The Nursing Cohort Report - A longitudinal study of New Zealand and internationally qualified nurses 2020 Edition - New Zealand Doctor
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The Nursing
Cohort Report
A longitudinal study of New Zealand
and internationally qualified nurses
2020 EditionCopyright The Nursing Council of New Zealand permits the reproduction of material from this publication without prior notification, providing all the following conditions are met: the information may not be used for commercial gain, must not be distorted or changed, and the Nursing Council of New Zealand must be acknowledged as the source. Requests for copies of this report and enquiries concerning reproduction should be directed to: The Nursing Council of New Zealand PO Box 9644 Wellington 6141 Published April 2021 ISBN: 978-0-908662-26-5 Disclaimer The purpose of this publication is to facilitate informed discussion and assist in future policy development. The opinions expressed in the publication do not necessarily reflect the official view of the Nursing Council of New Zealand. The Nursing Council of New Zealand gives no indemnity as to the correctness of the information or data supplied. The Nursing Council of New Zealand shall not be liable for any loss or damage arising directly or indirectly from the supply of this publication. All care has been taken in the preparation of this report. The data presented in the report was deemed to be accurate at the time of publication. Acknowledgements The Nursing Council of New Zealand thanks The Bramwell Group for the preparation of this report. The statistics used for this publication were released with the approval of the Ministry of Health. Reference: Nursing Council of New Zealand. (2020). The Nursing Cohort Report: 2020 Edition. Wellington: Te Kaunihera Tapuhi o Aotearoa | Nursing Council of New Zealand.
Foreword
On behalf of Te Kaunihera Tapuhi o Aotearoa, the Nursing Council
of New Zealand, I am pleased to present the fifth report in our Nursing
Cohort series.
We began these publications in 2013 with an how critical a strong, sustainable and capable
initial report looking back at the experiences of nursing profession is to the wellbeing of Aotearoa
nurses who registered in the 2005/06 year. From New Zealand.
2014 we decided to expand this into an ongoing
The pandemic environment has also highlighted
series, continuing to report on those nurses and
the value of our efforts to collect and report on
beginning to track the experiences of nurses who
workforce data. This year’s Cohort Report provides
had registered in the 2012/13 year. By the time of
us with a picture of these nurses’ work right to the
the previous report in this series we had described
brink of COVID-19’s emergence in Aotearoa New
12 years of practice for the first population and five
Zealand. The surveyed period ends just a month after
years for the second.
the country’s first recorded case, 12 days after our
This year we decided to refresh the series, with the national borders were closed, and six days after we
aim of ensuring these reports clearly reflect the went into complete Level 4 lockdown. The next report
priorities that underpin the Nursing Council’s work. in the series will therefore be able to clearly show
As a result, from this year we will no longer follow the how responses to the virus affected these nurses’
2005/06 Cohorts. In their place we have established careers in the short and medium term.
three new ‘focused’ Cohorts based on the 2012/13
We are fortunate to have such robust and reliable
population, which report on Māori nurses and those
information on our nursing workforce; many other
who identify with Pacific ethnicities. Alongside this
countries envy our access to such data. But the
we have reviewed the ethnicity data of the overall
Council is only able to present this information
population.
because people choose to provide it to us. Because
Revising our approach demonstrates the Council’s of this I would like to thank all nurses – those whose
commitment to having a nursing workforce that are members of the Cohorts described in this
reflects the ethnic and cultural diversity of the report and those who are not – for their ongoing
country and communities that it serves. Doing so participation in the survey that accompanies renewal
acknowledges the nature of modern Aotearoa New of their Annual Practising Certificates.
Zealand – including the Council’s obligations under
Te Tiriti o Waitangi – but also enhances quality, safety
and equity in practice. Clearly tracing the experiences
of Māori and Pacific nurses not only highlights
distinctive patterns amongst these members of
our workforce, but also enables us to identify
systemic issues that the profession, employers and Catherine Byrne
policymakers must work to resolve. Chief Executive/Registrar
This year’s report is also distinctive in having been
prepared in the midst of our worst national and
global pandemic in living memory. The full social,
economic and cultural effects of COVID-19 have yet
to be felt, but rarely has a single event demonstrated
Te Kaunihera Tapuhi o Aotearoa | The Nursing Council of New Zealand + The Nursing Cohort Report 2020 1Contents
Foreword 1 – Practising Status 32
– Practising Region 33
Table of Contents 2
– Main Employment Setting 34
List of Tables and Figures 3 – Main Area of Practice 35
– Workload 36
Executive Summary 5
6. The Internationally Qualified Nurses
1. Introduction 8 Cohort 37
2. Defining the Populations 10 6.1 Demographics of the IQN Cohort 38
2.1 New Zealand Qualified Nurses 11 – Age and Gender 38
– Enrolled Nurse Scope of Practice 11 – Ethnicity 40
– Registered Nurse Scope of Practice 11 – Qualifications and Experience 41
2.2 Internationally Qualified Nurses 12 6.2 The IQN Cohort Over Time 45
– Australian registered nurses 12 – Practising Status 45
– All other internationally qualified nurses 12 – Practising Region 48
– Main Employment Setting 48
3. Methodology 13 – Main Area of Practice 49
– A Note on Timing 14 – Workload 50
3.1 Data Collection Instrument 14
– Response Rate 14 Section Two: The Focus Cohorts 51
3.2 Constructing and Revising the Cohorts 15 7. The Māori Registered Nurse Cohort 52
– Foundation Cohorts 15 7.1 Demographics of the Māori RN Cohort 53
– Focus Cohorts 15 7.2 The Māori RN Cohort Over Time 54
3.3 Defining annual populations over time 16 – Practising Status 54
3.4 Altered Variables and Reporting Approaches 16 – Practising Region 56
– Accounting for Gender Diversity 16 – Main Employment Setting 57
– Recalculating Ethnicity 16 – Main Area of Practice 58
– Multiple Practice Regions 17 – Workload 59
– New Employment Settings 17
3.5 Notes on Interpretation 17 8. The Pacific Registered Nurse Cohort 60
– Practice Areas and Direct Care Nursing 17 8.1 Demographics of the Pacific RN Cohort 61
– Interpreting Multiple Responses 18 8.2 The Pacific RN Cohort Over Time 63
– Practising Status 63
Section One: The Foundation Cohorts 19 – Practising Region 65
4. The New Zealand Qualified Registered – Main Employment Setting 66
Nurse Cohort 20 – Main Area of Practice 67
4.1 Demographics of the NZQN-RN Cohort 21 – Workload 68
– Age and Gender 21 9. The Māori Enrolled Nurse Cohort 69
– Ethnicity 22 9.1 Demographics of the Māori EN Cohort 70
4.2 The NZQN-RN Cohort Over Time 23 9.2 The Māori EN Cohort Over Time 72
– Practising Status 23 – Practising Status 72
– Practising Region 25 – Practising Region 74
– Main Employment Setting 26 – Main Employment Setting 75
– Main Area of Practice 27 – Main Area of Practice 76
– Workload 28 – Workload 77
5. The New Zealand Qualified Enrolled Appendix A:
Nurse Cohort 29
Allocation of Qualification Countries to
5.1 Demographics of the NZQN-EN Cohort 30 Region Categories 78
– Age and Gender 30
– Ethnicity 31 Appendix B:
5.2 The NZQN-EN Cohort Over Time 32 Ethnic Identification of Foundation Cohorts
– Registered Nurse Pathway 32 at Registration and Revision 79
2 Te Kaunihera Tapuhi o Aotearoa | The Nursing Council of New Zealand + The Nursing Cohort Report 2020List of Tables and Figures
List of Tables
Table 1: Example of multiple response data 18
Table 2: Gender and age at entry to the Register of NZQN-RN Cohort members 21
Table 3: Ethnicity and age at entry to the Register of NZQN-RN Cohort members 22
Table 4: Ethnicity and gender of NZQN-RN Cohort members 23
Table 5: Practising status of NZQN-RN Cohort members, 2014-2020 24
Table 6: Changes in active practising status of NZQN-RN Cohort members, 2015-2020 25
Table 7: Main practising region of NZQN-RN Cohort members, 2014-2020 25
Table 8: Main employment setting of NZQN-RN Cohort members, 2014-2020 26
Table 9: Main practice area of NZQN-RN Cohort members, 2014-2020 27
Table 10: FTE – workload of NZQN-RN Cohort members, 2015-2020 28
Table 11: Gender and age at entry to the Register of NZQN-EN Cohort members 30
Table 12: Ethnicity and age at entry to the Register of NZQN-EN Cohort members 31
Table 13: Ethnicity and gender of NZQN-EN Cohort members 31
Table 14: Practising Status of EN to RN Pathway Cohort members, 2014-2020 32
Table 15: Practising status of NZQN-EN Cohort members, 2014-2020 32
Table 16: Changes in active practising status of NZQN-EN Cohort members, 2015-2020 33
Table 17: Main practising region of NZQN-EN Cohort members, 2014-2020 33
Table 18: Main employment setting of NZQN-EN Cohort members, 2014-2020 34
Table 19: Main practice area of NZQN-EN Cohort members, 2014-2020 35
Table 20: FTE workload of NZQN-EN Cohort members, 2015-2020 36
Table 21: Gender and age at entry to the Register of IQN Cohort members 38
Table 22: Ethnicity and age at entry to the Register of IQN Cohort members 40
Table 23: Ethnicity and gender of IQN Cohort members 41
Table 24: Ethnicity and country/region of qualification of IQN Cohort members 42
Table 25:
Highest qualification of IQN Cohort members at entry to the Register, by country/region
of qualification 43
Table 26: Years since first qualification of IQN Cohort members at entry to the Register,
by country/region of qualification 44
Table 27: Practising status of IQN Cohort members, 2014-2020 46
Table 28: Changes in active practising status of IQN Cohort members, 2015-2020 47
Table 29: Percentage of IQN Cohort members actively practising in New Zealand by entry
qualification and country/region of qualification, 2015-2020 47
Table 30: Main practising region of IQN Cohort members, 2014-2020 48
Table 31: Main employment setting of IQN Cohort members, 2014-2020 48
Table 32: Main practice area of IQN Cohort members, 2014-2020 49
Table 33: FTE – workload of practising IQN Cohort members, 2015-2020 50
Table 34: Gender and age at entry to the Register of Māori RN Cohort members 53
Table 35: Practising status of Māori RN Cohort members, 2014-2020 54
Table 36: Changes in active practising status of Māori RN Cohort members, 2015-2020 56
Table 37: Main practising region of Māori RN Cohort members, 2014-2020 56
Table 38: Main employment setting of Māori RN Cohort members, 2014-2020 57
Te Kaunihera Tapuhi o Aotearoa | The Nursing Council of New Zealand + The Nursing Cohort Report 2020 3Table 39: Main practice area of Māori RN Cohort members, 2014-2020 58
Table 40: FTE workload of Māori RN Cohort members, 2015-2020 59
Table 41: Gender and age at entry to the Register of Pacific RN Cohort members 61
Table 42: Distribution of Pacific RN Cohort members across Pacific ethnicities 62
Table 43: Practising status of Pacific RN Cohort members, 2014-2020 63
Table 44: Changes in active practising status of Pacific RN Cohort members, 2015-2020 64
Table 45: Main practising region of Pacific RN Cohort members, 2014-2020 65
Table 46: Main employment setting of Pacific RN Cohort members, 2014-2020 66
Table 47: Main practice area of Pacific RN Cohort members, 2014-2020 67
Table 48: FTE workload of Pacific RN Cohort members, 2015-2020 68
Table 49: Gender and age at entry to the Register of Māori EN Cohort members 70
Table 50: Practising status of Māori EN Cohort members, 2014-2020 72
Table 51: Changes in active practising status of Māori EN Cohort members, 2015-2020 73
Table 52: Main practising region of Māori EN Cohort members, 2014-2020 74
Table 53: Main employment setting of Māori EN Cohort members, 2014-2020 75
Table 54: Main practice area of Māori EN Cohort members, 2014-2020 76
Table 55: FTE – workload of Māori EN Cohort members, 2015-2020 77
List of Figures
Figure 1: Comparative ages at entry to the Register of male and female NZQN-RN Cohort members 22
Figure 2: Comparative active practising rates of 2005/06 and 2012/13 NZQN-RN Cohorts 24
Figure 3: Comparative ages at entry to the Register of NZQN-EN and NZQN-RN Cohort members 30
Figure 4: Comparative ages at entry to the Register of male and female IQN Cohort members 39
Figure 5: Comparative ages at entry to the Register of IQN and NZQN-RN Cohort members 39
Figure 6:
Percentage of IQN Cohort members with fewer than 10, and 10 or more years of
post-registration experience at entry to the Register, by country/region of qualification 45
Figure 7: Comparative active practising rates of 2005/06 and 2012/13 IQN Cohorts 46
Figure 8: Comparative age categories at entry to the Register of Māori and non-Māori RNs 54
Figure 9: Eligibility and active practising status of Māori and non-Māori RNs, 2014-2020 55
Figure 10: Comparative age categories at entry to the Register of Pacific and non-Pacific RNs 62
Figure 11: Eligibility and active practising status of Pacific and non-Pacific RNs, 2014-2020 64
Figure 12: Comparative age categories at entry to the Register of Māori and non-Māori ENs 71
Figure 13: Eligibility and active practising status of Māori and non-Māori ENs, 2014-2020 73
4 Te Kaunihera Tapuhi o Aotearoa | The Nursing Council of New Zealand + The Nursing Cohort Report 2020Executive Summary
This is the fifth Nursing Cohort Report commissioned by Te Kaunihera
Tapuhi o Aotearoa, the Nursing Council of New Zealand. It presents data
related to the population of nurses who joined the Register between 1 April
2012 and 31 March 2013 (the 2012/13 year). This population is divided into
three Foundation Cohorts, whose experiences have been followed through
earlier reports in this publication series: New Zealand Qualified Registered
Nurses, Internationally Qualified Registered Nurses, and New Zealand Qualified
Enrolled Nurses.
In addition, this year three Focus Cohorts have further education and become Registered Nurses.
been added. These track the experiences since In the case of both Registered Nurse Cohorts, these
registration of Māori Registered Nurses, Māori practice rates were noticeably higher than earlier
Enrolled Nurses, and Registered Nurses who identify populations. Seven years after joining the Register
with Pacific ethnic groups. These have taken the only 67% of NZQNs and 48% of IQNs who had joined
place of the 2005/06-registered Cohorts who were in the 2005/06 registration year were still practising.
included in earlier iterations of this series. The
ethnic identification of the population has also been Practising Regions
updated as part of this, reflecting the point that how
The two Registered Nurse Cohorts showed little
people choose to define their ethnicity can change
change in geographic distribution over the period. As
over time.
expected, both NZQN-RN and IQNs practised mainly
This report profiles each Cohort and presents data in the large urban centres of Auckland, Canterbury,
on these nurses’ first seven years of practice. It Waikato and Wellington. In 2020, 62% of the NZQN-
provides a picture of career trends in employment RN Cohort and 73% of the IQN Cohort were located
setting, clinical (and non-clinical) practice choices, in these four areas.
geographic shifts, and retention in the workforce.
This year, it also highlights how the experiences of The geographic distribution of the NZQN-EN Cohort
Māori and Pacific nurses differ from those of their differed noticeably from the Registered Nurses,
non-Māori and non-Pacific colleagues. showing both more change over the period and less
concentration in particular areas. Whereas in 2020
Auckland was the largest single practising region
The Foundation Cohorts for both NZQN-RNs (28% of Cohort members) and
A total of 3,046 nurses joined the Register in the IQNs (35%), only 21% of Enrolled Nurses practised in
2012/13 year, of whom 150 were Enrolled Nurses Auckland that year. In general, a greater percentage
(NZQN-ENs) and 2,896 were Registered Nurses. Of of NZQN-EN Cohort members were practising in
the Registered Nurses, 1,639 were New Zealand ‘regional’ parts of New Zealand. For example, 13%
Qualified Registered Nurses (NZQN-RNs) and 1,257 were practising in Southland in 2020 compared to 2%
were Internationally Qualified Nurses (IQNs). Over of NZQN-RNs and IQNs.
three-quarters of the 2012/13 IQN Cohort had
degree-level qualifications, while 19% had diploma- Employment Settings
level qualifications. This report covers the first seven
The NZQN-RN Cohort was employed primarily in
years of post-registration practice for these Cohorts.
Acute DHB, Primary Health Care and Rest Home/
All experienced some attrition over this period, but Residential Care settings over the surveyed period,
this was much higher amongst IQNs and Enrolled while IQN Cohort members worked primarily in
Nurses than New Zealand-Qualified RNs. In 2020, Acute DHB, Other DHB and Rest Home/Residential
75% of the NZQN-RN Cohort were practising in New Care. Compared to their New Zealand-Qualified
Zealand, while 60% of IQNs and 42% of Enrolled counterparts, very few IQNs were employed in
Nurses were doing so – although an additional Primary Health Care (7% of the IQN Cohort in 2020,
13% of the Enrolled Nurse Cohort had completed compared to 16% of NZQN-RNs). The most common
Te Kaunihera Tapuhi o Aotearoa | The Nursing Council of New Zealand + The Nursing Cohort Report 2020 5specific setting across the timeframe for Enrolled Nurse Cohorts, with an average 0.84 FTE workload,
Nurses was Rest Home/Residential Care, although although the percentage working on a part-time basis
in 2020 a notable shift in employment patterns was comparable to the NZQN-RN Cohort at 20%.
occurred and Acute DHB was the most often
reported setting (33% of NZQN-ENs, compared to
The Focus Cohorts
30% in Rest Home/Residential Care).
Of the 1,789 New Zealand-Qualified nurses who
In all three Cohorts District Health Boards accounted joined the Register in the 2012/13 year, 203 were
for the majority of employment, although this was Registered Nurses who identified as Māori, 138 were
longer amongst Enrolled Nurses than in other RNs who identified with at least one Pacific group,
Cohorts. In 2020, 64% of NZQN-RNs and 60% of and 38 were Enrolled Nurses who identified as Māori.
IQNs were employed by DHBs, compared to 52% of These represent 12%, 8% and 25% respectively of the
NZQN-ENs. overall Registered or Enrolled Nurse Cohorts. For all
three, their share of the corresponding Foundation
Practice Areas Cohort was higher than the percentage of the labour
By the end of the timeframe, members of the NZQN- force who identified as Māori and Pacific when these
RN Cohort had been present to some extent in all nurses joined the Register. For Māori ENs and Pacific
practice areas, with the most common in 2020 being RNs it was also higher than the percentage of the
Primary Health Care (13%), Surgical (12%), Emergency & overall population identifying as Māori or Pacific at
Trauma (11%) and Medical (10%). Of these, Emergency the time.
& Trauma also experienced a continual rise in
Māori and Pacific Registered Nurses were slightly
popularity over the period, while both Surgical and
older at registration than non-Māori and non-Pacific
Medical nursing declined. Interestingly, while Primary
RNs respectively, while Māori Enrolled Nurses were
Health Care was the most common area in 2020,
significantly older than non-Māori ENs. In terms
the actual percentage of nurses working in it fell
of gender, men made up a significantly larger
considerably compared to previous years. The area
proportion of the Pacific RN Cohort than non-Pacific
had previously experienced an ongoing increase over
RNs: 12% compared to 8%. In contrast, there were
the timeframe, and in 2018 it had hit a highpoint of
very few male Māori RNs; men made up only 2% of
18% of the Cohort.
the Cohort, compared to 9% of non-Māori RNs.
As with NZQN-RNs, members of the IQN Cohort were
Immediately after registration, almost 20% of Māori
likewise represented in all areas apart from School
RNs were not practising as nurses – significantly
Health by the end of the timeframe, and were also
higher than the 7% of non-Māori RNs who did
commonly practising in Medical (17%) and Surgical
not practise. However, this Cohort also displayed
(10%) areas. However, only 6% were practising in
noticeably higher retention rates than non-Māori,
Primary Health Care, while the most common practice
so that practising rates converged over time and by
area was Continuing Care (21%), although that figure
2019 were essentially the same. In a mirror of this
had been continually falling over time since an early
pattern, over the first few years post-registration
high of 36% in 2015.
a significantly higher percentage of the Pacific RN
Unsurprisingly given the prominence of the Rest Cohort were practising compared to non-Pacific
Home/Residential Care setting for the NZQN-EN RNs, but a significant fall after 2016 saw these
Cohort, Enrolled Nurses largely worked in areas rates converge from 2017 onwards. In contrast to
associated with aged care such as Continuing Care both of these, practising rates for Māori ENs were
(25% in 2020) and Assessment & Rehabilitation substantially and consistently lower than non-Māori
(30%). However, the timeframe also saw an ongoing over the whole timeframe.
increase in the number working in inpatient Mental
Health and Primary Health Care – though both of Practising Regions
these fell in popularity between 2019 and 2020. As with the Cohort as a whole, most Māori RNs
Enrolled Nurses were also concentrated across a worked in major urban areas. However, unlike non-
smaller range of practice areas than Registered Māori a significant number were located outside
Nurse Cohorts. Eight out of 27 practice areas had no these areas in the regional upper North Island zones
NZQN-EN members in more than one year over the of Northland, Bay of Plenty and Tairāwhiti. In 2020,
surveyed timeframe, including all ‘non-clinical’ areas 30% of Māori RNs worked in these regions compared
other than Nursing Administration & Management. to 10% of non-Māori. This tendency was also present
amongst Māori ENs. Pacific RNs, in contrast, were
Workload located overwhelmingly in Auckland and Wellington;
In 2020, the average (mean) workload was 0.87 FTE 77% of the Cohort worked in one of these regions in
for the NZQN-RN Cohort and 0.95 FTE for the IQN 2020, compared to 36% of non-Pacific RNs.
Cohort. This difference was due in large part to the
proportion engaged in part-time employment: 21% Employment Settings
of NZQN-RNs worked on a part-time basis (less than For Māori RNs, as with non-Māori, the Acute DHB
0.8 FTE), compared to 12% of IQNs. Enrolled Nurses setting was the most common form of employment
generally worked fewer hours than both Registered over the timeframe. However, members of the
6 Te Kaunihera Tapuhi o Aotearoa | The Nursing Council of New Zealand + The Nursing Cohort Report 2020Cohort also had a strong focus on community- Workload
based health care. The percentage of Māori RNs
The mean FTE worked by the Māori RN Cohort
working in Primary Health Care/ Community settings
was broadly similar – although consistently slightly
was consistently higher than non-Māori, and from
lower – to non-Māori other than in 2017. In that
2016 onwards this was the second-most commonly
year a significant one-off spike in the mean FTE of
reported setting. Similarly, Community DHB settings
Māori RNs saw it rise noticeably higher than non-
were much more common amongst Māori RNs than
Māori. In contrast the mean workload of Pacific RNs
non-Māori. In 2020 these two settings accounted for
was consistently higher than non-Pacific RNs. This
38% of the Māori RN Cohort, compared to 25% of
difference was driven both by proportionally fewer
non-Māori. While employment with a Māori Health
Pacific RNs working part-time and significantly more
Service Provider was initially common it declined in
working over 1 FTE. The mean FTEs of Māori and
popularity over the timeframe, as did Rest Home/
non-Māori ENs were very similar, with occasional
Residential Care. Māori Enrolled Nurses largely
variations being caused mainly by the small
worked in Rest Home/Residential Care settings over the
population of Māori ENs magnifying minor shifts
timeframe, to an even greater extent than their non-
amongst individual members.
Māori counterparts.
The Pacific RN Cohort displayed a similar focus on
community health as Māori RNs. While the Acute
DHB setting was always the most popular, from 2017
onwards the two community-focused settings noted
above consistently accounted for approximately a
third of the workforce. Also similar to Māori RNs, the
Pacific Cohort initially had a strong presence in the
Rest Home/Residential Care setting, but this fell away
significantly in later years.
Practice Areas
In keeping with the employment trends noted above,
for both Māori and Pacific RNs Primary Health Care
was an especially prominent practice area over the
timeframe. For the Māori Cohort this was consistently
the most popular area, accounting for approximately
a fifth to a quarter of members each year. For Pacific
RNs this area was highly popular until 2020, when
it saw a sudden fall and was overtaken by inpatient
Mental Health and Medical nursing. Conversely, Pacific
Cohort members were noticeably less likely to work
in surgery-focused and highly acute areas such as
Surgical, Perioperative Care, and Emergency & Trauma
nursing.
The Māori EN Cohort was dispersed across a range
of practice areas, although in most cases only one or
two nurses worked in each area. The one area with
a significant and consistent concentration of Cohort
members was Continuing Care, although 2020 saw
a third of practising members working in Assessment
& Rehabilitation. This pattern was repeated amongst
non-Māori ENs.
Te Kaunihera Tapuhi o Aotearoa | The Nursing Council of New Zealand + The Nursing Cohort Report 2020 701
Introduction
8 Te Kaunihera Tapuhi o Aotearoa | The Nursing Council of New Zealand + The Nursing Cohort Report 2020This report is the fifth in Te Kaunihera Tapuhi o Aotearoa, the Nursing Council
of New Zealand’s (the Council) series of Cohort Report publications. This series
forms part of the Council’s commitment to publishing and using the data it
collects from nurses in order to inform good quality workforce policy and
planning. The publications it prepares provide valuable information for the
Government, industry and non-government organisations that have an interest
in developing the nursing workforce in order to meet the current and future
health needs of the Aotearoa New Zealand population.
The Council’s primary workforce publication is This decision also led to reviewing ethnicity data for
the series of biennial reports: The New Zealand the 2012/13 population to reflect how members have
Nursing Workforce: A profile of nurse practitioners, changed their identification over time, and updating
registered nurses and enrolled nurses.1 These profiles protocols to reflect changes in data collection
use the data collected by the Council to present a processes and policy.
comprehensive picture of the current state of the
The Cohort Report consists of two sections. The first
nursing workforce.
of these examines the 3,046 nurses who joined the
In 2012, to complement this core publication series, Register between 1 April 2012 and 31 March 2013.
the Council commissioned its first Cohort Report. This population is divided into three Foundation
This retrospectively profiled those Registered Cohorts: Registered Nurses who gained their
Nurses who joined the Register between 1 April qualifications in New Zealand (NZQN-RNs), Enrolled
2005 and 31 March 2006, and tracked their work Nurses who gained their qualifications in New
experiences from registration until the year of Zealand (NZQN-ENs), and Registered Nurses who
publication. In 2014, the Council decided to turn gained their qualifications in another country (IQNs).
this into an ongoing series by continuing to follow In each case the report provides a basic demographic
the experiences of this population and beginning profile of that Cohort, and then presents data
to follow those nurses (including Enrolled Nurses) describing the first seven years after registration (up
who gained entry to the Register in the 2012/13 until 31 March 2020).
registration year. The report produced that year
The second section of the report describes the
covered the seventh and eighth years of practice for
experiences of groups within the New Zealand
the 2005/06 nurses, and both profiled and described
Qualified population as defined through three Focus
the first year of practice of the 2012/13 population.
Cohorts: Registered Nurses who identify as Māori
Further publications were produced in 2016 and
(Māori RNs), Enrolled Nurses who identify as Māori
2018, each presenting a further two years of practice
(Māori ENs), and Registered Nurses who identify
data.
with one or more Pacific ethnicities (Pacific RNs).
This year the Cohort series was reviewed to ensure The chapters addressing these groups each follow
it was fit for purpose. As a result, the Council chose the same basic format as the Foundation Cohorts,
to stop following the original 2005/06 Cohort (which consisting of an initial short profile followed by
this year entered its 14th year of post-registration descriptions of the Cohort over time.
practice). In its place, the Council has decided to
focus on highlighting and exploring the experiences
of Māori and Pacific nurses within the population.
1
These and other reports can be downloaded from http://www.nursingcouncil.org.nz/Publications/Reports
Te Kaunihera Tapuhi o Aotearoa | The Nursing Council of New Zealand + The Nursing Cohort Report 2020 902
Defining the Populations
10 Te Kaunihera Tapuhi o Aotearoa | The Nursing Council of New Zealand + The Nursing Cohort Report 2020This report examines the profile and experiences of nurses admitted to
the Register for the first time in the 2012/13 year (running from 1 April 2012
to 31 March 2013). Within this population there are two distinct groups:
1. newly qualified nurses who have just graduated from a New Zealand
nursing programme; and
2. nurses originally educated and registered in another country.
As these are quite different populations – for example, those who were
educated overseas will be more experienced than those who are newly
educated – they are treated as two distinct types of nurses: New Zealand
Qualified Nurses (NZQNs) and Internationally Qualified Nurses (IQNs).
2.1 New Zealand Qualified Nurses Enrolled Nurse Scope of Practice
Members of NZQN Cohorts gained entry to the The Enrolled Nurse Scope of Practice covers nurses
Register through a process established by the who work under the direction and delegation of a
Council. Currently, this requires: Registered Nurse or Nurse Practitioner (or in some
cases another regulated health professional) to assist
+ completion of a Council-approved qualification at with the provision of nursing care. Enrolled Nurses
an accredited institution; are required to successfully complete a programme
+ confirmation from the Head of Nursing at the leading to a Level 5 Diploma in Enrolled Nursing at
relevant education provider of the candidate’s a provider approved by the Nursing Council, and
fitness to be registered as a nurse, including the achieve a pass in both an assessment of relevant
ability to communicate effectively in English; competencies set by an approved provider and the
Nursing Council-set examination for Enrolled Nurses.
+ a declaration from the applicant as to their fitness
to practise; Registered Nurse Scope of Practice
+ a police check; and The Registered Nurse Scope of Practice covers
nurses who use nursing knowledge and complex
+ a pass in the Council’s State Final Examinations.
nursing judgment to assess health needs and
Once a candidate has met all these requirements provide care, and to advise and support people to
they apply to the Nursing Council of New Zealand manage their health. They practise independently
and are granted registration. and in collaboration with other health professionals,
perform general nursing functions, and delegate to
There are three scopes in which a nurse can register:
and direct enrolled nurses, health care assistants and
Enrolled Nurse (EN), Registered Nurse (RN) and Nurse
others. They provide comprehensive assessments to
Practitioner (NP). As Nurse Practitioners constitute an
develop, implement and evaluate an integrated plan
advanced scope gained after initial registration – and
of health care, and provide interventions that require
are a small population – they have not been included
substantial scientific and professional knowledge, skills
in this publication series. Brief descriptions of the
and clinical decision making. This occurs in a range
differences in practice between RNs and ENs and
of settings in partnership with individuals, families,
their required qualifications are outlined below.2
whānau and communities. Registered nurses may
practise in a variety of clinical contexts depending on
their educational preparation and practice experience.
They may also use this expertise to manage, teach,
evaluate and research nursing practice.
2
Full descriptions of the Enrolled Nurse and Registered Nurse scopes are available on the Council’s website: www.nursingcouncil.org.nz
Te Kaunihera Tapuhi o Aotearoa | The Nursing Council of New Zealand + The Nursing Cohort Report 2020 11The Council’s decision to allow an IQN entry to
2.2 I nternationally Qualified
the Register currently requires the applicant to
Nurses demonstrate that they meet the following seven
Members of IQN Cohorts have gained entry to the standards:5
Register through one of two pathways established
by the Council. The first pathway is specifically for + establishment of identity
nurses registered with the Nursing and Midwifery + competence in the English language,
Board of Australia (NMBA),3 and the second is for all demonstrated by success in either the
other IQNs seeking registration in New Zealand. In International English Language Testing (IELTS)
addition, all international applicants must complete at level seven in all four bands, or Occupational
an International Criminal History Check. English Language Test (OET) with 350 in each
band
Australian registered nurses
+ verification of current registration in country of
Nurses registered with the NMBA are eligible to
origin and evidence of good standing
register in New Zealand under the terms of the
Trans-Tasman Mutual Recognition Act 1997. Section + equivalence of educational preparation, with
15(1) of this Act enables registered practitioners to nursing qualifications assessed as equivalent to
move quickly and freely between the two countries: the NZ Bachelor of Nursing programme
The Trans-Tasman mutual recognition principle in + post-registration experience, comprised of at
relation to occupations is that, subject to this Act, least two years’ practice within the last five years
an individual who is registered in an Australian comprising at least 2,500 hours, in a registered
jurisdiction for an occupation is entitled, after nurse scope of practice
giving notice to the local registration authority for
+ fitness to practise as a registered nurse, including
the equivalent occupation,—
an original International Criminal History Check
(a) to be registered in New Zealand for the
+ competence to practise, demonstrated through a
equivalent occupation; and
curriculum vitae, and a certificate of employment
(b) pending such registration, to carry on the providing evidence of at least two years of clinical
equivalent occupation in New Zealand. practice within the last five years.
On presentation of the relevant documentation Registration is a three-stage process. All
and verification of registration with the NMBA, the documentation, including proof of identity, is
nurse is deemed registered and may practise in submitted by the nurse to external specialists in
New Zealand. Full registration is granted once the verification. Once the verification report is accepted,
application is formally accepted by the Council. it is then submitted directly to the Council for
assessment. The Council then makes a decision and
All other internationally qualified nurses requires successful applicants to formally declare
Internationally Qualified Nurses registered in their fitness for registration. If not convinced of an
countries other than Australia who apply for entry applicant’s competency within the specific context of
to the New Zealand Register are required to have health care and nursing in Aotearoa New Zealand,
a nursing qualification from a programme that the Council may also require the completion of a
is deemed equivalent to a New Zealand nursing Competency Assessment Programme at an approved
programme (including being authorised and provider before granting registration.
monitored by the relevant nursing regulatory Once an IQN is accepted for registration the Council
authority), must demonstrate they are competent to determines the allowable scope of practice (for
practise, and be fit for registration.4 This includes the example, Registered Nurse or Enrolled Nurse),
requirement that applicants are able to communicate and may put conditions on practice depending on
effectively in English for the purpose of nursing the applicant’s education programme and type
practice. The Council is responsible for determining of registration in their country of origin. These
if an individual nurse meets these criteria. conditions may restrict the nurse’s area of practice
in terms of specialty. Their register entry would then
include such conditions and record that the IQN can
only practise as a nurse in one of the following: a
general setting, mental health, Child Health, or with
consumers with intellectual disability.6
3
See https://www.nursingmidwiferyboard.gov.au/Registration-and-Endorsement.aspx.
4
See Health Practitioners Competence Assurance Act 2003, ss 15-16
5
https://www.nursingcouncil.org.nz/IQN/H5.aspx?WebsiteKey=fa279da8-a3b1-4dad-94af-2a67fe08c81b
6
None of the supplied IQN records used to construct these Cohort populations listed such conditions.
12 Te Kaunihera Tapuhi o Aotearoa | The Nursing Council of New Zealand + The Nursing Cohort Report 202003
Methodology
13 Teof
Te Kaunihera Tapuhi o Aotearoa | The Nursing Council Kaunihera
New Zealand + The
Tapuhi o Aotearoa
Nursing| The Nursing
Cohort Council
Report 2020 of New Zealand + The Nursing Cohort Report 2020 13This report has been constructed primarily from data collected by the Council
as part of its maintenance of the New Zealand Register of Nurses (the Register)
and the associated renewal of Annual Practising Certificates (APCs). Section
136 of the Health Practitioners Competence Assurance Act 2003 (the Act)
requires the Council to keep a Register of Nurses. The Council gives each
practitioner on the Register a unique registration number and records their
Health Practitioner Index number issued by the Ministry of Health.7
Annual Practising Certificates must be renewed
3.1 Data Collection Instrument
by practitioners each year at one of four points
depending on a practitioner’s date of birth: 1 July, The Council uses an online self-completed
1 October, 1 January or 1 April. The data for this questionnaire to collect data on the demographic
series is extracted from the Register as at the end and employment details of each nurse. The questions
of the first annual quarter, and thus the surveyed covered in this report relate to:
timeframe for the Cohorts in this report is 1 April + gender;
2013 to 31 March 2020.
+ date of birth;
Section 138 of the Act lists the mandatory
information the Council must keep in respect of + ethnicity;
each practitioner. This includes name, qualification(s), + current employment setting;
scope(s) of practice and any change to the scope,
and whether the practitioner holds an APC or Interim + current area of nursing practice;
Practising Certificate. This section also allows the + hours of work in an average week;
Council to collect information on “any other matters
… the authority thinks appropriate”. In addition, + geographic location of main practice; and
following amendments passed in 2019, s 134A of + completed qualifications, including country,
the Act requires the Council to provide specified provider and year of completion.
workforce-related information to the Director-
General of Health. It is under these sections that the The questionnaire is accompanied by the Guide to
Council has a mandate to collect additional data on completing your application for practising certificate,
the nursing workforce. which provides explanatory notes related to the
questions, and the codes for completing the ethnicity,
A Note on Timing employment, practice type, and geographic location
questions.
The Council operates on a financial year basis, in
which a given year begins on 1 April, and finishes on
Response Rate
31 March the following calendar year. This has been
used to define both the Cohort and annual divisions While it is not mandatory that nurses complete the
in the surveyed timeframe. However, for ease of survey, the Council has historically obtained a 100%
use, this report refers to years by their calendar year response rate. Recently, some nurses have chosen
end date unless otherwise indicated. For example, not to provide questionnaire data (compulsory
the ‘2020’ year refers to the period beginning on 1 information is still collected) and current total
April 2019 and finishing on 31 March 2020. Where response rates are therefore between 95% and
relevant, the Foundation Cohorts are referred to 100% in each year. Response rates for individual
as 2012/13 Cohorts to reflect that members were items within the questionnaire also vary. Non-
registered between 1 April 2012 and 31 March 2013. responses have been included in this report but are
recorded as Not Stated.
Other authorities, such as the Medical Council, carry out similar functions for relevant regulated professions under the same section of the Act.
7
14 Te Kaunihera Tapuhi o Aotearoa | The Nursing Council of New Zealand + The Nursing Cohort Report 2020Registered Nurse status is not added to the NZQN-
3.2 Constructing and Revising the
RN Cohort.
Cohorts
This report series began by comparing two sets of For each Cohort, age and gender data was taken
populations: those nurses who gained registration in from initial registration information. No data needed
the 2005/06 year, and those who gained registration to be imputed for these variables. Ethnicity data
in the 2012/13 year. The Council has now decided was initially taken only from registration data, but
that the 2005/06 Cohorts (representing nurses who following construction of the Māori and Pacific
are now in their fourteenth year of practice) should Cohorts a review was undertaken of these values as
be discontinued in favour of additional focus on discussed under Section 3.4 below. In addition, as
particular priority groups within the more recently- also noted in that section, changes to the Nursing
registered population. Specifically, the Council is Council’s recording of gender data mean that this
interested in highlighting the experiences of Māori variable is now being checked during preparation of
and Pacific nurses who registered in the 2012/13 reports in this series.
year.
Focus Cohorts
For that reason, those Cohorts previously referred
This year’s report introduces separate Focus
to as the 2012/13 Cohorts have been renamed
Cohorts that describe the profile and experiences
Foundation Cohorts. The individual nurses within
of particular groups of nurses within the overall
these Cohorts have not changed from those
Foundation Cohort populations. These are
reported in previous publications, although ethnicity
data has been revised as discussed below. Data for 1. All members of the NZQN-RN Foundation Cohort
the 2005/06 Cohorts is no longer being analysed who recorded New Zealand Māori as an ethnic
and reported, although some earlier data has been identity at least once when registering or re-
included to provide a historical comparison for registering. This is the Māori RN Cohort.
information in the current report.
2. All members of the NZQN-RN Foundation Cohort
who recorded at least one Pacific ethnicity as an
Foundation Cohorts
ethnic identity at least once when registering or
Using the Council’s records, three prospective re-registering. This is the Pacific RN Cohort.
Cohorts were constructed comprising all nurses who
registered for the first time between 1 April 2012 and 3. All members of the NZQN-EN Foundation Cohort
31 March 2013. These consisted of: who recorded New Zealand Māori as an ethnic
identity at least once when registering or re-
1. All nurses who gained entry to the Register registering. This is the Māori EN Cohort.
through the process for New Zealand Qualified
Nurses under the Registered Nurse Scope of The population of Pacific nurses in the NZQN-
Practice. This is the NZQN-RN Cohort. EN Foundation Cohort was very small, with only
11 members, and so a Focus Cohort was not
2. All nurses who gained entry to the Register constructed for this population. The membership
through the process for New Zealand Qualified of these Cohorts is not exclusive; Registered Nurses
Nurses under the Enrolled Nurse Scope of with both Māori and Pacific identities were included
Practice. This is the NZQN-EN Cohort. in the Māori RN and Pacific RN Cohorts.
3. All nurses who gained entry to the Register Ethnic identification can be a complicated area, and
through one of the processes for Internationally people may choose to change the ethnic group(s)
Qualified Nurses, and whose scope was recorded with which they identify for a range of reasons. Initial
as Registered Nurse. This is the IQN Cohort. review of Focus Cohort populations found that many
The division between New Zealand Qualified and people who did not identify with Māori or Pacific
Internationally Qualified nurses is based on the ethnicities at registration added such identification
country of registration qualification, not ethnicity in later years. For that reason, construction of these
or nationality. A New Zealand citizen who received Cohorts adopted an inclusive and comprehensive
their nursing education in the Philippines, for approach to ethnicity, in which a nurse from a
example, would be included in the IQN Cohort, Foundation Cohort would be eligible for inclusion in
while an ethnically Indian citizen of Fiji who was a Focus Cohort if they identified with the appropriate
educated in New Zealand would be included in an ethnicity(ies) at any point from initial registration
NZQN Cohort. Twenty-one members of the IQN through to 2020 (i.e. the year in which the Cohorts
Cohort reported at least one of their ethnicities were constructed).
as New Zealand European, and five identified as This approach has allowed the largest possible
New Zealand Māori. An IQN who later completed window for establishing Cohort membership.
postgraduate qualifications in New Zealand will still However, continuing to recalculate membership in
be counted as an Internationally Qualified nurse, every Cohort Report would mean constantly revising
as it is their qualification at time of registration historical data; for example, values recorded for
which determines Cohort membership. Similarly, a 2018 could be different in a report produced in 2020
member of the NZQN-EN Cohort who subsequently compared to the next report produced in 2022.
followed the formal pathway from Enrolled Nurse to Given this, membership of Focus Cohorts will be
Te Kaunihera Tapuhi o Aotearoa | The Nursing Council of New Zealand + The Nursing Cohort Report 2020 15fixed at 2020 and future reports in the series will not Accounting for Gender Diversity
reconstruct membership and re-analyse historical
When these nurses joined the Register, data
data based on ethnic identification in 2021, 2022,
collection allowed respondents to choose only Female
etc. This supports maintaining a consistent time-
and Male genders. The Council has recently updated
series, which is particularly important for longitudinal
its database and (re-) registration materials to
reporting and analysis, including workplace planning.
reflect the right of people to identify with non-binary
genders and have this reflected in official records.
3.3 D
efining annual populations As a result, nurses are now able to record a Gender
over time Diverse identity. This reflects Statistics New Zealand’s
official standard for recording gender.8
There are at least three different ways in which the
overall number of nurses (the denominator) can be The Council and the authors of this report recognise
defined for the purpose of looking at annual statistics that gender is a complex and sensitive area, and
such as the percentage who are working in a respect the right to gender self-identification. As a
particular practice area or a given region. These are: result, from this point onwards gender data will be
rechecked during the preparation of future reports
The total population. This includes all Cohort
1.
in this series. As of 2020, only one member of the
members, irrespective of whether or not
overall population (a member of the NZQN-RN
they are still in the nursing profession. This
Foundation Cohort) has identified as Gender Diverse,
is the population used for constructing the
and no members have changed identification from
demographic profile of each Cohort.
male to female or vice-versa. As reflecting this
2. The active practising population. This consists of information in the demographic tables may have
everyone in the Cohort who is currently working privacy implications for the person who identifies
as a nurse. It excludes Cohort members who as Gender Diverse, we have chosen not to update
have not maintained an APC, or who have kept relevant tables and instead acknowledge gender
their APC but are not actually working as nurses. changes in an explanatory note. This decision will be
It does, however, include nurses who are not revisited in the future if more members of the Cohort
working in New Zealand. choose to identify as Gender Diverse and/or otherwise
amend their gender, and the risk of privacy breaches
3. T he New Zealand practising population. Like the
reduces as a result.
active practising population, this is based on
Cohort members who are currently working as
Recalculating Ethnicity
nurses. However, it excludes nurses who are not
working in New Zealand (i.e. who state that their To date, this publication series has included
main practising region is Overseas). information on the ethnicity of participants as part
of the initial profile of the Cohort populations.
For this report series it has been decided that the Reports have presented the ethnic identification of
New Zealand practising population is generally the participants as at the point they joined the Register
most relevant population group. The exception to and not recalculated this data each year. While a
this is information on ‘Practising Region’; in this case, small group of nurses chose to change their ethnic
it has been agreed that for New Zealand Qualified identification each year, this was not a focus of
Nurse Cohorts (not Internationally Qualified Nurses), the reports and it was deemed more important to
including information on the percentage of Cohort maintain a consistent demographic profile of the
members who are practising outside New Zealand is population at a particular point in time (i.e. when they
relevant to understanding the experience of Cohort began to practise).
members. Reporting of this information uses the
active practising population instead. Note that this is However, as discussed earlier, this year’s report has
used only for identifying the main region in which involved the construction of new Focus Cohorts
New Zealand Qualified Nurses are practising – for that explore the experiences of nurses from specific
other variables the New Zealand practising population ethnic groups. Determining membership of these
is used. populations took an inclusive and comprehensive
approach, in which a nurse who identified as Māori
or with at least one Pacific ethnicity in any year over
3.4 Altered Variables and the surveyed timeframe (registration to 2020) was
Reporting Approaches included in the relevant sub-Cohort.
The development of this year’s report has involved As part of this process, the authors have taken
changes to several variables. These stem from a mix the opportunity to review and revise the ethnic
of changes to the data collection questionnaire and identification of the Foundation Cohorts in the
approaches to analysing that information.
See Statistics New Zealand. (2015). Gender Identity. At http://archive.stats.govt.nz/methods/classifications-and-standards/classification-related-
8
stats-standards/gender-identity.aspx. The Gender Diverse category includes transgender, non-binary and other identities. It is important to
recognise that some people who do not identify with the gender they were assigned at birth may record a gender with which they do identify
(i.e. male or female) rather than identifying with a separate gender diverse category.
16 Te Kaunihera Tapuhi o Aotearoa | The Nursing Council of New Zealand + The Nursing Cohort Report 2020same way as Focus Cohorts. For example, a Cohort However, 10 members of the NZQN-RN Cohort and
participant who identified as Chinese at registration two members of the IQN Cohort listed practising
but in 2016 changed their ethnic identification to locations that sat across multiple New Zealand
both Chinese and Samoan is now included as part regions. These nurses have been counted once
of both populations. Similarly, participants who did under each region for which they reported at least
not provide an ethnicity at registration but did so in one location. For example, a nurse practising in
later years now have that information recorded. This Kaipara, Whangārei and Rodney would be counted
was done primarily to ensure consistency between once under the Northland region (for Kaipara and
Foundation and Focus Cohorts; for example, the Whangārei) and once under the Auckland region (for
number of Registered Nurses from Pacific ethnic Rodney).
groups is the same in both the NZQN-RN and Pacific
RN Cohort chapters. However, it also provided a New Employment Settings
useful review point for ensuring that baseline profile Changes have recently been made to the list of
information is in keeping with how Cohort members employment settings used in the questionnaire.
may have chosen to identify themselves over time. Specifically, Public Hospital (DHB) and Public
The Other ethnicity category was handled slightly Community Service (DHB) have been added to
differently from others. When it was clear from the list of possible options. To reflect this and to
responses in later years that this referred to another preserve consistency with earlier publications in this
existing category, this response would be recoded series, these responses have been recoded to DHB
to that category. For example, if from 2015 a (Acute) and DHB (Community) respectively. Where
respondent specified that their Other ethnicity was this would have created duplicate entries – for
‘Welsh’, their ethnicity would be recoded as Other example, a respondent that originally listed their two
European. This is in keeping with policies for recoding employment areas as Public Community Service (DHB)
Other ethnicity responses when Cohort profiles were and DHB (Community) – the second entry has been
originally established. removed from the dataset. Future reports and other
workforce publications may follow different reporting
As a result, the ethnicity demographics presented approaches.
in this report for the Foundation Cohorts differ
from those in earlier publications in the series. For
example, in the NZQN-RN Cohort the number of 3.5 Notes on Interpretation
New Zealand European nurses has risen from 1,077 Unless otherwise indicated, percentages in this
to 1,115, and the number of Indian nurses from 95 report have been rounded to the nearest whole
to 101. Appendix B lists the ethnic identification of number in text and to one decimal place in tables. A
each Foundation Cohort at registration and after this value of ‘0.0’ in a table indicates that a value has been
year’s revision. This is a one-off recalculation and will rounded to zero, while ‘-’ indicates the original value
not be repeated for future reports. was zero.
Multiple Practice Regions Practice Areas and Direct Care Nursing
The Practising Region item in the data collection Not all forms of nursing practice involve working
instrument asks nurses what they consider to be directly with patients, the public, and other
the main geographic area in which they practise. consumers of health and support services. The
In most years respondents have only been able to Nursing Council recognises this by including the
provide one response but, due to changes in the non-‘Direct Care’ roles of Nursing Administration
data collection instrument, in 2020 nurses were & Management, Nursing Professional Advice/Policy,
able to report multiple areas. Most practitioners Nursing Education and Nursing Research as defined
continued to list only one area, and when multiple practice areas in its data collection instrument.
ones were listed they consisted of a small number of
Following standard practice in New Zealand, this
areas that fell within a single aggregated region (e.g.
report treats nurses who work in only these areas
listing Ashburton and Timaru, which are part of the
equally to those who provide services directly to
Canterbury region).
individuals and communities and are considered
As this and other workforce publications report part of the practising population. However, relevant
geographic data using aggregated regions rather sections of this report do include information on how
than individual areas, the reporting of multiple many within the Cohort are only practising in one of
regions has had minimal impact on analysis. For the four areas above. Note that for these purposes a
example, a practitioner who stated that they practise nurse who reports both a Direct Care and a non-
in both Kaipara and Whangārei would simply be Direct Care area – for example, Nursing Education and
noted once, as practising within the Northland Public Health – will be counted as working in Direct
region. This avoids double-counting. Where one of Care.
the listed areas was overseas, the nurse has only
For context, the OECD’s ‘practising’ definition
been counted as part of the Overseas region; the
corresponds only to nurses working in Direct Care
authors have assumed that other area(s) reflect their
areas, while its ‘professionally active’ definition
practising location when last in New Zealand.
encompasses all of New Zealand’s practising nurses.
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