The life history narrative of clinical nurses with more than 30 years of experience

The number of nurses with long-term careers in clinical settings shows a clear declining trend. According to a survey on the current staffing status of hospital nurses by Korea Hospital Nurses Association in 2018, 45.5% of new nurses resigned within 1 year. Additionally, among the nurses in service, those with work experience of between one and 3 years accounted for the highest proportion, at 22.0% [1]. The average number of years in service was only 7 years and 8 months [1]. Hard and intensive work, a professional environment that requires working in shifts, and an organizational culture comprising a variety of interpersonal relationships, are factors contributing to the challenges in maintaining a long-term nursing career [2]. Further, the culture of frequent turnover and pursuit of individual quality of life and happiness also serve as factors affecting long-term service [3].

From 2017, approximately 49.6% of the total number of licensed nurses were in actual service in hospitals [4]. This indicates nursing staff shortages. With the aggravating problems of nurse turnover and staff shortages, an analysis of the causes and countermeasures for these problems, as well as establishment of strategies for retaining a skilled nurse workforce, have emerged as issues of key importance [5]. The turnover and resignation of nurses increase the workload and stress for their colleagues still in the workforce [6]. This, in turn, compromises organizational stability, and leads to a shortage of experienced nurses, subsequently lowering the standard of nursing professionalism [7]. Although generation-specific changes in values are desirable for a greater number of nurses to be retained, to be able to provide long-term service. This is due to the inherent characteristics of the nursing profession that requires relevant skills and human care [6].

To investigate the phenomenon of skilled nurses’ career retention, exploring the strength of long-term service will be instrumental. It is also useful to conduct an analysis on the causes of turnover and the establishment of strategies for workforce retention. Further, when considering the historic nature of nursing within the same culture, recording the narrative of a nurse’s life history through interviews with long-term career nurses is necessary. Therefore, through the narrative of nurse clinicians with careers of over 30 years in clinical practice, this study aims to explore the experiences that nurse clinicians undergo in the midst of the changing times and social environments. It also explores the strengths that sustained them in retaining their profession as nurses for this duration.

This study explores the inherent structure and core empirical themes of the experiences that enabled nurses to retain their long-term careers. The study’s findings are expected to lay the groundwork and provide basic data for the development of policies and practices that will help improve nurse retention and address nursing staff shortages.

This study aims to analyze the life history narratives of nurse clinicians in the baby boomer generation to explore the strengths and structure of their experiences. This is in regard to their long-term career retention as nurses for over 30 years. This aim was explored using the following research questions: “What is the lived experience of clinical nurses who have worked over 30 years?” and “What was the most important aspect of career retention over 30 years?

Life history narrative qualitative research design was conducted. Mandelbaum’s life narrative method influenced this study. This method designed to explore life history narratives through three categories: Dimensions, Turnings, and Adaptations [8].

Since the 30-year careers of nurse clinicians are multi-faceted, to develop a proper understanding of their careers, research using life-history narratives was conducted. It explored the entire life cycle, allowing a consideration of the relevant time- and context-specific issues. This method is regarded as being more appropriate than a cross-sectional study, which investigates only a specific period [9].

Six nurses, who had been working at a general hospital for 30 years or more at the time of the study participated. As Patton [10] suggested, the sample size was based on the aim of ensuring thematic data saturation. Thematic data saturation is achieved when the data collected is reviewed repeatedly to try and find relevant themes for analysis. When the analysis no longer produces new information that addresses the research question, it results in thematic data saturation. Additionally, convenience sampling was used to select the participants.

All six participants were female, aged between 54 and 60 years. Four were married and had two or more children. Two were single and lived with their parents. Regarding their educational level, three had a master’s degree and three had a Ph.D. Their years of clinical nursing experience ranged from 30 to 36 years.

The study received ethical approval by the Institutional Review Board of Gachon University (1044396–201,706-HR-102-01). We informed participants that participation was voluntary, their identities would remain anonymous, their information would be kept confidential, and they could withdraw from the study at any time. All study participants provided written informed consent, after the purpose and procedures of the study was explained. They were also informed before they gave consent that the interviews would be recorded, and the advantages and disadvantages of participating was discussed. To ensure that the participants were protected, any identifiable information was excluded from the digital file name saved on the main researcher’s computer. Participants were also informed that the data will only be used for research purposes.

Unlike in the case of standardized interviews, the three steps of a biographical-narrative interview [11] were employed in this study. This is a method of spontaneously narrating one’s life history, as experienced by the speaker in his or her daily life. This occurs without the intervention of the researcher through the speaker’s own choices and decisions. The first step was to build trust. The second was to use open-ended questions, and the third was to use semi-structured questions for further clarification of the interviews’ contents.

The interview guide included three stages. Stage 1: Please describe what your professional life was like starting with whatever comes to mind. Could you talk about the single most memorable moment or event regardless of whether it was a good or a bad one? Stage 2: What were your thoughts or emotions when you considered resigning or changing workplaces? Stage 3: After you considered resigning or changing workplaces, have you experienced any changes in your original thoughts? Please explain the process of how you decided to continue in your original job.

The data collection period was from July 2017 to June 2018. Each participant underwent three sessions of the interview, with each session lasting 90–180 min. An unrestricted environment is required to present oral narratives; therefore, each time, the interviews were conducted at a time and place selected by the study participants. Additional interviews were conducted over the phone or in writing. When no more topics could be derived from the analysis, data saturation was assumed to have been achieved. Hence, we stopped collecting data after six participants.

The data were analyzed manually by two researchers. They discussed and shared their experiences and opinions regarding data collection and analysis. The initial analysis was conducted by the interviewer, following which the other researcher read the transcription and analyzed them again.

The recorded interviews’ contents were transcribed and summarized. Additionally, we undertook a review process, whereby the presence of any distortion or mis-description of the content was reviewed and clarified by the individual participants through e-mails. For the data completed via the review process, Braun & Clarke’s [12] six steps of thematic analysis method were applied. This is a method that focuses on identifying the common themes for the phenomenon of interest. In the present study, we first repeatedly read transcribed materials and highlighted the contents related to the study’s purpose. Second, initial codes were generated and the interview content was sorted via codes. A total of 94 significant thematic statements were extracted. In the third step, the sorted codes were grouped by candidate themes. Finally, 24 themes were derived from the 94 thematic statements. Once these were analyzed, a collection of four comprehensive and abstract categories emerged. In the fourth step we reviewed whether the grouped themes were related to the transcribed content. In the fifth step, themes were extracted from the categories, and defined and named. To review the themes, the researchers cross-checked the themes in relation to both the coded extracts and the full dataset. These themes were defined and named by writing a detailed analysis and identifying the essence of each. A weaving analytic narrative was written and contextualized. Finally, the three frames of reference—Dimensions, Turnings, and Adaptations—proposed by Mandelbaum [8] were applied and, based on this, the data were analyzed again to achieve the study’s purpose. This involved exploring the strengths of retaining a career for over 30 years.

To ensure rigor in this study, we applied the criteria proposed by Sandelowski [13]: reliability, fittingness, auditability, and confirmability. The data of this study revealed the actual experiences of the nurses who worked in a clinical setting for over 30 years. The individual interviews were recorded and transcribed verbatim. Accuracy of the transcriptions was ensured by comparing the recordings with the transcriptions. Citations were identified to illustrate the themes derived from the data. The participants’ narratives were described and interpreted according to these themes. After the accomplishment of these steps, the manuscript was read multiples times, and all the analytical procedures that led to the initial codes, sub-themes, and themes were described clearly. The researchers also tried to remain unbiased throughout the research process.

The dimensions were categorized into individual and career dimensions. For important turning points in their lives, empirical and environmental conditions that posed a threat to their career retention as nurse clinicians were analyzed. Regarding adaptations, their individual methods of adaption and social interactions were analyzed. These served as strengths that helped the individual nurses overcome the threats they encountered (Table 1).

In Life as an individual domain, the following were derived: baby boomers growing up as model students, a dreamer who realized the dream of a professional, and a superhero who juggles multiple things pursuing excellence in all domains. Life as a nurse domain was divided into three areas: growth from a novice nurse, being a proficient nurse, and professionalism.

To explore the strengths that enabled long-term career retention in the original data of the participants’ narratives, a reanalysis was conducted using Braun & Clarke’s [12] thematic analysis method. The core theme identified “Finding value in myself,” which served as the fundamental strength and helped the nurses achieve a long career of over 30 years. It represents value and joy in the growth of the nurse clinicians, throughout the entire spectrum of their lives. The participants faced difficult moments in which they had to consider changing departments or resigning. However, they regarded these events and situations as opportunities for growth. Their growth could be attributed to receiving acknowledgment and support from their families, their line managers’ support, their trust in themselves, and being valued and appreciated by their patients. This growth was expressed by some participants in terms of endless gratitude for the patient as well as their devoted affection for nursing. It served as a driving force for their career retention. Therefore, merely the adaptation to the events of life turning points encountered in their job is not the entire story. The themes of “acknowledgement and support from family,” “healthy relationships at work,” “trusting myself,” and “accumulation of small achievements,” each served as a pillar of strength. This is consolidated as “Finding value in myself” (Table 2, Fig. 1).