Nursing

Our nursing workforce is our single biggest health workforce. There are 78,703 nurses with current New Zealand Annual Practising Certificates (APCs) as of March 2024 – an increase of over 9,000 since March 2023. However, it is likely that not all these nurses are currently practising in New Zealand.

We train a lot of nurses domestically each year. In 2023 New Zealand had around 2,700 nursing graduates, including 2,253 registered nursing graduates, 278 enrolled nursing graduates, and 162 new nurse practitioners. But our attrition rates out of domestic training remain unacceptably high, with around 3 in 10 nursing students not completing their training (higher for Māori and Pacific students).

The proportion of our nursing workforce who first trained overseas – our internationally-qualified nurses (IQNs) – has grown substantially over the past year, from 36.4% to 42.6%. This has had a significant impact on the sustainability of our nursing workforce across most of the country, with around 3,000FTE nurses added to Health NZ’s workforce. We also understand that primary care and aged care are experiencing lower levels of nursing pressure.

However:

• IQNs are somewhat less likely to stay in New Zealand after registering here than our home-grown workforce; only 71% of IQNs continue to work in New Zealand after 3 years. This means we need to monitor for increased attrition in coming years.
• A high proportion of IQNs means poorer representation for Māori (7.0%) and Pacific peoples (3.9%) in our nursing workforce, which means those communities can’t access the same care quality as other New Zealanders.
• We still have relatively lower numbers of enrolled nurses and nurse practitioners than comparator jurisdictions.
• We still have some gaps in specialist nursing workforces: mental health and addictions, and critical care.

Nurses are an exceptionally versatile workforce, with a wide-ranging scope and large numbers practising.

Over time, we want to support nurses making more use of their scope, and support specialisation in areas where we have growing demand. We also want more nurses to be used to their potential in the community – including in general practices, and as part of ambulatory care teams (which can provide care to people in a range of places).

Short-term, some of our hospital teams have grown nursing capacity above what our health system can afford – so we expect a flattening of growth to our nursing workforce over the next year in hospital and specialist settings; though some specialties will continue to grow.

In the short-term our nursing workforce is in a good position – so our focus for nursing is closing our remaining specialist and rural vacancies, and then building a more sustainable pipeline of home-grown nurses for the future. This means our focus for the next three years needs to be on:

• Expanding opportunities for specialist training. This will take our good supply of generalist nurses and make it easier for them to specialise where we still have need.
• Target growth to enrolled nurses and nurse practitioners. While we have good supply of registered nurses, we still need more enrolled nurses and nurse practitioners, particularly as we adapt models of care – so we want to focus growth there.
• Strengthen domestic training. Focus on ensuring a sustainable supply of home-grown nurses into the future, with a focus on Māori and Pacific nurses, so our nursing workforce reflects the diversity of our population.

These short-term priorities are likely to flow straight into our long-term plans for nursing – with a continued focus on supporting relative specialisation, and increasing improving the balance between New Zealand-trained nurses and IQNs as international competition mounts.