A nurse Education and Training Board for New Zealand

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F.Future demand for Nurses in New Zealand

The nature of the general uncertainty about the size and mix of the nurse work force

There is considerable uncertainty about the size of the nurse workforce we will need in the long term. The nature of second tier nurse roles as they evolve will be just one consideration in managing this uncertainty. Similarly, the extent to which in New Zealand nurses can adopt roles that rely on skills that are elsewhere held by nurses, such as nurse anaesthetists, but which in New Zealand remain as medical roles only. It may well be that rigidities we now have in roles across the health services are unsupportable in the longer term. Over the last decade the increase in health resources reduced pressures that would otherwise necessitate challenging any rigidity in roles. The coming decade will undoubtedly see a very much lower capacity to retain many longstanding rigidities that ultimately affect the productivity, reach and responsiveness of the health service as a whole.

We expect the trend of the past two decades, for nurses to increasingly work outside of hospital settings, to continue. This trend will be better managed the more the increasing share of nurses who will work autonomously retain good collegial support, and are able to develop clinical competences in a supportive environment.

Concern about the large number of New Zealand trained nurses who work overseas must leave us with some concern about the working life in New Zealand of those who enter nursing. Retention rates may be lowered because of the many other employment opportunities available to experienced nurses, as their mix of relationship, technical and organisational skills are highly valued elsewhere as well as in nursing. Influencing the retention rates of nurses will be difficult, and necessitates a richer understanding than we have now of why people enter nursing, and how that has changed with each new generation of nurses. We will be unable to introduce the leadership we need to influence the number of people entering nurse education in New Zealand without a deeper understanding of the different attitudes to nursing of each generation of young people.

An exercise to project the need for nurses over the next twenty years would be more effective if it were preceded by a study of the nurse work force over the next five years, in the context of its capacity to provide a platform for sustaining and most likely increasing nurse numbers by 2030. Such a study would analyse the existing career pathway to educate, develop and advance the early career of the new nurse, and find measures of attrition and leakages, as well as shifting attributes such as working week preferences. We need assess the vulnerability that the age distribution of migrant nurses brings. Despite the fact of having an historically small share of nurses aged under 35 years, some 30 percent of nurses now under 45 years are overseas trained.

The projected demand for health services

The demand for health services in New Zealand over the next four decades has been projected by the Ministry of Health, in collaboration with the New Zealand Treasury. The impact of both population growth and increased longevity on demand has been assessed, taking into account the shifting prevalence of health conditions that have an impact on health services. The projection model has also taken into account the comparatively large impact of increased wealth creation on the demand for health services, given the clear relationship between income levels and the share of income spent on health. We have little ability to estimate in advance how much of this last effect will influence the nurse workforce, as much of this in the past has been linked to increased use of pharmaceuticals, intensive surgical interventions, and higher incomes of health professionals. We have not estimated the implications for nurse numbers, but recognise that on the basis of simple extrapolation of demographic trends that we will eventually conclude that we will most likely need to have somewhere between 10,000 and 25,000 additional nurses above what we have now will be needed in 20 years time. In the more immediate future, we face the possibility that actions we take now will have a greater influence than usual on the number of New Zealand trained nurses working in 2030 and 2040. The DHBNZ Nursing and Midwifery Strategy group is working with the CTA, the Ministry of Health and other bodies to develop estimates of future demand. Such estimates are long overdue, and the current initiative will enable a more serious assessment of strategies which must now have some urgency because of the demographic profile of the current nurse workforce. This work would enable a Nurse Education and Training Board to start with a well informed understanding of the place of training in responding to the imperatives we face.

Contribution to changed demand for nurses between

2009 and 2030


Strong increase (>5,000)

Population growth

Increased Longevity

Increased Wealth of New Zealanders

One-off effect of the retirement of nurses concentrated in the baby boomer cohorts

Moderate increase (>5,000)

Epidemiological influences

Increase in range of skills applied by nurses

Reduced working hours/working life as nurse

Moderate decrease (<5,000)

Reform of health services organisation around New Zealand

Adaptability in relating roles and skills

Significant decrease (<10,000)

Nurse assistants and related roles

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