1. Identifying and understanding the career destinations of double degree nursing graduates using a mixed method approach Noelene Hickey University of Newcastle

3. Background A world wide shortage of Registered Nurses (RNs), more so in rural areas – 2010 in Australia 10,000 – 12,000 RNs. RN shortages → poorer healthcare of patients → stress, burnout in nurses Young people disinterested (a University recruitment issue) 2002 – 2008 Australian Government increased Bachelor of Nursing (BN) funded places at Universities 2002 - University initiative double degrees (DDs) commenced at Charles Sturt University (CSU) Australia 2009 - 33% of BNs in Australia enrolled in a DD (Preston 2009) DD graduates choosing nursing ? It is unknown. What sort of students enrol in and complete a cross disciplinary DD? Which career do they prefer? why? Does this change? Influences? What is potential impact of DDs? 3

4. Career choices 4 Registered nurses (RNs) (BN) Early childhood teachers (ECT) (BN/BECT) Paramedics (Para) (Ambulance officers) (BCP/BN)

5. Aim and Methodology AIM: To identify and understand the CAREER and LOCATION preferences of students and graduates undertaking multi-disciplinary degrees that encompass a Bachelor of Nursing. Methodology Sequential mixed method approach → quantitative & qualitative data gathered from single degree (SD) & DD students and DD graduates Cross sectional survey ALL undergraduate BN students (n = 209) Longitudinal study – 1 st year and 2 nd year DD graduates (n = 32) Interviews - 1 st & final year DD students (n = 34) - 1 st & 2 nd year DD graduates (n = 34) CSU Australia the context (72% response) Data analysis – descriptive statistics, chi square & ANOVA (SPSS) - thematic analysis (NVivo) 5

6. 6 Beginning DD students A sequential explanatory mixed method design process PHASEPROCEDUREPRODUCT quantitative data collection Cross sectional cohort survey (n = 70) Numerical data quantitative data analysis Data screening SPSS quantitative software V17 ANOVA, chi square, frequencies Descriptive stats, missing data, Mean, st. deviation, significant differences between groups connecting quantitative & qualitative phases Convenience sample of DD students from survey participants Developing interview questions Participants (BN/BECT n = 5; BN/BCP n = 7) Interview protocol qualitative data collection Individual in-depth tape recorded interviews with 12 beginning DD students Text data (interview transcripts) qualitative data analysis Transcripts entered into NVivo Coding at tree nodes Within group & across group theme development Cross thematic analysis Visual thematic maps data analysis Codes and themes Similar & different themes and categories Cross thematic analysis Integration of the quant. & qualitative results Interpretation & explanation of quantitative and qualitative results Discussion Implications Recommendations

7. Demographic profile *,ł Statistically significant differences at P < 0.05 level ¶ Marginal differences 7 BNs (77)BECT/BN (31)BCP/BN (101) Age on enrolment (mean range 21.1) School leavers 18 -19 years – n (%) [average 62.2%] 23.4* ł 37 (48.1)* ł 19.8 ł 18 (58.1) ł 19.7 * 75 (74.3) * Male - n (%) [average 16.7%]9 (13.0)*0 (0.0) ł 26 (34.6) * ł Rural background > 8 years – n (%) [average 70.3%] ¶ 61 (79.2)22 (71.0)64 (63.4) Fathers occupation (mean range) (S/D) Overall mean 7.1 (S/D 3) Mothers occupation (mean range) (S/D) Overall mean 7.1 (S/D 2.9) Fathers education (mean range) (S/D) Mothers education (mean range) (S/D) 6.1 (3.2)* ł 6.3 (3.1)* ł 3.7 (1.7)* 3.7 (1.8) 7.9 (2.1) ł 7.9 (2.5) ł 3.6 (1.7) 4.1 (1.7) 7.5 (2.8)* 7.5 (2.7)* 4.4 (1.6)* 4.2 (1.7)

8. SD & DD students career location preferences at beginning and end of program 8 Rural decision factors Lifestyle & enjoyment Belonging – familiar people, places Relationships and support Rachel (BN/BECT) “My family is here & I come from a farm, I like the wide open spaces, I can work as an RN in a hospital near home” Metropolitan decision factors Excitement & challenges Career opportunities Interesting work – career advancement John (BN/BCP) “ I come from a rural town but I want to go to the city, paramedics in the city yeah, more exciting & better conditions”

9. 9 Agree 11% undecided 11% disagree 78%Agree 37% undecided 23% disagree 40% DD students career preferences for nursing at beginning and end of program

10. Why did students choose a DD? CAREER OPPORTUNITIES Flexible options Stephen “Just the fact that I can chop and change. I always change my mind a lot, so having two careers to choose from is fantastic.” Safety net Maria “It was just.. I want to do nursing as a backup, something that I can travel with and be able to add midwifery onto it later, a paramedic first though”. Gaining workplace mobility Theresa “There are a lot of opportunities with nursing, you can take 6 months off and go work overseas, it's very hard to do that though with paramedics” Improving employment chances Sarah “Cause I didn’t know what I wanted to do when I left school and I always thought teaching or nursing you’re always going to get a job everywhere in the world” Value addedness Penny “I want to be a paramedic and I figured one more year for a whole other degree, it’s worth it. I’m not wasting any time, I’m still getting what I want plus something extra, some extra knowledge”. 10

11. Final year UG DD students: What has influenced career preferences? Practicum experiences (positive or negative) Pauline “I did my final paediatric nursing – I did paeds as my final week on my last prac and totally knew there and then that’s what I was meant to do”. Sarah “I haven’t enjoyed some teaching pracs because they can go on, and on and on and on. Plus all the preparation is really hard in teaching pracs. I prefer nursing.” Penny “I found that I couldn’t cope with it- like with paramedics one of my biggest fears was finding someone who had committed suicide, and that happened on prac, so I just thought ‘no more’, I’m doing nursing” Expected personal rewards Expected personal rewards ( enjoyment, excitement interesting work) Nicholas “ I enjoyed the paramedics pracs more, they were great, more exciting work, we had a stabbing on my second prac” Work location choices Work location choices ( home/relationship ties, supportive environment, graduate program availability) 11

12. 1 st year DD graduates career choices Why did they chose their present career? Past practicum and own work experiences (+ ve & - ve)  exciting work, challenging work,  witnessing poor practice, mundane activities, unsupportive role models. Expected personal rewards  enjoyment, autonomy  perceived better working conditions eg monetary considerations, or shift work rostering Work location availability  graduate program availability, ongoing support, family ties Peter “If you go into the ambulance service as a paramedic your shifts are 4 days a week. The money is better than nursing, more enjoyable and there is more autonomy too”. 12

13. 2 nd year (DD) graduates career choices Why do they stay in their chosen career? Enjoyment and work satisfaction Heather BN/BCP “While I am young I will go down the para (paramedic) path I like it more....if I want to go overseas I will go back to nursing, do some casual nursing – keep my skills up to date” Workplace conditions - support from staff & facility, Mandy (BN/BCP) “Was only going to stay at (...city hospital) for the graduate year but decided to stay, good support, can’t fault the organisation, we rarely need agency nurses... they also have salary packaging” Career advancement opportunities Clare (BN/BECT) “It’s cool..doing what I enjoy most. I just think there’s more options, more career options (in nursing) than paramedics, we are encouraged to do further education”. Why did they leave their first career? Stress and burnout Maria (BN/BCP) “I had too many patients, I couldn’t get my work done and I worried about making a medication error, I’d go home some days and just cry” Loss of enjoyment and work satisfaction Sarah (BN/BECT) “I knew I had to leave as the bad days were starting to out number the good, it just wasn’t for me... all the rushing in nursing and staff shortages”

14. Challenges faced by nursing academics Cross Faculty curriculum challenges Time tabling (negotiating subjects and classes) Course content challenges (negotiating professional requirements) Practicum requirements in both degrees (practicums in semester breaks) Teaching challenges DD students compare degrees and content eg skill & competency levels Academics (particularly casuals) often unaware of DD students in classes Academics unaware of content taught in other degree (eg high level resuscitation skills in paramedics) Student/teacher relationships - DD students are “different” to SD students DD students are brighter (higher university entry scores) but also easily bored See themselves as different “elite” as doing DD (only socialise together) but feel unsupported by either faculty Many DD students uninterested in some nursing content (eg aged care) 14

15. Conclusions More school leavers in DDs Type of student and reasons for enrolling differs between SD and DD students Preferences for a “rural” location decreases over program DD students preference for nursing career low. Final year DDs career path strongly influenced by ‘practicum experiences’ 1 st yr DD grads career choice influenced by enjoyment, & work availability 2 nd yr DD graduates careers influenced by enjoyment & satisfaction, support, advancement opportunities DD RN graduates stay or leave for the same reasons that RNs stay or leave Low numbers of DD students choosing nursing creates challenges for the nursing profession due to existing shortages. 15

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