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How many IQNs will New Zealand need?

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Around 26 per cent of the nursing workforce are internationally qualified nurses. As the population increases and ages, and nurses retire, that proportion will probably be needed for quite some time.

A recent NZNO submission to Immigration New Zealand about nursing shortages in five specialties suggested these specialties be removed from the Essential Skills in Demand (ESID) list. (1) The five nursing specialties are aged care, critical care and emergency, medical, mental health and perioperative.

In a time of new graduate under-employment, the submission argues, it is unnecessary to bring nurses into New Zealand from overseas to fill vacancies in these areas.

The Filipino Nurses Association of New Zealand is strongly opposed to any closing of doors to internationally qualified nurses (IQNs), an action NZNO's submission appears to be recommending.

An abrupt disruption to the inflow of IQNs would drastically alter the balance between nursing workforce and population growth. The growth of the nursing workforce, in general, is predicted to to keep pace with population growth until 2025. (2) It is speculated this trend will be reflected in most practice settings, except for cancer nursing, where the need is expected to outpace workforce growth. A decline in Maori, Pacific and enrolled nurse (EN) numbers is also foreseen, with continuing care of the elderly facing the largest proportional decline in the number of nurses. (2)

Interestingly, despite the predicted decline in Maori, Pacific and EN numbers, the slightly positive general workforce trend is projected to occur against a backdrop of IQNs continuing to make up 26 per cent of the registered nurse (RN) workforce. IQNs are predicted to make up 50 per cent of RNs in continuing care (elderly) settings by 2025. (2) There is, however, a need to prioritise and push for nursing workforce initiatives for Maori, Pacific, ENs and RNs in continuing care of the elderly. IQNs are not in competition with any of these groups.

IQNs bring with them culture and experience that match the cultural diversity of patients in need of nursing care in various specialties. Recent figures show the most common country of qualification of IQNs was the United Kingdom (32 per cent), followed by the Philippines (24 per cent) and India and Sri Lanka (17 per cent). IQNs represent 25 per cent of the overall practising nurse workforce, 11 per cent of nurse practitioners, 26 per cent of RNs and seven per cent of ENs. (3)

Not competing with new graduates

Contrary to what some believe, IQNs are not in direct competition with new graduate nurses. Thus, IQNs should not be blamed for new graduate unemployment. In a recent article in Nursing Praxis, the writers state that the nurse-entry-to-practice (NETP) programme is not universally available in primary care or aged residential care. (4) The nurse-entry-to-specialist-practice (NESP) programme, likewise, offers limited placements. NETP is only open to New Zealand citizens and permanent residents, thus newly migrated IQNs will never have a chance to get into these programmes. The writers conclude that new graduates prefer to work in an acute hospital environment, as opposed to aged residential care, primary health care (PHC) and mental health. New graduates want to consolidate their learning in the hospital setting first, before moving to what are considered to be more challenging and less supportive contexts. (4)

The writers recommend that understanding, managing and working on strategies that will address new graduate preference is urgent, if the goal is to have more new RNs working in PHC and mental health. Another recommendation is for nurse educators to be made aware of the impact their attitudes have on the choices students make about employment post-registration. With these findings, focus should be on influencing nurse educators' attitudes and in making more NETP and NESP places available to new graduates.

Lastly, the nursing workforce is ageing, thus the nursing workforce supply should replace the increasing numbers of retiring nurses and meet the extra demand for nurses as a result of population growth. In a 2013 Nursing Council document, it is estimated that by 2035, the population will be around 5.26 million. (5) As the population increases, the demand for health-care services is also expected to grow, based on ageing and lifestyle factors. With the ageing population comes the ageing of the nursing workforce. It is predicted that over half our present workforce will retire by 2035. (5) Keeping all workforce factors constant --if the number of domestic and international students enrolling and completing nursing qualifications, the number of nursing school places available, the rate nurses enter and leave the workforce, and the proportion of IQNs all remain the same--it is predicted there could be a shortage of up to 15,000 nurses by 2035. (5) With these projections, it is evident New Zealand would still need IQNs in specialty areas until at least 2035.

In conclusion, the FNANZ believes it is imperative the five nursing specialties remain on the ESID list.

Monina Gesmundo, BScN, PGCertTT, PGDip HSc(Merit), MN(Hons), is a clinical nurse specialist for infection prevention and control at Counties Manukau Health. She is also president of the Filipino Nurses' Association of New Zealand.

References

(1) NZNO. (2016). Review of Essential Skills in Demand Lists 2016. Submission to the Ministry of Business, Innovation & Employment. Retrieved from http://www.nzno.org.nz/resources/submissions

(2) Ministry of Health. (2016). Office of the Chief Nurse: Sector update. Retrieved from http://www.health.govt.nz/system/files/documents/ pages/office-chief-nursing-officer-update-apr2016.pdf

(3) Nursing Council of New Zealand. (2015). The New Zealand Nursing Workforce. A profile of Nurse Practitioners, Registered Nurses and Enrolled Nurses 2014-2015. Retrieved from http://www.nursingcouncil.org.nz/Publications/Reports

(4) Wilkinson, J., Neville, S., Huntington, A., & Watson, P. (2016). Factors that influence new graduates' preferences for specialty areas. Nursing Praxis in New Zealand, 32(1), 8-19.

(5) Nursing Council of New Zealand. (2013). The future nursing workforce. Supply projections 2010-2035. Retrieved from http://www.nursingcouncil.org.nz/News/The-Future-Nursing-Workforce
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Title Annotation:viewpoint; internationally qualified nurses
Author:Gesmundo, Monina
Publication:Kai Tiaki: Nursing New Zealand
Geographic Code:8NEWZ
Date:Oct 1, 2016
Words:990
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