With bumper numbers of new nurses graduating in recent years, a new nursing forecast model indicates that fears of a nursing shortage hitting as early as 2020 is now looking less likely.
But nursing organisation leaders say the pressure is still on as the new forecast scenarios rely on new graduate cohorts remaining high and the developed world's highest reliance is on overseas trained nurses. Plus the new model is still predicting major shortfalls in aged care nurses, as well as in Māori and enrolled nurses.
The Future Nursing Workforce: Supply Projections 2010-2035 (often called the BERL report) report released in 2013 by the Nursing Council predicted a shortage could start hitting from 2020, the increase in nursing supply would fail to match population growth by 2025, and by 2035 the country could be short by at least 5000 and up to 15,000 nurses.
Now a new nursing workforce forecast model (see Figure 1), developed by the Office of the Chief Nursing Officer and Health Workforce New Zealand (HWNZ), is evidence for some cautious optimism. It is predicting that the growth in the nursing workforce as a whole is on track to match population growth by 2025, but is still predicting steep declines in the proportion of aged care, Māori, Pacific and enrolled nurses required to meet projected demand. The new model does not project further than 2025. (The BERL report predicted that the ageing workforce meant more than half of the 2010 nursing workforce would be retired by 2035.)
Dr Jane O'Malley, the Ministry of Health's Chief Nursing Officer, says significant progress had been made since the BERL report predicted a shortage of 15,000 nurses in 2035 if the nursing growth trends in 2010 continued.
"Since 2010 the number of registered nurses being educated in New Zealand has increased by approximately 600 per annum," said O'Malley. The number of locally educated enrolled nurses had also increased.
"The model forecasts there will be 56,065 practising nurses (ENs and RNs) by 2025," says O'Malley. "This means the growth in the nursing workforce is now keeping pace with population growth."
She says in 2015 there were 52,584 practising ENs and RNs in New Zealand, which was ahead of all the scenarios BERL modelled for the Nursing Council. "By 2025 the supply of nurses is forecast to be about where BERL predicted it would need to be to keep pace with the aging population, provided the current supply and other factors stay the same as they are now."
This includes internationally qualified nurses (IQNs) continuing to make up 26 per cent of the registered nurse workforce – the largest proportion of any country in the OECD – and IQNs are expected to make up 50 per cent of the RNs in residential aged care and all continuing care (elderly) settings by 2025. The overall ratio of nurses working in aged care per 100,000 New Zealanders aged over 60 is expected to decline by 38 per cent.
Memo Musa, chief executive of the New Zealand Nurses Organisation says NZNO welcomed the model as a useful tool to inform the National Nursing Workforce Programme, but said it did not take the pressure off or ease worrying about a nursing shortage occurring in 2025. "We do need to continue to plan and prepare for a shortage of nurses."
This is echoed by Professor Jenny Carryer, the executive director of the College of Nurses, who says while the model shows there is the potential to have a viable workforce the risk remains of a shortage and it would be "very bold to say otherwise". "I think we have to keep on our toes."
"And we certainly shouldn't waste new graduates by not employing them – we should treasure every one we get."
Musa says the model assumes New Zealand will continue to train the same number of new graduate nurses as it has in the past five years and also assumes a continued over-reliance on overseas-trained nurses. Carryer also says there are questions over whether the increased graduating class levels – up from 1200 a year to 1800 a year – are sustainable, particularly the pressure to find quality clinical placements.
Asked whether she is concerned that the model does not forecast beyond 2025, she says the history of workforce planning indicates it is not really possible to reliably predict workforce trends out as far as 2035 as there are too many unknowns.
Musa says the new forecast model also assumes that the current models of care and service – and employment practices – will stay the same, which might not be the case.
O'Malley says the Nursing Workforce Forecasting Model shows that further work is particularly needed in the area of aged care and the Ministry's Nursing Workforce Programme has submitted a paper to the HWNZ Board on beginning specific work related to the aged care sector.
*Nursing Workforce Forecast Model
The forecasting model uses Nursing Council of New Zealand annual practising certificate (APC) data from the last five years. The model tracks changes in individual APC data based on age, practice setting and specific entry and exit patterns. It assumes the patterns over the last five years will continue for the next ten years. The model also shows the forecast changes against predicted changes in the total population, the population aged 60 plus and the Māori and Pacific populations.
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