Nursing students are rejecting careers in aged care. A staffing crisis is coming

Samantha Heath, University of Waikato

A ministerial advisory group delivered a blunt verdict on the state of aged care in New Zealand last week.

The system, as it stands, cannot cope with the projected rise in the number of New Zealanders aged 65 or over, from 950,000 today to 1.3 million by 2040.

Without change, the report warns, New Zealand faces a shortfall of more than 9,000 residential care beds within a decade. Problems are already emerging through workforce shortages, bed closures and overstretched carers.

The report states plainly that aged care cannot be delivered without a stable, well-trained workforce. It recommends developing a strategy to promote aged care as a career and expand the recruitment pipeline.

But workforce training and accreditation fell outside the advisory group’s mandate. As a result, its recommendations focus largely on attraction, marketing and immigration settings, rather than on the students already enrolled in health professional programmes who are deciding, well before graduation, that aged care is not for them.

This gap matters. A reform programme of this scale cannot solve a shortage it was never asked to diagnose. No marketing campaign or immigration setting will close a workforce gap of this magnitude on its own.

What’s at stake

This is not an abstract problem. It affects whether older New Zealanders receive care when they need it.

Even if New Zealand built more beds and redesigned funding models, the recommendations outlined in this report rest on a workforce that will not exist as long as new graduates continue to opt out of aged care.

Many nursing students, and students in other health professions, decide against aged care early, often well before they qualify. That decision begins during placement, not in response to a recruitment campaign.

A national study involving more than 700 nursing students across 11 New Zealand polytechnics shows reluctance towards aged care commonly developed during undergraduate education, long before students chose their first job.

Subsequent research has explored why. The placement experience matters enormously. For many students, an aged-care placement is a shop window into the sector. It is often their first substantial exposure to aged care and, for some, their only one.

What they see there, rightly or wrongly, shapes their perception of aged care as a career for years afterwards. If that first encounter presents aged care as an under-resourced and undervalued corner of the health system, no amount of downstream reform will easily undo that impression.

Not an attitude problem

It is tempting to interpret this reluctance as an attitude problem, as though students simply do not want to work with older people. Recent research suggests otherwise.

Students are not rejecting older people; they are responding to the conditions in which care is delivered. What shapes their perceptions is not the people receiving care, but the environments in which that care occurs.

This is not an isolated observation. The Nursing Council’s independent review of nursing education, published in January this year, identified the same concern. Aged-care providers emphasised that residents’ needs are increasingly complex, often requiring care that resembles specialist gerontological or palliative practice.

Some education providers continue to use aged care as a first-year placement largely because it is available, not because it offers the strongest introduction to contemporary nursing practice.

The review recommends new guidance on what constitutes a quality clinical placement – one in which students work alongside experienced aged-care nurses managing genuinely complex care, rather than simply observing personal care tasks.

A workforce already short on regulated staff

New Zealand’s aged residential care sector relies heavily on an unregulated workforce. Workforce data estimate about 16,300 personal-care assistants and carers for the aged or disabled, compared with only 2,100 registered nurses – a ratio of almost eight care workers for every registered nurse.

An infometrics report commissioned by the New Zealand Nurses Organisation estimates aged care is short of 1,550 registered nurses to meet safe staffing levels.

Left unaddressed, this gap will continue to be filled by unregulated healthcare assistants doing work once done by registered and enrolled nurses, with less training and no scope of practice to legally define the exact limits, duties and tasks that can be performed.

Care complexity in aged care is rising. Regulation of who delivers it is not.

No beds without a workforce

The advisory group concluded fundamental reform of the aged-care sector is the only option. It applied a sense of urgency to beds and funding.

The same urgency must apply to placement quality and nursing education. Otherwise, the workforce those beds depend on will not exist by the time they are built.

The workforce cannot be treated as a separate component of reform. It is central to whether reform succeeds at all.

Improving placement quality requires no new beds and comparatively little additional funding. It requires recognising, in partnership with educators and providers, that clinical placements are one of the most powerful influences on the future choices of healthcare graduates.

Get the shop window wrong, and the workforce this report is counting on may simply never walk through the door.

This article is republished from The Conversation under a Creative Commons license. Read the original article.