A senior nurse is calling for a cross-Government push to address massive issues in the nursing sector
Next Thursday, the anniversary of Florence Nightingale’s death in 1910, is International Nurses Day.
But while the world ostensibly commemorates the work of those who care for the ill and infirm, nurses in New Zealand aren’t feeling particularly celebrated.
It’s been a rough few years for people working in the sector, as labour shortages and the global pandemic have meant long hours at low pay. Many have reported feeling like they are still in lockdown due to the deleterious psychological and social impacts of the enormous pressure that comes with being a nurse in an unprecedented pandemic.
Tough times have coincided with a global shortage of 13 million registered nurses, while New Zealand has one of the highest rates of reliance on overseas nurses in the OECD. Couple that with border closures that have all but cut off the stream of new migrant workers, and things are looking a bit dire for healthcare providers and aged care facilities.
Dr Frances Hughes is the general manager of clinical and care services at Oceania, one of the biggest aged care service providers in the country.
She says the shortage of nurses has many aged care providers up against the wall, with beds already being lost around the country – all while the need for them grows due to New Zealand’s rapidly ageing population.
Demand for aged residential care is expected to increase by an estimated 15,000 beds by 2030, according to data from the New Zealand Aged Care Association (NZACA).
According to Hughes, the national supply of beds in aged care has reduced by more than 500 since December. Surveys from the NZACA have shown almost 1000 vacant positions for registered nurses at aged care facilities.
“Everyone’s hurting with regards to retention and supply,” she said. And this didn’t happen overnight – Hughes said it’s like frogs on a slow boil.
As chief nursing adviser to the Ministry of Health, she was on the 1998 national taskforce that undertook a major review of the sector, which ultimately recommended the development of advanced clinical nursing roles.
But over the ensuring 24 years, Hughes says policy has shifted away from recognising how critical nurses are in healthcare provision.
“There’s been a clear lack of policy effort that might allow self-sufficiency,” she said.
A 2020 report from the WHO pointed out the international maldistribution of the nursing workforce, with around 3.7 million (or one in eight) nurses practising in a country other than the one where they were born or trained as a nurse.
The flames of international mobility among nurses are in turn fanned by a heavy reliance on migrant nurses from countries with low domestic production, such as New Zealand. The report advised countries with low domestic nurse production to “aim towards greater self-sufficiency by investing more in the domestic production of nurses”.
It’s an area where New Zealand is lagging. In Australia, there are over 100 nursing graduates per 100,000 people, while in New Zealand the number is fewer than 40 per 100,000.
As a result, New Zealand has maintained a heavy reliance on the migrant workforce, with 43 percent of nurses on visas, with the main countries of origin being the Philippines (39 percent) and India (37 percent).
Further exacerbating the issue is the fact that both countries are on the non-visa waiver list, meaning travel is curtailed until later this year. This may dissuade migrants from making the move even if they can get the right visa to get in the door tomorrow – uncertainty around split families already seeing recent migrants return home over the last few years.
Hughes wants to see a national taskforce that brings together the different government departments that could have an effect on the sector, including the Ministry of Health, Ministry of Education, Immigration New Zealand and the Treasury.
But rather than a 20-page report on the issue in six months, she wants to see real changes, now.
“We need equitable wages and ethical recruitment agreements between DHBs and aged care providers,” she said. “As well as clear career pathways and recognising and valuing the nurses in aged care.”
Hughes said when you value the nurses who care for them, you are in turn caring for and valuing the elderly themselves.
“The elderly have contributed to New Zealand society and they deserve to have the best care possible,” she said, adding that an important step to providing this care is making sure the nurses front and centre in the treatment of the elderly feel valued.
“You can’t substitute for a registered nurse,” she said. “They are the canaries in the coal mine for the elder care sector. They are bedside scientists – they see what’s happening with the people in their care.”
She stressed that woes for the nursing sector don’t translate to inadequate care, saying aged care service providers would rather close down than try to operate without the necessary number of nurses.
“I don’t want the public to feel like aged care is an unsafe place,” she said. “Our bottom line is for the residents.”
Speaking last month on the living wage increase, New Zealand Nurses Organisation kaiwhakahaere Kerri Nuku said the poor pay rates in the health sector can perpetuate poverty.
“Governments have ignored the wage crisis for far too long and driven many whānau into hardship,” she said. “A lot of nurses, midwives, health care assistants and kaimahi hauora, some currently earning below the Living Wage, are taking second jobs or leaving their profession because the pressures of working within the health system are not worth the mental and physical distress. This is only exacerbated when it’s hard to put food on the table.”
And with big reforms to the health system coming in July when Health New Zealand and the Māori Health Authority take the reins from the Ministry of Health on many operational matters, it may be a ripe time for another ministerial taskforce.