Nursing Career Pathways Project
Executive Summary
Capturing Nursing's diversity
The research team from the Centre for Research into Nursing and Health Care of the University of South Australia has prepared this report for the National Review of Nursing Education Secretariat to present research findings regarding nursing career pathways. The research project was deliberately structured to capture industrial, professional, educational and organisational perspectives within the Australian and international contexts of issues relevant to the articulation of career pathways in nursing.
The aim of the research was to produce the first analysis of the understandings, relationships and comparisons, of career pathways for Australian nurses (registered nurses [RNs] and enrolled nurses [ ENS - known as RN Division Two in Victoria]) to inform the deliberations of the National Review.
In completing the project, the research team:
- Identified literature-based data and pertinent stakeholders to provide insight into understandings about current and potential future career pathways in nursing.
- Conducted a critical literature review framed by specific questions related to career pathways and gained an understanding of how career pathways are currently articulated in Australia and internationally.
- Consulted with identified key nursing stakeholders, and other health, educational, regulatory and industrial professionals and identified potential future career pathways.
- Critically evaluated findings and re-assessed new knowledge with current knowledge related to career pathway.
- Provides recommendations on career pathway models that capture the diversity of nursing.
Key Stakeholder participants agreed that nursing career pathways are mosaics from which persons can make decisions about, anticipate, make sense of, adjust, create futures, and identify strategies for action in relation to careers in nursing. Nursing career pathways need to be articulated as processes, agreed upon by nurses to capture nursing's diversity, to nurses and persons interested in nursing as a professional career, educationalists, policy makers and the wider community.
Key stakeholder participants concur that as processes, nursing career pathways need to be developed to depict:
- Nursing practice roles
- Employment opportunities
- Qualification Requirements
- Ongoing learning options
- Registration requirements
- Nursing classifications
- Integration of nursing practice
- Diversity of educational practice placements.
These processes are described in more detail in Chapter 3 of this report.
Any mapping of potential nursing career pathways should acknowledge and promote the diversity of nursing as a career, and the transferability and skills gained through nursing education and experience. This is captured in the following quote from one of the key stakeholder participants who suggested that:
Nursing should be seen as a generic degree for life. You may not stay in the discipline of nursing but you can move into other positions because you are a fantastic communicator, manager, somebody who understands the scene, is sensitive and has a more global perspective to work and is flexible and is energetic and that is what employers want today. (Extract from interview with participant from key stakeholder group)
Nursing career pathways as described in this report provide an opportunity for the promotion and marketing of nursing at the international, national and state level. The research findings support the view that a Bachelor of Nursing (or however titled) provides a generic entry point to employment and educational opportunities in all health care services, yet the way that nursing is marketed by limits the potential of nurses and roles that they can undertake.
Study participants highlighted that while there are visible dimensions on which progress in nursing continues to be made, progress towards a stable nursing work force is not likely under the current circumstances. Participants in this research have suggested that, the ambivalence, contradictions and conflicting underlying messages about nursing and the value of nursing at the national level need to be addressed and ameliorated to enable nursing to be viewed as a positive and valued career. This view is encapsulated from one participant who suggested that:
In any hospital or health area, nurses are seen on the red side of the budget and the doctors on the black. In other words, doctors bring in the patients and the nurses' cost. The reality is that doctors' would not be able to bring patients in if there were not nurses. So that is why it is easy to look at nursing as a high cost that we can cut. Not only has staffing been affected by this very narrow view of number crunching but it is also not linked to quality and it also interferes with career pathways for nurses. (Extract from interview key stakeholder participant)
There is more than one career in nursing and more than one pathway in these nursing careers and as such, there is much to gain from the innovative website development proposed in this project. What is needed is for nursing's diversity to be made accessible to nurses, potential nurses, educationalists, policy makers and the wider community. A program to market and describe nursing that includes encouraging ongoing developments in the educational preparation of nurses is anticipated to be part of the panacea that will see nursing considered as a career with exciting futures and unlimited possibilities.
1. Introduction
There is no end to the practice context and the work that nurses are doing. ... One of the things that I am constantly surprised by, is the lack of knowledge or ignorance of people about that which nurses can actually do. (Extract from interview with key stakeholder participant).
This research project is one of many contributions to inform the deliberations of the National Review of Nursing Education. The research team for this project was:
Dr. Kay Price
Assistant Director & Key Researcher, Centre for Research into Nursing and Health Care, Senior Lecturer School of Nursing and Midwifery, University of South Australia
Ms. Marie Heartfield
Key Researcher, Centre for Research into Nursing and Health Care, Senior Lecturer School of Nursing and Midwifery, University of South Australia
Ms. Terri Gibson
Key Researcher, Centre for Research into Nursing and Health Care, Senior Lecturer School of Nursing and Midwifery, University of South Australia
To facilitate the management of this project, Dr. Elizabeth McDonald provided advisory support.
The National Review of Nursing Education was announced on 30 April, 2001. The review is to examine:
- the effectiveness of current arrangements for the education and training of nurses;
- factors in the labour market that affect the employment of nurses and the choice of nursing as an occupation; and
- the key factors governing the demand for, and supply of nursing education and training.
While nursing, nurse education and nurses have been the subject and object of several reviews, progress towards achieving a stable nursing work force to meet health care needs and consumer demands, appears to have been unsuccessful the worldwide.
The nursing culture that has been created over the last twenty or so years, concomitant with feminist reforms, plays an important role in explaining the current state of events. Shifts in the attraction of nursing to young women into nursing threaten future sources of the next generation of nurses for health care systems. Thus issues of the nexus between nursing education and the demands of the labour market have again become a focus of attention for the federal government. Given the current nursing shortage and career opportunities available to young people, factors that will affect the retention of nurses and the recruitment of potential nurses include:
- working conditions and the opportunities that flow from these conditions,
- the opportunity to gain or use certain skills,
- the range of potential career directions available for nurses.
Work conditions have been the focus of overseas reviews. For example The Health Departments for Great Britain document outlining the NHS Plan (2000) states:
The NHS Plan will make a huge investment in services and extra staff that will directly address staff concerns about workload, standard of care and working conditions. (The Health Departments for Great Britain, 2000; 12).
Recurring views expressed by key stakeholder participants of this project that relate to work conditions for Australian nurses are represented in the following quotes:
I think that here is an opportunity for us to put to the National Review some claims to ask for some political clout and say that the reason we need reviews is not because nursing is not working but because the system is not working and we are tired of propping it up. (Extract from interview with participant from key stakeholder group)
My bent is about looking after people, but we don't value our people in our health work force. Maybe if we valued them a bit more we might not have the problems that we've got, both in medicine and nursing. (extract from interview with participant from key stakeholder group).
The timing and focus of this research project, to address the concept of nursing careers pathways, has the potential to make a positive contribution to attracting and retaining the services of one of society's key assets in the promotion of health and provision of health care - a nurse.
2. Research design
2.1 Overview
The project was a descriptive and exploratory multi-method study addressing the following research questions:
To what extent do career pathways for Australian nurses:
- Articulate flexible career pathways, within and out of nursing:
- Address current and projected nursing workforce needs:
- Integrate nursing with other parts of the health work force:
- Demonstrate coherence / links between educational and industrial awards:
- Organize, link and show the need for, and importance of specific and ongoing education and training:
- Describe nursing as an attractive, diverse and skilled career and relevant career choice?
The project comprised five stages. Stages one to four, used multiple- methods to help to collectively build an account of career pathways and offer recommendations for future career modeling in Australian nursing. This was done to impact positively and directly on the content and style of career pathways in Australian nursing. These methods also enabled a detailed description of the issues that impact on career pathways.
2.2 The research plan
Figure 1 figuratively displays the project.
Figure 1 A diagram to portray the research plan
2.3 Stage 1 - Identify and negotiate access to data sources.
Ethical approval to conduct the research was obtained from the University of South Australia, Human Research Ethics Committee. To facilitate timely completion of this study, the research team utilised purposeful sampling techniques. Within the broad framework of purposeful sampling, the research team used a combination of strategies for purposeful selection of participants including, judgement, opportunistic and snowball sampling (Burgess 1982, Patton 1990).
Data sources included:
- Published national and international literature inclusive of journal articles and textbooks, formal and informal documents of professional, policy and regulatory organisations, legislation, industrial awards and agreements, and data received from nurses and obtained from the Internet (details included as Appendix A).
- Two rounds of interviews (audiotaped and transcribed) with seventeen stakeholders who were representatives of health and education industries (public and private) from metropolitan, rural and regional venues in Australia, regulatory, professional, industrial and health-focused organisations (details included as Appendix B).
- Invited submissions from eighty other nursing organisations in relation to relevant documentation relating to the research questions (details included as Appendix C).
- Invited submissions from nursing personnel representing international (eg. International Council of Nurses) and overseas nursing organisations (eg. Royal College of Nurses, United Kingdom) (details included as Appendix C).
- Invited submission from members, Royal College of Nursing, Australia members via electronic newsletter.
- Survey of sixty-three employment areas for nurses in health related businesses including health insurance companies, Red Cross, National Heart Foundation, Medical Radiations and Pathology services (details included as Appendix D).
Participants interviewed were approached by written communication in the first instance, explaining the purpose of the research, their involvement and with a request to return a signed consent form if they agreed to participate. Follow-up contact with participants was by telephone (details included as Appendix B).
2.4 Stage 2 - Understanding "What is"
A national and international critical review of literature and key documents was conducted to inform the understandings of career pathways in Australian nursing.
The searches were inclusive of:
- Searches of internet sites (eg. government websites including DETYA, educational, industrial and professional organisations),
- Key databases relevant to health and education (eg. Eric, Sociofile, Psychlit, Cinahl, Medline, Svetsnet navigator, Ingenta, AMED, Synergy, Ebscohost and Austhealth, and government databases like Osiris, Austlii, Scaleplus),
- Industrial awards related to health professionals,
- Organizational structures of health industries (public and private) from metropolitan, rural and regional venues in Australia,
- Articulation models for nursing programs and lists of programs, level of qualifications and articulation models between programs from educational providers.
Search terms for database searches included: career, career pathways, career structures, career systems, career development, career planning, career modelling, career mobility, nursing qualifications and career pathways, nursing careers, image of nursing linked to careers in nursing, conversion programs, and traineeships in nursing/health.
The following sub-questions formed the framework for the review of data collected:
How are nursing and health career pathways articulated in national and international literature and documents?
How are career pathways in nursing currently structured in Australian states and territories and how do they compare to each other?
What do career pathways offer / provide / promote / facilitate for:
- Prospective nurses?
- Current nurses?
- Emergent nursing roles e.g. Nurse Practitioners?
- Education providers - public and private (Secondary, Vocational and Tertiary)?
- 'other' Health professionals?
- Industrial, Professional and Regulatory authorities in the health industry?
- Employers (public and private)?
How do current career pathways in nursing link with health labour-force requirements?
To what extent is there a nexus between career pathways and education (Secondary Vocational and Tertiary)?
What relationship does a career pathway for nurses have with other parts of the health work force?
Whose core business is it to review, monitor and provide information regarding career pathways in Australian nursing?
How do career pathways in Australian nursing relate to international nursing issues and concerns?
Descriptive analysis of data collected involved reading the corpus of material in order to describe the different perspectives and/or ways of thinking in relation to the above stated questions. The research team carefully read all responses collated to elicit patterns of meaning, contradictions and inconsistencies. Contrasting ways of thinking and exceptions to patterned routines, that included contradictory descriptions, were examined. Thematic analysis of data contributed to an initial picture of career pathways which formed the basis of a discussion paper to inform the first round of stakeholder consultations. (See Appendix E)
2.5 Stage 3 - Stakeholder consultation:
Seventeen representatives of key stakeholder groups were interviewed to forecast potential career pathways in Australian nursing. Prior to the arranged telephone interviews (two rounds), a briefing paper was prepared each time and forwarded to participants who had previously consented to participate. Discussion focussed on possible models for career pathways that meet the current and projected health industry needs as well as needs of individuals choosing a career in nursing. The interviews, with the consent of the participant, were audio taped, and transcribed. The transcriptions and notes were carefully analysed to elicit patterns of meaning, contradictions and inconsistencies. Contrasting ways of thinking and exceptions to patterned routines, that include contradictory descriptions, were examined. (See Appendix F)
2.6 Stage 4 - Critically evaluate and re-assess:
The research team integrated the findings from stages two and three with a critical reflective questioning arising from:
- Raising some questions and not others,
- Involving some people in the process and not others,
- Observing some phenomena and not others,
- Making sense of the situation and not alternative senses.
By critically reflecting on their own practices as described above, the research team were in a more informed position to identify how taken for granted assumptions and ways in which their assumptions had been challenged, and how outcomes were developed, were influenced accordingly. Where privilege is given to a specific way of thinking about career pathways, then a critical analysis of this way of thinking will explore the implications such a way of thinking may have on:
- Nursing education,
- Recruitment and retention of nurses and
- Forecasting future career pathway models.
To facilitate achieving a consensus view amongst key stakeholder participants, preliminary findings from the research were presented as recommendations for review and comment. Key stakeholders involved in Stage 3 were forwarded these recommendations by email and requested to forward changes and/or support. The research team analysed responses and notes to identify contradictions, inconsistencies and new knowledge, which subsequently informed the discussion in the final report.
2.7 Stage 5 - Produce Outputs
Outputs of this project include:
- Completion of a progress and final report to the National Review of Nursing Education Secretariat, detailing all aspects of the project and its findings.
- In addition, the research team is seeking permission to progress that work commenced as a consequence of this research, and with a national nursing representative group progress the development of a Nursing website.
- Presentation by members of the Research Team to the Research Forum of the Review Secretariat.
- It is anticipated that journal articles for refereed journals and media advice as agreed to by the Department of Education, Training and Youth Affairs will be produced.
2.8 Limitations
The need to complete the project within a short time frame meant that decisions had to be made regarding what could realistically be achieved in order to provide useful information to assist the deliberations of the National Review. Thus the research did not undertake a detailed state-by-state analysis of industrial awards or nursing career classifications. This decision was based on the recurring view by key stakeholder participants that states and territories need to maintain their individuality as evidenced by industrial awards and classifications, while at the same time participate in the production of a national framework for nursing career pathways. Nor was there opportunity to conduct wider consultations with large numbers of individual nurses. Rather, the focus was upon gaining a broad overview of how career pathways could be described so as to capture the diversity of nursing, with the aim of continuing the work commenced in this project to comprehensively articulate career pathways for Australian nursing.
Nursing represents the activity of nurses (registered nurse and enrolled nurse) and like every human activity is a political act. What this means is that the activity of nurses provides focus for the attention of others with activities able to be mapped for different purposes including the deliberations of the National Review of Nursing Education, as indeed this research. How any perceived problem or concern (for example the nexus between nursing education and demands of the labour market) has been described will in turn construct the parameters in which a discussion can take place. Of particular significance is how 'the self-policing' or self-surveillance of many professional groups within their own boundaries is now commonly called into question by governments worldwide. Evidence of this for the medical profession can be seen in The Bristol Royal Infirmary Inquiry, and in Australia, by the National Incidence Monitoring activities. This research was designed with the understanding that there are many different ways to consider what are a career and a career pathway. Indeed there was no single agreed definition or framework for career pathway from which the research could progress. This lack of definition was not considered by the project participants to be problematic as it opened up possibilities for nursing as a profession to elaborate its diversity given the recognition that nursing exists in a context in which marketing of the profession is understated even marginalised.
Participants in this research project interpreted the National Review of Nursing Education as an opportunity for nurses to make visible the flexibility, scope, diversity and necessity of nursing to meet the needs of the changing labour market. Dissemination of this research report and implementation of its recommendations are viewed as a strategy to meet this aim.
Any comments or queries should be sent to: highered@dest.gov.au
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