Workforce shortage will stay if nurses can’t graduate: Q&A

Financial barriers for students and an unwillingness of hospitals to provide practice placements are hindering studying nurses from graduating, a new study has found.

Lead researcher, Professor Lesley Andrew from Edith Cowan University, says that it's critical nursing students are able to graduate and enter the workforce.

"It’s one thing to attract people to study nursing, but another to keep them at university until they graduate."

Andrew's study also revealed that the nature of the nurse as a student had changed over the last century, where many are of a mature age when they enter the profession.

"Nurses described their attempts to protect their partners and children from the 'intrusion' of university on the family and to continue prioritising their family's needs over their own academic and career ambitions," she says.

"This meant they rarely asked partners and children for help with domestic tasks; many recounted how they would forgo sleep and rest to fit-in study."

Nursing Review spoke with Andrew about how problems around practice placements are impacting nurses wanting to graduate.

NR: In what way has nursing study changed over the years?

LA: Nurse students originally were between 16 and 18-year old and they were all women. Men weren't allowed into nursing until the last century. Today, it has changed hugely. It's still mainly girls – only 10 per cent of our students are men despite many efforts to get males into the profession. But people start their nursing careers much later than before. The average age of the nursing student is at mature age, so over 25. So, they're older, which means that many live with partners or not with parents, and are more likely to have mortgages, children and rent.

Nurse education has also changed in recent decades from a model where the student is a passive recipient of information, to a critical model where the student is engaged in the process of developing autonomy and empowerment. Embedding gender theory within nursing studies would allow women nursing students to be comfortable in enacting changes in their home lives to support studying their degrees, enrich the profession and protect the future workforce supply.

What problems are more likely to arise from them being older, and what can we do to resolve these issues?

Older students are, of course, still really valuable: they bring lots of life experience to the job and are more empathetic. But they're less likely to work as long because they graduate later in life, so they have a shorter lifespan in nursing. They also tend to work more part-time if they have families. So we don't want to lose those students, but instead make it easier for them to graduate because they're currently facing real difficulties. After all, the degree can make it hard for them to prioritise university over family. It's challenging for these students to do that.

We also have the issue of younger students. We want to attract more younger and male students, but when you look at Generation Z, they are interested in fair pay, respect, and flexibility – these things are just not there in nursing. Nurses earn less than other graduates in health professions, and there's a lot of bullying in nursing; there's not a lot of respect from other occupations. Some other disciplines subjugate nurses, as we found in research. And also, within nursing, bullying and hierarchy can cause a problem within the profession. Our generation Z students don't want to live to work. They want to live with a job rather than it being everything to them.

What are some barriers for students that would cause delays in graduating?

Particularly women with children and full-time jobs, there are some significant barriers. Most students don't just study anymore – they work. And for those with family and childcare, the degree can be a real issue, especially practice placement. So students will go out on placements for between two and eight weeks at a time, four or five times during their degree, and they have to do that full-time. During that placement, they can't work, so they receive no income. Some have to give up their permanent jobs because they can't get eight weeks off. So, that's real financial problem, especially if these students have mortgages or rent to pay.

Another issue is that practice placement might be arranged one or two hours drive away from their home, which means the student has to have access to a car to get there. 

The real problem is that we're not organising practice placements in collaboration with students. We're not looking at where they live or try to make it easier for them to have placements at home. And a lot of the hospitals are really problematic in that they will not let students park at the hospitals, so how do they get there? It's seven in the morning, the seven o'clock shift, and some hospitals don't give students their rosters until the day they start. Can you imagine getting a month of duty, not knowing your roster until the day you start and having children and work to think of? How do you get childcare? How do you arrange that? And also, how do we get childcare for a seven o'clock start in the morning, or a nine o'clock end in the evening, or weekends or nights?

These students struggle if they don't have a supportive family or a partner. And we lose these students, so the university and the hospitals need to realise that if they want a strong workforce, they have to work with the students to complete their degrees. These students are no longer 17-year-olds living at home with mom and dad with loads of money. Of course, some still are, but it's changing.

Over time, it can become more difficult for students to shield their family as the expectations of university study competes for their time and energy. This creates a conflict for these women, leading to feelings of guilt and distress and ultimately impacting their capacity to engage in the range of study opportunities offered by the university.

Why are hospitals not too keen to take on students for practice placements? 

One reason a hospital wouldn't be interested in taking on placements is the extra time to educate them. When I was young, as a student, we worked part-time in the hospital and actually did things. We gave drugs out under supervision, we did wound checks, and we did observations, but students now are supervised much more closely, so you need that one-to-one supervision all the time. So that's supernumerary, and obviously, that staff member is already working overtime and burned out. Then they've got to have the students following them around, asking questions and being watched and supervised, so that's a real issue in the Australian system.

What role is the government currently playing concerning these issues?

The government has made the degree less expensive, but there's no funding to cover these placements. People are living hand-to-mouth with the rising fuel costs and living at the moment. In Victoria, they talked about bringing in three degrees, so there are no fees, but we've still got the issue of the fact that there is no payment during placement. That's eight unpaid weeks multiple times during a degree. It's still an issue.

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