Health of the Health Workforce

Dentists

In 2009, there were 1976 dentists with annual practising certificates registered with the Dental Council of New Zealand (DCNZ). This grew by 112 to 2088 by 31 March 2013; these are the latest figures available. In terms of head count, the ratio of practising dentists to the total population rose from 45.8 per 100,000 to 46.7 during this period.
In the past few years, the trend has been for roughly half of newly registered dentists to be New Zealand-trained. In 2012–13, for example, 48.2 percent of newly registered dentists gained their primary qualification overseas.¹¹
Other figures cited in this section are from the DCNZ’s 2009 workforce survey, the most recent available. In that survey, 2.8 percent of dentists identified as Māori and 1 percent as Pacific peoples.¹²
In common with other countries – and other health professions – dentist shortages are most apparent in rural areas. This is illustrated by the ratio of FTE dentists to patients in each of the 20 DHB regions.¹³
Just eight had more than 44 FTE dentists per 100,000 population in 2009. Five had fewer than 30 – Lakes, Tairawhiti, Whanganui, West Coast and South Canterbury. International comparisons of developed countries show ratios ranging from 44 to 94 FTE dentists per 100,000 population.
For information on other professions that provide dental care, particularly to children and young people, see the Allied health workers section of this report.

Nurses

The nursing workforce has grown steadily over the past five years. There were 51,387 nurses with annual practising certificates registered with the NCNZ as of 31 March 2014, including:

129 nurse practitioners

48,390 registered nurses

2868 enrolled nurses.¹⁴

Figure 4: Hard-to-staff communities for nurses on the 2015 Voluntary Bonding Scheme


This represents an increase of 5422 since 2009, when there were 45,965 practising nurses, and 2860 since 2011 (48,527).
Figures cited in this section are from the New Zealand Nursing Register as of 31 March 2014, unless otherwise stated.
The number of practising nurses per 1000 population has increased from 10.6 in 2009 to 11.4 in 2014. The Auckland region has the highest number per head of population, while Lakes, Bay of Plenty and Whanganui DHB regions have the lowest. See Appendix 3 for numbers of nurses per 100,000 population by DHB and in New Zealand as a whole.
Nurses currently work an average of 29.7 hours a week (just under 0.75 FTE based on a 40-hour week), down slightly on 2009’s average of 30.6 hours.
The practice area with the highest percentage of nurses is surgical (10%). The lowest percentages are in youth health (0.3 %) and family planning and sexual health (0.3%).
The Voluntary Bonding Scheme signals aged care (also known as continuing care), primary care and mental health, including addiction services, as 2015’s hard-to-staff specialties for nurses. The percentages of nurses currently working in these specialties are:

8.9 percent in aged care

4.7 percent in primary care

7.6 percent in mental health services

0.4 percent in addiction services.
Almost 1500 New Zealand-trained nurses graduated in 2013/14. In recent years, not all graduates have found employment immediately, but New Zealand will need to train nurses in greater numbers by 2017, when numbers retiring from the workforce will become critical.¹⁵
Nurse Entry to Practice (NETP) training programmes support nursing graduates in their first year of employment.¹⁶ Up to 200 extra NETP places will be funded in 2014/15, of which 40 will be in aged residential care (ARC NETP), bringing the total number of funded NETP places to 1300. Nurses can enter a NETP programme up to 24 months after graduating. An extra 25 nursing graduate scholarships are also available to work in GP practices in high-needs communities in 2015, in addition to the 48 scholarships funded in the past year.¹⁷
Nursing is an ageing profession. This is a trend common across health workforces in New Zealand and overseas. The average age of nurses is 46.4 years (this is lower in main centres and higher in rural areas) – up from 45.9 in 2009. In 2014:

54 percent of nurses have been in practice for 15 or more years

46 percent are aged over 50 – up from 40 percent in 2009.
Table 2: Nursing workforce statistics

Nursing workforce*
Size	Age 50+	Gender split	Ethnicity	Workplace^	Qualified outside New Zealand
51,387	46%	Female 91.7% Male 8.2%	European 90.7% Māori 6.6% Pacific 2.5%	DHB employed 52% Primary health organisation 12% Other 36%	26%

* Annual practising certificate data as of 31 March 2014.

^ Main place of employment.

West Coast DHB has on average the oldest nursing workforce, followed by South Canterbury, Wairarapa, Nelson Marlborough and Hawke’s Bay.
The risk of staff shortages becomes greater as the proportion of experienced nurses approaching retirement increases. This is a particular issue in specialty areas with the highest average ages, such as palliative care (for which the average age of nurses is 53 years, up from 50 in 2009) and mental health (for which the average age is 51 years).
As the age profile suggests, the New Zealand-trained workforce is at present skewed towards experienced nurses. Nurses who trained overseas are somewhat more evenly distributed with respect to age and level of experience.
Overseas-trained nurses make up 26 percent of New Zealand’s nursing workforce. Their average age is 43.1 years, compared with 47.6 years for New Zealand-trained nurses. Just over half of overseas-trained nurses come from Australia and the United Kingdom. The remainder arrive mainly from Asia.
As Figure 5 shows, the majority of registered nurses, both New Zealand- and overseas-trained, have more than 15 years’ experience.
Figure 5: Distribution of levels of experience for nurses trained overseas and in New Zealand


There is a demographic mismatch between the nursing workforce and the general population. The percentage of Asian registered nurses exceeds that of the Asian patient population in 16 of the 20 DHBs. In contrast, Māori and Pacific nurses are under-represented compared with the Māori and Pacific patient population across all DHB regions.
The percentage of Māori nurses is slowly rising – increasing from 3.6 percent in 2009 to 6.6 percent in 2014 – but the percentage of Pacific nurses has remained static at 2.5 percent since 2009. (The number of Pacific nurses is rising but so is the size of the overall nursing workforce.) Nursing is the second largest occupational group for Pacific peoples in the health and disability workforce, behind care and support workers (see the Non-regulated workers section).¹⁸ The majority of nurses who identify as Pacific peoples work in the greater Auckland area, home to seven in 10 of New Zealand’s Pacific population.
A further issue for the nursing workforce is that when economic conditions improve, the trend has been for nurses to exit the New Zealand workforce. Some leave the profession; others seek employment in countries such as Australia, where a shortage of nurses is forecast. This is expected to place further pressure on New Zealand’s future supply of nurses.
A nursing workforce programme is under way, a partnership between HWNZ, the Office of the Chief Nurse and the National Nursing Organisations. See our companion report, The Role of Health Workforce New Zealand, for more information.