‘Too many immigrants’?

Response to NZNO Consultation Request: Essential skills shortage review – Immigration New Zealand, from Grant Brookes

It is widely accepted that anti-immigrant sentiment is on the rise in developed countries. Negative attitudes towards new migrants are seen as a factor in many political developments today – from the popularity of US presidential hopeful Donald Trump, to the UK’s “Brexit” vote to leave the European Union, the growth of European Far Right parties and the implementation of harsh anti-asylum seeker policies in Australia. The powerful emotions which often accompany the immigration debate have also been used by politicians here.

NZNO is currently involved in a review of Essential Skills Shortages in nursing, being undertaken by Immigration NZ. The outcome of the review will affect how easy it is for Internationally Qualified Nurses to gain temporary work visas and possible residence in New Zealand.

NZNO members are being consulted, to inform our organisation’s input into the review. If you’re a member, you can have a say by emailing NZNO Senior Policy Analyst Marilyn Head (marilynh@nzno.org.nz) by 17 August.

In my role as President, I represent NZNO to external stakeholders. When I do this, I reflect our organisation’s agreed positions.

But I am also a member of NZNO. And in that role, since our position has not yet been decided, I would like to express my own individual views about Essential Skills Shortages in nursing. This will be considered, along with every other member’s feedback, in shaping NZNO’s input into Immigration NZ’s review.

I would like to start by stressing that in today’s world, it is especially important that NZNO’s position is based on careful, dispassionate examination of the available evidence and informed by critical social theory. Prevailing social attitudes can colour our perceptions in ways we are unaware of. This is a particular risk for those of us who benefit from prevailing social conditions, such as white privilege.

The review is considering shortages in five nursing specialties – Aged Care, Critical Care and Emergency, Medical, Mental Health and Perioperative. In each specialty, Immigration NZ has to decide three things – whether the occupation meets skill level requirements, whether it’s of sufficient scale to warrant a listing, and whether or not there is a shortage. Since all nurses are classified as skilled workers, and there are lots of us, the only real question is the third one.

To answer it, Immigration NZ has produced Preliminary Indicator of Evidence Reports (PIERS), which look at just five indicators of workforce shortage. The reports conclude that more information about these five indicators is needed to determine whether there is a shortage – from employers, government agencies, and from unions like NZNO.

As the consultation request for NZNO members points out, “there are many aspects affecting workforce supply and demand that are not reflected in the PIERS reports, and which should be considered as part of the review. Eg resourcing, recruitment and retention policies, pay and conditions, safety, quality etc.”. In addition to the ones mentioned in the NZNO consultation request, I think we also need to consider workforce projections.

As has been widely discussed, the Nursing Council of New Zealand commissioned a major report in 2012, titled The Future Nursing Workforce: Supply Projections 2010 – 2035. This report showed how factors such as ageing and increased life expectancy among the general population are expected to increase the demand for healthcare. It observed that the nursing workforce is ageing, and predicted that over 50% of our present workforce will retire by 2035. It concluded that under a “business as usual” scenario, the nursing supply will remain adequate until 2020 but then begin to diverge from health demand, resulting in a shortage of 15,000 nurses by 2035.

More recently, these projections have been questioned by the Office of the Chief Nurse and Health Workforce NZ (HWNZ), who this year published some results from their own workforce modelling (see coverage in Nursing Review, “Nursing Shortage Forecast Cautiously More Optimistic In Short Term“). Their updated forecast notes a sharp rise in the number of registered nurses being educated in New Zealand since 2010. It predicts that the growth in the nursing workforce as a whole is on track to match population growth by 2025. But it is still predicting steep declines in the proportion of aged care, Māori, Pacific and enrolled nurses required to meet projected demand.

And crucially, this (slightly) more optimistic overall picture is based on the assumption of internationally qualified nurses (IQNs) continuing to make up 26 per cent of the RN workforce, including 50 per cent of the RNs in residential aged care and all continuing care (elderly) settings by 2025.

While they’re outside the narrow scope of Immigration NZ’s review, these workforce projections would not provide evidence for removing the five nursing specialties from Essential Skills Shortage lists.

There are two other arguments which have been raised for removing nursing from the lists, which also lie outside the current scope. The first is the impact of immigration on new graduate employment opportunities.

New grad employment is an issue which is very dear to me. It breaks my heart that only 54% (677) of the 1285 Registered Nurses who graduated last November got jobs through the December intake of the Nurse Entry to Practice (NETP) Programme. The disappointment and hardship suffered by each of the 568 unsuccessful new grads, after years of sweat and rising debt, is only compounded by the stress of all the RNs I know who are working short-staffed and needing more help, and the waste of taxpayer’s money spent on three years of underutilised higher education. I would support removing nursing from Essential Skills Shortage lists, if it reduced this misery and waste.

NZNO has committed to ensuring that there’s a NETP place for every new graduate nurse, by 2018 at the latest. And to be eligible for a NETP place, a new grad nurse must be a New Zealand citizen or permanent resident. IQNs cannot apply, so immigration has no direct impact on new grad employment.

It has been said that ongoing migration of IQNs undermines efforts to make Aged Care a priority area for voluntary bonding, since almost half of the IQNs currently working in New Zealand are employed in this sector. Adding Aged Care to the list of “hard-to-staff” specialties would provide financial incentives for New Zealand Registered Nurses (NZRNs) to work in this area, and would be valuable for new grads and workforce planners alike.

But whether or not they’re eligible for the voluntary bonding scheme, according to NZNO new grads in Aged Care still deserve to be employed under the NETP Programme. And as mentioned, these positions are only open to New Zealanders.

This means, essentially, that in NZNO’s view there should be no direct competition for jobs between IQNs and new grads – in Aged Care, or any sector of the health system.

In fact, depending on the specialty, IQNs must have three to five years post-registration experience in order to apply for a work visa under an Essential Skills Shortage category. So while there is some competition for jobs with more experienced NZRNs, the positions which IQNs are taking are not positions which a new grad could fill.

Therefore, reducing the IQN intakes under current Essential Skills Shortage categories would not improve new grad employment prospects in any significant way. What’s worse, continuing to focus on immigration distracts us from real solutions to new grad unemployment.

Last year, delegates to NZNO’s AGM voted for a resolution: “That NZNO continues to prioritise and support campaigns towards nurses and midwives entry to practice programmes, for Registered Nurses, Registered Midwives and Enrolled Nurses, with the campaign goal of 100 per cent employment of new graduates and improved health workforce planning in Aotearoa”. To address new grad unemployment woes, attention could turn instead to this positive alternative, and to NZNO’s new “Shout Out For Health” campaign for a health system fully funded to employ the nurses needed.

The other argument for making it harder for IQNs to obtain work visas, which is outside the scope of the current review, relates to concerns around the “cultural awareness” of IQNs. Some within the profession openly doubt the ability of IQNs to care for patients in New Zealand in a culturally safe way.

In response I say simply this: according to the 2013 Census, nearly 40 percent of the population of Auckland was born outside of New Zealand. That’s well over half a million people. The most common overseas birthplaces reported were in Asia.

It is my view that cultural competency must be seen at a workforce level, as well as at the level of the individual practitioner. Viewed from this perspective, IQNs do not detract from cultural safety, they add to the ability of our profession to care for our culturally diverse population.

NZNO has long advocated for Māori and Pacific nursing workforce strategies which will see the proportion of these nurses matching the ethnic composition the population. So there is some precedent for this approach. And just as in Māori and Pacific workforce development, the proportion of nursing students from other ethnic minority backgrounds currently being trained in New Zealand is also too low to meet population needs. Our input into the Immigration NZ review should therefore recognise the valuable cultural skills which IQNs bring.

None of this, of course, replaces the Nursing Council’s specific cultural safety requirements for every IQN to understand the health and socio-economic status of Māori, and to practise in accordance with the Treaty of Waitangi. As for all tauiwi, education will be required for an IQN to meet this competency. And this may take time. But despite the lack of previous knowledge of the Treaty, there are reasons to believe that IQNs from major source countries may be well predisposed to learning – including shared historical experience of being colonised by European powers, and a common experience of discrimination on ethnic grounds.

In conclusion, it worth noting what is at stake in this review. As at 30 June 2016, there were 8,371 NZNO members who identify as Indian, Chinese or other Asian ethnicities. These are our fastest-growing membership categories. Many of them will be IQNs on temporary work visas, which last a maximum of 30 months. If the nursing specialties are removed from the Essential Skills Shortage lists, then our fellow union members who’ve been in work for less than two years could lose their jobs, and be forced to leave the country. 

It is my view that evidence does not support the removal of nursing specialties in Aged Care, Critical Care and Emergency, Medical, Mental Health or the Perioperative environment from Essential Skills Shortage lists, and that arguments in favour of doing this are contradictory or flawed.

Above all, at a time of rising hostility and public debates over whether there are “too many immigrants”, it is important to recognise and value the special contribution that IQNs make to nursing in New Zealand.

If any other NZNO member would like their feedback considered as part of NZNO’s submission to Immigration NZ, as noted above they should email NZNO Senior Policy Analyst Marilyn Head (marilynh@nzno.org.nz) by 17 August.

You can still have a say up until 24 August though, as an individual, by emailing the Ministry of Business, Innovation and Employment on shortages.review@mbie.govt.nz. There’s more information about the review on the MBIE website: https://www.immigration.govt.nz/about-us/policy-and-law/how-the-immigration-system-operates/skill-shortage-lists