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Nursing director LORRAINE HETARAKA-STEVENS calls for innovative and courageous strategies to recruit more new graduate nurses, including under-represented Māori, into the ageing primary health nurse workforce.

 

It is well documented that New Zealand’s primary health care sector is under increasing pressure with an ageing GP/practice nurse workforce and reduced access to services in some communities.

BERL’s 2013 nursing workforce projection report for the Nursing Council of New Zealand predicted that more than 50 per cent of the present nursing workforce will retire by 2035. Increasing the supply of new graduate nurses into primary care is one way to build a sustainable workforce. However achieving this requires an understanding of the current structural and systemic influences impacting on new graduate recruitment in the primary care sector.

Since around 2006 the Nursing Entry To Practice (NETP) programme has provided a government-subsidised, supportive framework for new graduates across the district health boards (DHBs). In 2008, the the NETP programme was expanded to include primary care which gave new graduate nurses the opportunity to work in primary health without previously working in a hospital or other setting.

In 2012 the Nursing Advanced Choice of Employment (ACE) system was introduced enabling graduates to apply online for NETP places in multiple DHBs using one application. Graduates can also identify up to three preferred practice settings. Primary care is a popular choice and ranks as one of the top four preferred practice settings for new graduate nurses (after surgical, medical and mental health nursing).

Another advantage of ACE is that nationwide recruitment data is now available but the NETP statistics show that, despite the interest shown by new graduate nurses, the number recruited into primary care has been disappointingly low.

This, by and large, reflects the lack of resources in the primary care sector to support the recruitment and retention of new graduates. The current support resources available are largely administered through the DHBs, are non-flexible and focus exclusively on new graduates on NETP. This limits the primary care sector’s ability to develop sustainable workforce planning including areas like the retention and development of clinical leaders, increasing undergraduate placements, and wider practice team development (like whānau ora workers/nurse practitioners/pharmacists/health care assistants/general practitioners/administrators).

Recent initiatives to increase the uptake of new graduate nurses into primary care include the Ministry of Health’s new graduate nurse employment (scholarship) scheme in Very Low Cost Access (VLCA) practices serving high needs populations. The investment involved one-off extra funding of $2.4 million to employ and pay salaries for 48 new graduate nurses for 12 months in qualifying VLCA practices. The 2015 evaluation suggests that the scheme provided a valuable pathway for supporting new graduates into primary care. Further attention to this area would be valuable.

There are other health workforce strategies – nationally, regionally and locally – with a focus on increasing new graduates in primary care and, more specifically, on increasing the uptake of Māori new graduates. These include DHBs’ District Annual Plans, the DHBs’ Māori Health plans, workforce reports and policy documents. But workforce data suggests that strategies designed to increase the number of Māori in the health and disability workforce have had little impact on Māori workforce participation rates.

The National Nursing Organisations group (NNO), a group made up of New Zealand’s key nursing stakeholder organisations, prepared a report in 2014 on nursing issues for Health Workforce New Zealand (HWNZ). That report identified a number of key recommendations including employment of more new graduates, improved employment of new graduates in the aged care and primary care sectors and improved employment of Māori and Pacific new graduates.

Last year the HWNZ Nursing Governance Group set 2028 as the date for matching the Māori nursing workforce to the percentage of Māori in the population. To achieve this there needs to be short, medium and long-term strategies and goals, coupled with a whole-of-system approach and adequate, sustainable resourcing.

Recent ACE figures indicated 821 new graduate nurses (57 per cent) were known to be employed by late January 2016 and 630 were still looking for work through the Nursing ACE system. Of those 630 job-hunting new graduates 84 were Māori (13 per cent). A key target should be 100 per cent recruitment of all Māori new graduate nurses as the data suggests that even if we did recruit all Māori new graduates we would still fall short of achieving equity.

If we want to achieve results for increasing new graduate nurses in primary care, with a focus on 100 per cent recruitment of Māori new graduates, we need to be courageous, try innovative approaches and focus on results. ✚

Author: Lorraine Hetaraka-Stevens is a College of Nurses board member. She is the nursing director for Auckland’s ProCare primary health organisation and nursing director of the ProCare and Pegasus-owned teletriage organisation Homecare Medical.
N.B. References for this article are available online: www.nursingreview.co.nz.

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References:

1. Hoare, K., Mills, J. and Francis, K. (2013). New graduate nurses as knowledge brokers in general practice in New Zealand: a constructivist grounded theory. Health and Social Care in the community 21(4), 423-431. John Wiley & Sons, Inc.
2. Ministry of Health. (2015). Evaluation of the New Graduate Nurse employment scheme through the Very Low Cost Access initiative: Final evaluation report. Report for Ministry of Health. Synergia: Auckland.
3. Nana, G., Stokes, F., Molano, W. and Dixon, H. (2013). New Zealand Nurses: Workforce planning2010–2035. Nursing Council of New Zealand: Wellington.
4. National Nursing Organisations. (2014). Report from the National Nursing Organisations toHealth Workforce New Zealand.
5. Ratima, M., Brown, R., Garrett, N. et al. (2008). Rauringa Raupa: Recruitment andRetention of Māori in the Health and Disability Workforce. AUT University: Taupua Waiora: Division of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences.