“The Pure Hard Slog That Nursing Is . . .”: A Qualitative Analysis of Nursing Work

PURPOSE: To explore nurses' perceptions of the nature of nursing work as a factor that contributes to attrition from the profession. DESIGN: A nonpurposive sample of nurses from the Nurses and Midwives e-cohort Study in Australia, New Zealand, and the United Kingdom provided electronic responses about reasons for leaving the profession. Data were then subjected to qualitative content analysis. FINDINGS: Nurses at the "coal face," that is, those who actually do the work of nursing, in real working conditions, express dissatisfaction in relation to hygiene factors relating to the nature of nursing work and attribute these to nurses leaving the profession: workload, shift work, violence, and financial remuneration. CONCLUSIONS: Nurses' satisfaction with work and motivation to work are being sorely tested. There is manifest tension between the core concepts of nursing-compassion and care-and a system of work that actively precludes nurses from being able to exhibit these virtues and fails to reward them. Workload, shift work, violence, and financial remuneration are drivers of attrition and need to be addressed. CLINICAL RELEVANCE: Implications from this study are fourfold: determination of nursing workload, mitigating the impact of shift work, providing safe work environments, and adequate financial remuneration.