Keywords: Aged Care Graduate Nurse Program 2015, graduate nurse employment, readiness to practice, graduate nurse program, nursing education, global nursing workforce
In Australia, Graduate Nurse Programs (GNPs) serve as crucial formalized transition initiatives provided by healthcare employers. These programs are specifically designed for Graduate Registered Nurses (GRNs) as they embark on their first year of practice following the successful completion of their nursing degree. A critical analysis of nursing education in Australia has previously underscored a notable gap in comprehensive data concerning the transition from nursing student to practicing graduate (Australian Government Department of Health and Aged Care, 2019). While organizations such as the Nursing and Midwifery Board of Australia (NMBA), along with their international counterparts, meticulously track registration numbers, these figures often fall short of providing a nuanced understanding. They do not differentiate between those graduates who successfully secure employment in their field and those who, for various reasons, may choose to leave the nursing profession (NMBA, 2022). This lack of detailed insight presents a challenge in effectively planning and supporting the nursing workforce, particularly in sectors with growing demand like aged care.
Ensuring the long-term viability of the nursing profession necessitates a clear understanding of the prevailing challenges and proactive strategies to bolster the health workforce, especially to cater to the needs of expanding population demographics. Areas such as mental health, aged care, and remote or rural healthcare settings are particularly vulnerable and require robust workforce planning (Australian Government Department of Health and Aged Care, 2015). Adding to these concerns, the World Health Organisation (WHO) in their “State of the World’s Nursing 2020: Investing in Education, Jobs and Leadership” report, emphasized the escalating risks associated with an aging nursing workforce and the potential pitfalls of over-reliance on international recruitment to fill workforce gaps (WHO, 2020a). This report further highlights the critical need to support newly graduated nurses through enhanced employment opportunities and effective retention strategies to ensure a sustainable global nursing workforce (WHO, 2020b). This is especially pertinent in sectors like aged care, where the demand for qualified nurses is continuously increasing due to demographic shifts and the growing complexity of care needs.
The 2015 Australian Government Department of Health and Aged Care report, “The Nursing Workforce Sustainability: Improving Nurse Retention and Productivity” (Australian Government Department of Health and Aged Care, 2015), specifically identified a significant disconnect in Australia. This report pointed out the imbalance between the number of graduating nurses ready to enter the workforce and the actual availability of suitable employment opportunities for these graduates. To address this, the report recommended a strategic “increase in the breadth of graduate nurses employment opportunities” (Australian Government Department of Health and Aged Care, 2015, p. 17). However, data from the Department of Health, Nursing and Midwifery Office in Western Australia (WA) from 2018 indicated a concerning trend. It was estimated that only 35% of graduating registered nurses in WA successfully obtained positions through Graduate Nurse Connect, the state’s primary agency for graduate program placements (C. Barrett, personal communication, May 17, 2019). This concerning trend of graduate nurse unemployment has been on the rise, with reports indicating that 40% of graduates in 2016 and 37% in 2015 did not secure a graduate program position (O’Leary, 2016). These statistics paint a picture of increasing challenges for new nursing graduates seeking to enter the workforce, particularly within structured graduate programs that are often seen as essential for a successful transition to independent practice. This situation is especially critical when considering the growing needs within specialized areas of nursing, such as aged care, which require a steady influx of newly qualified and competently trained nurses.
Image alt text: Diverse group of smiling graduate nurses in uniform, representing collaboration and new professionals entering nursing, relevant to aged care and healthcare workforce.
It is becoming increasingly evident that a significant number of graduating nurses are facing difficulties in securing employment. Many graduates report applying for numerous positions without success, highlighting a systemic issue within the nursing job market. Recent studies, including research by Cottle-Quinn et al. (2021), corroborate the scarcity of research specifically addressing the factors that enable graduating nurses to successfully obtain their initial positions. Gilmour et al. (2017) suggest a confluence of factors contributing to this challenging landscape, including: (i) increased enrollments in nursing education to potentially address future nursing shortages, (ii) reductions in state spending on crucial health services, and (iii) a graduate employment market that is often more influenced by immediate staff vacancies rather than a proactive approach to ensuring the long-term sustainability of the nursing workforce (p. 251). The reality faced by graduating nurses is often stark: inability to find employment despite numerous applications, often attributed to a perceived lack of practical nursing experience, a genuine scarcity of positions available for new graduates, and the common prerequisite of completing a graduate nursing program to even be considered for many Registered Nurse (RN) roles (Australian Nursing and Midwifery Federation [ANMF], 2014). The latter point is particularly concerning as the actual number of employment opportunities accessible to new graduates continues to diminish. Furthermore, the prospects of securing a supported post-entry degree graduate program, which is often vital for new nurses to gain confidence and competence, appear increasingly limited. This situation has significant implications for areas like aged care, where a well-supported and growing graduate nurse workforce is crucial to meet the complex healthcare needs of an aging population. The challenges faced by new graduates in securing employment, especially in graduate programs, can impact the quality of care in sectors heavily reliant on nursing professionals, such as aged care facilities.
Study Methods: Investigating the Graduate Nurse Experience
Study Aim: In light of predicted global nursing workforce shortages (HWA, 2014; WHO, 2020b), this pilot study was designed to explore the experiences of graduating nursing students as they engaged with their chosen profession while seeking employment. The primary goal was to identify the enablers and barriers these graduating Registered Nurses encountered in their engagement with nursing. By understanding these factors, the study aimed to shed light on graduate pathways, which could, in turn, inform improvements in nursing education and workforce planning strategies. It was anticipated that the findings from this pilot study would provide valuable insights to support a more extensive state or national-level investigation, particularly relevant in understanding workforce needs within sectors like aged care.
Sample and Data Collection: A convenience sampling technique was utilized to gather data. To ensure a robust sample size, two distinct cohorts of graduating nursing students were invited to participate. The research team introduced the study to these student groups—those graduating at the end of Semester 1 and Semester 2 in 2020—at the beginning of their respective semesters. This initial presentation outlined the study’s objectives and methodology. Following the completion of semester-end examinations, email invitations containing links to the online survey were distributed to the students. Prior to commencing data collection, the study received formal ethics approval from The University of Notre Dame Australia Human Research Ethics Committee, ensuring adherence to ethical research standards.
The data collection instrument was an online survey, developed using Survey Monkey (SurveyMonkey Inc., 2022), comprising 27 questions. The survey incorporated both closed and open-ended questions designed to explore various aspects of participant engagement with the nursing profession. To establish face validity, the survey was rigorously reviewed and refined through input from multiple members of the research team, as well as a group of recently graduated nurses (n = 5). This collaborative approach aimed to ensure that the survey questions were clear, relevant, and effectively captured the intended information regarding the experiences of graduating nurses.
Data analysis was performed directly within the Survey Monkey platform, which facilitated the management and analysis of both quantitative and qualitative data from the survey responses. The platform automatically generated descriptive statistics for quantitative data, providing summaries of response patterns. For open-ended questions, qualitative analysis techniques were employed to identify recurring themes and insights. Cross-tabulation was also utilized for specific data points of interest to further explore relationships and patterns within the dataset (Punch & Oancea, 2014). This multi-faceted analytical approach allowed for a comprehensive understanding of the experiences and perspectives of the graduating nurses in relation to their employment seeking and professional engagement.
Study Findings: Employment Outcomes for New Graduate Nurses
The study participants were specifically instructed to complete the survey only if they were in their final semester of the Bachelor of Nursing program, ensuring that the data collected reflected the experiences of nurses transitioning into the workforce. A total of 194 fully completed surveys were returned and included in the data analysis. Among the participants, a notable subgroup of 40 graduates had previously completed a Diploma of Nursing—a two-year qualification that leads to registration as an Enrolled Nurse (EN), a role that operates under the supervision of a Registered Nurse. These participants had returned to university to further their education and become Registered Nurses. Interestingly, the majority of these participants reported limited engagement with the profession during their time as Enrolled Nurses, suggesting a significant shift in professional engagement upon graduating as RNs. Notably, all study participants, including those with prior Diploma of Nursing qualifications, indicated a 100% intention to register with the Nursing and Midwifery Board as a Registered Nurse (RN), demonstrating a strong commitment to entering the profession at the RN level.
For the first group of participants (G1), who were graduating in Semester 1 of 2020, an adjustment was made to the survey to account for a specific nurse recruitment strategy implemented by Western Australian Health in response to the emerging COVID-19 pandemic. An additional statement, “prior to the outbreak of Coronavirus/COVID-19,” was included in relevant questions. This modification was crucial to ensure that employment statistics accurately reflected the pre-pandemic employment landscape and to assess the impact, if any, of the COVID-19 related recruitment efforts on graduate employment rates. As detailed in Table 1, a significant proportion of G1 participants (47.5%, nearly half) did not secure employment in a formalized graduate transition program for registered nurses. Group 2 (G2), graduating in Semester 2 of 2020, showed a slightly better outcome, with just over 41% not obtaining employment in a graduate transition program. It is particularly noteworthy that none of the participants in G1 reported gaining an employment contract as a direct result of the WA Health COVID-19 recruitment drive. The specific question regarding COVID-19 recruitment was subsequently removed for the G2 survey, as there was no active recruitment campaign in response to COVID-19 during that period. This absence of a recruitment drive was a direct consequence of the Western Australian Government’s strict border control policies, which effectively prevented community transmission of COVID-19 (Government of Western Australia, 2020).
Table 1. Have you been offered a Graduate RN position in a graduate program?
| Yes | No | |
|---|---|---|
| Group 1 (G1) graduating nurses | 42 (52.5%) | 38 (47.5%) |
| Group 2 (G2) graduating nurses | 67 (57.8%) | 47 (41.2%) |
Participants who had received offers for a GRN position were further asked if they accepted the offered position. This question aimed to determine the acceptance rate of graduate programs and to understand the reasons why a graduate might decline a position offer. Among the respondents, only three participants declined a graduate nurse position. Of these, two had received multiple offers and chose to accept one while declining others, indicating a degree of choice in their employment decisions. The third respondent declined a nursing graduate position in favor of accepting a place in a Medical Degree program, suggesting a career path change rather than dissatisfaction with nursing opportunities.
Of the 84 participants out of the total 194 who did not secure employment in a GRN program, only a small fraction, nine participants, managed to obtain an independent level one RN position. Level one RN positions are defined here as offers of employment as a Registered Nurse but without the structured support of a formalized graduate transition program. To gain deeper insights into the circumstances of those who secured positions outside of GRN programs, the study explored whether this was their preferred employment pathway. Interestingly, only one participant indicated that securing a level one RN position was their preference. For the remaining participants who obtained level one RN roles, it was explicitly stated that this was a contingency, accepted only because they were unsuccessful in obtaining a graduate RN role. For those participants who did not secure any RN position, the survey inquired if they had obtained employment outside of nursing where their Bachelor of Nursing degree might still be beneficial. Five participants reported that they had secured positions in residential aged care facilities as support workers. It is important to note that in the Australian healthcare context, a support worker role in residential aged care is classified as a non-registered healthcare worker position, typically requiring approximately 6 months of vocational training. This finding underscores the challenges faced by graduating nurses in securing RN positions and suggests that some graduates are compelled to take on roles that do not fully utilize their qualifications, even within related sectors like aged care.
Image alt text: Compassionate nurse assisting senior patient in wheelchair, illustrating aged care nursing and supportive patient care, relevant to graduate nurse programs in aged care.
A recurring theme throughout the survey responses was the significant challenge of limited graduate positions. Advertised RN positions frequently stipulated a requirement of one year or more of prior experience. This experience prerequisite effectively made the already scarce graduate program openings even more competitive, creating a highly challenging job market for newly qualified nurses. Exemplary comments from survey respondents vividly illustrate these challenges:
- “Other than graduate programs, there are very few opportunities available for graduate RNs in WA; most advertised positions require 2-5 years of experience.”
- “Lack of available positions for RN graduates – we are competing against a large number of other graduates for the few graduate positions offered.”
- “The intense competition for each position and the difficulty in knowing which hospital environment would be the best fit for my career goals.”
- “The high level of competition and the pressure to ensure my application was of a high standard to even be considered.”
- “It is extremely stressful knowing that there are simply not enough graduate positions to accommodate the number of students graduating each year.”
- “I am disappointed that the university over-enrolls students, fully aware of the lack of job opportunities available to us as graduates.”
- “The system is failing us; there is a projected need for more nurses in the future, yet there is a refusal to allocate more funding to expand graduate programs.”
Beyond the overarching issue of limited graduate positions, respondents also highlighted significant difficulties in crafting effective selection criteria responses to ensure a high-quality application. Many also reported experiencing challenges and setbacks during the interview process. On a personal level, some graduates expressed feelings of frustration and inadequacy, noting that they did not perform well in interview settings, often describing the interview process as anxiety-provoking. Other respondents commented on a perceived lack of adequate preparation for interviews during their nursing education and the challenge of insufficient time to properly prepare for each interview. The theme of stress was consistently prominent throughout the qualitative feedback, underscoring the considerable pressure and anxiety experienced by graduating nurses in their job search. One respondent provided a particularly reflective summary that encapsulated the common challenges faced by graduating nurses, resonating with numerous participant responses:
“When I received feedback from my first hospital choice, they indicated that my selection criteria were very strong, and had I applied to a larger hospital with more positions, they believed I would have had no difficulty securing a graduate program. Since not receiving a graduate program offer, I have applied for MANY level 1 RN positions. However, I have remained unsuccessful, despite my prior experience as a support worker. It is incredibly difficult to obtain a level 1 RN position because nearly all of the job postings I have encountered specify a minimum requirement of 3 years of nursing experience. I continue to apply for these positions, but I am not very optimistic because I do not meet the stated criteria due to having zero RN experience. Furthermore, many of the applications required the completion of selection criteria responses, and I am limited to drawing upon my experience as a support worker rather than RN-specific experience, which is not as compelling as applicants who possess prior RN experience.”
The personal impact of these challenges was evident, with respondents expressing frustration with their interview performance and feelings of being unprepared for the demands of the job application process. These findings highlight the multifaceted barriers faced by new nursing graduates as they attempt to transition from education to employment, particularly within the competitive landscape of graduate nurse programs, and the implications this has for workforce sustainability, including in specialized areas like aged care.
Discussion: Bridging the Gap Between Graduation and Employment
The findings of this study clearly indicate a significant disparity: approximately half of the surveyed graduating nurses successfully gained employment, while the other half did not. Despite an initial call for nurses at the onset of the COVID-19 pandemic, the successful containment of the virus within Western Australia meant that no additional employment contracts were ultimately offered through specific COVID-related recruitment initiatives. Outside of the graduate programs offered within Western Australia, a small number of graduates (three) were successful in securing positions overseas with the English National Health Service. Notably, no participants reported gaining positions within Australia but outside of Western Australia. Within WA, a small proportion (nine participants) managed to secure positions as level one Registered Nurses, which are positions without the structured support of a formal graduate program. An additional five participants accepted employment in non-registered care roles, working as careers or support staff, often in sectors like aged care. These findings strongly support the conclusions of the 2015 Australian Government Department of Health and Aged Care report (2015), which highlighted the critical lack of alignment between the number of graduating nurses and the availability of suitable employment opportunities. Furthermore, the study’s results reinforce the report’s key recommendation for an “increase in the breadth of graduate nurse’s employment opportunities” (Australian Government Department of Health and Aged Care, 2015, p. 17) to address this growing imbalance.
The study findings underscore the significant reliance of graduating students on securing traditional graduate program positions as their primary pathway into Registered Nurse employment. Moreover, the unemployment rates observed in this pilot study—47.5% and 41% for the two graduate groups, respectively, with only an additional 3% and 5% securing RN positions outside of GRN programs—reflect a concerningly persistent trend of low graduate nurse employment. These rates fall considerably short of the 70% “absorption rate of graduates into the labor market” recommended by the WHO (2020b, p.65) as necessary for nursing workforce sustainability, particularly in the face of a looming global nursing shortage. Of particular concern for the future sustainability of the nursing workforce is the substantial number of graduating nurses in this pilot study who did not secure employment either as a GRN within a graduate program or as a Registered Nurse in a level one position. The implications are significant: with some graduates pursuing further studies in different fields and others seeking employment opportunities entirely outside of healthcare, there is a risk of losing these qualified professionals from the nursing workforce and the broader health industry. This attrition is especially concerning given the considerable investment of time and resources required to educate and qualify Registered Nurses. For sectors like aged care, which are already facing workforce pressures, this loss of newly qualified nurses can exacerbate existing challenges in providing adequate care.
The study participants placed significant emphasis on the importance of gaining entry into a graduate nurse education program to enhance their long-term career prospects. This emphasis is largely driven by the well-documented bottleneck of Australian graduating nurses competing for a limited number of Graduate Nurse Program (GNP) positions. Graduates are acutely aware that without securing a place in a GNP, their subsequent employment opportunities as RNs are significantly restricted (HealthTimes, 2020). This situation is particularly concerning given the established body of literature that underscores how professional practice experience is crucial for enhancing graduates’ confidence and overall competency in nursing practice (Hawkins et al., 2019; Spector et al., 2015).
Further, structured GNPs play a vital role in providing a supportive environment where clinical decision-making and the development of sound nurse judgments are nurtured. These programs facilitate essential professional socialization within the healthcare field (Ankers et al., 2018; Fowler et al., 2018) and have been shown to reduce the incidence of clinical practice errors (Spector et al., 2015). This comprehensive support offered by GNPs directly contributes to enhancing graduate nurse practice readiness, which is intrinsically linked to improved patient safety and overall wellbeing, particularly when coupled with appropriate resources and mentorship (Murray et al., 2018; 2020). Investing in career pathway progression for nurses and strategically investing in nursing education to develop a robust nursing workforce aligns directly with the United Nations Sustainable Development Goals (SDG), specifically SDG 3 ‘Ensure healthy lives and promote well-being for all at all ages’. Achieving this goal is fundamentally reliant on having a competent and adequately supported nursing workforce (WHO, 2020b), including in specialized and high-demand areas such as aged care nursing.
Conclusion: Addressing the Graduate Nurse Employment Gap
The findings from this pilot study have clearly illuminated a significant and concerning gap between the number of nursing students graduating in Western Australia and the actual employment opportunities available to them, particularly within structured graduate nurse programs. This disparity highlights a critical challenge for both nursing graduates seeking to launch their careers and for the broader healthcare system aiming to ensure a sustainable and competent nursing workforce, including in sectors like aged care.
To gain a more comprehensive understanding of this issue, further data collection is essential. Future research should focus on tracking subsequent graduating cohorts and their long-term engagement with the nursing profession. Such longitudinal studies will be instrumental in providing deeper insights into typical career pathways for nursing graduates and in informing more effective workforce planning strategies. To effectively address global healthcare workforce predictions and to support the achievement of the WHO (2020b) Sustainable Development Goal 3, it is imperative to develop an international understanding of nursing graduates—their employment trajectories, their places of work, and the tangible impact of graduate nurse education programs on their career progression and retention. This global perspective will be invaluable in supporting strategic planning and in fostering long-term nursing workforce sustainability worldwide, ensuring that sectors like aged care have a consistent supply of well-prepared and dedicated nursing professionals.
Author Note
Significant changes to Western Australian Government policy regarding border control in early 2022 led to an increase in COVID-19 cases within the state and a corresponding surge in hospital demand. The immediate impact of this short-term demand resulted in a rapid recruitment drive for all health professionals in late 2021, subsequent to the data collection period for this study. This shift in recruitment strategy, occurring amidst the ongoing COVID-19 pandemic, necessitates close monitoring to fully understand the long-term effects on nurse recruitment trends and graduate employment outcomes.
Authors
Kylie Russell, PhD
Email: [email protected]
ORCID ID: 0000-0001-9737-8533
Bachelor of Nursing, Graduate Certificate Human Resource Management, Master in Health Science (Education), PhD.
Kylie is a Professor in the School of Nursing & Midwifery, and School of Medicine at The University of Notre Dame Australia.
Tracey Coventry, PhD
Email: [email protected]
ORCID ID: 0000-0003-3228-6448
Bachelor of Science (Nursing), Master of Nurse Education, PhD.
Tracey is a Senior Lecturer in the School of Medicine at the University of Notre Dame Australia.
Sheralee Tamaliunas, PhD
Email: [email protected]
Sheralee Tamaliunas: Bachelor of Science (Nursing), Diploma Project Management, Graduate Diploma Clinical Nursing (ICU), Master of Clinical Nursing, PhD.
Sheralee is the Clinical Director Workforce and Innovation at the Department of Health Western Australia and an Adjunct Associate Professor at the University of Notre Dame Australia.
Dianne Juliff, PhD, MSc(Nsg), BSc(Nsg), RM, RN, GradCertMgmt(Leadership)
Di is a sessional Senior Lecturer, Research Associate and HDR Supervisor for the University of Notre Dame Australia.
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Table 1. Have you been offered a Graduate RN position in a graduate program?
| Yes | No | |
|---|---|---|
| Group 1 (G1) graduating nurses | 42 (52.5%) | 38 (47.5%) |
| Group 2 (G2) graduating nurses | 67 (57.8%) | 47 (41.2%) |
