Nursing Career Pathways Project
3.4 Career Pathways for Australian nurses
Drawing on the descriptions in the literature, and data generated from key stakeholders, the understandings underpinning the development of career pathways that have been supported by key stakeholder participants for Australian nurses, are described in the following statements.
Nursing career pathways are mosaics from which persons can make decisions about, anticipate, make sense of, adjust, create futures, and identify strategies for action.
Nursing career pathways need to be structured in such a way that they articulate nursing's diversity to nurses, persons interested in nursing as a professional career, educationalists, policy makers and the wider community.
Nursing career pathways need to depict:
- Nursing practice roles (both clinical and non-clinical)
- Employment opportunities
- Qualification Requirements
- Ongoing learning options
- Registration requirements
- Nursing classifications
- Integration of nursing practice
- Diversity of educational practice placements.
Nursing career pathways incorporate choice, recognise skill development, and provide a framework to set out the goals and strategies to achieve them.
Nursing career pathways need to be flexible to accommodate individual life experiences, access to information, personal decision-making and emergent changes to health care systems.
Nursing career pathways need to be responsive to health care needs and contribute to health outcomes for all Australians, and incorporate and respond to Australia's cultural diversity.
3.4.1 Nursing Practice Roles
Nursing career pathways need to elaborate the breadth and depth of nursing as a professional career, and show how the scope of nursing practice involves different roles with the potential to accommodate the education, training and employment needs of different nursing groups. As stated by a participant:
That's one of the beauties of nursing is you can be a clinician and you will always get a job. But, hey, if you want to do something else, you have got the grounding in nursing to do almost any other job in the country. (extract from interview with participant from key stakeholder group)
For each nursing practice role, what is needed to be elaborated includes; a role description; pre-requisites for the role; locations for practice of the role; and, a rationale for why a person may work in this role that includes future opportunities.
Figure 2 Variety of registered nurse roles
Pre-requisites for the different nursing roles will vary as much as the rationale for why a person may work in this role. Locations for practice relate to the many different environments in which nurses may work.
Figure 3 Locations for practice
Naming nursing locations for practice as clinical or non-clinical, will produce a variety of different understandings amongst nurses and educationalists. The way in which the phrase 'Clinical practice roles for nurses' is being used in this report, represent the locations for practice in which the variety of nursing specialties would exist. Specialties like the suggested broad bands of nursing specialties and related sub-specialties that have been previously identified by Russell, Gething and Convery (1997) in the National Review of Specialist Nurse Education. It is also acknowledged that sub speciality roles as identified by Russell, Gething and Convery continue to be developed. For example, Military nursing and the newly created General Medical Practice Nursing role, or Practice Nursing as some may identify this role, names the role for nurses who work with General Practitioners in their medical practice. Therefore, clinical refers to roles directly impacting on client / consumer care including research, management and education roles.
Non-clinical, is a term in the Vocational Educational Training sector that has been used in the Community Services National Training Packages to classify a qualification for example - Mental Health (non-clinical). Non-clinical in that context refers to units of competency that focus on understanding mental health needs of people and is an educational program for those persons who do not practise (or not being registered to practice) as a mental health practitioner (eg. a police officer). Key stakeholder participants sought a term to describe locations for practice like for example, a person registered as a nurse who works in the pharmaceutical industry. In this report, non-clinical nursing roles seek to represent the environment in which nursing roles require (or benefit from) an understanding of nursing without specifically practising in this role as a nurse in a speciality area. Some may argue that the broad band speciality term functional nursing, used by Russell, Gething and Convery (1997; 14) replace non-clinical. In the context of this report, functional nursing is a category of nursing whereas clinical or non-clinical refer to locations for practice.
3.4.2 Employment Opportunities
What key participant stakeholders acknowledged was that registered nurses could obtain employment in diverse geographical and organisational locations. These included:
- Australian and overseas geographical settings
- Metropolitan, rural, regional and remote settings
- Residential care facilities
- Rehabilitation practice settings
- Acute care and Day Surgery hospitals (adults and children)
- Community Centres
- Neighbourhood Housing
- School Health facilities
- Health industry / health focussed business settings
- University, vocational, and school educational settings
- Maternity / Birthing facilities
Indeed, 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.
Despite the global shortage of nurses, it was identified by stakeholders that the acknowledgement of the value of nursing as a profession remains dubious. The following is an example of evidence that supports the view that nursing exists in a context that does not actively market the value of nursing as a profession:
A search of the Australian Careers Directory stated as an 'index that is up to date' failed to provide a match for the search term nursing as a career choice ('no documents can be found that matched your search query'). Additionally, a search of the Job Guide 2001 using the job name: registered nurse, revealed that '0 matches were found for your search'. The Job Guide 2001, does not list nursing (or written about at all) in the eleven personal interest groups within 'Choosing a Career - Step 2 Which career is right for you?' even though 'Medical' is listed.
When reviewing what is termed 'key information' about registered nurses within the Australian Job Search - Australian Careers, the occupation category listed for this career is: 'Health, Fitness, Hair and Beauty'.
An example of confusion about nursing as a profession exists within government departments with nurses classified as para-professionals in one department listing and professionals in another. Nurses are classified as paraprofessionals in the 'Definition of Occupation Types' Trends in Staff Selection and Recruitment' (July 2001, with scientists, engineers, teachers, lawyers and doctors classified as professionals. However in the Australian Standard Classifications of Occupations (ASCO) Second Edition, nurses are classified as professionals
The lack of visibility of nursing at a Federal level was linked by many participants to the lack of nursing representation at that level of government. Displaying nursing's diversity and having a flexible career pathway concept enables the emergence of different roles and challenges. But, as all participants highlighted, government, the wider community and other health care leaders have minimal and generally ill informed information about nursing. In relation to the lack of visibility of nursing, one participant commented:
That discovery is probably in line with the fact that the Commonwealth Government has found it so difficult to acknowledge that nursing is a national resource. That they actually have to take some responsibility and interest in it. (Extract from interview with key stakeholder participant)
Society needs nurses. Thus, the recruitment and retention of nurses must be a priority focus. This view needs to be supported and facilitated by the National Review of Nursing Education. Education programs need to enable student registered nurses or student enrolled nurses to be prepared for the multiple levels of options within the community services and health industries and not just for a specific job. As well, the required leadership and mentorship to facilitate transition to further education, training and employment opportunities needs to exist like in any other occupational group.
The document Nursing labour force 1998 (AIHW 1999) states that "Number of persons in nursing support occupations increased significantly between 1991 and 1996. The number of nursing assistants increased by 27.1% from 20,402 to 25,941, while personal care assistant emerged as a new occupation, numbering 16,706 in 1996" (1999: 3). This increase in nursing support occupations confirms the increasing demand for nursing services, yet at the same time there is a splintering or dilution of the nursing role. The increase in nursing support occupations is viewed by many as an economic strategy designed to cut costs through the delivery of outputs by unlicensed support workers that they are not prepared, or able to produce.
What all stakeholder participants agreed was that any person (with or without other qualifications) would be required to undertake a Bachelor of Nursing program to be able to present for registration as a RN to a registering authority. This included direct entry Bachelor of Midwifery graduates.
The view expressed above did not preclude the acknowledgment by the majority of participants to the acceptance of unlicensed support workers (or however titled) to work with nurses. As participants indicated:
The assistant in nursing, enrolled nurse, registered nurse - I'm actually a strong advocate for that model within nursing. (Extract from interview with key stakeholder participant)
Well I know a lot of nurses aren't in favour of having carers to take away their body care, but I think they are an important part of the system and for some of those carers, there is no reason why they could not progress to become a RN if they upgraded. (extract from interview with key stakeholder participant)
I think nursing is very fortunate in being able to have so much variety and flexibility, however there are key points in a career pathway that are common across all contexts and all specialty areas. So you have your basic entry level as an assistant in nursing or whatever the classification might be and that is one of the difference s between job roles in industrial instrument and education, in that the classification is really an industrial term. It may be different to the classification in the workplace and it may be different terminology to the educational qualification. That is a compounding factor that needs to be taken into consideration. However, the first entry level at the certificate 3 level has some articulation into the pre-enrolment level, the enrolled nurse level. (Extract from interview with key stakeholder participant)
However, there was the view proposed by some that nurses were leaving the profession because of the pressure to delegate nursing work to 'unregulated workers'. A participant stated:
We would be looking to see if career pathways can resolve some of the issues that we have got currently with respect to nurses leaving the profession and there is feedback that some people are leaving the profession because they do not want to delegate to unregulated workers. (Extract from interview with key stakeholder participant)
In relation to nurse practitioner roles and advanced nursing roles, stakeholders considered these important. While some participants expressed disappointment that the nurse practitioner role had not achieved the numbers currently that they would have hoped for, it was commented that:
... nurse practitioner roles and advanced nurse roles are important. We have got a few advanced nursing roles, which has meant an awful lot to them to move into it and to be creating new roles and doing new things. The nurse practitioner is a really good start out for people who are really clinically orientated and want to do that. It will give them a new pathway and something to aim for and they can go there and I think those roles will develop and they will be great for nursing. (Extract from interview with key stakeholder participant).
3.4.3 Qualification requirements (including registration)
Stakeholder participants unanimously expressed the view that enrolled nurses (or however titled) be prepared in the Vocational Educational Training sector and registered nurses (RNs) in the university or tertiary sector. The university sector is acknowledged as a context that provides experiences for students to gain the essential attributes of a registered nurse, including developing critical and creative thinking skills, assessment and decision-making skills, accepting autonomy and responsibility as they relate to nursing.
Stakeholder participants agreed that only approved tertiary organisations to be allowed to offer a Bachelor of Nursing (or however titled). Participants understood that Registered Training Organisations (RTOs) accredited by the Accreditation and Registration Council to deliver vocational educational training may seek to expand their scope of registration to include Australian Qualifications Framework (AQF) Level 7 (Bachelor degree). This acknowledgment raised an in depth discussion about the nature of VET and tertiary education in relation to the sector most suitable for the preparation of a registered nurse. VET (provided by either private RTOs or TAFE) was positioned by stakeholder participants as having a very technical focus and an appropriate environment for the preparation of enrolled nurses (or however titled) given that these nurses worked normally under the direction of RNs. Tertiary institutions were positioned differently and best suited to prepare a student for the critical questioning and analytical skills required of RNs. Stakeholder participants considered that preparing Registered Nurses for registration was only one part of the tertiary preparation of RNs and that the graduate qualities those students gained were critical to the skills required of a RN.
I was educated in the apprenticeship style initially and I would have to say that it is unbelievably scary to think that [nursing should return to a more vocational education] even then let alone now when our throughput is faster, our stay is shorter, our presentations are more complex. That anyone could even suggest that you could be educated on the job without theoretical underpinnings to your practice! I was in charge of a ward of 60 people routinely at the age of 18 when I had absolutely no theoretical basis for anything that I did or that I directed other people to do and having gone through the university systems as well there is absolutely no comparison between the depth of study that I did at university to the shallowness of the study, not that it was anyone's fault, it was the sort of study that was provided then but when you compare them there is no comparison. (Interview extract)
Therefore, the entry points into a Bachelor of Nursing (or however titled) include:
- Required tertiary entry score or however titled
- Enrolled nursing
- Certificate 4 / diploma / advanced diploma / other Bachelor degrees (including Bachelor of Midwifery)
- Certificate 4 Aboriginal Health Worker
- Special entry categories (eg. Mature aged entry)
Credit recognition for any individual student into a Bachelor of Nursing program was viewed as the role and responsibility of the university to which an application, for credit recognition, is made. There was also discussion that a Bachelor of Nursing (or however titled) provides a generic entry point to educational opportunities in all health care services.
Some small but significant changes that key stakeholder participants believed needed to be made include that students undertaking a Bachelor of Nursing (or however titled) program, approved by the relevant nurse regulatory authority, be referred to as student registered nurses, and, that the supervision of student registered nurses during the required clinical experience be undertaken only by persons who themselves are registered with the relevant nurse regulatory authority to act in the role of a registered nurse.
Enrolled nurses interviewed expressed concern that experienced enrolled nurses were often not involved in the educational preparation of students or trainees. Stakeholder participants agreed that, similar to the student RN, that the term student EN or trainee EN be adopted to depict these students as they prepare for enrolment and that experienced ENs with the necessary skills be involved in the educational preparation of student ENs. There was general agreement amongst stakeholder participants that having enrolled nursing at different AQF Levels (Level 4 or AQF Level 5), presented difficulties for transferability across states and territories. Stakeholder participants expressed the view that findings of a national study by the Australian Nursing Council Inc. into competencies for Enrolled Nurses as well as a review of an EN curriculum in Victoria, would offer insight into the most appropriate preparation and hence career pathway developments for ENs. Completion of an accredited enrolled nurse program by the relevant state or territory nurse regulatory authority was accepted as being required for enrolment with that authority to work in the role of an enrolled nurse.
Entry points into an enrolled nursing program include:
- Completion of Year 11/12
- Certificate 3 / other certificate 4 / diploma / advanced diploma / other Bachelor degrees
- Special entry categories (eg. Mature aged entry)
Key stakeholder participants acknowledged that credit recognition for any individual is the role and responsibility of the Vocational Educational Provider to which an application for credit recognition is made. It was also agreed that students undertaking an enrolled nurse (however titled) VET program that has approval from the relevant nurses regulatory authority, needed to be referred to as student enrolled nurses. Additionally that the supervision of student enrolled nurses during the required placement experience be undertaken only by persons who themselves are either enrolled nurses or are registered with the relevant nurses regulatory authority to act in the role of a registered nurse.
Figure 4 Educational qualifications of different nursing groups
Some other key points that participants suggested should be elaborated in career pathways include:
- That the educational preparation of nurses occurs in either the Vocational Educational Training sector (VET) or the tertiary or university sector. There was complete agreement by stakeholder participants that the preparation of registered nurses occurred within the university sector. There was also acknowledgment that the preparation of enrolled nurses (however titled) focussed predominantly on technical skills.
- The Australian Qualification Framework (AQF) enables enrolled nurses (however titled) who have obtained a nationally recognised qualification (for example Certificate 4) to have ongoing educational (and hence career) opportunities other than progressing onto registered nursing education.
- Advanced nursing and nurse practitioner roles normally require the attainment of additional qualifications and experiences.
In relation to unlicensed support workers (or however titled), a respondent stated:
Up until recently, assistants in nursing received little or no training and were expected to give supervised personal care to elderly residents. As the acuity and frailty levels of residents increased so did the need for these untrained workers to receive at least basic training in nursing skills... Certificate III is regarded as a minimum level qualification for anyone involved in direct personal care. This certificate articulates with the TAFE enrolled nurse course which in turn articulates with Bachelor of Nursing pre-registration courses for professional nursing.
The Community Services Training Package (CSTP) that was endorsed in February 1999, and the soon to be endorsed Health Training Package (HTP), provides to RTO's a description of the units of competency to be achieved and how to achieve these, for the different qualifications in community services (inclusive of aged care) and health areas. There has been general acceptance that AQF Level 3 is the qualification level for unlicensed support workers (or however titled) in aged care. Though it also needs to be noted that there is concern about the proliferation of qualifications within the Training Packages and as stated by a respondent concern about the 're-invention of basic nursing work' under various classifications and titles.
Stakeholder participants understood that there were multiple entrance points into a Bachelor of Nursing program (or however titled) and acknowledged that special entry arrangements to address access and equity issues, VET in School programs, and the Australian Qualifications Framework opened up different possibilities for entry into a Bachelor of Nursing. However, stakeholder participants also expressed the view that as a consequence of the skills required of a RN, entrance into a Bachelor of Nursing (or however titled) would normally be successful completion of a Year 12. Potential students would gain entrance having gained the required tertiary entrance score for entry into a Bachelor of Nursing (or however titled).
Stakeholder participants acknowledged that students who had completed Australian Qualifications Framework (AQF) Level 4 without completing an Enrolled Nursing program would be able to apply for entry into a Bachelor of Nursing (or however titled). Other than the Aboriginal Health Worker, some participants expressed concern about the variability in appropriate experiences of some of these students enabling them to apply for entry and possible credit recognition. There was agreement by participants that entry into a Bachelor of Nursing program (or however titled) not be lower than AQF Level 4.
It was also agreed that recognition for prior learning or current competencies and subsequent credit arrangements was the responsibility of the university to which an application for admission was made. Stakeholder participants expressed concern about the perception of what it was that students in a Bachelor of Nursing program were preparing for - registration as a RN, and the qualifications of persons at times placed in supervisory roles during clinical placement. Given this concern, it was agreed that firstly the language used to describe students in a Bachelor of Nursing program while at university and during clinical placements, be student Registered Nurse, and secondly, only those who were Registered Nurses supervise student RNs during clinical placement.
Figure 5 Entry points and learning options for registered nurses
Figure 6 Entry points and learning options for enrolled nurses
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last updated on Tuesday, 04 December 2001
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