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Riding out graduate supply

Significant underemployment of graduates is predicted for 2012. Linda Belardi reports on how government policymakers are managing this workforce challenge.

Australia is currently experiencing a boom in tertiary nursing enrolments. Federal government figures released in September show new commencements in nursing rose by 9.2 per cent in 2010.

As a national priority area, the Commonwealth is investing millions of dollars in new training places to boost Australia's nursing workforce in the long-term. But to what extent are cash-strapped health departments able to absorb them?

Professor Ged Williams, executive director of nursing and midwifery at the Gold Coast Health Service District, says high growth in the tertiary sector compounded by the lagging effects of the financial downturn is creating a "perfect storm".

Williams says older nurses choosing to stay in the workforce for longer are creating fewer vacancies for new graduates, at a time of high growth out of universities.

"We're in oversupply now relative to available vacancies but we're heading towards a shortage."
Williams says it's critical that universities don't lose confidence in employment in the health system now and start to reduce student numbers.

"What's likely to happen is that in three or four years' time it's all going to change. If the economic situation gets better, all of those nurses who were going to retire last year and this year and have held off retirement will retire at once. Then, we may have an issue with too few graduate nurses to fill those vacancies."

Exacerbating the problem is an underinvestment in detailed workforce planning in nursing to be able to understand and respond to the 'boom and bust' trends that characterise the profession.

Right now, Williams says, governments and health departments need to avoid repeating the mistakes of the 1991-1993 nursing boom and recruit as many graduates as they can, so they are not lost to other industries. If a large number of these graduates in 2012 don't get jobs they will never come back to nursing and in 2014 and 2015, when we are absolutely desperate for nurses, it is likely that we will have to go elsewhere to find them."

2012 he says will be the first of the risk years.

There are some strategies that can be used to accommodate more graduates, including offering part-time graduate positions in metropolitan services and full-time employment in rural and regional areas as an incentive.

"Our government policy leaders need to make some of these hard decisions to the benefit of the whole system. At the moment they let every individual hospital and every individual district make its own choices rather than mandating some of this behaviour."

In 2011 Queensland Health employed 1142 graduates, excluding graduates in the private and aged care sectors. In the last four years, the department has seen a 50 per cent rise in the number of applications to its graduate nurse program, says Acting Chief Nursing Officer, Cheryl Burns.

The expansion of state infrastructure both in the private and public health systems will increase the capacity of Queensland Health to employ more graduate nurses, she says.

Beth Mohle, secretary of the Queensland Nurses' Union predicts less than half of Queensland's 2000 nursing graduates will find employment with Queensland Health. She says part of the problem is a lack of government leadership on this issue because of ambiguous and overlapping funding responsibilities between state health employers and a mix of a state and federally funded tertiary sector.

"No one level of government is responsible for this right now. But someone has to take responsibility because we are going to be in an absolutely dire set of circumstances if we don't start planning for it now."

Mohle is also calling for a new funding model to employ graduates across different settings including aged care, primary care, as well as private and public hospitals. "We have to totally shift our thinking about graduate employment as an investment in the future of our health system rather than a bottom line cost."

South Australia
Elizabeth Dabars, state secretary of the Australian Nursing and Midwifery Federation SA, says there has been a proportionate decline in the number of graduate nurse positions being offered by SA health.

Of SA's approximate 1400 nursing graduates, Dabars says the department now employs around 400 graduates down from 600 in previous years.

However, a spokesperson for SA Health said it offers a sufficient number of graduate positions for new nurses and disputed suggestions it has reduced its annual intake.

"Since 2005-06, SA Health has consistently provided around 500 positions for new nurse graduates into SA Health's graduate program."

Its graduate program is not compulsory and is one of many options for new graduates to gain employment in SA or interstate, said the spokesperson.

This year the department has received 1012 graduate applications and has made first round offers to less than half (476 graduates).

Dabars says as part of its lobbying of the SA government on the issue it had won in principle support for private providers to be linked in with their graduate nurse program. But SA health is yet to follow through on its commitment, which Dabars says would be relatively low cost and high impact.

"It has been with extreme frustration that this solution was considered favourably but yet they have failed to act. The union has also requested strategic material on how it plans to support the retention of graduates in the system following their 12-month contract.

In Victoria graduate numbers for 2012 are likely to match available places, although system-wide data is inconsistent, says Katy Fielding, the department of health's manager of nursing and midwifery policy.

"In particular it is anticipated that, as in previous years, employment by the larger metropolitan health services will continue to be oversubscribed, while smaller and rural sites will have places available after the [department's] computer match process."

While the past decade of sustained growth in nursing graduate numbers has created some pressure, there is not so much a crisis in numbers as a crisis in graduate expectations, she says.

Significant questions have to be asked about the role of the private and non-acute sectors. In Victoria, 70 per cent of first year graduates are employed within the public health system.

"With the future health care needs on models that are community-based and wellness and health promotion focused, there is a strong case for this being the focus of undergraduate preparation and then subsequent graduate employment.

"However, not all nurses are convinced and many hold onto the view that acute exposure with medical and surgical rotations is essential for first year of practice, despite a comprehensive curriculum being in place for years."

Fielding says graduate positions are competitive, merit-based appointments and the government does not mandate maximum graduate numbers.

Ultimately Fielding's message to graduates is to be flexible, open and proactive in a competitive workforce.

"A formal graduate program is not mandatory for practice and not all graduates want, or need, a formal program," says Fielding.

However, like in the medical profession, Ged Williams says the graduate year should be a mandatory part of nursing education.

"If we can afford it for medicine we should be able to afford it for nursing and the consequences of not doing it are the same for both industries."

In the ACT where the graduate program is compulsory its retention of graduates after the first year is 97 per cent.

"This sort of investment in the longer term will pay dividends with a far more experienced workforce five or six years down the track," says ACT chief nurse, Veronica Croome.

Croome says the oversupply in ACT is small, manageable and short-term. Currently the department receives about 1.5 applications for every advertised position, discounting multiple offers. However, she says ACT's small size makes it quite dissimilar to the other states.

"One of the strategies that we can adopt and possibly will, is to put on increased intakes throughout the year. We might introduce a mid-year intake in April if we think if there are lots of graduates out there who are looking for positions."

The Tasmanian Health Minister, Michelle O'Byrne, recently announced a reduction in the number of graduate nurse positions for 2012 to 98 positions.

Fiona Stoker, Chief Nursing Officer with the Department of Health and Human Services (DHHS), said the 2012 intake returned graduate nurse numbers to a "sustainable level" following an increase in 2009-2010. "This temporary increase reflected the state government's commitment to helping as many new graduate nurses as possible find employment in any given year."

DHHS engages with providers within the private sector around recruitment and offers support where they choose to establish graduate programs. While the department engages with private providers there is no requirement for private facilities to report to DHHS the number of graduate nurses they employ.

Western Australia
Chief Nurse Catherine Stoddardt said the supply of graduate nurses in WA peaked in 2010.
"We still have some vacancies anticipated for early next year, but I would expect by the first quarter in 2012 we'll have full graduate recruitment." Approximately one third of all graduates undertake a postgraduate scholarship offered by the department and most work less than a full-time position.

Stoddardt has also staggered its centralized graduate intake throughout the year to alleviate the pressure in any particular quarter. "The oversupply of graduates means that graduates are making choices to go into areas that are not traditionally perceived as being the high priority areas, so areas such as mental health, rural and remote, outer metropolitan areas are getting a bit of a look in at the moment."

New South Wales
A spokesperson for the NSW Ministry of Health said the state has seen a steady increase in the number of graduates applying for positions in the public system.

"While graduate positions will be keenly contested, the majority of graduates will gain a position in the field either in public facilities or private and aged care sectors."

Northern Territory
This year the NT has received 300 graduate applications for its 2012 intake.

While the recruitment process is due to be finalised in December, the department has made 122 graduate offers so far - an increase of 26 positions on 2011. Fourteen graduate midwives will also receive positions in next year's intake.

The NT Department of Health is also working with the aged care sector to include the industry in the Territory's graduate nurse program,

Frontier services, a major aged care provider in the NT has expressed an interest in taking on 12 graduate nurses in 2012.

Marie Hughes, co-ordinator of the Nursing Development Practice Program in the NT says applications for its graduate nurse program have increased significantly in the past two years.
"In the past NT Department of Health has taken about 100 graduate nurses each year, of which 65 per cent have stayed on for at least a further year in the Territory following completion of the program," said Hughes.

Contrary to some of other larger states, the NT, to some extent, actually suffers from an undersupply of local graduates, relative to its international and interstate applications.
This year, of the 300 graduate applications 20 per cent were from local students, plus a cohort of defence partners who will become locals.

In the past two years, the number of international student applications has accounted for approximately 30 per cent of applicants.

National data collection
At a national level, analysis undertaken by the Department of Education, Employment and Workplace Relations, stated there was a lack of evidence indicating an oversupply of graduate nurses.

The department's June 2011 'Skills Shortage Australia' report said that advice from employers indicated adequate graduate nurse supply was adequate.

"While there has been a strong increase in training numbers for nursing professionals over recent years combined with an easing in the labour market for these professions, there is no substantial evidence of an oversupply of nursing graduates at this stage."

Also at a federal level, Health Workforce Australia is currently developing a 'National Training Plan' to address the future supply and demand for nurses, doctors and midwives. A spokesperson for HWA said it is due for completion in December.

NR understands that one of the strategies currently under development by HWA is a national register for unemployed graduate nurses in 2012 from which employers can fill vacancies.

Likely state of play for 2012 graduates:

VIC: Graduate supply is likely to match demand but inadequate distribution in rural areas
NT: Vacancies: 122 offers of graduate employment have been made, up 26 positions on 2011 plus 14 graduate midwives.
SA: Graduate oversupply: SA Health has offered 476 graduates positions as part of the first round offers.
TAS: Graduate oversupply: Intake returned its graduate nurse numbers to a "sustainable level" following an increase in previous years.
WA: Full graduate employment
ACT: Small oversupply
NSW: Graduate supply to match demand
QLD: Large graduate oversupply

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