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Presentation

Session: Human Health Resources
Room: Meeting Rooms 22+23
Time: Thu 10:15-11:30

Presenter: Michelle Cunich (The University of Sydney. School of Public Health)

Abstract

DESCRIPTION:

Motivation:
There is currently an international shortage of registered nurses (RNs). This shortage is driven in part by nurses exiting the profession at a fast rate. The causes of this are multi-faceted and include ageing of the nursing workforce, greater mobility of university qualifications, an increase in the roles and responsibilities of RNs in the health system, a lack of clear career paths in nursing, and heavier workloads of nurses. A range of policies have been implemented to address the shortage of registered nurses in Australia, from providing extra training and support to new graduates to active recruitment of nurses who have been trained overseas. This paper examines one facet of the retention issue by analysing the effect of country of training on the decision to exit from clinical nursing in Australia’s most populace state, New South Wales. In particular, this paper examines whether, and if so how, the length of time spent in clinical nursing differs for RNs on the basis of their country of training (i.e. Australia, England, the Rest of the UK, Ireland, Western Europe, Northern Europe, Southern Europe, Eastern Europe, Asia, Africa and the Middle East, the Americas).
Aim:
The aim of this paper is to examine whether the region of pre-registration training (i.e. country where RNs received their initial training) has an impact on the probability of RNs making a transition from clinical nursing to administration and or management.
Methodology:
The data used in this paper has been drawn from three separate data files: (1) registration (administrative) data, (2) Nursing Workforce Annual Surveys-New South Wales 1993-2002, and (3) qualifications data. The sample of spells analysed in this paper is the sample of first spells in nursing where the type of work performed is in a clinical setting. The sample consists of 3,233 nursing spells, where a spell is defined as the uninterrupted number of years that an RN is working in nursing in a clinical setting after initially entering the workforce in NSW in 1993.
A series of duration models are estimated to identify the effect of country of training on the occupational mobility of RNs in NSW between 1993 and 2002. These models control for individual characteristics (such as gender, age, home location, whether they have received their pre-registration training from a hospital or university, and whether this training was undertaken at a hospital or educational institute in Australia, the UK, or other geographical areas), job characteristics (such as place of work [e.g. public hospital, private hospital, nursing home] and specialty) and labour market conditions (such as the unemployment rate in the home location). Various specifications of the duration model are estimated to test for the robustness of the effect of country of training on duration in clinical nursing, including the discrete time proportional hazard model with Gamma and non-parametric corrections for unobserved individual-specific heterogeneity.
A range of methodological issues are discussed in the paper, such as methods for dealing with left and right censoring in nursing workforce data, the main reasons for using an inflow sampling process to construct the analysis sample, methods for estimating hazard models which take into account the discreteness of duration data, and how to extend the basic hazard model to include corrections for unobserved individual-specific heterogeneity.
Main results:
Almost 92 percent of RNs (3,233 nurses) had first jobs in nursing in the clinical setting in 1993. By 2002, only 67.81 percent of these nurses were still in clinical positions. Results from the duration models estimated thus far indicate that the transition rates of exiting clinical positions for nurses who have received their training overseas are statistically significantly different from the rates for nurses who have received their training in Australia. Nurses who have completed post registration courses and nurses who are working in the private sector exhibit shorter spells in the clinical setting.
Conclusion:
This paper serves to highlight the role played by geographical region of pre-registration training on the occupational mobility of RNs in Australia.

Key Terms

discrete time duration data, duration analysis, registered nurse workforce, nursing workforce policy

Authors:

Michelle Cunich (The University of Sydney. School of Public Health)

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