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 workforce Māori 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 Workforce

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 MaturesBoomersXersGen 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 StyleSeniority, 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 Hours9 – 5Dusk 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 1945Baby Boomers: Born between 1946 and 1964 Generation X: Born between 1965 and 1977Generation Y: Born between

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 Patient Enrolled Nurses Specialist Nurses Generalist Nurses Prescribing Nurses New Graduates Community Health Workers Expanded Practice roles Community Health Workers Practice Assistants Healthcare Assistants Nurse Practitioner

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: Brookoorn M Where are all the Māori nurses and midwives? Clendon J, Walker L Young Nurses in Aotearoa New Zealand. New Zealand Nurses Organisation. URL: HWNZ Whakapuāwaitia Ngāi Māori 2030 Thriving as Māori Māori Health Workforce Priorities HWNZ 2012.Retention of the nursing workforce in their ‘third age’. Hirschkorn CA, West TB, et al Experienced nurse retention strategies: What can be learned from top-performing organisations? Journal of Nursing Administration, 40(11): Ineson S Report on retention of midwives in their ‘third age’.Health Workforce New Zealand. O’Malley J, et al 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 (AKA BERL Report)