That’s the view of nursing academic and researcher Sharon Brownie, who told Kaitiaki that these policies were designed to ease a nursing shortage which worsened during the COVID-19 pandemic when normal migration patterns were disrupted.
Government policies directly after COVID-19 restrictions ended led to a huge influx of migrant nurses — 31,720 IQNs joined the New Zealand register between the start of 2022 and the end of 2024 — which used up the recruitment budget and failed to support domestic nursing students.
The outcome has been an imbalance in the nursing workforce, tilting much too heavily toward IQNs, who now make up 46.8 per cent of those on the nursing register (according to December 2024 Nursing Council data). Brownie said the outcome of these policies, which led to a hiring freeze, was “distressed IQNs, a distressed domestic workforce, and distressed new graduates”.
Unable to find work
Many recently-arrived IQNs were now unable to find work, despite large financial outlays, while the domestic workforce was struggling to integrate the quantity of nurses new to New Zealand practice.
Meanwhile, hundreds of new graduates, having answered their country’s call to alleviate a nursing shortage, found themselves unable to find work, saddled with a large student loan, and struggling to pay their bills. According to Te Whatu Ora, at the end of January, 580 of the most recent November 2024 graduates were still seeking nursing jobs.
Tell your story of how you became an NZ nurse
What were your experiences and challenges as a New Zealand nursing student or a recently arrived migrant nurse?
A team of researchers, including Sharon Brownie and Patrick Broman, are conducting a study on this subject and want to hear from you. Participants will initially fill in an online survey, and will then be invited to take part in an interview to further expand on their experiences.
The study has been designed to increase understanding of the support available to nurses during training and for internationally qualified nurses (IQNs) on arrival in New Zealand.
The researchers are also seeking information on the challenges you have faced during your training or entry to New Zealand. The information will help in advocacy for future support.
If you interested in taking part, first read the participant information sheet then fill in and sign the participant consent form and send it to Jenny Song ([email protected]) or Jia Rong Yap ([email protected] ). If you agree to take part in a follow-up interview, you will receive a $50 grocery voucher.
The survey can be accessed here or via the following QR code:
Brownie said graduate-entry nursing students were worse off, as they were not entitled to a student allowance.
In an article titled “Growing our own, the abyss of data monitoring and support for New Zealand’s domestic nursing workforce pipeline”, published in the 2024 edition of NZNO’s nursing research journal, Kaitiaki Nursing Research, Brownie and fellow researcher Patrick Broman, a specialist demographer, described New Zealand’s increasing reliance on IQNs as a “national nursing workforce crisis”.
They said IQNs should be “valued, welcomed and appropriately supported”. However balance was needed across the IQN and domestic workforce. They also said the transition to practice in New Zealand was difficult for many IQNs as “they enter a fragmented and uncoordinated system no more capable of looking after them than it is of looking after its own”.
Graduate-entry nursing students were worse off, as they were not entitled to a student allowance.
The health system appeared to be “devoid of a single point of governance, funding, data and performance monitoring, or accountability”. They said a whole-of-government approach to fixing the domestic nursing pipeline was urgently needed.
Brownie told Kaitiaki that in data she tracked using Official Information Act requests, she found that in the two years following the opening of the border, the Government spent more than $50 million on policies to encourage the inflow of migrant nurses.
CAP fees reimbursed
The Ministry of Health had paid $17.8 million to offshore nursing recruitment agencies. And it set up a fund to reimburse IQNs for their competency assessment programme (CAP) fees once they got a job in New Zealand. These CAP programmes, offered by a range of tertiary education and private providers in New Zealand, cost around $10,000 a head.
Between March 2023 and March 2024, 3350 IQNs had their CAP fees reimbursed to the tune of $26.54 million,and a further $7.64 million in reimbursement was paid out between April and July 2024. The ministry told her they had hired two extra staff to process CAP reimbursement.
In that time, domestic nursing students, many of whom struggle financially, received no extra financial support.
“A lot of support has been given to recruitment, education and fees reimbursement of IQNs who are new to New Zealand. Similar levels of support in some areas have not been available to New Zealand citizens who have chosen to be nurses. And many of those New Zealand citizens who have chosen to be nurses have been driven into poverty and now have no jobs. In terms of cost to the Government, how many are now on jobseeker unemployment benefits?”
According to Nursing Council quarterly data reports, a total of 31,720 IQNs joined the New Zealand register between the start of 2022 and the end of 2024. During 2022, with pandemic restrictions easing halfway through the year, a total of 4928 IQNs joined the register. This doubled to 11,660 in 2024, and tripled to 15,132 in 2024. From the start of 2023 to the end of 2024 the proportion of IQNs in the workforce rose from 36 per cent to 46.8 per cent.
Domestic numbers steady
Over these three years, the number of New Zealand-trained nurses joining the register each year remained reasonably steady, just above or below 2500 (2363 in 2022, 2572 in 2023, and 2445 in 2024).
However, large number of IQNs had now given up on New Zealand, due to being unable to find work. The Australian Health Practitioner Regulation Agency has reported nearly 12,000 nurses migrating there from New Zealand in the past year, and most are understood to be IQNs.
Brownie said the current Government was resetting some policy — CAP reimbursement was now only available to experienced specialist IQNs. And the new Social Investment Agency has been established with an emphasis on use of government data and cross-sector consultation to inform decision-making.
Brownie, a New Zealand-registered nurse and midwife, has practised in a variety of nursing fields, and has extensive experience working across departments in the fields of health education, economic development and employment, in New Zealand, the Middle East, Africa and Australia.
‘And many of those New Zealand citizens who have chosen to be nurses have been driven into poverty and now have no jobs.’
She has a particular interest in capacity building of services, workforce development, remote rural and regional development and equity of access, and has worked with both the WHO and ICN on a range of major reports related to nursing workforce status, planning and utilisation.
She now holds academic positions in both New Zealand and Australia, as director of health strategy and partnerships at Swinburne University of Technology in Melbourne, and as adjunct professor in the centre for health and social practice at Waikato Institute of Technology (Wintec) in Hamilton.
Ethnic and cultural balance vital
She said a vital reason for maintaining a well-balanced workforce was the need to maintain an ethnic and cultural balance with the patients and communities that nurses cared for. Research showed that no matter where in the world, patients responded better to a nursing workforce that matched it in culture and language. In New Zealand, this was particularly so for Māori and Pacific people.
While working in the Middle East, she had argued that more Arabic-speaking nurses were needed, and had helped Arab countries establish their own schools of nursing, rather than relying on expatriate IQNs.
“If you want to have meaningful and effective therapeutic communication, and if you want to be able to get people to improve their health status and manage the health challenges that they have, you have to have a congruence [match], both linguistic and cultural, between the carer, the patient and their families.
Brownie and Broman found it impossible to get good data to provide a comprehensive picture of the state of the New Zealand nursing pipeline and workforce.
“Which is why, for example, for nurses who are not Māori, it’s important that they understand Māori ways of knowing and being, and there’s such an emphasis in our curricula in New Zealand on those things,” Brownie said.
She said health workforce planning was complex, but the International Council of Nurses (ICN) had told countries that they had to get better at it. What was needed was a whole-of-government approach to workforce planning — including health, education, immigration, and regional development — informed by good data.
However, in their Kaitiaki Nursing Research article, Brownie and Broman found it impossible to get good data to provide a comprehensive picture of the state of the New Zealand nursing pipeline and workforce.
In their article they said New Zealand was not alone facing challenges regarding its homegrown nursing workforce. In a recent report, Sustain and Retain in 2022 and Beyond, ICN had said each country needed to undertake “immediate and ongoing assessments of the local nursing workforce, including factors such as new-graduate entries, retirements, turnover, retention and migration (both incoming and outgoing), to underpin data-informed planning for nursing workforce education, development and retention.
“Against this backdrop, we have attempted to access data to inform a current state-assessment of New Zealand’s domestic nursing workforce pipeline. While some data was easily sourced, access to a full and complete picture proved impossible,” Brownie and Broman said.
Brownie was a member of the expert panel that contributed to the World Health Organization’s first international state of nursing report in 2020. The profile for New Zealand noted this country’s nursing workforce was 27.25 per cent foreign-trained, the highest of the countries studied — and just over half what it is now.
The two authors said the effects of the pandemic and of the uncertainty and change brought about by reforms of the health and vocational education sector had exacerbated New Zealand’s dependence on IQNs.
Brownie and Broman said responsibility for, and information related to, the pipeline and workforce were held by many entities including the Ministries of Health and Education, the Tertiary Education Commission, New Zealand Qualifications Authority, Te Whatu Ora, the Department of Immigration with the Ministry of Business Innovation and Employment, and the Nursing Council.
Fragmented inconsistent information
“Information is fragmented and often inconsistent, and while some information is gleaned via parliamentary questions and official information requests, the overall picture remains incomplete,” they said.
“Analysis of data that can be collected paints a disturbing picture of a lack of unified governance, of uncoordinated data monitoring and of insufficient support for the preparation of a domestic nursing workforce.”
The major problems they identified were:
- Poor nursing and education workforce data
Despite attempts to improve it, there were ongoing problems of inaccessible and inconsistent nursing workforce data.
“For example, the training funder (TEC) does not hold specific data about nursing enrolments and is unable to determine whether student intakes have declined or increased,” Brownie and Broman said. TEC has advised that it holds data about course completions rather than enrolments.
Inquiries about which providers were funded to provide postgraduate papers linked to the nurse-entry-to-practice programme were refused on the basis it was too time intensive to collate the information.
Te Pūkenga was unable to provide updated information on the turnover of nurse educators since the reform of vocational education started, on the basis that it was fragmented across different payroll systems.
- The impact of vocational sector reform
Prolonged change and funding shortfalls had adversely affected the Te Pūkenga network which graduates about 70 per cent of New Zealand’s nurses, while the process of creating a unified nursing curriculum was troubled.
The authors noted a “large-scale loss of nursing leaders from the sector” — with a 38 per cent retention rate for heads of nursing at Te Pūkenga schools of nursing in the period from January 1, 2019, to July 5, 2023. And data obtained under the OIA showed at least 69 nursing educators had left their jobs at Te Pūkenga in 2023 alone.
Nurse educators were undervalued, and their pay gap with Te Whatu Ora nurses was widening. Brownie said there were also significant pay differentials across Te Pūkenga and between university and polytechnic nurse educators.
They also found worrying trends in student attrition. Te Pūkenga released data via OIA request in 2023 showed first-year attrition rates from 2022 enrolments as high as one third at Unitec and Weltec-Whitireia and above 20 per cent at Eastern Institute of Technology, Manukau Institute of Technology, Northtec and Wintec. Attrition continued into the final year — up to 15 per cent in third year at some providers.
“Urgent research is required into why nursing students are abandoning study throughout the programme, including those close to completion. Additionally there is a need to identify effective mitigation strategies to reverse these trends.”
- Lack of support for graduate-entry students
Because graduate entry students are in postgraduate programmes, they are not entitled to student allowances, nor social welfare benefits as they are full-time students.
“Graduate-entry nurses enter the workforce on the same pay and conditions as those coming via the undergraduate pathway and yet they cannot access support during study.”
Brownie said the irony was they were saving the Government money by taking an expedited two-year course to become registered nurses, but were not entitled to financial support they could access if they chose to do the three-year BN degree.
- Disparity of outcomes for Māori and Pacific students
Brownie and Broman emphasised the pivotal role of Māori and Pacific nurses in the health service due to their cultural competence and understanding of their communities’ health needs, but found their attrition rates were higher than for all students.
Via an OIA request to Te Pūkenga they found that, averaged across Te Pūkenga’s 13 providers, Māori bachelor of nursing (BN) attrition rates in 2022 were 24.4 per cent from first year, 21 per cent from second year and 13.9 per cent from third year. Averaged attrition rates for Pacific students were 33.4 per cent from first year, 34.8 per cent from second year, and 13.5 per cent from third year.
“A continued failure to address this issue will ensure continued under-representation of Māori and Pacific nurses and hinder efforts towards a more inclusive and equitable health-care system.”