1. Overseas-qualified nurses in Irish general hospitals: RN4CAST study results Matthews A, Scott PA, Kirwan M, Lehwaldt D, Morris R, Staines A Dublin City University

2. Outline The RN4CAST study – Data sources Distribution of Irish/overseas qualified nurses – Organisational data- hospitals – Nurse survey data- hospitals and wards Characteristics of hospitals and wards- some exploration Discussion

3. RN4CAST study Framework 7 European study, 12 countries 2009-2011 Ireland: 30 large acute general hospitals, 112 wards – Nurses completed a survey about their organisational working conditions, their own characteristics General medical or surgical or mixed med/surg wards – Organisational profile data were collected for each hospital – Patient survey and discharge data were also collected Question: Do these data help to explain the patterns of recruitment and retention of overseas qualified nurses in Irish general hospitals? – What is the extent and distribution? – What organisational factors are associated with high levels?

4. Nurse survey data 1,406 responses, medical and surgical wards, 57% response rate Asked if received basic nurse education in Ireland or not; if not, which country – Overall almost 40% qualified outside Ireland (n=536) Just over half of whom qualified in the UK (n=274) India (n=111) and the Philippines (n=92) – approx one fifth each – We did not ask about nationality Other partners: % all overseas-qualified nurses: – Switzerland (22.1%) and England (16.7%), Norway (5.5%), Germany (5.1%), Greece (5.1%), Belgium (3.1%), Netherlands (2.4%), Sweden (2.3%), Spain (1.3%), Finland (0.9%), Poland (0%) England: Philippines (31.0%, n=153) and India (22.7%, n=117) sub- Saharan Africa (15.9%, n=78) of overseas

5. Nurse data: qualified in Ireland/ not by hospital Source: RN4CAST nurse survey Number of nurses Hospital

6. Ward level: Irish/other qualified

7. Hospitals with 50% + overseas qualified Non-EU qualified as % all registered nurses (org data) 30% or more trained in India or Philippine s number of wards with 50%+ overseas trained Dublin /City /Town University / not Large (>500 beds) / not high EE average hospital (>27), of 7 hosps Hospital poor practice environm ent, of 16 hosps Hosp ID 30 2/ 4Dublin 20 38 1/ 4Dublin highlow25 50 3/ 4Dublin 24 45 2/ 4Dublin 15 1/ 4Town27 202/ 4Town 6 73/ 3Townlow23 1/ 4Cityhighlow1 3/ 4Townlow3 1/ 4Townlow7

8. Organisational profile data Numbers of nurses… – who qualified in another country ; with a non-EU qualification; who are not EU citizens – total number of registered nurses Proportion of nurses with non-EU qualification – Could be calculated for only 12/30 hospitals (range 1-50%)

9. Non-EU qualified nurses as % all: Organisational and nurse data

10. Hospitals with 30%+ non-EU qualified nurses DublinUniversityLarge (>500 beds) high hospital burnout level (total of 7, all low PES) poor work environment (low PES) across hospital (total of 16) Hosp ID (red same as 50%+ overseas) 20 25 24 15 27 13 17 14 16 Using nurse survey data as available for all (though subject to response rate))

11. Discussion Lack of hospital-reported data- not known or not available (‘work-to-rule’) To some extent nurse-reported data provide baseline (only for medical and surgical wards, based on respondents only), suggest extent and distribution – Not possible to clearly identify ward or hospital factors associated with distribution pattern Cross-sectional data collected in 2009/10 cannot capture the dynamics of recruitment and retention – Current nurse-reported data limited to indicate ‘push’ away/ ‘anti-Magnet’ (of domestically trained nurses); – is it possible to identify stable/enduring organisational factors?

12. Thank you www.RN4CAST.eu Anne.matthews@dcu.ie Seminar DCU 14 March 2012, RN4CAST findings, workforce planning implications