Document Type



In a comprehensive survey of Indian Health Service (IHS) nurses, this study takes an in-depth look at those factors influencing recruitment and retention of registered nurses. Areas examined via questionnaire are: background of the respondents, circumstances surrounding entrance into IHS, current intentions with regard to employment with IHS, nurse's professional experience, community health nurse's professional environment, management, administration, supervision, comments regarding current IHS Nursing Recruitment Program, Indian preference policies of IHS, economic issues, security/safety issue, and living environment. The primary purpose of the study is to determine what factors influence nurses to either remain with or leave IHS, and what factors associated with both the living and work environments were perceived as satisfying or dissatisfying. It is anticipated that positive factors can be enhanced and that negative factors can be corrected insofar as possible.A questionnaire consisting of fifty-six items was administered to 1,339 IHS nurses across all areas. This number represents a 79% rate of return that is unusually high for a survey method. The survey was designed to profile registered nurses currently employed by IHS: who joins, who remains, who leaves, and the factors influencing those decisions. The questions were close-ended with space made available for more narrative responses. Effort was made to minimize time spent on response while maximizing analytical data available.The summary of findings is presented in nine sections. It should be noted, however, that the fifty-six questions covered a large range of professional issues. Additional qualification is presented in the main text of the study. IHS registered nurses are predominately female, married, 42 years of age and Caucasian. Twenty-nine percent are Native American, however, only 12% of the Commissioned Officers are Native American. Fifty-three percent of the total had been employed in the public sector prior to joining IHS. The majority found their IHS positions through word-of-mouth rather than advertising. Thirty-two percent of the respondents graduated from a bachelors program and 25% from an associate degree program. The top five positive factors influencing registered nurses to select employment with the IHS were: 1) type of work; 2) location of first assignment; 3) job security, 4) fringe benefits; 5) opportunity to learn about serving another ethnic, cultural or socioeconomic groups. Respondents were satisfied with many aspects of their professional work experience. Of the factors presented as potentially influencing a decision to remain with or leave IHS, the five factors associated with professional aspects of the nurse's job that are influencing the most nurses to remain with the IHS are: geographic location of present assignment; quality of nursing staff; learning about and serving another ethnic, cultural or socioeconomic group; ability to provide quality care with available staff; and ability to provide quality care with available equipment and supplies. The five factors associated with professional aspects of the nurse's job that are influencing them to leave the IHS are: equality of opportunity for advancement; training and career development opportunities; professional recognition and status; available support for in-service/continuing education; and requirement to perform nursing tasks under-utilizing skills and knowledge. The IHS management should make an effort to improve the following areas if improvement in the retention of registered nurses is to be achieved: improve work place security; service unit management that values the input of the nursing staff; recognition and rewards for deserving nursing employees; improvement in the accessibility of continuing education to improve and maintain nursing skills; more attention to the equality of opportunity for career advancement; improve the quality of supervision; provide staffing levels that eliminate the need for nurses to maintain heavy workloads and perform non-nursing functions; and attention to nurse's preferred work shift/work hours. Some of the solutions to the problems should be developed on a national level, some at the Area or Service Unit level and some should be developed and geared toward specialties such as Inpatient Nurses, Outpatient Nurses, Community Health Nurses, Nurse Specialists, etc.

Publication Date



Indian Health Service, Staff Office of Planning, Evaluation and Research, Rockville, MD 20857 (E-95).