Writing this a week or so before Christmas I really can’t believe how quickly the year has gone by. Then again, I am increasingly taken aback as discussions arise about policy issues I was first involved with over a decade ago – I guess it’s an age thing.

So, listening to nurse leader Eseta Finau on ‘Nine to Noon’ last week claiming English language testing makes it too hard for her Pacific compatriots to register in New Zealand had me rummaging in the archives for notes of a meeting that took place on December 18th 2008 – there you go with the decade thing.

As then Chief Nurse I had called this meeting as a result of increased petitioning – both of me and Health Minister Tony Ryall – on the very issue Eseta raised. Pacific nurse representatives came along as did those from Nursing Council (most appropriately led by their renowned Chair Dr Margaret Southwick, a Pacific nurse leader herself,  as well as then new Registrar Carolyn Reed) together with Counties Manukau DHB, Whitirea Polytechnic and NZNO, whilst I was joined by Ministry colleagues from the Pacific Innovations team.

The long and short of the discussion was the Nursing Council reiterated that they were bound by law to use  two accepted language tests – the International English Language Testing System (IELTS) or the Occupational English Test (OET) – as the means of establishing that internationally qualified nurses (IQNs) had a satisfactory level of English proficiency to underpin their nursing practice.

During this conversation the possibility was also raised of rolling the determination of language proficiency into the competence assessment programme (CAP) which is also required for some IQNs to enter our register.  This is similar to what Eseta Finau was suggesting as an option on Radio NZ. A decade ago this option was particularly supported by Counties Manukau as an employer keen to increase its Pacific nurse numbers, but Council reiterated the need for a conservative approach, citing an increasing influx of nurses from the Philippines and Asia.

Time for new language testing option?

So back in December 2008 the status quo seemed set to continue but, after a good deal of talking, we got to the point that the Nursing Council agreed it might be possible to develop a ‘New Zealand-focussed test with the same rigour of the IELTS, but of relevance to the New Zealand nursing situation’.  Yes! How cool would that be? (My thoughts at the time, but not minuted.) So what happened to that notion and why ten years on do we not have such a thing in place?

I can only speculate but, as Council had suggested, the numbers of Filipino nurses entering New Zealand did soar and on January 3 2009 a hard hitting ‘Herald’ article gave vent to claims these nurses were subject to prejudicial and unfair requirements for language testing. These assertions were the culmination of increasing criticism from some quarters of the Nursing Council’s decision to follow their counterpart Australian regulator in increasing the IELTS score requirement level to band 7. This was a result of harmonisation of scores needed across Australia with our Council having little alternative but to match the level as a result of our Trans-Tasman Mutual Recognition (TTMR) agreements.

Further pressure ensued with Council eventually issuing a media release on February 25 2009 strongly reiterating the need for robust testing systems and entrenching extant policy. This stance in turn was a likely response to increasing concern about disreputable immigration advisers and questionable practice in several countries with respect to certification of immigrant nurses’ credentials.  So that was that.

But is the time right once more to consider the idea of a bespoke Aotearoa / New Zealand test?

Notions of cultural competence and relevance have been further embedded in the past decade and it could well be possible to construct a means of ensuring all nurses seeking registration in our country can communicate in an appropriate manner with their patients and clients. Rather than the pretty generalised approach of IELTS and the OET, we could try and get to the nitty-gritty of what it means to be relevant in use of language with our population in whatever specific cultural context that presents itself.

Just writing those words though makes me wonder as to the enormity of that task.

New Zealand increasingly multiracial and multilingual

We still await data from the Census just gone, but the 2013 stats provide some interesting background to this subject.  Our population is increasingly multiracial with just under 40% of us born overseas. In the decade preceding that census the Chinese population increased by 16%, Indian 48%, Filipino 138%, Japanese 18%, Sri Lankan 35% and Vietnamese by 39% (albeit the last three in small numbers). Yet, if they all speak English shouldn’t IELTS / OET still serve its purpose?

Well, the same census data shows 87,000 people living here don’t speak English at all.  So how do nurses – measured against their ability to speak English – fit in here when it comes to providing the best possible care? Are we sure our translation services are up to the challenge of the immediacy of bedside communication? I guess I’m being a little facetious here given the 4.7 million of our population who do actually converse in the IELTS tested tongue, but a due consideration maybe.

Pushing this a little further, we could perhaps conceive of a cadre of nurses proficient in their particular language who are tasked to look after folks of similar culture and speech. For instance, of the non-English speakers 33,000 use a Chinese dialect, so would it be possible to limit the practise of an immigrant Northern Chinese nurse to the 10,000 people speaking only Mandarin who all pretty much seem to be clustered in the Auckland region?  Aside from the complexity for our regulator this would of course depend on the health system being able to communicate in Mandarin and we aren’t really geared up for that just yet.

What about our own indigenous population though? Only around 9,000 Māori speak Te Reo alone; but what do we say to the increasing refrain of racism in our health service and Māori deserving health care from Māori in a system designed and run by Māori?

I was once asked as Chief Nurse to support a charge of racism against Nursing Council and a consequent quest to establish a parallel regulatory structure for tangata whenua. This went nowhere following my suggestion that we first work with Council to identify whatever racism was thought to be inherent within their structure and deal with that – the evidence wasn’t forthcoming.

I could see an argument unfold in the not too distant future though where some Māori want to be educated as nurses in a culturally responsive educational setting using their language alone and deemed competent to care consequent to their prowess in Te Reo, not English. As Treaty partners that might be hard to discount.

Designing a bespoke system for our nation is overdue another look and with the new Council Registrar Catherine Byrne stating her intent for nursing registration to be ‘forward focused, evidence based, flexible and the right touch’, there may be room for change; although there will be no doubt much for her to chew over before anything radical happens.

As for me, I’m just off to munch on a vegemite sandwich!*

Dr Mark Jones was Chief Nurse at the Ministry of Health from 2005-2010 and is also a former head of Massey University’s School of Nursing.

*Article title and vegemite sandwich references courtesy of Down Under by Men at Work.

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