Nearly one in three nursing students drop out before qualifying, due to financial pressure, family responsibilities and other factors made worse by COVID-19.
At the same time, health boards and rest homes are spending hundreds of thousands of dollars trying to attract nurses from overseas to fill an estimated 4000 vacancies.
Jade Power began her nursing degree at Otago Polytechnic two-and-a-half years ago, at the start of the pandemic.
On top of their demanding course load, she and her fellow students must clock up 1100 unpaid hours' working in hospitals and other health settings.
Due to COVID-19 and workforce shortages, there had been less support for students on those placements, she said.
"They've really been needed as another pair of hands.
"Working 40 hours for placement and then trying to do shift work - I work as a care assistant- trying to do shifts on the weekend or where I can. It's certainly a concern for students because are they going to be burnt out before they even start the profession?"
A report from last June commissioned by district health boards found 29 percent of nursing students enrolled between 2010 and 2017 dropped out.
Students enrolled after 2018 were not included because they were not due to graduate before 2020.
But there's some evidence that the drop out rate has accelerated since COVID-19 began.
Power, who also chairs the national student unit of the Nurses Organisation, admits the pressure has made her second guess her career choice.
"I can't say I haven't thought about it, it's been very challenging. The staff shortages and the pay equity [campaign] and just everything that's going on at the moment is just making nursing students question their decision to become nurses because it's scary out there."
The drop-out rates for Māori and Pasifika students are higher - averaging 33 percent over five years between 2012 and 2017 for Māori, and 37 percent and trending up for Pasifika.
Another student rep, Waiharakeke Biddle from Te Whare Wananga o Awanuiarangi in Whakatāne, said if the health system wanted a more diverse workforce, it needed to make it easier for them to stick the course.
For single parents and those in financial hardship, it was almost impossible to do a nursing degree, she said.
"There's no consideration that you're more than just a student."
She counted herself lucky to have received scholarships - but even then, money was still very tight and sometimes study time had to be sacrificed.
"I usually take maybe a Monday and a Friday off every second week just to get some working hours."
Free fees and paid placements would help more nursing students graduate, she said.
Auckland University of Technology head of nursing professor Stephen Neville said COVID-19 had had a massive impact.
"We've had anxiety among students, students having to stay home and look after family members, which has meant they haven't been able to do their assignment work or go to clinical.
"Being close contacts with others which has meant they've had to self-isolate. All of those things are quite stressful."
Professor Neville, who also chairs the council of deans for all the nursing schools and is deputy chair of Australasian council, said some of the problems driving attrition rates predated COVID-19.
Some students were simply not prepared for the academic demands of the course.
"In some places in New Zealand, which have high numbers of Māori and Pacific groups, there are high schools that don't have science teachers. There isn't even the option for students to take science subjects."
Head of Pacific nursing Porirua's Whitireia Polytech Tania Mullane said entry criteria were purposely "broad" to encourage a diverse range of students from different backgrounds.
"Some of our students have never experienced academic success previously.
"So it's not just cross our fingers and hope it's going to work, but highly intensive and a huge amount of support, holistic support, is wrapped around them to ensure they can be successful and that confidence is grown."
Whitireia's degree in Pacific nursing was the first of its kind when it was set up 17 years ago and has been hugely successful, with up to 90 percent graduating.
Mullane admitted the drop out rate had increased under COVID-19.
Many Pasifika students struggled with online learning, and some have had to pull out to work or care for family members.
Sometimes the best option for an individual was to defer study, she said.
"So it's like 'What is the right option for you here? Just because you haven't been successful this time, doesn't mean you can't be successful the next time'. So the goal of you being a nurse is still there, we've just stretched the time out a bit, but we haven't take that goal away."
However, with at least three years needed to train a nurse, everyone in the sector would be hoping those students return to their studies sooner rather than later.
The Nursing Pre-Registration Pipeline Working Group, which includes representatives from health boards, the ministry, unions, the Nursing Council, aged care providers and the tertiary sector, has been set up to ensure there will be enough nursing graduates in future.
A spokesperson said more work was needed to identify the reasons why students were not completing their studies.
RNZ
