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Graduate registered nurses are becoming an important part in the health care system in Australia and elsewhere around the world. Their effectiveness to provide the health care services as trained in their learning can be influenced by the perceptions that they develop during the process of learning (Australian Health Practitioner Regulation Agency 2010, p. 5). There are possibilities of health care stakeholders developing a perception about their position in the health care system. This is evidenced by the estimates released by a number of professional health care bodies in Australia, including the Queensland Nursing Union, in terms of the imminent shortage of nurses and the anticipated expansion of hospital facilities in the country. The Commonwealth Government of Australia has, for instance, increased funding for training institutions across the country planning to train and register more nurses to work in the health industry.
However, questions have emerged among the educationists and clinicians about the adequacy of preparation of the registered nurses and their ability to handle the current challenges in the health care system. A review of several research findings indicates that there is a big problem when it comes to transition from learning to practice for many registered nurses. The current paper is a literature review of the perceptions of graduate registered nurses regarding their undergraduate learning and preparedness to handle the challenges faced by Australia’s health care system.
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Specifically, this literature review addresses the following research question: What are the perceptions of graduate registered nurses in Australia with regard to their undergraduate learning preparation to handle the challenges faced by the country’s health care system?
The growing demand for health care services among the Australians and the possible shortage of registered nurses in health care facilities have transformed graduate registered nurses’ perceptions of their roles in the health care system (Nursing & Midwifery Board of Australia 2015, p. 2). As stated by Health Workforce Australia, the cause of this perception is the doubts that clinicians and educationists have placed over the quality of education and the eventual preparedness of the nurses to deal with challenges of the health care system in the country. There have been efforts of the government to streamline the number of nurses that graduate and get registered in the country. However, the perception about preparedness has something to do with the perceived imminent increase in demand for health care services following what Health Workforce Australia (2012, p. 3) described as aging population. The population is made of those “who will consume larger numbers of healthcare services, compounded by … an increasing prevalence of chronic conditions’ pose significant challenges for Australian authorities” (Health Workforce Australia 2012).
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The Department of Education, Employment and Workplace Relations in Australia (2009) estimated that close to 40,000 students enrolled in the course in nursing and 30,000 sought registration in 2010. This large number of graduate nurses entering the workforce is consistent with the plans of the government to train more nurses. It is also a reflection of the increasing demands in the market. However, as noted by Ryan (2009, p. 9), the need to have graduate nurses who are adequately prepared to deal with the challenges is important. Most employers in the market begin to doubt the preparedness of the graduate registered nurses to deal with the emerging issues in nursing. The theory-practice gap coupled with inadequate preparation of nurses is becoming an issue of long discussions about contemporary nursing among stakeholders in Australia.
The position occupied by nursing students and their perception about preparedness to work in a dynamic environment is important to the achievement of government’s investment objectives. Currently, the education of nursing is very much diversified on the frontline making graduate nurses have a wide scope of the areas they would want to work in when they graduate (Australian Nursing & Midwifery Accreditation Council, 2010, p. 4). Employers and stakeholders in the health care industry have raised an alarm about what they term as degree-levels which has tremendously impacted the cost of learning. While there is a huge need for nurse practitioners in the health facility, most of the students prefer the research section of nursing which does not put them directly in the nursing environment. Also, the dynamics in the health system in Australia and elsewhere around the world have led to the emergence of clinical doctoral level and practice doctorate for nursing students that do not put emphasis on the practice of nursing (Department of Education Employment and Workplace Relations, 2009, p. 1). The appearance of two types of clinical doctorates in the recent years will impact on the choices that graduate RN are likely to make when advancing their education. The absence of the mandate for education programs that are directly approved by an accrediting group means that educational programs for nurses will be competing for potential nursing students at the expense of the quality of education and preparedness to practice nursing in the actual context.
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The perceived imminent shortage of nurses in the future is a contributing factor to emerging professionals in nursing (Australian Nursing & Midwifery Accreditation Council 2010, p. 19). The factors that contribute to the quality of the workforce in the nursing industry are inherently found within the education sector itself. A good example is the need of education institution owners to make quick profits at the expense of quality learning. Another factor is the changing needs in the health sector occasioned by the perceptions of employers about the preparedness of graduate nurses to practice nursing. Finally, there are some requirements and policies developed by different professional bodies to influence the credentialing and licensing process (Health Workforce Australia 2010, p. 2). The government and third-party payers like insurance companies also influence the choices that graduate RNs make before they enter into the practice of nursing. Furthermore, the issues that affect the preparedness of RNs to practice nursing in the context of the contemporary health care challenges are compounded by different, and sometimes contradicting, educational preparation levels for nurses in the country.
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The role of graduate RNs in the Australian health care system is largely influenced by the kind of training that they receive in their schools. To this end, most graduate RNs are likely to perceive their role in the nursing profession as influenced by the skills and knowledge that they have acquired in classrooms. In addition, the government and accrediting bodies’ policies also have a big impact on the perception of graduate RN in Australia (Collier 2006, p. 56). Some of the heavily regulated sections of the nursing professional provide poor-to-no career advancement. Therefore, they are likely to induce high turnover or frustration of nurses who get into this field (Department of Education Employment and Workplace Relations, 2009, p. 12). The perception that the fields that they have entered do not provide room for professional advancement can affect the nurse’s productivity. The result is another graduate RN in the nursing profession who is not just concerned with the professional growth but also looking for a different job. As stated in Health Workforce Australia (2012, p. 2), “at the post-secondary education levels of one-year technical training programs and two-year associate degrees, in many fields there are too few applicants who are qualified based on their preparedness to undertake the academic rigor of the curriculum.” The implication of this phenomenon is that training institutions are developing many training programs for nurses that cannot prepare them to undertake the emerging challenges in the health sector.
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As stated by International Council of Nurses (2009, p. 3), despite the high number of graduate RNs in Australia, most of the educational programs producing health professionals are not directly in line with the future requirements of the industry. The problem is also compounded by the high rate of experienced nurses who are retiring from the work, leaving only new graduates with insufficient knowledge and skills in nursing. The fact that the health care workforce is also aging means that young graduate RNs will have to take up these positions regardless of whether they are qualified or prepared to take up the challenging positions. Many educational institutions try to develop programs that can address the projected needs of the health care industry even though a wide gap still exists in the professional sphere. Roxon (2011) proposes that educational institution should develop programs that are responsive to the needs of the graduate RNs. The problem is the delay between the time the shortage is noticed and the development of a program that can address that shortage.
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The other area of concern is the duration that students take when training as nurses irrespective of the degree-level of their training program. The financial needs for four or five years that are required to go through most of the nursing programs in Australia may influence the perception that a learner eventually develops towards the profession they are training for (Commission on Accreditation in Physical Therapy Education 2014, p. 3). The financial challenge is likely to be faced during approval processes, licensing, and accreditation. It has to be ensured that nurses graduate from a new and expanded program. These factors affect the emotional and psychological preparedness of the students to deal with the nursing challenges that they finally encounter when they go into the real world.
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