NZNO's Blog


Some questions and answers about our campaign for new grad nurses

NZNO Colour-31 Alex smNZNO acting professional services manager, Hilary Graham-Smith answers a few of the questions people have been asking about our campaign to get a ‘nurse entry to practice’ position for every new grad nurse.

Q:    Aren’t the tertiary institutions just churning out too many nurses? It’s just “bums on seats” with no thought for the workforce needed.

A:     The NZNO petition calling for 100% of new graduates to be employed in a NEtP programme has drawn comment about the role of the education providers in creating what is seen as a glut of new graduates i.e. the problem of lack of employment for new graduates is seen as a consequence of large intakes of students to boost enrolment numbers and keep the tertiary institutes fiscally upright.

NZNO has been working with other national nursing organisations (known as the NNO group) in developing a report on the New Zealand nursing workforce for Health Workforce New Zealand (HWNZ).

The report describes the demographic and fiscal challenges facing the health system and plots these against the challenges facing the New Zealand nursing workforce. The challenges to the system are the growing and aging population with the incumbent increase in demand for health services. The challenges for nursing are similar with 50% of the nursing workforce predicted to retire over the next 21 years.

Filling the gap requires forethought and planning, not in 21 years time but now, including knowing the numbers of student intakes in tertiary institutions and whether these are appropriate for future nursing workforce requirements.

Q:    How can there be a shortage of nurses if the ones we’re training can’t get a job? Doesn’t that suggest the opposite?

A:    The NNO report states that if everything remains the same (student recruitment, retention, numbers active in the workforce) then we will have sufficient nurses in the workforce until about 2020 but maintaining the existing status quo will result in a shortage of 15,000 nurses by 2035. The supply issues need to be addressed now both in terms of recruitment and retention and the NNO group has signalled the need for those workforce planning conversations to occur across the sector so that we have enough nurses and so that the nursing workforce reflects the needs of our population.

Q:    What’s the big deal about NEtP anyway? Shouldn’t nurses just get a job like any other new graduate coming out of a tertiary institution?

A:    The aim of the NEtP programme is to ensure that new graduate nurses commence their careers in a safe, supported clinical environment where they can grow their skills and confidence as RNs. It provides a framework for further learning and development and contributes to the development of a sustainable nursing workforce. The education providers and their curricula are subject to monitoring and approval by the Nursing Council in order to ensure a high quality of delivery and achievement.

Q:    Why do we need a plan? Isn’t “supply and demand” enough?

A:    Our campaign for 100% employment of new graduate nurses is as much about the need for a nursing workforce plan, something which is woefully absent at present. Given the predictions in regard to the shortage of nurses NZ will experience in the not too distant future we want Health Workforce New Zealand (HWNZ) to realise its commitment to work with the NNO group and sector to put a plan in place to avoid this shortage. Our new graduates are an important part of that plan in terms of managing the supply side pressures.

Q:    Nice idea, but where’s the money going to come from?

A:    Medicine (ie doctors) currently receives 60% of HWNZ funding for workforce development. Nursing shares the other 40% with other allied health professions. We believe it is time that nursing as the largest health workforce are given an equitable share of the funding so that we can recruit to and retain our New Zealand prepared nursing workforce.

We’re asking the Minister of Health, Tony Ryall to commit to 100% NetP for new graduate nurses and to come up with the funding to achieve this.

And we’re asking you to sign and share the petition with your family and friends.

Ma whero ma pango ka oti ai te mahi
With red and black the work will be complete
(If we all do our part our goal will be achieved)

You can find out more about the New Zealand Nurses Organisation campaign to support our new grads here:



Every new grad nurse deserves the best start to their career

New grad bannerToday the New Zealand Nurses Organisation is launching a petition aimed at achieving a nurse entry to practice (NEtP) position for every new grad nurse.

New Zealand is facing a significant nursing shortage over the next decade. We need to begin growing a sustainable, home-grown and highly skilled nursing workforce if we are to maintain the high quality of nursing care we all deserve. We’re educating some of the nurses needed to fill that gap and we need to support them to gain experience and stay in New Zealand.

The nurse entry to practice programme is a structured support programme for newly graduated nurses. The programme provides each new graduate nurse with support and mentoring in their first year of practice.

The Minister of Health, Tony Ryall needs to fund a one year nurse entry to practice programme for 100% of new graduate nurses, now – it’s the only way to get the nursing workforce we want in years to come.

New Zealand is educating  nurses and then leaving large numbers of new graduates unable to find work in a clinical setting due to limited places on NEtP programmes and/or employers requiring them to “have experience” before they will employ them. In the latest ACE round 233 of the 645 applicants have jobs. That leaves 412 new graduate nurses without jobs. The risk is that some of these nurses will gain employment in unsupported environments where there are insufficient RNs to provide mentorship. And, sadly, some won’t get a nursing job at all. This is not just about employment it is about employment in a NEtP programme.

The issue of employment in the health sector for new graduate RNs and ENs needs urgent attention. NZNO supports the national nursing organisation’s (NNO) vision for “100% graduate employment by 2018 at the latest”(Report from the National Nursing Organisations to Health Workforce New Zealand, 2014).

Many new graduates approach NZNO seeking assistance with finding a NEtP position.

We’re asking Tony Ryall to come up with the funding.

And we’re asking you to sign and share the petition with your family and friends.

NZNO has 46,000 members and we’re hoping that every NZNO member and their family, whānau and friends will get behind this campaign!

Ma whero ma pango ka oti ai te mahi
If we all do our part we will reach our goal

You can find out more about the New Zealand Nurses Organisation campaign to support our new grads here:

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Referrals from ED to primary care

B7_emergencyIn a bid to reduce patient numbers Southern DHB announced this week that it would implement a new system in its Emergency department, where patients not deemed in need of urgent medical attention would be asked to see their GP instead.

Those unable to afford to see their GP would be issued with a voucher. Southern PHO would be the partnering community provider of GP services.

Southern PHO head, Ian Macara wasn’t keen to publicise the vouchers though:

”We don’t want to set up a free service – that all you’ve got to do is trot down to your local ED and get a voucher and away you go.” 

The new Southern DHB system proposes that a triage nurse (if comfortable to do so) would have a conversation with a patient and ‘encourage’ them to see a GP instead. If cost was a barrier a voucher could be issued.

Southern DHB says they are not turning patients away, merely “offering the patient the choice of an alternative treatment provider.”

NZNO was asked our view of the new system. Our answer is – it must comply with Ministry of Health guidelines on the interface with primary care.

Making sure every single New Zealander has access to Emergency Departments is a fundamental part of our public health system.

The decision to treat someone in ED or redirect them is a clinical decision with clinical and professional accountabilities for the health practitioner.  We all know what happens when something goes wrong!

According to the plan, the burden of this work will fall on registered nurses.  Our members were not part of the design of this local system and we fear they may be pressured to reach targets, either of acuity or numbers of patients seen in ED.

Not only that, but the system is counter to the Ministry of Health NZ guidelines on the interface with primary care, which includes the important proviso that ‘encouragement’ to leave ED and make an appointment with a GP instead should not occur at the triage stage of the process. Triage does not accurately determine the appropriateness of a patient’s condition for presentation at either the ED or primary health care.

The Ministry of Health guidelines also state that the NZ public will not be declined care in emergency departments.

If the system does not change at Southern DHB, patients will not receive the assessment/diagnosis that must happen before a decision is made, triage nurses will be at risk and their workload will increase greatly.  This is not good for patient safety.

Nurses should have been part of the planning for this process and now need to have education on the redirection process, including the understanding of professional accountabilities.

NZNO will be working with Southern and other DHBs to ensure patients and staff receive high quality care, where and when they need it. The College of Emergency Nurses NZ -NZNO is drafting a position paper to detail responsibilities. We’ll link to that when it is finalised.

Below are the relevant sections of Ministry of Health’s 2011 guidelines on the Interface with primary health care.

2. Referring patients from ED to primary health care for ongoing care

2.4  The extent of ED care prior to referral to primary health care will vary, but the guiding principles should be that sufficient assessment/care is undertaken so that ED staff are satisfied that the patient is clinically:

  • safe (a need for alternative or more urgent care does not appear to be needed);
  • comfortable (distressing symptoms are addressed); and
  • appropriate (sufficient diagnostic work-up has been done so that there is reasonable certainty that primary health care is best suited to continue the patient’s management).

4. Identifying and referring patients for whom primary health care is better suited to meet their needs

4.4  However, referral to primary health care may occur if further clinical assessment determines that primary health care is better suited to meet the patient’s needs. This clinical assessment must be over and above the usual triage process and should ensure that the criteria in paragraph 2.4 are met. In addition, referral to primary health care in this context must:

  • be facilitatory and not against the patient’s wishes (ED care should not be denied);
  • be based on a high level of comfort from the assessing clinician that referral is best for the patient (the assessing clinician must not feel any institutional pressure to ‘refer’ patients to primary health care and must be protected from any undue risk associated with the referral of patients); and
  • occur in the context of a responsive primary health care service (the patient must be able to be seen in primary health care in an appropriate timeframe for their condition).



Apology needed, stat!

Apology - Street ArtLast week an odd article appeared online and in the Dominion Post praising Hutt Hospital for taking on the lessons of Unilever soap factory.

Along with description of the hospital’s new “nerve centre”, with its centrepiece of four huge screens displaying brightly coloured speedometers, bar graphs and traffic lights, there were some other, more depressing, comments as well.

Hospital manger Peng Voon implied that staff were regularly dishonest; “hiding beds”, lying about the time scheduled to change dressings and saying that a culture change was needed.

While there is no doubt that the new system means things are working more smoothly, it is absolutely no fault of the nursing team that they weren’t previously!

At NZNO we hear about stressed and overworked nurses with not enough resource to consistently provide the quality of care they wish to. At the DHB, overtime has been stopped (unless pre-approved), so nursing staff are absolutely at breaking point.

I have heard that the awful comments made about them have brought some nurses to tears, and others to anger. What a shame that what could have been a positive article for the hospital and staff should have been ruined by the undermining comments of someone who seems to have lost her faith in nursing.

Nurses at Hutt Hospital want an apology and we at NZNO certainly think they deserve one.

Apparently the Chief Operating Officer, Peter Chandler has apologised for the comments on the hospital intranet but that’s not enough. The comments were made publicly, to a readership in the tens, if not hundreds, of thousands – his apology must be made publicly too.

Hutt DHB, your staff deserve an apology, stat!


Photo credit: Phil King via Flickr


Asbestos needs a ban and a plan

asbestos_fibres_under_the_microscope_2Asbestos is the single greatest cause of work-related deaths in New Zealand. The government estimates that 170 deaths occur a year from asbestos-related diseases in New Zealand and that this will rise to over 300 as the results of the ‘asbestos boom’ of the 1970s take their toll. That’s as many as the current road toll. Even 170 is double the number of workplace deaths per year from injury – which itself is far too high, several times other countries such as the U.K. and Australia. These conditions are irreversible and the treatment options are only palliative.

According to the World Health Organisation, no level of exposure to asbestos is safe, and this has been known at least since a declaration by the World Health Organisation in 1986. The World Health Organisation says that “the most efficient way to eliminate asbestos-related diseases is to stop the use of all types of asbestos”.

Asbestos fibres, once breathed in, can stay in your body for decades before signs of disease show. Asbestos can cause serious diseases including asbestosis, pleural thickening, mesothelioma and cancers of the lung, larynx and ovary, anything from 10 to 50 years after exposure to it.

Ask any nurse who works with patients suffering from the diseases caused by asbestos and they will tell you in no uncertain terms that we must get rid of it, now!

That’s not going to happen overnight but in the meantime, we must have much better protection and training for people working with asbestos or who might be exposed to it.

We urgently need to ban the import, supply and new use of any products containing asbestos; and create and implement a plan to eradicate asbestos from the built environment by no later than 2030.

The NZ Council of Trade Unions is leading the work to achieve a ban and a plan for asbestos, and we wholeheartedly support the campaign. A healthy New Zealand can only happen when we take action against to stop preventable illness and death.

Please take a moment to sign and share the petition to ban asbestos and implement a plan to remove it from our environment.



Young nurse of the year award

Young nurse awards FB picThis year NZNO is hosting the very first Young nurse of the year award, so if you know a nurse aged under 30 who has gone the extra mile, or demonstrates exceptional commitment to the profession and to their patients, then get your nomination in now.

Nominations close on 1 August and the awards ceremony will be held at the NZNO AGM and conference in September. The winner will receive a fantastic prize package including cash, a cash contribution toward education or professional development, a trophy and certificate, and travel and accommodation to attend the special awards dinner in Wellington.

This prestigious award will acknowledge the hard work and commitment of one young nurse, but behind the award is NZNO’s desire to publically support all young nurses and help keep them in the profession and in New Zealand.

The idea of the Young nurse of the year award is the brainchild of a project team made up of nurses aged under 30 (and supporting NZNO staff) who were tasked with identifying ways NZNO could support younger nurses in the workplace.

Along with a website, Facebook page and blog the group identified that an award would give their peers and colleagues a way to recognise the contribution young nurses make to their profession, patients and workplace.

Significant planning has gone into the awards with the project group developing a project plan, seeking sponsorship, and developing nomination forms, assessment criteria and establishing a judging panel.

We hope everyone will get behind the initiative and show their support for the Young nurse of the year award. It’s just one way we can make sure our future nursing workforce is skilled, valued and sustainable.


A message to nurse managers

A message to nurse managers from NZNO acting professional services manager, Hilary Graham-Smith. Hilary has had a long career as a registered nurse working in primary health care and as a Director of Nursing in primary health care.take a chance on a new grad

“A sustainable, fully utilised nursing workforce is NZNO’s number one priority.

We also want a sufficiently funded nurse entry to practice (NEtP) programme so that 100 percent of our new graduate RN and ENs are employed and appropriately mentored and supported during their first year of practice.

The current nursing workforce has a vital role to play in that. Sadly, we still have a significant number of new graduates who do not get into NEtP programmes who are looking for work – they need our help.

We know that many of your work environments are stretched by less than adequate staffing and we hear many of you say, “We haven’t got time to preceptor new graduates”. However we all have a role to play as experienced nurses to make sure that our new grads are welcomed into the workforce; our collective experience and expertise will help to grow the nursing workforce of the future.

I encourage those of you who are in decision-making roles and involved in recruitment to stop and think for a moment before deciding NOT to offer a job to a new grad; so many of the responses to Keren MacSween’s story were from new grads who had been turned down because of a lack of experience.

I ask, isn’t that our role? – to make sure they get experience in an environment where they can not only learn from others but share their new knowledge. New grads don’t come without skills they just need time to grow their self-assurance and confidence in clinical practice.

Remember how that felt – being the newbie RN or EN? This is about nurses doing it for nurses and the wellbeing of the whole profession.

So think about it next time a new grad applies for a job in your ward/unit/ department – give them a go. Go on you know you want to!”