EDITORIAL
Vol. 23 No.1 - 2007

In 2005 funding was announced by the Minister of Health for the development of a national framework for the first year of practice for new graduate nurses. A year on from the implementation phase of this national project a number of District Health Boards (DHBs) are about to produce graduates from their first Nurse Entry to Practice (NETP) programme. It is timely to reflect on the past year and also consider the future direction of the programmes.
The national project came about after many years of lobbying from a variety of nursing groups. Their concern arose from what appeared to be poor outcomes from many informal hospital programmes that had varying degrees of success in retaining this valuable component of the nursing workforce – namely new graduates. Exacerbating local nursing workforce shortages was the fact that many New Zealand graduates were taking up opportunities overseas where it appeared they would be part of well supported new graduate programmes.
The national project is part of wider DHB collaborative work through the Future Workforce programme and was planned to build on a successful pilot programme undertaken by three DHBs in 2002. While the sector probably felt the time delay between the pilot and the national project was unnecessary, it did allow key lessons from the pilot to be well considered and integrated into the final specification and form the foundation of the national framework.
The following main themes emerged from the pilot as the basis of a well structured graduate nurse programme: supernumerary time, the opportunity for flexible clinical load sharing where graduates could settle into their new environment without the pressure of a full patient workload and preceptorship which recognised the need for an identified designated preceptor for each graduate – someone who understood the graduate’s learning needs and was available to provide support and feedback. Two further elements were centred around education: the need for a well structured education programme for the new graduates and also education and support for the preceptors (Ministry of Health, 2004).
Many within the profession will feel that these themes are so well understood by the sector that the process of providing support to the new graduates and preceptors should already be in place. However, anecdotally, it seems that for many DHBs the implementation of the NETP programme specifications has demonstrated that it continues to be difficult to deliver these elements, while at the same time juggling the core business of patient care and trying to develop and support the new graduate nursing workforce.
The next phase of the journey will see this project implemented outside the secondary service setting. Traditionally a significant number of New Zealand’s new graduates have found their way into the aged care sector where many feel the availability of a supported first year of practice programme is long overdue. This situation raises the question of where the priority should lie - in the fast paced secondary sector with acutely unwell patients but where, potentially at least, there is registered nurse support, or in the aged care sector. The latter has an increasingly complex ageing population and limited or no registered nurse support. It is fortunate that in the near future both the aged and primary sectors will have access to funding through their local DHBs to support their new graduate nursing workforce, and so the above conflict should cease to exist.
The infrastructure needs and work practice issues experienced by the secondary service provider arms in the last year will also be felt by these other parts of the sector. While hospitals have traditionally had supported programmes, this will be new territory for the primary/aged care sector. The challenge will be for nursing leaders and organisations across the sector to support this initiative regionally to ensure the successful retention of the new graduate nursing workforce.
The initial national project draws to an end in June 2007. Anecdotal reports suggest that it has been successful and demonstrates to the health care sector an excellent example of work undertaken across a number of national organisations: District Health Boards NZ (DHBNZ), the Ministry of Health (Clinical Training Agency) and the Nursing Council of New Zealand. A formal evaluation process will be undertaken over the next few years with organisations and the graduates themselves to ascertain the impact of these programmes on the retention of our new graduate workforce.
Currently all DHB secondary service provider arms are engaged in delivering a NETP programme and within the nursing sector this development has been acknowledged as one of the more significant events for New Zealand nursing in the last decade. When we consider the dire predictions about the nursing workforce numbers in the future, an appropriate level of support during the first year of clinical practice remains the most cost effective way of ensuring nursing and the health services of New Zealand do not face critical staff shortages.

Kerry-Ann Adlam, RN, MN, MCNA(NZ)
National NETP Programme Co-ordinator
Director of Nursing
Taranaki District Health Board

Reference
Ministry of Health. (2004). New graduate first year of clinical practice nursing programme.
Wellington: Author.