Te wero, our challenge, to grow our own workforce

August 31, 2022

The COVID-19 surge workforce — of unregulated health workers — could be an important source of new nurses.

We have now reached the stage, in Aotearoa, where the nursing workforce crisis is adversely affecting the health and wellbeing of our communities.

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COVID-19 has certainly taken its toll, placing additional, significant pressures on nurses. And while burnout and attrition rates are high, the passion, dedication and professionalism of the nursing workforce across the sector, to ensure timely and safe access to care, is exemplary.

But this workforce crisis was in the making long before the pandemic. It is time to rethink strategies, but more importantly to act upon ideals and ideas.

Under the auspices of Te Whatu Ora (Health New Zealand), work is underway to develop models to recruit and retain nurses, and to staircase nurses’ career development – this is known as the nursing pipeline programme.

While this is intended to be a whole-of-sector approach, the challenge – te wero – for the leadership group at the helm of the pipeline work is: How will the capability and capacity of primary health care (PHC) nurses be supported to unleash their potential to deliver health equity?

PHC nurses the poor cousins

For too long, PHC nurses (including those working in aged care and across communities) have been the poor cousins of the secondary sector, in terms of both pay and access to career development funding.

It is time to acknowledge the PHC nursing workforce as central to promoting the health and wellbeing of Aotearoa’s population. They deliver care to people with increasingly acute, complex and long-term needs, and reduce the burden on hospital services.

 The COVID-19 pandemic has left us with an opportunity, in the form of the so-called surge workforce.

Further inequities are experienced by Māori and Pacific nurses and those working for Māori and Pacific health providers. Our workforce equity statistics are poor. Despite a decade of rhetoric about increasing the number of Māori nurses in our workforce, the number still sits around just eight per cent of the total nursing workforce — no change in well over a decade;1 four per cent are Pacific; and 27 per cent are internationally qualified.2

The current drive to bring in overseas trained nurses is one priority of Te Whatu Ora, which is offering $10,000 per nurse to support visa and registration requirements. Yet after six weeks (by mid-August 2022) of the accredited employer work visa, just 18 nurses had applied.

Instead, we have solutions in our own back yard. The COVID-19 pandemic has left us with an opportunity, in the form of the so-called surge workforce. Many of the kaimahi (unregulated health workers) who were part of this surge are Māori and Pacific, who stepped courageously and effectively into roles to support the COVID response for their communities.

Such a local workforce has embedded cultural safety, and, with enrolled nurse (EN) or registered nurse (RN) education, will deliver nursing care to their communities for years to come.

Supporting kaimahi through the EN diploma

A scheme to support kaimahi through their EN diploma (which takes 18 months) is successfully underway in Te Tai Tokerau as part of the EN-NP workforce programme funded through the Ministry of Health.3 Benefits will be far-reaching where those kaimahi/ENs role-model and support local rangatahi to follow in their footsteps (whether into health or another profession). This generational sustainability supports broader socio-economic determinants and wellbeing, activating the flourishing of whānau and communities.

Once in the nursing workforce, PHC nurses need to be supported to develop their careers, including as RN designated prescribers, nurse practitioners and senior leaders. Across the country there are multiple examples of nurse-led services innovatively working to deliver health care. It is time such services were accessible to all our communities.

Once in the nursing workforce, PHC nurses need to be supported to develop their careers, including as RN designated prescribers, nurse practitioners and senior leaders.

As part of the EN-NP workforce programme and NP training programme, we are intentionally supporting Māori and Pacific RNs to progress through their NP pathway.4 Providing equity of access to funding, appropriate support, and culturally safe education and mentoring are just some essential requirements in place.

Engaging with consumers and whānau through co-design is now a requirement of health entities under the Pae Ora (Healthy Futures) Act 2022. Communities want to be active partners in determining local solutions and models of care. Our EN-NP workforce programme engages with local communities, iwi and hapū, and providers, to develop models of care.

While similarities emerge, so does diversity. Nationally, there is an opportunity now to bring in new people with new vision, who can ask questions and challenge entrenched institutional perspectives. It is time to be courageous, to do things differently.

If the principles of Te Tiriti o Waitangi were embedded in workforce planning programmes, recruiting kaimahi into nursing and the career development of RNs and NPs would be prioritised across the health and education sectors, working with local communities to co-design solutions.

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Resources would be fairly distributed and achieving health equity would be central to all activities. Surely, this would be a marker of health policy where social justice is truly enacted.


Sue Adams, RN, PhD (tāngata tiriti), and Josephine Davis, RN, NP (tāngata whenua), are co-leaders of the EN-NP workforce programme, University of Auckland.

See also Maranga Mai!Education — what needs to change and Nurses around the country protest lower pay in primary health care

References

  1. Chalmers, L. (2020). Responding to the State of the World’s Nursing 2020 report in Aotearoa New Zealand: Aligning the nursing workforce to universal health coverage and health equity. Nursing Praxis in Aotearoa New Zealand, 36(2), 7-19. https://doi.org/10.36951/27034542.2020.007  
  2. Nursing Council of New Zealand. (2019). The New Zealand Nursing Workforce: A profile of Nurse Practitioners, Registered Nurses and Enrolled Nurses 2018-2019.
  3. Adams, S., Davis, J., Wiapo, C., & Cooper, B. (2021, December 1). ENs take lead in primary mental health care. Kaitiaki Nursing New Zealand.
  4.  Adams, S., Oster, S., & Davis, J. (2022). The training and education of nurse practitioners in Aotearoa New Zealand: Time for nationwide refresh [Editorial]. Nursing Praxis in Aotearoa New Zealand, 38(1), 1-4. https://doi.org/10.36951/27034542.2022.01