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Graduate nurses face frustration in gaining registered nurse experience

There are challenging times ahead for the nursing workforce due to the increasing global nursing shortage and the continued marked attrition rate of newly graduated registered nurses.

A recent study on the lived experience of nine male West Australian GRNs in their first year has revealed that two of them, James and Oliver (not their real names), had trouble securing GRN positions post-graduation.

Their experiences concur with the findings of a 2014 graduate nurse and midwife questionnaire. Respondents who were unable to obtain employment, even after applying for multiple positions, cited issues such as lack of nursing experience, lack of nursing positions for new graduates, and lack of jobs without the completion of a nursing graduate program.

It had been over six months since James had completed his undergraduate nursing degree before he started in the mid-year GRN program, although he would have preferred to start straight after his registered nurse (RN) registration.

James continued to work in patient care assistance while waiting for his program, as he knew many other new GRNs who had been unsuccessful in obtaining nursing positions despite copious applications to various health services. The reasons for this, according to James, included their lack of RN experience and novice status.

He also revealed that as the months went on after graduating, he became more nervous about commencing as a new GRN and was not sure how it would go for him. He further recapped on his lack of confidence: “The responsibility of having a patient load on my own was definitely a big factor, coupled with the medications – ensuring not to make an error, etc.”

This lack of confidence intensified as he neared his entry into the graduate program. He doubted his ability to perform as an RN and meet the team’s expectations of him in his new role, stating: “I fear not holding up my end when it comes to being in a team environment.”

Although his previous career was in a team environment – his background in the army and the associate life experiences he saw as a big advantage – James still felt he required a transition platform such as the GRN program due to the nuances of the nursing profession and the socialisation required when entering a dynamic and ever-changing health environment.

For Oliver, he did not apply for a GRN program as he could not find one that was specific to aged care, the area he believed was his best fit. The months after his graduation proved very challenging as he received rejection after rejection on his nursing job applications.

His frustration is illustrated in one of his responses: “They keep saying I need more experience – this coming from both the acute and aged care jobs I applied for – but how can I get the experience if I can’t get jobs in the first place?”

Finally, four months post RN registration, Oliver started working in a small private aged care facility as the casual RN. On the first day, he felt overwhelmed and overloaded with his duties. As the shift progressed, he found himself getting faster and becoming more confident: “I just needed to find my way around the ward and get my head around what I was expected to do. It was because of my limited experience but mainly due to the lack of support – no one there to ask how things worked, etc. It was really hard when I was the only RN on duty.”

The next shifts, which were a few days apart, proved to be no better. Two residents needed hospitalisation and took up a substantial amount of his time, resulting in some uncompleted duties being handed over to the following shifts.

As a result of the uncompleted work, and with no consideration for Oliver’s overall workload and his novice status, he was not given any further shifts. He said: “I was not alone in this situation, as other graduates had faced the same fate.”

He went on to comment: “I felt really let down and really disappointed, and felt very disillusioned. I am rethinking my career and if I should look for something else.”
Oliver said finding a nursing position, as a new GRN, was very difficult. “Employers seem to seek out more-experienced nurses for permanent roles and use the inexperienced nurses as casual relief as a last resort.

“I personally feel that in order to support myself and a family in the future, if this is the problem you face when entering the field of nursing, then it is quite discouraging. It has made me feel that nursing isn’t a stable career option and that I may need to consider other opportunities.”

At the six-month post-RN-registration contact, Oliver acknowledged that he had persevered in his quest to gain a GRN program, remarking: “I felt that after my aged care RN experience, the only way I would find the support needed to transition into a competent RN, and then be able to obtain a permanent position within nursing, was through doing a GRN program.”

On his first attempt, he was given an interview but was not successful, due to very limited graduate positions, but he was offered a place on his second attempt.

Oliver said: “I am excited and happy about this opportunity but a bit disappointed it will be nearly a full year before I gain entry into a GRN program.”

He discussed his experience and voiced his disappointment at the lack of opportunities for new graduates who are unable to obtain entry into GRN programs in order to find a job for which they have been trained. He further reiterated that there is a very unrealistic view of what new GRNs should be able to do as they enter their new career environment.

The challenging situation faced by Oliver and James in finding employment due to their novice RN status and lack of clinical nursing experience is a phenomenon common across the Australian nursing workforce.

The concerns about decreased employment opportunities for Australian graduate nurses and health employers’ tendency to employ 457 visa RNs are outlined in the March 2016 Senate report, A National Disgrace: The Exploitation of Temporary Work Visa Holders. The report highlights the lack of transition support as a major issue, which is consistent with the experiences of James and Oliver.

New GRNs require access to the professional practice environment to gain RN experience with given time to synthesise their nursing theory to practice. Therefore, the challenge to reduce graduate nurses’ frustration in gaining registered nurse experience requires health industry financial investment for GRN professional support and the opportunity for successful transition into the professional-practice environment with gainful nursing employment are paramount.

Moreover, it can be argued that there is a need to establish quarantined graduate registered nurse positions within the health environment and to invest in nurse leadership in the form of mentor support and role modelling supportive transition for novice nurses in professional practice.

Dianne Juliff is a nursing PhD candidate at the University of Notre Dame Australia, Fremantle.

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15 comments

  1. Excellent report. So glad to see someone is taking the lead in highlighting this situation.
    I work in the allied health field, across disability, mental health and aged care and believe that having the 457 visa in place has cost our on-shore Australian graduates heavily to say the least, not only in the nursing profession either. It is time the government invested in our own workforce and ensured Aussies undertaking degrees at their own expense are given the opportunities they so desperately need and seek.

    I would also like to see that students undertaking work placements get at least a subsidiary payment for their time spent on the job. Encouragement is needed or else we are going to see a decline in local qualified people and thus more imports from across the globe which is totally unnecessary if the right approach is implemented.

    .

  2. If I’d known that I would be bullied & harassed constantly I would never
    have taken the new grad position I fought so hard to get.
    I’m humiliated, made feel like I’m worthless, not included in team – all because I dared complain
    about lack of support from educators. I’m a mess. I have had time off each week as I just can’t cope anymore.
    I hate myself, I have let everyone down, I’m worthless, I always say or do the wrong thing .I hate everything to do with work because my so called colleagues have made me that way. ive felt it would be best if I just jumped of the nearest cliff.

    • Hi len,

      I’m in my second year of working as an RN. I clearly remember how much I struggled when I graduated. I know some of my friends left their grad year half way through because of the stress and lack of support. Please don’t feel that you are alone. Try to reduce your hours as it helps me cope better.

    • The support international nursing students get when it comes to applying for grad year is very poor.

    • sfleming (Div 1 retired)

      Hello Jen, I am sad to read what has happened and how low you feel, and I am very concerned for you. I thought that this type of appalling unprofessional behaviour towards new nurses stopped 40 years ago. It is a shameful way to treat new staff. It is the duty of care of all registered staff to mentor and support new nurses – it is a requirement of their registration.
      You are to be admired for continuing to try to complete your training requirements.
      May I suggest you seek out some professional support and advice from AHPRA and talk to your nearest and dearest about your experiences and how you are feeling? You are young and have a life to live. Get all the help you can and find happiness again. I am sure you will be a great nurse. Hang in there!

    • Hi Jen,
      That is so sad to hear that senior (and maybe some not so senior staff) could treat a new grad like that. It is very daunting entering a new workplace especially one with so much responsibility. We deal with people’s future health and lives which makes us more nervous that we are careful and completely competent with our care that we deliver.
      I remember not being supported at times during pracs during my new grad phase and feeling like a nuisance. I’ve heard nurses mutter that they weren’t having a student to mentor. Have they read the nursing standards that we sign to adhere to when becoming registered? We agree to ‘participate in the education of others’. Therefore all nurses are educators. There is a culture in the nursing profession which attracted funding from the health service / government to research ‘why nurses eat their own’!
      When I was a new grad I would be driving to work dreading the day ahead, not the nursing duties but the constant lack of support and negative remarks from others, feeling isolated from the group (pack) and not included in anything, to the point where all the other nurses would work together during the busy early morning part of the shift and I would be on my own copping the odd snide remark. It was disgusting behavior. I readily ‘save’ new staff from the pack and help them settle in and remind others that we are all educators and they were once a beginner.
      I have seen very competent, caring new grads leave the profession due to the negative culture. I have encouraged some to stay or cut back their hours until they can cope a bit better, some find that this works or given them strategies to manage the bullies. I report the bullying to our very concerned manager. Some of the bullies back off for a while but it is so embedded into their behavior that they more often than not revert to their old ways, kind of like a dog that bites, a bit hard to break the habit!
      Hang in there Jen. I was once like you but decided that I had invested a lot of time, and my family time studying to give it up for a bunch of losers which these bullies are. My sister believes in karma, I hope she is right as it will come back to bite them. Hugs from me.

  3. Geee as an RN of 30 years this makes me sad to hear! Hospitals used to take on so many graduates & buddy them up with an RN for a period. Doesn’t that happen anymore??

  4. As an early career RN who completed an aged care graduate year in 2014, I am surprised at the graduate who could not find a graduate year in aged care. As an advocate for the advancement of aged care nursing as a recognised specialty, I am often frustrated by aged care graduate programs being unfilled after the computer-match process. I can imagine how hard it must be for a newly graduated RN to take on the role RNs play, particularly in residential care, if they have not had the chance to learn there way over a year. The bachelor degree ignores most aspects of this specialty; residential RNs need to be able to manage staff, families, and residents medical, social and psychological needs. I hope Oliver did not give up. Interested nurses are desperately needed in aged care, particularly in regional areas. Many opportunities are available in aged care, but graduates must understand that to get a start in the area of choice they may need to relocate as I did.

  5. Without new Australian trained nurses our professional culture will dwindle and die.
    Universities, Hospitals & all RNs must support newly graduated nurses ( and each other )
    We need foster a welcoming environment rather than be discouraging to new grads.
    We are all on the same side – some RNs wear a cloak of arrogant competence which
    they use to smother junior staff – however, they too were once junior and inexperienced.
    I am eternally grateful to those senior staff who took me under their wing and taught me well.
    ( and roused on me when I needed it ). I’ve been Nursing for 45 years and hope to put in another 5 more years.

  6. Thank you for your article, I was unaware this type of behaviour from both hospitals and aged care facilities still exist. I cant imagine why you would throw a GRN in to a position where they felt vulnerable and not prepared.
    I work in an aged care facility where we welcome new graduates and ensure they have the support they require. Providing a buddy system for as long as needed is essential, as well as ongoing mentoring ensures you have a staff member that feels welcome and included.

  7. It is sad new graduates sometimes only get a temporary position.This seems to be what is happening in a lot of industries besides Nursing.How can people settle and get a sense of pernamance?No wonder the economy isn’t confident as a whole.

    Due to continuity of care Graduates are better than overseas temporary staff.And Graduates learn fast enough to become good.Stress caused by this lack of opportunity makes it much harder for Graduates to perform.It is called the J curve.I hope that is taken into consideration.

  8. I agree working part time for a while helps lessen the stress.

  9. Being on the sidelines these days, my observations are that it isn’t a nursing shortage issue, it is the issue of not enough Nursing positions. The positions there are, are often overwhelmed with roles, including the supporting Grad Nurse protégées, who have a reasonable expectation to be employed after successful completion of their Qualifications. If I remember correctly ‘in my time’ after a Nursing shortage, Governments seemed to decide not have this happen again, by flooding the market with graduates. However if each graduate needs a grad year – how does this work with limited positions available to do this. Where is the responsibility of the funding bodies – who say ‘we are funding large numbers of nurses in training’. Why does there still remain a shortage, and then importing nurses? Should there be a serious evaluation of where the $ resources are being spent for best outcomes? Less no’s in training and more nursing positions which enable more support for the grad years. I am not sure what the funding bodies are afraid of – being over run by qualified and experienced nurses? I can see that could be scary.

  10. The health system is under enormous strain. So much so that existing RN’s cannot support Graduates due to workloads and lack of time to spend explaining and demonstrating nursing systems.

    In aged care we see that many of the duties of the RNs and ENs are being handed onto Personal Carers, who they employ on a casual or limited permanent hours to keep costs down. Of course as nurses we know this is a false economy which has been evidenced by many studies stating this.

    Acute and Community Care is all about ‘smoke and mirrors’, the emphasis is on statistics not on actually providing individual services. Governance, KPI’s, WPH&S, have become more important as bureaucrats (including managers and academics with nursing registration) are more interested in ‘demonstrating’ work activity than providing nursing care.

    Frankly my advice to those who are considering nursing or currently undertaking studies, is to look at other career options. If you want to be in the health industry, consider one of the Allied Health Professions. Engineering or Business/Marketing are more likely to provide a satisfying career than nursing in the early 21st century. Hopefully that will change back…but not in our lifetime. At the moment nursing is not about caring and compassion, even though most nurses want to demonstrate these qualities, but simply can’t because of the system.

  11. dear Dianne,
    thank you for your insightful article. I hear this story again and again from young nurses looking for the career opportunity they deserve after years of study and investing many thousands of dollars. It is difficult to understand this lack of opportunity for new grads, our health care future stacks up against the looming giant workforce shortage. As the mother of 2 sons who studying nursing this is even more real.

    APNA has has pilots underway to develop transition to professional practice for new grads and qualified nurses into primary health care. The evaluation of the pilots is due in 2018. Hopefully we can encourage employers outside the tertiary sector to be supported and see the benefits of employing newly graduated nurses. Karen Booth President Australian Primary Health Care Nurses Association (APNA)

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