Diverting the Stream

Published 13 March 2017. Last updated 20 April 2021.

Macksville Hospital developed a 24-month New Graduate Program for nursing staff that involved a 12-week intensive induction period, with clinical exposure and support over the course of the program.


To increase bed occupancy in the General Ward at Macksville Hospital from 73.5% to 85% by June 2017.


  • Improves bed occupancy rates.
  • Improves staffing levels.
  • Reduces costs and stress associated with staff overtime.
  • Improves bed access and clinical care for patients.
  • Reduces travel time for family and carers, as patients can stay in a local hospital.
  • Improves the level of Activity Based Funding.


When Macksville Hospital moved to an Activity Based Management system in 2015-16, it became increasingly important to maintain occupancy levels to ensure budgets were met. In November 2015, Macksville Health Campus’ bed occupancy dropped to a new low of 61.5%. A working group was established to determine the key factors affecting bed occupancy. These included:

  • seasonal fluctuations in the local population
  • a low-acuity or medically stable patient population (if a patient is too sick they are transferred, if they are too well they are discharged)
  • recruitment difficulties (33% of all staff left the ward between September 2015 and June 2016).

It was determined that attracting and retaining quality staff was essential to improving bed occupancy rates. Prior to the project, there were minimal or no applications for nursing roles available, despite implementing seven recruitment processes in the previous nine months. The reduction in staff meant beds had to be closed, to ensure there were appropriate levels of nursing staff available to care for patients safely.


  • Consultation with former job applicants found that the wording in job advertisements was confusing for staff, as they weren’t sure what terms like ‘KPI’ meant or how to address them in the application.
  • The wording was changed to be simpler and more direct, but this did not impact the number of applications received.
  • The working group proposed two alternative options for increasing the staffing levels within the General Ward:
    • source overseas-trained nurses through visa sponsorship
    • invite the 182 graduate nurses that missed out on the first two rounds of the NSW Health Graduate Program in 2016 to apply, as they were already eligible and had been through the review process.
  • Consultation was undertaken with staff, the union and executive management. It was determined that all parties preferred to support local new graduate nurses.
  • A 24-month New Graduate Program was developed, comprising a 12-week induction period with clinical exposure and support. The support team met with graduates each week for the first 12 weeks to provide adequate support, then met with graduates at six, 12 and 18 months.
  • A handbook for graduates was developed in consultation with previous graduates, educators and managers. It was designed with best practice and adult learning principles in mind and featured timelines for expected competency-based outcomes.
  • A calendar of social functions was developed to complement the graduate program and introduce graduates to colleagues and mentors.

Project status

Implementation - the initiative is ready for implementation or is currently being implemented, piloted or tested.

Key dates

  • Project start: February 2016
  • Project implementation: September 2016
  • Project evaluation: June 2017

Implementation sites

Inpatient General Ward, Macksville Hospital, Mid North Coast Local Health District


Clinical Excellence Commission Clinical Leadership Program


  • Bed occupancy increased from an average of 61.5% in November 2016 to an average of 86.9% in February 2017.
  • Overtime expenses dropped from an average of $5,000 per month in November 2015 to an average of $1,000 per month in February 2017.
  • A survey conducted with participants in the 2016 New Graduate Program found that satisfaction rates were 98% at the end of the 12-week induction period.
  • The ‘Your Say’ survey conducted in 2016 found that staff satisfaction increased in all areas.
  • Clinical support was reduced by 50% at the six-week mark, at the request of participants in the New Graduate Program.
  • Over the next two years, the program will be expanded to include cannulation training and Front Line Emergency Care Course accreditation.
  • The graduate handbook will be refined and improved as the program evolves over time.

Lessons learnt

The New Graduate Program has been a great opportunity to open dialogue with staff and future registered nurses. The open planning process helped staff take ownership of the process and become stakeholders, who pushed for the success of the program and cared about the new graduates who joined the workforce. This established strong social integration and support quickly and efficiently.

The working group identified that some staff struggled to see how the program could succeed. They were consumed with potential negatives and required intensive change management support throughout the project.


Mark Tyler
Deputy Director of Nursing
Macksville Hospital
Mid North Coast Local Health District
Phone: 02 6568 0623


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Capability buildingStaff experienceMid North CoastRural and regionalInpatientClinical Leadership Program
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