Nursing provides an extensive range of post registration education and training, including level 7 speciality programmes, and Masters and Doctoral programmes. A large number and growing share of nurses seek and obtain such qualifications. Such training is supported in a variable way by DHBs, and there is some that is paid for by nurses themselves.
While the core nursing degree is directly relevant to nursing practice, and is essential for it, post graduate nursing qualifications might still be better linked to roles, employment structures or financial reward systems.
The more recent trends in post graduate degrees suggest a need for some concern at the numbers enrolling, and the capacity to influence the continual ageing of the nurse workforce that we currently experiencing.
Chart 8: Total enrolments on masters level nursing courses, 2002 to 2008
Source: Ministry of Education
Note: this is a student headcount
The match of post graduate nursing qualifications to nursing practice and recognition structures seems quite loose.
Employment pathways as a senior nurse do not reflect the post graduate nurse qualifications that are held or are being undertaken by an increasing share of the nurse workforce. The linkages between post graduate qualifications and vocational pathways in nurse practice, or remuneration are not well determined. The many nurses undertaking masters preparation in a clinical area of interest to them may not be doing so in an area supported by service requirements in their region or employment organisation. The Ministry of Health did a stock-take in 2008 of cancer and palliative care nursing that showed just only 19 percent of the nurses they surveyed (649) had post graduate qualifications. That report judged this to be a "low" figure for the uptake of post graduate qualifications. Alongside this, a recent NZNO study showed that nurses on average in NZ are better educated and qualified than in the UK3. There are very limited funded career pathways for advanced practice roles unlike those that exist for vocational training for doctors. Some of this may reflect the inadequacy of the ongoing engagement between the DHB system as a whole, and the nurse education institutions as a community in matching employment needs to education options, as they evolve. Given the size of New Zealand, among health professions the balance between specialisation and generalist skills will remain an active tension. The response of nursing to this will not be completely independent of what happens in medicine. This not only affects training of nurses in higher level roles, but for support and assistant roles as well. As noted above, the nature of defined vocational pathways identified for nursing in part determines the fit between clinical practice and education. There needs to be a greater understanding of the existing links with service delivery in terms of anticipating medium and longer term workforce/skills requirements. This may never be a fully satisfactory means of establishing a New Zealand-wide resolution of this.
Maori and Pacific Island nurses in the health workforce
Maori generally live in areas that are less well served by doctors, and so have a higher reliance on nurse led services, as an alternative to admission to hospital. Maori are more likely than other New Zealanders to face multiple chronic conditions in later life. A predisposition to conditions such as diabetes brings not only a lower life expectancy, but high morbidity in many other health conditions where we are now much more aware of the potential of primary care and population focused initiatives to reduce their prevalence.
Over the past three decades health services have sought to recognise elements of Maori custom, in ways now have less risk of being ignored. Strengthening the Maori health workforce is critical to sustaining this recognition, just as it will be more likely to bring about equitable access to health services in places and among communities where access is poor. A clear place for Maori leadership in the evolution and integrity of ways of providing health services would lead us to highlight ways that health services can recognise their distinct world view and deliver in accordance with it. Fundamental to this is a regular injection of newly qualified Maori nurse graduates, at a significantly greater level than has occurred in the past two decades.
The share of nurses who are Maori is now seven percent, much lower now than twenty years ago. This low share has already stimulated a number of initiatives to increase Maori in nursing. Relationships with secondary schools have been used to highlight the nature of nursing as a career, and increase applicant numbers. Mentoring schemes for Maori students have reduced the attrition rate significantly in some courses, while pre-entry courses to provide education that has been missing from high school teaching, particularly in science has also contributed to lowering attrition. Over the past decade, approximately ten percent of Maori women under 25 have continued to enrol in nurse degree programmes. Over this time, the share of women aged over 25 years who have been first year enrolments has declined severely, from around 70 per year to not even a quarter that number in the most recent years. Undoubtedly this decline has stimulated the more recent initiatives at MIT and at Whitireia, to focus intently on wider influences on the attrition of older students, and these programmes have immense importance in assessing our capacity to reverse this shift. Even if successful specific Maori and Pacific initiatives were to be widely applied, the generally poorer access by Maori and Pacific children to secondary education at the standard presumed essential for entry to BN studies will not be fully countered without initiatives within the education sector to ensure as a relevant preliminary that all schools can offer relevant teaching in science and mathematics.
Where the place of learning is located is an important influence on the share of Maori who seek nurse education. Local teaching attracts the population of the region, and Maori are a higher than average share of the population in Northland, Tairawhiti, Counties Manukau, and Lakes. The existence of educational institutions in such places outside of the main centres is significant for Maori. Similarly is the capacity to adopt a “staircase” approach to education, so that lower level courses dovetail into higher level programmes, with full recognition of prior learning. It is understood anecdotally that in the past about one half of Maori and Pacific Island enrolled nurses ended up as registered nurses. For Maori, the education pathway is critical to manage the risk that Maori get blocked in at the lower end of training.
The Maori nursing workforce has a smaller share of older nurses, and at each older age group the share declines. This may well mean that the age distribution will remain younger for some time, but this will depend on the capacity to retain in nursing nurses once trained This will seriously challenge not only the capacity to maintain the number of Maori nurses at the current level, but will place in jeopardy the capacity to return the share of nurses who are Maori to past levels. Without specifically targeted initiatives, not only in recruitment but also retention, it is unlikely that Maori will be a similar share of the nurse population as they are in the population overall. Specific initiatives that focus on both increasing the share of nurses who are Maori, and on retaining those who have been trained, need to be are underpinned by initiatives that heighten the significance of nursing generally as an occupation, otherwise their impact will have less impact. There is a need for particular consideration as to how Maori will be recognised in the Nurse Education and Training Board
Maori nurses often work in isolation in community services. This can increase significantly the demands placed on them, and this may affect retention rates at vulnerable times during their career.