Trained but nowhere to go

Nurses around the country are struggling to find graduate placements so industry leaders are calling on state and federal governments to solve the urgent problem. Flynn Murphy reports

It's an ugly time to be a graduate nurse in Australia. A fraction of this year's cohort have secured graduate placements vital for their transition into the workforce, and many are considering other professions or looking seriously at moving overseas.

Unemployed nurses are collecting Centrelink payments, and those fortunate enough to gain an interview sometimes travel hundreds of kilometres just to be rejected.

Quinn McGuinness, 20, is due to graduate from Curtin University in July. He hasn't found a graduate placement yet, and doesn't like his prospects.

"I have several months of unpaid hospital experience, several years of paid experience working as a care assistant in aged care and other practical placements such as working for the Royal Flying Doctor Service under my belt. I have even received cash grants off the government to become a nurse," he said.

McGuinness - who believed that with the nursing profession in high demand, the degree would provide job security - said he was now facing the prospect of being registered with the Nursing and Midwifery Board, but unemployed.

While Australian Institute of Health and Welfare figures for 2012 are not yet available, the

Australian Nursing Federation (ANF) estimates that only half of the nurses that graduated in South Australia last year have been employed, only 30 per cent of nurses in Tasmania, and as few as 10 per cent in Queensland. The union said 800 graduates were without employment in Victoria.

Where the jobs are

Queensland Nurses Union secretary Beth Mohle said her state was worst hit by the shortage, due to the state's widespread, ongoing health cuts. In one example, she said the Royal Brisbane

Women's Hospital graduate program would this year take a fraction of the approximate 170 new graduates admitted last year. RBWH responded in a statement that it would employ 12-16 new graduate nurses in 2013, though it recognised the importance of providing the positions.

In NSW, things are looking better, with the health ministry announcing in early February that in addition to 600 graduate nurses and midwives who had found positions in the state, a further 1400 would "take up duties in the weeks and months ahead".

In Western Australia, the Health Department last year offered 827 places in its graduate program. Around 1400 applied. The issue promises to take on a political dimension in the lead up to the March 9 state election, with a graduate-run campaign called "Give Grad Nurses a Chance" attracting 500 followers on Facebook and a great deal of media attention. The campaign, backed by the federal branch of the ANF, the state branch of United Voice, and WA opposition health spokesman Roger Cook, included a rally by graduates at the WA Parliament in November.

One of those at the rally was Edith Cowan University graduate Jess Tully, who started the campaign's Facebook page and has become something of a spokeswoman for disenfranchised graduates.

"I just want to be a nurse. That's what I want to be. It's driving me insane," said Tully, 21, who since graduating in December has been working 12 hours a week at a pharmacy, and still qualifies for Centrelink payments.

She said she had searched all over Australia for a graduate position. "I just sit here on the computer all day filling out forms and cover letters ... There have been a lot of rejection emails. A few have told me straight out that it's because I've got no experience, and others have told me that after I called up.

"I just don't think [the WA government] planned for so many graduates. They told us right at the end of uni we didn't need a graduate placement [to be employed], and that we could work anywhere as an RN. So I started thinking it would be OK, that I could get a job elsewhere. But that's not the case at all."

Ariane Baayens transferred to nursing two years into a degree in criminology and psychology, believing it would provide a more stable career.

"It's really not good enough," she said, adding that she wouldn't advise anyone to do a nursing degree. "I feel like it's been a waste of time and money."

When asked where she sees herself later in the year, she replied: "on Centrelink."

ANF federal secretary Lee Thomas said the graduate placement situation across Australia was a crisis, given Health Workforce Australia's prediction that the country would be short 109,000 nurses by 2025.

"We have nurses educated, ready to work, and they can't get work. It's madness."

But just who is to blame for the shortage?

Passing the buck

According to the ANF, the disconnect between the federal and state governments is partly to blame. This is theme of their Australia-wide campaign on the subject: 'Stop Passing the Buck! Nursing Grads Need Jobs!'

While the federal government has jurisdiction over broader workforce planning and tertiary education, the state and territory governments actually employ the majority of nurses.

"We see this as a unique opportunity for [state and federal governments] to actually work in co-operation to solve this problem," said Thomas. "But you've got the state governments saying they don't have enough money and the federal government saying 'well we don't employ nurses'."

"Workforce planning has been done in a vacuum ... It hasn't connected education to health services," said Professor Phillip Della, head of Curtin University's school of nursing and midwifery.

"The number of nurses we take into our programs has been very directed by health workforce planning," said Della. "In Western Australia that was 1000 graduate nurses a year to meet workforce demand. The mismatch is between the workforce planners and their utilisation when graduates come out."

Governments have downplayed the lack of available graduate positions, maintaining that nurses can get jobs without undergoing a graduate placement, but graduates who spoke with Nursing Review said that the nurse managers who had rejected them consistently cited their limited experience.

Della added that while placements were an essential part of a nurse's education, they were about more than just helping graduates transfer their knowledge into a practical clinical environment - the support and mentoring they provided were essential to ensure nurses remain in the workforce.

"There are jobs they can get straight out, but if you want to be serious about retention of nurses, you need to support them in their first year. It's a minimal cost, but support them and they are more likely to stay within the health service."

Thomas said every graduate that wanted a placement should be provided with one.

The graduate crisis isn't just affecting younger nurses. Like many in this year's cohort, Reshid, 46, came to nursing from another profession, putting herself through a nursing degree at the University of South Australia while working full-time at a bank. She also made the decision to study nursing to ensure her job security - and her fears about the banking sector were realised when she was made redundant last year.

Despite good grades, Reshid has been rejected for entry-level jobs at hospitals in Tasmania, Queensland and South Australia, being told she lacked the relevant experience. She once drove 300km for an interview that was ultimately unsuccessful.

"I'm willing to relocate anywhere and ready to take any nursing position in a rural area, or any regional hospital, as long as I get a chance to practice ... what's frustrating is I know I'll have possibly another 20 working years left in me, yet I feel time is running out for my new career," she said.

"I am desperately keen to kick-start my career in nursing."

Solutions

Although she has never been to Centrelink, Reshid decided to register for job-seeking assistance, but was told she needed to be unemployed and on benefits for three months before they would start assisting her search.

She has decided to undertake a short-term pathology collection course to improve her chances of finding work, and is considering leaving the country if that fails.

Thomas said innovative and creative thinking were the only way to solve the problem. She suggested the federal government could refund the HECS debt of nurses taking placements in areas of high need, such as rural and remote health.

"There are lots of missed opportunities. We see graduate years run pretty much exclusively in public hospitals and private acute [care], and we'd like to see some support for graduates to work in some of those non-traditional graduate year areas, for example primary care, schools, doctors' surgeries, community centres."

Thomas said graduate programs which rotated through various areas were an option worth discussing.

"It would take some organisation but we need to think outside the square - there are many positions that graduates could rotate through and get a well-balanced graduate year," Thomas said.

"These graduate nurses are our senior nurses of the future, and it's nonsense that we can't get them jobs. Unless we do something now we are going to be in a terrible situation in a few years."

Health Workforce Australia (HWA), a federal workforce planning body, launched the Nursing and Midwifery Graduate Jobs information portal in January last year to help link up graduates with health services.

A spokesperson for HWA said the portal, which is free to use for both employers and graduates, could highlight non-traditional placements in settings such as primary care, aged care and Aboriginal health. In the first year of operation, the portal has registered 2426 graduates, but HWA does not keep figures on how many graduates have been successfully placed.

Thomas said the idea of the portal was "absolutely right", but that the reality was there just weren't enough jobs to go around.

Meanwhile, Professor Della said it was too early to tell if the current job insecurity would have an impact on enrolments. "We haven't seen a drop in applicants. Curtin has the highest entrance score [for a nursing degree in Australia], and we take two intakes a year at 250 students an intake.

"The impact will be in the later years, when graduates aren't getting jobs," he said.

"Nursing's a fantastic career," said Thomas, who is herself a registered nurse and midwife. "But we have a group of graduates this year who may well be looking for jobs elsewhere. I think that's just not acceptable.

"They've wanted to be nurses, they've educated themselves to become nurses and have a HECS debt of $18,000 to $20,000 as a result of their education, and yet they can't get jobs. I wouldn't like to think that that would turn people off, but ... unless we do something people are going to think twice about doing nursing, and that's going to leave an even greater hole in years to come."

The Nursing and Midwifery Graduate Jobs information portal is available at www.nmgj.org.au

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