Nursing in terminal decline

Nursing is in trouble in New Zealand with one in five new nursing graduates leaving to work overseas and more than a third of the resident nursing workforce aged over 40. According to New Zealand Health Information Service statistics, just 6.9 per cent of New Zealand's 34,660 active registered nurses and midwives are aged between 25 and 29.

Anecdotal evidence and low nursing graduate numbers also suggests few secondary school pupils are interested in nursing. In the 12 months ending March 31, New Zealand had just 1325 registered nursing graduates; many aged in their mid thirties.

"While we're not unhappy to have mature nurses, if a profession or career isn't attractive to school leavers, then it is a dying profession," says Geoff Annals, chief executive for union and professional organisation New Zealand Nurses Organisation (NZNO).

So what's the problem? Surprisingly, it may not be money. In 2004, the NZNO brokered a deal with the 21 District Health Boards which will see nurses' wages rise by between 14 and 30 per cent by July next year, and nurses spoken to for this article insist money is less of an issue than the workforce factors of stress, understaffing and lack of sufficient supervision, mentoring and psychological support.

"Nurses without enough time or support to meet the professional standards they are required to uphold resolve this by getting out of nursing or going overseas," says Annals.

Or they become burned out. Registered nurse Jane Hinds says when employers cut budgets, nurse support services are the first thing to go, yet are the most critical.

"Burned out nurses stop emotionally caring and can start to resent the people coming in," says Hinds. "They can start using black humour or become cynical."

Hinds, 51, has been a New Zealand registered nurse for more than 30 years and is currently employed as a night nurse for an A&E clinic. She began training at 18 through Auckland public hospitals when a tertiary degree was not required and nursing was seen as steady work for women of the Baby Boomer generation (now age 41-59). Today, this group makes up the largest percentage of registered nurses in the Western world.

Like many women of her generation, Hinds has worked as a nurse through marriage, separation, raising three children, and furthering her education - testimony to the career flexibility nursing can afford. Hinds recently gained a Masters degree in health science and psychotherapy, which she wants to use to help supervise, support and mentor student and working nurses.

Previous employers have included Plunket, private practices, public hospitals, and A&E clinics and Hinds has also worked as a clinical tutor. For all this effort and experience, her present salary is less than $50,000, but Hinds agrees with Annals that money is not the most important thing. While nursing can offer opportunities in travel, teaching and education, the lack of adequate staffing and support in hospitals makes it a harsh environment.

"You get too tired, too stressed, too often. Nursing can be deeply satisfying, unique, grounding and holistic and helps people to care for themselves as well as others. But everyone in a caring profession needs some form of supervision or psychological support," says Hinds.

While Government health and safety organisations have done a "tremendous" job of upgrading practical health and safety in the nursing environment, Hinds says not enough is done to provide a psychologically healthy workplace.

Nurse staffing problems were recently highlighted by the introduction of "MIA's", cardboard cut out nurses designed by the NZNO. An MIA (Missing in Action) will be put on display in hospital wards when the number of nurses on duty falls below a number the NZNO considers safe.

In September, NZNO outgoing president Jane O'Malley told the Herald that while most hospitals were aware of the issue, the public needed to be too. The NZNO estimated public hospitals were short by 2000 nurses.

Annals says without initiatives to address the problem of not enough staffing, psychological support and mentoring, New Zealand will continue to lose its nursing workforce.

Meanwhile, bad press is probably not the only thing keeping young people away from nursing. Research by New Zealand HR and recruitment companies reveal energetic, creative, and well educated school leavers with an eye to lifestyle and travel are less interested in the so-called 'caring professions' than the generations that preceded them. This may be especially true for nursing which Annals says young people perceive as involving 'yukky work'.

Additionally, some career advisors see nursing as less than ideal from a feminist or masculine perspective. When Annals' daughter enquired about nursing, her school careers advisor tried to talk her out of it and into medicine.

"Nursing can be perceived by women as a [gender stereotyped] occupation to be avoided," says Annals.

He says the ideal demographic makeup of a nursing workforce should reflect the demographics of the population; but only 3.1 per cent of active enrolled nurses in New Zealand are men; 68 per cent are New Zealand Europeans and about a fifth are immigrants, mostly from Britain.

So what's the answer? Annals has high hopes for the outcome of a joint NZNO and Government inquiry and report into nursing and midwife workloads and working conditions, due in May next year.

"The outcome of that will be critical to the future of nursing in New Zealand; it is the most important thing at the moment," says Annals.

Health Minister Pete Hodgson says the Government is aware of the need to recruit and retain nurses.

"We've committed over a half a billion dollars to a massive pay jolt for nurses and have recently facilitated a recruitment campaign with the Johnson and Johnson Foundation to encourage school leavers to enter nursing," says Hodgson.

He says it is important to orientate and support entrants into nursing and the Government has provided for a New Entry to Practice Programme for new graduates that will be launched early next year.

But what can be done about people's perceptions of nursing as 'yukky'? Annals says once people start nursing their [negative] perceptions turn around. Viewed separately from the current workplace environment, nursing is intrinsically rewarding and stress only occurs when workplace conditions don't allow a good outcome for nurses or patients.

"If employers can create a work environment that enables nurses to do a good days' work, then nurses will be proud of the work they do and speak well of it. This will attract school leavers," says Annals.

In other words, while nursing may not be Shortland Street, if well supported it can be rewarding and enjoyable.


* At least four years of secondary education is required to enter tertiary nursing training and five years is preferred. Useful subjects include English, maths, chemistry and biology.
* Nurses generally obtain a Bachelor of Nursing degree through a tertiary institution before starting work as a hospital nurse.
* Nursing also requires training or an affinity for using information technology systems, particularly software programmes used to monitor medicines and keep patient information up to date.
* The largest nursing employers in New Zealand are the Government (through public hospitals and healthcare services) and private institutions specialising in care of the elderly.
* Nursing specialty areas include district nursing, occupational health, midwifery, surgical, and mental health.
* The majority of registered nurses in New Zealand earn between $40,000 and $65,000 a year and work between 33 and 40 hours a week. Many positions require shift work.