Characterising graduate-entry nursing degrees in Australia: A discussion and reflection

Drawing of graduation cap sitting on top of a stack of three nondescript books.

Graduate-entry nursing (GEN) degrees provide a pathway to registered nurse (RN) practice for students who already hold a bachelor’s degree in a field other than nursing. GEN degrees were first introduced in Australia in 1997 (Duke 2001) to address a shortage of nurses by providing an accelerated two-year pathway to registration (Everett et al. 2013). 

Fifteen GEN programs are currently available; six bachelor and nine master degrees1. The bachelor degrees provide credit for the first year of a standard-entry nursing (SEN) bachelor’s degree, allowing direct entry into second year. Master’s degrees are specific to graduate cohorts. The majority of programs require either the student’s first degree to be from a health-related field or the completion of a tertiary-level anatomy and physiology course prior to admission1

Internationally, these programs are increasingly common, particularly within the United States, Canada (Everett et al. 2013), and United Kingdom (Sheppard, Stacey & Aubeeluck 2018). They have attracted some publications, however the research base in the Australian context is still developing.

Despite the increased prevalence of these degrees, observationally, there is a poor awareness of their existence. To add to this confusion, there is no uniformity in the naming of each master’s degree1 and some share the same name as traditional post-graduate master’s degrees. For example, one university1 has a graduate-entry Master of Clinical Nursing, while at least five other universities2 offer a post-registration degree of the same name, further complicating the matter.

As graduate-entry master’s students, my cohort and I are frequently required to explain our role and that we are not already RNs. One student on their first placement was yelled at by an RN because they did not know something that a master’s student ‘should’ know. Despite a previous discussion, the RN did not comprehend their level of education and was confused by our non-traditional program. Another student reported being bullied by an RN who did not believe any nurses should have degrees; our program was particularly undesirable to this nurse.

Similar to other GEN programs, my cohort is diverse. We have backgrounds in midwifery, enrolled nursing (also holding non-nursing degrees), allied health, and medical science through to journalism, graphic design, architecture, and information technology, amongst others. We are a mix of domestic and international students. Approximately 30% of our cohort are male, similar to other GEN degrees and a much higher rate than SEN programs (Everett et al. 2013; McKenna, Brooks & Vanderheide 2017; McKenna & Vanderheide 2012). While some students have entered straight from a bachelor’s degree, with high school immediately before, many have left established careers to become an RN, with family, and other personal and financial commitments that may not be as salient for many SEN students (Neill 2012).

GEN students typically have an academic advantage over SEN students, obtaining higher academic results (Duke 2001; Everett et al. 2013). Having already completed at least one degree, GEN students have established a well-practiced approach to learning, promoting advanced critical thinking (Everett et al. 2013), an ability to incorporate broader perspectives (McKenna & Vanderheide 2012), and higher levels of motivation (Neill 2012). To my knowledge, there is no published Australian data on whether this leads to improved employment outcomes, however there is some evidence from the United States that GEN and SEN students have similar long-term outcomes in most domains (Schwartz et al. 2015).

Given the heterogenous demographics and level of academic experience in GEN students, it is unsurprising that we are considered more difficult and exhausting to teach than SEN students (McKenna & Vanderheide 2012). Our previous education may shape expectations of our current course and lead to more questions from students, promoting more challenges to academic content (McKenna & Vanderheide 2012). Additionally, at course commencement, some students had a high level of health care literacy, while others were naive, making it difficult to tailor content to individual knowledge and maximise learning outcomes.

Similar difficulties can occur during clinical placement. A nurse complained to me that another student asked too many questions and was too curious. This student was previously an allied health practitioner and I am sure was trying to fill the gaps in their knowledge between the two professions. They are a confident and enthusiastic learner. The nurse thought the student was mentally demanding and this detracted from their desire to work with this student. Unsupportive attitudes towards question-asking can contribute to a poor sense of belonging and reduce students’ ability to learn (Levett-Jones et al. 2008). In this case, it also had a flow-on effect, as I was less inclined to ask questions after this interaction.

A number of students in my degree have studied at post-graduate level, including doctoral level, which has been said to be particularly challenging to academics who are also studying at this level themselves (McKenna & Vanderheide 2012). Students do not expect academic lecturers to be experts on every detail in all topics they teach. However, when they are teaching students who may have expertise in these areas, it creates an interesting dynamic. 

The lecturers in my program are generally accepting of student’s previous experiences. Some students are confident and will speak up, clarifying incorrect information, however others are concerned how this will be perceived and remain quiet. It is difficult to know how to approach such a situation. 

Previous research has found students in similar situations become frustrated when unable to integrate their previous experience and knowledge (Duke 2001; Neill 2012). Conversely, they feel valued when this was recognised (McKenna & Vanderheide 2012), which may further enhance learning. It is interesting to note that a study in the United Kingdom found GEN students felt the need to avoid disclosing their previous experiences and carefully manage any critical evaluations so as not to appear threatening (Stacey, Pollock & Crawford 2016). Many students in my course were particularly anxious about this before beginning placement. 

An inability to utilise previous experiences caused personal conflict when I recently attended my first placement. I witnessed markedly poor and missed care that I may not have had the knowledge to detect without this experience. Having previously advocated for patients in clinical and research roles, it was natural for me to want to speak up, as well as problem-solve. I was advised by the university that I could not discuss my prior knowledge or assessment of the situation because I may ‘teach’ something. Teaching was beyond my scope of practice. Being able to identify simple, no-cost improvements for some of these issues (most were structural) based around fundamentals of care and communication, with no agency to even discuss what I witnessed was incredibly frustrating, leading to moral conflict. I did not want to be complicit in these activities. Sheppard, Stacey and Aubeeluck (2018) highlight the importance of support and clinical supervision for GEN students to work through these situations. Unfortunately, there was no access to support in this instance, which compounded the distress I experienced.  

I am not an expert in nursing education and the intricacies of how scope of practice and competencies are determined at each stage of learning. However, students with relevant previous qualifications may be an under-utilised resource. The ability to have respectful discussions with nurses about our previous experiences and if they could be applicable to their environment may promote patient advocacy, critical thinking, problem solving, and inter professional learning in both students and practicing nurses. At best, a student may be able to provide a different perspective and improve patient care. At the least, they may gain insight into how nursing practice differs from their previous practice, providing a valid and helpful learning experience.

While GEN students finish their degree with the same entry-level registration as SEN students, there are a number of differences between these populations. Until there is a greater awareness of GEN degrees, there will not be an adequate understanding of the unique experiences of GEN students, the strengths they can bring to the nursing profession, and how these students can be better supported.

Perhaps this recognition could begin with professional nursing organisations, where there is little acknowledgement of those undertaking postgraduate entry-to-nursing programs. Student membership to the Australian College of Nursing, for example, is called ‘Undergraduate Membership’ and grants the post-nominals ‘MACN (Undergraduate)’ (Member of the Australian College of Nursing). This applies to all pre-registration students, regardless of the degree level. Adopting ‘Pre-registration’ may be a more inclusive term than ‘Undergraduate’ and help promote awareness that alternative degree pathways are a recognised mode of RN education. 

Footnotes

 1Australian graduate-entry nursing programs and relevant academic prerequisites 

UNIVERSITYDEGREEPREREQUISITES
Bachelor Degrees
Flinders UniversityBachelor of Nursing (Graduate Entry)Bachelor degree
La Trobe UniversityBachelor of Nursing (Graduate Entry)Bachelor degree preferably in health, behavioural, or biological sciences

Human biology course (or bridging)
Queensland University of TechnologyBachelor of Nursing (Graduate Entry)Bachelor degree within 10 years
University of the Sunshine CoastBachelor of Nursing Science (Graduate Entry)Bachelor degree 
University of Technology SydneyBachelor of Nursing (Graduate Entry)Bachelor degree in human physical or behavioural science within 8 years 
Western Sydney UniversityBachelor of Nursing (Graduate Entry)Bachelor degree in biological, health, or behavioural science within 10 years
Master Degrees
Curtin UniversityMaster of Nursing PracticeBachelor degree with GPA≥70%  

Research and human biology courses (or bridging courses)
Edith Cowan UniversityMaster of Nursing (Graduate Entry)Bachelor degree with GPA≥60%  

Human biology course (or bridging)
Monash UniversityMaster of Nursing PracticeBachelor degree with GPA≥60%  

Human biology course (or bridging)
University of AdelaideMaster of Clinical NursingBachelor degree with GPA≥4.0  

Human biology course (or bridging)
University of MelbourneMaster of Nursing ScienceBachelor degree within 10 years 
or 
Older bachelor degree with postgrad or 5 years relevant work experience 

Tertiary anatomy and physiology knowledge assumed
University of New EnglandMaster of Nursing PracticeBachelor degree in health related discipline 
University of QueenslandMaster of Nursing StudiesBachelor degree with GPA≥4.0  

One course in biological science, chemistry or physics
University of SydneyMaster of NursingBachelor degree within 10 years (older qualification at discretion)
University of Western AustraliaMaster of Nursing Science (Entry-to-practice)Bachelor degree, others unknown

Please let me know if I have missed any programs, I will be happy to amend this list. 

2Australian Catholic UniversityCentral Queensland UniversityCharles Darwin UniversityEdith Cowan University, and University of Tasmania

All URLs are accurate as of 5 July 2019.

References

Duke, M. 2001. On the Fast Track speeding nurses into the future: A two-year bachelor of nursing for graduates of other disciplines, Collegian, 8(1), 14-18. doi: 10.1016/S1322-7696(08)60397-2

Everett, B, Salamonson, Y, Trajkovski, S & Fernandez, R. 2013. Demographic and academic-related differences between standard-entry and graduate-entry nursing students: A prospective correlational survey, Nurse Education Today, 33(7), 709-713. doi: 10.1016/j.nedt.2013.03.006

Levett-Jones, T, Lathlean, J, Higgins, I & McMillan, M. 2008. Staff – student relationships and their impact on nursing students’ belongingness and learning, Journal of Advanced Nursing, 65(2), 316-326. doi: 10.1111/j.1365-2648.2008.04865.x 

McKenna, L, Brooks, I & Vanderheide, R. 2017. Graduate entry nurses’ initial perspectives on nursing: Content analysis of open-ended survey questions, Nurse Education Today, 49(Feb), 22-26. doi: 10.1016/j.nedt.2016.11.004

McKenna, L & Vanderheide, R. 2012. Graduate entry to practice in nursing: Exploring demographic characteristics of commencing students, Australian Journal of Advanced Nursing, 29(3), 49-55.

Neill, M. 2012. Graduate-entry nursing students’ journeys to registered nursing, Nurse Education in Practice, 12(2), 89-94. doi: 10.1016/j.nepr.2011.08.002

Schwartz, J, Starts-Hopko, NC & Bhattacharya, A. 2015. Comparison of demographics, professional outcomes, and career satisfaction in accelerated and traditional baccalaureate nursing graduates, Journal of Nursing Education, 54(3), S39-S46. doi: 10.3928/01484834-20150218-11

Sheppard, F, Stacey, G & Aubeeluck, A. 2018. The importance, impact and influence of group clinical supervision for graduate entry nursing students, Nurse Education in Practice, 28(Jan), 296-301. doi: doi.org/10.1016/j.nepr.2017.11.015

Stacey, G, Pollock, K & Crawford, P. 2016. The rules of the game in graduate entry nursing: A longitudinal case study, Nurse Education Today, 36(Jan), 184-189. doi: 10.1016/j.nedt.2015.09.016

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