Factors that influence new graduates' preferences for specialty areas.

Abstract

IntroductionIn 2012 all District Health Boards (DHBs) in New Zealand participated in a national pilot of the online Advanced Choice of Employment (ACE) system to recruit graduating and newly graduated registered nurses. These nurses enter one of two supported first year of practice programmes: the 'Nurse Entry to Practice' (NETP) programme or the 'Nurse Entry to Specialist Practice (mental health)' (NESP) programme offered in DHBs and by some private providers. The online ACE system requires the graduating or newly graduated nurse to choose in order of preference up to four DHBs and three clinical areas where they would like to work. Nurse Entry to Practice Programmes were first established in 2005 when the then Minister of Health announced new funding to ensure DHBs provided a supported first year of practice for newly registered nurses (Nursing Council of New Zealand, n.d.). In 2007 this scheme was extended from acute areas to cover newly registered nurses in agerelated residential care and primary health care. Many of the DHBs offering NETP programmes also require the nurses to complete a postgraduate paper offered by a Nursing Council approved tertiary education provider. The NESP programme is specifically for those newly registered nurses working in mental health and addiction services. The NESP varies slightly from NETP in that NESP requires the nurses to complete a postgraduate certificate as part of their supported programme (Te Pou, 2015).BackgroundThe research literature is replete with surveys of final year student nurses who have been asked to rank their preference to work in a range of clinical practice areas as registered nurses (Birks, Al-Motlaq, & Mills, 2010; Ganz & Kahana, 2006; Halcomb, Salamonson, Raymond, & Knox, 2012; Koskinen, Hupli, Katajisto, & Salminen, 2012; Larsen, Reif, & Frauendienst, 2012; McCann, Clark, & Lu, 2010; Shen & Xiao, 2012; Stevens, 2011; Stevens & Crouch, 1998). The relative popularity of some clinical practice areas over others is therefore well known. The most common methods of data collection are by survey using forced choice and free-text responses, and interviews or focus groups. Invariably the findings are that the desirability of cardiac care, intensive care, emergency department, and acute medical/surgical settings is high. These clinical practice areas are viewed as 'high-tech', dynamic and life-saving. Conversely, aged care and mental health settings are viewed as 'low-tech' areas, are considered boring and unfulfilling, and are consistently the least desirable areas to work as a newly registered nurse. Community health (the term used in the literature to describe all nurses who work outside of hospitals or long-term care) features less often, but where it is included, it ranks with the other low-tech less 'dynamic' areas (Leh, 2011). These preferences have changed very little over the last 20 years at least (see Happell, 1999; Stevens & Dulhunty, 1997). Nonetheless, workforce shortages in three government priority areas (mental health [MH], age related residential care [ARRC] and primary health care [PHC]) suggests there is need to better understand the factors that influence graduating nurses' choice of clinical practice setting in New Zealand (Ministry of Health, 2015). This paper reports on a national survey of recently graduated registered nurses and explored the factors that influenced their preference for employment with particular reference to the three government priority specialty areas.Review of the LiteratureStudies were identified for this review through searching PubMed and the EBSCO platform databases, which included Medline, CINAHL Plus, Academic search premier and Health source (Nursing/Academic edition, Education source and PsychINFO). The key words and MeSH terms used in the search were 'students, nursing', 'specialties, nursing', 'choice', 'career choice', 'education, nursing', 'baccalaureate' and 'new graduate nurse'. …