Who will look after us? Student nurse perceptions of a career in aged care.

The aged care sector will need to provide more extensive care due to increasing health complexities, while also providing a different type of care for those that are aging well. With aged care providers already struggling to recruit staff, and with significant numbers due for retirement in the coming years, solutions need to be found to avoid a dramatic shortfall in future care.

‘Around 50% of registered nurses will reach retirement age over the next 15 years, as educators we have a responsibility to ensure aged care providers have a workforce supply,’ explains Samantha Heath, Senior Lecturer in Nursing and Research Fellow from the Unitec Institute of Technology.

Existing literature on the low uptake of aged care as a career shows that student nurses are reluctant to engage in aged care placements. Heath identified a gap in the literature – the student perspective on aged care was missing.

‘Our team invests a lot of time and effort in preparing student nurses for placements in aged care. We talk about New Zealand’s future health strategy and about their career opportunities, but it isn’t having the effect we want, so we thought, let's actually ask the people who are going to fulfil the positions,’ explains Heath.

Heath undertook a survey to identify students’ impressions of, and their intentions to work in, aged care. All nursing students at Unitec were invited to take part in a short anonymous online survey. Over one third (38%) of students responded, this group contained 84 Bachelor of Nursing students from Years 1-3, and students enrolled in the Competency Assessment Programme (CAP) – a programme designed for nurses returning to work after some years absence or nurses who qualified internationally. The survey was comprised of primarily quantitative questions, with some open-ended fields to assist in understanding the students’ views regarding what they thought about aged care.

Qualitative data was analysed using Braun and Clarke’s general inductive approach to draw out the themes.

‘We were really surprised by some of the things that we found, including the reasons why students would choose to go and work in aged care. It sparked significant questions about where we put aged care in terms of the undergraduate curriculum,’ says Heath.

Bachelor of Nursing students were less likely to indicate they would choose aged care the further they progressed through their degree. Internationally qualified and return to nursing CAP students saw aged care as a potential pathway to other specialities, but many indicating they would not choose aged care as a long-term career option.

Overall aged care ranked poorly in contrast to other specialities, with only 12% indicating it as a speciality they would consider working in once they had completed their programme.

‘While there is a perception that aged care nursing is routine and requires basic skills, the reality is that it is also socially complex, with multifaceted disease and pharmacology as well as the potential for emergency care. The second-year students picked up on this aspect more than the CAP students. Due to their recent placement experience, the Year 2 students also found it confronting in terms of experiencing death and grief, and in managing their own grief,’ explains Heath.

Other negative responses included the impression that aged care was very routine, boring and underpaid; that it was understaffed, and nurses were overworked; concern about loss of residents (death); that it would not develop nursing skills; that it was difficult, challenging and intimidating; and concern about being the only registered nurse on duty.

‘There were some beautiful examples where students said that it is really challenging work, but it is incredibly rewarding and it's very privileged work to do. It's a way for them to give back to the previous generation,’ says Heath.

Other positive themed feedback included the perception that there was less emergency care, enduring relationships with patients, the routine and predictability, and a sense of satisfaction.

‘It was really insightful for us to see what students’ expectations and experiences were. I’m particularly interested in the notion of happenstance. When students are placed in a particular area it will either confirm or deny what they previously thought. Clinical exposure often shapes what students think for the rest of their careers,’ explains Heath.

She will use the results of the study to further inform the timing of placements and development of the nursing curriculum, and specifically to better support student’s experiences of placements – including better grief-support and preparation for the unexpected realities of aged care.

Heath is keen to collaborate across Te Pūkenga network to discover if her research is representative of New Zealand students. She is also interested to partner with aged care providers to ask nurses why they chose aged care, which will give a fuller picture to her findings.

‘This is going to be a big area of workforce development for the future and Te Pūkenga offers us a fantastic opportunity to inform nursing curricula with the possibility of it being delivered in a national way,’ says Heath.  

• Dr Samantha Heath is currently a Senior Lecturer in Nursing at Unitec in Auckland. She is course leader on the undergraduate Bachelor of Nursing programme, teaching human biology for nursing and evidence for nursing practice. Samantha has held teaching positions in both clinical and academic nursing settings here and in the UK. Her research is focussed on undergraduate and continuing education for nurses. She holds degrees in cancer nursing and education for healthcare professionals. She is a graduate of Massey University where she completed her doctoral studies in 2019. Contact Samantha Heath.

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