I have silently observed and noted the increasing dialogue around the nursing workforce in the aged care sector.
A significant part of the conversation in the media is about internationally qualified nurses (IQN or migrant nurses) and questioning whether aged care nursing is the best practice setting for them.
I have also noted the debate on IQNs being ‘filtered’ or ‘funnelled’ towards aged care nursing, with many arguing about the lack of recognition of a migrant nurses’ previous skills or the disadvantages in clinical learning experiences compared to working in the acute hospital sector.
I would like to present my view on how IQNs benefit from working in the aged care nursing sector and why it is important for IQNs to understand gerontology nursing within the New Zealand context. While I will be presenting this viewpoint based on my personal experience, I will also draw from examples of IQNs that I know who have enjoyed their career in the aged care nursing sector.
A privilege and great learning experience to work in aged care
I never felt deskilled because I have worked in aged care nor felt there was a mismatch (filtering) of my nursing skills. From an acute medical-surgical nursing background in a Philippine hospital, it was a total privilege to be a registered nurse (RN) in an aged residential care facility in New Zealand.
Although I admit that the setting was quite different from my previous workplace but it was never about being deskilled or being unable to utilise my nursing skills. Instead I accepted the challenge and at the same time was inspired each day to provide the best care to older people with complex and multiple co-morbidities. I was able to effectively do this because of my previous clinical expertise and work experience.
The aged nursing care experience is important for migrant nurses to learn about the differing healthcare contexts. Longer life expectancies in New Zealand also enable nurses to build skills in nursing clients with different complex conditions affecting some of the older populations like dementias.
Moreover, the management of long-term conditions in older people is common but is also quite unique, for example diabetes in an 80-year-old client. Knowledge of caring for older people in aged residential care setting is transferrable to any setting because of the ageing populations.
Lastly, talking to older people, enriched my knowledge of New Zealand culture, significance of events, places, names and political landscapes within and beyond nursing.
We need to stop talking about the issue of deskilling, filtering and skills mismatch among IQNs and the aged care nursing sector. Instead we need to look at the nursing workforce in a holistic way.
Moral act to nurse where there’s greatest need?
As IQNs we form part of the overall nursing workforce – it is not only about our previous nursing skills.
Though of course I strongly agree that we (IQNs) bring invaluable nursing skills, clinical expertise and cultural accommodation to the increasingly diverse New Zealand.
However, we need to look back at why are we in New Zealand in the first place? Each migrant nurse chooses their own destiny within the host countries, some consider themselves to be fortunate by being able to practice in their preferred clinical settings or align with their previous nursing experience from their home country.
For those who were not able to follow that pathway, do you consider yourself disadvantaged or being filtered to aged care? Isn’t it a morally grounded act to respond to where the nursing staff shortage occur within the host country’s nursing sector? Isn’t your broad skills and expertise of being able to practice in any settings one of the grounds for you being considered for registration in New Zealand?
These are critical questions we need to consider. While each nurse has the freedom to transition between practice settings or to change specialities, we need to stop thinking about one nursing practice setting as superior over the other. We need to stop the notion that ‘if you are an IQN from an acute care background and you worked in the rest home in New Zealand, then you are less skilful nurse than you were’.
Focus on supporting not devaluing aged care nursing
I think it is high time to divert our attention and think in a more holistic way and not presenting ourselves in silos that do not help us progress as a workforce.
We need to look after our homegrown nurses and exert effort to retain the nurses who are currently in the country. We need to focus on the support we can provide to those IQNs who are currently working in aged care or to those who would like to work in aged care. This is where we need to invest our energy on.
While not every migrant nurse is successful in transitioning to New Zealand, we need to understand that the transition is multifactorial, which include personal circumstances. I have several IQN colleagues who have worked in aged care for many years. Some of them are in managerial and executive roles now. These journeys serve as inspiration to IQNs who are currently working in aged care that career progression is available for them.
Every nurse decides their own practice transitions, but it is my hope that aged care nursing should not be considered as having lesser value. While work conditions within the sector could be better, that should not devalue gerontology nursing specialty as career pathway for New Zealand nurses.
Author: Dr Jed Montayre is a nursing lecturer at AUT University who came to New Zealand from the Philippines in 2011 and started his New Zealand nursing career in the residential aged care sector.