The two overarching themes, ‘family pressures’ and ‘practicum poverty’, explore the impact of the family responsibilities and family finances on the accessibility of the practicum, student achievement, thoughts of attrition, stress and wellbeing and family tensions. The impact of the organisation of the practicum by the university and healthcare providers is also explored across these themes. Where direct quotes are used to illustrate themes, participants are described as follows: (pseudonym, age, work (full time FTW or part time PTW), dependent children at home (CH) and FIFO partner (work, CH and FIFO only included where applicable).
The first theme describes how the time demands associated with the women’s family responsibilities compounded issues related to the organisation of the practicum, influenced practicum accessibility, student stress and individual and family wellbeing, as well as leading some participants to contemplate withdrawing from the course.
The women in this study described how they continued to take responsibility for the domestic work and childcare once they began university [see 15,17]. Participants reported that in their relationship, their male partner did not regard themselves as responsible for domestic duties, and instead viewed their role as largely restricted to the main breadwinner. Participants explained that they had to juggle family, university and work demands on their own, and their capacity to manage these competing demands was further exacerbated by the way practicums were organised and communicated to students. For example, the university did not provide students with the opportunity to request which rotation (part of the semester) they would undertake the practicum, and typically communicated this information at the start of each semester, immediately before the practicum commenced. This left participants with little time to make arrangements for managing paid work and childcare. Late communication of shift details from the hospital or other practicum provider was also commonplace, as indicated by this quotation:
You don’t get your roster [of shifts] until a week and a half before you go. I mean some hospitals; you get it on the day you turn up there (Candice, 40, PTW, CH3, FIFO).
Participants explained how the timing of shifts was a particular issue for participants with young children. As early shifts began at 7.00am and childcare rarely opened before 6.30am, this left little time to travel to the practicum placement each morning. The university’s allocation of practicum during school holidays also meant finding a childcare provider with little notice.
Some participants experienced periods when they had no practical support from their partners during their practicum. This was particularly the case for nine participants whose partners worked in ‘fly-in-fly-out (FIFO) positions. FIFO describes employment that, because of distance from home, requires the worker to remain at the work site for weeks or months at a time. While most partners who worked in FIFO positions offered little support when at home, their absence at remote worksites, often for weeks at a time, guaranteed lack of help for female partners who ‘held the fort’ at home. A similar situation was experienced by participants who had migrated to WA, and who had limited local extended family.
Physical distances to practicum were a further source of stress. Participants reported that the university did not consider students’ home addresses when allocating placements, with participants often having to travel long distances. Brenda (46, CH2, FIFO) recalled students’ panicked reactions when practicum details were released:
When the prac. placements go up you get a flood of nurses saying ‘Oh God, I got south of the river and I live north can anyone swap please? I can’t get there’. How they expect loads of us to travel north who live south and then another load who live south to travel north it doesn’t make sense. I mean I know they have lots to organise, lots of placements, but that doesn’t make sense.
The students described how the difficulties associated with their practicum location were further compounded as many of the major hospitals did not allow student parking, and participants were therefore restricted from using their own car. Participants explained that the additional time needed for using public transport further reduced the time available to study and to spend with family, leaving many feeling exhausted. Jilly (45, PTW, CH 2) for example, explained:
So, I was down at [hospital] and you’re not allowed to park, so that’s a bit of a nightmare, because it’s like up at 4.30 to drive to the train then a bus to start at 7am. Then home again, you’re not getting home till 5pm with the transport. So, it’s a really long day. You just find when you’re on those shifts, you’re neither use nor ornament when you come home. By the time you come home, get yourself sorted for the next day, you’re in your bed at 8pm, so it’s ‘hi, bye’
Students completed theory units and assessments at the same time. This concurrent running of theory and practicum units further reduced participants’ ‘down time’:
You’re out on prac doing early, late [shifts] then to come home and stay up all hours of the night and try to do uni stuff. (Jilly, 45, PTW, CH 2)
Participants recounted how, as the length of the practicum increased throughout the degree, the stress associated with managing the combined expectations of university and home life took its toll on their health and wellbeing. Participants commonly talked about sacrificing sleep and social time with family and friends and resorting to convenience foods. Complaints of subsequent weight gain, social isolation and exhaustion were common. These combined and cumulative stressors toll their toll on some participants’ mental health. Paige (24, FTW, FIFO) for example described how she “ran into a bit of trouble” as her coping mechanisms were worn down in the later stages of the degree, forcing her to reduce her study load to part-time, while Candice (40, PTW, CH3, FIFO) recalled friends who found these competing demands impossible as the practicum lengthened:
Some really good people who pulled out of their degree in later semesters because they could not organise time with family commitments.
These comments reveal how conflict with partners and children arose because of the time the women’s study and practicum commitments took away from family, coupled with the lack of partner domestic support. Towards the end of their degree, eight of the participants’ intimate relationships broke down [discussed in detail in 14] requests for assistance from university staff during the practicum resulted in mixed responses. On separating from her partner, Frankie requested more practicum late shifts, to fit in with childcare opening hours. The first staff member she approached refused to help, explaining that nursing was not a flexible degree. This rigid approach left Frankie in a situation where her only option was to leave university - a situation that was remedied when her mother offered her a temporary home. Fortunately for Frankie, in the following semester, a different staff member was more accommodating and worked with Frankie to rearrange the location and times of her practicum.
Around half the participants, especially those with young dependent children, and whose partners worked in low-paid occupations, indicated that they could not cease paid work or drastically reduce their hours to help them better manage during the practicum. These participants reported using a range of strategies to enable them to complete their practicums.
A common practice of accepting additional paid work before and after practicum weeks helped compensate for the loss of income during the practicum for some participants. A downside of this strategy, however, was that it left even less time available for study; a situation that these women described as…resulted in lower grades than usual in academic assessments. Kylie (20, FTW, FIFO) for example, worked 30 hours a week to meet the family mortgage. In the weeks preceding and following the practicum she increased her work to 40 hours per week. As she explained, during these periods study became impossible, because she “simply didn’t have time for uni”. While Kylie explained this had a detrimental impact on her grades, she explained that increasing her work hours had been unavoidable.
In the first year of the degree, some participants were able to use their annual leave to complete the comparatively short early practicums. In the second and third year however, practicums ran for a total of eight weeks and 10 weeks respectively, making fixed employment contracts difficult to maintain for these participants. One solution was to move to casual contracts, as described by Marla (21, PTW, FIFO):
The (casual) job that I have now is more supportive and that’s also why I went for it, because they are a lot more supportive of uni… Whereas the last work I was at, they wanted me to do certain days, and of course if you’re timetable changing every semester it was hard. They weren’t too happy about me going on prac.
However, casual work brought additional problems such as the loss of important employment benefits such as sick pay and annual leave entitlement, which added to financial difficulties and personal fatigue.
Participants who stayed in their original work contracts resorted to other ways to accommodate practicums. This included using unpaid leave entitlements; a solution, however, that caused periods of financial stress to the family. For example, Ros (40, PTW, CH 2, FIF0) combined her study leave, long service leave and annual leave entitlements to attend the final year practicum. While this strategy enabled her to complete the practicum component of the course, the resultant loss of free time in this final year left her feeling stressed and exhausted.
Participants’ reduced income following relationship breakdown exacerbated financial stress. Some of the eight women who separated from partners increased their paid work hours to support themselves and their children. While this alleviated some financial stress, it also created a further barrier to practicum accessibility. Other participants were able to move in temporarily to their parents’ home, and while this home brought financial relief, it also meant that some had to travel much further to attend practicums.