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Give nursing grads a fair go

By NZNO member leader and nursing student Phoebe Webster, as part of the Shout Out campaign.

nzno-students-30Pictured- Phoebe Webster, 3rd year nursing student.

“I am a 25 year old nursing student in my 3rd and final year of nursing study, and looking forward to starting my professional career. By the time I finish my Bachelor of Nursing (BN) I will have completed over 1100 hours of approved supervised practice. I will have spent countless more hours attending practice laboratories, clinical preparation sessions, lectures, tutorials, guest speaker sessions and workshops as compulsory components of my BN degree. After completing this I will sit my state final exam and, all going well, will become a Registered Nurse (RN).

My course is designed to make sure I am a safe, competent, innovative, and articulate nurse. It means that I can work in different parts of the health care sector and improve health outcomes for local, national and global communities. But there is still a steep learning curve going from a student nurse to confidently performing all of responsibilities of an RN.

The Nurse Entry to Practice/Specialist Practice (NEtP/NESP) 1 year programme provides new graduate nurses with an invaluable introduction into the healthcare system. It’s really crucial support for us going through this steep learning curve. It provides a safe and supportive environment for graduate nurses to slowly transition into the responsibilities of a competent registered nurse. This crucial support is sadly not available to all graduates however, and I can’t help wondering how I will fare in this competitive race for employment after my state finals. Only around half of graduates manage to get a NETP position in the first year, and the job opportunities for new graduates outside of the programme can be limited- everywhere wants ‘experience’, but how can we safely obtain it?

More funding is needed to provide these NEtP and NESP placements for new graduates. Sure, it is possible to enter the workforce without a NEtP position, but why make this transition less safe and harder for new grads?

More highly trained nurses are exactly what our complex healthcare system needs. Comorbidities, where patients have many related and often serious health problems going on at the same time are common. Nurses now deal with complicated care under widening scopes of practise. Making sure these new scopes are adequately prepared for and supported is vital for future workforce planning.

Other professions in New Zealand are supported to train and transition slowly into their jobs. When entry to training is regulated with supervised progression, people who come out the other end are better recognised as highly skilled professionals. Take the police force for example. In New Zealand new police undertake extensive entry requirements and progress through a (paid) training programme and are then placed in supported roles in different areas of the police force. Builders have apprenticeships which provide many hours of supervised, supported time on the job. Should the same on the job support and continued supervised learning not be available to all nursing graduates, not just the lucky ones?

The NEtP programme is based on many other successful and effective new graduate programmes around the world. Benefits include transferability of skills recruitment and retention of New Zealand nurses. I really, really want to be the best nurse that I possibly can. After sitting my state final exam this year in November it worries me that I may be entering the workforce without the support in place to give me a fighting chance to achieve that quickly. Building the strong, competent nurses of tomorrow is something I see as worth investing in. It’s a profession that I have invested in, in every way, and hope to continue to do so throughout my life. All I’m asking for is that my country supports me a little bit more, to help support them.”

NETP (Nursing Entry to Practice) and NETSP (Nursing Entry to Specialty Practice) key stats

  • There were 1455 applicants in total in the November end of year pool in 2016.  Of these 1303 were NETP applicants and 152 were NESP applicants.
  • There were 151 applicants indicating they were repeat applicants (128 NETP and 23 NESP) and 1304 (1175 NETP and 129 NESP) who indicated they were first time applicants. (Note: 1274 applicants said they completed their degree at the end of 2016.)
  • There were 121 second time applicants, 26 third time applicants and 4 fourth time applicants.
  • Only 52% of NETP applications were employed as at the 25th of November 2016, and 65% of NESP applicants were employed by the same date
  • Of the remaining applicants in the NETP pool, 605 were unmatched, 17 withdrew, were declined, or did not finish their degree. In the NESP pool, 53 were unmatched and 1 either withdrew, was declined or did not finish their degree.

That’s 658 New Zealand qualified nurses who wanted further on the job support but didn’t have NETP/NESP placements to go to at the end of last year. With a nursing workforce shortage hitting us right now, NZNO believes we need a placement for every new grad.


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Not so ACE

Yesterday, about 600 new graduate nurses had their hopes raised and then dashed when the ACE system malfunctioned badly.

Graduate nurses were mistakenly sent an email congratulating them on gaining a Nurse entry to practice (NETP) position at Auckland DHB.

If you were one of those nurses, we feel for you, it must have been a tough day.

ACE assures us this is a one-off and that’s good to hear because NZNO believes the system is a really good way of matching new grads with jobs.

We can’t help noting that this mistake wouldn’t have happened if the Government funded a NETP position for every new grad nurse. We believe this is the only answer for a fair, well-supported and sustainable nursing workforce that can take us into the future, and you can count on us to keep pushing for that.

 

You can find out more about our campaign for 100% NETP here: http://www.nzno.org.nz/get_involved/campaigns/newgrads


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Its tough out there for new grads

NETPNZNO associate professional services manager Hilary Graham-Smith talks about the realities of too few Nurse Entry to Practice (NEtP)places and too many new grad nurses not getting the support they should have.

It’s a busy time of year for everyone, especially for the hundreds of newly graduated nurses out there who have just got the results of their state finals and are now looking for jobs.

It’s tough out there. We know it. And that’s why we’re feeling pretty disappointed that the Minister of Health is putting out press statements painting a rosy picture of the nursing landscape.

NZNO, and the other national nursing organisations have a goal of 100% Nurse Entry to Practice places for all new grad nurses by 2018. We’re pushing hard to make it happen and pursuing every avenue for change.

The issues are complex:

  • There just aren’t enough NEtP places
  • The Government has not allocated enough funding to the NEtP programme
  • Employers want ‘experienced’ registered nurses
  • No NEtP programme for new graduate enrolled nurses
  • New graduates in their first year of practice working outside of the NEtP programme have inadequate support

The results of the latest Advanced Choice of Employment (ACE) round for graduating nurses makes for depressing reading. Of the 1451 applicants including first time and repeat applicants, 51% (735) gained employment in a Nurse Entry to Practice programme. November 2015 graduate numbers were 1245 and of those 568 did not gain employment through the ACE round. We can endlessly slice and dice the numbers every which way but the point is that we still have large numbers of graduating nurses who do not gain employment on a NEtP programme. Just hold that thought in your head as you read on.

The Minister’s press release celebrating this will have been of no comfort to unsuccessful applicants and makes those of us who know the real story shake our heads in dismay. For the Minister to say “This result is in line with the pattern seen in the first four years of ACE” suggests that the status quo is OK? Really?

In November 2013 the National Nursing Organisations convened a workshop with Health Workforce New Zealand (HWNZ). The purpose of that meeting was to inform HWNZ’s and the Office of the Chief Nurse’s direction for education, workforce development programmes and innovations. It was agreed that one of the key action points from that meeting should be “a balanced approach to the nursing pipeline, including full utilisation of Nurse Entry to Practice funding to support a goal of 100 per cent employment of new graduates”*. The timeframe for achieving this was 2018 at the latest.

One could reasonably expect that two years on we would see some improvement in the numbers of new registered nurses being employed through the ACE programme.

In the same press release the Minister goes on to say “The data also shows from past ACE rounds that the vast majority of graduate nurses find employment over the next year”.  The salient truth about this statement is that the new graduates may well find employment outside the NEtP programme but this is likely to be in environments where they will be given too much responsibility and will not have the support and oversight of more experienced nurses. Our experience is that  these new graduates end up in competency reviews, disciplinary proceedings, in front of the coroner’s court or being reported to the Health and Disability Commission. NZNO lawyer, Margaret Barnett-Davidson had this to say, “In rest home/hospitals where nurses faced allegations relating to their practice, there were a number of common issues that increased the nurse’s vulnerability….. unsupportive managers and caregivers, time pressures too challenging for the skill set, busy environments and accepting responsibilities beyond manageability or competence level.” (Kai Tiaki Nursing New Zealand, November 2013)

Remove the gloss and spin from the rhetoric and the fact is that the registered nurse workforce is being disadvantaged by systemic unfair funding models that do not recognise it as the largest health workforce in New Zealand and one that is pivotal to providing safe and effective care for our populations and communities.

Yes the issues are multi layered as are the solutions, yes there needs to be collaboration between the education providers and employers and yes we need a strategic plan that takes account of the nursing workforce shortage predicted for 2035. But first of all we need an equity lens passed over the funding that is made available to nursing, in particular our new graduate nurses.

* (Summary of selected themes and some agreed actions that emerged from discussions at the Health Workforce New Zealand (HWNZ) Nursing workshop held on 29th November 2013).

 

 

 

 


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My journey, my patient’s journey

emotional-intelligenceHere’s another blog by West Coast mental health nurse Teniah Howell. This blog is cross-posted with permission  from the Nurses Station blog “The Tea Room”. You can read Teniah’s previous post here.

The topic of emotional intelligence has come up multiple times in my journey through nursing school and into the “real world” of nursing. When the topic was first mentioned to me, I had never heard of such a thing before, and really never considered the need to become competent in this area.

Emotional intelligence, essentially, is the ability to recognise your own feelings, emotions, and responses, as well as those of others. Now, we recognise these emotions in different ways – some people journal, some people simply contemplate, and others discuss with trusted mentors/supervision/work place support etc. The importance in understanding where we are at in our own lives allows us to more easily interpret the emotions and responses of the patients we work alongside. It is easier to help our patients find strategies for coping that work for them, if we have first acknowledged and recognised our own strengths and abilities to cope. Nurses cannot relate to patients and help them if they are themselves in an emotionally unstable place.

One thing that I have noticed in my own practice, is that in order to truly develop a therapeutic relationship with a patient, I must be able to differentiate between my own thoughts/emotions and the situation. I have to be able to know what I think and believe about myself and yet not push my own thoughts and beliefs onto my patient. I have to be able to recognise that my patient’s strengths and ways of coping will be different than my own. In my experience this ties into the idea that we all possess a “shared humanness”. While we share a lot of the same emotions, experiences, desires etc.; each one of us is unique and individual. While we all have different strengths and ways of coping with the challenges of life, we all still share the experience of being human. Therefore, we can offer each other grace, knowing that we are in many ways the same.

A patient’s journey can be made easier by having a nurse who will walk alongside them, who understands that human experience; a nurse who has her/himself faced challenges and experienced a range of emotions; a nurse who can relate to them, and also recognise their uniqueness. It takes an emotionally intelligent, competent nurse to do this. It takes someone who has explored their own thoughts and beliefs; someone who is not only able to recognise their own strengths, but can also recognise the individual strength of their patient.


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Building confident nurses

bigstock-D-Knob-Confidence-Level-46141444-583x437Teniah Howell is a newly graduated nurse, NZNO member and advocate for young nurses. She currently works as a mental health nurse on the West Coast having spent the previous 18 months in the medical surgical unit at Grey Hospital. This blog is cross-posted from the Nurses Station blog “The Tea Room”

I have had many recent conversations with young nurses from my graduating class, as well as the new graduates who joined our nursing team in January, about the process of building confidence in nursing practice.

It would seem that for many, confidence is something that progressively builds over time. As our skills, knowledge, and experiences increase, we become more certain that the decisions we make are indeed the right ones. We learn to adapt more quickly, and to trust our instincts. For me personally as a new grad, I found that it took several months to really feel that I could trust my instincts and my decisions and stand strong in advocating for my patient’s care and for the decisions that I believed were the right interventions for my patient. I would say that there was probably a significant jump in my confidence at about five months into my nursing career. I felt at that point that I had learned to trust myself a bit more, and had gained valuable skills and experiences along the way.

At our DHB, the new graduates do a department switch at six months. This meant getting “knocked back” a bit with my confidence as I was then in a completely new environment and relying on skills and judgment that I had not yet developed. I found, however, that this time around my confidence grew faster and within a few months I felt much more capable. In talking to others it would seem this is a common theme.

I have found that confidence is something that grows (almost in a step-ladder type of fashion). It builds on the experiences and skills that you gain as you continue your nursing career. I say this to really encourage those young nurses out there who are starting out and are only just beginning to realise your potential within the nursing team. Remember that it is a process. It will come with time. Offer yourself the grace to recognise that it will take time to build the trust in yourself, and for the team in which you work to trust your judgment as well.

It has also been my experience that the team you work with can either build or break down your confidence depending on how they respond to your nursing practice and your suggestions for patient interventions and care. Working with a nurse who is demoralising and cuts you down every moment of the day can really make you feel small and insignificant. It can be extremely hard to build your confidence in this circumstance. On the contrary, when someone encourages you and says that you have made the right decision, it can do wonders for building your confidence and your trust in your own decision making. I would like to challenge you to be type of nurse that lifts others up. Be the one who helps to build other’s confidence by offering words of encouragement to your colleagues. (Especially the young nurses and student nurses whom you might be working alongside).

I am moving into a new role next week, and will once again be starting off in an area where my experience is limited. As I embark on this new journey, I am aware that at first my confidence may “take a hit”, but through my past experience I know that it will quickly build back up again. I am encouraged by this, and do hope that I will be lucky enough to be supported along the way by my colleagues. We can only hope that if we give good out, we will have good returned to us.

As Mahatma Gandhi said, “Be the change you wish to see in the world.”


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8,000 signatures! Petition goes to Parliament.

Today we took our 8,000 strong petition calling for a nurse entry to practice position for every new graduate nurse to Parliament. Ryan Boswell from TV1 and his cameraman were waiting to find out what was going on.

You can see the ONE news piece here: Desperate nurses call for jobs action

NZNO president Marion Guy talked about the nursing shortage New Zealand is facing – we will be short more than 15,000 nurses by 2035!

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Kaiwakahaere Kerri Nuku explained how important it is to have a homegrown nursing workforce. We need nurses who are representative of our population; that means we need to train and retain way more Maori and Pacific nurses and rely less on internationally qualified nurses.

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We had a quick photo with the petition before Marion, Kerri and our CE Memo Musa went into the Beehive to meet with Minister of Health Tony Ryall. An entire class of school kids spontaneously joined us!

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Marion, Kerri and Memo head into the meeting.

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The rest of us, enrolled nurses, registered nurses, student nurses, new grads, delegates and NZNO staff, unfurl the petition. It’s massive! 8,000 signatures takes a lot of paper to print.

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While a few members roll the petition back up, the reporter talks to new grad, Kim Lane. Kim talks about what it’s like to spend years getting a nursing degree and have no job to go to at the end of it. Madness! We’re going to need every nurse we can get in a year or two…

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Here’s hoping the Minister sees the sense in what we’re asking for. The nursing workforce must be a priority.


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Some questions and answers about our campaign for new grad nurses

NZNO Colour-31 Alex smNZNO acting professional services manager, Hilary Graham-Smith answers a few of the questions people have been asking about our campaign to get a ‘nurse entry to practice’ position for every new grad nurse.

Q:    Aren’t the tertiary institutions just churning out too many nurses? It’s just “bums on seats” with no thought for the workforce needed.

A:     The NZNO petition calling for 100% of new graduates to be employed in a NEtP programme has drawn comment about the role of the education providers in creating what is seen as a glut of new graduates i.e. the problem of lack of employment for new graduates is seen as a consequence of large intakes of students to boost enrolment numbers and keep the tertiary institutes fiscally upright.

NZNO has been working with other national nursing organisations (known as the NNO group) in developing a report on the New Zealand nursing workforce for Health Workforce New Zealand (HWNZ).

The report describes the demographic and fiscal challenges facing the health system and plots these against the challenges facing the New Zealand nursing workforce. The challenges to the system are the growing and aging population with the incumbent increase in demand for health services. The challenges for nursing are similar with 50% of the nursing workforce predicted to retire over the next 21 years.

Filling the gap requires forethought and planning, not in 21 years time but now, including knowing the numbers of student intakes in tertiary institutions and whether these are appropriate for future nursing workforce requirements.

Q:    How can there be a shortage of nurses if the ones we’re training can’t get a job? Doesn’t that suggest the opposite?

A:    The NNO report states that if everything remains the same (student recruitment, retention, numbers active in the workforce) then we will have sufficient nurses in the workforce until about 2020 but maintaining the existing status quo will result in a shortage of 15,000 nurses by 2035. The supply issues need to be addressed now both in terms of recruitment and retention and the NNO group has signalled the need for those workforce planning conversations to occur across the sector so that we have enough nurses and so that the nursing workforce reflects the needs of our population.

Q:    What’s the big deal about NEtP anyway? Shouldn’t nurses just get a job like any other new graduate coming out of a tertiary institution?

A:    The aim of the NEtP programme is to ensure that new graduate nurses commence their careers in a safe, supported clinical environment where they can grow their skills and confidence as RNs. It provides a framework for further learning and development and contributes to the development of a sustainable nursing workforce. The education providers and their curricula are subject to monitoring and approval by the Nursing Council in order to ensure a high quality of delivery and achievement.

Q:    Why do we need a plan? Isn’t “supply and demand” enough?

A:    Our campaign for 100% employment of new graduate nurses is as much about the need for a nursing workforce plan, something which is woefully absent at present. Given the predictions in regard to the shortage of nurses NZ will experience in the not too distant future we want Health Workforce New Zealand (HWNZ) to realise its commitment to work with the NNO group and sector to put a plan in place to avoid this shortage. Our new graduates are an important part of that plan in terms of managing the supply side pressures.

Q:    Nice idea, but where’s the money going to come from?

A:    Medicine (ie doctors) currently receives 60% of HWNZ funding for workforce development. Nursing shares the other 40% with other allied health professions. We believe it is time that nursing as the largest health workforce are given an equitable share of the funding so that we can recruit to and retain our New Zealand prepared nursing workforce.

We’re asking the Minister of Health, Tony Ryall to commit to 100% NetP for new graduate nurses and to come up with the funding to achieve this.

And we’re asking you to sign and share the petition with your family and friends.

Ma whero ma pango ka oti ai te mahi
With red and black the work will be complete
(If we all do our part our goal will be achieved)

You can find out more about the New Zealand Nurses Organisation campaign to support our new grads here: http://www.nzno.org.nz/newgrads