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National Review of Nursing Education
Nursing Education and Graduates Part 24. Concluding ThoughtsEach State and Territory has its own nurse registering authority and established guidelines for course accreditation leading to Division 1 nurse registration. While there are agreements between authorities to use Australian Nursing Council Incorporated (ANCI) competencies for Registered Nurses and mutual recognition of registration, there is no national agreement in Australia that governs the number of hours of clinical experience expected in undergraduate pre-registration programs for students to meet the requirements for ANCI competency. When comparing the clinical experience hours reported in the present study (excluding on-campus laboratory hours) with the results of the 1994 NRNE, it would appear that the minimum number of hours for clinical experience in pre-registration nursing programs has increased from 354 hours to 600 hours. The maximum number of hours has decreased from 1770 reported in 1994 to 1100. Comparison of the range of clinical experience hours reported in 1994, with the range reported in the present study shows that, whilst there is still a range in hours provided by universities, the variability has reduced. It is important to note also that there is some uncertainty as to whether the clinical experience hours reported in the NRNE (1994) included on-campus clinical experience hours. Several universities reported the number of intakes per year for postgraduate courses as either being "unlimited" or "continuous". It could be expected that except for students undertaking higher degree studies, there may be up to three intakes a year coinciding with beginning of first, second and summer semesters. Developments in information technology and electronic delivery of courses may now facilitate universities enrolling students at any stage throughout the semester, making the task of capturing student enrolment and completion data in a timely and accurate manner, extremely difficult. Russell et al (1997) and Ogle et al (2001) suggested that broad-band specialties be further modified to capture accurate data about graduates from specialist postgraduate university nursing programs. This study supports findings of previous studies of Price, Smith, Sutton, Lee and Cheek in 1994 and ANF in 1993 (both cited in Russell et al., 1997) and argue that it would be in the interests of nursing for a consistent definition of ‘specialty nursing’ and specialty classification for tertiary nursing courses be developed. This study found that, in addition to the lack of consistency in terms of what constitutes an area of specialty practice, there was considerable variability in terms of specialty course appellations, length of courses in fields of study and levels of specialty award. These differences make it extremely difficult to make comparisons of courses either across universities and even between nursing courses offered at the same university. Consistency of definitions will facilitate the development of comparable course appellations as well as levels and length of courses and enable a more accurate capture of statistics about graduates from university specialist courses to better inform national labour force planning. This study found that only one university offered a program in Indigenous Health and that, this year, there are three students in this program. Given the vast evidence about the poor health of Indigenous communities, the paucity of courses or students in such programs is surprising, particularly in States that have large Indigenous populations. However, there are several factors that may have impacted on these findings. Firstly, it may be that tertiary education programs have been developed around models of health promotion and public health and offered through faculties/schools other than nursing and hence would not have been captured in the data that informed this study. Secondly, it may be that universities are collaborating with Indigenous centres in universities to offer culturally inclusive programs in nursing resulting in graduates who are able to practice in Indigenous communities and building capacity in Indigenous health care labour force. Student numbers from such programs would have been captured in data but not be identifiable as students in Indigenous health programs. In 1997 Russell et al found that there was extensive duplication of course offerings within the same geographical setting and within the same specialty areas. These findings are again echoed in this study. There are a plethora of courses being offered by many universities within close geographical proximity. This raises several issues. Firstly, in some instances course are offered with very small student numbers. While student/academic staff ratios might equate to higher quality teaching it reduces teaching and learning opportunities for students with peers. Secondly, the variability in course length, appellation across fields of study and levels of courses must make it difficult for potential students to compare and assess relevance and appropriateness of courses for their particular career aspirations. Thirdly, as a result of the entrepreneurial climate in which universities are now operating, there is intense competition between universities to capture the market on specialty nursing courses. It can be projected that this reduces the capacity of universities to develop and maintain distinctive and cost effective capability in particular specialist practice areas of nursing education. This will also reduce their ability in concentrate specialist nursing practice expertise and scholarly activities that could develop areas of specialty nursing education and research. In this study generic specialty nursing courses were found to be 11% of the postgraduate courses offered. In order to capture data about specialist nursing courses, where universities offered a generic program of study, they were requested to provide information in specific categories of nursing specialty. It is suggested that any future studies exploring the relationship between numbers of students completing for postgraduate nursing specialty courses and labour force planning use a similar methodology. The findings of this study have reported projected completions for midwifery and postgraduate specialty nursing programs. Students changing from full-time to part-time studies confound the exact number of actual new graduates entering a specialty field. Completion numbers provided may also include students upgrading previous hospital based qualifications to graduate diploma status and as such, these students would not be new to a particular nursing specialty. Hence, new graduates entering the workforce in specialty nursing practice may actually be less than that reported. However, anecdotal evidence suggests these numbers are small and dwindling each year. Nevertheless, to gain a more accurate picture of actual numbers of new speciality nursing graduates it would be necessary to contact each university to ascertain actual new graduate completion numbers from graduates who are upgrading hospital-based qualifications. There are major challenges world wide around the issue of the provision of an adequate nursing workforce to meet the health care needs of communities. This study has been successful in highlighting the robustness of the database established for the Ogle et al (2001) study to better inform nursing labour force planning. It also has further highlighted the need for uniform minimum datasets between the higher education sector and DEST and the many issues that surround postgraduate nursing specialty education.
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