Submission made by the College Of Nurses

Ryan McLean
Policy Analyst
Sector Directorate, Workforce Team
Ministry of Health
P O Box 5013
WELLINGTON

SUBMISSION on: The Qualification Supply Analysis - The New Zealand Health Sector

The College of Nurses Aotearoa (NZ) (CNA(NZ)) welcomes the opportunity to comment on this document and is aware of the importance of this work as a basis for future policy, in particular phases two and three of the project.

The responses CNA(NZ) wishes to make are specific to nursing workforce development and education.

CNA(NZ) would recommend that at the next phase of work a sector reference group be established to review the qualifications in order to aid accurate recognition of the credential as it pertains to a health qualification. We are concerned about the way courses have been designated as ‘nursing’ without the recognition that some are introductory courses, which do not directly result in a nursing qualification, instead provide a staircase into health/nursing degrees. We believe that this reporting has the potential to misrepresent not only the funding analysis but also the perceived capacity in the sector of entry level health workers.

Responses are set out in answer to the questions posed in the executive summary of the report. CNA(NZ) submission also addresses the questions set out in the letter requesting comment on the document dated 26 November 2004.

1) What range and volume of health qualifications are currently provided by the tertiary education sector?

The range of nursing qualifications in the report is not accurately represented due to a number of factors including:

• The 08:22310 Nursing 01: Certificate/Diploma field includes pre-entry courses for potential nursing (and other health or education related) students. Of the 16 listed only 2-4 (Contemporary NZ Nursing practice, Diploma in Health (Mental Health Nursing), Professional Certificate in Nursing practice, and Short Courses in Nursing) appear to be qualifications for registered nurses. CNA(NZ) considers that the others listed should not be included in a nursing workforce programme analysis as they are provided for people who do not meet entry criteria for nursing.
  
• Mental health is a specialised area of nursing practice yet it would appear that some of the qualifications available for registered nurses practising in this area are not categorised as nursing. For example: Category 08 Mental Health Workers: 04 PG Cert/Diploma: Post Graduate Diploma in Health Sciences (Endorsed in Nursing) and New Graduate Certificate in Mental Health Nursing. Conversely, 08: 22310 Nursing 01: Certificate/Diploma includes Diploma in Health (Mental Health Nursing).
  
• Prior to 2003 NZQA was less clear about the requirements of programme nomenclature resulting in many programmes with very different names delivering similar subject matter to similar student groups. Since that time the NZ register of quality assured qualifications has meant that there is more commonality in programme names. Data from subsequent years will provide more clarity in the NZQA level of programmes and therefore it will be easier to compare and count programmes.
  
• Post graduate education is under-represented in this report. It is an aspect of nursing education that has advanced significantly since 2002 with the expansion of post registration nursing programmes and the number of participants in these programmes to meet the requirements of NZQA, the profession, the Nursing Council and the Ministry priorities for health. For example, most clinical masters programmes leading to Nurse Practitioner status have become available since 2002. Therefore future analysis that may compare this data with 2003 or 2004 data will find a reduction in, for example, Bachelor of Nursing for Registered Nurses programmes as nurses can now gain provisional entry into post graduate programmes without a completed Bachelors degree.
  
• CNA(NZ) is concerned that the analysis of graduates (p. 18) may assume that the majority of nursing students are school leavers. In reality approximately 1/3 are school leavers with 2/3 being 25 - 45 years or older at programme commencement, with consequence for longevity in the profession.
  
• It appears in the report that the number of nurses completing higher qualifications is low. This is caused by the fact that many programmes that nurses complete are not specifically named ‘Health’ or ‘Nursing’ so are not captured in the SDR4 data return. For example, nurses completing Masters in Education or Arts programmes of study complete the qualifications to directly influence and enhance nursing practice but these qualifications are not captured in the data in this report. Similarly many nurses have completed Doctoral qualifications e.g. PhD which are also not featured in this report yet these graduates contribute to the health workforce, often in leadership roles. Under the HPCA (2003) the Registered Nurse scope of practice acknowledges that the registered nurse contributes nursing knowledge and skill in research, management and education of nurses (New Zealand Nursing Council) further supporting the direct relevance of the higher degree to health. The designation of professional degree or Doctorates as a health degree and not the PhD fails to recognise the similarity in qualification profile (NZQA). Furthermore, the Nursing Council requirement for advanced degrees for educators means that these degrees (e.g. PhD, MA and MPhil in nursing) need to be considered within the supply analysis.

2) Where and by whom are these qualifications provided?

The document would appear to equate the location of the institution of programme accreditation with the location of programme delivery. For example Otago Polytechnic delivers post graduate programmes in Dunedin, Christchurch, Palmerston North and Gisborne. There is therefore a concern that if the location of delivery is not included in the revised report decisions may be made about oversupply of programmes in some centres when in fact that is not the location of delivery.

3) For what health qualifications is clinical training provided and how is it funded?

Clinical experience ‘training’ is a key component in all applied nursing programmes. In undergraduate nursing programmes (which appear to be accurately reported) the Nursing Council requires that 50% of the programme must be completed in clinical settings. The cost of providing these placements is met by each Tertiary institution from a TEC clinical component grant. However the amount of funding provided in this grant was based historically on a time when DHBs provided all clinical nursing placements. In the current Primary Health Care environment there is not enough funding to cover the cost of the time that a mentor/clinical supervisor needs to spend with a student. The cost is therefore hidden and paid by DHBs, NGOs, and education institutions (often in reciprocity e.g. free room usage and fees for DHB/NGO employees) in return for clinical placements. With the cap on increasing student fees there is no longer the ability to raise fees to pay for suitable quality placements.

4) How is the cost of these qualifications shared between the Crown, the learner and others?

Nursing students are all liable to pay students fees at the rate set by the educational institution. The method of payment is usually student loans, although scholarships are becoming more common for some students. Students also bear the cost of travel, accommodation if required and studying in their own time. In some cases (usually for educators) employers will pay part of or full fees if the qualification is an essential upgrade required for the role.

5) How is the cost to the Crown shared between various Crown funders?

As the report reveals nursing does not gain a fair proportion (in relation to the size of the nursing workforce compared to medical funding) of CTA funding. CTA funding (apart from that allocated for mental health nursing education programmes) is problematic as it is not a reliable funding stream. Even if all programme criteria and accreditation requirements are met and the programme directly contributes to workforce development to support MOH priority health outcomes, there is no funding guarantee for CTA for nursing programmes. CTA funded programmes also require different NZQA accreditation than TEC funded programmes because of he requirements for clinical hours, and enrolment numbers are usually restricted. TEC funding by comparison is reliable as long as accreditation requirements are met and currently numbers are not restricted. Therefore the majority of nursing undergraduate and post graduate programmes are TEC funded.

In conclusion CNA(NZ) has some major concerns about this report being used as any type of benchmark for future nursing education provision. The College would be willing to support the further work identified in the report in any way that would be useful in order to ensure that further analysis is based on reliable recognition and relevance of the qualifications.

Yours sincerely

Lyn Dyson
RN MA (Hons) FCNA(NZ)

Dr Jan Pearson
RN PhD FCNA(NZ)

Dr Dianne Roy
RN PhD FCNA(NZ)
MA MCNA(NZ)

Susan Scott
RN RM BA (Hons)