health care. Teachable practices can be integrated into nursing education and staff development to improve professional career longevity of experienced nurses at the bedside.