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Feature

Building and strengthening the healthcare workforce

31 August 2022
Health reforms are a start but more needs to be done to increase staffing and support existing workers to upskill and keep pace with change, say experts

Of all the challenges facing Aotearoa New Zealand’s health system, the one the media most often refers to as a crisis may be staffing. Particularly since the Covid-19 pandemic, recruiting and retaining enough appropriately trained healthcare staff has been a global challenge.

In its health reforms, the government has prioritised building and developing the health workforce – it’s one of five strategic ‘system shifts’ it has identified. It recently announced a suite of measures to expand training domestically and make it easier to get international health workers to New Zealand.

Experts at Waipapa Taumata Rau, University of Auckland, say the measures are a start. However, they agree more needs to be done to increase numbers of health workers, particularly of Māori and Pacific backgrounds, and to better support existing workers to upskill given the quick pace of change.

 Many of the problems boil down to resourcing, says Associate Professor Tim Tenbensel, a health systems expert.

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Julia Slark

“Per capita government spending on health did not increase through the 2010s. In comparable countries, the norm was a three percent increase per annum. If you add that up over close to ten years, you’ve got a very big gap in funding.”

“Health reform is an opportunity to innovate and review the traditional structures we’ve had,” says Toni Laming, who as UniServices Executive Director of Business Units heads organisations providing learning and development for health professionals.

“The workforce has been neglected for a long time. We really need to be brave and put a lot more money in.”
Julia Slark

“With the technological change we’ve seen in the health sector, some of the training pathways have not kept abreast of the skills workers need.”

“The workforce has been neglected for a long time,” says Associate Professor Julia Slark, head of the School of Nursing. “We really need to be brave and put a lot more money in.”

Training challenges

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Tim Tenbensel

University experts welcome the government’s plans to increase trainee numbers in some fields but say it’s only a step towards meeting the needs. However, ramping up training further won’t be easy.

“You can say you want more GPs and nurses but there needs to be the capacity to support placements at particular points in training,” says Tenbensel. “That’s a real bottleneck at the moment.”

“The government could provide more money to district hospitals so they can have dedicated education units with staff whose job it is to support students,” suggests Slark. “You would get much more meaningful clinical experiences and we might not need to do as many placement hours. It might also encourage graduates to work in the regions.”

Another issue is that training for healthcare workers doesn’t focus enough on prevention, say the experts.

“We need to focus on the hauora of our communities rather than deploying health services as an ambulance at the bottom of the cliff,” says Laming.

“We need to focus on the hauora of our communities rather than deploying health services as an ambulance at the bottom of the cliff.”
Toni Laming

Building a more diverse workforce

Slark and some of her colleagues have examined the reasons behind the low numbers of Māori and Pacific health workers and found that though systemic racism is a factor, “it largely comes down to hardship,” says Slark.

“Some of the Māori and Pacific nursing students have got three jobs and are trying to study, so it’s not too surprising they end up dropping out. We need to remove fees and support students financially while they’re training.”
Julia Slark

One change Slark would like to see would be to pay student nurses for their final transition-to-practice placement.

“Trainees do night shifts and weekends, so they can’t work other jobs at the same time,” says Slark. “We need to pay them to do that final placement, just like we pay training police officers, so all they have to concentrate on is becoming competent as a registered nurse.”

Another opportunity could be to encourage healthcare assistants and other kaiāwhina, especially those who completed vaccinating health worker training through the UniServices-run Immunisation Advisory Centre (IMAC) during the Covid-19 vaccination push, to undertake further training for roles beyond vaccination.

“A lot of healthcare assistants are Māori and Pacific but some don’t think they can go further in their careers,” says Slark. “We need to support them to do their enrolled nurse training and then to do their registered nurse training. With enough support, some of these people will be the nurse practitioners and other high-level health professionals of the future.”

Training organisations and health administrators also need to think about how they partner with communities to deliver workforce development and health services, says Laming.

“It’s about building trusting partnerships and stepping out of the way when appropriate,” says Laming. “We don’t have control over some of the delivery in Māori and Pacific environments – and that’s okay. We need to trust that local providers know what to do for their people and support them with access to the ongoing training they need for their communities.”

Getting workers to the next level

Among the measures the government recently announced is doubling the nurse practitioners trained annually from 50 to 100. Slark welcomes this, especially given that some of the funding will be available to Māori health providers to develop registered nurses into nurse practitioners.

“Nurse practitioners are the ones living in the community and who want to support their communities, so that’s a good use of money,” says Slark.

Slark would also like to see more support for nurses to undertake specialty tertiary education in fields such as stroke, palliative and mental health and addiction care – and more flexibility regarding when they do it.

Besides postgraduate education, there are many opportunities for health workers to build their skills through professional learning and development. UniServices-run organisations are among the providers of that learning.

 runs team-based training where multiple types of health practitioners can come together to work through acute care and trauma simulations to enhance their team effectiveness.  runs a range of vaccinator training with development pathways as well as providing resources and advice to health professionals.

On the mental health and social support side,  provides workforce development for people working in child and youth mental health and addictions. The  provides those who work in family, domestic and sexual violence support with relevant evidence-informed insights and knowledge.

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Toni Laming
“Technology is making workforce development more efficient and affordable, increasing connectivity through building digital cohorts and also providing resources people can go back and refer to.”
Toni Laming

With the government’s emphasis on workforce development, there are opportunities for UniServices to do more, says Laming.

UniServices is moving to a single digital platform so people can more easily undertake learning from different streams to support their mahi. For example, someone taking childhood vaccination training from IMAC might also be interested in learning from ³ܰ how to deal with childhood trauma.

Offering more online learning is a pandemic-induced change that’s here to stay, says Laming.

“It means a better-informed, better-connected workforce across the country because people in regions and rural areas are no longer disadvantaged in participating,” says Laming. “Technology is making workforce development more efficient and affordable, increasing connectivity through building digital cohorts and also providing resources people can go back and refer to.”

Further steps for the future workforce

The work the government and organisations such as UniServices are doing to expand and upskill the health workforce will help, say the experts. However, these measures alone may not be enough.

“We need to think more widely and ensure workforce development is supported across the full health system to truly increase capacity,” says Laming. “Health sector recruitment and development are global challenges so we need to consider how New Zealand can compete when there’s a global sector shortage.”

“We need to properly support the providers that are taking care of all of us so they can continue to provide high-quality healthcare.”
Jamie King

“There are a lot of issues with international graduates who can’t work because they need to get through the local registration process,” says Tenbensel. “Also, scopes of practice are strictly defined, which makes it difficult for people to work across areas even when there are workforce shortages. A lot of these things are not within the control of the government; they’re within the control of the health professions. And bodies like the College of General Practitioners are part of an international system, so it’s not easy for them to make unilateral changes.”

Even so, the New Zealand government could work more boldly to increase health worker training spaces and expedite immigration for health workers, says Professor Jaime King, a health law expert. It also needs to do more to support the existing workforce to limit burnout-induced resignations, she adds.

“We need to properly support the providers that are taking care of all of us so they can continue to provide high-quality healthcare.”

Interested in connecting with University researchers on health workforce development?