Nurses will be aware that Health Workforce New Zealand (HWNZ) is currently supporting taskforces addressing workforce challenges for nursing, medicine, midwifery and the kaiāwhina workforce.
As chair of the National Nurse Leaders group, I have been chairing the nursing taskforce (known as the Nursing
Workforce Governance Group) and would like to take this opportunity to share the project with the wider profession.
The five major issues addressed by the taskforce in 2016 were:
1. Primary health models of care or models of service delivery
We agreed that the primary health care and community health nursing workforce needs to be better aligned to the needs of the community and more able to deliver the patient or person-centred care signaled by the refreshed 2016 New Zealand Health Strategy. This strongly echoes the goals of the Investing in Health document produced by the Ministry’s Primary Health Care Nursing Expert Advisory Group back in 2003.
We consider that current, siloed-approaches to funding, contracts, and some employment relationships are limiting the best deployment of primary health care nurses. Community-based and primary health care nurses should be pivotal to the achievement of better integrated services across the full continuum from wellness promotion to management of long-term conditions.
We are not convinced that levers are in place to ensure the necessary changes.
Issues discussed by the taskforce include:
- the need for greater investment and uptake in postgraduate funding of primary health care nurses
- increased deployment of nurse practitioners (NPs) in general practice and in boundary-spanning roles between
- primary, aged care and child health settings
- more courageous and speedy consideration of innovative models of service delivery
- better alignment between aged care and primary health care nursing
2. Aged care
The aged care nursing workforce is forecast to decline at the same time as demand is increasing due to the growth in the older population and its increasing share of the total population.
Aged care considerations should be refocused to be:
- inclusive of all of the aged care workforce
- focused on the care that people require wherever they are
- mindful that the aged care workforce needs to be linked to primary and community teams.
Levers to assist the nursing aged care workforce are considered to be:
- Nurse Entry to Practice (NETP) funding the Voluntary Bonding Scheme (more dollars for working in aged care)
- removing aged care from Immigration’s Essential Skills in Demand (ESID) Lists (noting this will need to be a staged approach) a review of the allocation of postgraduate nursing funding.
It was noted by the taskforce that pay parity is not expressed as an issue in the workforce in the Health of Older People’s strategy.
3. Māori nursing workforce
The taskforce has accepted a goal of parity by 2028 between Māori nurse numbers in the workforce and the percentage of Māori in the population. This is an ambitious but critically important goal.
Four levers have been accepted so far to encourage the growth of the Māori nursing workforce:
- Establish and lead a cross-government working group.
- Strengthen DHB regional planning guidance towards increased participation of Māori and Pacific in the health workforce.
- Require organisations receiving HWNZ funding to have an action plan for workforce diversity.
- Publish a biennial report tracking progress towards the Māori nursing workforce matching the proportion of Māori in the population.
- In addition it is agreed that:
- there should be more Māori/Pasifika nursing academics as this is fundamental to student retention in nursing degree programmes
- areas/populations should reflect the demographics they serve e.g. Auckland has a high Pasifika population.
4. Nurse practitioners
Members are universally committed to the need to support and increase the NP workforce, especially, but not exclusively, in the areas of primary health care and aged care.
5. Review of vocational training funding
The taskforce agrees that the historical patterns for allocating post-entry education funding (of the health workforce) should be examined to see how closely the funding allocation aligns with meeting the needs of the population in the most cost-effective manner.
Opportunities exist to influence the future direction of postgraduate funding for nursing, especially in the context of the 2016 New Zealand Health Strategy and HWNZ’s review of medical vocational funding. We see postgraduate funding as crucial to ensuring nursing is well placed to contribute effectively to future health needs, and we will remain fully engaged in all relevant discussions.
The nursing taskforce will consistently argue for a whole-of-workforce, fresh approach to aligning the workforce to meet identified person, patient and community needs. Instead of funding, training for and replicating old styles and roles of delivery, we see value in asking what ‘disruptions’ would support cost-effective and more sustainable service delivery.
AUTHOR: Professor Jenny Carryer is the Executive Director of the College of Nurses and Professor of Nursing at Massey University’s School of Nursing.