Category: Brief reports

Beryl Meiklejohn, Judy Ann Wollin, Yvonne Lorraine Cadet-James

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Abstract The number of Indigenous registered nurses (RNs) in Australia is disproportionately small when compared with the population numbers. Strategies to increase recruitment, retention and successful completion of the Bachelor of Nursing (BN) at Queensland University of Technology (QUT) have included: strong collaboration at School, Faculty and Indigenous support unit level; the development of specialised academic roles; and streamlining of admission processes. Individual study plans and support have assisted in the successful completion of the BN at QUT by 24 Indigenous students since 1994. Suggested citation: Meiklejohn B, Wollin JA, Cadet-James YL (2003) Successful completion of the Bachelor of Nursing by Indigenous people. Australian Indigenous HealthBulletin;3(2): Brief report 1. Retrieved [access date] from http://www.healthinfonet.ecu.edu.au/html/html_bulletin/ bull_32/brief_reports/bulletin_briefreports_meiklejohn.htm

Introduction

The disproportionately small number of Indigenous people in the health professions has been well established. Indigenous registered nurses make up 0.05% of the registered nurse population, which is well below the representative 2.6% of the total Australian population . Conversely, Indigenous health issues are immense and require urgent attention with long-term strategies that address not only the symptoms but also the contributing social factors.

There are a disproportionately small number of Indigenous people successfully completing tertiary education in Australia . Historically, Aboriginal people were denied secondary education, and tertiary education is often alienating with its European traditions and paucity of studies recognising and focusing on Aboriginal values, lives and people .

In an attempt to address both the health and education needs of Indigenous people, the Queensland University of Technology’s (QUT) School of Nursing, in collaboration with the Oodgeroo Unit (QUT’s Aboriginal and Torres Strait Islander support unit), has put in place collaborative strategies over the last nine years that have increased the recruitment, retention and successful completion of the Bachelor of Nursing (BN) program by Indigenous students.

Recruiting Indigenous students

The need to address the educational needs of Indigenous people reflected two critical elements. An Indigenous academic in the School of Nursing drew attention to the absence of any Indigenous students successfully completing units. Two students were enrolled in the BN in 1991, but neither successfully completed units at that time. This humble beginning has resulted in a range of strategies that have been implemented over a nine-year timeframe and have resulted in 24 Indigenous students graduating with the QUT BN.

The recruitment of students to the BN is a multi-faceted program of activities. Recruitment activities undertaken by the School of Nursing and the Faculty of Health complement the recruitment drives implemented by the Oodgeroo Unit.

Advertisements have been placed on radio (4AAA), in the Koori Mail, and in the Aboriginal and Islander Health Worker Journal. To date, the most effective media advertisements have been those placed in the Koori Mail. The information provided in the advertisements is brief and indicates that Murri people who want to be registered nurses should ring specific staff in the Oodgeroo Unit, School of Nursing or the Faculty of Health. Applicants are invited to QUT for an interview.

Student selection

Recruitment interviews are run for several reasons: to give the School of Nursing, the Oodgeroo Unit and QUT a chance to discuss university and applicants’ expectations and the educational background of applicants, and to design an academic plan that is likely to be successful for a given applicant. An Indigenous academic leads the interview with the non-Indigenous academic from the School of Nursing taking a secondary role and concentrating on the academic component of nursing. Family connections are explored to build links with the applicant so that an emphasis on community and community needs is developed. The goals are to ensure that applicants feel at ease at QUT and that QUT is an extension of their community. This is achieved by exploring family and friendship links with students and staff at QUT. This is particularly important since the undergraduate nursing degree at QUT has 1,000 students and Indigenous students can and do feel isolated and alone.

The outcomes of the interview are two-fold – an offer of a place and an individualised study plan. All applicants interviewed are told informally at the conclusion of the interview if they have a place in the School of Nursing. The speedy decision-making is of critical importance to applicants and, therefore, to the success of the whole program of improved recruitment and retention of Indigenous students into the BN program. The ongoing practice of streamlining the application process and drawing on family ties is an important strategy in the successful recruitment of Indigenous people into nursing and has recently been confirmed in the report of the Indigenous Nursing Education Working Party .

Admission process

The streamlined handling of admission processes is critical to achieving higher enrolment numbers. Most Indigenous applicants to the BN have experienced educational disadvantage – many experiencing racism at school, having been advised to take the non-academic units of study, failing to complete high school and not meeting the prerequisite requirements for tertiary studies. Applicants who at interview are deemed to have limited formal education are told of pathways that would provide educational opportunities to achieve their goals. The applicants are well aware of their educational disadvantage and are doubtful about the sincerity with which university studies are offered. Normal delays in offering places, sending out confirmation letters and letting applicants know they have a place is enough to reinforce applicants’ doubts that university was ever open to them.

The strategy adopted in the School of Nursing is to delegate to one academic the responsibility of offering a place in the BN. The Oodgeroo Unit is responsible for all recruitment, interviewing and offering of places at QUT. It is a collaborative effort between the Oodgeroo Unit and the School of Nursing, but the practice in nursing has been to accept the Unit’s recommendations for a particular student. The close ties between Indigenous staff in the Oodgeroo Unit and the Indigenous community often give social insights into the students’ circumstances that may not be recognised by non-Indigenous academics. The importance of employing Indigenous registered nurses in this role cannot be underestimated, and has been affirmed recently as a recommendation in the report of the Indigenous Nursing Education Working Party .

The outcome of this process is that the academics from the Oodgeroo Unit and the School of Nursing can make decisions, which are supported by the School of Nursing and Faculty of Health and acted on swiftly. Applicants’ relief when a place is offered at the conclusion of the interview is always obvious and, on many occasions, a very emotional time – disbelief that university is really open to them.

Other recruiting strategies

Other recruiting strategies utilised include academic staff (Indigenous and non-Indigenous) attending career displays for Indigenous community members and high school students. This has resulted in important links being made. Very small numbers of students have been directly recruited from career drives, but this is an excellent opportunity to raise the university’s profile among community members The contact with community members and parents is very useful for raising students’ awareness that university education is achievable.

The vast majority of applicants are offered a place in the BN program – usually in the order of 12 to 15 students. Of these, usually 8 to 10 arrive on day one of semester, and 6 to 8 remain enrolled at census date and continue to progress through the course. The interpretation of these numbers needs to recognise that places are offered to nearly applicants months prior to university commencing, and life events, jobs and family responsibilities all affect whether or not an applicant actually arrives at university and progresses through the program. The rate of progression and time taken to complete the degree varies from the 3 years (minimum time) to 9 years: again reflecting the impact of more important life priorities. Particular care is taken to leave the university door open with the use of ‘leave of absence’ when a student’s progress is stalled by outside factors.

Retaining Indigenous students in the BN program

The vast majority of applicants are offered a place in the BN program at QUT. The skill is in matching a study program with the educational needs of the applicants. The BN is usually a three-year full-time degree. After assessing the applicant’s educational background, a plan is devised in conjunction with the applicant, so that their needs are meet – this increases the likelihood of success. For those applicants who have less than grade 10 education or limited work experience, single units of study are offered. This mechanism is used to allow students to overcome educational disadvantage. An alternative strategy for applicants who have not completed grade 12 or who not been employed in positions likely to augment their education, is to offer the degree over four years. This extension of the course allows students to master academic skills and receive support through the Aboriginal Tutorial Assistance Scheme (ATAS) and therefore improve the likelihood of success. The BN program has mid-year entry for Indigenous students for the same reason, to extend the course and to allow time for educational disadvantage to be overcome.

Supporting students

Supporting students enrolled in the Bachelor of Nursing is an on-going collaborative effort between the Oodgeroo Unit, the School of Nursing and the Faculty of Health. One academic is the key contact in the School of Nursing for all Indigenous students enrolled in the BN program.

The Oodgeroo Unit academics are responsible for coordinating the tutor assistance (funded through ATAS) and also providing general academic support, cultural support and a social hub for Indigenous students enrolled at QUT. Again, the practices at QUT are consistent with the recommendations in the report of the Indigenous Nursing Education Working Party . The vital role Oodgeroo staff play in the academic success of Indigenous students is highly valued by the School of Nursing, and students are encouraged to identify with and utilise the resources provided by the Unit.

Supportive strategies adopted in the School of Nursing have included morning teas, drop-in sessions, and telephone calls to students. All these strategies have the aim of building trust between the key academic in the School and Indigenous students. The informal meetings and telephone calls also provide opportunities for students to raise issues that they have not felt comfortable to raise themselves. Two important outcomes from these meetings have been the recognition of the advocate role of the academic and growing awareness of this role among other academics in the School. Academics and Indigenous students alike raise issues of concern with the key academic on a regular basis.

Addressing barriers

Early in the program of increased recruitment of Indigenous students, a number of issues were identified as causing difficulties for Indigenous students. Feedback regarding their studies at QUT was first sought from all Indigenous students enrolled in the BN in 1994. A number of recommendations were made on the basis of student feedback:

1. Streamline matching of tutors with students so that the tutoring program is in place by week one of the semester.
2. Implement a program of general study skills from week one of the semester.
3. Promote peer support among students.
4. Promote collaborative ‘get-to-know’ functions between School and Oodgeroo staff and Indigenous students.
5. Ensure students have access to textbooks.
6. Arrange mandatory ATAS tutoring for first semester to overcome ‘shame’ of needing to ask for tutors, and to assist students to be successful right from the start of the BN.
7. Arrange positive role models from QUT graduates.
8. Be culturally sensitive and responsive to the needs of Indigenous students.
9. Identify and address racism (for example, one form of racism was verbal abuse from non-Indigenous students, usually in the large lecture theatre that seats 400 people. The risks to the perpetrators were small with detection unlikely. The responses from the School were to offer counselling to the victims and the Head of the School to address the student body as a whole and point out that racism contravened university policy, was unacceptable, and that disciplinary action would be taken against perpetrators. Faculty of Health and Oodgeroo Unit staff were informed of instances of racism, allowing Unit staff to provide extra ongoing support).

Since the initial survey, feedback from Indigenous students has informed the support strategies adopted. A number of key issues have been identified over time that adds to our students’ difficulties at university. Isolation and loneliness can be so great that students feel no one is interested in them or in their studies. A management strategy utilised is to refer the students to the Oodgeroo Unit. This enables students to link with other Indigenous students in person, building a community network, and using the Oodgeroo Unit as a social net – a place of belonging.

While studying, maintaining an income is of critical importance. Eligibility for Abstudy is considered when planning a student’s course. The need for textbooks is acknowledged by students, but more pressing issues prevail (such as rent, food and other essential living costs). One strategy initiated, but with annual funding difficulties, is the provision of class sets of textbooks.

Accommodation is an issue for some students. A lack of family and a social network can leave students feeling very isolated and lonely. Until recently, QUT provided accommodation but was not the first choice for Indigenous students. Short-term hostel accommodation is utilised by some students, but the lack of suitable accommodation prevents some students from taking up their offer of a university place.

Family support and family needs are both significant issues. Support from family can add to the motivation and the ease with which a student undertakes full-time study. On the other hand, family demands (particularly for paid employment and childcare) can be so pressing that study comes second. This is where a trusting relationship allows a student to disclose pressing personal issues to academic staff, and study plans can be modified to accommodate family issues. Family responsibilities, child care, community requests for support, and being called home for family reasons are not usually negotiable for Indigenous students, and the university needs to be able to respond sensitively and without penalty – such as waiving a fail grade for late withdrawal from a unit.

Systems barriers

Educational history can and does impact on a student’s academic success at QUT. Most of the applicants to the BN present with a history of educational disadvantage. Of the 28 students currently enrolled – three have completed some tertiary studies elsewhere, one has completed diploma studies, and eight students came from year 12. The 16 remaining students have not completed year 12 or equivalent. Students previously employed in jobs that require the preparation of written reports usually make satisfactory academic progress, but still struggle to pass the science subjects (this is not limited to Indigenous students).

The timing, mechanism and time taken in the normal university academic admission process discourages many Indigenous applicants. As 57% of the applicants are not school leavers, they are unaware of having to apply for entry to university in September but know that study starts in late February. A missed cut-off date incurs a financial penalty in the first instance. For some Indigenous applicants, this confirms the view that universities don’t really want Indigenous students, because they are being penalised for missing a closing date they were not aware of.

Successful completion of the BN program

The most important element in promoting academic success among Indigenous students is a collaborative approach between academics in the School of Nursing, Faculty of Health and the Oodgeroo Unit in meeting the individual needs of each student.

The Faculty of Health has provided support in the form of a small amount of funding for textbooks to establish a class set of text in the early days. The Faculty Equity Committee established the needs of Indigenous students as a Faculty issue. Faculty support encouraged schools to comply, by supporting school level initiatives aimed at increased recruitment, retention and successful completion of academic studies by Indigenous students.

At a School level, the most strategic and successful innovation has been the appointment of a key academic responsible for Indigenous students. This has provided a focus for both students and academics. The closer links with students has meant the key academic can make contact with students who have not attended university and make arrangements for their return with minimum embarrassment and disruption. The students experience less ‘shame’ about coming back because of the personalised support offered.

The most powerful motivators for academic success were, and are, the students’ own successes. The first large group of 13 students began in 1994: four completed the BN in the minimum time; an additional three have since graduated, and another student is studying to graduate this year. A total of 72 Indigenous students have enrolled in the BN since 1994, with 24 graduating and a further 28 currently enrolled.

Students have become powerful role models for each other. A critical mass of eight students has been identified as the minimum number of enrollees at any one time likely to result in successful completion of studies. Numbers of less than eight may leave students feeling isolated, and without study partners, encouragement and peer support. The larger numbers also mean that a student on a prolonged study program is likely to have friends studying with them.

The continued enrolment of students who fail units has been a second powerful role model. Until the larger cohort of Indigenous students in 1994, students who failed even a single unit left the course, often without even terminating their enrolment. In that early large group, the return of students to successfully complete failed units encouraged other Indigenous students to come back and try again. A sign of success has been the number of students returning to complete previously unsuccessful studies. Among the student body there has developed recognition that it is OK to fail and continue – the important thing is to finish in the end and that little hiccups in the middle are OK.

Recommendations

Based on the experiences of the QUT School of Nursing, Oodgeroo Unit and Faculty of Health regarding recruiting, retaining and successful completion of the BN program among Indigenous people, a number of recommendations have been formulated:

1. a close collaborative relationship must exist between university Schools and Aboriginal and Torres Strait Islander support units in order to achieve the range of strategies needed to meet the needs of Indigenous students;
2. admission processes need to be flexible, including allowing for late admissions without penalty, in order to encourage more applications;
3. applicants need to be informed after interview of an offer of a university place in order to promote a sense of acceptance at QUT;
4. individualised study programs need to be developed in order to optimise a student’s potential and in order to overcome educational disadvantage;
5. Abstudy funding needs to be maintained for as long as it takes for a student to complete a university-approved program of study in order to avoid undue financial difficulties that prohibit study;
6. key personnel, both at School level and in the Aboriginal and Torres Strait Islander support unit, need to be identified to support and act as advocates for Indigenous students. This is particularly important early in the course of a student’s studies; and
7. there needs to be a critical mass of students, in order to optimise support, reduce the social isolation, provide opportunities for friendship development and promote academic success.

Conclusion

It is essential that universities develop strategies that increase the successful recruitment, retention and completion of tertiary studies among Indigenous people. The QUT School of Nursing, Oodgeroo Unit and Faculty of Health have implemented a number of strategies since 1994 that have resulted in some successes with 24 Indigenous students graduating from the Bachelor of Nursing program.

Acknowledgments

The recruitment, retention and successful completion of the Bachelor of Nursing by Indigenous students at QUT reflect commitment to Indigenous education, a collaborative team approach and much hard work. The current team wishes to acknowledge the contributions of Sally Goold OAM and Colleen Spencer in the early years.

References

Goold S (1995) Why are there so few Aboriginal registered nurses? In: Gray G, Pratt R, eds. Issues in Australian nursing. 4. Melbourne: Churchill Livingstone:235-252

DiGregorio KD, Farrington S, Page S (2000) Listening to our students: understanding the factors that affect Aboriginal and Torres Strait Islander students’ academic success. Higher Education Research and Development;19(3):297-309

Lippmann L (1991) Generations of resistance: Aborigines demand justice. 2nd ed. South Melbourne: Longman Cheshire

Goold S, Turale S, Miller M, Usher K (2002) ‘Gettin em n keepin em’. Report of the Indigenous Nursing Education Working Group. Canberra: Commonwealth Department of Health and Ageing

Faculty of Health, Queensland University of Technology Beryl Meiklejohn, BN (PostGraduate), RN with psychiatric endorsement, Grad Dip Health Promotion, Lecturer, Indigenous Health School of Nursing, Queensland University of Technology Judy Ann Wollin, RN, PhD. Lecturer School of Indigenous Australian Studies, James Cook University, Cairns Yvonne Lorraine Cadet-James, RN, Midwifery Certificate, Grad Dip Education, Bachelor of Nursing, Dip App. Sci. Head of School