Trained up & nowhere to go

We need to find graduate positions for new nurses to prevent a future staffing crisis. By Penny Paliadelis

More than a decade ago, the National Review of Nursing Education report, Our Duty of Care, found that not all nursing graduates were able to gain entry to graduate nursing programs. The 2002 report identified that "even if a facility has a graduate program, there is no guarantee that all new graduates employed there will be offered a place on the program".

So if the difficulty of getting into a graduate program is not new, what is making the current situation for newly graduated nurses even more challenging?

Graduates feel understandably disillusioned by the difficulty in securing a new graduate position, as most entered nursing courses when universities were being funded to increase enrolments to meet projected nursing workforce shortages.

It was predicted that a mass exodus of baby boomers in the early 2000s would leave a huge gap in the nursing workforce. A recent report by Health Workforce Australia, Health Workforce 2025, continues to provide compelling evidence of a looming shortage of nurses, with a suggested shortfall of more than 100,000 by 2025.

However, there appears to be a mismatch between the predicted shortages and the number of positions vacant. The Courier-Mail reported last November that since 2010, Queensland Health had received 10,400 applications for graduate nursing positions, but employed only 2467 of them. Tasmania offered only 140 graduate positions across both the public and private health sectors in 2012.

The lack of graduate programs has more to do with funding than anything else, as state and territory governments grapple with increasing budgetary pressures, forcing them to cut health spending. The situation is exacerbated by the high cost of delivering structured graduate nurse programs, because of the need for supernumerary days, education days, supervision and mentoring to ease the transition of new graduates into the workforce. So reducing or cutting these programs is an easy way to reduce costs.

In rural areas the need to recruit and retain registered nurses is even more acute, and the preliminary results of a study by Jackie Lea at the University of New England suggests that rural facilities have difficulty actually recruiting into graduate programs as there is no guarantee of ongoing employment after completion, and there are few alternative employment options in small rural towns.

The short-sightedness of such strategies cannot be overstated. The evidence is overwhelming that Australia will experience a critical shortage of nurses in the future as the projected mass exodus of older nurses has been delayed; staff have stayed longer in employment as a result of the global financial uncertainty and the poor performance of superannuation funds.

The cutting of new graduate programs will force new members of our profession to seek employment elsewhere or take their skills overseas. This cycle of oversupply of new graduates, followed by shortages, is similar to previous cycles in the 1990s and 2000s.

The coming decade will also see a dramatic increase in demand for healthcare services, so the existing nursing workforce will experience even greater workload demands if this situation is not addressed.

When will governments learn that it is false economy to see the nursing workforce as a financial liability? When will they stop using nurses as pawns to balance health budgets for the next election?

The federal government needs to develop a national scheme to fund new graduate programs to support nurses' educational development and career pathways, much as Health Workforce NZ is doing, rather than promote the use of unregulated health workers as the solution.

Funders of healthcare services clearly need to adjust their focus to see the recruitment and retention of professional nurses as an investment in the health of our nation, and commit funding to nurture our new graduates to lead us into a healthier future.

Associate Professor Penny Paliadelis is acting head of the school of health at the University of New England, NSW.

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