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Economic uncertainty has seen the nursing workforce swell in recent years. An economic upturn could see the workforce deflate just as rapidly.

PhD candidate Willoughby Moloney is to research strategies to keep nurses nursing… and on this side of the Tasman.

Economic recovery is expected to be a mixed blessing for the health sector.

A reversal of the economic pressure that brought back nurses or kept them longer in the workforce is expected to see those same nurses cut back their hours, leave, or retire.

Willoughby Moloney hopes her PhD research into the retention of nurses in boom and recession economic cycles will help employers stem the tide.

Moloney has been awarded an Advanced Training Fellowship by Health Workforce New Zealand (HWNZ), the first nurse ever to be granted the fellowship, which has up to now only been offered to medical graduates.

Brenda Wraight, HWNZ director, says the ATF scheme was always intended to support training and research in high-need areas and Moloney’s fellowship fitted in well.

She says the nurse fellowship was prompted by a need to not simply add to the existing research on nurse retention, but more importantly, to identify how to use Moloney’s research findings and others to actually make effective change in retention patterns for nurses and other health professionals, particularly when nurses become more mobile again as the economy improves.

“When we look at the shortages that are predicted in Australia, for example, how does New Zealand hold on to its nurses in the face of a very significant drain on our nursing resource?”

Moloney is well aware of the enticements across the Tasman. Many of her younger classmates have got jobs in Australia since her class graduated two and a half years ago from Massey University’s Wellington school.

As a more mature student, she had already travelled and tried a number of careers before discovering nursing in her late 20s. Her first degree was in film and television, after opting to follow her director mother into the industry, but it was in nursing she says she found her calling.

Since graduating, she has worked at an accident and medical clinic in Auckland, which she describes as a fantastic place to start nursing, as it provided the fast-paced challenge of accident nursing as well as the long-term management of general practice patients.

She also last year graduated with first class honours from the University of Auckland, which led to her being offered the ATF grant and which, along with a university scholarship, allowed her to start her full-time PhD studies in mid-September (though she continues to nurse at the clinic one day a week, with her long-term aim being to combine an academic and clinical practice career).

Moloney, speaking to Nursing Review just before starting full-time on her PhD, says she is really excited by her relevant and really important research topic.

“There is compelling concern that when the economy recovers, the nursing workforce will reach critically low numbers due to a lot of reasons, including RNs feeling financially able to work less.

“That is also set to coincide with baby boomer RNs ageing into their 50s, and recent research shows that an increasing proportion of RNs are retiring earlyish in their mid-50s.”

At the same time, the ageing population will increase the demand for health care, and higher salaries to nurses overseas will also be beckoning. “So all these things combined suggest that New Zealand could be facing a nursing workforce crisis in the next decade or so.”

The first phase of Moloney’s research is to carry out a literature search, followed by a series of unstructured interviews with a group of representative RNs to identify themes to develop a survey tool on retention. Once tested, she plans to send the validated questionnaire or survey tool out to up to 40,000 RNs working throughout New Zealand – probably by midway through next year.

The survey findings will be analysed to identify key factors associated with people returning and leaving work. “And perhaps, more importantly, a thorough understanding of what would be required to enable RNs to remain in the workforce.”

The aim at the end is for Moloney to complete her doctoral thesis while along the way delivering research findings that can provide policy makers like HWNZ with practical indications of what is needed to retain and recruit RNs in the workforce.

Beware the deflating bubble…

A recent US study* found that while the 2007–2008 recession saw the US economy overall lose 7.5 million jobs, the nursing workforce swelled by 243,000. This was the largest increase in nurses in work for any two-year period for the previous four decades.

The authors put the sharp rise in RN employment down to RNs filling job vacancies because of concerns about their family’s economic future, particularly married woman either returning to the workforce or stepping up to full-time work.

The expectation is that many of those RNs are likely to leave their jobs once the economy recovers, but the lack of empirical evidence to back this up prompted the authors to develop a workforce model looking at RN cohort trends, population effects, and the annual unemployment rate over recent decades.

They found that whenever the unemployment rate was high, the RN workforce tended to be larger than predicted and decreased more than expected when the unemployment rate fell. The trend showed that a one per cent increase in the unemployment rate was associated with a 1.2 per cent increase in the RN workforce.

But the model’s projections also confirmed the latest increase is largely a “temporary bubble that was due to deflate during the next several years”. The authors estimate, based on the predicted lowering of unemployment by 2015, that approximately 118,000 RNs will exit the workforce. This withdrawal will occur at the same time as an expected wave of retirements among baby boomer RNs.

“Therefore, plans to counter the reemergence of a post-recession shortage and to use existing RNs – both incoming and outgoing – as efficiently and effectively as possible should be a priority for policy makers.”

*Source: Registered Nurse Labour Supply and the Recession – Are we in a Bubble?, by Staiger, Auerbach et al, New England Journal of Medicine 2012