The aged care sector is facing a chronic shortage of nurses and rest homes fear they will lose yet more staff once a collective agreement between the District Health Boards and the nurses’ union is settled.
The New Zealand Aged Care Association (NZACA) suspects many RNs (registered Nnurses) will leave the aged care sector to fill the 500 new nursing positions promised as part of the DHB NZNO agreement currently being voted on.
“Where will these nurses come from?” asks NZACA chief executive Simon Wallace. “Not the graduate pool. They’ll move from the aged care sector, and already are.” He said vacancies were very high in the sector already. “Potentially, we’re looking at being down by up to 1,000 nurses in a very short space of time. That’s unsustainable.”
Dr Noeline Whitehead, an aged care nursing consultant, said she feared that the sector’s nursing workforce would be in crisis by Christmas.
The current annual turnover rate of nurses working in aged care is already very high, rising from 26 per cent in February 2017 to nearly 38 per cent as of July this year.
In a recent survey of its members, the NZACA found that 58 per cent of respondents were affected by New Zealand nurses leaving their care facilities to take up positions in DHB hospitals, and 36 per cent were affected by internationally qualified nurses moving to DHB roles. The 500 proposed new positions in the DHB NZNO deal are likely to exacerbate this trend.
“This data spells a crisis for the ability of our providers to deliver safe and quality care for our older citizens, with potential closure of units and facilities putting pressure on the DHBs. Where else will these residents go?” says Wallace.
Wallace says the shortages are already taking their toll on aged care providers.
“I am aware of some of our members considering closure of their facilities or units in their facilities because they are unable to staff them with nurses to provide safe and quality care for the residents. This situation is going to worsen.”
She said facility nurse managers were already struggling to find bureau staff to fill roster gaps. Pressured managers are asking RN staff to work extra shifts – or stay on site themselves – to meet contract requirements of having an RN on site. The difficulties were compounded by the requirements to have interRAI trained RNs and facilities committing to training nurses and “within months they are off to the DHB”.
The reality is that it is getting harder to find New Zealand-trained nurses wanting to work in aged care.
This is partly in response to the care and support worker pay equity settlement, which saw caregiver wages soar, while RN salaries have remained fairly static. Pay rates for nurses working in aged care range from a lower quartile of $26.45 to an upper quartile of $29.85 with a median of $28.00. These rates are only marginally higher than those of a caregiver working in aged care (currently between $19.80 and $24.50 per hour), despite the higher level of responsibility and qualification required of RNs.
Wallace said the pay gap between aged care and DHB was definitely a factor in then current shortages. He said DHBs made a commitment to the sector, after negotiating the latest Aged Residential Care funding contract in May, that it would return to the table once the DHBs and NZNO had finalised the new MECA (nursing collective agreement). “It implied they are prepared to come around the table and they are acknowledging that we have an issue with our nurses – and that’s important.” Wallace said he could not predict what the outcome of those post-MECA discussions would be.
Another factor is that many rest homes are unable to provide the support required by graduate nurses and those on the Nurse Entry to Practice Programme (NETP).
Migration changes impact
Rest homes rely heavily on migrant nurses. However, due to immigration policy changes, they are struggling to recruit and retain these nurses as well.
The role of Aged Care Registered Nurse (RN) was moved from the long-term skills shortage list to the immediate skills shortage list, leaving many internationally qualified nurses feeling insecure and undervalued.
Nursing Lecturer at AUT University Dr Jed Montayre, a Philippines-trained nurse who worked in the aged care sector in New Zealand before moving into nurse education, says the current settings are detrimental to migrant nurses.
“For those RNs who are currently working in aged care in New Zealand, it would mean less or no chance for them and their families to apply for residence in New Zealand, which also means lack of security regarding their future here.”
In its submission to MBIE’s Review of Essential Skills in Demand Lists the NZACA argues why they believe the role of aged care nurse needs to go back on the long-term skills shortage list.
“There are not enough New Zealanders willing and able to work in the [aged residential care] industry to enable us to provide this level of care.
“Our members rely on being able to recruit and retain [internationally qualified nurses] but the change in policies have left these migrant workers with insecurity, as they are unsure whether they will be able to remain in New Zealand long term, and being undervalued, as they contribute to our industry and society without being recognised,” it states.
The New Zealand Nurses Organisation in past reviews of migrant skills lists has consistently argued that difficulties recruiting nurses into the residential aged care sector was due to inappropriate staffing levels, heavy workloads, and disparities in wages and conditions.
Montayre says putting aged care nursing back on the long-term skills shortage list would give nurses and their families a greater chance of gaining residency.
“Having that security with their job and the future is very important for many migrant families, including nurses,” he says.
“While nurse migration is not new, including NZ-trained nurses moving to other countries, it is important to consider why migrant nurses choose NZ in the first place, from the many nurse-importing countries? It is because they have heard good things about NZ and wanted to live permanently and restart/rebuild their lives here.”
He points to a survey conducted by AUT in 2017 on migrant nurses and healthcare assistants, that asked about what would make them leave.
“The majority of the answers are around unfavourable immigration policy changes that will leave them and their families uncertain about their future.”
The NZACA says the other big uncertainty is the impact on the care of New Zealand’s increasing ageing population.
“If the pool of RNs available to work in [aged residential care] does not increase this will have significant impacts on the industry and the vulnerable older people they care for,” states the NZACA’s submission.