Introduction
The shortage of qualified healthcare professionals is a major concern worldwide for both developing and developed countries. In particular, the shortfall of registered nurses (RNs) continues to be a significant headache for healthcare providers and governments (Organization for Economic Co-Operation and Development, 2010). This paper will seek to briefly examine the worldwide shortage of nurses while examining in detail the factors leading to the nursing shortage in New Zealand, and the working requirements and conditions for the immigrant nurse workforce in New Zealand.
The shortfall of registered nurses is well spread between developing and developed countries. According to a policy brief on the focus migration website, the UK had a total of 57 000 nurse shortage in the year 2001, Canada expected to have a 78 000 nurse shortage by the end of the year 2011, while Australia reported a 40 percent nurse shortage in its healthcare system in the year 2006 (Focus Migration, 2007).
The developing countries were worst hit by the nurse shortage with sub-Saharan Africa estimated to have a shortage of a whopping 600, 000 nurses (Focus Migration, 2007).
The nurses’ shortage in developing and developed countries is caused by a different set of social-economic contexts and governmental policies (Medscape, 2011). According to a policy brief on the focus migration website, nurses’ shortages in developed countries can easily be corrected by offering incentives to the nurse professionals (Focus migration, 2007). This is because nurse shortage in developed countries is brought about by demand for the nurses exceeding their supply in the economy (Focus migration, 2007).
In contrast to the developing countries, the nurses’ shortage in developed countries is periodic as is thus temporary (Focus migration, 2007). Nurse shortage in developing countries is often caused by a lack of adequate training facilities and opportunities as well as inadequate professional incentives in the career progression lines (Focus Migration, 2007). Other factors include low pay, epidemics such as HIV/Aids, and poor working conditions (Focus Migration, 2007)
The developing countries have responded to the decreasing nurse shortage by creating professional opportunities for mostly immigrant nurses from developing countries (Focus Migration, 2007). The net effect is that this further contributes to nurse shortages in developing countries.
In the global nursing market, the Philippines form the largest supplier of the immigrant nurse workforce (Focus Migration, 2007). Among the organization for economic co-operation and development (OECD) countries, it was estimated that over a quarter of the registered nurse workforce in the United States, United Kingdom, Australia, and New Zealand are immigrant nurses (New Zealand Nurses Organization, 2008).
Examining the extent of nurse shortage in New Zealand
New Zealand Standard classification of occupations as cited by the DLNZ (2005), groups registered nurses in New Zealand into five categorizations: occupational health nurses, public health and district nurses, psychiatric nurses, principal nurses, and registered nurses.
According to the New Zealand Health Information Service and the nursing council of New Zealand as cited by DLNZ (2005), registered nurses consist of 93 percent of the ‘nursing and midwifery groups in the year 2001. According to the department of labor of New Zealand (2005), registered nurses consist of up to 65 percent of the healthcare professionals.
The shortage of career nurses in New Zealand is a documented fact by the Immigration Department of New Zealand (IDNZ) (2011). The IDNZ groups the essential skills demand needed from immigrant workforces into two groups; the long term skill shortage list (LTSSL) and the immediate skill shortage skill (ISSL) (IDNZ, 2011).
It is significant to note that IDNZ categories some of the specialties of the nursing field to be in the long-term skill shortage skill list. Among the nursing specialties in the LTSSL include registered nurses in research, aged care, surgical, child and family care, community health, development and disability, and critical care and emergency (IDNZ, 2011). Others include nurse researchers, managers, and practitioners (IDNZ, 2011).
IDNZ sets the minimum professional qualifications for the immigrating nurse force as a bachelor’s degree in nursing, a comprehensive nursing diploma, or a hospital-based certificate (IDNZ, 2011). In addition, the immigrant workers must get a New Zealand registration. Being placed in the LTSSL gives the immigrating nurse workforce an advantage over immigrating to other countries. While ISSL is only used for temporary work visas consideration by the IDNZ, the LTSSL is also used for residence consideration under the work to residence policy or skilled migrant category (IDNZ, 2011).
Reasons for nurse shortages in New Zealand
Several factors are contributing to the nurse shortage in New Zealand. The Department of Labour of New Zealand (DLNZ) (2005) noted that while there were no shortages of trained nurses in New Zealand, there was however a shortfall of local nurses wishing to take up employment in the existing work conditions. DLNZ estimated that only about 63 percent of advertised nurses’ vacancies were being filled up within eight to ten weeks of advertising, of which an average of 1.1 of the applicants were qualified for the advertised positions (DLNZ, 2005).
Local nurses in New Zealand perceive the working conditions and remuneration to be relatively low compared to other professions. DLNZ estimated that a total of 4452 registered nurses in the year 2003 were not actively employed despite having a practicing certificate (DLNZ, 2005). DLNZ thus considered the profession to have a “recruitment and retention” problem as opposed to a nurse shortfall.
DLNZ to evaluate the nurse shortage, categories skills shortage into two groups: genuine skill shortage and recruitment and retention difficulties (DLNZ, 2005). Genuine skill shortage has been defined as “employers having difficulties filling their job vacancies because there are not enough individuals with the required skills in the potential labor force to fill the positions on offer” (DLNZ 2005, 12).
On the other hand recruitment and retention, problem is defined as the occurrence “…considerable supply of individuals with the required skills in the potential labor market but they are unwilling to take up employment at the current levels of remuneration and conditions of employment” (DLNZ 2005, 12).
Among the factors leading to a “recruitment and retention” problem is “occupational detachment”, which refers to the registered nurses exiting the profession (DLNZ, 2005). The percentage of local nurses remaining in active service has declined from a once high of 81 percent in 1990 to a low of 61 percent in 1998 (DLNZ, 2005).
Working conditions and pay were cited as the main factors influencing “occupational detachment” (DLNZ, 2005). However, these issues were expected to decline through the improvement of working conditions, particularly the significant pay increase of up to 20 percent from the year 2004 (DLNZ, 2005).
Local nurses leaving New Zealand for other countries has been relatively high. Popular destinations for New Zealand nurses include the United Kingdom and Australia (DLNZ, 2005). Factors cited as resulting in New Zealand nurses immigrating to other countries include higher overseas work wages.
This in return contributes to a faster payoff of student loans. On the other hand, the department noted that it was only a small number of returning New Zealand nurses who assumed active nursing duties (DLNZ, 2005).
Another factor contributing to the declining number of local nurses in the New Zealand health system is the declining nursing graduates. While there are still sufficient training facilities and opportunities, DLNZ noted that the nursing graduates have been gradually declining since the year 1990 (DLNZ, 2005). While there were about 1485 nursing graduates in the year 1996, the same had declined to 1059 nursing graduates by the year 2003 (DLNZ, 2005).
The declining nursing graduate has also contributed to a declining training rate. Training rate is defined as “a measure of training output relative to employment in the occupation” (DLNZ 2005, 5). The rate stood at 3.1 percent in 2003 from 4.1 percent in 1996 (DLNZ, 2005).
The aging New Zealand population is expected to put a further strain on the nursing workforce. There is an expected surge in the elderly New Zealand population (Badkar et al,2009). According to Statistics New Zealand Populations for 2004, as cited by DLNZ, the number of people aged 65 years and above would hit 1.33 million by the year 2051 (DLNZ, 2005). DLNZ noted that while by the year 2002 the people over 65 years consisted only 12 percent of the overall population in New Zealand, they nevertheless consumed 39 percent of the total healthcare expenses (DLNZ, 2005).
Immigrant nurse force into New Zealand healthcare system
With a biting nurse shortage in its workforce, New Zealand has no option other than to allow an immigrant nurse workforce into the country. The country has been criticized in the past for its overreliance on the immigrant workforce to sustain its healthcare system. New Zealand receives a significant share of the immigrant nurse force in its healthcare system.
According to Zurn & Dumont (2007) cited by Walker (n.d), New Zealand has the highest level of immigrant nurses among the organization for economic co-operation and development (OECD) countries.
Overseas registered nurses working in New Zealand are estimated to be between 23.2 % to 27% of the total practicing registered nurses, according to the New Zealand Census of population and dwellings (2006) and Nursing Council of New Zealand (2007) as cited by Walker (n.d). United Kingdom, Australia, South Africa, and the Philippines form the largest suppliers of nurses to New Zealand (Walker, n.d).
According to the New Zealand Ministry of Health (NZMH) (2011) in its website, New Zealand offers a variety of work opportunities for registered nurses looking for career opportunities in the country. Some of the specialization areas include public health, aged care, child health, primary health care, mental health, telehealth, and rehabilitation (NZMH, 2011).
There are several requirements for an immigrant nurse workforce wishing to take up nursing careers in New Zealand. According to NZMH (2011), immigrant nurses must obtain a work permit from the New Zealand immigration service.
However, there are certain citizens exempted from the work permit requirements including Australian citizens and Australian residents equipped with a valid Australian resident return visa (NZMH, 2011). Foreign qualified nurses wishing to practice in the country must also register with the Nursing Council of New Zealand (NZMH, 2011). However Australian applicants with valid Australian nursing registration need to apply through the Trans-Tasman mutual recognition act (NZMH, 2011).
According to New Zealand’s Ministry of economic empowerment (NZMEE, 2011), the Trans-Tasman mutual recognition act is a “… nontreaty arrangement between the commonwealth, state and territorial governments of Australia and the government of New Zealand”. The act is meant to strengthen economic ties between New Zealand and Australia. Immigrant nurses from Australia may have relatively easier access to opportunities in New Zealand healthcare as compared to immigrants from other countries.
The immigrant nurses wishing to work in New Zealand must in addition be competent to work in their specialty and be able to communicate effectively in English (Nursing Council of New Zealand (NCNZ), 2011). There are two tests used to examine the English competencies of the immigrating nurses. The tests are either Occupational English Test (OET) or International English Language Testing (IELT) (NCNZ, 2011).
The department of immigration may from time to time impose specific conditions for the immigrant nurse workforce from specific countries. For example, immigrant nurses from the Philippines must provide a three-year-long full-time offer of employment for them to be considered for work permits (IDNZ, 2011).
The factors contributing to the immigrant nurse force can generally be grouped into two broad categories: supply-push factors and demand-pull factors. Demand-pull factors would include factors that make New Zealand attractive to immigrant nurse forces as compared to other destinations. The supply push factors on the other hand would include factors that make the immigrant nurses exit their birth countries. Such factors may generally include unfavorable working conditions, poor remuneration, and career progression lines, as well as political and economic instability.
Among the demand-pull factors leading immigrant workers to New Zealand include reasonable living conditions and wages. New Zealand also has a lower withholding tax of about 24 percent which implies a higher take-home salary. This makes New Zealand attractive to immigrant nurses than its competitor says the United Kingdom which has a withholding tax of 40 percent New Zealand also provides an avenue for later migration to other countries including the United States of America, the United Kingdom, and Australia.
Challenges facing immigrant nurses in New Zealand
Immigration to New Zealand has not been without its challenges. Among the challenges facing nurses who have already migrated or wished to immigrate to New Zealand are the language requirements. The Nursing Council of New Zealand (NCNZ) as cited by the New Zealand Nurses Organization (NZNO) (2008), requires all immigrant nurses to pass level 7 in the International English Language Test (IELT). The immigrant nurses were expected to achieve the 7.0 pass across the four constituents of IELT which include speaking, comprehension, reading, and writing (Walker, n.d).
The language requirements were seen as a major challenge to the immigrant nurses wishing to pursue their professional careers in New Zealand. For example, Indian immigrant nurses who had passed the English-based conversion course felt it was draining to both their finances and time (Walker, n.d). Noting that a significant number of immigrant nurses come from the United Kingdom, the language requirements were expected to discourage the number of immigrant UK nurses into the New Zealand healthcare system (NZNO, 2008).
The New Zealand Nursing Council has particularly been vocal on the sufficiency of IELT as an English standard test for immigrant workers into the New Zealand workforce (NZNO, 2008). Apart from the costs associated with taking the test, NZNO argues that the test is “…inconsistent, culturally inappropriate and, at times, unethically administered…” (NZNO 2008, 3).
Getting registered by the New Zealand nursing council has been noted as one of the major challenges (Walker, n.d). There have also been cases of agency exploitation of nurses wishing to immigrate to New Zealand.
Existing Knowledge gap on nurse immigrants in New Zealand
There are knowledge gaps in the area of nurse immigration trends in New Zealand. Sufficient studies have not been conducted on the demand-pull factors of the immigrant nurse work force to New Zealand, the challenges facing the immigrant nurses in New Zealand, and the impact of the immigrant nurse workforce on the quality of health care in New Zealand.
Of particular significance would be how the immigrant nurses interact with the local nurses. Altitudes and working relations between the local and immigrant nurses would be very critical. When it comes to union matters, a particular area of study would be on the representation of the immigrant nurse force into the existing nurse workforce.
It would also be critical to evaluate on the career progression lines of the immigrant nurses once they enter the New Zealand. Of particular importance in this regard would be the consideration on whether if they are senior immigrant nurses at the managerial level, how they might have affected the governmental policies in regards to immigration of nurses into New Zealand.
One could also study the working conditions of the immigrant nurses in comparison to the local nurses. The impact of the immigrant nurses on the overall New Zealand healthcare would also be of significant study interest.
One also notes that considerable academic research has been done by governmental organizations including nursing council and the department of labour. It would be significant to study on whether independent studies would confirm different results or offer new perspectives on the immigrant nurse workforce in New Zealand.
The ageing New Zealand population has been cited as one of the sources of nurse shortage in New Zealand. However there are no sufficient studies in different nurse specializations, and in particular in regards to aged care. The governmental policies in place to face the future should be evaluated at an in-depth level.
Another significant area of study would be study of the impact of the Trans-Tasman mutual recognition act on the nursing professions. While recognising that that the act is meant to be beneficial to the two countries that is New Zealand and Australia, it would perhaps form part of academic curiosity of the net effect of the nurses movement between the two countries.
On the economic front, it would be significant to quantify the economic benefits of the immigrant nurse force into New Zealand. In this context one would be interested with the role of the support industries to nurses’ immigration such as educational providers, language examiners, immigration lawyers etc. To what extent does the nursing does the nurse immigration support this economic activities in comparison to other immigrating professionals.
References
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Department of Labour of New Zealand. (2005).Registered Nurse: Occupational Skill Shortage Assessment. Web.
Focus migration. (2007). Migration and Recruitment of Healthcare Professionals: Causes, Consequences and Policy Responses. Web.
Immigration Department of New Zealand. (2011). Essential Skills in Demand Lists. Web.
Immigration Department of New Zealand. (2011). Philippines Special Category. Web.
Medscape. (2011). Headline: Trends in International Nurse Migration. Web.
New Zealand Nursing Organization. (2008). Proposed Changes to English language Policy. Web.
New Zealand’s Ministry of Economic Empowerment. (2011). Trans-Tasman Mutual Recognition Arrangement. Web.
New Zealand’s Ministry of Health. (2011). Nursing in New Zealand. Web.
Nursing Council of New Zealand. (2011). International Nurse Registration. Web.
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Walker, L. (n.d). A Mixed Picture: The Experiences of Overseas Trained Nurses in New Zealand.