Student nurses still phobic of aged care

Above: Associate Professor John Stevens, Southern Cross University, presenting at the 9th Asia Oceania Gerontology and Geriatrics Congress in Melbourne last week

By Keryn Curtis

Two nursing academics say radical change is needed to the way aged care nursing is taught in universities if aged care is to attract the nurses it needs to care for increased numbers of elderly people over the next few decades. 

Despite more than a decade of targeted efforts to improve the aged care nursing experience of nursing undergraduates, student perceptions of a career in gerontic nursing remain extremely negative.  This was the finding of a research project presented last week at the 9th Asia Oceania Gerontology and Geriatrics Congress in Melbourne.

The research, undertaken by Associate Professor John Stevens of Southern Cross University, was a follow-up study emulating the research project Professor Stevens had undertaken for his PhD in 1995.  

In the 1995 research, Professor Stevens had tracked the perceptions of students in six nursing degree programs in New South Wales. The study asked students, based on their study and personal experience of placements, to give a ranking, in order of their preference, to ten different areas of nursing practice where they might like to work.  Rankings were measured across the three year degree program to see if and how nursing students’ views and perceptions about aged care nursing varied over the period*. 

The 1995 research found that first year students had relatively low expectations of aged care nursing as a career choice but not strongly formed views, ranking aged care seventh in a list of ten areas of nursing practice.  However, by second year and following exposure to practical placements in aged care, students’ original views were only strengthened, with aged care being ranked ninth.  By third year, students ranked aged care tenth (last) in their list of preferred nursing career areas.

In the 2010 survey, while some of the cited reasons have changed, the rankings given by first, second and third year nursing students for aged care, versus the nine other areas, remain unchanged. 

Professor Stevens said he was personally very disappointed with the results of the study.

“After all the efforts I and my colleagues have put in to improve the image and experience of aged nursing over the last ten years, I had expected things to improve yet there was almost no change at all. So I was quite disappointed. 

Professor Stevens said efforts to improve the image of aged care nursing had included better training to supervisors, reduced student ratios, getting more aged care specialists into the teaching program and coaching for nursing home staff to help make students feel welcome.  

“We’ve tried to address the balance of weight given to aged care versus acute care and other areas.  But there is a strong correlation between how much time was spent in practical placements and attitudes to aged care.  Basically, the greater number of days spent working with older people, the less they want to work with them,” he said.

The only changes between the two surveys, he says, related to the reasons students gave for the low rankings.

“In 1995 the main difference was nurses said they didn’t like the places they had to go to. They said nursing homes were nasty places to work.  By 2010 they were saying that it would have a negative impact on their career.

“They say things like, ‘you wouldn’t get to use all of your skills…you’d forget how to inject stuff….or how would I ever become a CNC?’  They say they want a career where they can make a difference but they see aged care nursing as managing slow death. 

“They say they want to work with people who are going somewhere. They look at intensive care and say, this is where the action is.  Status is the biggest problem.  There’s this underlying view of aged care being ‘low tech’.  Even if they got the pay disparity right, there’s still issues of status that need to be addressed.  It’s just not valued by the profession,” Professor Stevens said.

Meaningful solutions

Andrew Robinson, Professor of Aged Care Nursing and leader of the Wicking Dementia Research and Education Centre teaching aged care facility program at the university of Tasmania, says his own research reflects identical results.

He says the teaching of aged care nursing needs an integrated, strategic approach based on evidence, rather than piecemeal efforts.

“Yes, student attitudes to aged care just get worse over time,” said Professor Robinson who was also a speaker at the Gerontology and Geriatrics Congress in Melbourne last week.

“That’s because in our curricula, we are not addressing ageing in a meaningful way. We’re not addressing the whole issue of elderly people in a way that is meaningful for these young health professionals.  

“Yet, as I point out to them, this is 80 per cent of who they will be looking after. I used to get a whiteboard full of pejorative terms and say so this is what you think about the people who will be 80 per cent of who you look after?  So we made it personal. To address these kinds of views you need to make it meaningful and you need to make it interesting,” Professor Robinson said.

He said teaching and research aged care facilities (TRACS) were an important and effective response to many of these problems.  

“In our teaching aged care facility, the medical students said they appreciated and understood the importance of seeing elderly people in a non-acute phase.  Otherwise, how would they know what an elderly person might look like or be like normally if they never see them in anything but an acute phase?  

“If we give nurses exposure to someone with dementia then they’re scared.  But if we give them training and experience in research about people with dementia then it becomes interesting. We need to be strategic about this, not just reactive, and it needs to be based on evidence.  What we are doing with our teaching aged care facility is based on ten years of research,” he said.

* Professor Stevens says he was careful to ensure the follow up study fifteen years later was conducted with the same questions, in the same way, to enable robust comparison.  The key difference with the 2010 study was a reduced number of nursing degree programs – three in the second study as opposed to six in the original one

The ten areas of nursing practice were: paediatrics; intensive care; operating theatre; surgical; medical; community health; elderly/aged care; psychiatric; community mental health; and developmental disabilities