Nursing workforce issues in New Zealand

What can we anticipate in the future and how might we configure our skill mix and work force plans?

Presentation By:

Denise Kivell Director of Nursing,

Counties Manukau Health

Margaret Dotchin Chief Nursing Officer,

Auckland District Health Board

Setting the Scene:What do you need to know?

As our population grows and ages we need to increase our nursing workforce supply to meet our population need

Workforce Development

Understanding the pipeline

An international perspective:How do we compare?

Nursing Workforce-supply modelling

Bachelor of Nursing

Setting the Scene:What do you need to know?

The demographic of our workforce versus the population it serves

Māori health and disability workforce development is a key enabler of health outcomes

Māori RN 2803 ‘active’ in the health workforceMāori Doctors 330

Nursing Workforce

Setting the Scene:What do you need to know?

76% of nurses employed in DHB’s have greater than 5 years experience

How do balance retention, recruitment and cost?

Nursing WorkforceSkill Mix of RNs on DHB/NZNO MECA salary scale steps 1-5 2004-2011

Step Jun-2004 Sep-2006 Sep-2009 Mar-2011 Salary

Step 1 (New Grad) 5.6% 6.7% 6.6% 5.4% $47,057

Step 2 6.0% 6.1% 6.4% 5.5% $50,940

Step 3 6.2% 5.8% 6.7% 6.4% $54,116

Step 4 6.8% 6.5% 6.2% 6.5% $57,176

Step 5 75.5% 75.0% 74.0% 76.2% $63,528

TOTAL 100% 100% 100% 100%

Source: DHB Shared Services

Appendix Ten:

Skill mix of RNs on DHB/NZNO MECA salary scale steps 1-5 by DHB (March 2011)

DHB Step 1 Step 2 Step 3 Step 4 Step 5

South Canterbury 0% 1% 3% 6% 91%

Canterbury 6% 5% 5% 5% 78%

Waikato 5% 5% 6% 6% 77%

Northland 4% 5% 7% 7% 77%

Waitemata 6% 7% 5% 7% 76%

Auckland 4% 5% 8% 7% 75%

Capital & Coast 5% 8% 7% 7% 73%

Counties Manukau 6% 7% 8% 9% 70%

Setting the Scene:What do you need to know?

Our workforce is aging – 60% Nurses are older than 40 years old

Working with “younger nurses” ‘Effective workforce planning aimed at

achieving a sustainable nursing workforce must consider the characteristics and needs of this generation of nurses in order to ensure effective succession planning’. (Clendon J, Walker L. 2011)

Nursing Workforce – age profile

Changing Workforce Dynamics

Matures Boomers Xers Gen Y

Work Environment

Discipline, hard work & teamwork

Individual success, wealth & loyalty

Opportunity to learn and move around

Opportunity to learn rapidly and make a difference

Work Style Seniority, rules driven

Corporation driven

Question the norm

Entrepreneurial

Value of Work

Expertise and experience

Want their hard work valued

Want company to value their contributions

Want to value their own contributions

Work Hours 9 – 5 Dusk to dawn

What do you mean 8 – 6?

Work until work is done

Drivers in Work

To build a life

To build a better life

Work to live better

To live a purposeful life

Matures: Born pre 1945 Baby Boomers: Born between 1946 and 1964 Generation X: Born between 1965 and 1977 Generation Y: Born between 1975-87

Setting the Scene:What do you need to know?

75% of nursing graduates in 2012 were employed

How do you enable new graduates into employment?

Do you need to move from a vacancy driven model to prepare for the future?

Graduate Nurses Face Cuts

Setting the Scene:What do you need to know?

Skill/ skills mix required to meet patient requirements

How do you change the composition of your nursing workforce?

Match your workforce to patient need whilst increasing access, quality, safety whilst constraining cost

Nurse Practitioner

Healthcare Assistants

Practice Assistants

Community Health

WorkersExpanded Practice

roles

Community Health

Workers

New Graduates

Prescribing Nurses

Generalist Nurses

Specialist Nurses

Enrolled Nurses

Patient

Setting the Scene:What do you need to know?

60-70% of DHB budgets are salaries

Components of the Budget

Reducing waste and improving outcomes, quality and safety to reduce costs– right number, right skill to match demand-capacity

Open for better care / First Do no harm / Releasing Time to Care

Setting the Scene:What do you need to know? Better sooner more

convenient shifts the focus to community based models

The opportunities

Reconfiguring the secondary and tertiary workforce (skill mix, skills mix)

Innovation – roles and models Strengthening primary and community care to

keep their community well Strengthening the aged care workforce to keep

older people well in their own homes

As a nurse leader – what do you need in your toolkit?

Understanding of the strategy and priorities – national, DHB, organisation

Data on your workforce composition – ward, team, facility or practice

Understanding your budget and cost constraints Voice at the decision making table Agreed plan to transition to the future state Change management, coaching and mentoring capability

You hold the solutions

References:http://www.healthworkforce.govt.nz/new-roles-and-scopes

Brookoorn M. 2011. Where are all the Māori nurses and midwives? http://www.nursingreview.co.nz/pages/section/article.php?s=Opinion&idArticle=17489

Clendon J, Walker L. 2011. Young Nurses in Aotearoa New Zealand. New Zealand Nurses Organisation. URL: http://www.nzno.org.nz/LinkClick.aspx?fileticket=YKiHM4WjjDk%3d

HWNZ 2012. Whakapuāwaitia Ngāi Māori 2030 Thriving as Māori 2030. Māori Health Workforce Priorities

HWNZ 2012.Retention of the nursing workforce in their ‘third age’.

Hirschkorn CA, West TB, et al. 2010. Experienced nurse retention strategies: What can be learned from top-performing organisations? Journal of Nursing Administration, 40(11): 463-467

Ineson S. 2012. Report on retention of midwives in their ‘third age’.Health Workforce New Zealand. O’Malley J, et al. 2009. Rural Nursing Workforce Strategy Final report July 2009 West Coast DHB & Central Otago Health Services

Nursing Council of NZ(2013).The future Nursing Workforce supply projections 2010-2035 (AKA BERL Report)