The role of overseas nurses in our health system: nurses and midwives from overseas are a growing component of our workforce. Here we outline the process nurses go through to gain New Zealand registration and some share their experiences and observations.

NEW ZEALAND'S health services would be under far more pressure, were it not for the number of overseas nurses working within them. Between 2000 and 2003 the number of overseas nurses registered in New Zealand, jumped from 1119 to 1514--a 35 percent increase. That upward trend is continuing, with 1706 overseas nurses and midwives registered last year. That figure is almost double the 974 nursing and midwifery students who passed State finals in November last year.

Nursing Council figures show that just over 13 percent of nurses and midwives identify their ethnicity as other than New Zealnd Maori or New Zealand European.

New Zealand's health services will have to rely on overseas nurses to fill staffing gaps for years to come, judging by a range of pertinent factors: the numbers entering the profession; the attrition rate during the three-year programme; the numbers travelling overseas on graduation; and the numbers opting out of the profession.

According to Nursing Council statistics, there were 32,687 active registered nurses and midwives in New Zealand last year, a decline of 1.3 percent over the 2002 figures.

Fewer than 1500 students began the BN programme last month. (See news and evetns p9.) The head of one of the country's largest nursing schools, Cathy Andrew of Christchurch Polytechnic Institute of Technology, said an emerging trend was non completion of the programme or taking longer than three years to complete it because of financial or family commitments. "Based on current figures we are likely to only produce 140 graduates a year. This is a very real concern considering there are currently more than 4000 nurses with practising certificates in Canterbury."

Last year 908 nursing students sat State finals, with 894 passing. Of those, 9.3 percent intended heading overseas for work. (See news and events p9.) Eighty-two midwifery student sat State finals with just two failing to pass.

Of the 1706 overseas nurses and midwives who registered last year, 829 were from the United Kingdom, 149 from India, 148 from the Phillipines, 134 from Australia and 122 from South Africa. The largest increase over the previous three years was from the Phillipines and India, according to Nursing Council figures.

The process for gaining New Zealand registration varies according to where nurses trained. Nurses with Australian registration (except from Western Australia) can apply under the Trans Tasman Mutual Recognition Arrangement (TTMRA) that came into effect on May 1, 1998. Under the TTMRA, applications can be processed within a month, at a cost of $105. Applicants from other countries face a wait of up to 12 weeks to have their application processed, pay $211 and are assessed differently.

The Nursing Council's deputy registrar Pamela Lee said decisions were guided by Council policies and where overseas nursing and midwifery programmes were known to be similar in content to an equivalent New Zealand programme. Some applicants were required to undertake a period of clinical experience and/or theory and a clinical competency assessment programme before being considered for registration.

Lee said that in the process of individual assessment, differing requirements for applicants from different countries were considered. "For example, in general, applicants from India are required to successfully complete a competence assessment programme through an education provider and meet the English language requirements. United Kingdom applicants do not."

Applicants from countries where English is not the first language have to provide evidence, obtained within the last two years, of their ability to speak, write and understand English. The Council has raised its English language requirements, effective from February 1 this year.

Not all overseas applicants are assessed for culturally safe practice. Those applicants who have to complete a competency assessment programme are assessed against the cultural safety competency for registration. But those applicants who do not have to go through such a programme do not have to meet any cultural safety requirements. On registration, all applicants are provided with the council's publication Guidelines for Cultural Safety, the Treaty of Waitangi and Maori Health in Nursing and Midwifery Education. Final registration decisions are made by the Council.

Commenting on the differing cultural safety requirements, Council chair Annette Huntington said employers also had a responsibility to ensure the staff they employed were appropriate for the communities they served. She said the Health Practitioners' Competence Assurance (HPCA) Act gave the Council greater flexibility in terms of applying conditions on practice, once a nurse was registered. "It provides quite an array of conditions that can be applied to ensure safety and competence but the TTMRA still transcends that Act."

Overseas applicants were subject to considerable scrutiny, she said, and the council's Registration Committee interviewed a reasonable number of applicants.

The competency assessment programmes were important and the Council relied on the reports it received from the programmes. "The nurses who are doing the assessments are very considered in their reports. They do no let every one in."

Under the current legislation there were a number of registers an overseas applicant could enter and the Council may sometimes suggest an applicant be placed on the roll rather than the register.

Some diversity in the nursing population was positive for the profession. "We have an increasingly diverse population in New Zealand so an increasingly diverse nursing population can be a strength," Huntington said.

The increasing number of applicants come from an increasing diversity of countries--Ghana, Nigeria and Somalia among them. "This is one impact of globalisation and there are certainly ethical issues involved in the movement of nurses from countries where there is desperate need to First World countries," Huntington said.