1. Daniel Terry, Frances Barraclough, Sabrina Pit, Tony Smith
Getting them out there: The impact of rural exposure on satisfaction and practice intention among nursing students
Daniel Terry, Frances Barraclough, Sabrina Pit, Tony Smith
I would like to acknowledge the Mouheneenner (pronounced Moo-he-ne-nah) people and the traditional owners of this land and the elders past and present.
I would also like to thank the conference organisers for accepting this paper and allowing us to present some of the findings of this research

2. Thanks to the Student Survey Working Group and Data Analysis Sub-group
Tony Smith – University of Newcastle Department of Rural Health
Keith Sutton and Helen Chambers – Monash Rural Health
Frances Barraclough and Sabrina Pit - University Centre for Rural Health
Merylin Cross – Centre for Rural Health, University of Tasmania
Stephanie King – Mt Isa Centre for Rural and Remote Health
Amanda Urquhart – Deakin Rural Health
John Walker and Robyn Phillips– Broken Hill UDRH, University of Sydney
Kuda Muyambi & Michelle Bochnicek – University of South Australia Department of Rural Health
Claire Courtney – Western Australia Centre for Rural Health
Annie Farthing and Pauline Walsh – Centre for Remote Health, Alice Springs
Daniel Terry and Joelene Mitchell – University of Melbourne Department of Rural Health
Jane Smith and Janine Ramsay – Australian Rural Health Education Network
This research was undertaken with the corporation and collaboration of a large number of people, some of whom may be in the audience.

3. Background What is ARHEN? What are UDRHs?
The peak body that connects 11 University Departments of Rural Health (UDRHs) in Australia
Leads and initiates the rural and remote health agenda in education and research
What are UDRHs?
Rural academic units that support health professional students and practitioners 
They are diverse and form the most significant rural and remote health academic consolidation in Australia
The support rural placements for students from all health disciplines
All the UDRHs have been required for some years to collect the satisfaction of students who undertook placements supported by the UDRHs to report to our funding source in the Australian Government. In 2013 under the banner of ARHEN, we all came together to collaborate on their students satisfaction surveys

4. Location of UDRHs
All the UDRHs have been required for some years to collect the satisfaction of students who undertook placements supported by the UDRHs to report to our funding source in the Australian Government. In 2013 under the banner of ARHEN, we all came together to collaborate on their students satisfaction surveys

5. Aims
This presentation is about survey responses from nursing students who attended placements supported by UDRHs
Research questions:
What is the profile characteristics (age; gender; discipline; Aboriginality; type of placement; length of placement) of students who undertook a regional, rural or remote placement?
Were students satisfied with their placement and what factors influenced their level of satisfaction?
Did the placement experience change their rural practice intentions after compared with before the placement?

6. Methods
Survey used a questionnaire that had 21 core questions used by all UDRHs, including:
Demographic questions
Health profession, program and stage
Placement location, length and type
Experiences and access to resources
Satisfaction
Rural practice intention
Data was aggregated for all the sites for July 2014 until November 2015
Ethics clearance by 14 different ethics committees
Placement location was categorised using the Modified Monash Model (MMM)

7. Modified Monash Model MMM 2-3:
eg. Ballarat, Hervey Bay, Coffs Harbour, Warrnambool
MMM 4-5:
eg. Port Fairy, Sale, Lithgow, Roma
MMM 6-7:
eg. Mt Isa, Katherine, Kununurra
Used the Modified Monash Method categories for classifying
MMM 1&2 eg Ballarat, Hervey Bay, Albury / Wodonga
MMM3-5 eg Port Augusta, Geraldton and Roma
MMM6&7 eg Mt Isa, Katherine and Kununurra. According to the MMM – these are remote and very remote areas so we are going to call them remote.

8. Responses came from students undertaking placements across Australia in areas covered by the UDRHs.
Student demographics and background and placement characteristics
Satisfaction with various aspects, such as accommodation, supervision, resources, cultural orientation and overall satisfaction
Impact on the intent of the students to take up rural/remote practice after graduation

9. Placement Location
Sample size = 1,273 nursing and midwifery student responses MMM 2 – 7 sites
LIMITATION: We don’t have an accurate response rate for the total cohort of students on placement at this time as response rates varies across the UDRHs

10. Demographic Profile 89% female
2.6% Aboriginal and/or Torres Strait Islander
Age

11. Type of placements
Discuss ‘other’
Private Hospital
Private Practice
Residential Aged Care
Rural community
School based
‘Other’: Private Hospital, Private Practice, Residential Aged Care, Rural community, and School-based placements

12. Length of Placement Length of placement MMM 2-3 (%) MMM4-5 MMM6-7
Total (%)
Less than 2 weeks 4 1 3
2-4 weeks 36 31 18 32
5 weeks to 3 months 45 52 51 48
Greater than 3 months 15 16 30 17
Most of the placements were between 5 weeks- 3 months.
p < , Chi squared test

13. Satisfaction Students who ‘Agreed/Strongly Agreed’ they are satisfied
Satisfaction with …
MMM2-3
(%)
MMM4-5
MMM6-7
p-value
Indigenous cultural training 48 37 71
<
Workplace supervision 86 90 87
0.265
Access to educational resources 79
0.035
Placement accommodation 69 81
Overall satisfaction 91 93
0.481
Students on placement on the whole satisfied with their placements
In response to the statement above

14. Strongly Disagree / Disagree
‘I received adequate Indigenous cultural training during my placement?’ by placement
Placement
Strongly Disagree / Disagree
(%)
Neutral
Agree / Strongly Agree
Community Health Centre 40 30
Private Hospital 36 28
Private Practice 67 33
Public Hospital 21 27 52
Residential Aged Care 24 46
Rural community 13 50 37
School based 20 80
Total 25 47
p =

15. Rural Practice Intention
Before placement – 55% intended to take up a rural or remote position
After placement – 62% intended to take up a rural or remote position
(p = , Chi squared test)
Intention to enter rural practice in the future by MMM classification of placement
Rural practice intention …
MMM2-3 (%)
MMM4-5 (%)
MMM6-7 (%)
p-value
Prior to placement 56 54 58
0.455
After placement 60 61 72
0.05
Q4: Is there a difference between the different MMM categories on intention to practice rurally.

16. Post-Placement Rural Practice Intention by Length of Placement
Percentage of students who intend to practice rurally in the future
Length
Strongly Disagree / Disagree
(%)
Neutral
Agree /
Strongly Agree
Less than 2 weeks 13 33 54
2-4 weeks 27 60
5 weeks to 3 months 16 23 61
Greater than 3 months 12 20 68
Total 14 24 62
Q3: Do longer term placements lead to higher future intent to practice rurally?
DISCUSSION: We should question if we need to arrange more long-term placements to increase long-term exposure in remote locations?
p = 0.415, Chi squared test

17. Student Experiences
I gained more confidence in this setting than I have ever had on any placement
I would do all my placements rural if I could. It was well organised
This placement has made me realise a rural career is what I would like to do in the future
I enjoyed seeing a different side of nursing that I was almost unaware existed
It has been the best experience in terms of making me feel welcome and supported while on placement.
There should be better promotion of rural placements as they are excellent.
I strongly recommend a placement ... in a rural and regional area.
Have included some of the comments from the students who undertook a placement in a rural area when asked what they enjoyed
Being a rural hub I was able to experience a wide variety of scenarios more so than I would being in... a metro site

18. Some more thoughts ...
The professional communication and work ethic between the multi-disciplinary team was outstanding.
The staff were so welcoming from the first moment... and went out of their way to help me learn and to give me the best possible experience
All of the staff were exceptionally friendly and helpful, I really felt like a valued member of their team
I had the opportunity to collaborate with other members of a healthcare team, enabling me to broaden my scope of knowledge and learning.
This placement was my favourite, and has been a significant influencing factor in my decision making about where I want my career to go
When asked about their experiences, there were a few thoughts that came through.
I adored being able to live near the place I was working because it meant I was able to focus on my studies

19. SUMMARY High overall satisfaction and satisfaction with supervision
No statistically significant difference in satisfaction with supervision with placement location classification
No statistically significant relationship between longer placements and rural practice intention
Longer stays occur more frequently in remote areas
Satisfaction with Indigenous cultural training and accommodation was higher in remote areas
Satisfaction with educational resources was lower in remote areas
Increased rural practice intention after compared to before placement
According to the data:
Discuss limitations of data.

20. Can it make a difference?
‘Prior to this placement, when asked what sort of Nursing I wanted to do my answer was always "doesn't matter, I just want to be a nurse"...now I know where I want to work, a district or rural facility with strong links to the local community.’