Transition to work and the career destinations of double degree nurses.

Abstract One third of undergraduate nursing students in Australia are studying nursing concurrently with another undergraduate degree. This study examined the career preferences of double degree (DD) nursing students and the career destinations of graduates to gain an understanding of the reasons why nursing is chosen or not chosen. The design was a sequential mixed methods explanatory study. Questionnaires and interviews collected information during the final year of the DD, on commencement of work, and after 2 years in the workforce. Results revealed less than half of final year students indicated a preference for nursing, but 60-73% were employed in nursing after graduation. Career decisions were influenced by intrinsic and extrinsic rewards unique to nursing but also the other discipline. Practicum experiences and location of work were also important factors. Strategies are needed to avoid losing potential nursing graduates to other disciplines at a time of nursing staff shortages.

Why nursing? Applying a socio-ecological framework to study career choices of double degree nursing students and graduates.

AIM: To report a study that investigated the career development, aspirations, and choices of undergraduate students and graduates of nursing double degree programmes. BACKGROUND: Over one-third of Australian undergraduate nursing students study by double degree mode. Their career destinations will have an impact on the availability of graduates in a time of nursing shortages, but little is known about why nursing students choose double degrees or take up a career in nursing vs. the other specialization. DESIGN: A qualitative study using two longitudinal methods. METHODS: The study was conducted in 2008-2009 with 68 participants from an Australian regional university offering double degrees in nursing. A time series method involved interviews with 12 first year students followed by focus group interviews with 22 final year students. A longitudinal method involved repeated interviews with 34 graduates. Interview transcripts were analysed thematically. RESULTS: Enrolment in a double degree was influenced by advice from significant others; previous experiences of health care; and the anticipated rewards associated with a choice of two careers. Career development and decisions of undergraduates were influenced by intrinsic and extrinsic rewards distinctive to each area of specialization and marketing and job availability. For graduates, the impact of workplace experiences such as prior practicums and past and present workplace support were foremost. CONCLUSION: This study provides previously unknown information about double degree nursing students' and graduates' career development and career choices over time. A socio-ecological framework adapted to nursing enabled a broad understanding of the many environments and contexts that confirm or discourage a nursing career.

Using a socioecological framework to understand the career choices of single- and double-degree nursing students and double-degree graduates.

Untested changes in nursing education in Australia, such as the introduction of double degrees in nursing, necessitate a new research approach to study nursing career pathways. A review of the literature on past and present career choice theories demonstrates these are inadequate to gain an understanding of contemporary nursing students' career choices. With the present worldwide shortage of nurses, an understanding of career choice becomes a critical component of recruitment and retention strategies. The purpose of this paper is to demonstrate how an ecological system approach based on Bronfenbrenner's theory of human development can be used to understand and examine the influences affecting nursing students' and graduates' career development and career choices. Bronfenbrenner's socioecological model was adapted to propose a new Nursing Career Development Framework as a way of conceptualizing the career development of nursing students undertaking traditional bachelor of nursing and nontraditional double-degree nursing programs. This Framework is then applied to a study of undergraduate nurses' career decision making, using a sequential explanatory mixed method study. The paper demonstrates the relevance of this approach for addressing challenges associated with nursing recruitment, education, and career choice.

The design and implementation of an Interactive Computerised Decision Support Framework (ICDSF) as a strategy to improve nursing students' clinical reasoning skills.

This paper describes the conceptual design and testing of an Interactive Computerised Decision Support Framework (ICDSF) which was constructed to enable student nurses to "think like a nurse." The ICDSF was based on a model of clinical reasoning. Teaching student nurses to reason clinically is important as poor clinical reasoning skills can lead to "failure-to rescue" of deteriorating patients. The framework of the ICDSF was based on nursing concepts to encourage deep learning and transferability of knowledge. The principles of active student participation, situated cognition to solve problems, authenticity, and cognitive rehearsal were used to develop the ICDSF. The ICDSF was designed in such a way that students moved through it in a step-wise fashion and were required to achieve competency at each step before proceeding to the next. The quality of the ICDSF was evaluated using a questionairre survey, students' written comments and student assessment measures on a pilot and the ICDSF. Overall students were highly satisfied with the clinical scenarios of the ICDSF and believed they were an interesting and useful way to engage in authentic clinical learning. They also believed the ICDSF was useful in developing cognitive skills such as clinical reasoning, problem-solving and decision-making. Some reported issues were the need for good technical support and the lack of face to face contact when using e-learning. Some students also believed the ICDSF was less useful than actual clinical placements.

Understanding and enhancing the learning experiences of culturally and linguistically diverse nursing students in an Australian bachelor of nursing program.

The growth in numbers of culturally and linguistically diverse students entering nursing programs in Australia presents challenges for academic and clinical staff, and most importantly the students themselves. In this paper we present the findings from a pilot study designed to explore these issues and to develop strategies to address them. This study used a qualitative explorative approach to gain rich in-depth data. Eleven culturally and linguistically diverse students, three clinical facilitators, and four academic staff participated in focus group interviews. Four major themes emerged: level of English language competence, feelings of isolation, limited opportunities for learning, and inadequate university support. The issues we identified led to a meaningful discussion of the political, financial, social and intercultural context that they are entrapped in. This paper provides educators, clinicians, policy makers and researchers with an insight where and how they commence to break the trap and highlights, the need for further research into the perspectives of Australian students' who study and socialise with their international peers.

The 'five rights' of clinical reasoning: an educational model to enhance nursing students' ability to identify and manage clinically 'at risk' patients.

Acute care settings are characterised by patients with complex health problems who are more likely to be or become seriously ill during their hospital stay. Although warning signs often precede serious adverse events there is consistent evidence that 'at risk' patients are not always identified or managed appropriately. 'Failure to rescue', with rescue being the ability to recognise deteriorating patients and to intervene appropriately, is related to poor clinical reasoning skills. These factors provided the impetus for the development of an educational model that has the potential to enhance nursing students' clinical reasoning skills and consequently their ability to manage 'at risk' patients. Clinical reasoning is the process by which nurses collect cues, process the information, come to an understanding of a patient problem or situation, plan and implement interventions, evaluate outcomes, and reflect on and learn from the process. Effective clinical reasoning depends upon the nurse's ability to collect the right cues and to take the right action for the right patient at the right time and for the right reason. This paper provides an overview of a clinical reasoning model and the literature underpinning the 'five rights' of clinical reasoning.