EDITORIAL

The issue of workforce preoccupies the thinking of many people in the health sector. Documents on workforce issues and workforce planning now line many office bookshelves; there has been a huge amount of consultation, some considerable analysis and a good deal of concern expressed at what appears to be an impending crisis.

All of this has occurred since 2000. Prior to that under the Government ethos of the 1990s, workforce planning was considered inappropriate as most bureaucrats either believed, or were required to believe, that the market would prevail and that workforce planning would take care of itself.

Five years is a long time in which we have invested considerable time, money and concern in workforce issues. I am not sure however that we are much further ahead. New Zealand is certainly not alone in its workforce worries as similar challenges face many other countries. Put simply, the demand for health services is increasing at a faster rate than we can produce or prepare a health workforce. All health professional groups are ageing, many have shortages and many are experiencing a degree of burn-out already.

The reason for increased demand is well known. The population is ageing, the chronic disease and cancer burden is increasing, we keep people alive more readily following major injury and trauma and we keep people alive longer when they are very unwell. Much of this most particularly increases the need for nursing services. Overall however the New Zealand Institute for Economic Research indicates that by 2011 we will have between a 28% and 42% deficit in the health workforce.

The deliberations of the many people charged with addressing workforce issues have taken a number of directions. In particular it has been argued that old ways of doing things will not be sustainable, some have argued for some vague kind of generic health worker, not bounded by old patterns and traditions; all have argued for increased flexibility. In essence the deliberations seem almost paralysed by a search for some magic innovative solution that defeats old patterns of presumed self-interest and non-consumer focused service patterns.

I have no idea whether such a solution is possible or indeed desirable but I do feel that we are “fiddling while Rome burns”. For nursing at least there are a number of clear and useful developments which we know will sustain, resource and develop the nursing workforce and continue to release the potential of nursing as was argued way back in the Taskforce report of 1998.

I think nursing IS the generic workforce for which the sector is searching. The ability of nursing to flex “up” and flex “down”, the sheer diversity of areas in which nursing practises and the close match between what nursing does and the areas of escalating need, make this a realistic assumption. For this reason I think it is reasonable to pay some immediate attention to the areas we have already identified as needing work in order to sustain and develop the nursing workforce. It is profoundly irritating that we cannot get rapid movement on these issues at the same time as further stock takes, further analysis and more hand wringing continue unabated. At the risk of being boring, I would like to reiterate the well-researched workforce strategies which nursing considers to be important.

1) Let's consider Magnet hospitals. There is no longer any doubt that Magnet hospitals retain precious nursing staff through high job satisfaction whilst keeping patients more comfortable and very much safer. Emerging evidence also shows that they do so very cost effectively. Retaining the nurses we do have seems a rather obvious approach to a workforce crisis. Yet despite this compelling evidence only two hospitals in New Zealand (Hutt Valley Health and MidCentral Health) are seriously pursuing this goal. Why is this I wonder?

2) We have (since the Taskforce report in 1998) argued for funding for the new graduate year. This is needed to protect patient safety through ensuring safe entry to practice for graduates. It is also needed to address the high attrition of new graduates when such a mechanism is not present. Thanks to the previous Health Minister, Annette King, this year has finally seen the injection of money to allow 600 of our graduates to have a funded new graduate year. At the risk of sounding churlish and ungrateful however we really need money for every new graduate and we need clear mechanisms for ensuring it is available for nurses to enter primary health positions. Again retention of those who have chosen nursing and completed the three year degree would seem a basic workforce development strategy.

 

3) We need a national scheme for developing the training and implementing the employment of Nurse Practitioners. Again thanks to Annette King, we have a working party now and some good funding to address this issue. But as a member of that working party I know that our work will be an uphill battle rather than a welcomed assistance to workforce development. The work of the group will need to be vast in its scope and will come up against the many remaining barriers to NP employment on a playing field that has, despite the rhetoric, still to be levelled. This is a major workforce issue as nurse practitioners' way of working both addresses GP shortages and other medical deficits and provides the very sort of care which our increasing burden of chronicity demands.

 

4) Postgraduate education. I worry about exhausted nurses with demanding jobs and young children who are also trying to fund themselves with money and time through critically important postgraduate education. But I have seen over and over the difference postgraduate education makes; to the quality of practice; to the self-confidence and professional identity of nurses and to the clinical and management leadership capacity. It is thus an essential aspect of workforce development but one which, for nursing, remains sporadically and inadequately funded. As the workforce crisis deepens it will be harder and harder to release nurses for study time. We need the kind of guaranteed, taken for granted, protected studying and thinking time which is commensurate with professional practice and should be a given for all knowledge workers.

 

5) Way back when the debate about the reintroduction of enrolled nurse training first began, many of us proposed the standardised national training of a generic health support worker. Such a notion has been in the “too hard basket” ever since but I think the idea is a good one. Just as there is a great deal in an acute hospital ward that needs to be done by such a person, I suspect there is similar work in general practice settings and other primary health care locations. Again this is a workforce issue as it ensures that health professionals are able to use their time most productively.

 

All of the above strategies except the last have been well researched, constantly explored, consulted and debated. There are probably others I have omitted. All have good evidence to support their adoption. Yet we continue to drain the energy of scarce nursing leadership in arguing for these obvious means of developing and sustaining a productive nursing workforce. At the same time we are constantly called to consult on yet another workforce strategy, the preparation of yet another workforce document or called by the media to comment yet again on workforce shortages. It all seems rather silly!!

Jenny Carryer

RN PhD FCNA(NZ)

Executive Director