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Shift focus back to regional campuses

Rather than enticing more nursing students to go to big cities, Karen Francis argues we should ensure access to quality universities in rural areas

In 2010 there were 7708 new graduate nurses registered for practice with the Nurses and Midwives Board of Australia. Health Workforce Australia (HWA) maintains that unlike other health professions nursing is presently a stable workforce that is relatively evenly distributed across all geographic regions including those classified as remote.

HWA, however, caution that they are concerned about the future sustainability of the rural health workforce including rural nursing.

Nursing is one of the professional programs offered by universities located in rural and regional Australia. Regional universities are central providers of tertiary education for rural and regional communities.

These institutions are reflexive and understand the context in which they operate. The suite of programs offered reflect the aspirations and needs of students and the broader community. To accommodate the diversity of students accessing regional universities, innovative methods for entry to courses have been established.

Regional universities have invested in new modalities for course delivery and work in partnership with other providers such as the vocational education sector and industry to ensure graduates are contemporary and meet student and employer expectations.

Securing the future of the rural health workforce requires careful consideration and review of the factors that impact on recruitment and retention of students, graduates and the existing health workforce.

Studies such as the nursing e-cohort study are providing robust national and international trend data on the nursing and midwifery workforce inclusive of students and graduates to guide future workforce planning. With the introduction of national registration, a common data set that permits better understanding of the nursing and midwifery workforce and other health professions will allow more effective modelling to inform workforce planning.

While nursing numbers are relatively stable and evenly distributed there is concern that the workforce, particularly the rural nursing workforce, is ageing and increasingly working part-time.
Keeping nurses in the workforce is now accepted as a major driver for workforce reform.

Recommendations identified in the literature that are purported to be useful methods supporting retention include: comprehensive orientation to the workplace, mentorship, career opportunity, access to local professional development education, time to participate, workplace flexibility and being valued.Identifying the relevant factors that predispose a person to work in a rural or regional area is complex, however, the published research makes it difficult to sustain a case that “rurality” is not an influential factor.

The World Health Organisation (2011) noted that rural doctors were four to 12 times more likely to have origins from a rural area and have undertaken training in a rural setting. The limited regional offerings of medicine make it impossible to validate these figures in the Australian context, however, providing rural and regional communities with the option of studying local to become a nurse has ensured a level of workforce sustainability; adding weight to the growing body of evidence that suggests living in a rural area and being educated locally impacts on graduates choices to stay rural.

The ACER report, Australian Regional Higher Education: Student Characteristics and Experiences (2011) concluded that there was a strong proximity effect associated with regional higher education. ACER data indicates that 65.7 per cent of graduates of regional higher education institutions are working in rural and regional areas five years after graduation.

2010 student data published by Charles Sturt University, a regional provider of tertiary education in NSW, found that of the 132 nursing on-campus student graduates for that year 78 per cent were from rural and regional areas, and more than 70 per cent of the cohort accepted rural or regional employment on graduation.

The same data set demonstrated that a significant proportion of CSU graduates who originated from a metropolitan area commenced their careers in regional areas on graduation. Further, the Australian Regional Higher Education: Student characteristics and experiences report highlighted that older female graduates are more likely to remain in rural and regional areas on graduation. The demographic of the nursing workforce, particularly the rural nursing workforce supports this finding.

There are a number of studies highlighted in the health literature arguing a case for tailored programs in nursing, medicine and allied health to be offered by regional education providers as a method for supporting the sustainability of the workforce. The World Health Organisation (2011) affirms this strategy and encourages curriculum modification that ensures graduates are well prepared for rural practice.

The principles underpinning the WHO’s position are acknowledged as appropriate. Rural schools of nursing and midwifery support this recommendation with some choosing to supplement mandatory curriculum content with knowledge that informs future practice in rural and remote settings. They also support workplace learning experiences in diverse practice settings or developing programs such as double degrees in nursing and midwifery that meet workforce need.

The proposal to introduce mandatory enrolment targets for rural students for all universities as a standalone initiative will have little effect on rural and regional recruitment of nurses or the health workforce in general. (STORYCODE: 01-310712)

Increasing the number of rural and regional students training at metropolitan universities is only likely to increase the pool of candidates for metropolitan employment. To ensure a sustainable supply of tertiary qualified nurses and other health professionals to rural practice, access to high quality educational programs at regional higher education institutions is necessary.

Retaining the workforce in rural and regional areas in the long-term requires a major review of conditions and structure.  Regional universities are significant providers of nursing education with many graduates choosing to enter professional practice in regional, rural and remote settings.

While there are many challenges facing the nursing workforce that must be addressed, the decision to support nursing education in all geographic regions has been extremely successful.

Continuing to provide rural communities with access to a broad range of health and other programs of study is a useful strategy that must continue if the health workforce challenges identified by Health Workforce Australia are to be resolved.

Professor Karen Francis is the head of the school of the nursing, midwifery and indigenous health at Charles Sturt University. A fully referenced version of this article is available upon request. 

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