Identifying and understanding the career destinations of double degree nursing

graduates using a mixed method approach

Noelene HickeyUniversity of Newcastle

Background • A world wide shortage of Registered Nurses (RNs), more so in rural areas

– 2010 in Australia 10,000 – 12,000 RNs.

• RN shortages → poorer healthcare of patients → stress, burnout in nurses

• Young people disinterested (a University recruitment issue)

• 2002 – 2008 Australian Government increased Bachelor of Nursing (BN) funded places at Universities

• 2002 - University initiative double degrees (DDs) commenced at Charles Sturt University (CSU) Australia

• 2009 - 33% of BNs in Australia enrolled in a DD (Preston 2009)

• DD graduates choosing nursing ? It is unknown.

• What sort of students enrol in and complete a cross disciplinary DD?

• Which career do they prefer? why? Does this change? Influences?

• What is potential impact of DDs? 3

Career choices

4

Registered nurses (RNs)(BN)

Early childhood teachers (ECT)

(BN/BECT)

Paramedics (Para)(Ambulance

officers)(BCP/BN)

Aim and MethodologyAIM:

To identify and understand the CAREER and LOCATION preferences of students and graduates undertaking multi-disciplinary degrees that encompass a Bachelor of Nursing.

Methodology• Sequential mixed method approach → quantitative & qualitative data

gathered from single degree (SD) & DD students and DD graduates • Cross sectional survey ALL undergraduate BN students (n = 209) • Longitudinal study – 1st year and 2nd year DD graduates (n = 32)• Interviews - 1st & final year DD students (n = 34) - 1st & 2nd year DD graduates (n = 34)• CSU Australia the context (72% response)• Data analysis – descriptive statistics, chi square & ANOVA (SPSS) - thematic analysis (NVivo) 5

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Beginning DD students

A sequential explanatory mixed method design process

PHASE PROCEDURE PRODUCT

quantitative data collection

•Cross sectional cohort survey (n = 70)

•Numerical data

quantitative data analysis•Data screening•SPSS quantitative software V17•ANOVA, chi square, frequencies

•Descriptive stats, missing data, •Mean, st. deviation, significant differences between groups

connecting quantitative & qualitative phases

•Convenience sample of DD students from survey participants•Developing interview questions

•Participants (BN/BECT n = 5; BN/BCP n = 7)•Interview protocol

qualitative data collection

•Individual in-depth tape recorded interviews with 12 beginning DD students

•Text data (interview transcripts)

qualitative data analysis

•Transcripts entered into NVivo•Coding at tree nodes•Within group & across group theme development•Cross thematic analysis

•Visual thematic maps data analysis•Codes and themes•Similar & different themes and categories•Cross thematic analysis

Integration of the quant. & qualitative results

•Interpretation & explanation of quantitative and qualitative results

•Discussion•Implications•Recommendations

Demographic profile

*,ł Statistically significant differences at P < 0.05 level¶ Marginal differences

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BNs (77) BECT/BN (31) BCP/BN (101)

Age on enrolment (mean range 21.1)School leavers 18 -19 years – n (%) [average 62.2%]

23.4*ł

37 (48.1)*ł 19.8ł

18 (58.1)ł 19.7 *75 (74.3) *

Male - n (%) [average 16.7%] 9 (13.0)* 0 (0.0) ł 26 (34.6) *ł

Rural background > 8 years – n (%) [average 70.3%] ¶

61 (79.2) 22 (71.0) 64 (63.4)

Fathers occupation (mean range) (S/D)Overall mean 7.1 (S/D 3)Mothers occupation (mean range) (S/D)Overall mean 7.1 (S/D 2.9)Fathers education (mean range) (S/D) Mothers education (mean range) (S/D)

6.1 (3.2)*ł

6.3 (3.1)*ł

3.7 (1.7)*3.7 (1.8)

7.9 (2.1)ł

7.9 (2.5)ł

3.6 (1.7)4.1 (1.7)

7.5 (2.8)*

7.5 (2.7)*

4.4 (1.6)*4.2 (1.7)

SD & DD students career location preferences at beginning and end of program

RURAL

metropolita

n

undecided

overseas

05

101520253035404550

single degree joint degree

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RURAL

metropolita

n

undecided

overseas

05

101520253035404550

Single degree joint degree

Rural decision factors •Lifestyle & enjoyment•Belonging – familiar people, places•Relationships and support Rachel (BN/BECT) “My family is here & I come from a farm, I like the wide open spaces, I can work as an RN in a hospital near home”

Metropolitan decision factors•Excitement & challenges•Career opportunities•Interesting work – career advancementJohn (BN/BCP) “ I come from a rural town but I want to go to the city, paramedics in the city yeah, more exciting & better conditions”

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disagree78%

undecided11%

agree11%

All DD students preferences for nursing in 1st year

disagree40%

undecided23%

agree37%

All DD students preferences for nursing in final year

Agree 11% undecided 11% disagree 78% Agree 37% undecided 23% disagree 40%

DD students career preferences for nursing at beginning and end of program

Why did students choose a DD? CAREER OPPORTUNITIES

Flexible options Stephen “Just the fact that I can chop and change. I always change my mind a lot, so

having two careers to choose from is fantastic.”

Safety net Maria “It was just .. I want to do nursing as a backup, something that I can travel with

and be able to add midwifery onto it later, a paramedic first though”.

Gaining workplace mobility Theresa “There are a lot of opportunities with nursing, you can take 6 months off and

go work overseas, it's very hard to do that though with paramedics”

Improving employment chances Sarah “Cause I didn’t know what I wanted to do when I left school and I always

thought teaching or nursing you’re always going to get a job everywhere in the world”

Value addedness Penny “I want to be a paramedic and I figured one more year for a whole other

degree, it’s worth it. I’m not wasting any time, I’m still getting what I want plus something extra, some extra knowledge”. 10

Final year UG DD students: What has influenced career preferences?

Practicum experiences (positive or negative)Pauline “I did my final paediatric nursing – I did paeds as my final week on my last prac and totally knew there and then that’s what I was meant to do”.

Sarah “I haven’t enjoyed some teaching pracs because they can go on, and on and on and on. Plus all the preparation is really hard in teaching pracs. I prefer nursing.”

Penny “I found that I couldn’t cope with it- like with paramedics one of my biggest fears was finding someone who had committed suicide, and that happened on prac, so I just thought ‘no more’, I’m doing nursing”

Expected personal rewards (enjoyment, excitement interesting work) Nicholas “ I enjoyed the paramedics pracs more, they were great, more exciting

work, we had a stabbing on my second prac”

Work location choices (home/relationship ties, supportive environment, graduate program availability)

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1st year DD graduates career choices Why did they chose their present career?

Past practicum and own work experiences (+ ve & - ve) exciting work, challenging work, witnessing poor practice, mundane activities, unsupportive role

models.Expected personal rewards

enjoyment, autonomy perceived better working conditions eg monetary considerations ,

or shift work rosteringWork location availability

graduate program availability, ongoing support, family tiesPeter “If you go into the ambulance service as a paramedic your shifts are 4 days a week. The money is better than nursing, more enjoyable and there is more autonomy too”.

2nd year (DD) graduates career choicesWhy do they stay in their chosen career?

Enjoyment and work satisfaction Heather BN/BCP “While I am young I will go down the para (paramedic) path I like it more....if

I want to go overseas I will go back to nursing, do some casual nursing – keep my skills up to date”

Workplace conditions - support from staff & facility, Mandy (BN/BCP) “Was only going to stay at (...city hospital) for the graduate year but

decided to stay, good support, can’t fault the organisation, we rarely need agency nurses ... they also have salary packaging”

Career advancement opportunitiesClare (BN/BECT) “It’s cool..doing what I enjoy most. I just think there’s more options, more

career options (in nursing) than paramedics, we are encouraged to do further education”. Why did they leave their first career?

Stress and burnoutMaria (BN/BCP) “I had too many patients, I couldn’t get my work done and I worried about

making a medication error, I’d go home some days and just cry”Loss of enjoyment and work satisfactionSarah (BN/BECT) “I knew I had to leave as the bad days were starting to out number the good,

it just wasn’t for me ... all the rushing in nursing and staff shortages”

Challenges faced by nursing academicsCross Faculty curriculum challenges • Time tabling (negotiating subjects and classes)• Course content challenges (negotiating professional requirements)• Practicum requirements in both degrees (practicums in semester breaks)Teaching challenges• DD students compare degrees and content eg skill & competency levels • Academics (particularly casuals) often unaware of DD students in classes• Academics unaware of content taught in other degree (eg high level

resuscitation skills in paramedics)Student/teacher relationships - DD students are “different” to SD students• DD students are brighter (higher university entry scores) but also easily

bored• See themselves as different “elite” as doing DD (only socialise together)

but feel unsupported by either faculty• Many DD students uninterested in some nursing content (eg aged care)

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Conclusions• More school leavers in DDs • Type of student and reasons for enrolling differs between SD and DD

students • Preferences for a “rural” location decreases over program • DD students preference for nursing career low.• Final year DDs career path strongly influenced by ‘practicum

experiences’• 1st yr DD grads career choice influenced by enjoyment, & work

availability• 2nd yr DD graduates careers influenced by enjoyment & satisfaction,

support, advancement opportunities• DD RN graduates stay or leave for the same reasons that RNs stay or

leave• Low numbers of DD students choosing nursing creates challenges for the

nursing profession due to existing shortages.15

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