Last July it was determined the country’s public health service was in need of 4,800 more nurses. In June, Te Whatu Ora gave an update, saying the hospitals were 2,000 nurses ‘ahead’. Nurses and their union disagree.
“I used to leave work and sit in my car and just sob every day – every day. It’s not that I couldn’t do the job – I could – but it was so soul destroying.” Charlotte* has been a nurse for about 35 years. Until recently, she was a duty nurse in charge of allocating staff to different departments of the hospital. She says there were never enough nurses, so she’d have to roster them according to the risk of death in each area. “That just about broke me.” Now, she’s back to being a regular nurse on a ward. She, and four other nurses spoken to by The Spinoff, described “broken” hospitals in which senior staff don’t have time to eat or go to the toilet. She’s moved on from crying – now she’s angry.
Nurses are New Zealand’s largest health workforce, and it’s widely understood there’s not enough of them – data from July 2023 showed there was a shortage of about 4,800. National campaigned on delivering more nurses in response to a “system in crisis” and a “severe shortage”. In February, health minister Shane Reti said addressing health workforce shortages was his number one priority, and that “my end goal is to have New Zealand, homegrown, domestically culturally competent nurses”.
And yet in April, hospitals were asked to save $105 million by July. Staff were encouraged to take leave and working overtime was clamped down on. If “non-frontline” staff left, they were not replaced and existing vacancies were wiped. Reti said that reducing day-to-day operational spending would mean “they can re-invest in the frontline”. Then, in June, Te Whatu Ora chief executive Margie Apa told RNZ “we are about 2,000 nursing FTEs [full time equivalent] ahead of where we planned to be [in hospitals]”. She was speaking about the recent decision to limit the number of graduate nurses placed in hospitals. Instead, many of the 535 graduates will be placed in primary care, private sector aged residential care, child health services or public health.
“Suddenly, we’ve gone from Te Whatu Ora acknowledging that we’ve got 4,800 nurse vacancies across the country that haven’t been filled, to all of a sudden we’ve got a surplus of full time equivalent nurses, and in fact – 2,000 nurses over,” says Kerri Nuku, kaiwhakahaere of the New Zealand Nurses Organisation (NZNO), which represents about 62,000 nurses around the country. She says the call was made without consulting unions. NZNO says that the government is trying to save money on their staffing by restricting the employment of graduate nurses and cutting back on existing staff, and that we are still in a nursing crisis.
When asked for clarification on these 2,000 nurses and what they were ahead on as well as nursing numbers on the whole, Te Whatu Ora provided comment from chief people officer Andrew Slater. “We have increased our nursing numbers significantly with an extra 2,899 in the last year,” he said, but added that it was “not a surplus”. If they’re “ahead” by 2,000, this suggests they were only expecting to increase numbers by 900 last year. “We continue to recruit to our nursing workforce – particularly in specialist areas such as mental health and addictions, and critical care.”
Graduate nurses are placed by Te Whatu Ora into the Nursing Entry to Practice Programme (NETP). The programme provides a paid one-year placement where they’re well-supported in the transition to work. Apa’s suggestion that there aren’t vacancies in hospitals was “a really bizarre call”, says Nuku. Just two months ago NZNO set out to find out just how thin nurses are on the ground, requesting official information from Te Whatu Ora. The data they got back showed that on average over a quarter of Te Whatu Ora hospital shifts were understaffed in 2023. Twenty hospital wards reported shifts below target more than two thirds of the time. Staffing was the worst in mental health wards. “The reality is that they [nurses] go to work every day not knowing if they’ve got a full complement of staff that are going to be able to deliver the quality of care,” says Nuku.
Alice*, a nursing student, wants a NETP placement at a hospital next year. She is currently in her final year of a nursing degree on placement at a hospital. She is rostered on full time shifts like any other nurse. While she’s there for training, senior nurses are often too busy as wards are “obviously understaffed”, she says. “A lot of times we’re just following around our preceptors [experienced supervisor] and trying to help out where we can.”
She went into nursing to care for patients in hospitals, like many of her peers. “That’s where we’ve been doing our placements, and that’s what we’ve been preparing for.” Being placed elsewhere for the NETP year means they could miss out on hospital-specific skills and knowledge, and it’s frustrating, she says, when she can see the hospital needs more nurses. Recent news has made Alice and her cohort uncertain about this future. “It’s really stressful because obviously, we’ve studied for the three years to get into this job, and now we’re not really guaranteed to actually get a job, and it’s hard to know what’s factual and what’s not, because there’s so much talk. Obviously that talk is coming from somewhere, but then other places are denying it, so we’re kind of up in the air.”
Olivia*, who has been nursing for about eight years, says not giving graduate nurses jobs in hospitals is “hideously short-sighted”. She says it’s part of a cycle she has seen before – without jobs, new graduates leave, then there are not enough nurses so the government pushes for people to study nursing, only to then not offer them places – “it’s just baffling”. She says that when she graduated, about half of her cohort weren’t given jobs in hospitals. “It’s so demoralising,” she says. “You’ve done all this study, taken on all this loan – it’s a really challenging degree in terms of the time you spend doing placements and stuff – and then to not be able to get a job was really awful for people.” Worse is that many have moved away from nursing, she says.
Taking on graduate nurses should be viewed as an investment into our healthcare system, she says, even if at the moment the shortage isn’t as great as it once was. “Even if for a year or so we’re actually borderline well-staffed, would that really be such a bad thing?” Instead she’s noticed “people are leaving and they’re not being replaced. If two nurses leave, and then you don’t hire somebody to take over, to fill that role, that is essentially cutting frontline staff.” And nurses don’t work independently of other staff – “if you’re cutting admin staff or reception staff, nurses just have to pick up that slack as well.”
Claire*, a “homegrown” nurse, has been working for about four decades. She says when she started on a surgical ward one nurse might have had six patients to look after. That was fine then, but things are different now – “the patients are older and sicker. You can’t do it. You almost need to have one nurse to three patients, but that ratio just isn’t possible.” She gets angry when she hears someone say the population is ageing. When four of her patients in one morning are over 100 years old, it’s clear it’s already aged. “Shane Reti, he said that the other day, and I nearly jumped through the TV to punch him. It’s not ageing – it’s aged.”
Older people have more comorbidities (the simultaneous presence of two or more health conditions) and need more support and care. Claire is angry because “we knew this was going to happen. Medical science is improving all the time. People are going to live longer. People are going to come into hospital with a list of comorbidities and on all sorts of drugs, and that means they’re going to stay in hospital longer.” That, paired with population growth, has rendered our hospitals “fundamentally not fit for purpose”, she says. “We spend our entire life trying to push patients into places which aren’t the right places for them to be.” Sometimes that push is out the door – “everyone’s under pressure to kick someone out, and it’s horrible. That’s not what we went into medicine for.” Claire says these conditions are demoralising. “You work your arse off, and when you go home, you feel like you haven’t been able to give good care. That’s horrible. That’s an awful feeling.”
*All nurses’ names have been changed to protect their anonymity and employment.