NZNO's Blog


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!”


Keren’s story

10173782_10152419167743426_5467771467065139208_nLet me introduce myself, my name is Keren MacSween and I am 43 years old. I am married and we have two beautiful daughters aged 12 and nine years. Around five years ago I made a bold decision to change my career direction (much to my husband’s surprise!) and retrain as a registered nurse.

I am a meticulous planner and managed to organise study, work and family and unfortunately, with all the sacrifices that had to be made, it was sometimes my family that came last. But with the support of my husband and my very understanding children we managed to get through four years of study, clinical placements and assignment deadlines along with the stress of exams.

Apart from the emotional sacrifices there have been huge financial sacrifices as well. As a family we have gone without to try and make ends meet. When I eventually had to give up work once I started the degree we had to find other ways to manage financially. While I am thankful that we are able to provide a home for our children the fact that we have not been able to pay any principle off our mortgage has been a strain on our marriage. Also the only way I could go back school and study was to apply for a student loan for the four years of study to reach my goal of earning a degree and a career. At the most recent statement this is around $36,000 and with no job prospects on the horizon there is no chance of that reducing in the near future.

We used to have a credit card, but that got out of hand and we have just recently managed to pay it off. I hated having to choose between getting petrol in the car so I could take the girls to a park or see family or buy milk and bread so they would have sandwiches for their school lunches. We are still living week by week and some weeks are harder financially than others. With my financial management I have been able to keep on top of the bills but that does mean living to a strict budget every week. This also has another effect on our meal planning, some weeks we do not know what we will be having for dinner until that day because I need to be vigilant on food and meat specials and are only able to buy on the day. But I am lucky to have grown up in an era where I have learnt to make or bake from scratch.

While still dealing with all this financial stress I have gained a qualification that I feel is not worth the fees I have had to borrow to pay for it. I am seven months down that track after gaining my nursing degree with no job or job prospects that are visible. Although I feel very lucky to have a casual support worker position within an organisation that provides for people living with a mental illness, this is a casual role and dependent upon regular staff being sick or on annual leave. While this has given some relief to the financial stress it is in no way full time employment utilising my qualification. What I am feeling now is desperation but in the same breath I also feel optimistic that there is a job out there for me, one that I can really shine in and show my qualities.

It’s an amazing thing an interview it’s where you as a candidate can show the recruitment team your qualities and strengths, this is very hard to do in a cover letter but a cover letter is the only way you are able to let the recruitment team know what they might be missing out on. I have had one interview in the last seven months out of more than 60 applications submitted. Also I have to note that not all jobs applied for have given me the courtesy of a reply positive or negative. And I feel that some have not even considered my application as soon as they read ‘new graduate’. I have changed my cover letter to ‘sell’ myself as advised and I have not limited myself to one clinical area or DHB region. Other advice given was to volunteer at rest homes or such places but as soon as they discover that I am an RN they do not want to take the risk. What risk are they taking? I am the one that could do something outside my scope as a volunteer and jeopardize my registration before I get a chance to use it. I am unable to work as a health care assistant (HCA) as DHB policy states this, although NZ Nursing Council stated that as long as I do work within the scope of practice as an HCA it should be alright.

Everywhere I look people want experience, but to gain experience you need to be working in a clinical setting. This is where the NEtP programme comes into play. The negatives to this programme are that there is only one way to get onto the programme and there are very limited spaces compared with the amount of new graduates every six months. Your other options are to apply through health care providers directly, agencies and casual pool nursing organisations. Downfall of this is that they all require proven clinical experience so will not even take your details. Applying directly to private hospitals and rest home with hospitals attached? Once again require 2-3 years proven clinical experience.

If I go back to the cover letter, how can you show somebody your maturity, your compassion and empathy along with your willingness to learn more and that because of the change in direction of career at a later stage in life, which you are in this career for the long haul? How are you able to show your passion in educating young and old about their health and health options that are available to them?

I am willing to travel up to two hours away from my home to make sure I have that experience, but this still does not help. I am getting desperate but am also optimistic there is a job out there for me; there has to be!

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Succession planning

passing the baton (1)Succession planning is a big part of solving our looming nursing workforce crisis. We already know there are many strands to consider when planning for a sustainable, home-grown and highly skilled nursing workforce.

At the moment we have, at one end of the spectrum, great newly graduated nurses, who are motivated, want to give something back to society but who are unable to find jobs. And for the new grads lucky enough to get a job, some of those positions are not suitable for a new grad unless there are appropriate supports in place, and they shouldn’t be forced to take them. For example, sole charge residential aged care roles, with no support or mentoring/preceptoring available – a pretty scary proposition for a first time RN.

At the other end of the nursing spectrum there are thousands of skilled, experienced nurses who have had long and varied careers who would love to be able to pass their knowledge on to a new graduate, but are not given the opportunity to.

No matter which way you look at it, the nursing workforce is in a quandary!

We need to value our New Zealand educated nursing workforce, and think about succession planning in terms of passing the baton – sharing the knowledge, skills and experience held by the existing workforce with new graduates. It’s just another way we can walk the talk of “growing our own”. (And there’s no doubt that a predominantly home-grown nursing workforce is what we should be aspiring to. But more on that in another blog…)

We need our experienced, skilled older nurses to be prepared to step up as preceptors/mentors; what they know and can share is vital to the development of the workforce.

If it doesn’t happen, where will we be in 2020/2035 when the workforce shortage really bites?

We need a sustainable health workforce plan that supports all our new grads into “nurse entry to practice positions” and at the same time releases our valuable late career nurses from enough of the work at the coal face so they can build the mentoring relationships with younger nurses that will strengthen our workforce and profession.

You can find out more about the issues on our website:


The personal cost of government failings

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A new grad nurse talks about what it’s really like to be failed by the system. After not receiving a NETP position after graduating this new grad did volunteer work to keep up her skills. Recently she got a part time position as an “emergency response attendant” at a retirement village.

I am happy to share my story. What I want most out of this is for other people to feel brave enough to speak out. And for the government to come to the party and provide new grad nurses with the job opportunities and Nursing Entry to Practice (NETP) positions that they require.

I suppose my biggest gripe is that I was never ever told throughout my degree that there were limited NETP positions and so, along with my friends, I had the attitude that I would get a NETP position.

The last year of my degree was tailored around paediatrics, where I was totally in my element, working in the area I am so passionate about and the reason I chose nursing as my career.

I am well aware that New Zealand has an experienced nursing shortage… but I feel that the answer to that is to support those new grads who trained in NZ to get NETP positions and then there will be more experienced nurses.

I am no politician, but I’m sure there are better solutions to this situation.

I feel pretty devastated to hear about NZ saying we are short on nurses when there are hundreds just like me.

I know I am lucky to have the job at the retirement village after months of unemployment but I also know it’s not what I trained to do.

I have dreams of working as a registered nurse with children and their families with full support from other nurses and clinical preceptors.

New grads like me are being forced into unsuitable jobs and, although we apparently have a nursing shortage, at each of the six extra interviews I had after my ACE interviews in November, I was unsuccessful due to more experienced nurses applying for the same position.

So while I reapply for ACE and hope and pray that I am successful, I will keep trying to find answers to a situation I now do not understand at all. There really isn’t much to say about it except that it’s unfair on so many levels.

I just hope through my voice I can help other new grads and nursing students because I would never wish for anyone else to experience the amount of disappointment I have in the last six months.


It’s not a skill shortage, it’s a planning deficiency

600px-New_Zealand_on_the_globe_(New_Zealand_centered).svgThe Immigration Department’s “Skill-shortage list” is a list of occupations that are in short supply in New Zealand. The list means that would-be migrants with those particular skills are given preference over migrants whose skills are not on the list. It seems like a great idea and a good way to ensure that New Zealand’s skills needs are met.

Unfortunately, it is sometimes used for the benefit of employers, not the NZ workforce as a whole.

NZNO is constantly responding to consultation requests from Immigration NZ as DHBs and other health providers, especially within the aged care sector, push for nursing and health care assistant roles to be added to the skills shortage list.

Recently, Hawkes Bay DHB, Southern DHB and Capital and Coast DHB have all applied to have registered nurse and midwife positions added to the skills shortage list, and to renew their accredited employer status so they can fast track offshore recruitment of nurses and midwives.

We absolutely reject that the DHBs need to recruit nurses and midwives offshore while there are large numbers of nursing and midwifery graduates still seeking employment.

As a country we need to start addressing the root causes of recruitment and retention difficulties and plan for a sustainable, home grown workforce.

It is not fair that we continue to educate and train nurses and then deny them employment while continuing to recruit offshore. Only 61 percent of last year’s nursing graduates have found placements in nurse entry to practice positions and only half of the country’s DHBs are offering placements in the second advanced choice of employment (ACE) round.

Overseas recruitment processes are long and expensive and often include a six week competence assessment programme. Surely, that time and money would be better spent on supporting new graduates into practice, and facilitating internal appointments with training and education that supports expanded practice and rewarding career pathways for nurses and midwives.

NZNO recognises that demand for nurses is increasing, as New Zealand’s population and the nursing workforce ages, but recruiting from overseas to fill workforce gaps is not the answer.


No nursing vacancies?

no vacanciesIn November 2013 Health Workforce New Zealand (HWNZ) briefed the Parliamentary Health Select Committee on nursing and medical workforce issues in New Zealand.

We’ve read the report of the Committee (you can find it here ) and have come to the conclusion that HWNZ must be telling the members of parliament what they think they want to hear. It makes no sense to us at all.

Here’s what the Health Select Committee report says about nursing:

“HWNZ told us that at present there are no nursing vacancies, and district health boards are employing newly qualified nurses on a casual basis rather than in graduate positions.However, the average age of nurses is 50, and many are expected to leave nursing when the economy moves out of recession. This will result in vacancies, and HWNZ is working to ensure an adequate, sustainable nursing workforce over the next decade. For example, a “nursing pipeline working group” is being established to align nursing student numbers with employment opportunities.”

HWNZ’s assertion that “there are no nursing vacancies” is patently untrue. NZNO members tell us that they are constantly working under stress, that nurses on leave are not replaced and that vacancies are taking months to fill or are not being filled at all. All these factors create constant churn in the workforce, with the nursing team working short-staffed and under pressure. There is no fat in the system and patient safety and quality care is being compromised as a result.

Why is HWNZ pulling the wool over the Parliamentarian’s eyes? We know, and they do too, that good policy and legislation can only happen when select committees receive free, frank and honest advice. The Health Select Committee has said they will “monitor the situation with interest” – if they knew the truth they would be taking urgent action.

NZNO is doing what we can; lobbying, researching, planning, listening to members and finding solutions to the crisis in the nursing workforce. What we need now is for HWNZ to get on board and do the job they are supposed to do – engage, listen, plan, act.


New grads – we’ve got your back!

ImageThere has been a lot of media lately about the situation new graduate nurses are finding themselves in after graduation. Many struggle to get nurse entry to practice (NETP) places, a scheme whereby newly graduated nurses are supported and mentored for their first months in the workforce, and those who are not successful in getting a place on such a programme also struggle to find a nursing role because employers want experience.

There is commentary from various quarters that we should train fewer nurses but we have a looming nursing workforce crisis as many of the current workforce move toward retirement. We need to educate and prepare the replacement workforce now, and we also need to plan for how we will employ and support them so that they are ready to replace today’s experienced and skilled workforce.

It is Health Workforce New Zealand’s (HWNZ) job to make sure supply meets demand in the health sector. So, what are they doing about preparing such a plan? Precious little to date.

The result is that newly graduated nurses are paying the price, with massive student loans and limited chances of employment. We estimate that around 500 nurses each year are not able to find NETP places.  Some will find employment in various parts of the sector but many find employment outside the sector; in retail for example, just to pay the bills. A number will inevitably take their talents overseas. The numbers are terrible, and the impacts on families and communities will be felt across the country (and economy).

Students and new graduates are contacting us daily with sad stories of how their dreams of a nursing career are fading. And like Michelle Duff’s article says, these nurses should be in “hot demand”!

It’s a disaster for individuals and the health system too. We want to see some change.

NZNO wants to see 100 percent employment for every single nurse graduate who wants a position in the New Zealand health sector.

We want our new graduates to be well supported in practice and to have sound preceptorship / mentorship. New Zealand is going to be around 15 000 nurses short by 2035, so we’re going to need them.

We want them to have NETP placements that are meaningful and that provide an opportunity to grow their clinical experience and clinical practice in a supportive environment.

We want a confident, experienced, highly skilled nursing workforce. New Zealand deserves it.

Fortunately, NZNO is a large organisation; 46 000 members have a lot of clout, and we are using it to get a great result for our student members, now and in the future.

We have raised the issue along with the National Nursing Organisation group at the Health Workforce NZ meeting on November 28th last year and it was prioritised by that group as an issue for urgent attention.

We are raising the issue in the media whenever we can. Public pressure, alongside private pressure on Health Workforce NZ is surprisingly effective. The Minster of Health will not want the issue to remain unresolved during an election year.

We raised it with the Minister late last year in a meeting and agreed that a solution needed to be found.

NZNO has a clear ask of HWNZ – step up and work with the DHBs and the rest of the health sector to develop a robust and sustainable workforce plan for nursing.