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International student fees bring in $1 billion a year. Do our 19 nursing schools limit how many international fee-paying student nurses they enrol? Nursing Review reports its survey findings. 

International student numbers vary widely in nursing schools across the country from none to more than 15 per cent of their student nurses.

Nursing schools can charge around $20,000 to $21,000 in tuition fees a year for an international bachelor of nursing student compared to about $6,000 to $7,000 for domestic students. Overall the international education industry grew by 14 per cent last year area with tertiary education minister Steven Joyce stating that the record enrolments provided benefits beyond its obvious economic contribution.

Some nursing schools and district health boards (DHBs) have pushed back and have strong "grow your own" policies that prevent or discourage them from enrolling and offering clinical placements to students that are not New Zealand citizens or residents.

But strong demand for nursing degree places from overseas students and the chance to boost institution's bottom lines sees nearly all schools enrol some international students in their nursing degree programmes with the most common source countries being India, Philippines and China but also Korea, Fiji, United Kingdom, Japan, Scandinavia and the Middle East. Most students start as first years but others use recognition of prior learning to enrol in the second or third year of the degree programme. Eleven schools also offer Competence Assessment Programmes (CAP)  – which most internationally qualified nurses (IQNs) need to complete before gaining New Zealand registration – and charge international students between $7000 to $10,000 for the up to 12 week programmes.

Most schools told Nursing Review they had no policy limiting how many international students they take but in the majority of cases international students made up between two to seven per cent of nursing degree enrolments (see statistics from the Nursing Review survey in table below). Several schools reported they were under institutional pressure to take more.

A handful of schools do take more with their proportion of international nursing students ranging from 9-15 per cent of their BN programmes (see statistics below).

Institutions point out that that international students are not just money earners with some students having attended secondary school in New Zealand, that they add to the learning experience of local students and at least one school reported good employment rates for its international graduates. Though another reported international students expressing concern at their employability on graduation as they were not eligible for places on Nurse Entry to Practice (NETP) programmes through the ACE job clearing-house system

Willem Fourie, dean of Manukau Institute of Technology's nursing faculty, said it currently has no international students in its nursing degree intakes as it adheres to Counties Manukau DHB's 'grow your own' policy. Though it had taken a Pacific international student on to its Bachelor of Nursing Pacific in the past and could take one or two in the future because Fourier said both the DHB and MIT's wanted to increase the number of Pacific nursing graduates.

He said his institute's international office would be keen for nursing to take international students as there was a waiting list but at present BN intakes were full already with domestic students.

Te Whare Wānanga o Awanuiārangi also has a 'grow your own' policy. Nursing director Ngaira Harker, said the wānanga's aim was to ground the kaupapa of the programme – which was to boost the Māori health workforce and Māori health outcomes –  and that meant the programme's intake was predominantly Māori. But she added that it was in the future looking to have an indigenous student exchange programme.

Annette Huntington, head of Massey University's nursing school said international students made up less than one per cent of its BN cohort as its policy priority was to fill course places with domestic students.

"Although we would welcome international students we cannot take them while there are such restrictions on clinical placements as we always aim to provide quality clinical learning experiences," said Huntington. She added there was a concern that increasing international student numbers could be used as a way of managing budgets in tertiary institutions and she believed institutions had a responsibility to "ensure the best possible experience including appropriate pastoral care, for these high fee-paying students".

At the other end of the spectrum there are schools that usually allocate 10 per cent or more of nursing degree places for international students.

International students make up 15.65 per cent of UCOL's bachelor of nursing programme with 64 students drawn from mostly India, Philippines, China and South Korea. Penny O'Leary, UCOL's head of nursing education, said its nursing degree was UCOL's most popular programme for international students, it had no policy on limiting international student numbers, and UCOL was "passionate about the benefits of internationalisation" to both domestic and international students. She said international completion rates were very good.

Glennis Birks, manager of WINTEC's undergraduate nursing programme, said it limited international student places to a maximum of 12 per cent and currently it had 89 international nursing students which was 11.3% of the nursing degree students across the three years. The most common source country for international students at Wintec was China followed by India, Kenya and South Korea. Birks said its international students added a rich diversity to the student and graduate mix. "Employment outcome for this group are very positive."

Jane Anderson, the nursing programme leader at NorthTec said its overall international student enrolment numbers were slightly down this year from 31 last year to 22 (9.4%). She said its policy was to take five international students in February (9% of the intake) and eight (15%) in its July intake but seven of the eight students offered places in its midyear programme this year experienced problems getting visas in time to commence the programme. The majority of its international students are from India.

Half a dozen of the nursing schools have regular international student numbers making up between 4-7 per cent of their enrolments.

Brighid McPherson, head of Waiariki Institute of Technology's nursing school said its international student enrolments had remained at about seven per cent for the past three years with it usually taking ten students into year two and five into year one.

"If you have a robust RPL (recognition of prior learning) process and interview all students via Skype you get good quality students," said McPherson who said it had one international student with a masters degree graduating later this year who had already had been offered a job.

She said Waiariki limited its international students in its masters programme at five. The nursing school no longer offered infection control courses, once linked to its CAP course, but Waiariki's health department offered a graduate diploma in infection control to a predominantly international cohort including internationally qualified nurses (IQN).

Linda Kinniburgh, head of the Otago Polytechnic's nursing school said it currently had eight international students which was less than eight per cent of its BN enrolments – a similar proportion to recent years. She said it tried to prioritise domestic enrolments as it had applications from all over New Zealand. She added the school did not actively pursue international students though there was "some pressure by our institution to do so". "Many (international) applications don't meet the entry criteria."

Sally Dobbs, the leader of Southern Institute of Technology's (SIT) nursing school said its international student numbers stayed steady at around five per cent (which was about ten students). SIT had no policy on limiting international student numbers but interviewed all international students (even if by Skype) with most coming from China. Dobbs said some international students were concerned about their employability on graduating because they were not eligible for NETP places.  "Their lack of employment and opportunity to participate in a supportive new graduate programme is a concern." 

Stephen Neville, head of nursing at Auckland University of Technology, said AUT set a limit of 10 per cent international students per intake but its current enrolments sat at 4.2 per cent (37 students) and there had been a steady decline in international numbers in recent years. It also had a handful of international students in its master's programmes.

The University of Auckland's international students also made up about 4.2 per cent of its nursing degree programme. Robyn Auld, the school's group services team leader, said it aimed to enrol a minimum of five international students into the first year of its nursing degree each year and currently had two international students doing their PhD.

A Unitec spokesperson Angela Jones said it had 23 international students, which was five per cent of its BN enrolments – a very similar figure to recent years. She said it usually took about 7-10 international students into year one of the programme and there was generally a waiting list for places with this year students coming from China, India, South Korea and Australia.

The remainder of schools enrol a handful of international students a year with the foreign fee-paying students making up between 1-3% of their current BN enrolments (see details of numbers in table below).

These include Western Institute of Technology at Taranaki (WITT), the Eastern Institute of Technology (EIT), Nelson Marlborough Institute of Technology (NMIT), Whitireia New Zealand, and Ara Institute of Canterbury (former CPIT).

Ara Institute of Canterbury head of nursing Cathy Andrew said about 15 years ago it did have a limit on its international intake – when domestic applications had slumped and international applications were high – but it was not been an issue in recent years with international BN enrolments sitting around 2.5%. She said a number of the 19 international students currently enrolled were internationally qualified nurses (IQNs) with family links to the Christchurch rebuild and had entered the programme at third year. Some students had also attended New Zealand secondary schools. It also had eight international students enrolled part-time in its graduate certificate in nursing to meet Nursing Council requirements for registration.

Philippa Seaton, director of the University of Otago's Centre for Postgraduate Nursing Studies –which this year is offering for the first time a graduate entry, preregistration Master of Nursing Science programme ­­– said she would not provide statistics on international students on its MNSc programme because as it was only the first year the figures would "skew" the overall results. She said the international students in the department were largely PhD and masters research students.

The 19^th nursing school, Victoria University of Wellington's Graduate School of Nursing, does not offer a pre-registration programme.

Eleven of the 18 nursing schools offering pre-registration nursing training also offer Nursing-Council approved Competence Assessment Programmes (CAP). The up to 12 week programmes (including clinical placement) cost around $2500-$5000 for New Zealand registered nurses and $7,000 to $10,000 for IQNs - who usually make up the vast majority of CAP students. At least one of those schools, MIT, only take domestic CAP students because of the CMDHB's 'grow your own' policy

NMIT is one of the 11 schools offering CAP programmes and head of school Chriss Dunn said they had three CAP intakes a year with about 11-15 international students per intake and around two to four domestic students.

Another is Otago Polytechnic with Kinniburgh reporting applications for its 100 CAP places being constant with usually 80 per cent of CAP students being from the Philippines and 20 per cent from India.