More than a thousand job hopefuls inundated the 16 employers represented that day. All but three were recruiting for Australian roles, and of those hiring in New Zealand, only one was looking for nurses.  

Fair organiser and Healthdaq managing director Nathan Cox said two weeks on, recruiters were still working through applicants.  

They were, he said, “surprised” by the numbers of IQNs without New Zealand work rights, and that had made the hiring process more complex when few roles came with a job sponsor.   

Despite that, he said the fair was a success and “conservatively” estimates between 60 to 100 attendees will get a job offer.  

It wasn’t such a success for the Maningo twins, who did not even make the short-list – unsurprising given the odds, but still a blow after months of job hunting.  

“Honestly, if we had known that this is how hard it would be, maybe we’d have changed our mind about coming to New Zealand,” Tiffany Maningo says.  

But if they return, the twins worry about how they’ll be able to pay their family back the $68,000 (and counting) they owe – the equivalent of two million pesos. 

A WELL-TRODDEN PATH  

Nurses from countries like India and the Philippines are well aware setting their sights on New Zealand comes at a significant cost – but until very recently the required investment seemed low risk.  

Others’ success had long sign-posted their way here.  

Overseas-trained nurses make up a significant proportion of New Zealand’s nursing workforce. Close to half (44.7%) of all nurses with a practicing certificate are IQNs, according to Nursing Council figures.  

Of those in work in 2023, the majority of IQNs were first trained and registered in the Philippines (7,549) and India and Sri Lanka (a combined 5,618). 

The sheer number of those who’ve done it before is one of the reasons why Filipino nurse Sam made the move – despite first getting her nursing registration in Australia.  

“They said it would be easy to find a job,” the former neonatal nurse says. “My cousin works [in New Zealand], and she said, ‘we are always under-staffed.’ She’s always doing overtime.”  

But it hasn’t been so easy here. While Sam has a job in an aged-care facility now, it’s only part-time. 

THE PANDEMIC RUSH 

In the early years of the pandemic, New Zealand’s need for nurses was more certain. Covid’s arrival and the subsequent border closures came on top of a long-documented nursing shortage in the country.  

The acute need for nurses saw the then-Labour government add nurses to the Green List’s straight to residency category in December 2022 – as well as a funding programme to help repay IQNs for some of their course costs. 

New Zealand’s call for more workers has seen a notable spike over the last 18 months of new nurses who have registered to work here. 

The majority – 85% - of the 16,606 new nurses on the Nursing Council’s register in the year to June 2024 were from overseas. However, a large number of these may have just registered with the intent of coming but are yet to arrive. 

Of those new nurses, there were 5,321 IQNs who had likely arrived this year to complete the necessary in-country assessments before they could be added to the register. This is a 131% increase on the 2,299 who did the same the year prior. 

BIG MONEY

The individual cost to nurses who must come here to be assessed is not trivial – and combined, it’s worth millions, a significant proportion of which is injected into the New Zealand economy.  

Until very recently, those nurses have had to come here to do what’s called a Competency Assessment Programme (CAP), a multi-week programme involving both theoretical studies, as well as a six-week clinical placement, that can cost nurses more than $10,000 in course fees alone.  

For some, it’s their sole business. Others run it alongside a comprehensive range of other tertiary courses. Plunket only offers it to those nurses it's offered work to, for example, while Presbyterian Support, which runs the Enliven Cap programme, says it does not recruit for nurses from outside the country. 

But based on the numbers that did do the course in the last year, that’s at least $53.2 million paid across 19 accredited training providers around the country – not all of which would have been eligible for a refund.  

Then there’s the millions these nurses will collectively spend on accommodation, food and other living expenses across their minimum six weeks in the country.  

Accent Health Recruitment founder Prudence Thomson questions why the CAP courses continued to take in foreign students despite knowing how tight the market is right now.  

And she questions why some who do have extensive experience still have to go through an in-country assessment process in the first place.  

Thomson says while there are still nursing vacancies in New Zealand, there’s a sense many IQNs from non-comparable health systems need additional support to be able to work here.  

It angers her to see so many spending thousands on a dream with little chance it will come true.  

She says so many IQNs have arrived, it’s upset the balance of new graduate nurses and those new to the country to local nurses with experience. 

It appears that sentiment was shared within Health NZ / Te Whatu Ora. In February, job adverts were posted in Canterbury that explicitly said applications from nurses who’d just recently completed their Competency Assessment Programmes (CAP) would not be accepted.  

The adverts were quickly pulled, but weeks later, an Official Information Act request revealed the reason for that was an influx of new nurses putting pressure on a depleted pool of senior staff who would be required to support them.  

1News asked the Nursing Council whether it could consider putting a limit on the number of IQNs arriving in the country to take the assessment programme, or if it could work with Health New Zealand / Te Whatu Ora so that nurses could be linked to jobs before arriving.  

In a statement, the council spokesperson said no-one was available for an interview. It said the council’s role was to assess if nurses met its standards and is “unable to stop receiving, assessing and registering overseas nurses”.  

The spokesperson said it was unable to provide forecast data as nurses have two years to complete the process.  

1News also asked the Ministry of Health if it would look to limit those coming through. A spokesperson said it is aware of the concerns raised and would be working with the Ministry of Business Innovation and Employment (MBIE) to help align immigration policies with health workforce needs.  

They said IQNs who “choose to come on a visitor visa are making a personal decision to assume the financial risks with this pathway, understanding that employment is not guaranteed”. 

But for many whom the Nursing Council say must do a competency assessment course there is no choice – that must be done here.  

And that’s seen nurses who’ve pinned their hopes on New Zealand become vulnerable to those seeking to profit.  

Places like the large Indian state of Kerala are known as nurse-producing hubs – and with that has come a proliferation of agents in India who sway nurses into paying them in the hopes of making their overseas dream come true. 

India’s High Commissioner to New Zealand, Neeta Bhushan, said there are agents who have misled many nurses, charging them a fee for visas and enrolment costs, without informing them of the reality of job prospects.  

“Many of them have very good jobs elsewhere in India, in other places in the Gulf and so on. So, for them to leave those jobs, and move with their spouses and children, it concerns us a lot,” she said.   

The High Commission has since issued an alert to Indian nurses “not” to travel to New Zealand unless they have a genuine job offer and is working to crack down on dodgy agents based in India.  

But she also warns aspiring nurses “only to come if they have a genuine job offer”. 

It was a targeted ad that caught Indian nurse Dhanya Chandran’s attention.  

With 13 years of nursing experience, including 10 in the emergency department and eight of these working in Saudi Arabia, she believed her skills were needed here.  

She arrived in Aotearoa on May 31, having paid $1,000 to a recruiter, who she said did not make it clear until she arrived how tight the job market had become.  

Four months on, she’s considering returning to India, having spent thousands more on course fees, accommodation and other living expenses.  

NURSING DEMAND 

New Zealand’s job market has become tighter. The last year has seen the addition of thousands of new nurses to the workforce, while overall vacancies have dropped.  

Those on the frontline say the remaining budgets are tight, and they don’t have the capacity to support all nurses from overseas when many of their senior staff are struggling with their own workloads.  

Health New Zealand’s latest data shows the nursing pool saw its biggest rise in new full-time equivalent roles added to their books in the year to June.

What these figures don’t show is how many nurses are still needed. Figures obtained by 1News showed that overall nursing vacancies had dropped to around 2,000 – with the greatest area of need across mental health and critical care.  

Nurses at a recent conference in Wellington said the number of new nurses hired nationwide in the last year had made little difference for their areas.  

Waikato Emergency Department nurse Tracy Chisholm said it’s a daily struggle.  

New Zealand Nursing Organisation chief executive Paul Goulter said, if anything, the staffing crisis has worsened.  

The union obtained data via the Official Information Act which showed 90% of wards were understaffed 50% of the time in July.  

“It doesn’t matter what words Te Whatu Ora or the Government use. There is a [frontline hiring] freeze.  

“We’ve got this curious situation where we’ve got enormous vacancies in areas like emergency departments, and mental health. Yet we’ve got a surplus of internationally qualified nurses who can’t get jobs.  

Health Minister Shane Reti has repeatedly denied there’s a freeze on frontline staff and said the latest workforce figures reflect that - “the net result is an increase”. 

Te Whatu Ora chief executive Margie Apa told 1News there are still shortages “in areas like mental health, emergency departments, critical care ... it does take a lot longer to fill those places”.  

But the health boss said she’d be interested in hearing more about cases where nurses with in-demand skills have been told they can’t be hired because of budget constraints. 

GLOBAL CONCERNS 

The historic reliance on foreign nurses is seen by some as a sign of countries like New Zealand failing to invest adequately in their health systems.  

A recent International Council of Nurses (ICN) report said that reliance is “masking underlying issues in the domestic health systems ... such as poor retention rates, inadequate working conditions and insufficient domestic training capacity”.  

The report said the post-Covid bounce back has migration numbers reaching “crisis” levels globally.  

The average proportion of overseas-trained nurses in OECD countries has increased from 5% in 2011 to nearly 9% in 2021 – a figure that’s almost certainly risen further since.  

New Zealand sits well above that average, with 44.7% of its nurses on the register in 2024 originally trained overseas - though it's unclear how many of those are currently working here. The latest figures available from 2023 show of those nurses who were working, 36% were first trained overseas - a number that's expected to have risen significantly since.

ICN President Pamela Cipriano said it is “disappointing” to see via 1News’ stories the difficult situations individual nurses were being put in upon arriving in New Zealand. 

While she said these problems are not unique to New Zealand, the lack of clarity around the job market and registration does appear more “pronounced”.  

“The difficulty in the process in terms of bringing nurses in, the wait time, and the mismatch between what they expect when they arrive, versus the cost, and the duration of the training programmes, but then not having a guaranteed job.  

“That’s really something I would highly encourage be looked at by the Government ... because I think that’s where the major disappointment comes,” she said.

DIPLOMACY IN ACTION 

Earlier this year, Philippine officials met with the Maningo twins and representatives of the local Filipino community, who have been rallying to help the struggling nurses.  

The Philippine Embassy has since issued an advisory to its nurses yet to travel to New Zealand, cautioning them not to do so unless they have a solid job offer in place.

Philippine Ambassador to New Zealand Kira Azucena said she’s particularly concerned training providers continue to bring foreign nurses in while there are so few jobs.  

“That’s the root of the problem here,” she said. “If you keep on offering those programmes, you are in effect saying; ‘come here, take this programme, and you will be hired.’” 

But she said during an economic downturn, and amid the major reforms facing the health sector, it’s clear, “opportunities are just not there”.  

SYSTEMIC TWEAKS  

Azucena said Philippine and New Zealand officials have been working on how they can improve the pathway for foreign nurses.  

The two nations’ leaders recently signed a joint memorandum outlining the desire to “strengthen the relationship” and review “bilateral migrant worker arrangements”.  

Azucena said there has been some change since officials first aired their concerns.  

It’s understood a recent transition from the Nursing Council’s long-standing CAP programme to a shorter Objective Structured Clinical Examination (OSCE) was partially driven by their concerns.  

That change was revealed in December 2023 when the Nursing Council announced it would move towards fully implementing the OSCE process over a period of 18 months.  

The complete assessment involves a two-day orientation and preparation course, followed by the three-hour OSCE exam.  

It’s much shorter than the minimum six weeks the CAP process required, but it’s unclear how much difference that will make, given applicants must still come to New Zealand to do it.  

Having to be on visitor visas at a time when few employers are willing to sponsor nurses means the “root of our concern is still there”, Azucena said.  

Unlike other international students, nurses who come to New Zealand have come expressly for a course designed to get them working here. But because they come with zero work rights and aren’t eligible for any post-study visas, they need sponsorship. 

But many companies are reportedly more reluctant to sponsor nurses from overseas – and say they’re only able to consider those who already have work rights.  

Earlier this year, Immigration Minister Erica Stanford was questioned on whether she would consider offering foreign nurses a limited, one-off work visa to make that process easier.    

Her response was “many nursing jobs are available - if they are unable to get one, it indicates to me that they should not be in New Zealand”.

According to the Ministry of Health, work is in the pipeline to help “align” immigration policies with workforce needs, with MBIE leading a review of broader immigration settings in 2025.  

But even those who have a visa are finding the job market tough. Canadian Renee Antoniuk was lured to New Zealand by her childhood memories of travelling across the South Island in a motorhome with her family.  

In early 2021 she graduated as a nurse, and now has four years working in medical, palliative and emergency specialties on Prince Edward Island, Canada.  

She arrived here in early September, on a working holiday visa. Her partner, who is a mental health nurse, was offered a job in Wellington, but she said they were told due to budget restrictions they were no longer able to hire him.  

And Antoniuk is also struggling to get clarity from the Nursing Council around what she needs to do to be registered here.  

Despite lodging her credentials for assessment five months ago she’s still waiting to hear back if it’s been approved, or if she’ll need to go through the new OSCE examination in Christchurch.  

Antoniuk said that lack of clarity is making it even harder for her to secure a job. 

For many, that lack of certainty around work here has seen them turn to Australia, where they can move to once registered in New Zealand, thanks to the Trans-Tasman Mutual Recognition Act of 1997.  

The Act allows for certain types of occupations registered on either side of the Tasman to undergo a more streamlined registration process. 

Australia’s Health Practitioner Regulation Agency’s 2022 – 2023 annual report shows thousands looked into working across the Tasman.  

In total, 7,848 nurses from New Zealand registered in Australia, a 164% increase on the year prior, when 2,968 registered. 

It’s a number far greater than the 262 internationally qualified nurses who came here.  

The ICN said that could be a sign of a health system that’s relied so much on its international workforce that it’s masked high staff turnover, inadequate working conditions and insufficient domestic training.  

The Maningo twins are now looking at using New Zealand as a stepping stone.