Something’s not working

 

Graduates brought in to meet future shortages are struggling to find jobs at present. 

Australia may be gearing up for a nursing shortage in 2025, but in the interim, nursing graduates around the country are struggling to find work.

A report by Health Workforce Australia (HWA) last year revealed that Australia will face a shortage of 109,000 nurses and 27,000 doctors by 2025.

The anticipated shortage has caused a relaxation of guidelines to allow more students to undertake nursing studies but the gaps in the job market are yet to appear, causing many graduates to ponder their decision.

“At the moment the equation is simple: too many nurses not enough jobs,” says Elizabeth Dabars, CEO of the Australian Nursing and Midwifery Federation’s South Australian branch.

“In the past, up to 80 per cent of graduate nurses were being employed by South Australian Health, now that is at 50 per cent. We can’t expect graduates to go to unsupervised practice.

Dabars, who has worked in regional and metropolitan settings, including acute and aged care, believes the imbalance will eventually sort itself out but meanwhile federal and state governments need to revise their strategy to employ more graduate nurses.

“We need to ensure that the graduate nurses have a couple of years behind them before all the more senior nurses start to leave the system,” Dabars says.

“The system needs to be changed so that more senior nurses can work part-time, thereby creating funds available for graduate nurses to enter the healthcare system.

“We also need a more flexible system as to where nurses work so they can gain more valuable experience. If we could incorporate private and government practice into graduates training and placements they would benefit enormously.

“If SA Health graduate programs allowed nurses to work in aged care and other areas of private practice, it would give a better grounding and make them more aware of future options. We would also expose a far greater array of nurses to different opportunities.”

South Australia isn’t the only place where graduate nurses are experiencing trouble finding suitable employment, it’s happening across the country. Australia could find itself in an even worse predicament than HWA’s report forecasts if graduate nurses go searching for jobs outside of their training.

“As is well-documented, Australia is experiencing a growing shortage of nurses,” ANMF federal secretary Lee Thomas says. “That’s why the ANMF thinks it’s disgraceful that more and more graduate nurses can’t find employment in their graduate year. There continue to be limited job opportunities for graduate nurses right across the country and almost every state is affected.

“For example, Queensland is employing only 10 per cent of graduates, while in Victoria more than 800 graduate nurses are without employment.

“It seems incredible that state governments are unable to see that not employing graduate nurses will in the long run have a devastating effect at the bedside. Graduates today are the senior nurses of the future.”

Thomas believes the new Australian Government has the opportunity to make the nursing shortage a major platform of its health agenda.

“The Abbott Government can work with state and territory governments and key stakeholders such as the ANMF to fund new places for graduate nurses across the health and aged-care sectors,” Thomas says.

“This will not only address the growing nursing shortage but also deliver the ongoing promotion of safe patient care.

“As part of our ‘Stop passing the buck, Australia’s nursing grads need jobs’ campaign, the ANMF has put forward a range of solutions to address the nursing shortage, including waiving HECS fees for graduate nurses who accept work in areas of need, funding by state and federal governments of [24/7] clinical supervision and mentoring, rotation through non-traditional graduate areas such as primary care and aged care in addition to acute settings, and joint federal and state funding for graduate positions.”

One of the issues facing nursing graduates is their ability to take on all the responsibilities from day one when they enter the workforce.

Linda Shields, professor of nursing-tropical health in the Centre for Nursing and Midwifery Research at James Cook University, believes the expectations on nurses to be fully up to speed straight away are a tad unrealistic.

“It’s a fallacy to believe that nursing graduates should hit the ground running,” Shields says. “No other profession demands this. Medicine has a residency year, engineering and architecture graduates do an intern year, as do lawyers. It is crazy to demand this of nursing graduates, and that’s why supported graduate years are so important. In fact, I believe we should have provisional registration when the graduate year has been fully completed.”

Australian Health Practitioner Regulation Agency statistics show that there were 346,508 practising nurses and midwives in Australia at the end of March. There were another 3437 who were non-practicising.

Shields says that whilst the hospital and health system are well connected with the universities offering nursing degrees, further improvement could be made.

“Improvements could occur in a bit more creative thinking around clinical placement,” she says. “Let’s think a lot more about community, prison health services, GP surgeries, Defence Force clinics and so forth. The only real problem is finding enough clinical places, something that is happening in other professions, too.”

Professor Maxine Duke, head of Deakin University’s school of nursing and midwifery, says it’s the ability to determine what “work ready” means for each workforce sector that guides practical training and educational development at universities.

“Health service employers often have difficulty articulating what they mean by [work ready],” Duke says. “A study completed some years ago titled Safety Chain attempted to get some rigorous evidence around this term. The authors found that, in the main, employers wanted graduates who were confident about their abilities, knew how to resource information about what they didn’t know, asked questions when unsure, had competent assessment and problem-solving skills, and provided safe care.

As chair of nursing development, Duke has led numerous initiatives in national and international arenas. She has oversight of the school’s clinical partnership network, which connects it to eight healthcare organisations in the public and private sector and in metropolitan and non-metropolitan areas of Victoria. It facilitates applied clinical research and extensive placement advantages for students of Deakin.

“Most universities have close relationships with hospitals,” she says. “Deakin is closely linked with eight healthcare organisations in Victoria. These formal partnerships support both research activity and student clinical placement opportunities through the joint appointment of staff. Our courses adhere strongly to the benefits of an experiential approach to nursing and midwifery education.

“Undergraduate students have the opportunity to engage in patient care experiences in the clinical setting, commencing in the first few weeks and continuing throughout their course.

“The school also offers undergraduate students the opportunity to participate in the unique clinical fellowship program. Students selected for the clinical fellowship are able to complete most of their clinical placements in the one health service and in some cases attend tutorials and simulated learning sessions in that health service.”

Should nurses train at hospitals?

One explanation for the difficulty nursing graduates have finding jobs today is that many potential employers are reluctant to take on an inexperienced nurse. Does that mean there should be a return to more training in hospitals? A leading academic says no.

Teaching nurses through hospitals is no longer relevant or appropriate, says Jill White dean of Sydney Nursing School at the University of Sydney.

“It is a ludicrous suggestion to train nurses at hospitals,” White says. “I was a product of that system back in the 1980s and you basically had to pull the textbooks out after a shift.

“There was very little theory taught and the hospital system has changed dramatically since those days. I believe New South Wales stopped that practice back in 1985 and the rest of the states followed by 1990.

“The reality is, the way we operate, the change in healthcare practice and the system in general has changed dramatically and all for the better. I can tell you now that intensive care patients wouldn’t survive today if we treated them like we did 30 years ago.”

White, who has been an academic for 30 years in the areas of nursing, midwifery and education, as well as being a registered nurse and midwife and chair of the Australian Nursing and Midwifery Accreditation Council, says the gap between theory and practice is narrow.

“Our relationship with the health services and hospitals around the country is very good,” she says. “[Nursing school] students are lapped up by employers and we find that the clinical experience gained through the nursing degree – which involves two placements between six to eight weeks and eight to 12 weeks – gives them very good hands-on learning.

“In fact, we find most of our graduates look for opportunities either where they undertook their clinical training or [in] their local health district.”

White also points out that nurses undertake a thorough examination to ensure that they are ready to enter the professional world of health services.

“[Nursing schools] work closely with hospitals and health services across the nation to ensure best practice at all times,” she says. “I think the standard of Australian nurses is very good.”

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