This backs ongoing calls by the national nursing organisations for 100 per cent placement of new graduates in new graduate programmes – a goal they had set to be met by this year.

The Ministry of Health analysis found that 86 per cent (806) of the 2012 nurse graduates who gained a place in a government-subsidised NETP (Nurse Entry to Practice) programmes were still in nursing five years on.

The proportion was even higher for mental health nurses with 88 per cent of the 123 new grads signed up to a specialist mental health NESP (New Entry to Specialist Practice) Programme) still having valid annual practising certificates (APC) five years later.

In comparison just 73 per cent (330) of the 455 new graduates who failed to gain a place in a NETP or NESP programme still had an APC in 2017. Overall 1244 (82%) of the 1514 nurse graduates registered in 2012 were still in nursing five years later. (See table below)

Chief Nurse Jane O’Malley said the higher proportion of new graduates still nursing if they had started their careers in a funded new graduate programme was “telling” and showed the importance of the programmes for nursing retention.

In 2013 the National Nursing Organisations – including the New Zealand Nurses Organisation and College of Nurses Aotearoa – called for full utilisation of all NETP funding to support the goal of 100 per cent employment of new graduates by 2018.  Government funding is potentially available to subsidise 1300 NETP and about 125 NESP places but lack of vacancies and tight budgets – particularly at district health boards – means only all the NESP funding is fully utilised.

New graduate nurses employed under a year-long NETP programme must receive clinical preceptor support for the duration of the programme and the equivalent of 12 study days with the aim of new nurses starting their career “well supported, safe, skilled and confident in their clinical practice”.

The analysis of the 2012 new graduate cohort – that uses data from the ACE new graduate placement and Nursing Council of New Zealand annual practising certificate data – also showed the vast majority of the new nurses still holding APCs were practising for more than 15 hours a week. (NB nurses practising for less than 15 hours a week but still with valid APCs may be on parental leave, travelling overseas or between jobs.)

The APC data indicated that just over a dozen nurses with valid New Zealand APCs were currently practising overseas.  (Retaining an NZ APC indicates that they may only be working overseas for a limited amount of time and/or wanted to retain the option of returning to New Zealand to nurse.)

Overall 582 (43 per cent) of the 1389 applicants found out on November 22 last year that they were unsuccessful in the first job match. While most of the unsuccessful applicants were seeking surgical or medical nursing positions, the latest ACE report shows a high proportion of graduates seeking mental health and addictions, aged residential care and primary health care roles were also unsuccessful.

Hilary Graham-Smith, professional services associate manager for the New Zealand Nurses Organisation, said yesterday that hundreds of graduates missing out on jobs was unacceptable considering the national nursing workforce goal was 100 per cent placement by 2018.

The ACE Nursing Algorithmic Match Report provides a breakdown of the 913 jobs on offer and the 775 new graduates matched with jobs on November 10 in the end-of-year round of the ACE new graduate nurse job-matching process. In all, 57 per cent of the 1389 applicants found out on November 22 that they had been offered positions on Nurse Entry to Practice (NETP) and Nurse Entry to Specialist Practice (NESP) programmes. At least 138 positions were still to be filled as at November 10 and historically more graduates are also offered jobs over the summer break as vacancies arise leading up to NETP and NESP programmes getting underway in late January/early February this year.

Graham-Smith said the overall trend in new graduate jobs for nurses showed no significant increase. “This is not the case in medicine: every new graduate doctor has a place on an entry programme. This speaks to the chronic under-investment in nursing and a complete lack of progress on guaranteeing all new graduates of a place on a programme by 2018,” she said.

She said Health Workforce New Zealand head Des Gorman has called it a “perfect storm” as nursing has gone through a long period of under recruitment and training. “This matches our research on nursing employment. We have an aging workforce and over-50s leaving. We are simply not attracting, training or retaining enough nurses to future-proof our healthcare services,” she said.

Concern was expressed last year about shortages and high vacancies for acute mental health nursing positions. The ACE match report shows that 55 of the 210 applicants who expressed interest in the NESP programmes for mental health and addiction nurses were unsuccessful.

In addition, 25 of the 39 nurses who indicated a preference for aged residential care and 189 of the 359 who were keen on primary healthcare positions (which include practice nursing, prison nursing, Plunket and hospice positions) were unsuccessful in the first job round.

The DHBs in which it was hardest to get jobs (i.e. which turned away the highest proportion of applicants who had put that DHB down as their first preference) included Hutt Valley, Mid-Central, Capital & Coast, Waikato, and Auckland, which accepted between 28 to 42 per cent per cent of the first-preference applicants (see table at bottom of article for the number of jobs on offer).

Ethnicity and second-time-around job rates 

The percentage of Māori and Pacific nurse graduates offered jobs on November 10 was again slightly higher than the average job success rate at 70 per cent (145 of 206 applicants) and 63 per cent (54 of 85 applicants) respectively, compared with 57 per cent for all applicants.

Asian applicants were once again the least successful in obtaining job offers, with just 39 per cent (86) of the 220 applicants being offered a job in the first round. The job rate for the ‘other’ ethnicity category (largely Pākehā/European) was the same as for all applicants – 57 per cent – with 490 of the 846 applicants being successful.

The vast majority of the November applicants were first-time-round applicants and 60.5 per cent of those applicants were successful. Just over 35 per cent of the 115 second-time-round applicants were successful and 26 per cent of the 49 applicants applying for a third time or more.

The ACE Nursing Intake Summary Report was prepared by the agency TAS (formerly known as DHB Shared Services), which owns ACE Nursing on behalf of the 20 DHBs.

The next ACE report is not due until after the National Talent Pool, from which DHBs can employ unmatched new graduate applicants, closes in late June.

Report author Kamini Pather said there was a lot of dynamic change to ACE daily statistics as applicants get offered jobs, withdraw from the talent pool for other reasons or change their preferences. This meant there were only two points in the recruitment cycle where stable and reliable data could be extracted. Those were at the time of the electronic match (November 10) and once the National Talent Pool and end-of-year intake closes, which is about seven months later in late June.

The ACE Nursing Intake Summary Report** for the mid-year intake showed that 447 –  just short of 68 per cent of the 659 applicants – received a job offer for a new graduate programme place between July and late October via the ACE job-match process.

When the mid-year pool closed on October 27 there were 190 (28.8%) left in the pool who were still seeking supported new graduate jobs – over a hundred less than the same time last year.

This was the lowest percentage of the mid-year intake still job-hunting into the spring since ACE records began in mid-2013 – and just over a hundred less than the same time last year, when 43 per cent of mid-year applicants were still job-hunting in the spring.

The 51 nurses taken on by mental health and addiction providers for NESP [new entry to specialist practice – mental health and addictions] programmes contributed.  The improved mid-year employment rate was also reflected in the findings of the annual mid-year graduate survey undertaken by NETS (Nurse Education in the Tertiary Sector).

According to the ACE report Pacific nurse graduates were proportionately the most successful in getting a job through ACE with 83.7 per cent of the 43 applicants being employed. The next most successful were Māori graduates with 77.7% of the 94 applicants being matched with a job.

The “other” ethnicity category – which includes New Zealanders of European descent – made up just over half of the applicants – 360 (54.6%) and had a job success rate of 69.2%, which was just above the overall job success rate of 67.8 per cent*.  Kiwi nurse graduates of Asian ethnicity made up 162 (24.2%) of applicants and had a 54.9% per cent job success rate – the lowest of the four ethnic groupings.  (NB to be eligible to apply for a funded NETP [nursing entry to practice] or NESP [new entry to specialist practice – mental health] position through ACE you need to be a New Zealand citizen or hold a permanent/returning resident visa.)

In November 2015 the Health Workforce New Zealand’s (HWNZ) Nursing Governance Taskforce for Nursing set a date of 2028 to meet a goal of significantly increasing the number of Māori nurses so as to better match the proportion of Māori in the population, with the aim of improving access to care and the quality of care for Māori.  ACE statistics for the end of 2015 showed 54 per cent of Māori graduates were known to be employed, compared to 50 per cent of non-Maori and 53 per cent of Pacific applicants.

By mid-2016 the Governance Taskforce had consulted and endorsed ‘levers’ to help meet the goal including supporting all Māori new graduates into employment, building on current initiatives to promote nursing careers, and building Mâori faculty at universities and other providers.

The mid-year intake analysis indicate that the push may be paying off but the director of the Wānanga based kaupapa Māori nursing degree, Ngaira Harker, has expressed disappointment at the intial job offers for its first graduate cohort of 19 nurses who are part of the latest end-of-year ACE intake.  At the end of November nine had jobs (just under half) which was a lower job rate than the 57 per cent of total applicants who had been offered jobs in the same time period, according to early ACE stats for this latest job match round.

Auckland biggest source of jobs

The cost of living in Auckland didn’t seem to put off new graduates seeking work for the three Auckland district health boards.

Auckland DHB had the highest number of applicants putting it as their first preference (118) and had 312 applicants in total expressing a preference for Auckland as their first, second or third preference.  Waitemata DHB was the first, second or third preference of 229 applicants and Counties-Manukau had 200 applicants.

In all there were 260 applicants in the mid-year intake (just under 40 per cent of total applicants) who were graduates from the five nursing schools based in Auckland. The three Auckland DHBs between them took on 199 new graduates (Auckland DHB 87 and the other two 56 each) which was the equivalent of 44.5 per cent of the total jobs on offer nationwide.

The other two largest DHBs, Canterbury and Waikato – also got high interest with 108 graduates putting Waikato as their first preference and 106 putting Canterbury.

Canterbury DHB employed the highest number of new graduates in the country, 91, and Waikato employed 56.

*ACE Nursing mid-year job match round statistics

• 659 applicants took part in the ACE mid-year job match (461 were first time applicants, 169 second-time applicants and 29 were applying for their third round or more.)
• 389 jobs were initially offered by employers (338 NETP and 51 NESP)
• 327 applicants in July were electronically matched and a further 26 manually matched with jobs.
• 346 accepted the job offers (seven applicants failed state finals or declined job offers)
• 101 of the remaining 306 unmatched applicants were offered jobs before the ACE national talent pool closed on October 27.
• 447 (67.8%) of ACE applicants in total were successfully matched with a job.
• That left 190 (28.8%) of applicants still seeking a NETP or NESP placement as at October 27 and a further 22 (3.4%) of applicants had declined offers, failed state exams or withdrawn from the pool.

**The ACE Nursing Intake Summary Report was prepared by agency TAS (formerly known as DHB Shared Services) which owns ACE Nursing on behalf of the 20 DHBs.  

NB: This article was corrected on December 22 to clarify that the report was released by TAS rather than the Ministry of Health.

But there were 583 new graduate applicants without job offers vying for those remaining 139 positions. So many new nurses will once again start the summer job-hunting and hoping more positions will open up over the Christmas/New Year break.

The Ministry of Health this week released initial data on the 2017 ACE Nursing end-of-year job ‘match’ between the 1357 new graduate nurses who applied and the 901 positions on NETP (Nurse Entry to Practice) and NESP (new entry to specialist practice, mental health and addictions) programmes being offered via the 20 district health boards and Southern Cross.

In the first round in mid-November 774 applicants (57 per cent) were matched and were sent job offers on November 22, leaving 139 positions still to be filled by the remaining 583 applicants in the talent pool.

The proportion of graduates matched with jobs by mid-November appears to be slightly up on last year. Statistics released on December 9 last year for the 2016 round showed 779 new grads had jobs (54 per cent of applicants) but that figure included 16 applicants who secured jobs after the initial mid-November match and 13 applicants known to have got non-NETP or NESP positions. The number of applicants in 2016 was the highest ever with 1455 initial applicants of which 1434 took part in the job match.

Further information on the latest round will be made available in mid-December including which clinical settings the new nurses have been offered jobs in and how many graduates have accepted the initial job offers and how many jobs were still to be filled from the remaining talent pool.

The Ministry of Health says data trends from previous end-of-year new graduate recruitment rounds have followed a similar pattern with about 50 per cent of graduates gaining employment before they know the outcome of the Nursing Council State exam and that almost all (96-98%) graduates applying though ACE will be employed within 12 months.  But a number of these will be employed outside of the government-subsidised and mentored NETP and NESP programmes – including in residential aged care – which has prompted continued calls from nursing organisations for all graduates to be offered new graduate programme places.

New graduate Nov ACE job trends

*Number of applicants can drop by the time job offers are made in mid-November as graduates either get jobs with other employers or withdraw for other reasons. From 2014 onwards eligibility for applying to ACE nursing was extended so new graduates could apply for NETP/NESP positions for up to two years (i.e. up to four times) after passing state finals.

**The cut-off date for supplying job offer data can vary slightly from year to year from – so sometimes includes additional jobs offered in late Nov/early December. Employers keep offering jobs over the summer so the number who actually start NETP programmes in the New Year is always higher.

NA = not available

So stated the 1998 Ministerial Taskforce on Nursing. The Taskforce report also noted many acute hospitals expected nursing graduates to “immediately take up a high workload and a high level of responsibility with little structured help or support”.

It’s been 10 years since the government gave the green light to funding new graduate programmes, bringing in the first nationally consistent clinical training support for novice nurses.

At the time, support for new graduates in their first year of practice varied considerably across the country with some fortunate new graduates securing a place in formal new graduate programmes and others, like the less fortunate casual pool nurses, being expected to be work-ready in any setting.

The gold standard then was the already long-established new graduate programme for mental health nurses (now known as the NESP or new entry to specialist practice programme). The Taskforce recommended NESP be the template for a national framework of funded new graduate programmes to support this “vital time in the development of a truly professional and effective nurse”.

After a pilot in 2002 and a positive evaluation report in 2004, the government in July 2005 finally announced funding for a national framework of nursing entry to practice programmes (NETP).

So in mid-2006 the first three district health boards to gain Nursing Council accreditation for their NETP programmes were given a subsidy of $6,000 per graduate to deliver the course – roughly 50 per cent of the estimated cost. The rest of the DHBs came on board in 2007 and in 2009 the first NETP places were offered in primary health and residential aged care.

Fluctuating supply and demand for NETP places

For many of the early years of NETP there were more funded places available than were ever filled, with a number of DHBs struggling to attract new graduates in a buoyant job market.

But this reversed when the global financial crisis saw nursing turnover stagnate and DHB budgets tighten, at the same time as record numbers were graduating from the country’s nursing schools in readiness to replace the country’s ageing nursing workforce.

It was a perfect storm that saw NETP numbers fall and plateau in 2010 and 2011 (see table) and then start to steadily climb, but not fast enough to match the growing graduate cohorts. Faced with keen new graduates struggling to find work – and the added fear they could be lost to the profession, which would ultimately need them to replace retiring baby boomers – the New Zealand Nurses Organisation (NZNO) last year launched a petition calling for the government to fund an NETP place for every graduate.

The petition reached 8,000 signatures and the then health minister, Tony Ryall, responded by announcing 1,300 NETP places would be funded in 2015. Unfortunately, with nearly 1,800 new graduates registered last year, this falls far short of NZNO’s expectations. Also, whether the sector will be able to step up and employ 300 more nurses than last year (see table) to fill those extra NETP places is yet to be seen.

Improved data is now available on graduate trends through the central clearinghouse for NETP and NESP applications known as ACE, which was first used for the February 2013 NETP intake. The February 2015 ACE round saw an increase in new graduates in NETP jobs and also saw places in the mental health NESP programmes swell from 152 last year to 175 this year. And for the first time NETP funding has been allocated to new graduates employed at private surgical hospital provider Southern Cross (see sidebar).

NETP: a year for clinical consolidation and/or postgraduate study?

“I don’t think anybody would argue that the NETP programme has been a tremendous asset to establishing people’s first year of practice in a safer way then we used to do,” says Professor Jenny Carryer, executive director of the College of Nurses.

“But there are still issues around the fact that we are not funded for every single graduate and so a number of graduates miss out on the NETP programme, therefore can fall between the cracks,” says Carryer.

While only a handful of DHBs at the outset included postgraduate papers as part of their NETP programme, this has expanded over the years until only a handful now do not. Some DHBs have taken this a step further and are offering top graduates an honours programme in their second year, with the option of progressing into studying for a health sciences doctorate.

Carryer, for one, sits in the camp that believes NETP should be a year focused on the consolidation of clinical skills. “It is a year they [new graduates] are under enormous pressure to think on their feet, time manage and take responsibility for decision-making – all of those first-year learning challenges. And personally I don’t think we should distract them with a postgraduate paper that year.” Also, graduates in their first year of practice usually haven’t yet decided on their likely career path or specialty.

Sitting in the other camp is associate professor Judy Kilpatrick, head of The University of Auckland nursing school, which offers postgraduate papers in partnership with many DHBs’ NETP programmes.

“What we actually found was that graduates were doing some quite high-level things in that first year and postgraduate study was a perfect way to give credit and shape up their thinking.” She said the paper involved a high level of clinical assessment but formal study did not commence until the second semester of the NETP year to give graduates a chance to adjust to working life.

“I think that postgrad study firstly helps retain the graduates; secondly, they are able to get new knowledge – at a sharper and higher level than undergraduate – that they can apply in the clinical area; and lastly, by the end of the first year they are already cementing themselves in the pathway of where they want to go.” She says rather than being burnt out, the graduates all complete and many will go on to pursue further postgraduate study (though quite a few take a break after completing their postgraduate certificate and look around before resuming study at the next level).

Sue Hayward, director of nursing for Waikato DHB, which offers the honours programme to leading second-year nurses and now has two recent graduates on the doctoral path, also believes postgraduate study in the NETP year consolidates what graduates have learnt in their undergraduate degree.

She says the Midlands region of DHBs have negotiated for graduates then to have a longer gap, if they wish, before they do the second paper of their postgrad cert but most have completed their certificate within three years. “It’s not arduous – though it’s not easy,” says Hayward. And retention, even taking into account the current economic environment, was very good, with 96 per cent of NETP graduates staying on and going into permanent positions.

Dr Kathy Holloway, national chair of nurse educator group NETS, was part of a team that evaluated the first three years of NETP and found the supported first year of practice programmes was enhancing trainees’ confidence and competence.

She says DHBs had always done some form of new graduate programme but they were very variable across the country and there needed to be some consistency and structure, which national funding enabled it to have. And expanding the scheme into primary health care, aged care facilities, some non-governmental organisations and some private surgical hospitals meant it could support graduates entering the wider nursing workforce.

“But we still have the goal of 100 per cent employment of nurse graduates into an NETP position if they seek one.”