Critical nursing shortages are being experienced both internationally and nationally. With the nursing workforce ageing successful recruitment and retention of young people is a high priority in order to secure and maintain strong healthy employment levels for the future.

In partnership with the NSW Department of Education and Training, NSW TAFE, University of Western Sydney and The Australian Catholic University, Sydney West Area Health (SWAHS) has developed an innovative approach to recruit secondary school students into nursing. The first area wide Nursing Initiatives In Schools Program was established in 2007. This paper outlines the SWAHS response to the NSW Health State Health Plan Strategic Direction 6 – "Building a sustainable health workforce" and sets out the implementation process and student outcomes.

The Nursing Initiatives in Schools (NIIS) program aims at increasing the number of secondary students enrolling to undertake nursing studies across Sydney West hospitals by providing incentives and opportunities.

For SWAHS the availability of a skilled workforce is a major issue now and in the future. This is due to a number of factors including workforce ageing, lower average working hours, increasing specialisation in a number of professions and issues of job satisfaction” (SWAHS Workforce Development Plan 2007 – 2010). NSW is facing a significant nursing workforce shortage (Australian Health Workforce Advisory Committee 2003).

The National Review of Nursing Education 2002 recommended the implementation and expansion of opportunities in vocational education and training in schools based on the Health Training Package to attract secondary school students to the nursing profession and provide a career pathway from school to nursing.

Prior to 2005 the vocational education pathways provided to secondary school students wishing to pursue a career in Nursing were limited to aged care. Whilst it is of high importance to recruit into aged care, students did not find this an attractive option and course entry numbers were low. Year 10 secondary school students who had undertaken nursing work experience in the acute care environment indicated that they wanted more, a viable career pathway that would give them recognition of prior learning into entry level nursing courses and work ready skills upon completing secondary school.

Evidence suggests that school career advisers had limited knowledge of nursing pathways roles and responsibilities. "Despite a range of initiatives to promote registered nursing as a career choice, careers advisers are not influencing significant numbers of school students to consider registered nursing as a career" (King, Hardie, Conway 2007) Further, it has been found that "Australian tertiary students were more likely to leave the nursing course than those with a more accurate perception". (King, Hardie, Conway 2007)

In line with NSW State Health Plan – Strategic Direction 6 – 'Building a sustainable health workforce" (recruitment and retention) SWAHS has contained within it's Workforce Development Plan (2007 – 2010) the impetus to strategically manage self sufficiency in workforce supply which includes the development and implementation of:

• The Nursing Initiatives in Schools program, providing an education career pathway for secondary school students into Nursing.
• Marketing and promotion strategies to target occupational groups with workforce shortages.
• Aboriginal workforce, strong networks formed with the Aboriginal and Torres Strait Islander (ATSI) community by providing incentives and opportunities for KOORI students. There are five students currently enrolled in SWAHS Nursing Studies.

In 2006 SWAHS established the first area wide Nursing Initiatives in Schools Program (NIIS) with the intent to:

• Recruit and train potential employees.
• Have school leavers with employability skills.
• Provide career pathways to the Certificate 1V in Nursing (Enrolled Nurse) or Bachelor of Nursing.
• Create professional development opportunities for staff in workplace training, evaluation and provision of feedback.
• Raise the profile of nursing within the school system by informing careers advisers.

In partnership with NSW TAFE, NSW Department of Education, University of Western Sydney and the Australian Catholic University the HSC NSW Board of Studies (BOS) endorsed Nursing Studies course was delivered to year 11 and 12 students at Auburn, Blue Mountains ANZAC District Memorial, Blacktown/Mt Druitt, Hawkesbury, Nepean, Westmead and Lithgow Hospitals.

This was also fully supported by the NSW State Government, NSW Nurses Association and Nurses and Midwives Board of NSW.

In 2006/7 preceding commencement of NIIS a comprehensive marketing strategy was undertaken by:

• Provision of a SWAHS Career Adviser Forum to introduce NIIS to Sydney West Region schools.
• Development and distribution of posters and brochures to schools and hospitals.
• Student/ parent information sessions and school career markets across Sydney West Region.

In Year 11 students gain an Australian Qualification Framework Statement (AQF) of Attainment "Nursing in the Acute Care Environment" and credit toward the Trainee Enrolled Nurse program or Certificate 111 Health VET pathways. Students attend weekly classes and participate in hospital based activities.

Year 12 comprises of two units from the Bachelor of Nursing (BN) Year 1 and attracts advanced standing and fast tracking of students into the BN. Supported by a team of dedicated clinical nurse educators, students participated in work experience and provided valuable ongoing feedback to assist in ensuring quality of education for future students.

SWAHS received 130 student applications from 39 government and non-government secondary schools in the Sydney West Region. (Initial target of 100) Of the 130 applications 105 students were enrolled and attended class at seven hospitals across Sydney West Area Health Service. Figure 1 & 2 demonstrates the participating schools involved in the program.)

39 schools participated in the program
24 government schools had 71 students participate
15 non-government schools had 34 students participate (Catholic Education)

Figure 1

Figure 2

Figure 3 demonstrates student retention rates.

Of the 105 participants there were 26 year 12 students who left school.
Of the remaining 79 students 8 students left school leaving a total of 71 Year 11 students continuing on to Year 12 2008.

Figure 3

On completion of Year 11 (2007) 105 students completed a questionnaire and provided feedback to SWAHS. 90% respondents expressed the desire to continue nursing studies at tertiary level. General comments were very positive and similar in response and included:

"This course was a fabulous insight into the world of nursing."

"So glad I undertook the course, it has helped me to make up my mind to enter nursing."

"Looking forward to being a uni student."

"Thank you, an awesome experience, please keep the course going."

All students have successfully achieved course goals and objectives. Feedback from NSW TAFE indicated that the course is popular with students and retention rates are higher than for other occupational HSC vocational education programs.

In order to ensure sustainability of this initiative SWAHS has also committed to the delivery of Nursing Studies through the establishment of a formal partnership with the NSW Department of Education and Training, Health Trade School at Jamison High School, Penrith in line with the state and federal governments vision of education reform.

Having led the way across NSW, SWAHS is now providing a consultancy role to other area health services that are implementing NIIS. VET programs in schools have been extended to include the Certificate 111 in Allied Health Assistant or Health Care Assistant, which will lead to employment.

SWAHS will also assist with employment to undergraduate students whilst completing the Bachelor of Nursing degree.

• Australian Health Workforce Advisory Committee (2003) Annual Report 2002 - 03. AHWAC Report 2003.1, Sydney.
• A New Direction for NSW State Health Plan Towards 2010, February 2007.
• An Employer’s Guide To Workplace Learning, © NSW Department of Education and Training (Vocational Education in Schools Directorate) November 2005.
• National Review of Nursing Education, Our Duty of Care, National Review of Nursing Education 2002, Commonwealth of Australia.
• Industrial Relations Policy and the NSW Nurse Shortage, A Report by the New South Wales Nurses’ Association, Prof John Buchanan, Workplace Research Centre. University of Sydney February 2007.
• “King J, Hardie K, Conway,J (2007) “The perceptions of High School Careers Advisers Regarding Nursing”. Contemporary Nurse Vol 24, Issue 2: 37 – 138, April 2007, Qld, Australia.
• Workforce Development Plan, Sydney West Area Health Service 2007-2010.

Associate Director - Clinical Governance, Clinical Governance Unit
Sydney West Area Health Service
Phone: 02 9881 7524