NZNO associate professional services manager Hilary Graham-Smith talks about the realities of too few Nurse Entry to Practice (NEtP)places and too many new grad nurses not getting the support they should have.

It’s a busy time of year for everyone, especially for the hundreds of newly graduated nurses out there who have just got the results of their state finals and are now looking for jobs.

It’s tough out there. We know it. And that’s why we’re feeling pretty disappointed that the Minister of Health is putting out press statements painting a rosy picture of the nursing landscape.

NZNO, and the other national nursing organisations have a goal of 100% Nurse Entry to Practice places for all new grad nurses by 2018. We’re pushing hard to make it happen and pursuing every avenue for change.

The issues are complex:

• There just aren’t enough NEtP places
• The Government has not allocated enough funding to the NEtP programme
• Employers want ‘experienced’ registered nurses
• No NEtP programme for new graduate enrolled nurses
• New graduates in their first year of practice working outside of the NEtP programme have inadequate support

The results of the latest Advanced Choice of Employment (ACE) round for graduating nurses makes for depressing reading. Of the 1451 applicants including first time and repeat applicants, 51% (735) gained employment in a Nurse Entry to Practice programme. November 2015 graduate numbers were 1245 and of those 568 did not gain employment through the ACE round. We can endlessly slice and dice the numbers every which way but the point is that we still have large numbers of graduating nurses who do not gain employment on a NEtP programme. Just hold that thought in your head as you read on.

The Minister’s press release celebrating this will have been of no comfort to unsuccessful applicants and makes those of us who know the real story shake our heads in dismay. For the Minister to say “This result is in line with the pattern seen in the first four years of ACE” suggests that the status quo is OK? Really?

In November 2013 the National Nursing Organisations convened a workshop with Health Workforce New Zealand (HWNZ). The purpose of that meeting was to inform HWNZ’s and the Office of the Chief Nurse’s direction for education, workforce development programmes and innovations. It was agreed that one of the key action points from that meeting should be “a balanced approach to the nursing pipeline, including full utilisation of Nurse Entry to Practice funding to support a goal of 100 per cent employment of new graduates”*. The timeframe for achieving this was 2018 at the latest.

One could reasonably expect that two years on we would see some improvement in the numbers of new registered nurses being employed through the ACE programme.

In the same press release the Minister goes on to say “The data also shows from past ACE rounds that the vast majority of graduate nurses find employment over the next year”.  The salient truth about this statement is that the new graduates may well find employment outside the NEtP programme but this is likely to be in environments where they will be given too much responsibility and will not have the support and oversight of more experienced nurses. Our experience is that  these new graduates end up in competency reviews, disciplinary proceedings, in front of the coroner’s court or being reported to the Health and Disability Commission. NZNO lawyer, Margaret Barnett-Davidson had this to say, “In rest home/hospitals where nurses faced allegations relating to their practice, there were a number of common issues that increased the nurse’s vulnerability….. unsupportive managers and caregivers, time pressures too challenging for the skill set, busy environments and accepting responsibilities beyond manageability or competence level.” (Kai Tiaki Nursing New Zealand, November 2013)

Remove the gloss and spin from the rhetoric and the fact is that the registered nurse workforce is being disadvantaged by systemic unfair funding models that do not recognise it as the largest health workforce in New Zealand and one that is pivotal to providing safe and effective care for our populations and communities.

Yes the issues are multi layered as are the solutions, yes there needs to be collaboration between the education providers and employers and yes we need a strategic plan that takes account of the nursing workforce shortage predicted for 2035. But first of all we need an equity lens passed over the funding that is made available to nursing, in particular our new graduate nurses.

* (Summary of selected themes and some agreed actions that emerged from discussions at the Health Workforce New Zealand (HWNZ) Nursing workshop held on 29th November 2013).