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A baby boom, not retiring nurses, is one of the major nursing workforce issues in China. Chinese nursing director Zheng Ying Wang reflects on other differences and similarities in nursing practice between our two countries.

Last year I was given the opportunity to attend a nursing leadership programme in New Zealand – my first experience of education outside China.

China is undertaking significant reform of its healthcare system to promote an international level of health practice. The government realises that nursing education and practice need to be further developed to meet the healthcare needs of an ageing population and growing demand for quality nursing care.

After 23 years in nursing my first overseas education opportunity came when the Shenzhen city government selected me as one of 10 nurses and midwives to participate in the Waikato Institute of Technology’s Leadership and Management programme (see story page 20). Even though we all came from a variety of different backgrounds we were all nurse managers in one way or another.

During the 12 weeks I participated in lectures and workshops on topics such as the New Zealand health system, nursing ethics, communication, client-centred care, nursing assessment, critical thinking and simulation. I also visited primary healthcare settings, a variety of Waikato Hospital units, Hospice Waikato and some aged care facilities. I got to understand the New Zealand healthcare system’s structure and nursing practice and learned about the similarities and differences in nursing practice and culture between China and New Zealand.

Baby boom hitting nursing workforce

Although there are staffing and workload issues in both countries, I think it is more serious in China. This is because of the two-child policy recently introduced by the Chinese government, where families are now allowed two children rather than just one.

Following last year’s workshop I returned to China, where I’m the nursing director at Bao’an Central Hospital, and did some investigations into the current nursing workforce in the Bao’an district of the city of Shenzhen*. This was six months after the implementation of the government’s new two-child policy.

I found that 10 per cent of the nurses were pregnant and more than 20 per cent intended to conceive in the next six months. This means that many nurses are going to be on six-month maternity leave around the same time, which will result in a critical nursing shortage in China.

According to the National Health and Family Planning Commission of the People’s Republic of China (NHFPC) the ratio of beds to nurses should not be less than 1 to 0.4. This means that if a
40-bed ward is full it should be allocated at least 16 nurses in total to cover all shifts across the week.

In reality, there are still many wards that have insufficient nurses to meet this benchmark. It is also stated by the government that a nurse should not be nursing more than 15 patients. This is in comparison with a nurse in New Zealand who will have a patient load of four to five patients.

At present nurses in China can only work in one health institution and most institutions only employ full-time nurses. However, Guangdong provincial health authorities are now considering the options of employing part-time nursing staff. This may promote a better lifestyle for nurses but may not solve the issues of the nursing workforce shortage.

Nursing scopes and progression

In New Zealand every nurse has a scope of practice under the Health Practitioners Competence Assurance Act (2003) and a registered nurse progresses from competent to proficient to expert. This is similar to what happens in China, where the progression is from junior nurse to senior nurse to nursing expert.

In China nurses can be promoted to senior nurses or nurse-in-charge by passing an examination held by the NHFPC. It is difficult to reach a senior professional title in China. There is a four-part examination, as well as a requirement to pass some professional papers (including research) and complete a certain number of night shifts.

Just passing these requirements does not guarantee a position as a chief nurse or associate chief nurse. In Guangdong Province there is an expert review panel made up of chief nurses. These panels assess potential applicants based on individual oral presentations and face-to-face interviews.

Nursing care: similar but different

During the past 20 years person-oriented care has been significantly developed in China, yet I was impressed with how patient-centred care is emphasised in New Zealand and how much information is given to patients.

The concept of culturally safe care was new to me. Chinese nurses need to understand that culture is a broad concept including beliefs, values, knowledge, customs, and life practice. Therefore, nurses need to take into account the diverse human care needs and consider cultural safety principles in their nursing practice.

In New Zealand there are multiple ‘flashcards’ that nurses can use to help them perform ongoing nursing assessments. These are the cards that nurses have attached to their pockets showing information about pain assessments, phlebitis assessment, falls risk and so on. Chinese nurses also have many guidelines for their work; however, they are required to memorise these. I have considered the possibility of adapting these cards for Chinese nurses to use, to save them time, and to give them more time to care for their patients.

Both China and New Zealand use many of the same nursing assessment skills and tools. For example, we use the same pain score scales, falls risk assessment tools and pressure ulcer risk tools. We follow identical infection control guidelines and apply the same nursing management theories as well.
Western and Chinese medicines

I discovered that New Zealand pharmacists have an important role and are active in medication management. In Chinese hospitals some pharmacists work at the hospital’s western medicine pharmacy and some, especially trained pharmacists, work at the hospital’s Chinese pharmacy.

We use both western and Chinese medicines. In Bao’an Central Hospital only controlled medications are locked in cabinets and are counted and recorded every day. To promote safe nursing care, Chinese nurses will need to utilise technological advances, such as New Zealand’s computerised medication storage and dispensing systems, while working closely with other health professionals, such as pharmacists and doctors.

This 12-week nursing workshop gave me a valuable experience of overseas nursing practice and encouraged me to work on innovative ways to promote safe and quality nursing practice in China. As the nursing director of Bao’an Central Hospital, patient safety and the competency of nursing staff are always my major concerns.

Giving nurses opportunities for professional development is important. Even though there are many challenges in promoting nurses’ learning – including a lack of time available for studying and increased workload – continuing education must be implemented to equip Chinese nurses with sound nursing knowledge and skills to meet patient needs.

*Shenzhen is a city of 20 million people just to the north of Hong Kong in the southeast China province of Gaungdong.