Younger, more ethnically diverse nursing workforce needed.

If the nursing workforce is to meet the future health needs of New Zealand's changing population, it must reflect the country's ethnic make up and focus more on primary and community settings.

These are two key challenges identified in the recently published Nursing Workforce Strategy, part of the District Health Boards' Future Workforce project. Currently only 16.7 percent of nurses work in primary health; 13.6 percent in aged care and 43.5 percent in secondary and tertiary services. Only seven percent of nurses identify as Maori and three percent as Pacific. Noting that the nursing workforce is the health sector's largest (approximately 52 percent) qualified professional workforce, the strategy suggests that nursing has the greatest potential to respond to the challenges of delivering care to an ageing population and one with an increasing incidence of chronic conditions.

Other challenges include the ageing workforce (25 percent of nurses are over the age of 50) and the fact the workforce is not evenly distributed across with country. There are lower nurse: population ratios in Auckland, the central North Island and Southland. Strategies to develop the nursing workforce in primary health, rural and community-based services include increasing the number of nurse practitioners, extending the nursing entry-to-practice programme to include community-based settings in primary health and other community settings, and implementing professional development and recognition programmes in primary health. To increase the ethnic diversity of the nursing workforce, the strategy suggests identifying target percentages for Maori, Pacific and Asian nurses and working with education institutions nationally and locally to increase programme uptake. By 2021, Maori are expected to make up 17 percent of the total population and Pacific people, 15 percent. These groups have a greater incidence of chronic illness than others and a greater need for culturally appropriate services.

Although comprehensive nursing training has been the norm since the 1980s, the majority of nurses are still either registered general and obstetric or single registration nurses. "The overall proportion of comprehensive nurses in the nursing population has grown very slowly," the report says.

The nursing workforce also has a significant proportion of part-time workers, with just under one third of all nurses working three days a week or less. The workforce is predominantly female (93 percent). Nursing needs to be promoted as a career choice for men, with the barriers contributing to this choice addressed. While new graduates and overseas nurses registering in New Zealand provide the main avenues for recruitment into the nursing workforce, New Zealand will increasingly face competition from the international pool of nurses. "Increased demand for health workers in the future requires a focus on retention and improved information on workforce flows to enable better workforce planning". There also needs to be "a more organised approach to return-to-nursing programmes".

The nursing subgroup that developed the strategy included former chair of the College of Practice [Nurses.sup.NZNO] Rosemary Minto and director of nursing, primary health care, at MidCentral DHB Chiquita Hansen.

* A pilot return-to-nursing programme is expected to begin at Whitireia Community Polytechnic next month, funded by the Ministry of Social Development in partnership with Capital and Coast District Health Board and the polytechnic. The programme will target registered nurses who have been out of the nursing workforce for five years or more. It will meet course fees and provide some assistance with employment at the end of the course. If successful, it is hoped the programme will be rolled out in other areas.