Epilogue

The value of a fourth year?

Debra Jackson
Professor and Research Coordinator, School of Nursing and Midwifery, University of Western Sydney, Sydney NSW

Michael Clinton
Faculty of Nursing and Faculty of Medicine, University of Calgary, Calgary AB, Canada; School of Nursing, American University of Beirut, Beirut, Lebanon

PP: 215 - 216

Article Text

Above all, nursing is a practice discipline, and as such, is incredibly complex because it involves the synthesis and application of knowledge drawn from many areas. Nursing graduates are required to have high level skills across various domains of practice, and the challenges associated with adequate preparation of nurses within six short academic semesters calls for high quality, well resourced and effective education systems. The challenges facing those charged with preparing nurses are compounded by a student demographic that has radically altered over recent years - many entering nursing preparatory programs are not school leavers, rather they come to nursing as mature aged students, with a range of life experiences and varying degrees of literacy and numeracy (Walker 2009). Notwithstanding the concerns that are sometimes raised about the quality of graduates and their fitness for practice (Mannix, Wilkes, & Luck 2009), nursing graduates have been readily employed into the health sector.

In Australia, up until (and including) the present time, the immediate post graduate period, or the 'fourth year' has been largely managed by industry with little input from the education sector, and has typically involved intense clinical immersion as beginning registered nurses through participation in a new graduate program. While the structure of new graduate programs varies between organisations, they generally involve a clinical rotation of some sort, the completion of learning packages, and participation in in-service education programs. Forms of support, such as preceptoring or mentoring support are generally used to assist in socialisation and transition to practice of new registered nurses.

Post-graduate employment of nurses has occurred in a context that has seen nursing experience severe and protracted workforce shortages. These shortages have generated an enormous amount of literature on recruitment and retention issues (Watson 2005), reflecting (among other things) the many strategies and models that have been put in place to try to facilitate the smooth transition from student to registered nurse. Indeed, one of the benefits of the nursing shortage has been the fact that there has been close to 100% employment for nursing graduates, at least in the Australian context for several years now, meaning that most graduates simply leave the university and promptly begin paid employment in a new graduate program.

However, nursing shortages are cyclical in nature (Buchan & O'May 1998), and writing in Shaw and Shaw (1993, p.1217) refer to 'the current problem of nurse unemployment'. This may seem difficult to believe given the shortages of recent times, but many of us can likely recall periods in the 1980s and early 1990s in which nurses did experience unemployment. This is not to say there was an over supply of nurses in real terms, but rather, there were financial imperatives affecting employing health care organisations, and so measures such as staff freezes and bed closures were put into place, and these measures affected nurse employment.

In the current economic downturn, we are starting to see health organisations again in the position of having to initiate staff freezes and similar strategies to reduce costs, and so it is questionable that full graduate employment will continue in the immediate short or longer term. It is likely that in (at least) the short-term we could see numbers of graduates unable to secure immediate employment as registered nurses.

Currently, those few graduates who have not been able to access employment in nursing do have some options. They could consider applying for entry into postgraduate courses such as midwifery, or in some universities, if they meet the entry performance (GPA or WAM) requirements, can enrol into Honours programs. However, not all graduates are able to apply for Honours (because only those who are high achievers meet entry requirements), or can secure entry into postgraduate courses such as midwifery, due to restrictions on the number of places. Faced with inability to secure employment in nursing, these graduates could be placed into a very difficult situation, as without on-going exposure to the clinical environment, they could lose their clinical knowledge and skills, and over time, even if positions became available, could become less and less employable as registered nurses.

In a pervasive climate of acute workforce shortage, much of the discourses to date have been about preparing nursing graduates as well, and as quickly as possible. Indeed, as a response to workforce shortages, compressed programs have been developed to fast track suitable candidates. The current environment of workforce shortage and the pressure to produce as many graduates as quickly as possible has meant that the notion of a fourth academic year has, as yet, received little or no attention.

However, should there be a reduction in employment prospects for graduates, the opportunity to consider initiating an optional fourth year for nurses could be considered. While this would present its own challenges, and careful deliberation of the nature of a program that could be offered as an optional fourth year for newly registered and inexperienced nurses would be required, a fourth year could enhance the students' education, and give the time to further develop some of the more advanced skills and qualities helpful for today's nurses. Carefully managed, this fourth year could provide opportunities for students to more meaningfully engage with concepts such as leadership, the role of registered nurse as teacher, both in patient education and clinical teaching, and research and scholarship in nursing. In addition to this a fourth year could provide continued clinical learning opportunities.

Currently, nursing is a four (academic) year program in some parts of the world, and three in many others (including Australia). While history has shown us that graduates from a 3-year program are able to effectively function as registered nurses, the idea of being able to provide an optional fourth year for those who want to pursue it is attractive. The current economic downturn could provide the window that is needed to explore innovative and cutting edge options for a fourth year for nursing.

View references

Navigate: Archives | Contents | Top of page

Search

Translate

Related Publications from eContent Management