International Nurse Recruitment to Ireland Dr. Niamh Humphries, RCSI Prof. Ruairí Brugha, RCSI Prof. Hannah McGee, RCSI

Overview Nurse Migration to Ireland International comparisons International Recruitment – a short term solution? Recession and nurse emigration from Ireland Discussion

International Nurse Recruitment Sources: Department of Jobs, Innovation and Enterprise, 2009; Irish Nursing Board 2010; Nursing and Midwifery Council, 2008 Ireland began actively recruiting nurses internationally in ,481 non-EU migrant nurses issued with working visas % of all newly registered nurses in Ireland 2000 to 2010 were from non-EU countries Ireland now has had a greater reliance on international nursing recruits than the UK.

Nationality of nurses newly registered with Irish Nursing Board N=31,810 Source: Irish Nursing Board

Nationality of nurses Newly Registered with Irish Nursing Board Source: Irish Nursing Board

Sources: Irish Nursing Board 2010; Nursing and Midwifery Council, 2008

Share of foreign-trained or foreign nurses in selected OECD countries, 2008 CountryForeign Trained Nurses as a Share of Total Ireland47.1 New Zealand22.1 Australia16.4 United Kingdom 8.0 United States3.5 Netherlands1.4 Source: OECD Policy Brief, 2010

International Recruitment Drives Interview panels (employers & nurse recruitment agencies) travelled to countries such as India and the Philippines to conduct interviews. In 2009, Nurse Migration Project surveyed non-EU Migrant Nurses working in Ireland(N=337) 83% (278) of survey respondents noted that a recruitment agency assisted in their migration to Ireland.  51% (173) from the Philippines, 33% (112) from India. Remainder from one of 16 other countries.  62% (208) worked in a public hospital upon arrival

A Short term Solution International nurse recruitment viewed as a short-term solution to the shortage of nurses. Response to the transition from 3 year to 4 year training and the ‘gap year’ of 2005 (no graduating nurses) Irish nurses would be prioritised for recruitment as soon as more graduates came on stream ▫‘... the Filipinos are on two-year contracts and are seen as a short-term solution to the shortage of nurses. As more Irish nurses are trained by the Mater, they will have first priority for jobs there... ’ (Irish Times article 2000) ‘I believe the State doesn’t really know... before they hire us they don’t have a plan or policy in place’ (Migrant Nurse Survey 260). Sources: Holmquist, K (2000)., From Manila to the Mater, Irish Times.

Future Plans of Migrant Nurses Future plans of non-EU migrant nurse respondents, 2009  19% (65) of respondents intended to stay in Ireland  49% (166) intended to return home and  23% (79) planned to migrate to another country. ▫At the time of survey, 80% (269) held permanent contracts in the Irish health system. Although onset of recession made them less confident about their future.  Though we are permanent we are uncertain of our jobs’ (Migrant Nurse Survey 142).  ‘The 'recession' has made us question ourselves: how long is the country going to need us? Being on a working visa only renewable every 2 years we are unsure of [our] security and stability here’ (Migrant Nurse Survey 222).

Nurse Emigration from Ireland Recession & Recruitment Moratorium 2008/9 Non-EU nurses considering emigration ▫ 4202 verification requests processed for non-EU migrant nurses between 2008 and ▫Equates to almost one third of those actively recruited since 2000 (if intent translates into emigration) Irish trained nurses also considering emigration ▫Verification requests for 805 Irish nurses in 2008, 909 in 2009 and 967 in 2010 ▫Nurses now actively recruited from Ireland to Australia and the UK. Source:Irish Nursing Board 2010

Source: Irish Nursing Board

Irish Registered Nurses ‘working abroad’ Source: Irish Nursing Board

Data Limitations Although Registration data really useful for Nurse Migration Project, registration data has its limitations for workforce planning, e.g. Details entry onto the Register rather than into workforce No information about where in the health system non-EU nurses are working Verification requests measure intent to migrate rather than emigration/exit Some emigrant nurses retain Irish registration after emigration Immigration information also used by project (Department of Jobs, Enterprise and Innovation ) Details acquisition of working visa/permit - probable entry into the workforce.

Discussion Ten years of international nurse recruitment and the Irish health system seems to still be heavily reliant upon non-EU migrant nurses [data?] Recession & recruitment moratorium have contributed to the emigration of nurses (Irish and non-EU) from Ireland [data?] How will this impact on the nursing workforce? [data?] Need for better data and analysis to enable better workforce planning. Assuming that migration (emigration and immigration) will always ‘work’ for Ireland over-plays the reliability of migration as a tool for health workforce planning [data?]

Thanks to... The Irish Health Research Board for funding the Nurse Migration Project: Research Project Grant RP/2006/222. The migrant nurses and key stakeholders who participated in the research The Irish Nurses and Midwives Organisation for their assistance in contacting qualitative respondents. The Irish Nursing Board and the Employment Permits Section of the Irish Department of Jobs, Enterprise and Innovation for providing statistics. Project Contact: Outputs from the project available at