Solving the looming nurse shortage

In 2017, 323,122 nurses and midwives were registered and employed in Australia, with an average age of 44.1 years.¹ This is a slight increase from 309,076 in 2012; however, an overview report on nurses² describes a shortfall of 122,846 nurses if nothing is done to influence attrition rates.

The economic cost of low retention rates in nurses further impacts the healthcare sector,³ with more nurses also required in leadership, administration and management positions.⁴ Key areas where lower attrition rates could increase the workforce pool are student nurses, graduate nurses and early-career nurses.²

The following is an exploration of how a specific group of student, graduate and early career nurses could be part of the answer, especially considering the acute need for professionals in community and primary health care and the aged-care sector.⁵

Mature-age student nurses and graduates — who are they?

Career pathways and employee perspectives have changed. Gone are the days of learning a trade or profession and then spending the rest of the working life within one area.

Technology and overall workforce mobility have created opportunities to advance and change focus within one profession or move into different areas of expertise multiple times. Nurses are studying for employment possibilities that are yet to be created.

Mature-age students are usually seen as those who do not enter the tertiary sector directly from school and could be as young as 21 years, or they might be making a career change at 45 years or older.

After establishing a family and other life experiences, many mature-age students are looking to enter nursing for various reasons. Common themes are ‘I always wanted to be a nurse but did not have the opportunity when I was young — now I am ready’, or they have experienced nursing care themselves or in their families and liked what they saw (or not, and want to make difference).

Many have not only cared for children but also their family members,⁶ and are seeking a job with meaning where they can utilise their life skills. Volunteering, charity work in domestic and international organisations, and other altruistic motives are further motivators and goals.

Will they stay?

Mature-age students usually do not commence a three-year university degree without being prepared to make sacrifices. Previous work and life experiences translate into commitment and advanced communication and organisational skills.⁷ This might be their last career change, and they want to make it work.

However, completing their education and gaining their first registration is easy compared with gaining a graduate position that will help them transition into the workforce. Stories of new nurses moving into rural and remote areas and leaving their family behind to pursue a graduate position are often heard. Stereotyping of mature graduates by employers can also lead to a difficult transition into nursing where professional socialisation is crucial to supporting new nurses.⁸

Notions of having to ‘do the time’ first, before considering nursing in other areas than hospital wards, hinder graduates who seek to practice in community, primary or aged health care. The lack of graduate or supported positions in these areas means that many potential nurses are deterred from starting their career non-traditionally, with the added pressure of hearing that if they have not worked in surgical-medical wards they will never be a ‘real’ nurse.

What could be done?

As employment pathways and workforce customs have changed, so should our perspectives on nursing career trajectories to a more flexible view and approach.

There is a graduate entry pathway for those who have completed a degree in business or other non-health areas. Could recognition of prior learning and work be formalised to provide initiatives for experienced mature-age candidates to commence a condensed, intensive course with possible specialisation?

Why are we still propagating the notion that two years’ experience in an acute setting is mandatory for a nurse to become accomplished? Formal education, including clinical placements, should provide the foundational knowledge that can then be applied and transferred into every nursing setting, with the specifics of that area being acquired on the job. No engineer graduate is expected to be able to work at the level of a senior professional, but is provided with an experienced mentor. How come we expect our graduates to ‘hit the floor running’?

Student nurses are often told that they should view each clinical placement like a protracted job interview. So, could this become a formal pathway where education and industry providers work together to integrate more student nurses in the healthcare workforce during their studies? Formal acknowledgement of minimum courses and placement hours could support mature-age students with transferrable skills to gain paid employment, particularly within the aged-care sector. This formalisation of skills would add to a transparent and accountable workforce, as student nurses are already registered with the Australian Health Practitioner Regulation Agency.⁹

Mature-age students are aware that they have less time to fulfil their career ambitions, so they are often keen and willing to work harder to reach their goals. Could this engagement be harnessed; aptitude, abilities and skills recognised; and accelerated pathways provided to fill the looming shortage in many areas of nursing?

Are the formal graduate positions the best way to socialise new nurse professionals and help them gain experience in a supportive environment? Anecdotally there is much which is lacking in this regard, with often only two supernumerary shifts after a one-day orientation and then an expectation the new nurse can supervise students, take on extended responsibilities and manage their workload without any issues.

And lastly, could we explore a transition model, where experienced nurses are appointed as mentors for graduate nurses and those who are entering a new nursing area, to support, engage, debrief, challenge and nurture our new colleagues who can grow and become a mentor to those following them? Can we start the conversation?

References

1. Department of Health, Australian Government (2019). Health workforce summaries; Nursing and Midwifery – 2017. 
2. Health Workforce Australia. (2014). Australia’s future health workforce - nurses.
3. Roche M. et al. (2015). The rate and cost of nurse turnover in Australia. Collegian, 22, 353–358.
4. Martin E. & Kallmeyer R. (2018). Strategies to recruit the next generation of nursing leadership talent. The Journal of Nursing Administration. 48(7/8) 368-374.
5. Commonwealth of Australia. (2019). Royal commission into aged care quality and safety; interim report: neglect.
6. Kiernan M., Proud C. & Jackson S. (2015). The juggling act: Do student nurses who care for dependants need an adapted course? An applied policy research study. Nurse Education Today, 35, 1085–1090.
7. Hayden L., Jeong S. & Norton C. (2016). An analysis of factors affecting mature age students’ academic success in undergraduate nursing programs: a critical literature review. International Journal of Nursing Education Scholarship, 13, 127–138. 
8. Kulik C., Perera S. & Cregan C. (2016). Engage Me: The Mature-Age Worker and Stereotype Threat. Academy of Management Journal, 59, 2132–2156. 
9. Australian Health Practitioner Regulation Agency. (2019). Student registration.

*Suzanne Volejnikova-Wenger is a hospital-trained nurse from Switzerland and a mature-age early-career community nurse who just completed a Master of Nursing (Clinical Leadership). As a tutor at the University of the Sunshine Coast, an Australian College of Nursing Emerging Nurse Leader and the Chair of the Nursing and Midwifery Alumni Network, she has personal experience with exceptional mentors and supports student nurses and peers, as well as having launched the #NursesNurtureTheirYoung hashtag.

Image credit: ©stock.adobe.com/au/zinkevych