DATOS IDENTIFICATIVOS 1 Miembros de la unidad familiar.

Direct logistic regression was performed to assess the impact of a number of factors on the likelihood that respondents would intend to remain in their current position longer than 7.5 years at Phase Three. The model contained 15 independent variables (Age, Sex, GPA, Residency Status, ESL, Undergraduate Employment, Previous Healthcare

Experience, Stress, Formal Structured Support Program, Satisfaction Scores, RFP Scores [Phases One, Two and Three] and WESE scores [Phases Two and Three]). Frequencies and collinearity statistics for predictor variables can be found in Appendix U.

The variables of sex, residency status, and formal structured support program violated the assumption of the minimum expected cell frequency, and therefore were removed from the model. The full model containing the 12 remaining predictors was not statistically significant, 2 _{(12, 𝑛 = 148) = 17.15, 𝑝 = .114, indicating the model was not}

able to distinguish between respondents who intended to remain in their current position longer than 7.5 years and those who did not. Although the model was not significant, as shown in Table 23 having undergraduate employment was a significant variable in the model, suggesting that respondents who had undergraduate employment were four and half times more likely to report leaving their current position within 7.5 years.

Table 23

Binary Logistic Regression Modelling to Predict Intention to Remain in Current Position

Variable 𝐵 𝑆𝐸 𝑂𝑅 95.0% CI Wald 𝑝

Age 0.65 0.48 1.92 [0.76 - 4.87] 1.88 .170

Grade point average -0.02 0.50 0.98 [0.37 - 2.62] 0.00 .973 English second language -0.30 0.61 0.74 [0.23 – 2.43] 0.25 .619 Undergraduate employment -1.30 0.61 0.27 [0.08 – 0.90] 4.52 .033 Healthcare experience -0.18 0.53 0.83 [0.30 – 2.34] 0.12 .730 Stress (P3) 0.10 0.51 1.11 [0.41 – 3.00] 0.4 .840 Job satisfaction (P3) 0.04 0.04 1.04 [0.97 – 1.12] 1.28 .257 RFP P1 -0.04 0.05 0.96 [0.88 – 1.06] 0.70 .401 RFP P2 -0.80 0.06 0.92 [0.82 – 1.04] 1.80 .180 RFP P3 0.02 0.06 1.02 [0.90 – 1.15] 0.09 .767 WESE P2 0.01 0.02 1.01 [0.97 – 1.06] 0.26 .610 WESE P3 0.03 0.3 1.03 [0.98 – 1.09] 1.28 .258

Note. CI = confidence interval for odds ratio (OR); P2 = Phase Two; P1 = Phase One; P3 = Phase Three;

RFP = Readiness for Practice scale; WESE = work environment, support and encouragement scale.

4.17 Conclusion

A comparison of the study sample to the Australian ECN population showed that the sample was representative. In this study, two-thirds of the ECNs were 25 years or younger, and almost 90% identified as female, correlating with Australian Institute of Health and Welfare (2017b) data about the general ECN population. This places the majority of this cohort in the millennial generation.4 _{Over 95% of the ECNs in this study}

4 _{Four generational cohorts currently make up the nursing workforce: Veteran nurses born between 1922} and 1946; Baby Boomers born between 1947 and 1964, representing the largest cohort; Generation Xers born between 1965 and 1978; and the Millennials or Generation Y born between 1979 and 2000, the second largest cohort (Hayes et al., 2012; Takase, Oba, & Yamashita, 2009).

had full-time study loads, and two-thirds reported a GPA above 5.51, suggesting the majority were achieving above distinction averages during their studies (The University of Queensland, 2013). One third of this cohort were not born in Australia, which is similar to ABS (2017b) data showing that in 2016 almost 30% of Australian residents5 _{were born}

overseas.

The total rate of ECNs not employed as an RN at Phase Two was 17% (𝑛 = 33), which decreased to 6.7% (𝑛 = 13) by Phase Three. The only factor that influenced securing employment as an RN was ESL. One quarter of this ECN cohort did not have English as a first language, slightly higher than the one fifth of Australians who in 2016 spoke a language other than English at home (ABS, 2017a). However, language spoken is not a variable captured by Health Workforce Data in Australia, and therefore a comparison to the national ECN population cannot be made. Those with ESL reported higher

percentages of tertiary qualifications and lower preference for the hospital setting. They also reported lower RFP scores, WESE scores, and job satisfaction scores. This group were less likely to be provided a formal support program, had different support items they desired from employers, and were more likely to leave the profession earlier, but remain in their current position longer. The majority of ECNs in this study had Australian residency status, although one third were born overseas and one quarter had ESL. This is significant as most of the literature regarding the impact of English as a second language on

transition to practice in nursing pertains to the international student cohort (Blackmore et al., 2014; Department of Education Employment and Workplace Relations, 2009), or

overseas-trained nurses (Deegan & Simkin, 2010; Mapedzahama, Rudge, West, & Perron, 2012; Wang & Jing, 2018).

The factors that impact on securing employment in the hospital setting are different from those that impact on securing employment in the out-of-hospital setting. English as a first language is predictive of securing employment, although it does not dictate

employment setting. Having a preference for the out-of-hospital setting and having prior healthcare experience are predictive of working in the out-of-hospital setting. Those working in the out-of-hospital setting received fewer support items, including formal

structured support programs, compared to those working in the hospital setting. They also desired different support items to aid their transition compared to those working in the

5 _{According to the Department of Social Services (2019), “an Australian resident is a person who resides in} Australia and has permission to remain permanently – either because they are: an Australian citizen; the holder of a permanent visa; or a protected Special Category Visa holder” (para. 4).

hospital setting. Those with a GPA above 5.51, and/or who had a relationship with their employer, either from clinical placement or undergraduate employment, were more likely to secure work in the hospital setting.

The factors that influence the intention to remain in the profession and a position are different. After 12 months the typical ECN was likely to continue working in the same fixed- contract position where they commenced as their first employment as an RN in Australia. After 12 months the turnover rate from a nursing position but remaining in the profession was 8.2% (𝑛 = 16). The most common reason for changing positions was for a better position. The turnover rate from the profession was 6.7% (𝑛 = 13) in total, consisting of 3.1% (𝑛 = 6) ECNs leaving a RN job and not taking another, plus 3.6% (𝑛 = 7) never beginning a RN job post-graduation. Over time ECNs’ average RFP scores decreased at Phase Two, and although they recovered in Phase Three they did not reach Phase One results. The typical ECN most likely did not have stress in their personal lives that

impacted on work; however, their job satisfaction decreased over time as did the number of years they intended to remain in the nursing workforce. The factors to which ECNs attribute their intention to remain in the profession are WESE scores and stress. RFP influences stress, while job satisfaction influences WESE.