Efforts to boost ICU capacity are struggling because internationally sought-after nurses can't get into the country, even after accepting job offers and despite the threat to New Zealand from Covid-19.
Some critical care nurses who are already in New Zealand on visas are leaving for much higher paid jobs in Australia and elsewhere, after immigration delays meant they couldn't plan ahead.
Concerned ICU leaders are set to jointly write to the Government to ask for urgent changes.
"Hospitals have got people from overseas who would like to come to work with them, but they are struggling to get them in through MIQ. Then there is a backlog of processing things with the Nursing Council. And there are problems with visas," said ICU doctor Craig Carr, who is the NZ regional chair of the Australia NZ Intensive Care Society.
"The frustration is that even if you interview and get someone, it's a real struggle to be able to facilitate them to get into the country.
"It is a sellers' market at the moment; these people are in demand all around the world. For instance, Australia is actively looking to recruit more intensive care nurses to be ready for border reopening. And we need to be doing the same."
A shortage of the highly-trained nurses is one of the main reasons why actual, day-to-day ICU capacity hasn't improved since the Covid pandemic began, despite the Government putting up more funding and buying equipment like ventilators.
That's because each patient needs one-to-one care from a specialist nurse. Their numbers can't be quickly increased locally, given it takes years of training.
"A bedside ICU nurse probably knows how to use around 20 to 30 different pieces of equipment that aren't used routinely anywhere else in the hospital - kidney machines, ventilators, cooling machines ... different types of pumps, syringe drivers, and they've got to become familiar with lots of medicines," Carr said.
About 5-8 per cent of bedside nurse positions in ICU are currently vacant. There are multiple reasons for that, Carr said, including the immigration and MIQ issues.
The staff shortages - also felt in many other areas of the health system - preceded the pandemic. ICU nurses aren't listed as a long term skill shortage in New Zealand, meaning they have to secure certain special purpose visas.
Immigration backlogs and uncertainty also affects overseas nurses who are already here, Carr said, who make up about 20 per cent of the ICU nursing workforce. No available MIQ spots meant they couldn't go home easily if a relative fell sick or for other urgent matters.
The Intensive Care Society and the country-wide network of clinical directors and charge nurse managers are likely to soon write to the Government "to express our concern that these things really need to be lined up if we are going to be able to improve capacity of intensive care in New Zealand," Carr said.
Tania Mitchell, chairwoman of the College of Critical Care Nurses, said anecdotally the college was aware of the issues affecting international nurses. Restrictive immigration rules didn't provide certainty that they and their families could stay here long-term, she said, and pay was relatively low.
Health Minister Andrew Little told the Herald the Government was focusing on getting healthcare workers across the border with exemptions, "and that is happening", with that group making up 43 per cent of people coming in.
"Since August last year, border exceptions have been approved for over 3600 critical healthcare workers to come into New Zealand and the Government is looking at options around the issue of residency applications. The Minister of Immigration has indicated he will have more to say on that soon."
All New Zealand's DHBs have plans to scale-up intensive care capacity if a Covid-19 outbreak spreads significantly, including steps such as using other areas to treat ICU patients. Other staff will be seconded to do the work of their intensivist colleagues.
Little said about 1400 nurses had been trained since last year to help in intensive care if normal capacity is exceeded.
A spokesperson for the Nursing Council said it was "very aware" of registration delays, which were exacerbated by the pandemic, including making it harder to get applicant source documents. Once documentation was received, it usually took about 21 days to register a nurse, they said.
National's health spokesman Dr Shane Reti has recently called on the Government to explain why more ICU bed spaces haven't been secured. The party also wants visa categories to be reopened and residence applications prioritised for critical healthcare workers, as well as offering residence class visas on arrival to experienced nurses.
Hospitals are actively planning how to cope when Covid becomes endemic in New Zealand; meaning the virus won't disappear even with high vaccination rates, but will instead regularly circulate in the population.
The unvaccinated minority are far more vulnerable, including to serious illness and hospitalisation.
Modelling work by Te Pūnaha Matatini, released yesterday, predicted a combination of very high vaccination coverage and public health measures could achieve population immunity.
However, there are scenarios where that doesn't happen. Even at 80 per cent coverage of over 5s, the modelling carried a median estimate of around 60,000 hospitalisations and nearly 7000 deaths – all within just a year. Such vaccination coverage would therefore likely require ongoing use of lockdowns.
New Zealand has the second lowest ICU capacity in the OECD. ICUs often struggled with "business as usual" capacity problems before the Covid pandemic, particularly in winter.
Making it easier to attract, keep and train ICU nurses was a "no regrets policy", Carr said. Without Covid patients, the extra capacity would mean fewer New Zealanders would suffer surgery postponement when a post-operative bed couldn't be found. However, it wouldn't take many Covid cases in ICUs to create pressure, he said. Future strains of the virus could be more dangerous than Delta, and vaccines might provide less protection.