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New graduate employment in New Zealand: the influence of fieldwork experiences.

Occupational therapy skill shortage is identified as an issue in New Zealand (NZ) (Department of Labour, November 2009). Skill shortages are a complex interrelationship between the availability of therapists with specific skills and the attractiveness of a particular work environment. This study sought to explore how a particular work environment might or might not be attractive to new graduates in NZ, building on existing international literature.

The high demand for, and short supply of, occupational therapists has been a global issue. Literature reviewed for this study explored: the recruitment of occupational therapists; the link between fieldwork experience and recruitment; and factors affecting the selection of career direction and found no studies about the experiences of NZ students. Few studies have explored the specific issue of fieldwork experience and subsequent recruitment to facilities where students had fieldwork placements. Given that employment of new graduates is as relevant to practice in NZ as it is internationally, we sought to explore the relationship of final fieldwork placement to later employment decisions through a cohort survey which permitted the purposive identification of appropriate individuals for a semi-structured interview. The interviews were tape recorded and subjected to qualitative data analysis to answer the research question: How do final fieldwork placement experiences influence the decisions of newly qualified occupational therapists in NZ to seek or not to seek employment in the same facility?

Literature review

Recruiting occupational therapists appears to be more difficult in certain practice and setting areas, in particular, mental health (Hayes, Bull, Hargreaves & Shakespeare, 2008; Philipps, Maloney, Stevens, Madigan & Cash, 1997), rural (Lannin & Longland, 2003; Millsteed, 2000) and adult developmental disability services (Crowe & Mackenzie, 2002). Factors contributing to recruitment difficulties include: the location, such as rural (Mills & Millsteed, 2002); the type of practice, such as mental health (Cusick, Demattia & Doyle, 1993); and the nature of the job, such as a generic role in mental health (Craik, Austin, Chacksfield, Richards & Schell, 1998; Harries, 1998; Hayes et al., 2008). Occupational therapy students have shown preference for careers in physical disability and paediatrics over mental health practice areas (Crowe & Mackenzie, 2002; Cusick et al., 1993; Sutton & Griffin, 2000).

The link between fieldwork experience and recruitment

It is reported that students who have had a good fieldwork experience in a specific area, such as mental health (Craik et al., 1998; Cusick et al., 1993), adult developmental disability (Crowe & Mackenzie, 2002), or physical health (McKenna, Scholtes, Fleming & Gilbert, 2001) are more likely to seek work in those areas. Similarly, recent graduates who seek work in Australian rural areas are more likely to have had rural fieldwork placements (Lannin & Longland, 2003; Lee & Mackenzie, 2003; Russell, Clark & Barney, 1996). There are many older studies that report a strong relationship between fieldwork experience and recruitment (Ezersky, Havazelet, Scott & Zettler, 1989; Lewicki, Smith, Cash, Madigan & Simons, 1999; Swinehart & Meyers, 1993). Occupational therapy student fieldwork placements, along with word of mouth and advertising were identified by Mulholland and Derdall (2005) as being among the most effective recruitment strategies. Several studies reported that fieldwork placement was the greatest influence on preferred clinical practice (Atkinson & Stewart, 1997; Christie, Joyce & Moeller, 1985a; Crowe & Mackenzie, 2002; McKenna et al., 2001). One study brings the perspective of fieldwork supervisors in Australia (Thomas et al., 2007), and concluded that the most commonly reported benefit of supervising fieldwork students is related to recruitment opportunities.

Having students brings the advantage that they become appropriately prepared employees (Rydeen, Kautzmann, Cowan & Benzing, 1995; Thomas et al., 2007). The final placement especially (Mulholland & Derdall, 2005) allows for employer canvassing of the student for potential employment (Thomas et al., 2007) and also for the student to explore the environment for potential employment (Crowe & Mackenzie, 2002; Rodger et al., 2007; Sloggett, Kim & Cameron, 2003; Thomas et al., 2007).

Factors affecting the selection of career direction

The decision of where to work may be influenced by several factors such as an individual's personal interest in an area; locality of the position (Crowe & Mackenzie, 2002); location of family and significant others; and job opportunities (Christie et al., 1985a; Ezersky et al., 1989; Polatajko & Quintyn, 1986). Experiences on fieldwork are also very influential (Christie et al., 1985a; Cusick et al., 1993) including the nature of the fieldwork programme. For example, it was important for the final placement that students were given responsibility and autonomy (Crowe & Mackenzie, 2002). Also influential are specific details of an occupational therapy position that make it attractive to new graduates, such as the presence of multidisciplinary team work and availability of senior staff for supervision (Borikar & Goodban, 1989; Crowe & Mackenzie, 2002).

A positive student experience with specific client groups, or in a specific setting, including mental health, can promote a positive attitude towards that group or environment (Crowe & Mackenzie, 2002; McKenna et al., 2001; Philipps et al., 1997; Rodger et al., 2007; Russell et al., 1996; Swinehart & Feinberg, 1990; Wittman, Swinehart, Cahill & St Michel, 1989). Negative experiences on fieldwork, such as a negative response to a client, or a negative experience with a supervisor can drastically influence the decision of where to work (Christie, Joyce & Moeller, 1985b; Crowe & Mackenzie, 2002).

Christie et al. (1985b) and more recent research (McKenna et al., 2001) found that fieldwork placements and clinicians had the greatest impact on the career plans of students. This is endorsed by other studies which report that the supervising therapist can be the main influence in the formation of a student's preference for a specific area of clinical practice (Hummell, 1997; Rydeen et al., 1995; Wittman et al., 1989).

Methodology

As this was an investigative piece of research (Keller, 2009) a qualitative method was used to gain an understanding of the experiences (Sandelowski, 2000) of newly qualified NZ occupational therapists.

Ethics

Ethics approval was granted by the Research Ethics Committee, Otago Polytechnic. Students and new graduate occupational therapists were not considered a vulnerable group of research participants as those associated with the researcher's place of work were excluded from the study. Students that had not passed the final placement were also excluded, as their opinion of the placement as a future employment option may have been distorted by that experience. No significant biases (Cohn & Lyons, 2003) were identified that would threaten the ethics or rigor of this research.

Confidentiality and consent

As NZ's occupational therapy population is small, participant confidentiality was paramount. Confidentiality was maintained through the use of pseudonyms for the participants with secure storage and eventual destruction of all research data and identifying information. By completing a questionnaire and emailing it to the researcher, students consented to participation in the research. Participants were made aware they could withdraw their data at any time prior to analysis, before all the data material was mixed and sorted, and therefore unable to be separated and removed.

Participants

Recruitment questionnaires (see Table 1) were used to purposefully sample from the population of third year, final fieldwork placement, 2008 Otago Polytechnic occupational therapy students. They were distributed by email with six (19 percent) out of the 31 returned. The questionnaire consisted of 10 questions: three questions determined eligibility to proceed; five pertained to fieldwork placements, and two covered demographics and consent. From the six completed questionnaires four consenting interviewees were selected with experiences that might inform the research question. Experiences strongly impacting, positively or negatively, on the students desire to seek a career in that setting or practice included the supervision received, supervisor and team environment. NZ has specific cultural requirements to consider issues that would be pertinent to Maori, related to the Treaty of Waitangi or of relevance to any other specific group (The Pu-taiora Writing Group, 2010). The demographic and interview data collected did not reveal any specific ethnicity other than NZ European, so additional consultation was not necessary.

Data collection

Semi-structured, open-ended interviews were conducted, one being face to face and three by phone. The interviews were audio taped at the time of interviewing and later transcribed verbatim by the researcher. The four transcripts were sent back to the interviewees for comments or amendments. None were amended.

Data analysis

All participants were female. Five were aged between 20 and 25, and one between 30 and 35 years. The four interviewees were aged between 20 and 25. Content analysis (Patton, 2002) was utilised as the data analysis method. Colour coding of the transcripts, creating themes and subthemes and supervisory input and support contributed to interpretation of the data. The process of data analysis also involved reading and rereading the interview transcripts and their questionnaire answers along with selected data from the questionnaires.

Trustworthiness

Due to the "focus on unmeasureables and use of subjective data" qualitative research is often questioned in relation to trustworthiness (Finlay, 2006, p. 453). To ensure trustworthiness for this study, reflexivity and bracketing; peer review and supervision; triangulation; and member checking were used.

Results

The results of this study derive from both the questionnaires and the semi-structured interviews.

Questionnaire results

The questionnaire results relating to experiences of final and pre final placement questions were comparable. That is, the influences on job choice are similar regardless of whether a placement is final or pre final. The main emphasis for this project, in terms of selecting interviewees, was derived from questions on final fieldwork placement. The answers revealed themes for and against working in a placement setting; these themes were confirmed in the interviews and are dealt with later in more detail. For example 'location' was cited both as a negative, and a positive, reason to seek employment in a fieldwork placement setting. Some reference was made to team dynamics as an attraction or as a deterrent. Whether 'team' meant multidisciplinary team (MDT) or occupational therapy team or another team was not always identified due to the participants' omission of this aspect.

Interview results

The results for this study were mainly derived from the interviews and came under the following themes: nature of placements; transitions; occupational therapy status; teams; supervisor(s); supervision; and tensions.

Nature of placements

In response to a direct interview question all four participants stated the type of placement they had for their final fieldwork, and in the course of the interview mentioned other fieldwork placements. A wide range of practice areas and settings had been experienced by the participants over the course of their studies allowing them good scope for comparisons.

Three out of the four participants had similar expectations and experiences on final placement. They saw it as a time to consolidate their understandings: "I was on my very last placement so that was kind of putting everything I've learnt over the last three years, putting it into practice". The things that the participants liked about their fieldwork placements made the setting more attractive to them, just as the things they did not like affected their enjoyment of the setting, and in some cases, deterred them from seeking employment in such settings.

Transitions

Issues around transitioning from student to therapist were raised by the interviewees when they commented about their fieldwork as it related to career choice, finding work upon qualification, and looking further into the future as occupational therapists. Three out of the four participants discussed the issue of 'grounding'. Grounding was explained by the participants as an opportunity to become well-versed in the fundamentals in occupational therapy which provides a good foundation for their career. Grounding was sought through experiences as a student, and/or as a new therapist. While on placement the participants were all actively considering and planning career moves whilst at least one reported the host organisation was considering the employability of the specific fieldwork student. All fieldwork, especially the final fieldwork experience, played an important part in preparing, or not preparing, students for occupational therapy practice. Fieldwork experiences influenced the participants' career direction and their practice preferences. Being treated like a colleague, socially and professionally were key factors in the attractiveness of a setting. In addition, being given the opportunity on the final placement to consolidate clinical reasoning and having appropriate autonomy to smooth the transition from student to therapist were significant contributors.

Occupational therapy status

Occupational therapy status is defined in this study as the degree of standing occupational therapy (Lloyd, King & Bassett, 2002) has within the fieldwork setting. The participants' view on what the occupational therapists did in their clinical settings, and the degree of status occupational therapy had within the setting had an influence on the attractiveness of the setting.

Aspects of mental health were not appealing to the participants, particularly the generic and caretaker roles held by the occupational therapist, as these roles were unclear, confusing and not obviously 'occupational therapy', so these roles had a lower status in the opinion of the participants.

Teams

The participants were involved in several types of teams during fieldwork placements. The participants identified team dynamics (positive and/or negative), occupational therapy specific, inter/intradisciplinary or multidisciplinary, in relation to the attractiveness of a setting. Tensions between colleagues contributed to a dislike of the setting, unless resolved professionally or countered by another positive team attribute.

Supervisor(s)

The fieldwork supervisor of an occupational therapy student is responsible for the day to day training and for the quality of professional practice skills. Supervisors and students have roles and learning obligations set out by the pertinent occupational therapy school in order to assist the student in achieving their goal to be an occupational therapist. Participants experienced and witnessed great supervision, which impacted positively on their choice of setting or practice area. For example one participant said "from that placement I knew that I wanted to work in paediatrics". Participants also reported questionable and unethical behaviour from some supervisors, which impacted negatively. For example, a supervisor rudely complaining about one student to another or a supervisor spending extensive work time playing computer games.

Supervision

Not only did the participants comment on the quality of their supervisors' practice and interpersonal skills, they also commented on the quality of the supervision received. The participants commented on the models of supervision experienced, the quality of the supervision received, and the consequences of supervision, especially in relation to the influence on job choice. The two fieldwork supervisors to one student and the collaborative (one supervisor to several students) supervision models did not work for the participants in this study. These issues require further exploration which is beyond the scope of this article. Positive and negative supervisory and supervision experiences clearly had a bearing on the type of experiences participants had on placement, which were directly linked to their practice and setting preferences for future employment. One participant succinctly demonstrated this: "Yes, I have had a couple of placements where I could see myself working. For me the supervision I have received really shapes the experience, and for the placements where the supervisor and supervision has been good I would consider employment".

Tensions

In the context of this theme, tension, may be defined as "mental strain or excitement; strained (political, social, etc.) state or relationship" (The Concise Oxford Dictionary, 1987, p.1102). Fieldwork placement at times was stressful for the participants and supervisors have a role in reducing this (Yuen, 1990). The participants commented on tensions experienced between themselves and their supervisors such as the fear of speaking up (and how they dealt with this fear), issues within the occupational therapy team and also issues between different teams.

An example of supervisor tension and fear of speaking up given by one participant discussing why she felt that she couldn't talk to her supervisor about not having enough supervision on a second year placement: "I don't really like confrontation, and ... probably the aspect of not passing the placement was there. I felt I couldn't really approach it with her because, I was just too scared I guess ..." Experiences of, or witnessing tensions during fieldwork placement in any capacity, greatly affected the attraction of a setting as a potential work environment.

Discussion

This study set out to explore the influence of final fieldwork placements on new graduates' employment decisions. Additionally, study participants had much to say about other placements, revealing that influences on job choice are similar, regardless of whether the fieldwork placement was final or pre final. The findings of this study apply to all fieldwork experiences. Analysis of the results revealed three significant and six less significant influences from placement experiences on subsequent interest in practice settings. The three major findings were: the spirit of teams; respect and value of occupational therapy; and the quality of the supervisor and supervision. The six minor findings were: location; type of practice; career building--grounding; social, emotional aspects; benefit to employers; and models of supervision. Two of the major findings, 'teams' and 'respect and value', demonstrate the power of these areas in influencing job choice and have not been previously reported.

Major findings

The spirit of teams

Participants' experiences of teams while on fieldwork were highly relevant to employment preferences. For a team to work well it needs a team spirit consisting of good communication, responsible actions and a striving to create hope (Peloquin, 2000). Positive teams had good communication, valued others' roles, were supportive, and welcomed the students, treating them as colleagues socially and professionally. Negative teams showed poor team communication, tensions, conflict, unethical behaviour, cliquey groups and lack of respect for occupational therapists. This concurs with Christie's and colleagues (1985a) findings that a supportive and caring environment has an impact on practice preference as the students' employment preferences were influenced positively and negatively by the team environment. Team dynamics affect students' perceptions. Interestingly a good occupational therapy team could override difficult MDT and interdisciplinary experiences. For example, if the participant had an unpleasant experience on the acute wards, but the occupational therapy team was supportive, and communicated well, the setting was still likely to be attractive to them for job seeking.

Respect and value of occupational therapy

Occupational therapy is a profession that often grapples with how other people understand its role and function (Craik, 1988) and often experiences a lack of respect and value held by other professions (Bailey, 1990). The participants related similar issues and identified these issues as highly relevant to employment preferences. If occupational therapists had low value, professional status or respect within a setting it was a negative factor in the choice of a setting or practice area. This is a new finding in relation to fieldwork and subsequent job choice, but not new for recruitment in general (Lloyd, King, & McKenna, 2004). Acute physical and community mental health settings had lower value in the eyes of the participants but three out of the four participants still chose acute physical over mental health when they were job seeking. Another new finding was that, despite unattractive aspects of a particular setting, new therapists would still give priority to an acute physical entry-level position when it was available, which may indicate that the occupational therapy profession collectively values these as career grounding choices.

This preference for acute physical positions, despite unattractive aspects of a setting did not hold for the mental health practice area. New graduates did not value the generic and caretaker aspects of occupational therapists working in community mental health teams which is consistent with other findings (Harries & Gilhooly, 2003; Lloyd et al., 2004). Ethical tensions, such as those relating to systematic and resource constraints (Kinsella, Park, Appiagyei, Chang, & Chow, 2008), while not valued by participants, did not themselves seem to influence job seeking, but rather how positively or negatively the issues were handled in a setting.

The quality of the supervisor and supervision

The quality of supervision is well represented in literature (Christie et al., 1985b; Crowe & Mackenzie, 2002) except for two newer issues found in this study: autonomy given to the supervisee on final placement and student experiences of supervision styles. Students expected final fieldwork placement to closely resemble that of an entry-level job and being given increasing autonomy was significant. This autonomy requires quality supervision and constructive interactions and needs to be appropriate to the student in the context of the setting. This need for autonomy, particularly in the final placement is consistent with Crowe and Mackenzie's (2002) findings. However, the influence of the supervisor and supervision in relation to the right amount of autonomy needed on final placements appears unexplored in literature.

The participants were aware of the importance of good supervision and recognised when it fell short. Participants experienced, and witnessed, what they considered as great supervision but also questionable behaviour from their supervisors. The quality of the supervisor, and the quality of the supervision, had a major influence on the enjoyment the fieldwork placement and practice/setting preference. Poor supervisor interpersonal skills on fieldwork placement provided a negative impact on setting and practice preference, consistent with the findings of Hummell (1997). The more positive the supervisory experience, the greater the desire to work in that specific practice area. Both Ryan (2000) and Elliott, Velde, and Wittman (2002) reported supervisors were key for the acquisition of clinical reasoning by the participants and unsatisfactory answers led to confusion and acted as a deterrent to practice. Being given the opportunity to consolidate clinical reasoning with appropriate autonomy in all placements during the transition from student to therapist were significant points.

Minor findings

Significant practical considerations included the size of team or size of the city the participants were in, and the opportunity to further familiarise with a preferred practice area which is not a new finding. There are frequently historical, practical and personal reasons around location based job choices. The need for participants to seek their first job with grounding experiences as a basis for their occupational therapy career launch is not a new finding but the finding that this factor can override a practice preference (such as mental health) established on final fieldwork is new. The degree of social inclusiveness a student experiences on fieldwork placement having a bearing on the attractiveness of that setting as job choice is also a new finding.

Recommendations

For occupational therapy educational institutions it is recommended that students be better prepared for the reality of generic roles in occupational therapy, especially addressing how to retain the unique occupational therapy contribution to mental health. Investigating student experiences of diverse supervision models is also warranted. Employers should recognise the power of fieldwork placements as a recruitment tool, and that dysfunctional teams and poor staff performance are negative influences. It is recommended employers actively provide the best quality placement experience especially with respect to supervisor/supervision, clinical reasoning, autonomy and human interactions in the work place.

When having a fieldwork student, the best quality experience should be provided, not only to help the student link theory with practice and thereby fulfil their fieldwork aims, but also to make the service an attractive place to work. Services should consider what friendly social opportunities their department offers, as particularly on final placement, students highly value being treated as if they were already a colleague. Another issue to be considered is ensuring the student has the appropriate level of autonomy. For those employers who have difficulty in recruiting to specific areas, it is particularly important to provide the best quality fieldwork experience along with clear roles, because fieldwork experience is a strong recruitment tool. Positions that offer a solid grounding experience for careers in occupational therapy such as the opportunity for rotational entry-level positions in a hospital are attractive.

Limitations

This study was of small size, with timing constraints (approaching students while on final fieldwork placement). This meant that the findings were limited to one NZ occupational therapy programme, one gender and one ethnic group. A more representational sample of occupational therapy student population in terms of age, gender, culture and both educational institutes would be more robust. The low response rate of the questionnaires (19 percent) led to a small sample number to select the interviewees from. While considerable effort was made to attract a greater questionnaire response, a better way to achieve a higher response rate needs to be identified.

Conclusion

This qualitative research sought to explore the experiences of NZ occupational therapy students on fieldwork placement in relation to job choice. The study demonstrated that all NZ fieldwork placement experiences across a student's education influence the later choices for both practice areas and specific settings. Of significance are the spirit of teams, respect and value of occupational therapy and the quality of the supervisor/supervision. It is unknown how well NZ employers of occupational therapists, particularly those who are not occupational therapists or health professionals themselves, know that NZ fieldwork experiences inform future practice choices. Employers who choose to use this research to address the issues highlighted, may find they can employ new graduates faster and better.

Key points

1. All fieldwork experiences influence future practice choices.

2. Provide only best quality fieldwork experiences. Final placement students require appropriate autonomy, and need to be treated like colleagues (professionally and socially).

3. A strong occupational therapy team can counter other problems in the setting.

4. Educational institutions and employers must prepare students for the range of roles to be encountered in mental health.

Acknowledgement

We acknowledge the students who completed the questionnaires, the participants who gave up their time for an interview, the pilot questionnaire and interview evaluators and the staff of the Otago Polytechnic, School of Occupational Therapy for their encouragement and support of this research project.

References

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Reference

Keller, S. & Wilson, L. H. (2011). New graduate employment in New Zealand: The influence of fieldwork experiences. New Zealand Journal of Occupational Therapy, 58(2), 30-36.

Susanne Keller and Linda Wilson

Corresponding author:

Susanne Keller MOccTher, PGDip Rehab, Dip OT, NZROT

Community Occupational Therapist, S.T.A.R Centre,

Palmerston North Hospital

Ruahine Street, Palmerston North

Email: saltnpepper@thinair.net.nz

Linda H. Wilson PhD, MSc, DHA, NZROT, NZCAET

School of Occupational Therapy

Otago Polytechnic
Table 1: Recruitment questionnaire circulated to Fieldwork Placement
7 students at Otago Polytechnic

 Question Answer

1 Are you currently completing your Yes/No *
 Fieldwork 7 placement?

2 Are you currently completing your Yes */No
 fieldwork 7 placement in the Midcentral
 Health DHB, which includes Palmerston
 North Hospital, Horowhenua or Tararua
 districts?

3 Have you, or do you intend to apply for Yes*/No
 an occupational therapy position in
 Midcentral Health DHB, which includes
 Palmerston North Hospital, Horowhenua
 or Tararua districts?

 Fieldwork 7 Placement
 Please do not name your fieldwork site

4 What are all the reasons that you can
 think of that might make you want to
 apply for a job in this facility?

5 What are all the reasons that you can
 think of that might make you not want
 to apply for a job in this facility?

6 How strongly did this fieldwork Please indicate on
 placement experience make you want to rating scale from
 apply for a job in the same setting? 1 (would definitely
 i.e. if you were offered a job would apply/take it) to 7
 you want to take it? (would definitely
 not apply/take it)

 Previous placements

7 Did you have any other fieldwork
 placement experiences at another time
 and location that would make you want
 to apply for a job in that setting or
 facility? Please explain

8 Did you have any other fieldwork
 placement experiences at another time
 and location that would make you not
 apply for a job in that setting or
 facility? Please explain

 You need to give some personal details
 for the research so I can describe the
 participants

9 Please identify your Ethnicity, Age
 and Gender

10 IF selected, do you agree to being Yes/No
 contacted by the researcher in January
 or February 2009 with a view to being
 interviewed by phone or face to face

* If this answer, the person was asked not to complete the
questionnaire further
COPYRIGHT 2011 New Zealand Association of Occupational Therapists
No portion of this article can be reproduced without the express written permission from the copyright holder.
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Article Details
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Title Annotation:RESEARCH ARTICLE
Author:Keller, Susanne; Wilson, Linda
Publication:New Zealand Journal of Occupational Therapy
Article Type:Report
Geographic Code:8NEWZ
Date:Sep 1, 2011
Words:5769
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