What was this consultation about?

Over 2020, the Nursing Council developed and consulted on new Education Standards for programmes leading to Registered Nurse (RN) registration. These came into effect in 2021, and can be found on our Standards For Programmes page.

Although the new Education Standards had not specifically explored what number of clinical hours might be appropriate in an RN qualification, the draft standards that went out for consultation had included a smaller minimum requirement. There was significant opposition to this move, and following consultation the Council decided that the number of hours should remain at 1100.

Over 2022, some nursing leaders approached the Nursing Council with requests that the minimum number of required hours be revisited. Arguments for doing so included the increased and extensive use of high-quality clinical simulation, and the larger number of students who might be requiring clinical placements in the coming years as nursing student numbers increased.

The Council agreed to consult on this specific issue, putting forward three options and seeking the sector’s views on them:

Retaining the current minimum requirements set out in the Education Standards.
Reducing the total minimum number of hours in clinical placements to 900 (while retaining the current requirements regarding minimum hours in the third year).
Retaining the current minimum requirements, but allowing up to 200 hours over the first and second years to be completed through simulation.

How was this consultation conducted?

The Council carried out consultation over October 2022. To help people consider their position and views we undertook a background review of relevant academic literature and requirements in other jurisdictions and made this available. You can download this below.

Clinical Hours Background Document
The consultation itself involved a short ‘fast feedback’ questionnaire, the opportunity to make written submissions, and two focused meetings: one with leaders of Schools of Nursing, and one with Directors of Nursing in former District Health Board regions.

What did we hear from the consultation?

The Council received a total of 204 submissions: 177 of these were from individuals and 27 from organisations. Nine organisational submissions were received via the feedback questionnaire, while 18 were received via separate written submissions. A summary analysis of the consultation can be downloaded below, and those submitters agreed to have their written responses made public are included at the end of this page:

Consultation Overview

Overall, respondents favoured retaining the status quo of 1100 hours with a significant number also in favour of incorporating some simulated hours (Option Three). There was little appetite for simply reducing the number of hours. This was especially apparent amongst the individual responses we received; the organisations who submitted to us were more split between options, with especially strong support for simulation from tertiary education providers making it the most popular option.

Table 1: Support for clinical hours options Submission

Submission Type	Option 1: Status Quo	Option 2: Reduction	Option 3: Simulation	No Clear Preference	Total
Individual	46.9%	18.1%	33.9%	1.1%	177
Organisation	25.9%	18.5%	37.0%	18.5%	27
Total	44.1%	18.1%	34.3%	3.4%	204

We did also allow respondents to indicate a second preferred option. Once these are included, 44% of consultation respondents would accept the status quo (Option 1), 40% would accept simulation (Option 3), and 17% would accept a reduction in hours (Option 2). However, the majority (51%) of those who favoured the status quo – the most popular first choice by a large margin – did not accept any other option, while 54% of those who favoured simulation – the second most popular first choice – favoured the status quo as their second choice.

Although this consultation related purely to the number of hours required in clinical placements, participants did take the opportunity to raise a number of other issues around the placement experiences. A particularly prominent theme amongst respondents who favoured Option 2 was the pressure that placements created on students. These issues were out of scope for this particular consultation, but will inform the Council’s future thinking.

We collected some demographic data from our respondents so that we could break these responses down and consider feedback from particular groups and perspectives.

Te Ao Māori and Te Tiriti Perspectives

No organisation that specifically identified as a Māori Health Service provider or as operating primarily with a Te Ao Māori perspective or health model, responded to the consultation. However, 32 of the 177 individual responses (18%) were from people who identified as Māori.

These respondents were noticeably less likely to support a reduction in hours compared to non-Māori; only 13% favoured this option compared to 20% of non-Māori. They were slightly more likely to favour retaining the status quo compared to non-Māori (50% compared to 47%), and also more likely to favour recognising simulation (38% compared to 34%).

Some respondents also noted that any change to hours requirements would require an exploration of Te Tiriti issues that might be involved. A related theme was emphasising the value of clinical hours for ensuring nursing students are adequately prepared to work with and care for Māori patients and their whānau. There were particular questions as to whether simulated clinical learning could appropriately substitute for kanohi-ki-te-kanohi experiences in this respect. The New Zealand College of Mental Health Nurses for example, argued that:

“From a Te Ao Māori perspective clinical hours are fundamental to Māori wellbeing as they reinforce the application of Māori values such as whanaungatanga, manaakitanga and wairuatanga in clinical practice. It is the intricate interweaving of cultural and clinical components which creates the specialised and distinctive practice of Māori mental health nurses.”

Views from Pacific Respondents

No organisations that specifically identified as a Pacific Health Service provider or as operating primarily with a Pacific perspective or health model, responded to the consultation. Fifteen of the 177 individual responses (8%) were received from participants who identified as being from one or more Pacific backgrounds.

Pacific respondents were very strongly in favour of retaining the status quo (60% compared to 45% of non-Pacific respondents). However, it should be noted that the actual number of responses was small.

Comments and written submissions did not raise specific issues around clinical hours for Pacific nurses or communities.

Student and Education Provider Perspectives

As well as engaging with education providers, the Council encouraged current and recent nursing students to take part in this consultation. Students made up the majority of individual responses, with 90 (51%) identify themselves as either a current student or a recent graduate.

These respondents were more supportive of both retaining the status quo and reducing hours than non-students/ graduates, while being notably less supportive of simulation (30% supported option 3, compared to 39% of non-student individual respondents). Importantly, however, the NZNO National Student Unit’s written submission expressed preference for the simulation option – making particular reference to learning lessons from COVID-19:

“We feel that the option to have 200 hours completed through clinical simulation labs is most appropriate for students at this time. Allowing 200 hours to be acquired in the first two years of study allows for any extenuating circumstances that prevent a student from being on placement for 1100 hours. We saw how this could have been incredibly beneficial to students when covid-19 first shut down Aotearoa and will continue to support students if something like covid, or severe illness were to disadvantage them.”

Nursing educators and education providers (a group which includes both individual and organisational respondents) showed notably less support for the status quo and notably more support for a reduction in hours than others. Although the status quo remained the most popular option, and an hours reduction the least popular, 27% of education respondents were in favour of option 2 compared to 16% of non-education respondents. Comments from written submissions indicate that a notable factor in this support for a reduction in hours stems from the pressure on organisations to find clinical placements; reducing the required hours would reduce this pressure on the education sector.

Support for simulation was particularly high amongst education organisations; of the 10 organisational submissions that favoured Option Three, eight were from the education sector (nine if the NZNO National Student Unit is included in this category). The position of Te Pūkenga Whiteria exemplifies this position, including referring to the quality of existing simulation practices in RN programmes:

“[Research shows]if simulation is well thought out and pedagogically sound, the effect of simulation in nursing education is equivalent to a clinical experience … Internationally, many countries are successfully using simulation for Nursing education. As an institution, Whitireia and WelTec have a long history of using simulation in Nursing education, it is embedded in all of our Nursing programmes: Bachelor of Nursing Māori, Bachelor of Nursing Pacific, Bachelor of Nursing, and Enrolled Nursing … We are confident in delivering high quality education to our ākonga and support kaiako in delivering high quality simulation education.”

However, even supportive submissions did often note the need for greater consistency and clarity in what the Council would expect of simulation. NETS (Nurse Educators in the Tertiary Sector) argued for:

“The importance of some central guidance on the underlying assumptions of simulation to be provided by the Nursing Council New Zealand that allows reporting entities to discuss learning and/or assessment through simulation, resourcing and risks consistently.”

What has the Council decided?

Considering this feedback alongside the consultation that was already undertaken in 2020 and led to the current Education Standards, the Council has decided to maintain the current minimum requirements of 1100 hours clinical practice in programmes leading to registration as a Registered Nurse.

Overall, consultation feedback showed:

Very little support for Option Two (reducing clinical hours), especially amongst Māori respondents.
High levels of support for Option One (retaining the current status quo of 1100 clinical hours).
Qualified support for Option Three (allowing up to 200 clinical hours to be completed through simulation), with especially strong support from nursing educators. However, a prominent theme in this area was the need for simulation to be accompanied by a formal education standard that would safeguard the quality of simulation education.

The Council does recognise the significant amount of literature and information provided around the value of simulation, including its current use by nursing schools. However, this has to be tempered against the concerns that some raised about both the appropriateness of simulation in some areas, and the need to ensure consistency of quality if this was to be formally recognised in the Education Standards. Te Whatu Ora Counties-Manukau summed up a common theme across submissions (including some that supported simulation):

“More needs to be understood about simulation before this can be a preferred option for us – at present this is variable between Nursing schools, with no expectations or standards in place, what would be NCNZ role in simulation oversight/regulation? and what impact would this have on curriculum/resourcing/funding to the tertiary sector? It is felt that simulation would not be suitable for mental health contexts.”

As a result, the Council has agreed to begin a programme of work to develop ‘good practice’ guidance for the use of simulation in nursing education. This will not rise to the level of a formal Education Standard. However, it will provide a basis for exploring some of the questions raised during consultation in more detail, including how simulation relates to and can support the specific requirements of nursing practice in Aotearoa New Zealand. This will be added to the Council’s work programme from 2024 onwards.

Below are the written submissions we received for this consultation and which we have been given permission to publish:

Candy Cassidy-Ellice College of Nurses Aotearoa
Directors of Nursing Fiona Murray National Directors of Mental Health Nursing NZNO Te Pukenga EIT Te Pukenga Unitec Te Pukenga WITT Te Pukenga Te Whatu Ora Te Tai o Poutini West Coast Te Whatu Ora Counties Manukau Te Whatu Ora Mid Central