Undergraduate pre-registration nursing education in Australia: a longitudinal examination of enrolment and completion numbers with a focus on students from rural and remote campus locations

Introduction: There is much evidence to indicate a shortage of Registered Nurses (RNs) in Australia and to suggest that the shortage may be more pronounced in rural and remote locations. Attracting RNs to work in rural and remote areas may not be as simple as increasing the intake of students into university undergraduate pre-registration nursing courses. There is some evidence indicating that student nurses may be more likely to enter the nursing workforce in rural and remote locations if they have existing associations with rural and remote areas and/or their undergraduate education provides opportunities to undertake supported placements in rural and remote settings. Two important difficulties have been associated with measuring outcomes in relation to rural and remote pre-registration nursing students. One is defining what constitutes a rural or remote location and the other is suspect data on the number of nursing students enrolled in, and completing, nursing courses. The aims of this study were to provide a longitudinal profile of the number of domestic students studying and completing undergraduate pre-registration nursing courses in Australia, with a particular emphasis on identifying those at rural and remote university campuses, and to compare results across States and Territories.Method: This study presents the combined findings from two investigative reports. Data on undergraduate pre-registration nursing student numbers were collected via electronic survey instruments completed by staff at all Australian educational institutions offering undergraduate pre-registration nursing education programs in 2001 and 2002. Australian domestic students were the focus of this study. Data included the total number of domestic students enrolled in undergraduate pre-registration nursing courses in 2001 and 2002, the number of domestic students who successfully completed courses in 1999, 2000 and 2001, and estimates for the number expected to complete in 2002. Surveys were sent to course coordinators or other staff nominated by heads of divisions of nursing at each institution.Results: There was a 100% response rate. Twenty-four rural and remote campus locations were identified using an adjusted form of the Rural, Remote and Metropolitan Areas (RRMA) classification system. The Australian Capital Territory and the Northern Territory did not have any rural or remote campus locations. In contrast, undergraduate pre-registration nursing in Tasmania was offered at a rural campus only (for the first 2 years). From 2001 to 2002, there was an increase of just over 5% in the total number of domestic students enrolled in undergraduate pre-registration nursing courses in Australia (2002 total = 22 811 students). Rural and remote location students accounted for slightly more than 25% of these students in 2001, and almost 27% in 2002. The States Victoria, New South Wales and Queensland had the highest percentage of students enrolled at rural and remote campus locations, greater than the Australian average for both years. In contrast, South Australia and Western Australia had less than 11% of students enrolled at rural and remote campus locations for each year. Total undergraduate pre-registration course completions increased by approximately 16% across Australia between 1999 (n = 4868) and 2002 (n = 5667), although for 2002, the figure was projected. Of these total course completions, the percentage of students completing at rural and remote campus locations increased from almost 23% to nearly 28% during the same period. Of the States/Territories with both metropolitan and rural/remote campus locations, only Victoria and Queensland had more than 25% of their total student completions consisting of students enrolled at rural and remote campus locations for each year. In contrast, South Australia and Western Australia had approximately 6% of student completions consisting of students enrolled at rural and remote campus locations in 1999, increasing to approximately 12% projected for 2002.Conclusion: In this study, the authors attempted to improve the accuracy of data collection in relation to the number of domestic undergraduate pre-registration nursing students in Australia, which is representative of the potentially new Australian domestic RN workforce. There was a trend towards an increasing number of students being enrolled in undergraduate pre-registration nursing courses, and also toward an increasing number of course completions. From the perspective of the rural and remote RN workforce, the percentage of students enrolled and completing courses at rural and remote campus locations was found to be increasing. However, there may be some areas of concern for education and workforce planners in States and Territories that are providing a smaller percentage of their undergraduate pre-registration nursing courses in rural and remote areas. Several study limitations are discussed and suggestions made for future research.<br /

Shifting (com)positions on the subject of management: a critical feminist postmodern ethnography of critical care nursing

This ethnographic study investigated nurses’ experiences of managing nurses and being managed by nurses within the context of a critical care unit. The four specific aims of the study were to: valorise and make space from which nurses could speak of their management perceptions and experiences; investigate and interrogate the cultural practices and knowledges that comprised and reinscribed the discourses of nursing management; identify the marginal, contradictory or subjugated discourses in the form of alternate or oppositional knowledges and practices embedded in nurses’ experience; and reveal how participants were inscribed by or resisted the various discourses, including the multiple and mobile subject positions they adopted. The ethnography was theoretically informed by critical, feminist, and postmodern perspectives. Utilising the strategy of writing from the authorial position of occupying a mobile or nonunitary subjectivity, the research highlighted the methodological tensions so as to struggle for social justice whilst contesting the romance of knowledge as cure (Lather, 2000). Music was metaphorically appropriated to interrupt, subvert, and draw attention to the partial, interpretive, and intertextual nature of ethnographic representation and to represent the feminine other in a thesis normatively privileging written text. Conducted over a period of ten months, direct participant observation, individual interviews, and reflective field notes comprised the data. Eleven registered nurses, from all levels of the nursing hierarchy, participated in the study, in addition to the researcher. The findings of this research revealed nurses experienced feeling abnormal, lonely, angry, and rejected. Interprofessional relations reflected a lack of individual valuing and predominantly vertical violence. Shifting subject positions were primarily informed by dominant instrumental, patriarchal, managerialist, and modernistic discourses that homogenised the identity of nurses and defined the meaning of progress and normal. Management activities were deemed superior to the activities and being of a clinical nurse. Alternate and subjugated discourses included notions of teamwork, equality, mateship, and viewing management as superfluous and contemptuously. Patriarchal behaviours separating personal life from work life were contested, and behaviours often denigrated and stereotyped as female were valued. Valuing and sharing being human within ordinary nursing work, valuing work for the enjoyment of the work itself, and viewing power as with rather than over were further alternate discourses. The major implications from this study for nursing as a profession relate to nurses explicitly and foremost valuing their own practice and fostering a culture that genuinely permits individual diversity to alter the existing pre-scripted relations that constrain nurses’ ability to engage in more meaningful interpersonal relations. Questioning current discourses and practices that value specific economic and scientific knowledges, support patriarchal behaviours, and silence nurses is essential. The articulation of alternative discourses that value women and nursing is crucial for reconstructing a reality that does not result in women and nurses feeling abnormal, rejected, and alienated; particularly within the context of a nursing shortage

Mobile subjectivities positioning the nonunirary self in critical feminist and postmodern research

Most scholarly work is written from the perspective of the author being a unitary subject occupying a sole, rational, and unified position. This article argues that scholarship may be enhanced by the author adopting multiple subject positions as a methodological framework. Such an adoption is advantageous in working against the romance of the notion of a single truth while also maintaining teleological values congruent with critical and feminist agendas. This article outlines the conceptual development of this methodological framework, the rationale for its development, an explication of the concept of multiple subjectivity, and an exemplar of its application within nursing research.<br /

ACCCN national nursing workforce survey of intensive care units

A descriptive study was designed and implemented by the Australian College of Critical Care Nurses (ACCCN) Workforce Planning Advisory Committee to capture data pertaining to workforce issues of intensive care nurses. All intensive care units (ICUs) within Australia were mailed a self reporting survey. Despite a low response rate (52 per cent) and difficulty reported by respondents in gaining the appropriate data requested, the results revealed an interesting snapshot of the intensive care nursing workforce.Types of services offered by units varied considerably; paid overtime hours were low (&lt;2 per cent of total hours worked) and use of both part-time and agency staff was also low (10 per cent of total hours worked). Private hospitals utilised a greater proportion of part-time and agency nursing staff than public hospitals (20:10 per cent). The turnover rate for registered nursing staff was estimated at 18 per cent, with education, skill acquisition and improved communication reported as the major incentives used by managers to attract and retain staff. This study demonstrated that valuable data are currently uncaptured and recommends a more refined process of a national database to record and manage this important information for future workforce planning.<br /

Nursing education and graduates : profiles for 1999 and 2000, with projections for 2001

An analysis of DEST statistical data on nursing education had suggested that there were issues with the classification of undergraduate data and new initiatives, such as combined degrees, which were poorly captured. This project had two distinct aims. First, to explore and map exhaustively the range of undergraduate programs offered by tertiary education providers across Australia leading to an initial qualification and entry into nursing practice. Second, to explore and map in detail specialist nursing education courses offered by tertiary and other education providers across Australia. This research was funded under the Evaluations and Investigations Programme (EIP). <br /

Nursing educations and graduates : profiles for 2001 and projections for 2002

The present study was commissioned for the National Review of Nursing Education. This is the second of two national studies commissioned to map in detail nursing education programs and to profile and make future projections regarding graduates from undergraduate and postgraduate nursing education courses in Australia.The first study was undertaken in 2001 by Deakin University School of Nursing under the auspices of the 2001 Evaluation Investigations Project titled &quot;Nursing Education and Graduates: Profiles for 1999, and 2000 with projections for 2001&quot;. This project sought data on nursing education within Australia in order to improve the accuracy of nursing education databases and to strengthen the ability of DETYA to provide advice on workforce planning. Issues that arose from that project included differences in data sets for undergraduate nursing courses in Australia and the complex process of attempting to tease out and accurately quantify postgraduate specialty courses when a trend towards postgraduate generic courses was evident. Approximately 26% of postgraduate domestic student enrolment data were reported utilising a generic nursing course category.The purpose of this study was, therefore, twofold. Firstly, this study validated and extended the existing database developed in the previous study mapping in detail the full range of undergraduate programs offered by tertiary education providers across Australia that lead to an initial qualification and entry into nursing practice.New data about the following was sought: * Undergraduate nursing degrees (both three-year and four-year courses); * Double/combined nursing degrees; * Courses offered by private universities; * Four-year bachelor degrees that concurrently provide both initial nurse registration and preparation for specialty nursing practice; * Courses that facilitate &lsquo;fast-tracking&rsquo; of students for initial nurse registration with previous tertiary or nursing studies, * Hours and configuration of clinical experience in undergraduate nursing courses. <br /

Mapping postgraduate nurse education in Australia 2001-2002

Workforce planning at a national level within nursing and midwifery has been largely fragmented and uncoordinated with health-care organisations, state health authorities, peak nursing organisations and the tertiary sector often engaging in independent decision making and planning. In order to gain an increased understanding of the complexity of contemporary nurse education and to quantify the number of graduates of nursing education courses into categories that are meaningful for workforce planning, the federal Department of Education, Science and Training commissioned a national study in 2002. The aim of this study was to map and quantify current and projected numbers of Australian domestic nursing postgraduate students within their respective specialisation according to each State/Territory. All Australian universities offering postgraduate courses in nursing were electronically surveyed (n=30). Two non-university providers of postgraduate nursing education were also asked to participate, but only one responded. Data were gathered on the number of domestic postgraduate nursing students enrolled in 2002, the number of course completions in 2001 and projected completions for 2002. Of the 13 broad band specialty categories developed for the study, the specialties of Midwifery and High Dependency were dominant in both student enrolments and course completions, including projected completions. The range of specialties that were offered varied by State/Territory, as did the number and percentage of students enrolled, completing and projected to complete each specialty program. Generic courses (without listed specialisations) continue to complicate the process of attempting to tease out and quantify accurately the number of enrolled and completing postgraduate students according to area of specialty practice.<br /

Nursing education and graduates in Victoria : profiles for 2000, 2001, and 2002 with projections for 2003

This project is the second of two projects commissioned by the Nurse Policy Branch, Victorian Department of Human Services (VDHS). The project investigated nursing education at the undergraduate and postgraduate levels in the university sector and in the VET sector. The data gathered from the project provided VDHS with a better understanding of nurse labour force issues.<br /