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Where are all the extra nurses?

Despite a pay increase reached after industrial action last year, district health boards across the country have reported large numbers of unfilled nursing roles.

And nurses say they’re still losing colleagues.

“It’s unsafe, it’s dangerous, and nobody is listening. We're still understaffed. We're still fighting to deal with the limited amount of staff that we've got to keep them where they are,” said one nurse.

All the nurses who spoke to Newsroom asked not to be identified by name. Some said they plan to leave the DHBs they currently work at for jobs in Australia.

Part of the agreement reached in August included 500 extra nurses across the country, as well as “plain language” bi-monthly reports showing workforce vacancies.

Official Information Act requests made by Newsroom last year to District Health Boards (DHBs) show some had hundreds of nursing vacancies. The total number  of1535 nursing gaps was reported.

Not all DHBs were able to supply exact information of unfilled positions. Some DHBs took until February to respond to the November request because their internal systems weren’t set up in a way to easily give a number of unfilled positions, the area they were in and the length of time they had been unfilled.

Some DHBs reported vacancies, and some reported the number of full-time staff required to fill vacancies, known as full-time equivalents. One full-time equivalent could equate to two or more part-time staff. Waikato DHB supplied statistics of “open requisitions” within their recruiting system, this could mean a single full-time equivalent role could have several requisitions if the person was to work in more than one ward.

While the way of counting differed, the story remained largely the same. For all DHBs, except Whanganui, the largest number of unfilled vacancies, full-time equivalents, or requisitions, was in nursing.

“We’re all dumbfounded - scratching our heads - going 'Where are all the extra nurses?' That’s what we were fighting for; more bums on seats, more nurses out on the floor. It’s really hurting. A lot of senior nurses are leaving.”

The Official Information Act request, which asked for vacancy numbers for full-time, part-time and contract staff as of November 26 showed there were 1535 nursing vacancies, requisitons, or equivalent full-time positions unfilled. All DHBs, except South Canterbury District Health Board, responded to the request.

Topping the list is Waikato DHB with 742 requisitions overall, including 302 identified as nursing. Counties Manukau DHB follows with 592 vacancies, 216 for nursing staff. Capital and Coast DHB had vacancies for the equivalent for 198 full-time nurses. Auckland, who supplied data for January, has the equivalent of 192.7 full-time nursing staff unfilled.

Numbers supplied by DHBs for November 26, with Auckland numbers from January. (R) indicates requisitions, (V) vacancies and (FTE) full-time equivalents. 

The impact of the 500 extra nurses promised in August is yet to be seen, according to the nurses Newsroom spoke to.

“We’re all dumbfounded - scratching our heads - going 'Where are all the extra nurses?' That’s what we were fighting for; more bums on seats, more nurses out on the floor. It’s really hurting. A lot of senior nurses are leaving,” said one nurse.

Staff are sometimes in tears due to the level of stress, and mistakes are being made. Due to the workload, nurses had very little time to spend with patients to offer the quality of care many joined the profession to give. There’s also no escape from the abuse which sometimes occurs.

“People would abuse you all the time. You get sworn at, groped, sexually assaulted, physically assaulted and told to fuck off - on a regular basis,” said another nurse.

According to nurses Newsroom spoke to, many are leaving for Australia or moving into primary health.

“I know three who have given up on nursing altogether.”

“That’s the only way we’ll ever get what we need. To go back down to patient ratios where it’s the law and management can be held accountable for not having the appropriate staff on.”

The New Zealand Nurses Organisation associate professional services manager, Hilary Graham-Smith, said the organisation is aware of members' stress - and distress - over staffing levels, but recruiting the extra 500 nurses could take time as people often need to hand in notice at previous roles.

“We’re just starting to get the reports in on progress on that front. We know DHBs are being proactive in recruiting, but the thing is, none of that stuff happens overnight.”

Along with the 500 extra nurses is the Care Capacity Demand Management (CCDM) system which is used to ensure safe staffing levels. Its use has been included in employment agreements since 2006. There’s now a deadline for DHBs to implement the system by June 21.

The CCDM system assesses how many patients are in a ward, and how much nursing assistance they’ll need. Based on this information, it then calculates the appropriate number of nurses needed to care for them.

The software itself comes at cost, and its calculations come with implications, said Graham-Smith.

“What we have had is real issues with implementation at the DHB level. If you are fiscally restrained, and that’s the experience of DHBs for some time now, the thought that a methodology is going to tell you that you need XYZ more staff and you’ve got no money to employ them, then you really are stuck. We’ve had a situation where some DHBs have really dragged their feet around implementing CCDM.

“We’re not only combatting the issues around funding, and leadership, but there’s also enormous cynicism from our members because they’ve bought into the programme and not seen any outcomes or results.”

The cynicism is echoed by nurses:

“CCDM is still not working. It’s not working. We’re basically where we were when we signed the MECA [multi-employer collective agreement]. We’re still understaffed.”

One nurse suggested patient-to-staff ratios might be a better system.

“That’s the only way we’ll ever get what we need. To go back down to patient ratios where it’s the law, and management can be held accountable for not having the appropriate staff on.”

Graham-Smith said the number of unfilled positions supplied to Newsroom “sound extraordinary” and that DHBs were just now starting to supply the organisation with reports on numbers of vacancies as agreed in the August negotiation. She hoped by the end of the week she would have reports from all DHBs.

Nurses to fill vacancies will likely come from a variety of sources. Some would be enticed back into the profession, others were likely come from offshore, she said. Other roles might be filled by nursing graduates.

It’s likely there will be movement within the industry, too. Aged care nurses who contacted Newsroom worry they’ll lose staff to DHBs. Some said they had found it increasingly hard to fill roles and were working extra shifts to pick up the slack. With penal rates for night and weekend work available at DHBs, but not some aged-care facilities, aged-care nurses worry roles in their workplaces will be become even harder to fill.

The nursing workforce crisis

Depending on what statistics you use, there’s crisis on the horizon. As of March 2017, there were 52,711 practising nurses in the country.

New Zealand Immigration’s website says 25,000 more nurses will be needed by 2030.

Population growth, an ageing population and an ageing workforce all contribute to the estimate.

Forty-three percent of current nurses are aged 50 or over and it’s expected around half of the nursing workforce will retire by 2035.

Auckland University of Technology head of nursing professor Stephen Neville said he would be cautious about exact numbers but acknowledges the problem is real.

AUT has the biggest university nursing programme in the country. It has increased student places in response to the workforce shortages, and he said there had been an increase in applications.

“We have a responsibility to the country to make sure that we meet workforce targets and because we're the biggest, it seems appropriate that we do that,” said Neville.

“As a profession we all meet and we're all talking about it and we're all trying to make sure that we have enough nurses for the future.”

Neville said roughly 1100 nurses graduate each year from nursing schools across New Zealand. From now until 2030, this adds up to 12,100 graduates, less than half the total number New Zealand’s immigration website suggests is needed.

Thanks to New Zealand’s reputation for quality nurses, Neville said some were recruited overseas after working in New Zealand for a year. Others put off pursuing nursing.

While new graduates are welcomed by current nurses, they worry low staffing levels are putting those new to the profession under too much pressure and there’s the risk of losing them.

“A lot of the times it’s so incredibly stressful because you’re put in situations where you haven’t been trained properly to do what you are doing. Especially when you first start,” said one nurse. She told a story of being put in charge of a patient with advanced needs. Alone on the shift, she had completed one day of training in those needs several months earlier.

When asked if they would recommend nursing in New Zealand as a career choice to others, the response given by nurses spoken to was “no”.

One said: “I worked as a fisherman on a deep-sea trawler and the work is not dissimilar. In fact, I would probably prefer being on a deep-sea trawler working 12 hours a day. It’s way less hard on you, mentally, physically.”

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