Introduction
The nursing profession globally faces a significant challenge: a looming shortage exacerbated by an aging workforce and increasing healthcare demands. In Australia, the transition from student nurse to registered nurse is often facilitated through Graduate Nurse Programs (GNPs), yet data reveals a concerning disconnect between the number of nursing graduates and available GNP positions. This article delves into the critical issues surrounding graduate nurse employment, drawing insights from a recent Australian study conducted around 2018 and reflecting on the broader context of aged care graduate nurse program opportunities during that period and its continuing relevance. Understanding the enablers and barriers faced by newly qualified nurses is paramount to strengthening the nursing workforce, particularly in crucial sectors like aged care, which require a steady influx of skilled and confident professionals.
The Australian Graduate Nurse Program Context in 2018
Graduate Nurse Programs in Australia are structured initiatives designed to support newly registered nurses during their crucial first year of practice. These programs are vital for bridging the gap between academic learning and the realities of professional nursing. However, an analysis by the Australian Government Department of Health and Aged Care in 2019 highlighted a significant data gap concerning the transition of student nurses to graduate nurses. While registration numbers are tracked, there’s a lack of detailed information on employment outcomes – specifically, how many graduates successfully secure positions and how many may leave the profession due to lack of opportunity. This statistical oversight obscures the true picture of nursing workforce sustainability.
The need for a robust nursing workforce is underscored by demographic shifts and evolving healthcare needs. A 2015 Australian Government report emphasized the necessity for strategic action to ensure a sufficient health workforce for growing population groups, including aged care, mental health, and rural communities. Furthermore, the World Health Organisation (WHO) in its “State of the World’s Nursing 2020” report, raised concerns about the aging nurse workforce and over-reliance on international recruitment, advocating for improved employment opportunities and retention strategies for nurse graduates to ensure long-term workforce sustainability. The “Nursing Workforce Sustainability: Improving Nurse Retention and Productivity” report (Australian Government Department of Health and Aged Care, 2015) specifically pointed to a mismatch between the number of graduating nurses and available graduate positions. This report recommended an “increase in the breadth of graduate nurses employment opportunities”.
The Graduate Nurse Employment Challenge: Data from 2018 and Beyond
Data from 2018 in Western Australia (WA) paints a concerning picture. The Department of Health, Nursing and Midwifery Office in WA estimated that only 35% of graduating registered nurses secured positions through Graduate Nurse Connect, the primary employment agency for graduate programs in the state. This low placement rate reflects a trend observed in previous years, with unemployment rates among graduate nurses hovering around 40% in 2016 and 37% in 2015. These figures highlight a persistent and growing challenge for new nursing graduates seeking to enter the workforce, particularly through structured graduate programs.
A pilot study examining graduating nursing students’ experiences further illuminates this issue. Researchers found a “dearth of literature that addresses factors that assist (specifically) graduating nurses to gain their first positions.” Contributing factors identified in existing literature include increased nursing education enrollments without corresponding increases in graduate positions, decreased public health expenditure, and graduate employment being dictated by staff vacancies rather than long-term workforce planning. The stark reality is that many graduating nurses, even after applying for numerous positions, remain unemployed due to a perceived lack of experience, a scarcity of positions for new graduates, and the prerequisite of completing a graduate nurse program for many entry-level roles. This creates a cyclical problem where graduates are unable to gain experience without a program, yet programs are limited.
Study Insights: Enablers and Barriers to Graduate Nurse Employment
A pilot study aimed to understand the experiences of graduating nursing students as they navigated the employment landscape. The study sought to identify the enablers and barriers impacting their engagement with the nursing profession, with the ultimate goal of informing nursing education and workforce planning strategies. Data was collected through online surveys from two cohorts of graduating nursing students in 2020.
The study revealed that while almost all graduating nurses intended to register as Registered Nurses, a significant proportion did not secure positions in formal Graduate RN programs. Approximately 50% of one graduating group and over 40% of another group did not obtain graduate program positions. Notably, a specific COVID-19 related recruitment drive in WA did not result in graduate program offers for the study participants, highlighting the pre-existing structural issues in graduate nurse employment even amidst increased healthcare demand.
Limited Opportunities and Intense Competition
The study participants’ experiences underscored the central challenge: a lack of graduate positions. Advertised Registered Nurse (RN) positions frequently required one or more years of experience, effectively excluding new graduates without GNP experience. Qualitative feedback from respondents highlighted:
- Limited availability of graduate programs compared to the number of graduates.
- Intense competition for the few graduate positions offered.
- The perception that most RN positions require prior experience, creating a barrier for new entrants.
- Stress and disappointment stemming from the lack of job opportunities despite the known future need for nurses.
- Concerns about universities accepting high numbers of students without corresponding job prospects.
Beyond the scarcity of positions, graduates also reported challenges in crafting competitive applications and navigating the interview process. Some felt unprepared for interviews or experienced anxiety related to the interview format. The overarching theme was one of significant stress and frustration with a system that appeared to have limited pathways for new graduates to enter the nursing profession.
The Critical Role of Graduate Nurse Programs in Aged Care and Beyond
The study findings emphasize the heavy reliance of graduating nurses on securing traditional graduate program positions for career entry. The unemployment rates observed in the study (around 40-47% not in GNP, and only a small percentage gaining RN positions outside of GNP) fall short of the WHO’s recommendation for a 70% “absorption rate of graduates into the labor market” for workforce sustainability. This is particularly concerning in sectors like aged care, which are critically reliant on a consistent supply of newly qualified nurses. The cost and time invested in nursing education become increasingly concerning if graduates are unable to find relevant employment, potentially leading to a loss of talent from the nursing workforce and the broader healthcare system.
Graduate Nurse Programs are not merely about securing a first job; they are crucial for professional development and patient safety. These programs provide structured support for clinical decision-making, facilitate professional socialization, and have been linked to reduced clinical practice incidents. GNPs enhance graduate nurse practice readiness, which directly impacts patient safety and well-being. This is especially pertinent in aged care, where nurses often work with vulnerable populations requiring specialized skills and confident practitioners. Investing in graduate nurse education, particularly in sectors like aged care, aligns with the United Nations Sustainable Development Goal 3, which emphasizes ensuring healthy lives and promoting well-being for all ages, relying on a competent nursing workforce.
Conclusion: Bridging the Gap for a Sustainable Nursing Workforce
The pilot study findings underscore a significant gap between the number of graduating nurses and available employment opportunities in Western Australia, a situation likely mirrored in other regions and relevant to the aged care sector nationally. Continued data collection and long-term tracking of graduate career pathways are essential for informed workforce planning. To address global healthcare workforce predictions and achieve the WHO Sustainable Development Goal 3, a comprehensive understanding of graduate nurse employment and the impact of graduate nurse education programs is vital. This understanding will inform strategic planning and promote a sustainable global nursing workforce, particularly within the aged care sector, which requires a dedicated and well-supported nursing cohort.
Author Note
While the initial data reflects a pre-COVID-19 landscape, it’s important to note that subsequent policy changes and increased healthcare demands due to the pandemic have led to rapid employment of health professionals. However, the long-term impact of these shifts on graduate nurse recruitment and the availability of structured programs, especially in aged care, requires ongoing monitoring and strategic planning to ensure sustainable workforce development.
Authors
Kylie Russell, PhD
Email: [email protected]
ORCID ID: 0000-0001-9737-8533
Professor, School of Nursing & Midwifery, and School of Medicine, The University of Notre Dame Australia.
Tracey Coventry, PhD
Email: [email protected]
ORCID ID: 0000-0003-3228-6448
Senior Lecturer, School of Medicine, The University of Notre Dame Australia.
Sheralee Tamaliunas, PhD Email: [email protected]
Clinical Director Workforce and Innovation, Department of Health Western Australia and Adjunct Associate Professor, The University of Notre Dame Australia.
Dianne Juliff, PhD, MSc(Nsg), BSc(Nsg), RM, RN, GradCertMgmt(Leadership)
Sessional Senior Lecturer, Research Associate and HDR Supervisor, The University of Notre Dame Australia.
References
Ankers, M., Barton, C., & Parry, Y. (2018). A phenomenological exploration of graduate nurse transition to professional practice within a transition to practice program. Collegian, 25(3), 319–25. https://doi.org/10.1016/j.colegn.2017.09.002
Australian Government Department of Health and Aged Care. (2015). Nursing workforce sustainability: Improving nurse retention and productivity. Resources. https://www1.health.gov.au/internet/main/publishing.nsf/Content/nursing-workforce-sustainability-improving-nurse-retention-and-productivity
Australian Government Department of Health and Aged Care. (2019). Educating the nurse of the future – Independent review of nursing education. Office of the Chief of Nursing and Midwife Officer. https://consultations.health.gov.au/office-of-the-chief-nursing-and-midwifery-officer/educating-the-nurse-of-the-future-independent-revi-1/
Australian Nursing and Midwifery Federation [ANMF]. (2014). Submission to the 457 integrity review. https://www.anmf.org.au/media/gbqemmhh/anmf_submission_to_the_457_review.pdf
Cottle’-Quinn, A., Tower, M., & Eley, R. (2021). Factors that influence Australian early career nurse employment outcomes and settings: A prospective cohort study. Journal of Nursing Management, 29(3), 459–467. https://doi.org/10.1111/jonm.13166
Gilmour, J., Huntington, A., Slark, J., & Turner, C. (2017). Newly graduated nurses and employment: A dynamic landscape. Collegian (Royal College of Nursing, Australia), 24(3), 247–253. https://doi.org/10.1016/j.colegn.2016.02.004
Government of Western Australia. (2020). Controlled interstate border. https://www.wa.gov.au/government/announcements/controlled-interstate-border
Fowler, S. B., Lind, S. C., Johnson, P. R., & Lewis, J. (2018). Qualitative description of new graduate nurses’ experiences in a nurse residency program. Journal for Nurses in Professional Development, 34(6), 319–324. https://doi.org/10.1097/NND.0000000000000496 PMID:30379765
Hawkins, N., Jeong, S., & Smith, T. (2019). Coming ready or not! An integrative review examining new graduate nurses’ transition in acute care. International Journal of Nursing Practice, 25(3), e12714. https://doi.org/10.1111/ijn.12714
HealthTimes. (2020, November 30). Generation next: helping graduate nurses and midwives find jobs. News. https://healthtimes.com.au/hub/nursing-careers/6/news/nc1/helping-graduate-nurses-and-midwives-find-jobs/1422
Health Workforce Australia (HWA). (2014). Nurses—Australia’s Future Health Workforce reports. Publications. https://www.health.gov.au/resources/publications/nurses-australias-future-health-workforce-reports?utm_source=health.gov.au&utm_medium=callout-auto-custom&utm_campaign=digital_transformation
Murray, M., Sundin, D., & Cope, V. (2018). New graduate registered nurses’ knowledge of patient safety and practice: A literature review. Journal of Clinical Nursing, 27(1–2), 31–47. https://doi.org/10.1111/jocn.13785
Murray, M., Sundin, D., & Cope, V. (2020). Supporting new graduate registered nurse transition for safety: A literature review update. Collegian, 27(1), 125-134.https://doi.org/10.1016/j.colegn.2019.04.007
Nursing and Midwifery Board of Australia [NMBA]. (2022). Statistics. About. https://www.nursingmidwiferyboard.gov.au/About/Statistics.aspx
O’Leary, C. (2016, January 19). Only 59p of nurse graduates get jobs. The Western Australian. https://thewest.com.au/news/wa/only-59pc-of-nurse-graduates-get-jobs-ng-ya-135469
Punch, K. F., & Oancea, A. (2014). Introduction to research methods in education (2nd ed.). SAGE.
Spector, N., Blegen, M., Silvestre, J., Barnsteiner, J., Lynn, M., Ulrich, B., Fogg, L., & Alexander, M. (2015). Transition to practice study in hospital settings. Journal of Nursing Regulation, 5(4), 24–28. https://doi.org/10.1016/S2155-8256(15)30031-4
SurveyMonkey Inc. (2022). SurveyMonkey. https://www.surveymonkey.com
World Health Organisation (WHO). (2020a, April 7). WHO and partners call for urgent investment in nurses. News. https://www.who.int/news/item/07-04-2020-who-and-partners-call-for-urgent-investment-in-nurses
World Health Organisation (WHO). (2020b). State of the world’s nursing 2020: Investing in education, jobs and leadership. Publications. https://www.who.int/publications/i/item/9789240003279
