The comments come after Kaitiaki revealed PHC practices have been slow to take on registered nurse (RN) graduates — despite incentives of $15-20,000 a year. Just 250 out of 400 available places were taken up over its first year to April 1 — 62 per cent.
HNZ has now revealed it plans to evaluate the scheme this year, to ensure the funding getting to where it needs to be to support graduate RNs.
Senior practice nurse from the East Coast, Ayla Evans, said primary health RNs cared deeply about supporting graduates into becoming skilled and safe practitioners — but often-small practice teams were incredibly slammed.
“We have to fit it in, squeeze it in — it’s another thing to do”, the NZNO delegate told Kaitiaki. “While we know everyone starts somewhere, it puts a lot of pressure on my team who we know are already under the pump.”
It was challenging, at times, to provide adequate mentoring — especially in a sector struggling with burnout and lower pay than elsewhere.
“It takes six months to a year to train to this position and even then you don’t know everything. It’s the complexity of it. We do the cardiac stuff, we don’t just do one thing — we do a little bit of everything across the entire age range.”
New RNs needed constant support, with buddying, regular meetings and reflection along with “complicated” IT systems and paperwork.
‘Constant’ supervision
“It’s making sure they’re never alone, they’re with a senior nurse or colleague — we are just constantly supporting them,” Evans said. “It’s hours [of extra work] for multiple staff. It’s not just my time — it’s everybody’s time. It increases the workload.”
‘It’s not easy and we owe it to the new grads coming out to do a good job. And sometimes I feel like we don’t.’
Despite this, the funding — which employers can use as they wish — did not always trickle down.
“We don’t get anything extra for the pressure it takes to train them — and [paperwork] expectations are through the roof,” Evans said.
“It’s not easy and we owe it to the new grads coming out to do a good job. And sometimes I feel like we don’t.”
Pay parity with HNZ, release time, simpler paperwork, administrative support and more flexible professional development for preceptors would all help ease the pressure.
Meantime, senior nurses were burning out. One local practice had already lost three nurses this year — one to retirement and two to better paid roles elsewhere. This wasn’t great for them, or graduates’ safe practice, Evans said.
“If they’re not well, they don’t want to come to work — they’re too stressed out, then we’re going to lose them.”
Te Whatu Ora-Health NZ (HNZ) living well director Martin Hefford would not commit to ringfencing the funding for senior RNs/preceptors — but told Kaitiaki HNZ would be reviewing the scheme later this year.
“The outcome from this will inform any future shape of the initiative to ensure investment is targeted effectively and continues to support positive outcomes for graduate registered nurses.”
Currently the funding was flexible in its use by employers, who just had to show they could provide preceptorship and HNZ’s supported first-year-of-practice programme to access it.
GP network ‘offers support’
Gabrielle Lord, nursing director and practice and clinical manager at Procare — a network of more than 140 general practices across wider Auckland — acknowledged supporting new graduates was time intensive. “However, in-practice training remains one of the most effective ways for new graduates to develop a strong understanding of how general practice operates in a real-world environment.”
She said ProCare had clinical improvement specialists and educators available to work closely with practices taking on graduates and support the preceptors.
“If a practice is experiencing challenges or requires further support, we will step in to provide additional assistance.”
She said the graduate funding was often used for backfill to cover the preceptor or external training for the graduate.
HNZ last year replaced its PHC nurse-entry-to-practice (NETP) programme with a ‘supported first year of practice’ which reduced the minimum employment hours from 0.8 to 0.6 full-time-equivalent and cut back mentoring and study hours.
Minister of Health Simeon Brown said only that supervising and mentoring graduates was “common in most workplaces”.