Nursing Council Announces Future Changes to Assessing IQN Competence

5 September 2022

Te Kaunihera Tapuhi o Aotearoa The Nursing Council of New Zealand has announced that it will introduce a new model for registering nurses educated outside Aotearoa New Zealand. From the beginning of 2024, we will directly assess a nurse’s competence to practice safely rather than relying primarily on documentation.

This new model is similar to the approach now used in Australia, the United Kingdom, and some other jurisdictions. It will involve directly assessing an applicant’s knowledge, skills, and capabilities over three main steps:

An online exam that tests a nurse’s theoretical and conceptual nursing knowledge. This will be based on the State Final Examination that domestically-educated nurses must pass to be registered.
An education module that introduces nurses to the key features and environment for nursing in Aotearoa New Zealand. This will cover the position of Te Tiriti and its importance for nursing, the specific way we approach concepts like cultural safety, the health and disability system, and our culture and expectations of nursing practice.
An Objective Structured Clinical Examination (OSCE). This will test a nurse’s clinical and professional skills in a simulated environment.

As part of this, we will also be introducing a clear dedicated path for those Internationally Qualified Nurses (IQNs) who wish to join the Register as Enrolled Nurses.

“We are confident this new model will preserve public safety, which is our core statutory role, and reflects modern good practice in regulation” said Catherine Byrne, Chief Executive and Registrar of the Nursing Council. “Requiring all nurses to complete an education module also helps ensure that from day one they understand the unique environment, culture, and expectations of nursing in Aotearoa New Zealand – including our specific approach to concepts such as cultural safety.”

Byrne also noted that this will reduce the compliance burden on international nurses wanting to practise here. “Because we will assess nurses’ competence directly, we can reduce the amount and type of other evidence we require. For example, rather than requiring a minimum number of recent practice hours, we will only be asking nurses to have practised for at least a year after gaining their initial qualification.”

The Council consulted on the new model over April and May this year through meetings, requests for written submissions, and an online survey. The Council received over 400 written and survey submissions on this issue – the largest response to a consultation round in its history. These responses expressed high levels of support for the proposed changes. Seventy-five percent of all survey respondents (and 79% of internationally qualified nurses) clearly supported moving to an exam and clinical assessment model, and 81% supported introducing an education module for all nurses.

What does this mean for current and new international applicants?

Our target date for implementing this new model is the beginning of 2024. If you are an IQN who is currently applying, being assessed, or considering coming to practise in Aotearoa New Zealand these changes will have no immediate effect on your application.

Over the next year we will be working with IQNs, employers, and other stakeholders to develop a fair transition process for any IQN who is still being assessed when the new model comes into effect. This includes working with CAP providers to ensure that nurses currently required to complete a CAP course are able to do so before the introduction of the new model.

We are committed to ensuring that international nurses are treated equitably, and avoiding disruption to current flows of nurses.

What does this mean for CAP?

When the new model is in place, nurses will no longer need to complete a Competence Assessment Programme (CAP) before joining the Register. Recent research and feedback to us has also shown that international nurses value the pastoral care elements of these programmes. Although most (58%) of respondents in our consultation favoured removing CAPs, many highlighted such aspects as worth preserving.

We will be working to ensure that these positive elements of the CAP experience are maintained under the new model. We want to engage with CAP providers to explore how we can do this, recognising their experience and expertise in orienting new nurses to practice in Aotearoa New Zealand.

Competence Assessment Programmes are also used by some nurses who have not practised in some time and want to return to work. We will be working to ensure return to practice programmes continue to be available for these nurses.

How much will the new model cost?

We have not yet set a fee structure. A set of fees that is affordable for applicants and will sustain the system will be developed over the course of 2023. We are confident that the total cost for applicants will be less than the current cost of completing CAP programmes.

Please note that the Government has recently announced a financial support scheme for nurses who need to complete CAP programmes. Further information about this can be found on the Te Whatu Ora website at https://www.tewhatuora.govt.nz/for-the-health-sector/nursing/internationally-qualified-nurses-cap-fund/

How will the new model be delivered?

The conceptual exam will be delivered online and nurses will be able to sit it overseas. This has been enabled through the Council’s recent move to digitise and update the current State Final Examination for domestically-qualified nurses.

The OSCE will be delivered in Aotearoa New Zealand Zealand and able to be completed in one day. We are also considering the inclusion of a short pre-OSCE orientation to support and explain the process to applicants.

We have heard a variety of views from the sector on whether the learning module should be delivered online or in Aotearoa New Zealand. We will explore delivery options during the development phase, but are committed to ensuring that large online elements and/ or options are available.

What is an OSCE?

An OSCE tests practice skills through a series of simulated clinical settings (‘stations’). In each station, an applicant is individually assessed for their performance during a specific clinical scenario designed to test a particular skill area. These types of assessments were initially developed in the 1970s and are commonly used for assessing health professionals across the globe. For example, the Medical Council of New Zealand uses an OSCE format for its NZREX Clinical assessment of international doctors.

How is the education module different to Competence Assessment Programmes?

At the moment, CAPs are not primarily intended as learning experiences; they are programmes through which a nurse can demonstrate they are competent and safe to practise in Aotearoa New Zealand. In the new model, conceptual competence is assessed through the initial exam and clinical competence is assessed through the OSCE. The education module will be designed specifically to teach IQNs about what it means to be a nurse in Aotearoa New Zealand, and how our context for health and practice might be different from the countries in which they were originally educated and have practised since then.

Completing this education module will take significantly less time than a CAP. It will also not have a clinical placement component.

In addition, under our current model only some nurses have to complete CAPs. Under our model all IQNs will receive a common and consistent orientation to being a nurse in Aotearoa New Zealand, in addition to what may be provided by their employer.

Will all nurses have to complete all steps of this model?

The Council has the ability to introduce alternative pathways to registration. During the development phase we are likely to explore options for nurses educated and registered in our peer International Nurse Regulator Collaborative jurisdictions (Ireland, Singapore, the United Kingdom, and some states in Canada and the United States). We also intend to explore pathways for nurses educated and registered in Pacific nations.

Irrespective of any such pathways, all IQNs will be required to complete the education module, as this is not designed to assess competence but introduce our specific nursing environment.

This new model will not affect nurses registered in Australia. They will retain their right to registration under the Trans-Tasman Mutual Recognition Act 1997.

How is the new model being developed?

Over the next 15 months the Council will work with the sector, national and international experts, and contracted partners to develop detailed elements of the new model. This time is needed to ensure that assessments are fair, calibrated appropriately, and comprehensive. We also need to make sure that the necessary delivery and assessment infrastructure is in place. It will also allow for a transition process to be developed that avoids unnecessary disruption for international nurses, their employers, and the health and disability support system.

We understand that, given current workforce pressures, some would like us to implement this new model more rapidly. However, we need to make sure that the model we introduce is fair to IQNs, robust, and defensible.

While the new model is under development, we will continue refining and enhancing our current assessment processes. This includes working with other agencies and employers on measures such as reducing unnecessary duplication of documents.

We will provide regular updates on the development process, including specific updates for key groups such as CAP providers. We are committed to being open about the decisions we make and why we make them.

How does the Council’s decisions reflect its original proposals?

The consultation period found significant support for our proposals. However, we have a large and rich body of feedback from this consultation that will inform how we develop the new model. The decisions we made around our English Language policy were announced on August 15.

The Table below shows the proposals on which the Council sought feedback, and the decisions we made as a result.

What We Consulted On	What We Decided
Introducing an exam and practical assessment for IQN assessment, including a dedicated process for Enrolled Nurses.	We will introduce an exam and practical assessment to assess internationally qualified Registered and Enrolled Nurses.
Removing all requirements for post-registration experience, as we are now directly assessing competence.	We will require IQNs to have at least 12 months post-registration practise experience, with the ability to waive this at the Council's discretion.
Introducing pre-entry education focussed on Te Tiriti o Waitangi, cultural safety, and the context for nursing in Aotearoa NZ.	We will introduce a compulsory pre-entry education programme, as proposed.
Introducing requirements for a period of supervised practise before registration.	We will not introduce pre-entry practice requirements, but will explore the possibility of good practice guidance for employers, including supervision.
Introducing requirements for post-registration education.	We will not introduce post-registration education requirements, but will explore the possibility of good practice guidance for employers including education for IQNs.
Moving away from CAP as an assessment tool.	We will cease using CAPs to assess competence of IQNs once the new model is implemented. But we will explore how the experience, expertise, and positive dimensions of CAPs and their coordinators may be preserved to support IQNs.
The future use of conditions on practice for some newly-registered IQNs.	The Council will continue to include post-registration conditions on IQNs where appropriate (e.g. where an applicant is only qualified to work in a specific practice area).
The use of alternative pathways to support and expedite registration for some groups of nurses.	The Council will develop expedited pathways, focusing initially on our INRC peers.