Comparing the Job Location Choices of University-trained and College-trained Professional Nurses in South Africa
Date
2018
Authors
Vambe, Debrah
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Abstract
Background:
In South Africa, university-trained professional nurses attain a degree after 4 years of training and college-trained professional nurses attain a diploma after 4 years of training. The competence of degree versus diploma nurses has been debated for a number of years. It is argued that degree programmes provide students with critical thinking skills, leadership and management, and a more in-depth study of the physical and social sciences, as well as community and public health nursing. There is also inconclusive evidence suggesting that university-trained nurses are more competent than college-trained nurses in certain areas. This has led to a shift towards university-trained nurses in many countries with the intention of improving patient safety and quality of care. The debates have mainly focused on the relative nursing skills of these two training routes, but there is limited evidence on the retention and job location choices of university-trained and college-trained professional nurses for different sectors (public or private), areas (rural or urban), or facility types (hospital, clinic/community health centre (CHC). Hence this study was conducted to compare the job location choices of college-trained and universitytrained professional nurses, as well as the factors associated with these choices over time as well.
Methodology:
This study was a secondary analysis of data from a prospective cohort study of South African college and university professional nursing graduates from two provinces in 2009 up to 2015. Job location choices, defined as working in the public or private sector; rural or urban area; and hospital, clinic/community health centre (CHC) or other facilities were the primary outcomes for this study. The main exposure variable was the training institution type which was defined as either university or college-training. Job location choices of these university-trained and college-trained professional nurses was assessed after 6 years of follow-up using Pearson’s chi-squared test followed by binary and multinomial logistic regression to adjust for confounders. Information on potential predictors of job location choices other than training institution type were assessed using Pearson’s chi-squared test and t-tests. All professional nursing graduates started in the public sector for community service, so we also evaluated the time to first move to the private sector during the period 2009-2015 using survival analysis. Kaplan-Meier curves were used to compare this outcome between university and college-trained nurses. A Cox proportional hazard model was used to determine the possible association of predictor variables and to obtain adjusted hazard ratios. Data were analysed using Stata version 14.0.
Results:
The results show that type of sector (public, private for-profit and private not-forprofit) was the only job location choice associated with training institution type after 6 years of follow up (p=0.019), with more college-trained professional nurses in the public sector (78.3%) as compared to university-trained nurses (62.5%). Work area (urban or rural) and facility type (clinic/community health centre, hospital or other), were not associated with training institution type, (p=0.179) and (p=0.459) respectively. When adjusted for confounders, training institution type was found not to be significantly associated with any job location choice including type of sector. Instead being male (OR=2.57; 95%CI=1.11-5.44), being white (OR=7.70; 95%CI:2.02-29.36), under 30 years (OR=2.30; 95%CI:1.10-4.89), having a child (OR=0.46; 95%CI:0.23-0.91) and having nursing as first career choice (OR=0.47; 95%CI=0.22-0.99) were strong predictors of choosing private sector job location as compared to public sector.
In the survival analysis, the proportion leaving the public sector at any given time was higher and earlier among university-trained compared to college-trained professional nurses (p=0.010). When adjusted for confounders, change from public to private sector was found not to be significantly associated with training institution type but age below 30 years (HR=2.21; 95%CI:1.35-3.62), being white (HR=3.16; 95%CI:1.64-6.03) and nursing as first career choice (HR=0.56; 95%CI:0.36-0.89) were strong predictors for moving to the private sector.
The top 3 reasons for job location changes from public to private, rural to urban and clinic/CHC to hospital were job dissatisfaction (64.1%), wanting to be closer home (46.8%) and wanting to earn higher salary (33.7%). The main reasons for movement from public to private sector alone were job dissatisfaction (27.3%), wanting to earn higher salary (19.5%) and advancement in career/wanting new challenge (12.7%).
Implications, Recommendations and Conclusions:
The study found some association between sector (private or public) and training institution type of professional nurses on bivariate analysis. On multivariate analysis, the association was no statistically significant but certain sociodemographic factors such as gender, age, having children, ethnicity and choosing nursing as first career choice were stronger predictors of job location choice. This analysis suggests that retention of degree-trained nurses in the public sector or rural areas is not significantly different to that of diploma-trained nurses, although larger studies from a wider range of training institutions are required to confirm this.
This study provides useful evidence for policy makers involved in the reform of nursing education in South Africa in order improve nursing skills and health care service quality, particularly in underserved communities. The South African government could therefore consider implementing the nursing education reforms and promoting primary health care re-engineering since these cadres have almost similar job location choices.
Description
A research report submitted to the School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Public Health in the field of Health Systems and Policy
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Citation
Vambe, Debrah (2018) Comparing the job location choices of University-trained and College-trained professional nurses in South Africa, University of the Witwatersrand, Johannesburg, <http://hdl.handle.net/10539/27715>