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					Employme nt opportunities for doctoral graduates in Australia, New Zealand and
the surrounding region. A paper presented at the 2007 INDEN conference in
Tokyo, Japan, 26th May, by Professor Kim Usher, School of Nursing, Midwifery and
Nutrition, James Cook University, Australia.


Australia and New Zealand have well developed health care and education systems which

in turn provide reasonably well for their population. However, our near neighbours are

not all so well off. Australia is part of The Western Pacific Region of WHO (WPRO)

and our near neighbours are in the South-East Asian Region known as SEARO. The

member countries of both WHO regions are at varying stages of development. In fact,

Pacific Island and South-East Asian countries still struggle with the management of

communicable diseases such as TB, Malaria and HIV/AIDS; and also struggle to provide

adequate care for people with noncommunicable diseases such as cardiovascular disease,

cancer and diabetes mellitus (WHO 2006). Further, our region has suffered numerous

natural disasters over the last few years ranging from devastating tsunamis to destructive

cyclones and earth quakes. All of these have taken their toll on health, health care

provision, the health workforce and health care education. For example, the Sachs Report

on the Pacific‟s achievement of the Millennium Development Goals indicated that the

Region was falling behind in many areas (The Pacific Pan 2005).

Given that research has clearly demonstrated how errors in health care are not only

frequent but also leading causes of mortality and morbidity (WHO 2006), and that a well

qualified nursing workforce is linked to positive patient outcomes (Aiken et al. 2003), the
need for a well educated health workforce is evident. A recent paper by Ketefian,

Davidson, Daly, Chang and Srisuphan (2005, p. 150) said that “Education is the driving

force in improving the health and welfare of communities globally” and they identified

doctoral education as “…critical to the provision of leadership in practice, scholarship,

research, policy and education”. To address this need, doctoral programs have increased

significantly over the past 20 years (Anderson 2000) and are now available in more than

30 countries in the world. Pleasingly, the number of doctoral programs in the developing

world is also increasing (Ketefian 2005).

In 2000, Carole Anderson said what was most impressive about the development of

doctoral education is the fact that the research of doctoral candidates has now changed to

become more focused upon clinical problems. As a result, doctoral programs are now

preparing nurse researchers to carry out research that is relevant to the practice of nursing

(Anderson 2000). However, as Anderson (2000) also so aptly points out, it is the success

of graduates after the program that best demonstrates the usefulness of the study. This

paper provides an overview of nursing doctoral education in Australia, New Zealand and

the surrounding Pacific Island Countries, identifies traditional and new employment

opportunities for nurses with doctorates within Australia and New Zealand and includes

the findings from a recent survey of Deans of nursing schools.

Pacific Island countries

In the Pacific Island region there is a great variation of standards for initial nursing and

midwifery education which has been identified as an impediment to the development of
standards of care and employment opportunities between countries. In some countries,

the initial nursing qualification is at diploma level while others offer credentials not

recognized outside of their own country (Tollefson & Jones 2006). Postgraduate offerings

vary similarly. None of the countries in the Pacific currently conduct nursing at doctoral

level but this has not prevented individuals aspiring to pursue a qualification at that level.

In Fiji, for example, there are currently 2 tutors on leave from the Fiji School of Nursing

while studying at the doctoral level in neighbouring countries. Opportunities for

employment within these countries would primarily occur within nursing education. I am

currently the team leader for a WHO and Pacific Island Forum Secretariat (PIFS) funded

study exploring the standards of nursing education across the Pacific Island region.

Australia and New Zealand

Doctoral level education has been available since the late 1940s in Australia, but was not

offered by School of Nursing until after they joined the academy in the 1980s onwards.

Unlike the American system where a large coursework component embedded within the

doctoral study is the norm, Australia‟s PhD system tends to be more closely aligned to

the British tradition with the focus on research training (Borbasi & Emden 2001).

However, Borbasi and Emden (2001) explain that contemporary practices in doctoral

education in Australia has resulted in industry and the academy moving closer together

where some form of practicums are beginning to be included as part of the degree process

and where the focus of the research is more closely linked to the clinical area. In fact, one

of the participants interviewed by Borbasi and Emden (2001, p. 191) said that “the key to
the „usefulness‟ of PhDs in the workplace lay in the selection of the doctoral project,

which should have the potential to have an impact on practice”. NZ?

A recent audit of Deans of schools of nursing in Australia and New Zealand revealed…

(Put over view of number programs, no. students, staff with PhDs etc)

Employme nt opportunities for doctorally prepared nurses in Australia and New



As indicated by Ketefian et al. (2005), academic positions have been the traditional

pathway for doctorally prepared nurses. There has been pressure on nursing academics in

Australia and New Zealand to upgrade their qualifications to doctoral level since the

move of nursing to the higher education sector. As a result, many schools of nursing still

have a number of staff undertaking doctoral studies part-time whilst employed as an

academic. In fact, in some school this is the case for the majority of staff as demonstrated

in the earlier slides.

Clinical Chairs

Clinical chairs have been established in Australia and New Zealand in order to achieve

more effective partnerships between academia and the health care sector. Clinical

professorial appointment, according to Dunn and Yates (2000, p. 171), “…provide one

means of addressing the perceived gaps in research, education and professional

development of the nursing community”. A survey of Schools of Nursing in Australia

and New Zealand by Professor Rhonda Griffiths (perso nal communication to the CDNM

2007), revealed that of the 17 responses, 7 in Australia and 2 in New Zealand had
incumbents in Clinical Chair positions. A further five universities were planning to

establish or appoint to currently vacant Clinical Chair positions while two indicated that

they did not have a Clinical Chair with a health care partner. Of the nine universities who

indicated that they had Clinical Chairs, there were a total of 24 appointments; 10 in

Victoria; 6 in Queensland; 5 in New South Wales; 1 in South Australia; and 2 in New

Zealand. Eighteen of those were said to be at Professor level and 6 at Associate Professor

level. Thirteen of the Clinical Chair positions were reported as not specialty specific

while the others covered the areas of aged care; mental health; nursing leadership;

practice development; evidence based nursing; acute care; cancer care; palliative care;

neonatal nursing, tropical health and critical care. The audit revealed that a further 7

positions are planned for the near future (Griffiths personal communication to the CDNM


Other employment opportunities

While the academy or clinical Chair positions may have been where most or almost all

doctorally prepared nurses were employed in the past, that trend is now changing. New

opportunities are now arising in the areas of health and nursing (Ketefian et al. 2005) and

even further a field. Clinical researcher positions are now becoming available and

doctorally prepared nurses are sought after for to fill such vacancies. These positions are

often closely aligned to, or work under the supervision of, Clinical Chair positions.

The survey of Deans of Schools of Nursing in Australia and New Zealand revealed a

range of employment opportunities including the traditional ones of academic and

Clinical Chair. However, the survey also revealed that doctorally prepared nurses were
finding employment in a range of other disciplines and fields including the defence

services, pathology, entrepreneurial activities such as private consulta nt or private


At James Cook University we have only offered doctoral education for a short time.

However, we now have a number of students studying areas of relevance to clinical

practice such as….

Our graduates have taken on varied positions. Dr Narelle Biedermann, who studied

Australian Army nurses‟ experiences in the Vietnam War, and who has written two books

on military history, is now employed as a strategist in the military. Dr Jane Williams,

who studied


Aiken, L.H., Clarke, S.P., Cheung, R.B., Sloane, D.M. & Siber, J.H. 2003. Education

levels of hospital nurses and surgical patient mortality. Journal of the American medical

Association, 290(12): 1617-1623.

Anderson, C.A. 2000. Current strengths and limitations of doctoral education in nursing:

Are we prepared for the future? Journal of Professional Nursing, 16(4): 191-200.

Borbasi, S. & Emden, C. 2001. Is a PhD the best career choice? Nursing employer‟s

views. Contemporary Nurse, 3-4: 187-194.

Dunn, S.V. & Yates, P. 2000. The roles of Australian chairs in clinical nursing. Journal

of Advanced Nursing, 31(1): 165-171.

Ketefian, S., Davidson, P., Daly, J., Chang, E. & Srisuphan, W. 2005. Issues and

challenges in international doctoral education in nursing. Nursing and Health Sciences, 7:


Tollefson , J. & Jones, S. 2006. Feasibility Design Study-Kiribati Nurses Initiative. Final

Report to AusAID. School of Nursing Sciences, James Cook University, Australia.