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The University of Sydney Rural Careers Project: A nursing perspective

B. Murphy, E.McEwen and R. B. Hayes

The Australian Journal of Rural Health © Volume 3 Number 1, February 1995

Aust. J. Rural Health (1995) 3,20-24

Original Article

THEUNIVERSITYOFSYDNEYRURAL CAREERSPROJECT:ANURSING PERSPECTIVE

Departments of IFamily and Community Health in Nursing, 2General Practice,

University of Sydney, New South Wales, and 3North Queensland Clinical School,

Townsville, Queensland, Australia

ABSTRACT: This paper describes the nursing involvement in the University of Sydney Rural

Careers Project. Funded by the Rural Health Support Education and Training (RHSET)

programme, the project was initiated to stimulate the awareness of undergraduate healthcare

students to the professional opportunities within the rural setting. During 2 years of operation

meetings have been convened for interested students to learn about working and living conditions

in a rural community. Speakers from a variety of healthcare settings have provided a wide range of

insights into rural working and social conditions. Scholarships are offered to cover travel and

accommodation costs for students to attend placements in rural areas and annual excursions to

rural communities provide students with experience of rural life and health-care practice. Although

the limitations of such activities are acknowledged, it is believed that students who have several

positive experiences of rural professional life may be more likely to try a longer period after

graduation.

KEY WORDS: nursing, RHSET rural career, students.

INTRODUCTION

Prompted by the research of Kamien and Butt-

fieldlJ the Department of General Practice at the University of Sydney initiated a multidisciplinary

rural careers project to promote rural careers in

undergraduate healthcare courses, and to link

rural practitioners and students. The target pro-

fessions were medicine, nursing, occupational

therapy, physiotherapy, communication disorders

Correspondence: B. Murphy, Department of Family and Community Health in Nursing, Faculty of Nursing, University of Sydney, Sydney, NSW 2006, Australia.

Accepted for publication September 1994.

and social work, although the project was not restricted to these disciplines. The Faculty of

Nursing was invited to join the steering commit- tee of representatives from these professions. The project convenes meetings at which interested

students can learn about working and living con-

ditions in a rural community. Guest speakers

have provided a wide range of insights into rural

working and social conditions. The project also

offers scholarships to cover travel and accommo-

dation costs for students to attend clinical place-

ments in rural areas. In addition, the project

funds an annual excursion to rural towns when

the students have an opportunity to experience rural life and healthcare practice.

RURAL CAREERS PROJECT: B. MURPHY ET AL. 21

The early activities of the project have been

reported elsewhere. 3,J Several meetings were held

on campus during 1992 and, in May 1992, the co-

ordinators of the project took a group of students

for a weekend excursion to Mudgee. The 62 stu-

dents represented a range of the healthcare disci-

plines within the University. Most students had

had limited prior exposure to life outside of the

metropolitan area. The weekend was a mixture of

formal and informal discussions with Mudgee

healthcare workers, with attention to both profes-

sional and social life in the community. Evalua-

tion of the trip showed that interest in a rural

career appeared to increase during the w-eekend

and students appeared to gain a more realistic

awareness of both positive and negative aspects

of working in a rural community.” The feedback

suggested that the Mudgee excursion met the

objectives of the project and a similar rural week-

end was planned for 1993. This paper reports the 1993 excursion, primarily from the perspective of

the nursing students.

1993 EXCURSION

Funding dictated the choice of a rural area within

relatively easy and inexpensive access from

Sydney. Consequently Cowra and Canowindra

were chosen as the centres for the second excur- sion, in April 1993. Cowra is approximately

310 km west of Sydney; a comfortable 4 h drive by car. The town population is approximately 8000 people with an area population of approxi-

mately 12 000. Located in the picturesque Lach-

lan Valley, Cow-ra has a fascinating history: the

excitement of bushrangers, nostalgia of the steam train era, grandeur of historic buildings and the

escape of prisoners of war from the Cowra prison-

er of w-ar (POW) camp. Visitors to Cowra can

inspect the ilustralian and Japanese war cemeter- ies, the POW campsite, the World Peace Bell and

the Japanese Garden and Cultural Centre.

Cowra is a pastoral centre that has experi- enced a decline in affluence in recent years. A 55

bed hospital and a wide range of community

health care services are located in the town. One

important social issue is the rising unemployment

due to the closure of a major fruit processing

plant. Cowra also has a w-ell-organized -Aboriginal

community comprising the Wiradjuri nation.

Canowindra, 36 km north, and known as the Bal-

loon Capital of Australia, w-as included in the

excursion because of its abundant health ser-

vices. Of a town population of 1700, it is esti-

mated that 120 people are employed in the local

hospital, nursing homes and the drug and alcohol

rehabilitation centre. The hospital is small: 18

beds and 12 long-stay patients but the community

services cover physiotherapy-, speech pathology,

occupational therapy and nursing.

The 61 students of medicine, nursing, den-

tistry, physiotherapy, speech pathology, occupa-

tional therapy, social work and Aboriginal health

arrived at Cowra Hospital Saturday afternoon.

The afternoon activities commenced with a talk

on Aboriginal culture and awareness given by

Fay Acklin, Lecturer in Aboriginal Studies,

Cumberland Faculty of Health Sciences, Univer-

sity of Sydney and Bill Murray, Aboriginal Health

Education Officer, Cowra. The students were

taken to visit the Erambie Aboriginal Reserve

where the ilboriginal community has established

numerous facilities: a day care centre, legal ser-

vice, children’s service; health service, homecare

services, housing cooperative cultural resource

centre, children’s homework centre and farm

enterprise.

The students then proceeded to Canowindra

where they were taken on a tour of the hospital.

Following their tour, local healthcare workers

addressed discipline-based groups while some

students visited particular facilities in the town-

ship. The Director of Nursing, John Bailey, gave

an informative talk to the 13 nursing students. He

explained the reasons for the high level of com-

munity services that are available to the local

population, the relationship of the hospital with

Cowra and Orange health services and the job

satisfaction that can be achieved from a rural

career. He also highlighted the positive and nega-

tive social aspects of living in a small community.

22

One of the important insights to evolve from his

discussion was the interaction, both social and

professional, of healthcare workers with all mem-

bers of the community.

The excursion coincided with a seminar week-

end for the Rural Doctors Resource Network at

Cowra Hospital. Saturday night social arrange-

ments had been orchestrated so that the students

could mix with the doctors and their spouses over

dinner at the Japanese Gardens. The dinner

initiated informal and valuable interaction. The

steering committee is well aware of the value of

informal discussions and welcomes the social

activities that play such an important part in

helping the project achieve its objectives. On

Sunday students were taken on tours of Cowra

hospital and the Community Centre, participated

in discipline-based discussions with local health-

care workers and attended the Rural Doctors

Resource Network seminars. The activities were

staged to allow the students to attend a range of

concurrent sessions. The weekend concluded

with a brief tour of the Japanese Gardens.

AUSTRALIAN JOURNAL OF RURAL HEALTH

EVALUATION

As with the previous excursion, students were

asked to complete a questionnaire on the forward

and return journeys. Details of rural background,

interest in a rural career, comments about the

most attractive and least attractive aspects of a

rural career were sought. Fifty-three students

(86.9%), including all 13 nursing students,

returned both completed questionnaires. Seven of the nursing students had a metropolitan back-

ground. Due to the small numbers involved the

analysis was primarily descriptive and quali-

tative.

In response to a request to rate their interest

in a rural career on a 1 to 10 point Likert Scale,

the mean response was 8.07 on the forward jour- ney and 8.92 on the return journey (1 represent- ing ‘no interest in a rural career’ and 10 representing ‘very interested in a rural career’).

Nursing students provided a total of 36 positive

and 32 negative comments about a rural career on

the forward journey and 38 positive and 28 nega-

tive comments on the return journey. Hence there

TABLE 1: Positive and negative comments of students before and after excursion

Positive Before After Negative Before After

Professional factors Professional factors

Variety 13 18 Isolation, lack of support 5 6

Independence - - Problems with self 5 3

Community involvement 8 5 Education 5 1

Increased knowledge 2 2 Lack of resources 1 -

Subtotal 23 25 Work too demanding - -

Subtotal 16 10

Personal factors Personal factors

Financially better off - - Financially worse off - -

Social factors Social factors

Relaxed lifestyle 6 10 Family dislocation 10 14

Clean environment 7 3 Education of children, spouse 1 -

Subtotal 13 13 Career 4 3

Country life too slow 1 2

Less social resources - -

Less anonymity - -

Sub total 16 19

Total no. comments 36 38 Total no. comments 32 29

RURAL CAREERS PROJECT: B. MURPHY ET AL. 23

was a small increase in positive comments and a small decrease in negative comments during the

excursion. The comments were content-analysed

according to the key issues identified in the

Mudgee evaluation within the broad categories of

professional, personal and social factors (Table

1). Most of the responses related to professional

factors (variety, independence, lack of support,

isolation) and social factors (lifestyle, environ-

ment, slow pace of life, separation from friends and family, education of children, spouse

careers). The positive responses relating to relaxed lifestyle were almost doubled after the

weekend, while negative comments about profes-

sional isolation, lack of professional support and

lack of professional resources decreased after the

weekend. Negative comments relating to family

dislocation and education of children increased.

There were no responses, either positive or nega- tive from the 13 nursing students in the category

of personal factors that related to financial issues.

DISCUSSION

No student rating fell as a result of the weekend’s activities. Thus one of the project’s objectives,

namely to encourage and maintain the interest of

students already interested in a rural career, was

fulfilled. This finding is consistent with results of

the previous excursion.3 The qualitative differ- ences in the open responses reflected an increase

in awareness of the positive aspects of rural pro- fessional life. In particular, there was an increase

in the awareness of variety and independence. It is probable that the excursion was responsible for

these changes in awareness, although the absence

of a truly experimental design does not allow this

conclusion to be drawn.

The 1993 excursion has supported the find-

ings of the previous excursion: it is possible to maintain the interest of nursing students to take

up a rural career despite the presence of some

negative professional and social factors. It is even

more significant when put in the context that the students were from one of Australia’s most metro-

politan universities (some students stated that

they had not been over the Blue Mountains prior

to this excursion!). It could be argued that the

present job prospects for nurses in Sydney are

extremely poor and this may play a part in the

decisions that have to be made. The absence of

concern about financial issues in a rural career

probably reflects this, although the award struc-

ture for employment as a nurse arguably provides

some compensation for higher living costs

through the provision of subsidized accommo-

dation in rural hospitals.

While the steering committee acknowledges

the concerns that the exposure to rural work and

life was too brief, the results of this project are

nevertheless encouraging. Further funding would

enable the exposure of even more students but

the project will not be funded after August 1994.

Surely the exposure to rural working conditions

and lifestyle that has occurred as a result of the

project, brief though it was, is better than none at

all? Further, the value of the project may be

demonstrated by the fact that some recently grad-

uated students have secured employment in

country hospitals as a result of having done an

elective placement through a Rural Careers Pro-

ject scholarship. The students were able to prove

themselves as valuable members of the health-

care team. Similar success for a rural nursing

elective placement was found by the Australian

Catholic University in NSW in 1990.5

In conclusion, this Rural Health Support,

Education and Training funded project has been

successful in promoting rural careers to nursing

students. In the light of this success it now

behoves the Government to continue to take

active steps to fund similar projects. It is also in

the profession’s best interest to push for State and

Federal initiatives which will continue to encour-

age and support rural careers for registered

nurses.

ACKNOWLEDGEMENT

The authors wish to acknowledge the financial

support provided through the RHSET program.

24

REFERENCES

1 Kamien M, Buttfield I. Some solutions to the

shortage of general practitioners in rural Aus-

tralia. Part 1. Selection of medical students. Med-

ical Journal of Australia 1990; 153: 105-107.

2 Kamien M, Buttfield I. Some solutions to the

shortage of general practitioners in rural Aus-

tralia. Part 2. Undergraduate curricula. Medical

Journal of Australia 1990; 153: 108-110.

AUSTRALIAN JOURNAL OF RURAL HEALTH

3 Hays R, McEwen E. Promoting rural careers.

Taking students to the bush. Australian Family

Physician 1991; 21: 1729.

4 Hays R, Acklin F, Chan P, et al. The University of

Sydney Rural Careers Project. Australian Journal

of Rural Health 1993; 2: 23-25.

5 Johnson P. A rural nursing elective at a metro-

politan tertiary institution. The Lamp 1991; 48:

37-39.