A Petition to Prime Minister Jacinda Ardern, Minister of Health Andrew Little, Minister of Education Chris Hipkins, The Ministry of Health, The Ministry of Education,

... and to all others with the POWER TO ENACT CHANGE:

Surmounting evidence shows the future of the nursing workforce in Aotearoa, NZ is vulnerable. As it stands, shortages across the country mean there are not enough nurses to fill shifts- to safely provide timely and necessary care for patients. What we see is nurses being perpetually asked to increase their workload to fill the gaps in the system instead of actions increasing the introduction of new nurses to compensate and balance the obvious demand-staffing deficit. It is no surprise that mid-career nurses often burn out and leave the profession, and potential recruits are hard to entice. A 2002 AMA study identified that patient mortality increased 7% for each additional patient added to the average nurse’s workload (Aiken et al., 2002). Hands up… Who wants to be their extra patient? The logic of increasing practicing nurses’ workloads is clearly unsustainable and dangerous. 

With such a demand, why don’t we see more entering the workforce annually? And why are roughly 1/3 of our nursing students dropping out of their programmes (Hill 2022)?

 Nursing students experience compounding vulnerabilities under normal circumstances within the dominant ideological systems of academic and clinical environments that impact their mental health and wellbeing – two of which are highly prevalent anxiety and bullying (Savitsky et al., 2020). Sounds fun, right? 

Amidst the COVID-19 pandemic, academic concerns from nursing students have grown to include an inability to achieve their optimal academic performance, worries about whether timely assignment, assessment, or programme completion is possible, whether it is possible to catch up on missed clinical hours, and, to a greater extent, whether registration will ultimately be achievable (Swift et al., 2020; Utvær et al., 2022). Furthermore, nursing students amidst the pandemic experience less placement support and additional stressors (include such things as fear of infecting self or loved ones, remote learning [or a lack of participation and belonging in face-to-face communal learning experiences], social isolation, childcare complications, inadequate PPE, staffing shortages, and recruitment of students to the frontline) compound their existing susceptibility to harm, their exposure to risks, and their liability for adverse events (Barrett, 2022; Savitsky et al., 2020; Utvær et al., 2022). 

On top of this, a 2019 NZNO survey revealed that nursing students are already susceptible to financial difficulties (Willis, 2019). In addition, many nursing students face increased social inequities through economic challenges or poverty because COVID-19 restrictions have impacted their ability to continue working (Utvær et al., 2022). Furthermore, evidence shows that income levels delineate social stratification and thereby limit nursing students’ future opportunities (Loh, 2017). If fortunate enough to make it into the nursing workforce, the financial inequity continues.  The government acknowledges nursing, as a female-dominated occupation, has been “underpaid for decades” (Little, 2022).  Are you sold on the career yet?

These negative consequences impact nursing students’ quality of life, learning, clinical competence, programme retention, and thereby extend to affect quality patient care (Al-Ghareeb et al., 2019; Rafati et al., 2017; Sanad, 2019; Shaban et al., 2012). Understanding the desperate need for nursing students and understanding that nursing students share the universal human right toward mental and physical health necessitates emancipatory change and a disruption of the status quo. Aotearoa NZ’s Mental Health and Addiction Inquiry (He Ara Oranga, 2018) identified preventing problems and promoting wellbeing as one of their ten significant focus areas. Now think about how only 1,100 national nursing students join the workforce annually (Hancock, 2019).  To ensure a tenable workforce, the way forward necessitates emancipatory change.

So, what steps can be taken to entice and retain more people into the profession? From a nursing student’s perspective, one must highlight the fact that currently, nursing students are not paid for the 1,100 hours of labour they provide over the course of their programmes.  Students in other trades are paid for their apprenticeships. In fact, the government launched an initiative early in the pandemic to ensure continued apprentice programme progression (New Zealand Ministry of Education, 2020). Perhaps gender pay inequality for this female-dominated profession can offer potential insight into why nurse training programs are also subjected to clear financial inequity. 

For comparison, the average apprentice earns $29.39 an hour (Apprentice Salary in New Zealand, 2022). To illustrate, electrical apprentices make $40,000 annually (increasing by 10% annually while still in training); trainee psychologists receive up to $59,000 per year; and police trainees receive nearly $53,000 annually (Pay and Benefits, 2022; Psychologist - About the Job, 2021; Stock, 2020). Medical intern trainees are even paid for their 12-month internships (New Zealand Ministry of Education, 2016). 

Meanwhile, nursing students must pay upwards of $20,000 for tuition depending on the programme, work full time at placements with no pay, attend classes, and find time for studying and rigorous homework demands- all while trying to work another job to cover their cost of living and tuition. Again, are you sold yet? Ready to apply? The Ministry of Health acknowledges the urgent need for nurses and is actively recruiting in order to support health outcomes for New Zealanders (Nursing Recruitment, 2022). However, with the 1/3 dropout rate from nursing programmes nationally, something needs to change. 

Here are two proposals to stop the status quo train heading toward disaster:

1. Pay students minimum wage for their placement hours. This may not seem like a lot, but it would have a resounding impact on the financial stressors nursing students experience during and after their programmes, supporting their journey into the profession.

• As part of proposal 1, current nursing students who have already completed part of their programmes should be entitled to retroactive pay equitable to compensation for their completed placement hours.

2. In addition to proposal 1, and because the need is dire, full tuition funding for nursing programmes can provide both support for current students and enticement for future students.

If you want to get really progressive and forward-thinking, the following additional option might help with programme retention:

3. Provide new nurses a programme completion bonus after passing their state exams. Even if it is a small bonus, it is an incentive to stick with the demands of the programme and join the workforce. Between this option or continually adding that extra patient, the decision seems self-explanatory. 

• With the inevitable concern that new graduates may take the funds and head across the ditch to better working conditions and pay if NZ cannot find the means to pay practicing nurses enough, then perhaps this bonus can be distributed incrementally through retention payments over the course of subsequent NZ-based employment.

It is time to think forward, building a new legacy to replace a professional culture that contradicts fundamental nursing values and contributes to the status quo.  We must adapt NOW to changing times and demands, and that means affordable education for the workforce and paid labour. The role of nurses evolves to meet the needs of the populations they serve. A paradigm shift that empowers the most vulnerable in the profession is required to ensure sustainability, wellbeing, and the future of the nursing workforce, and, by connection, the population of Aotearoa NZ.

 

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