Fund our training — it’s time for the Government to seriously invest in the domestic nursing workforce

The current nursing workforce crisis had been anticipated as far back as the early 1990s. It appears successive nursing and health workforce reports consistently promoted the same recommendations — that serious investment needed to occur if New Zealand was to sustain a nursing workforce that would endure the pending landslide of an increasingly ageing population.1,2,3,4,5,6,7,8,9

There is no doubt that an absence of political will by successive governments, along with ineffective nursing leadership, has contributed to the situation we now find ourselves in. This has been demonstrated by the lack of urgency to meaningfully address nursing workforce deficits. Instead there has been “tinkering around the edges” of the domestic workforce, while becoming increasingly reliant on filling the void with internationally qualified nurses (IQNs). IQNs currently represent 27 percent of the New Zealand nursing workforce, with projections of up to 40 per cent.10

This lack of serious investment in the domestic nursing workforce highlights the undervaluing and marginalisation of a predominantly female occupation. I say this as I enviously compare our situation with that of medicine, a predominantly male occupation. That has seen considerable investment by government in recent years — an investment that appears to be paying off with increases in the medical workforce and its diversity as a consequence.11

Māori have been unwilling participants in a 40-year experiment, and it’s evident that this experiment has been of very little benefit to Māori nursing.

Most frustrating has been this incessant drive to seek our nurses from overseas. My frustration was heightened recently by the Government’s decision to make available financial assistance to IQNs of up to $10,000 when seeking registration in New Zealand.12,13 I understand that we need nurses to fill our current workforce gaps, but my frustration lies with Māori nursing workforce inequity and the decades of under investment.

Since the introduction of the neoliberal changes that saw nursing move away from an apprenticeship hospital-based training to an academic-orientated profession, we have seen very little increase in the Māori nursing workforce.

Data on the Māori nursing workforce before these changes is scant. What we do know is the current system disadvantages Māori in so many ways. This is demonstrated through the ongoing static state of the Māori registered nursing workforce (around seven per cent of the total nursing workforce) for the last 40 years10,14 — glaring evidence that indeed something needs to change.

NZNO student leaders Manu Reiri and Rebecca Dunn are keen to see Aotearoa follow Australia’s lead, where thestate of Victoria is offering free training for up to 10,000 nurses.

Many factors contribute to Māori student nurse attrition. One of the most significant factors is economic hardship, and the recent COVID-19 pandemic has only added to the burden.15,16,17,18

To address the workforce inequity, I believe it is time to rethink the way nursing students are funded to do their studies in Aotearoa, particularly for Māori. I would go as far as suggesting that an equity-orientated funding model, such as “earn as you learn”, should be considered an appropriate intervention to seriously address the under-representation of Māori in the nursing workforce.

There are a number of examples of “earn as you learn”/apprenticeship models being implemented in nursing programmes around the world.19

Here in New Zealand there have been some small but successful examples of similar models being implemented, but the ongoing viability of these programs are uncertain.20,21 A primary focus of any New Zealand model must be its long-term sustainability to alleviate economic hardship via a pathway that provides a salary and minimises student debt. I believe such a program would be a game changer.

I believe it is time to rethink the way nursing students are funded to do their studies in Aotearoa, particularly for Māori.

That suggestion may provoke those ardent academics out there who foresee any type of apprenticeship model for nursing education as harking back to the “bad old days”. However, Māori have been unwilling participants in a 40-year experiment, and it’s evident that this experiment has been of little benefit to Māori nursing — surely the status quo can no longer be rationally defended.

The recent formation of the Workforce Taskforce (https://www.tewhatuora.govt.nz/whatshappening/work-underway/taskforces/) to look at priority workforce gaps brings together Te Whatu Ora (Health New Zealand) and Te Aka Whai Ora (Māori Health Authority) with a range of health sector representatives, including a couple of nursing voices (NZNO’s professional nursing services manager Mairi Lucas and Māori provider Te Puna Hauora Matua o Hauraki chief executive Taima Campbell).

The Ministry of Health-NZNO Real Nurses campaign launched in August hopes to recruit more Māori nurses

The taskforce will provide recommendations on future health workforce development approaches and the investment required to make transformational changes.12,22 What this transformational change may mean for nursing is yet to be determined. However,any new investment will likely be limited and the demand for it highly competitive.

I believe it is time to rethink the way nursing students are funded to do their studies in Aotearoa, particularly for Māori.

Up until now, most of the costs associated with educating nursing students have been spread between the Tertiary Education Commission, the Ministry of Health and the Ministry of Social Development. This funding structure has existed in numerous forms for the last 40 years and a rigorous review of how these government agencies impede or enhance our nursing workforce is well overdue.

When the Government talks about transformational change, this is where it actually needs to occur. Intersectoral collaboration that leads to comprehensive analysis of how much it currently costs this country to educate a nurse may prove to be an insightful activity.

NZNO’s national student unit say more financial support is needed for nursing students

A desktop analysis (albeit very primitive) suggests that pulling together all current investment/expenditure on the education of a student nurse, an “earn as you learn” model could quite possibly turn out to be cost-neutral.

The pressures on the nursing workforce are real, and things are going to get worse before they get any better. We need a workforce strategy that is focused on growing our domestic nursing workforce, that identifies urgent workforce needs, addresses inequities, and has sustainable solutions and targeted recommendations.

I believe such a programme would be a game-changer.

However, history has shown us that all the best strategies in the world are not worth the paper they are written on, if a government isn’t willing to meaningfully address the issues at hand. This is where nursing leadership needs to effectively and adamantly advocate on our behalf.

My greatest fear, with the formation of the new health entities, is that among the changes,nursing workforce development will continue to be marginalised and that any response will be small, ineffective and unsustainable. The Government’s recent release of the Te Pae Tata Interim New Zealand Health Plan 202212,22 has unfortunately not really allayed my fears.

Pipi Barton (Ngāti Hikairo ki Kāwhia), RN, MPhil(nursing), is a nursing lecturer at NorthTec and a PhD student at AUT. Her PhD research is on ‘Examining strategies for increasing the recruitment of Māori into nursing’.

See also Maranga Mai! Education – what needs to change?

References

Cook, L. (2009). A Nurse Education and Training Board for New Zealand — A report to the Minister of Health. (https://www.moh.govt.nz/notebook/nbbooks.nsf/0/9943A4089F23EF13CC2576150007745F/$file/nurse-education-training-board-nz-aug09-v2.pdf)
Health Workforce Advisory Committee. (2001). The New Zealand Health Workforce: A stocktake of issues and capacity 2001. (https://www.health.govt.nz/system/files/documents/publications/hwac-stocktake2001-introduction.pdf)
KPMG. (2001). Strategic review of undergraduate nursing education: final report to the Nursing Council. Nursing Council of New Zealand.
Ministry of Health. (1998). Report of the Ministerial Taskforce on Nursing — Releasing the potential of nursing. (https://www.moh.govt.nz/notebook/nbbooks.nsf/0/380F282D7CAEDADC4C25669B007C00CA/$file/report-ministerial-taskforce-nursing.pdf)
Ministry of Health. (2006). Health workforce development: An Overview. (https://www.health.govt.nz/publication/health-workforce-development-overview)
Nana, G., Stokes, F., Malano, W., & Dixon, H. (2013). New Zealand Nurses: Workforce Planning 2010-2035.
Ratima, M., Brown, R., Garrett, N., Wikaire, E., Ngawati, R., Aspen, C., & U, P. (2008). Rauringa Raupa: Recruitment and Retention of Māori in the Health and Disability Workforce. (https://www.health.govt.nz/publication/rauringa-raupa-recruitment-and-retention-maori-healthand-disability-workforce) Ministry of Health.
Te Rau Matatini. (2009). Ngā wawata o ngā neehi Māori me nga tapuhi: Responses from Māori nurses and midwives nationally.
Te Rau Matatini, & Te Ao Māramatanga. (2015). Māori Mental Health Nursing: Growing our workforce. (https://terauora.com/maori-mental-health-nursing-growing-our-workforce/)
Nursing Council of New Zealand. (2020). The New Zealand Nursing Workforce: A profile of Nurse Practitioners, Registered Nurses and Enrolled Nurses 2018-2019 (https://www.nursingcouncil.org.nz/NCNZ/News-section/newsitem/2020/2/Council_publishes_Workforce_Report_2018-2019.aspx).
Medical Council of New Zealand. (2020). The New Zealand Medical Workforce in 2020. (https://www.mcnz.org.nz/assets/Publications/Workforce-Survey/78253ef9cd/Workforce-Survey-Report-2020.pdf)
Te Whatu Ora. (Retrieved October 31, 2022a). Workforce Taskforce Update. Issue 1, October 2022. (https://www.tewhatuora.govt.nz/assets/Taskforces/Workforce-Taskforce-Update-21-October-2022.pdf)
Te Whatu Ora. (Retrieved October 31, 2022b). Internationally qualified nurses CAP fund. (https://www.tewhatuora.govt.nz/for-the-health-sector/nursing/internationally-qualified-nurses-capfund/)
Wilson, D., Barton, P., & Tipa, Z. (2022). Rhetoric, racism, and the reality for the Indigenous Māori Nursing Workforce in Aotearoa New Zealand. (https://ojin.nursingworld.org/table-ofcontents/volume-27-2022/number-1-january-2022/rhetoric-racism-and-the-reality-for-theindigenous-maori-nursing-workforce/#Nana) The Online Journal of Issues in Nursing, 27 (1), 1-20.
Barton, P., & Wilson, D. (2021). The experiences of Māori nurse educators in undergraduatenursing programmes and the impact on recruitment and retention. A report to NgāManukura o Āpōpō.
Chittick, H., Manhire, K., & Roberts, J. (2019). Supporting success for Māori undergraduate nursing students in Aotearoa/New Zealand. Kai Tiaki Nursing Research, 10(1), 15-21.
Foxall, D. (2013). Barriers in the education of indigenous nursing students: A literature review. (https://pubmed.ncbi.nlm.nih.gov/24575608/) Nursing Praxis in New Zealand, 29(3), 33-39.
Wilson, D., McKinney, C., & Rapata-Hanning, M. (2011). Retention of indigenous nursing students in New Zealand: A cross-sectional survey. Contemporary Nurse, 38 (1-2), 59-75. https://doi.org/10.5172/conu.2011.38.1-2.59 (https://doi.org/10.5172/conu.2011.38.1-2.59)
Devereux, E. (16 May, 2022). Nurse degree apprenticeship hits milestone of 6000 students. (https://www.nursingtimes.net/news/workforce/nurse-degree-apprenticeship-hits-milestone-of-6000-students-16-05-2022/) Nursing Times.
Adams, S., & Davis, J. (August 31, 2022). Te wero, our challege, to grow our own workforce. Kaitiaki Nursing New Zealand.
Yates, A. (September 24, 2022). New Auckland City Hospital ‘Earn and Learn’ programme to help tackle nursing staff shortage. (https://www.newshub.co.nz/home/newzealand/2022/09/new-auckland-city-hospital-earn-and-learn-programme-to-help-tackle-nursingstaff-shortage.html) Newshub.
Te Aka Whai Ora — Māori Health Authority, & Te Whatu Ora — Health New Zealand.(2022). Te Pae Tata Interim New Zealand Health Plan 2022. (https://www.tewhatuora.govt.nz/aboutus/publications/te-pae-tata-interim-new-zealand-health-plan-2022/)

Tags

Click to search for related articles: Nursing education, Māori nursing workforce

Uncut – news briefs

20 Dec	Health NZ introduces public reporting of key primary healthcare measures and PHO performance Health New Zealand \| Te Whatu Ora (Health NZ) has introduced public reporting of key primary healthcare measures and Primary Health Organisation (PHO) performance.
19 Dec	Quarter 1 performance report released Health New Zealand \| Te Whatu Ora has today published its Quarterly Performance Report for Quarter 1, covering the period 1 July to 30 September 2024.
18 Dec	Recent uptick in Boostrix immunisations amid whooping cough epidemic, but work still to do As the healthcare sector continues to respond to a whooping cough (pertussis) epidemic across the motu, it’s promising to see a recent uptick in the number of Boostrix immunisations among the 15- to 44-year-old age group, with a recent doubling of doses administered from about 1,000 per week to over 2,000 per week.
18 Dec	Extra security to again keep EDs safe this summer Health Minister Dr Shane Reti is again reminding New Zealanders that violence against patients, visitors and health workers won’t be tolerated, with additional security for hospital emergency departments across the country this summer.
13 Dec	Mental health and addiction targets implementation plans released Health New Zealand \| Te Whatu Ora has today published its first quarterly results for four of the five mental health and addiction targets, covering the period 1 July – 30 September 2024.
12 Dec	Health targets encouraging – work continues New data shows that the Government’s focus on health targets is putting the brakes on the steep decline in delivery seen over the past five years.
12 Dec	Gisborne receives mental health beds boost Minister for Mental Health Matt Doocey today opened Gisborne Hospital’s new acute mental health unit, Te Whare Awhi Ora, and says the region will be better served by a bigger, more therapeutic acute mental health unit.
9 Dec	Afghan women ‘banned from nursing and midwife training’ in latest blow to rights BBC News has reported that female nursing and midwifery students in Afghanistan have been told not to return to their studies, effectively ending women’s only access to further education, and putting women and children’s lives at risk.
9 Dec	How student and early career nurses can influence policymaking The International Council of Nurses (ICN) held a webinar which highlighted the vital importance of primary and preventative health care in meeting the World Health Organization’s (WHO) challenging goal of achieving Universal Health Coverage (UHC) by 2030
3 Dec	Health NZ end-of-year deficit confirmed In publishing its annual report, Health NZ has confirmed it ended the financial year with a deficit of $722 million, against a target surplus of $54 million.
2 Dec	ICN says COP29 climate finance shortfall threatens the planet’s health The International Council of Nurses (ICN) has expressed profound disappointment with the outcomes of COP29, held in Baku, particularly the New Collective Quantified Goal (NCQG) on climate finance that was passed despite significant objections from developing countries.
29 Nov	Minister reminds public health officials of priorities Minister of Health Dr Shane Reti says the National Public Health Service should concentrate its focus on prioritising serious public health issues facing New Zealanders.
29 Nov	Community providers rally to protect hapū māma and pēpi as national whooping cough case numbers surpass 1,000 for 2024 Hapū māmā are being urged to get immunised, and parents and caregivers are encouraged to get their babies immunised on time, as whooping cough case numbers continue to climb across Aotearoa New Zealand.
28 Nov	Govt ignores health crisis, plans to axe 1500 public health roles The health of New Zealanders will suffer because of the Government’s plan to axe nearly 1500 roles at Te Whatu Ora, coming at a time when the public health system is already under severe pressure.
27 Nov	Health New Zealand Establishes Technical Advisory Group to Lead Transformation in Maternity Care This team of experts and community representatives will play a key role in the development of the Maternity Commissioning Framework, a core element of the wider Kahu Taurima programme, which aims to make maternity and early years services more equitable, accessible, and whānau-centered.
22 Nov	Whooping Cough epidemic declared across Aotearoa New Zealand Health agencies have confirmed today that Aotearoa New Zealand is now in the early stages of a Whooping Cough epidemic, with a nationally coordinated response now in place.
20 Nov	A Global Map of Winter Depression Healthnews has released an extensive study that ranks 194 countries based on their winter-pattern Seasonal Depression Disorder (SAD) risk.
18 Nov	Potential travel disruption expected with Tuesday’s national Hīkoi Health New Zealand \| Te Whatu Ora urges those with an appointment scheduled at Wellington Regional Hospital on Tuesday morning or early afternoon, to please allow extra time to get to appointments.
15 Nov	ICN’s calls on G20 leaders to address international health worker migration crisis Ahead of the G20 Leaders Summit in Rio de Janeiro next week, the International Council of Nurses (ICN) welcomes the Declarations recently adopted by the G20 Health Working Group and health ministers.
13 Nov	Measles case confirmed in Tāmaki Makaurau Health New Zealand \| Te Whatu Ora has confirmed today that a new case of measles has been identified on Waiheke Island in Auckland. The case and their household are being supported by the National Public Health Service (NPHS), with those most at risk now in quarantine to help reduce the chance of further spread.
5 Nov	Safety fears ahead of changes to mental health 111 calls Mental Health Nurses have serious concerns about the safety of their patients, the public, their colleagues and themselves when police changes to emergency 111 calls come into effect on Monday, New Zealand Nurses Organisation (NZNO) Tōpūtanga Tapuhi Kaitiaki o Aotearoa says.
31 Oct	General practices welcome fast-track approvals process A new fast-track approval process is a good start, but more is needed to fix New Zealand’s chronic GP shortage, says the General Practice Owners Association (GenPro)
24 Oct	International Council of Nurses Bucharest Declaration priorities for the future of nursing The International Council of Nurses (ICN) marked the 125 years since its founding in 1899 with an anniversary conference held in Bucharest, Romania and hosted by the Order of Nurses, Midwives, and Medical Assistants of Romania.
10 Oct	Call to immunise now as New Zealand at high risk of whooping cough outbreak Pregnant people, babies, children and others at high risk from whooping cough are urged to get vaccinated as soon as possible, as Aotearoa New Zealand stands at high risk of an outbreak.
9 Oct	New pilot with Plunket to deliver childhood immunisations To increase access and boost immunisation rates, Health New Zealand \| Te Whatu Ora and Whānau Āwhina Plunket will pilot the delivery of childhood immunisations at a select number of sites across the country.
8 Oct	Health NZ Begins Development of National Perinatal Bereavement Care Pathway As Baby Loss Awareness Week shines a light on the heartbreak faced by many, Health NZ is taking a compassionate and hopeful step forward in transforming the support available for whānau who experience the loss of a baby.
7 Oct	Govt takes the scalpel to regional health budgets At Labour’s insistence, Te Whatu Ora financial documents have been released by the Health Select Committee today showing more cuts are on the way for our health system.
2 Oct	Orion Health and Streamliners form strategic partnership Orion Health, a global leader in digital health solutions, has announced a strategic partnership with Streamliners, creators of HealthPathways which provides an online manual used to assist with clinical assessments.
1 Oct	Rollout of new medicines across New Zealand begins Today marks the first day a range of new medicines, including cancer medicines, will start to become available in hospitals and health centres across the country.
27 Sept	New Dunedin hospital: Southerners deserve better The Government’s announcement today that it will scale back the new Dunedin hospital will negatively impact patient care, the New Zealand Nurses Organisation (NZNO) Tōpūtanga Tapuhi Kaitiaki O Aotearoa says.
26 Sept	Govt not addressing health workforce crisis The National Government is hiding the gaps in the health workforce from New Zealanders, by not producing a full workforce plan nearly a year into their tenure.
25 Sept	New programme offers step up for jobseekers seeking a career in health and wellbeing Local jobseekers have an exciting new opportunity to begin a career in Health following the launch of a new community-based kaiāwhina programme in the Hutt Valley.
23 Sept	Ministers oblivious to cuts’ effect on families The National Government is oblivious to the impact cuts to services will have on New Zealanders who are doing the hard yards caring for mentally ill family members.
19 Sept	Wānaka community to benefit from new overnight health service Health Minister Dr Shane Reti says an Overnight Acute Care Service opening in October will provide people in Wānaka and the surrounding area with the assurance of quality overnight care closer to home.
17 Sept	Dr Le Heron takes title of 2024 Alzheimers NZ Fellow Distinguished neurologist and cognitive neuroscientist, Dr Campbell Le Heron, has been made the 2024 Alzheimers NZ Fellow for his work researching and managing cognitive disorders.
11 Sept	Aged care will be worse off if redesign rushed New Zealanders needing aged care support and the people who care for them will be worse off if the Government pushes through a flawed and rushed redesign of dementia and aged care.
11 Sept	Govt takes action on mpox response, widens access to vaccine The Government is taking immediate action on a number of steps around New Zealand’s response to mpox, including improving access to vaccine availability so people who need it can do so more easily, Health Minister Dr Shane Reti and Associate Health Minister David Seymour announced today.
10 Sept	ICN launches new position statement and discussion paper setting out a revolution in the delivery of Primary Health Care The International Council of Nurses (ICN) is launching its new position statement and a discussion paper on Primary Health Care (PHC) at its Nurse Practitioner/Advanced Practice Nursing Network (NP/APN Network) Conference in Aberdeen, Scotland.
9 Sept	First cancer medicine decision following Pharmac funding boost Pharmac has decided to widen access to two medicines for several types of cancer. Pembrolizumab (branded as Keytruda) will be funded from 1 October 2024 for eligible people with advanced triple-negative breast cancer, head and neck cancer, colorectal cancer, bladder cancer, and Hodgkin lymphoma. Nivolumab (branded as Opdivo) will be funded from 1 November for eligible people with kidney cancer.
6 Sept	Health agencies working with Police on rebalancing roles for mental health responses Health New Zealand \| Te Whatu Ora and the Ministry of Health - Manatū Hauora are working with Police to change some of the ways agencies respond to mental health. The change will see an increased health-led response, supporting Police to focus on core Policing.
4 Sept	Nurses’ bargaining starts with action for safe staffing Nurses are kicking off their collective bargaining with Te Whatu Ora by taking action for safe staffing on Friday, New Zealand Nurses Organisation Tōpūtanga Tapuhi Kaitiaki o Aotearoa (NZNO) says.