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Aust J Rural Health. 2021;00:1–13. wileyonlinelibrary.com/journal/ajr
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© 2021 National Rural Health Alliance Inc.
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INTRODUCTION
Growth in the number of graduates exiting higher education
courses is most notable in the health sciences, with enrol-
ments increasing 92% between 2007 and 2017.1- 3 Coinciding
with this increase has been a marked deterioration in the
Australian labour market.1- 4 This has impacted graduate em-
ployability and increased the time taken to gain professional
employment.3,5 Prior to the global financial crisis in 2008,
85.2% of graduates gained full- time employment within
Received: 18 December 2020
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Revised: 14 May 2021
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Accepted: 10 June 2021
DOI: 10.1111/ajr.12773
ORIGINAL RESEARCH
Rural employment: A get- go for recent nursing and allied health
graduates?
BelindaJessup PhD
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TonyBarnett PhD
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MerylinCross PhD
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KehindeObamiro PhD
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SuzanneMallick PhD
Centre for Rural Health, College of Health
and Medicine, University of Tasmania,
Launceston, TAS, Australia
Correspondence
Belinda Jessup, Centre for Rural Health,
School of Health Sciences, College of
Health and Medicine, University of
Tasmania, Locked Bag 1322, Launceston,
TAS 7250, Australia.
Email: belinda.jessup@utas.edu.au
Funding information
University of Tasmania
Abstract
Objective: To explore the pathways recent nursing and allied health graduates have
used to gain initial employment in regional and rural Tasmania.
Design: A mixed- methods design comprising an online survey and semi- structured
interviews.
Setting: Tasmania, Australia.
Participants: Eighty- four recent nursing and allied health graduates from 18
disciplines.
Main outcome measures: Location and pathway to initial employment, job search
strategies, number of job applications and length of time taken to gain employment.
Results: Participants obtained their qualification from Tasmania or mainland
Australia. Rural- origin graduates were more likely to work in rural locations after
graduating. Graduates sought initial regional or rural employment to be close to fam-
ily; to avail themselves of more job opportunities and less competition from other
graduates; and for adventure. An inability to secure metropolitan jobs led others to
seek opportunities in regional and rural Tasmania. Graduates that used multiple job
search strategies and who were more flexible regarding location and field of initial
employment experienced fewer challenges gaining employment.
Conclusion: For recent nursing and allied health graduates, securing initial em-
ployment can be time- consuming and labour- intensive. Being flexible, persistent
and willing to adjust expectations about work location will help. Rural employment
might provide the right get- go for a professional career. Understanding the pathways
recent graduates have used to gain initial rural employment can help better connect
graduates and prospective employers.
KEYWORDS
graduate employment, health science graduates, labour market, recruitment, rural health
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JESSUP Et al.
4months of graduating.4,5 After the end of the mining boom
in 2014, this fell to a 17- year low of 68.1%.4,5 Although
recent data suggest improved graduate employability out-
comes, figures vary depending on the course studied.5 For
example, in 2019, less than two- thirds (63.4%) of psychol-
ogy graduates had gained full- time employment 4 months
after graduation, yet for pharmacy graduates, the figure was
95.7%.5 The growing divide between graduate numbers and
employability in some disciplines has led to speculation there
is an oversupply of graduates for the number of jobs available
in some health professions.6,7
Paradoxically, the increase in graduates has done little
to address the rural health workforce shortages. Employers
in rural Australia continue to struggle to attract a sufficient
number of health professionals, contributing to the maldistri-
bution of the workforce.8 Although rural and remote employ-
ment might appear less popular to graduates,9 efforts have
been made to ‘ruralise students' horizons’ by exposing them
to positive rural work- integrated learning experiences.10
Growing awareness among health graduates of difficulties
gaining initial employment in metropolitan areas7,11,12 might
have increased the attractiveness of rural employment, with
the number of vacancies available to graduates9,13 and re-
duced competition for positions offering latent workforce
potential.9,11
Studies have reported on initial rural employment and
aspects of undergraduate curricula that best prepare health
graduates for rural practice.12- 16 While these studies have
identified factors associated with seeking initial rural prac-
tices such as rural background and positive rural clinical ex-
periences, few have considered the availability of jobs.13 This
is a critical gap within the research literature, particularly
as a study by Kumar et al11 found the lack of metropolitan
job opportunities was a key enabler to seeking rural work.
Further exploration of health graduates' experiences gaining
work that considers job availability is therefore important to
comprehensively understand the ‘how, where and why’ of
their initial employment.
As a consequence, this study explores the pathways of
recent nursing and allied health graduates to employment
in non- metropolitan areas. Specifically, it examines the per-
ceptions and experiences of recent graduates gaining initial
employment and the strategies they used to look for and find
work in rural and regional Tasmania.
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METHOD
2.1
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Design
A convergent parallel mixed- methods study17 involving an
online survey and semi- structured interviews examined the
pathway recent nursing and allied health graduates used to
gain employment in Tasmania. This design saw quantitative
and qualitative data collected concurrently from the online
survey and semi- structured interviews, then analysed sepa-
rately before being compared to identify similarities and dif-
ferences between findings.17
2.2
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Recruitment
Participants were graduates who had completed a nursing
or allied health qualification in the last 3years (2015- 2018)
and employed in Tasmania. Participants were recruited to the
study in 2018 by a number of methods. Firstly, advertisements
were printed in the 3 local Tasmanian newspapers. These ad-
vertisements contained details about the study and invited
recent graduates to access the Uniform Resource Locator
(URL) of the online survey. Secondly, nursing and allied
health professional associations were contacted and asked to
forward an email invitation containing a hyperlink to the on-
line survey to Tasmanian members via professional websites
and social media. Further, job advertisements for nursing
and allied health professional positions in Tasmania posted
online through Seek, Jora, Indeed, Tasmanian Government
and Gumtree were prospectively collected between 1 January
and 31 December 2018. All identifiable contact persons
(n=435) were emailed an information sheet outlining this
study and asked to forward an email invitation (containing a
hyperlink to the online survey) to the people working in their
What is already known on this subject:
• Health workforce shortages persist in rural and
remote areas despite Australia producing record
numbers of nursing and allied health graduates
• Many health graduates prefer to work in metro-
politan areas; however, the positions available are
limited
What this study adds:
• This study identifies the pathways of recent nurs-
ing and allied health graduates to rural and re-
gional employment in Tasmania, Australia
• It provides information useful to future graduates
seeking work and to rural health employers keen
to recruit graduates
• It highlights the need to ruralise health sci-
ence curricula and include rural clinical place-
ments to adequately prepare graduates for rural
employment
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JESSUP Et al.
organisation who had completed a nursing or allied health
qualification in the last 3years. Finally, snowball recruitment
was also employed, with survey respondents encouraged to
forward the email invitation to anyone they knew of work-
ing in Tasmania who had qualified as a nurse or allied health
professional in the last 3years.
During January and February 2018, a total of 746 job ad-
vertisements were found for nursing and allied health profes-
sional positions, with 5.5% of these specifically mentioning
recent graduate suitability. To extrapolate these figures and
to ensure the sample would be of sufficient size, a calcula-
tion of the required sample size for a cross- sectional study
was done according to the method outlined by Charan and
Biswas.18 Using our estimate of the proportion of new gradu-
ates (5.5%), applying P<.5 with an absolute error set at 5%,
we calculated that the minimum sample size required, based
on advertisements, was estimated to be 80.
2.3
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Data collection
The survey comprised a series of questions on demographics,
discipline and place of study, self- reported rural background,
rural clinical placements, job search strategies, number of
job applications before becoming employed and location of
initial employment. All survey data were obtained anony-
mously. No personal identifiers were requested. Survey re-
spondents were also invited to participate in a semi- structured
telephone interview that sought further information on their
pathway to initial employment; perception of the job market;
the time taken to gain employment; and extra steps taken to
secure employment. Contact details for consenting survey re-
spondents were obtained independent of the online survey,
and therefore, survey data and interview data were unable to
be matched.
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Data analysis
To allow for integration, survey and interview data were
analysed separately by the first author.19 Survey data were
analysed using IBM SPSS Statistics for Windows, version 24
(IBM Corp.). Data about location of employment and place-
ments were classified according to the Modified Monash
Model, with locations MMM1 as metropolitan, MMM2 as re-
gional and MMM3- 7 as rural/remote.20 No areas of Tasmania
are classified as MMM1 (metropolitan), with Hobart, the
capital city, recognised as MMM2 (regional). Respondents
were considered Tasmanian graduates if they had studied in
Tasmania. Mainland graduates included those having studied
in other Australian states and territories or overseas.
Interviews were audio- recorded and transcribed verbatim.
Data were then deidentified and allocated an alpha- numeric
code to denote discipline and participant number. After mul-
tiple readings, transcripts were subjected to inductive con-
tent analysis. Data were coded and collapsed into categories
and subcategories, initially by the first author, then agreed or
modified through consensus discussions with the broader re-
search team to ensure they accurately reflected respondents'
accounts.21 Survey and interview data were then subjected to
the process of integration, with a focus on identifying simi-
larities and differences between the 2 data sets. A series of
meta- themes emerged after comparing the quantitative and
qualitative findings, which were then confirmed or modified
through discussions with the research team.19
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Ethics approval
Approval to undertake this research was granted by the
University of Tasmania's Health and Medical Human
Research Ethics Committee (H0017219).
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RESULTS
Between July 2018 and March 2019, 101 surveys were re-
ceived. Of these, 17 (16.8%) were excluded because they
were incomplete, or the respondent did not meet the eligi-
bility criteria. Of the 84 remaining respondents, 17 (20.2%)
consented to an interview.
3.1
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Recent graduates' characteristics
Survey respondents represented 18 different nursing and al-
lied health disciplines. Respondents were predominately fe-
male (83.3%) and younger than 34years (84.5%; median age:
27years; Table1). They had graduated from educational in-
stitutions in all states except the Australian Capital Territory,
with 42.9% from Tasmania and 16.7% from Victoria. The
highest qualification for over half of the respondents (56%)
was an undergraduate degree, though 39.3% held a postgrad-
uate qualification. Over half (57.1%) of the respondents re-
ported a rural background, and 38.1% had completed a rural
clinical placement while studying.
3.2
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Initial employment
Almost all survey respondents were initially employed in
either regional (72.6%) or rural/remote (23.8%) Tasmania
(Table 2). Regional jobs were predominantly in the public
sector (70.5%), with this trend reversed for the rural/remote
(45.0%) and metropolitan (33.3%) positions. Rural/remote
employers offered more permanent positions (55.0%) than
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JESSUP Et al.
regional employers (42.6%). However, twice as many re-
gional positions (83.6%) were full- time compared with rural/
remote (40.0%).
At the time of the study, almost 3 in 4 survey respondents
initially working in regional or rural/remote areas were still
employed in their first job, with the average time employed
12.8 months and 11.2 months, respectively. The graduates
initially employed in metropolitan areas (n=3) had all left
their first job and had been working in regional Tasmania
for an average of 6months. Survey respondents gave a va-
riety of reasons for leaving their first position including the
following: contract ending, not enjoying work, location and
salary, and not working in the field they wanted. Six gradu-
ates had left their first job to take on another role with the
same employer.
There was a significant association between rural origin
and rural/remote employment (P=.01), with 70.0% of sur-
veyed graduates working rurally reporting a rural background
(Table 3). Proportionally, more rurally/remotely employed
graduates (75.0%) had completed a rural clinical placement
than those employed regionally (49.2%) or in metropolitan
areas (33.3%); however, there was no significant association
between rural clinical placement and initial employment in a
rural area (P=.08).
3.3
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Pathways of recent graduates to
initial employment
Both survey and interview data shed light on graduates' path-
way to initial employment including the following: (a) prepa-
ration for employment; (b) perceptions of the job market; (c)
when and how graduates searched for and found initial em-
ployment; (d) where graduates searched for work; (e) number
of jobs applied for prior to employment; and (f) time taken to
become employed. The 17 interview participants were from
varied nursing and allied health disciplines including speech
pathology (n = 4), enrolled nursing (n =3), occupational
therapy (n =2), psychology (n = 2), exercise physiology
(n=2), midwifery (n=2), social work (n=1) and registered
nursing (n=1).
3.3.1
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Preparation for initial employment
Interview participants reported strategically preparing for
employment using industry- based work prior to graduating,
volunteering throughout their course, becoming a member of
their professional association and attending professional de-
velopmental events.
I was working as a carer…I knew that was kind
of an edge, like already being in there and start-
ing with the Certificate III. I think that does give
you a bit of…an edge just to even know about
terminology and settings…
(Enrolled Nurse #1, rural background)
We were told that volunteering looked really good
on our resume, so I did some volunteering work.
(Occupational Therapist #1, rural background)
I put a lot of effort into what professional devel-
opment I did, so that it looked good on your re-
sume… I did a lot of volunteer work throughout
my degree as well, like to do with refugees…
TABLE 1 Profile of recent nursing and allied health graduates
working in Tasmania
N=84 %
Sex
Male 14 16.7
Female 70 83.3
Age
>25y 27 32.1
25- 34y 44 52.4
35- 44y 3 3.6
>45y 10 11.9
Years post- graduation
≤1y 49 58.3
>1y but ≤2y 24 28.6
>2y but ≤3y 11 3.1
Highest qualification
Vocational 4 4.8
Undergraduate 47 56.0
Postgraduate 33 39.3
Place of study
Tasmania 36 42.9
Victoria 14 16.7
Queensland 11 13.1
New South Wales 9 10.7
South Australia 9 10.7
Northern Territory 2 2.4
Western Australia 2 2.4
Overseas 1 1.2
Background
Metropolitan background 48 57.1
Rural background 36 42.9
Rural clinical placements
Total 32 38.1
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JESSUP Et al.
just to show… I was obviously passionate about
it, but obviously that extracurricular stuff can
stand out as well…
(Occupational Therapist #2, metropolitan
background)
Interviewees were aware of the relationship between clini-
cal placements and employability. As such, some sought place-
ments in organisations they wanted to work in post- graduation.
Others also sought placements in vacation periods to gain addi-
tional experience and skills.
Modified Monash Model (MMM) location of
initial employment
Total
(n=84)
Metropolitan
(MMM1)
Employment
(n=3)
Regional
(MMM2)
Employment
(n=61)
Rural/
Remote
(MMM3- 7)
Employment
(n=20)
n % n % n % n %
Location
Tasmania 0 0.0 61 100.0 18 90.0 79 94.0
Interstate 3 100.0 0 0.0 2 10.0 5 6.0
Sector
Public 1 33.3 43 70.5 9 45.0 53 63.1
Private 2 66.7 18 29.5 11 55.0 31 36.9
Contract
Permanent 1 33.3 26 42.6 11 55.0 38 45.2
Temporary 2 66.7 35 57.4 9 45.0 46 54.8
Tenure
Full time 1 33.3 46 83.6 8 40.0 55 65.5
Part time 2 66.7 15 24.6 11 55.0 28 33.3
Missing 0 0.0 0 0.0 1 5.0 1 1.2
Still employed in first job
Yes 0 0.0 47 77.0 14 70.0 61 72.6
No 3 100.0 14 33.0 6 30.0 23 27.4
TABLE 2 First job characteristics of
recent nursing and allied health graduates
working in Tasmania
TABLE 3 Relationship between rural origin, rural clinical placement and initial employment location
Modified Monash Model (MMM) location of initial employment
Total
Metropolitan
(MMM1)
Employment
Regional
(MMM2)
Employment
Rural/Remote
(MMM3- 7) Employment
n % n % n % n %
Rural origin 0 0.0 22 36.1 14** 70.0 36 42.9
Metropolitan
origin
3 100.0 39 63.9 6 30.0 48 57.1
Total 3 100.0 61 100.0 20 100.0 84 100.0
Rural clinical placement
Yes 1 33.3 30 49.2 15 75.0 32 38.1
No 2 66.7 31 50.8 5 25.0 52 61.9
Total 3 100.0 61 100.0 20 100.0 84 100.0
**Significant difference (P<.01).
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JESSUP Et al.
…in holidays, I volunteered at a private prac-
tice and also one of my clinical educators when
I was [on] placement with her… we developed
a very good connection and she was a private
speech pathologist… she took me with her to a
lot of clients that she saw…
(Speech Pathologist #2, rural background)
3.3.2
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Perceptions of the job market
There were disciplinary variations in perceptions of the job
market among interviewees. Nursing graduates were confi-
dent they would find a job given the range of opportunities
available through graduate transition to practice positions in
the public sector, strong demand in aged care and that pre-
vious cohorts had been employed. They were aware that
outside these transition programs, the job market was primar-
ily casual, and they might need to accept less secure work.
Nursing graduates also perceived rural vacancies were hard
to fill and therefore offered more employment opportunities.
I knew that there were lots of opportunities
there, it was finding the right one was going
to be a bit of a problem had I not got a grad
position.
(Registered Nurse #1, metropolitan
background)
Midwifery graduates felt confident they would find em-
ployment after graduating but were acutely aware this would
likely be in a regional hospital due to a lack of opportunities and
strong competition in larger metropolitan hospitals. Further,
midwifery graduates stated that rural employment was not pos-
sible because rural hospitals preferred dual registered nurse/
midwives.
…a lot of the rural hospitals weren't taking di-
rect entry midwives at the time…
(Midwife #2, rural background)
Interviewees from allied health disciplines considered get-
ting a job was difficult and very competitive. Speech pathol-
ogy and occupational therapy graduates claimed the increase
in courses and graduates limited the opportunities available,
particularly in metropolitan areas. Lecturers advised them early
in their course that it could be challenging to get work and the
key message was to go rural where there are more opportunities
and less competition. Many shared the view that fewer people
apply for rural positions, and therefore, it offers a less compet-
itive gateway into the workforce. Graduates felt they would ul-
timately have to compromise where they wanted to work, both
geographically and clinically.
I knew it was going to be tough. I kind of had an
understanding that a few years ago there were
lots of jobs about but as more courses have be-
come available, you know it's tougher to find
work… we weren't kind of naïve about the fact
that we might have to work pretty hard at trying
to find a position and definitely the concept of if
you are willing to go anywhere, if you're willing
to rural, regional, you know, it will be easier to
get the foot in the door and find a position.
(Speech Pathologist #4, regional background)
Exercise physiology graduates were more positive when
interviewed and indicated their job market was growing.
Notwithstanding, they reported being fearful about gaining ini-
tial employment, with positions available predominantly in the
private sector because their discipline was not yet recognised in
the public system.
I think the only way it's going to be able to go
is to grow bigger, bigger, bigger. Anyone who is
in the job at the moment is far from retiring, so
there's never going to be any kind of turnover for
probably another twenty years.
(Exercise Physiologist #1, rural background)
For some reason the Tasmanian hospital system
does not utilise exercise physiologists. If you
look on the mainland they're everywhere.
(Exercise Physiologist #2, regional
background)
3.3.3
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When and how graduates searched
for and found initial employment
While most survey respondents (n = 52, 61.9%) reported
actively looking for employment prior to graduating, this
was more evident among Tasmanian graduates (75.0%) than
mainland graduates (52.1%). The remaining 38.1% of survey
respondents waited until after they graduated before looking
for work, most of them (n= 19, 22.6%), initiating their job
search within 3months.
Survey responses highlighted that the Internet was
most frequently used by graduates looking for employment
(75.0%), yet less than half (46.4%) of the initial jobs of grad-
uates were found online (Table4). Around one- third of grad-
uates also used work contacts and networks or approached
employers and university careers services to search for work.
Differences were identified between the strategies used by
Tasmanian and mainland graduates to search for work and
where jobs were eventually found. Mainland graduates relied
on the Internet more when searching for work (P=.02), and
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JESSUP Et al.
consequently were more likely to find their first job online
(P= .04). In contrast, Tasmanian graduates used work con-
tacts or networks more than mainland graduates (P=.02),
which also proved more successful in finding Tasmanian
graduates their first job (P = .01). Similar numbers of
Tasmanian and mainland graduates used university careers
services to look for initial work; however, this proved more
successful for Tasmanian graduates (P=.01).
Most surveyed graduates (n = 72, 85.7%) used 4 or
fewer strategies to look for work, with 19.2% relying on a
single- search strategy. The use of multiple- search strategies
was also evident during interviews, including the following:
meeting potential employers face- to- face before applying for
a position, seeking advice on writing a resume, cover letter
and selection criteria from university careers services, and
using clinical supervisors from placements to conduct mock
interviews and check responses to selection criteria.
I made contact with the director of nursing…
probably about 12 months prior to the appli-
cation process opening…and then… roughly
four months before the intake process actually
started… I travelled down and actually met with
her face- to- face to outline my interest in work-
ing in the hospital, so that when my paperwork
came across her table … being that I was [liv-
ing] three and a half thousand kilometres away,
that she would remember who I was and so that
I had given myself the best opportunity. So I re-
searched the hospital, I made contact with the
people that I needed to. I made sure that they
were in a position where they would employ
direct entry graduates from interstate, not just
graduates in the state…then I presented the best
CV and application that I possibly could with
some help of one of the clinical facilitators who
oversaw my training in the Northern Territory…
and it all worked out, thankfully.
(Midwife #1, rural background)
3.3.4
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Where graduates searched for
initial employment
Interview data offered further insight into where graduates
searched for work. Some graduates specifically sought re-
gional or rural/remote employment to live close to family.
Yeah, I did really want to get back… my brother
and his wife had just had a baby at the time, so
our family, I suppose, had just kind of extended
and I really wanted to be here [Tasmania] for
that…
(Speech Pathologist #3, rural background)
I'm happy to go visit any city but…all my
friends and family are here.
(Social Worker #1, rural background)
TABLE 4 Strategies recent nursing and allied health graduates used to search for and find initial employment (N=84)
Strategy
Searched Found
Tasmanian
graduates
Mainland
graduates Total
Tasmanian
graduates
Mainland
graduates Total
n n n (%) n n n (%)
Internet 22 41*63 (75.0) 12 27*39 (46.4)
Work contacts and networks 17*11 28 (33.3) 11** 4 15 (17.9)
Approached employer 13 15 28 (33.3) 3 9 12 (14.3)
University careers services 12 15 27 (32.1) 10** 3 13 (15.5)
Approached by employer 7 12 19 (22.6) 6 6 12 (14.3)
Family and friends 8 11 19 (22.6) 3 4 7 (8.3)
Social media 7 7 14 (16.7) 4 4 8 (9.5)
Newspaper 8 5 13 (15.5) 3 2 5 (6.0)
Other university source 2 9 11 (13.1) 3 7 10 (11.9)
Careers fair 2 8 10 (11.9) 1 0 1 (1.2)
Resume posted online 3 6 9 (10.7) 2 1 3 (3.6)
Employment agency 2 6 8 (9.5) 0 1 1 (1.2)
Employer promotional event 1 2 3 (3.6) 1 0 1 (1.2)
*Significant difference (P<.05); **Significant difference (P<.01).
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JESSUP Et al.
For mainland graduates with a metropolitan background
and no family links to Tasmania, regional employment was
considered an opportunity for ‘adventure.’
I grew up in Perth all my life but I wanted to
move away when I finished university and had
heard a lot of nice things about Tassie and had
travelled here before, so I sort of came on a
whim without really knowing anybody.
(Occupational Therapist #2, metropolitan
background)
Nursing graduates indicated where they searched for em-
ployment was governed by the location of ‘transition to prac-
tice positions.’ Some were only available in the larger regional
teaching hospitals and others in the smaller rural hospitals
across the state.
The deal…for enrolled nurses is that you have
a six month stint in a rural facility and then you
have six months in the [regional hospital] or
vice versa…
(Enrolled Nurse #3, regional background)
For other graduates, searching for positions in regional areas
was due to the lack of job prospects in metropolitan areas.
Melbourne is very hit and miss in getting a grad-
uate job because there are so many people ap-
plying and so little positions…those of us that
could, certainly looked further afield.
(Midwife #2, rural background)
Other graduates specifically sought rural employment as
they believed there would be more opportunities available and
less competition for positions.
…it's a lot more competitive in big cities, if you
go rurally like I did, there's a whole bunch of
opportunities all over the place…
(Psychologist #1, rural background)
After a period of unsuccessful job hunting in metropolitan
cities, some graduates shifted to searching regional and rural
Tasmania.
I got some little leads from people about, you
know, you might actually have to go where the
work is or travel far away. So then I started
searching things that were Australia- wide. It
just kind of led one thing to another, and I
applied more locally to Headspace and things
like that where I was living…I think I put
about 12 job applications in and they all came
back negative. So Tassie was ok, it was just a
process of elimination and trying to really feel
things out.
(Psychologist #2, metropolitan background)
3.3.5
|
Number and type of jobs graduates
applied for before gaining initial employment
Overall, survey respondents applied for an average of 4.1
jobs (median=2, range=0- 20) before becoming employed
(Table 5). However, graduates working in metropolitan
areas had applied for almost twice as many positions (6.3,
median = 6) as those employed in rural/remote areas (3.4,
median = 1). The number of positions applied for also varied
by discipline (Table6). For example, pharmacy and speech
pathology graduates applied for an average of 7.4 positions
before securing a job and occupational therapy graduates ap-
plied for an average of 5.6 positions. In contrast, radiogra-
phers and clinical psychologists were employed from their
first job application and the sonographer was offered a job by
an employer prior to graduating.
Regardless of initial work location, the majority of survey
respondents (88.1%) found employment in the clinical area
they wanted (Table5). Examples of situations where gradu-
ates did not find employment in the clinical area they wanted
became apparent during interviews, with some interviewees
highlighting that they accepted less skilled work to ensure
they entered the labour market quickly.
So my job was a physical health worker role,
it wasn't an exercise physiology job, purely be-
cause I was terrified that I would graduate with-
out a job to go into.
(Exercise Physiologist #2, regional
background)
…the position I started in…was casual work and
you don't need a Bachelor of Social Work to do
it, you could get away with a TAFE certificate.
(Social Worker #1, rural background)
Further, some interviewees accepted positions in less desir-
able clinical areas to gain employment in specific geographical
areas. These graduates indicated that the experience obtained
in their initial role would increase their future employability for
more desirable roles.
…I wanted to move here [Tasmania] with a job,
so initially I got one through sort of like a pain
management/aged care facility so that was my
|
9
JESSUP Et al.
initial job that I had to sort of move over here
for. I think I worked there for 2 months…my
aim was always to work at the [hospital] and I
wanted to have a sort of a rotational hospital job,
so my name was on the casual pool…and then
sort of two months into working at [aged care
facility] I was contacted for an interview and
got a job at the [hospital] which is where I am
now. (Occupational Therapist #2, metropolitan
background)
After a protracted period of unsuccessful job searching,
other interviewees reported that they were forced to accept less
desirable clinical roles.
I managed to find a rehabilitation general allied
health job. It wasn't really the work of a psychol-
ogist…you just needed to be an allied health
professional, so I think people that worked there
could have been an occupational therapist, so-
cial worker…it was mainly workers' compensa-
tion work…not core psychological work…you
could be any discipline…
(Psychologist #2, metropolitan background)
3.3.6
|
Time taken to gain initial employment
Interview data shed light on the time taken to secure employ-
ment. Of the 17 interviewees, 5 had a job prior to graduating
and 9 were employed within 2months after graduating.
I was in my last semester and a position came
up…as a regional physical health worker. So I
actually had that job about week 9 or 10 of my
last semester, so I graduated with a job.
(Exercise Physiologist #2, regional
background)
Two graduates delayed seeking work due to family reasons
but found work within 4months once they began looking. It took
the remaining graduate 6months to gain a position. Somewhat
desperate, they eventually sought work in Tasmania after trying
unsuccessfully to secure a metropolitan position interstate.
TABLE 5 Relationship between number of jobs applied for, desired clinical area and initial employment location
Modified Monash Model (MMM) location of initial employment
Total
(n=84)
Metropolitan (MMM1) employment
(n=3)
Regional (MMM2) employment
(n=61)
Rural/remote (MMM3- 7) employment
(n=20)
Jobs applied for
Mean 6.3 4.1 3.4 4.1
Median 6 2 1 2
Range 3- 10 0- 20 0- 15 0- 20
n (%) n (%) n (%) n (%)
Job gained in desired clinical area
Yes 3 (100.0) 53 (86.9) 18 (90.0) 74 (88.1)
No 0 (0.0) 6 (9.8) 2 (10.0) 8 (9.5)
Missing 0 (0.0) 2 (3.3) 0 (0.0) 2 (2.4)
TABLE 6 Average number of jobs recent nursing and allied
health graduates applied for by discipline (n=84)
Discipline Mean Median Range
Oral health therapist (n=1) 10 10 a
Pharmacist (n=6) 7.4 1 0- 20
Speech pathologist (n=11) 7.4 5 1- 20
Occupational therapist (n=9) 5.6 4 0- 15
Dietitian (n=1) 5 5 a
Physiotherapist (n=10) 4.5 3 1- 10
Podiatrist (n=3) 4.3 5 0- 8
Psychologist (n=3) 3.7 2 1- 8
Social worker (n=11) 3.2 2 0- 12
Paramedic (n=3) 3 2 1- 6
Enrolled nurse (n=4) 2.8 3 1- 4
Exercise physiologist (n=2) 2.5 2.5 1- 4
Registered midwife (n=4) 2 1.5 1- 4
Mammographer (n=2) 1.5 1.5 1- 2
Registered nurse (n=10) 1.4 1 0- 3
Clinical psychologist (n=2) 1 1 1- 1
Radiographer (n=1) 1 1 a
Sonographer (n=1) 0 0 a
Total graduates (n=84) 4.1 2 0- 20
aRange not reported as n=1.
10
|
JESSUP Et al.
…applying for lots of jobs up there [inter-
state] with no luck and a contract came up in
Tasmania and I just thought, why not? I'll take
it. It's been quite a few months, so I was get-
ting quite desperate… (Speech Pathologist #4,
regional background)
4
|
DISCUSSION
The results of this study confirm that some nursing and al-
lied health graduates experience challenges gaining initial
employment and that this varies by discipline and where
they want to practise. However, other graduates had positive
experiences entering the labour market, with these positive
pathways providing key insights into a range of strategies
that can be adopted to support future nursing and allied health
graduates to gain initial employment.
4.1
|
Lesson one: Gaining initial
employment takes time and effort
Although recent graduates might assume getting a profes-
sional job is a relatively quick and easy process,22 most grad-
uates took at least 2months to secure employment, and some,
4- 6months in this study. These findings mirror employability
research more generally, with only half of all graduates likely
to be employed within the first 2 months after graduating,
increasing to around 75% by 4months.5,7,15 However, health
graduates usually have a predetermined time frame for gain-
ing initial employment, with many unwilling to wait for up
to 6months to secure a job due to financial reasons.22 In a
study by Jones et al, as many as 70% of final- year students
would consider changing their career if unsuccessful in se-
curing a graduate position within their predetermined time
frame. This might explain why 10%- 16% of new graduates
from varying allied health disciplines are not working in their
field after graduation in Australia.7,13,15 Nursing and allied
health graduates should be made aware of a potential lag of
2- 6 months between graduation and initial employment in
order to avoid unrealistic expectations and minimise poten-
tial workforce loss.
Graduates might also need to develop strong psychologi-
cal armour to weather repeated rejections when applying for
initial employment, particularly if from an allied health disci-
pline.7 Although in this study the number of jobs applied for
before being employed averaged 4.1, some graduates reported
applying for as many as 20 positions before securing work.
This figure is consistent with recent research of occupational
therapy graduates, which found they completed an average
of 12 written applications and 3 interviews before securing
initial employment.15 Arguably, the sheer effort needed to
put together countless job applications is under- recognised,
particularly at the end of a degree when students already feel
academically fatigued. This might explain why recent gradu-
ates experience considerable stress when searching for initial
employment that is independent of the time taken to secure
employment.7 Future research evaluating health graduate
employment outcomes would benefit from considering the
personal effort, cost and emotional toll involved in securing
a job, rather than measuring employment success merely as a
function of time post- graduation.
To find all available employment opportunities and expe-
dite their chances of entering the labour market, recent gradu-
ates should use a range of different job search strategies. The
Internet is central to these efforts.23 However, a sophisticated
search strategy must combine trawling generic employment
search engines, with regular monitoring of specific company
websites for employment notices given that around a third of
job advertisements are only advertised directly on company
websites.23 Graduates should also use available work contacts
and networks, including those developed on clinical place-
ments. As this strategy was significantly more successful in
helping Tasmanian graduates obtain work, it might be that
regional and rural areas that struggle to attract health profes-
sionals use clinical placements to recruit staff.7 Alternatively,
it might be that word- of- mouth and personal connections
are an effective recruitment mechanism in regional and
rural areas. Either way, graduates would be wise to identify
and embrace networking opportunities within organisations
where they might wish to practise and proactively seek to
undertake their clinical placements or to volunteer to help de-
velop such personal connections. Graduates should also pro-
actively approach employers to canvas potential vacancies.
Highlighting the prevalence of unadvertised positions,1 al-
most 15% of graduates found their first job through proactive
contact. Finally, although prior research has suggested only a
modest impact of university- based job searching strategies on
obtaining employment,24 this approach proved significantly
more useful in finding Tasmanian graduates' employment.
This finding might reflect core differences between metro-
politan vs regional universities, with the latter committed to
supporting local communities and employers.25
4.2
|
Lesson two: Rural employment
might offer graduates the right get- go into the
labour market
Regardless of discipline, this study found graduates gained
employment in rural/remote areas after applying for fewer
positions than graduates working in metropolitan areas. This
validates the strategic choice by some graduates to use rural
employment as a career get- go, with their experiences of a
greater number of opportunities and a lack of competition
|
11
JESSUP Et al.
for positions against other graduates supporting the idea that
rural employment opportunities are typically less popular.9,11
For other graduates, the pathway to regional or rural/remote
employment was voluntary to reside close to family. This
concurs with research illustrating the strong pull towards fa-
miliar environments and social supports,26,27 with graduates
tending to return to within 50km of their pre- education post-
code.15 Although 2 graduates also voluntarily chose regional
employment through a perceived sense of adventure, both
of these graduates reported a desire for short- term employ-
ment before moving on. This confirms the tenuous nature of
non- local and early career professionals who move to rural
areas to practise28 and emphasises that efforts to address rural
health workforce should focus on the training of rural- origin
students in health degrees and ruralising students' horizons
through positive rural clinical placements.
However, some graduates explained initial regional or
rural/remote employment was necessary where graduate op-
portunities such as ‘transition to practice’ positions were only
offered in these locations. Others resorted to considering rural
vacancies only when efforts to secure employment in metro-
politan or regional areas had been unsuccessful. These path-
ways suggest that graduates end up practising in regional and
rural locations by necessity. This raises concerns regarding
research that documents the numbers of graduates working
rurally post- graduation without considering their motiva-
tion.7,12- 16 Linking job availability to initial practice might
provide a subsequent depth of insight into why retention is
poor in the longer term if graduates are begrudgingly accept-
ing rural work post- graduation. With the likelihood that some
graduates will eventually be employed in rural or regional
locations after a protracted period of unsuccessful job search-
ing, voluntarily seeking rural employment after graduating
might be a less stressful get- go for health graduates. Rural
opportunities might offer more secure employment, with a
greater likelihood of full- time positions,9 more plentiful
positions given the greater turnover of rural workers14 and
increased scope of practice.29 However, preparing graduates
for rural practice will require ruralising undergraduate curric-
ula, including opportunities for students to experience rural
practice through rural clinical placements. Ensuring adequate
professional support will also be required to encourage the
retention of graduates employed in rural areas.30
4.3
|
Lesson three: Learn to compromise
In the context of a precarious labour market, recent gradu-
ates do not have the luxury of being selective about who they
will work for and might need to compromise their ideals.7
This study observed that graduates who accepted less desir-
able clinical work benefited by entering the labour market
quickly and were able to work in a desired geographical area.
Fortunately, most graduates are likely to realise their ideal,
with 88% of recent graduates in this study gaining an initial
role in their desired clinical area. For those graduates strug-
gling to gain initial employment, a lowering of expectations
might help gain entry to the labour market. Though the re-
sults of this study are particular and therefore not generalisa-
ble, we found only 13% of recent graduates had left their first
job because they did not enjoy the work. Graduates forced
to compromise to secure initial employment might therefore
find the work more appealing than anticipated. Many of those
graduates who had left their first job also remained with the
same employer. This reflects other employment opportuni-
ties that arise within workplaces for recent graduates to tran-
sition to in the event they do not enjoy their initial role. The
clinical area they are initially employed in should therefore
be of less concern to recent graduates than simply gaining
employment in the first place. As outlined by graduates in
this study, the skills and experience garnered through initial
employment in a less desirable clinical environment might
provide a springboard into more attractive roles in future.
4.4
|
Limitations
This study only examined the pathway of recent nursing and
allied health graduates to employment in regional and rural/
remote Tasmania. Therefore, these findings cannot claim
to be representative of graduates working in other regional
rural/remote areas of Australia or elsewhere. The sample
surveyed only included small numbers of respondents from
nursing and allied health professions, with some allied health
professions not represented at all. This study might therefore
reflect self- selection bias, with recent graduates who experi-
enced difficulty obtaining initial employment motivated to
participate. Further, recruitment methods might also have bi-
ased the sample, with the use of contact persons from adver-
tised vacancies possibly increasing participants who gained
employment through this pathway. Survey respondents were
also asked to self- identify rural background. No informa-
tion was provided to define ‘rural.’ Acknowledging that
definitions of ‘rural’ vary, this might have led some respond-
ents to falsely identify themselves as having a rural origin.
Fortunately, the interviews provided an opportunity to dis-
cuss the background of participants in more detail and con-
firm the time spent residing in locations according to MMM.
A further limitation of this study was that students' academic
achievement and clinical placement performance were not
ascertained or discussed. It was therefore not possible to ex-
plore the impact of academic merits such as grade point av-
erage or evaluations of clinical competency from placement
experiences on subsequent employment pathways. Finally,
this study did not account for whether graduates were origi-
nally from Tasmania. This information would have helped
12
|
JESSUP Et al.
identify migratory patterns for study, as well as determine the
relative numbers of students wanting to return to Tasmania
following graduation.
5
|
CONCLUSION
Gaining initial employment as a recent nursing and allied
health graduate can be challenging. Successful employment
requires recent graduates to adjust their expectations with
respect to the time and effort it might take to gain a job, the
geographical location of the position and the clinical area
in which they initially practice. Securing an initial posi-
tion, regardless of its tenure, location or clinical area, is key
to gaining experience and opening the door to future em-
ployment opportunities. Rural employment opportunities
offer a get- go in an otherwise precarious job market, with
increased opportunities and reduced competition for posi-
tions being seen in Tasmania. Further research into health
graduate employment is needed given that job availability
influences initial employment choices. In particular, un-
derstanding more clearly the pathways of recent graduates
compelled to work rurally might provide critical insight
into novel recruitment and retention strategies to support
longer term stability in the rural nursing and allied health
workforce.
ACKNOWLEDGEMENTS
This study was supported by the Commonwealth Government
Department of Health Rural Health Multidisciplinary
Training (RHMT) Program.
CONFLICTS OF INTEREST
BJ, TB, MC, KO and SM do not have conflicts of interest to
declare.
AUTHOR CONTRIBUTIONS
BJ, TB and MC designed the study. BJ led the data analysis
and drafted the manuscript. All authors contributed to the in-
terpretation of the results and to the writing of the paper.
ORCID
Belinda Jessup https://orcid.org/0000-0001-9712-1703
Kehinde Obamiro https://orcid.
org/0000-0002-0265-1953
Suzanne Mallick https://orcid.org/0000-0001-6917-9756
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How to cite this article: Jessup B, Barnett T, Cross M,
Obamiro K, Mallick S. Rural employment: A get- go
for recent nursing and allied health graduates? Aust J
Rural Health. 2021;00:1– 13. https://doi.org/10.1111/
ajr.12773
