A Profile of Migrant Nurses in Ireland. Nurse Migration Project Policy Brief 4

Migrant nurses, mainly from outside of the EU, are now an essential component of the Irish nursing workforce. This is the result of almost a decade of active overseas nurse recruitment from countries such as India and the Philippines. Between 2000 and 2008, non-EU migrant nurses accounted for 40% of nurses newly registered with the Irish Nursing Board [2] (see Fig. 1). According to the INO, \u22It is a reality, not readily acknowledged by Irish health employers, that this country would now be forced to close literally thousands of beds”’ [3] without the presence of migrant nurses in the health system. Despite this reliance, there is little information available about Ireland’s migrant nurse workforce. Some quite basic questions remain unanswered including: How many migrant nurses currently work in Ireland? In what fields of nursing and at what grades do they work? How many are women and how many men? What ages are they? What skills and experience did they bring to Ireland and are these being well utilised? Do they have children, either in Ireland or in their home country? Are they satisfied working and living in Ireland? And – of crucial importance – do they intend to stay here? The RCSI nurse migration project is beginning to fill these information gaps, through qualitative and quantitative surveys of migrant nurses in Ireland. This policy brief is the third on emerging project findings

Nurse migration and health workforce planning: Ireland as illustrative of international challenges.

Ireland began actively recruiting nurses internationally in 2000. Between 2000 and 2010, 35% of new recruits into the health system were non-EU migrant nurses. Ireland is more heavily reliant upon international nurse recruitment than the UK, New Zealand or Australia. This paper draws on in-depth interviews (N=21) conducted in 2007 with non-EU migrant nurses working in Ireland, a quantitative survey of non-EU migrant nurses (N=337) conducted in 2009 and in-depth interviews conducted with key stakeholders (N= 12) in late 2009/early 2010. Available primary and secondary data indicate a fresh challenge for health workforce planning in Ireland as immigration slows and nurses (both non-EU and Irish trained) consider emigration. Successful international nurse recruitment campaigns obviated the need for health workforce planning in the short-term, however the assumption that international nurse recruitment had ‘solved’ the nursing shortage was short-lived and the current presumption that nurse migration (both emigration and immigration) will always ‘work’ for Ireland over-plays the reliability of migration as a health workforce planning tool. This article analyses Ireland’s experience of international nurse recruitment 2000-2010, providing a case study which is illustrative of health workforce planning challenges faced internationally

Overseas nurse recruitment: Ireland as an illustration of the dynamic nature of nurse migration.

This paper presents an analysis of Ireland\u27s recent experience of overseas nurse recruitment. Ireland began actively recruiting nurses from overseas in 2000 and has recruited almost 10,000 nurses, primarily from India and the Philippines since that time. This paper takes a timely look at the Irish experience to date. It reviews the literature on the supply and demand factors that determine the need for, and the international migration of, nurses and presents working visa and nurse registration statistics. This enables the authors to quantify and discuss the trends and scale of recent nurse migration to Ireland from outside the European Union (EU). The paper discusses the data essential for national workforce planning and highlights the deficiencies in the Irish data currently available for that purpose. The paper concludes with a discussion of the implications of Ireland\u27s heavy reliance on overseas nurse recruitment

Retaining Migrant Nurses in Ireland II. Nurse Migration Project Policy Brief 3

Active overseas recruitment efforts have attracted large numbers of migrant nurses into the Irish health system [1]. However, it will be Ireland’s ability to retain these nurses that will determine the long-term effectiveness of this workforce strategy. This is a key consideration both for individual employers and at national policy level [2], given the extent of Ireland’s reliance upon migrant nurses [1]. There is recognition internationally that poor support structures in the host country may encourage migrant nurses to seek employment elsewhere [2]. The challenge to retain these nurses takes place, as their recruitment did, in the context of intense global competition for nurses, which Kingma has called ‘the international war for skills’ [3]. This policy brief , which presents findings on migrant nurse retention in Ireland, cautions against the assumption that migrant nurses are all ‘here to stay’. The findings point to the need to engage with them to better understand the dynamics of their migration and to identify the factors that might determine whether they stay or leave Ireland

Career Progression of Migrant Nurses in Ireland: Nurse Migration Project Policy Brief 5

The career progression of migrant nurses within the Irish health system was an issue raised in our discussions with key stakeholders. Concern was raised that few migrant nurses had achieved managerial grades in Ireland (CNM1 or CNM2) and that perhaps this stemmed from a reluctance to apply for senior posts. Evidence internationally suggests that migrant health workers frequently occupy less desirable posts [1,2] within the health systems of their host countries and that they struggle to achieve career progression [3]. A number of reasons have been cited for their stalled career progression and these include poor take-up of training [4], a lack of transparency in the management of promotions [3] and ‘discrimination in the quality of support given to candidates in the promotion process. . .whereby chosen candidates were pre-selected and coached whilst others were ignored or received inadequate or misleading support’ [3]. This policy brief, which presents findings on the skills and expertise of Ireland’s migrant nurses and offers an insight into their perception of promotions and career progression in Ireland

Irish Trainees Continuing to Emigrate.

The Medical Council’s spotlight report on ‘Trainee Career and Retention Intentions’, to be released later in October 2015, will report further findings from its 2014 Trainee National Experience Survey1, to which over 1,600 non consultant hospital doctors (NCHDs) in training posts responded. This latest report will show that close to half of trainees – the cornerstone of hospital care and the future cornerstone of our health services – intend to pursue their careers outside of Ireland. Most worrying is that those in Higher Specialist Training are more likely to leave, resulting in greater loss to the Irish health system in terms of investment of effort and money, and lost expertise. The findings are consistent with a growing body of evidence on the medical workforce crisis facing Ireland. In early 2015, 88% of Irish medical students reported their intentions to leave Ireland on graduation, though close to half said they would return. However, the assumption that most doctors will return was dispelled in our 2015 survey of 307 emigrant Irish trained doctors who had left Ireland between 2008 and 2013.Since leaving, there had been a three-fold rise in those intending to remain abroad permanently and only a quarter intended to return to practice in Ireland

‘Emigration is a matter of self-preservation. The working conditions . . . are killing us slowly’: qualitative insights into health professional emigration from Ireland

Background Achieving a sustainable health workforce involves training and retaining sufficient staff to deliver health services. The Irish health workforce is characterised by a high level of emigration of Irish-trained staff and a heavy reliance on internationally trained staff. This paper presents qualitative findings from a mixed - method study of doctors, nurses and midwives who have recently emigrated from Ireland. Methods Using Facebook, this study elicited 556 (388 completed) responses to an exploratory mixed-method online survey in July 2014. Respondents provided rich responses to two free-text questions, one on health worker return (N = 343) and another on he alth professional emigration (N = 209) from the source country (Ireland). Results Respondents emigrated because of difficult working conditions in the Irish health system (long working hours, uncertain career progression), which compared poorly with conditions in the destination country. Respondents‘ experiences in the destination country vindicated the decision to emigrate and complicated the decision to return. Their return to Ireland was contingent upon significant reform of the Irish health system and an improvement in working conditions, expressed, for example, as: \u27It’s not about the money, it’s about respect . . . we love working in medicine, but we love our families and health more\u27 (RD283). Conclusions This paper highlights that doctors, nurses and midwives are emigrating from Ireland in search of better working conditions, clear career progression pathways and a better practice environment. The question for the source country is whether it can retain and attract back emigrant doctors, nurses and midwives by matching their expectations