Nursing and Midwifery Internship Student Survey 2017

Transcription

1 Nursing and Midwifery Internship Student Survey 2017 Prepared by the Irish Nurses and Midwives Organisation, in conjunction with the Executive Council Industrial Relations subcommittee.

2 Executive Summary: In the Republic of Ireland at present, there are just under 1,500 Nursing and Midwifery Interns completing their 36-week internship. This group are due to qualify in September The combined Children s and General group are due to qualify from February Due to ongoing staff shortages, the Irish Nurses and Midwives Organisation (INMO) undertook a survey 1 of all Nursing and Midwifery Internship students to examine where this group would seek employment upon qualification. This survey aimed to gather statistics and trends from the group regarding their gender, age, possibility of emigration, current employment prospects and incentives that would encourage them to remain within the Irish public health service. These responses provide important evidence of the reality for Nursing/Midwifery graduates. They also highlight the significant need to improve the current incentives being offered in the public health service and the need to offer full-time, permanent posts to current Internship students much earlier in their 4 th year. The main findings of the survey are as follow: 78.1% of respondents are considering emigrating from Ireland upon qualifying % of respondents stated that they would consider staying in the public service for at least a year upon qualifying if offered guaranteed permanent contracts. 70.2% of the respondents had been approached by overseas nursing companies to recruit them into their service versus 29.8% of the respondents being offered permanent or part-time positions in the Irish public health service. Of the 29.8% offered employment,only 16.25% had been offered permanent contracts in Ireland at the time of the survey % of the respondents are considering moving to the private sector in Ireland, but would stay if incentives were available. 1 This survey was conducted using a web-based tool, Survey Monkey, and was issued to the 1,096 INMO 4 th Year Student members who had a current address. There was a response rate of just over 40%. The survey itself has a 95% level of confidence with a 4% margin of error.

3 Page 3 This evidence contradicts the current Health Services Executive s (HSE) assertion that they are proactively offering permanent positions to all new graduates. Incentives The survey shows that the top three ranking incentives, to entice graduates to stay within the public health service are: Increase in Pay Improved Staffing Levels and Working Conditions Access to Funded, Postgraduate Education It is clear from this survey that the public sector has again lost or is losing the battle to recruit and retain new graduates to overseas employers, and to a lesser extent, the private sector in Ireland. The HSE s delay in offering permanent positions to interns, provides an advantage to international recruitment agencies who approach these interns as early as January in their placement year. This annual failure by the HSE to proactively recruit its own graduates in a timely and competitive manner, is clearly influencing graduate decision making regarding their employment post qualification. In the current highly competitive global market, a major improvement will have to be introduced by the HSE, in respect of their recruitment practices as the current practices: Promote emigration among new graduates; Lead to falling employment numbers in the Irish Public health service Require a consequent expensive overseas recruitment campaigns to recruit non EU and EU nurses and midwives, to fill vacant posts in Ireland in a time of a worldwide shortage of qualified nurses (WHO, 2006).

4 Page 4 Section 1. Introduction: 1.1 Background Due to the current recruitment and retention crisis in nursing and midwifery in the Irish public health services, the INMO undertook a survey of the current 4 th year (Internship) General Nursing students, Intellectual Disability Nursing students, Children s and General Nursing Students and Midwifery Students. The Union of Students of Ireland (USI) had conducted a survey of students, including nursing and midwifery students, in The INMO wanted to build on this work by undertaking a focused survey and report on the current 2017 internship group in particular. This survey focuses on where, upon qualifying, the class of 2017 see themselves working. These statistics provide valuable information to the INMO. The aim was also to determine their opinion on recruitment and post qualification employment options. 1.2 Purpose There is an annual intake of 1,500 students per year. From the period of , it is our understanding that the Republic of Ireland would have trained 9,000 student nurses and midwives. Table 1 Nurses & Midwives employed in the Public Health Services (Health Service Executive) Year Number of Whole Time Equivalent (WTE) Annual Net Gain /Loss WTE Change since , ,637-1, , , , , Despite training 9,000 nurses and midwives since 2011, the public health service employment figures show a overall fall in nursing WTE of -67 at the end of It is important to determine whether the HSE can meet the nursing and midwifery staffing requirements to maintain our current health services.

5 Page 5 The HSE has several major advantages over potential overseas employers of Irish graduates, these are; Irish recruitment requirements could be hugely reinforced by employing the large numbers of annual Irish graduates; The HSE has immediate exclusive access to these groups from beginning of their training to qualification; The HSE is the employer of this group for 36 weeks pre-qualification; and The HSE can exclusively offer the attractive option of consolidation of training in a familiar environment, by providing post qualification employment. The INMO research will show evidence that; The HSE is not utilizing this advantage correctly or proactively; Recruitment plans to date have failed to prevent the yearly exodus of Irish trained graduates; There is a clear need to introduce urgent measures to keep our highly trained and qualified graduates in the Irish public health service.

6 Page 6 Section 2. Individual Question Summaries 2.1 Gender Figure 1 Question 1 Are you male or female? In question one, we asked the respondents to identify their gender before completing the survey. The sole purpose of this was to compare and contrast the responses from male and female respondents. Studies suggest that online surveys such as this one are free of gender bias (Smith, 2008).

7 Page Age Profile Question 2 examined the age profile of respondents. A respondent over the age of 23 is classed as a mature student if they pursue further education or were already a mature student when commencing their course in This information is needed when assessing individual responses and comparing the age profile to selected responses throughout the questionnaire. Figure 2 Question 2 Are you under the age of 23? % of the respondents are 23 years of age or younger. 50% of male respondents were 23 years or younger. 67% of female respondents were 23 years of age or younger. * *Question 1 and Question 2 are cross referenced to determine age profiles of male and female respondents.

8 Page Emigration after Qualification Figure 3 Question 3 Are you thinking about emigrating when you qualify as a nurse or midwife? % of the respondents are considering emigrating. From the respondents older than 23 years, 54.36% would also consider emigrating. 21.9% are not considering emigrating. Of the 78.1% considering emigrating, 90.14% are 23 years or younger. From the 23 years and younger age group, 60.54% would consider staying if offered incentives by the employer as seen in Question 4. Furthermore, 80.24% of respondents 23 years or younger would consider working for at least 12 months if offered permanent positions (as per Question 6) % of respondents in the over 23 years old group would consider working for at least 12 months if offered permanent positions (as per Question 6) % of the total respondents placed pay, staffing levels and working conditions as the major reason for considering leaving the Irish public health service. (Comparing responses with Question 4).

9 Page Incentives/Changes Prompting in the public health service Figure 4 Question 4 What incentives/changes would prompt you to stay in the public health service? The rating average of priorities can be seen in Appendix 2. 1 Improved staffing levels and working conditions received the most number 1 preferences (42.44%) % of respondents ranked pay as the number one priority If you combined the 1st and 2nd priority incentives selected by respondents for increase in pay, 75.39% of respondents suggested an increase in pay is needed to keep them within the public service.

10 Page 10 Improved pay, staffing levels and working conditions and access to funded post-graduate education are considered as the crucial incentives in keeping the class of 2017 within the public sector. Based on these rankings and specificially looking at respondents aged 23 years of age or younger: % have put pay as the most important incentive. This is followed closely by improved staffing levels and working conditions with 71.77% ranking this as the 2 nd most important incentive. Access to post-graduate education was ranked third, with 56.8% 2.5 Likelihood of Staying in Ireland with Employer Incentives Figure 5 Questions 5 If an incentive(s) was given by the employer, would you stay in Ireland as a result? Question 5: If an incentive(s) was given by the employer, would you stay in Ireland as a result? 2.3% Very Likely 27.3% Somewhat likely 46.7% No as I wish to travel but will consider returning to work in Ireland if conditions improved. 23.7% Unlikely

11 Page % of respondents would consider remaining within the Irish public health service if incentives were given. 23.7% are somewhat likely to remain if incentives are given. 2.26% have decided that they are unlikely to work within the public health sector of the Republic of Ireland even if incentives were given % of respondents are considering travelling but will consider returning to the Irish public health sector if incentives are offered. Combining 1,2 & 3 from above indicates that 97.74% of current nursing and midwifery interns would consider working in the Irish public health service if incentives were offered. 2.6 Delayed emigration with guaranteed employment Figure 6 Question 6 Would you delay your departure for a year if your employers guaranteed employment for at least your first year after qualifying? Would you delay your departure for a year if your employers guaranteed employment for at least your first year after qualifying? 21.2% 78.8% Yes No

12 Page % of the respondents would delay leaving the public health service for at least a year upon qualifying if guaranteed employment for at least one year. 2 Of the 21.22%, 64.89% of these respondents would likely consider remaining in the public health service if incentives were offered. 2.7 Approach from Overseas Nursing Companies Figure 7 Question 7 Have you been approached by overseas nursing companies to recruit you to their service?

13 Page 13 Have you been approached by overseas nursing companies to recruit you to their service? 29.8% Yes No 70.2% In April 2017, the Internship students were over a third of the way through their internship. 70.2% of repondents had already been approached by overseas recruitment companies pending their graduation in September There is no significant difference between the age profile or gender of respondents. 2.8 Private Sector Employment Figure 8 Question 8 Have you considered moving to the private sector within Ireland after qualifying?

14 Page 14 Have you considered moving to the private sector within Ireland after qualifying? (If you have not been on clinical placement in a private hospital) 41.1% 58.9% Yes No % of respondents confirmed that they would consider moving to the private sector in the Republic of Ireland. The Irish private sector has been proactively recruiting HSE nurses and midwives and they have been very successful in that regard. This will be discussed later in this report when examining the current market % of the respondents aged over 23 would considering moving to the private sector. 2 However, 75.84% of this age profile would consider taking up employment in the public sector if offered postgraduate employment for at least one year % of the respondents aged 23 or younger are considering moving to the private health sector % of this age profile would consider taking up employment in the public sector if offered postgraduate employment for at least one year.

15 Page Working in Teaching Hospital Post Qualification Figure 9 Question 9 How likely are you to stay in your teaching hospital after qualifying? 1 This is consistent with Question 3, with 74.49% stating that they are unlikely to stay within their current teaching hospital without incentives.

16 Page Offer from Current Employer In 2016, the HSE stated that they would offer permanent positions to all new 2017 graduates upon qualifying. Figure 10 Question 10 Has your current employer offered you a job on qualifying? Has your current employer offered you a job on qualifying? 16.3% 1.8% 10.4% If Yes: Full Time Permanent If Yes: Part Time If Yes: Fixed Term contract No 71.6% 16.25% of the respondents have been offered permanent posts of 4/4/17 1 As of the 4/4/17, the closing date of the survey, 71.6% of respondents have not been offered permanent posts. 2 Only 15.31% of the respondents, 23 years of age or younger have been offered permanent posts % of the age profile older than 23 years of age have been offered permanent posts.

17 Page Work Place nearer to Home Figure 11 Question 11 Would you consider moving to a workplace closer to home? Would you consider moving to a work place closer to home? Yes: This is due to cost 36.4% 7.7% 24.7% 31.2% Yes: You would prefer to live closer to/at home Yes: You are not enjoying your current work place and/or where you are living No not yet

18 Page % of the respondents 23 years of age or younger are considering moving closer to home due to cost % of the respondents over the age of 23 are considering moving closer to home due to cost Information on Portfolios and Interviews Figure 12 Question 12 Have you been provided with information regarding portfolios or interviews by your employer?

19 Page Interest in INMO Seminar Figure 13 Question 13 Would you be interested in an INMO led Seminar in CV., Interview and Portfolio preparation? 2.14 Training Preparation for Workplace Figure 14 Questions 14 Have you found your training has prepared you for the workplace you have joined as a Fourth Year?

20 Page Comments and Concerns Question 15 was an optional question within the survey allowing participants to comment, question or voice concerns. These comments will be summarized in Chapter 4.

21 Page 21 Section 3. Overseas and Private Sector Competition 3.1 Nursing and Midwifery Statistics in Ireland In compiling this survey, the INMO examined current initiatives for recruitment and researched the current market. This information obtained was kindly provided by external private recruitment companies. It is common cause between the Department of Health, the HSE, and the INMO that the whole time equivalent compliment of nursing and midwifery staff fell from 39,006 at the end of December 2007 to 35,330 in November This represents a fall of 9.3% compared with an overall fall in public sector health personnel of 7.2%. In the same period the number of medical staff grew by 16%. The Staff Nurse compliment, at 24,598, was some 2,595 lower than it had been in These figures have been accepted by the Department of Health and the HSE, in an agreed paper presented to Department of Public Expenditure and Reform (DPER), in the context of nursing and midwifery recruitment in December It must also be considered that approximately 2% of nurses and midwives are on maternity leave at any given time and given the virtual ban on replacement, the actual number working is 2% less than is reported. Tables 2 and 3 below display the numbers of nurses and midwives employed at 31 December each year. Table 2 - Nurses and Midwives employed in the Public Health Services (Health Service Executive) Year Number WTE , , , , , , , , , ,835

22 Page 22 Table 3 Number of Whole Time Equivalent nurses and midwives employed in public health service 2016 The nursing and midwifery positions across the public sector continue to decrease with a net loss of -162 WTE from December 2016 to January 2017 as per the Health Sector Workforce Census (HSE, 2017). In March 2017, the nursing agency bill for the first ten weeks of the year was reported as 8,281,552. This represents 646 WTE posts. All figures are illustrated in the Irish Nurses and Midwives Organisation submission to the Public Service Pay Commission (INMO, 2017) 3.2 United Kingdom -National Health Service One of the largest International Competitors for the HSE is the National Health Service (NHS) in the United Kingdom (UK). They have already established a Centre for Workforce Intelligence which has predicted how many nurses it needs and in each region. To the knowledge of the INMO, there is no such research being carried out in the Republic of Ireland. The NHS is determinedly recruiting Irish new graduate nurses and midwives and is engaging with them with a view to recruitment as early as January - April of their final year as per the feedback from this survey. The NHS is approaching public sector staff here directly or through overseas agencies. NurseIreland (International Recruitment Agency) have found that the NHS is offering an attractive package for new graduates, highlighting the opportunities for further education, specialist training, academic support and flexible working/special leave. While the NHS does not offer a better basic salary for new graduates than the public sector in Ireland, the working week is shorter, (37.5 UK:39 IRL), payment of cost of living allowances in larger cities, the "High Cost Area Supplement" for example is automatically added to

23 Page 23 salaries in these areas, which is 20% of the basic salary; from a minimum of 4, 117 ( 5, 670) to a maximum of 6,342 ( 8,736). Opportunities to upskill, access to further postgraduate education and specialist training are better and more attractive to Irish graduating nurses/midwives. One is example is CPL Healthcare who were recruiting new graduates in 2016 for the NHS Queen Elizabeth Hospital in Birmingham. They were offering new graduates the opportunity to work in Intensive care or Theatre with a six-week induction program, mentorship program and further education. Interviews for these posts were held in March/April in Posts were offered and immediately accepted. Posts were not offered by the HSE until much later in the year, September 2016 in some areas. From this we know that attractive opportunities exist in the NHS for Irish new graduates and they are offering them earlier than later inferior offers from the Public Health Service. 3.3 Australia Allianz Healthcare are specialists in recruiting Irish nurses to work in Australia. Apart from the better climate, Australia boasts a much better salary compared to the Republic of Ireland. The starting salary according to NurseIreland in Australia is $54,234 which equates to 38,500. If you compare this to our own starting salary including the latest Lansdowne Road Agreement (LRA) 1000 restoration, the starting salary here is 28,483, 10,000 less. The working week for nurses in Australia is also shorter than the 39-hour working week in Ireland. Australia are mainly offering opportunities to nurses and midwives with a minimum of one year s experience. Therefore, it would be very important for the HSE to allow career breaks to nurses wishing to travel for short periods. This would allow them to gain international nursing experience and maintain a link with the public service in Ireland and could act as an incentive to return to Ireland after their travels. 3.4 International Pay Comparisons In terms of international comparisons (pay parity), the International Council of Nursing (ICN), through its international workforce forum, collects wage data on a bi-annual basis. The wage data collected relating to starting salaries for clinical nurses working in the public-sector hospitals, for the purpose of comparisons, it is converted into Purchasing Power Parity (PPPs). The table for purchasing power parity, is an internationally accepted table, and applying the 2016 conversions to the eight countries who responded to the wage survey, Ireland ranked lowest in terms of starting pay, using 2016 salary comparisons.

24 Page 24 Figure 15 - Starting salaries for clinical nurses working in public sector hospitals(in PPP) 3.5 The Irish Private Health Sector The HSE currently is not competing with the incentives being offered in the Irish private sector. The private sector in Ireland has identified that supply is low but demand is high and in a business-like fashion, they are prepared to offer the necessary incentives to attract nurses in an extremely competitive market. The private sector hospitals offering these incentives include all the major Acute Dublin private hospitals, i.e. The Mater Private Dublin, The Blackrock Clinic, The Beacon Hospital Dublin, The Hermitage Clinic, Dublin and St Vincent s Private Hospital, Dublin. Outside of Dublin other major acute private hospitals are also recruiting. (Bons Secours Cork & Tralee and the Mater Private, Cork). NurseIreland to date this year have placed 23 Irish trained nurses into the private sector (31/3/17). They forecast that they will place 100 nurses in total by the end of 2017 in private hospitals. This is just one of several recruitment companies seeking to place graduates in the private sector. The private hospitals hold at least two recruitment events each year. They advertise and recruit directly as well as engage recruitment agencies such as Head Hunt International to recruit on their behalf.

25 Page 25 What Incentives are being offered to new graduate nurses and midwives in 2017 in each private hospital? NurseIreland: Certain private hospitals (Mater Private Hospital Dublin) are offering excellent training to new graduate nurses with a starting salary of 29,497 in addition to 1,500 gross joining bonus, which commences in November of each year. Included in this is three rotational placements within the hospital. The graduate nurse will receive lectures from Clinical Nurse Specialists. The areas include emergency department, theatre departments, cardiac cath lab department, robotic surgery, surgical and radiation therapy, robotic assisted prostatectomies, and a various number of others. Head Hunt International: Some private hospitals (Blackrock Clinic, the Beacon Hospital Dublin and the Hermitage Clinic) are offering at least the 2 nd point of scale to new graduates, some offer fantastic graduate programs allowing newly qualified nurses to experience different specialities and skills. Financial incentives of a signing on bonus starts from euro plus in some hospitals they are offering a second bonus after one year of service. What incentives are being offered to overseas nurses and midwives in 2017 across private hospitals? NurseIreland: Nurses from abroad are being given 6,000 signing on bonus, which includes 50% after one month, and 50% after six months, which is subject to a 2 years minimum stay. They are also receiving accommodation allowance for the first month in Ireland. Along with this they are offered a refund of their NMBI payment and 250 towards a return flight to their homeland. (Beacon Hospital & Mater Private Hospital, Dublin). In the table below we will compare and contrast the HSE Bring them home campaign vs the Private Hospitals overseas recruitment who are also targeting Irish Nurses and Midwives abroad. For this example, we will assume a large Dublin Acute Hospital is trying to recruit a nurse who is now two years qualified. This nurse decided to work 12 months in the public sector upon qualifying and then decided to travel for a year in Australia. The nurse in question was forced to resign from her post before leaving for Australia as a career break was denied.

26 Page 26 Table 4 Comparison of HSE Bring Them Home Campaign and Incentives from a Private Hospital HSE Bring them Home Incentives offered Mater Private Hospital, Campaign Dublin st Sign on Bonus WRC Proposal One year loyalty bonus 3000 Receipted from the 1500 Flights 250 signing bonus N/A Accommodation NMBI Fee 300 Must apply locally Funded Postgrad Must apply locally 3,300 Total Benefit 7,980 From this survey, 28% of the current interns are considering travelling and it is crucial that the HSE must plan to recruit them back into the public sector upon their return. On this current scheme the HSE has failed to recruit the numbers needed to maintain current staffing levels across the sector or to meet targets they had set. 2 The average price of rent in Dublin as per the Daft.ie rental report in the final quarter of This price is set to rise when the 1 st quarterly report is released from Daft in May 2017.

27 Page 27 Section 4. Respondents Comments Review In this survey, Question 15 gave respondents the option to comment, question and voice concerns. This option was taken up by 27.8% of respondents (n=123). Due to the large number of responses, the comments were selected and have been put under the following headings to highlight the trends that emerged: Staffing levels and working conditions; employment prospects for Nursing and Midwifery Interns Pay; NHS recruitment drive; Emigration; and Education. 4.1 Staffing Levels & Working Conditions- Often, we don't get our evening breaks, don't get time to go to the toilet and feel totally in over our heads. It's no wonder most of our class plans on either changing profession or emigrating. (Survey respondent on 3/31/2017) The HSE place a lot of focus on patient s wellbeing, however the nursing staff's well-being and mental health are being forgotten about. ALOT needs to change to give nurses an incentive to stay in this country. (Survey respondent on 2/4/2017) Training has prepared us for patients however nothing can prepare you for the stress qualified nurses are under due to shortages, wages, long hours, busy wards. It's a real eye opener. (Survey respondent on 3/14/2017) The conditions we are working in at the moment are unhealthy- Something needs to be done, not only for nurses but for patients. The staffing levels and pay need to be amended immediately!! (Survey respondent on 3/13/2017) Less chiefs more indians (Survey respondent on 3/8/2017) As a girl who grew up only wanting to be a nurse. I have begun to hate it. We are not treated well, no valued and not paid enough (Survey respondent on 3/7/2017)

28 Page 28 I am a mature student with a family and have no choice but to stay and work in a role that I will be underpaid, undervalued and overworked. The majority of the interns in my year have stated that they will be emigrating upon graduation and if I could I would join them. Nursing in Ireland is a thankless job. We work tirelessly with a huge responsibility for very little take home pay. The cost of living continues to rise but salaries are not reflecting this thus leaving people struggling to survive. An increase in way is the only way that graduating nurses may continue to stay and work in this country. (Survey respondent on 3/7/2017) 4.2 Employment Prospects- We were advised by the director of nursing a number of weeks ago that there will not be enough jobs for us all in our training hospital when we qualify. This is extremely dis-heartening having spent four years training here it is also particularly frustrating when on placement and we see large number of adaptation nurses coming from overseas and filling these positions. There are continuous recruitment drives going on in other countries for nurses and they are not making efforts to try to recruit internally. (Survey respondent on 3/27/2017) Been told at the moment there are no jobs available upon graduation in the teaching hospital I am currently completing my internship in. (Survey respondent on 3/14/2017) I feel that we should be automatically offered a 1 year contract in our teaching hospitals as a staff nurse to pre reg etc. and this can be accepted or declined depending on what the person wishes to do. The hospitals should want to keep their own newly qualified staff that they have trained themselves over 4 years instead of getting adaptation nurses from Asia filling the vacant jobs (Survey respondent on 3/13/2017) Q9- I would love to stay in my teaching hospital for a minimum of two years but we have been told by the ADONs that the hospital is already over budget and have 30 nurses over their quota. This was extremely disappointing and disheartening to hear. (Survey respondent on 3/8/2017) We need to be offered jobs when we qualify. There needs to be better recruitment, resources and pay for nurses'. (Survey respondent on 3/8/2017) I will stay in my teaching hospital if offered a job there. However, we've already been told they probably won't be any jobs for us there despite being short staffed every day (Survey respondent on 3/7/2017) We were told that there are no jobs for any of year when we qualify in September in our teaching hospital (Survey respondent on 3/7/2017)

29 Page 29 Low grade pay scales and understaffed wards, whilst managing huge responsibility. Nurses being flown in from other countries and new graduates being told there are currently no nursing vacancies in our training hospital. Goodbye Ireland, I owe very little to a system that had used me from day one (Survey respondent on 3/7/2017) 4.3 Pay- Cannot afford to live in my home in Dublin with salary of nurse as well as paying for childcare this is driving me away to overseas... I wish I can stay and work here (Survey respondent on 3/15/2017) I really want to stay in Ireland but I am not because the conditions and pay are much better abroad. If it changed in Ireland I would stay. (Survey respondent on 3/7/2017) We need to be offered jobs when we qualify. There needs to be better recruitment, resources and pay for nurses (Survey respondent on 3/7/2017, 9:27pm) Nursing is tough; physically, mentally, emotionally. It is rewarding also and develops such valuable skills. But we are so underappreciated for all we do. We are scapegoated, we are laid with blame when things go wrong and it feels like we work so hard but it is never good enough for the ever-increasing numbers of management. They want us to be efficient robots when we work 13, 14, 15 hour days on our feet, get no sleep and care for our own families also on top of it all. We deserve to be paid and respected appropriately for the massive responsibilities that lay on our shoulders every day that we put on our uniforms. Respect nurses, respect our enormous efforts, respect our responsibilities, respect our invaluable contribution to the health service. (Survey respondent on 3/7/2017) The private sector offers a fair starting pay for nursing graduates which I intend to apply for upon graduation. (Survey respondent on 3/15/2017) 4.4 NHS Recruitment Drive- I am eager to gain as much skills as possible and believe that by moving to the UK better facilitation of pay, accommodation and training is available to me. (Survey respondent on 3/24/2017) UK: offering 9 months medical, 9 months surgical & 9 months CCU followed by my choice of preference, encourage to upskill + transfer wards during specialising. increase in pay, free 6 months accommodation euro deposit for continued accommodation (Survey respondent on 3/24/2017)

30 Page 30 I am now considering the UK as they seem enthusiastic in teaching us and giving opportunities in specialist care areas, unlike here. (Survey respondent on 3/13/2017) Disheartening. Already want to leave nursing because of the state of the wards. The atmosphere even at break time is upsetting. I have no intention of staying!! I have gone for interviews and been offered 2 jobs in the UK! (Survey respondent on 3/13/2017). I cannot afford to work for the HSE and try to build a decent quality of life for myself (Survey respondent on 3/27/2017) 4.5 Emigration- The current financial situation with the HSE is not worth the amount of study that was required to complete this degree and the level of risk that is involved in the work. It is much more beneficial to work abroad and better working conditions. (Survey respondent on 3/27/2017) Apart from family there is not many incentives to stay in Ireland. (Survey respondent on 3/13/2017) It's a career with many opportunities and horizons but so far fields seem greener on the other side which is why as soon as I have 12 months post grad experience I plan on emigrating and hope that when I return our fields will be greener. (Survey respondent on 3/13/2017) I love nursing but the state of the Irish public health system is appalling. As a person, I have no major desire to emigrate but it seems like I don't have many other options. (Survey respondent on 3/13/2017, 6:07pm) I will be leaving this country to find work as I want to be respected and given the proper pay and working conditions I deserve. (Survey respondent on 3/13/2017) I will be emigrating as it's unlikely conditions will change in Ireland. (Survey respondent on 3/9/2017) I don't want to emigrate. That's the last thing I want but I have no choice. I'm from Roscommon. There are no work opportunities in the midlands for me and Dublin is too expensive for the little money I make. There is too much responsibility here for the little money that I'd make- No one appreciates us. The money abroad is so much better as are the working conditions. (Survey respondent on 3/8/2017)

31 Page 31 I really want to stay in Ireland but I am not because the conditions and pay are much better abroad. If it changed in Ireland I would stay (Survey respondent on 3/7/2017) There is no incentive to stay. Horrendous pay. Even worse working conditions (Survey respondent on 3/7/2017) 4.6 Education- A lot of students are leaving because Ireland is poor in developing our education compared to countries like England. Conditions are better over there for the nurses' health (Survey respondent on 3/20/2017) Increased scope for specialist post grad courses and funding/reduced course costs to be available; in conjunction with arrangements to alter working hours tailored to those undertaking a course whilst in employment, would be beneficial and a motivating factor to keep graduates within Ireland, once qualified. Gaining recognition and encouragement of upskilling to fulfil necessary CNS positions, beneficial on a public-sector level and to one's personal portfolio. (Survey respondent on 3/14/2017) Increased access to postgraduate studies would be of paramount importance (Survey respondent on 3/9/2017)

32 Page 32 Section 5.Findings and Recommendations From the survey results and responder comments, there is clear confirmation that enhanced incentives are urgently required to persuade graduating nurses and midwives to remain working within the Irish public health service. These incentives / improvements are grouped into the following categories: 5.1 Pay Increase in pay: ranked as the highest incentive that would retain graduating nurses in Ireland. The re-alignment of nurse and midwife pay and hours to match pay rates for other degree entry allied health professionals (ANP), is now an imperative if Ireland is to provide a health service suitable to meet the needs of its people. there is a global shortage of nurses and midwives, based on the current market conditions, an immediate improvement in pay is necessary to allow Ireland to compete in this market. Equity of Pay: A significant enhancement and enrichment of nursing practice has occurred over the past decade. Equity demands that nurses and midwives be treated equally with employees who have comparable educational requirements and responsibilities in terms of pay and hours of work. Currently nurses and midwives work longer hours with lower salary scales than every other AHP in the public health sector. 5.2 Working Conditions Improved staffing levels and working conditions ranked very highly as an incentive to 42.44% of the respondents. We know that since 2011 despite training 9,000 nurses and midwives, the public health service employment figures show an overall fall in nursing WTE of -67 at the end of 2016.

33 Page 33 Improved working conditions (staffing levels) and realignment of pay with AHP must be central in any upcoming public service pay negotiations in order that the mass exodus of nursing graduates since the beginning of 2011 now ceases. If the Irish public health employers were serious there could be the potential to retain most the 1,500 new graduates every year and begin correcting the current staffing crisis. Permanent posts: This study found that 78.78% of the respondents would be happy to delay leaving the public health service for at least a year upon qualifying if offered permanent posts with improved incentives. The HSE would thereby recruit most new graduates, and retain them for minimum of one year if they offered permanent posts on qualification as standard. The frequently cited assumption that all young Irish nurses and midwives wish to immediately travel on qualification, has not been proven in this survey. Results show that just under 27.31% hope to travel but wish to return after a period. Timing: The HSE has stated that they will offer permanent contacts to all new graduates in However, as we saw in this survey, these posts are not being offered in all areas or are too late when they are offered. This is particularly significant given that competitors are actively recruiting once internship commences in January March of each year. To correct this the HSE must introduce a scheme to allow new graduates have automatic access to permanent posts upon qualification. (Responses to question 6 demonstrates this would at the very least delay the decision to emigrate).

34 Page 34 Graduate profile: It is time that the HSE acknowledged the reality that nurse/ midwifery graduates are highly educated and sought after professionals globally. They also have ambitions of personal and professional development. If their current employer is not affording them opportunities to develop, then they will seek opportunities/ accept offers, elsewhere as seen in this survey, however many would stay if identified incentives were made available to them % had already been approached by overseas recruitment companies. This isn t a new trend, it is simply a reflection of the demand for Irish trained nurses and midwives and the worldwide shortages. It is significant given the finding that 78.10% of the respondents are considering emigrating. In contrast, as of 4/4/17 only 16.25% of the internship students in this sample have been offered permanent posts by the HSE % had not being offered any positions; and 12.19% have only been offered part time or fixed-term contracts. 5.3 Educational prospects Further educational prospects and increased access to funded education for nurses and midwives must be put in place urgently. These measures will help prevent the migration of staff from the public to the private sector and abroad. The INMO has been continuously campaigning for recruitment and retention incentives and highlighted this in the recent submission to the public pay commission (INMO, 2017).

35 Page Rent allowance Rent allowance and the need to introduce same ranked as a prominent issue to the respondents. In addition, 31.40% of the respondents 23 years of age or younger are considering moving closer to home due to cost and 30.87% of the respondents over the age of 23 are considering moving closer to home due to cost. In Dublin currently, the house prices have increased by 17,500 in the first quarter of 2017 (DAFT, 2017). The rental report on the first quarter of 2017 which is due to be published in May by DAFT.ie is predicted to confirm the increasing cost of renting in major urban areas. This is recognized as a contributing factor to nurse/midwife graduates moving from one facility to another, or to the private sector/overseas. There can be little doubt that current property prices in Dublin and rising rents have a negative influence on nursing and midwifery graduates wishing to stay working in Ireland or those considering returning to work in Ireland. Recent publication from the Nevin Economic Institute illustrates the current Average Monthly Rent as a Percentage of Average Monthly Earnings which increased dramatically and was higher in Q 3, 2016, than at any time in the past 8 years: table 5.1 below: Table Nevin Economic Research Institute- Research for new economic policies- 21 st edition of the NERI Quarterly Economic Observer. Average Monthly Rent as a Percentage of Average Monthly Earnings

36 Page 36 Section 6. Conclusions: The main purpose of this survey was to gather statistics and identify trends among the Internship nursing students who will qualify from September 2017 onwards. The public sector is losing new graduates and experienced nursing / midwifery staff to the private sector and overseas on an ongoing basis. This trend must be halted given the current crisis in the Public Health Service, Ireland s aging population 3 and increasing demands on the public health service. To correct this and realistically achieve the best outcomes, this survey illustrates that it will be necessary to: Improve and increase the availability of post graduate education and specialization courses of education, this is very necessary to compete with UK and other markets; Improve nursing and midwifery pay (Parity of pay and Hours with comparable therapeutic grades employed in the Irish public health service has been sought by the INMO); Offer real competitive incentives to stay in Ireland and to return to work in the Irish public health services, these must at the very least match offers available in the Irish Private health services; Provide contracts that guarantee post qualification employment to all training nursing and midwifery students, this will render recruitment from overseas less effective; Provide for career breaks within the contract to allow travel for a period but maintain the employment link to entice those travelling abroad to return to a long-term job with an attractive future in the nursing profession; and At the very least start recruiting students on commencement of their internship year, to ensure their long term commitment to employment in the Irish Health service to counter early recruitment efforts by overseas employers. 3. The old population (i.e. those aged 65 years and over) is projected to increase very significantly from its 2011 level of 532,000 to between 850,000 and 860,700 by 2026, and to close to 1.4 million by (CSO, 2017)

37 Page Credits: Authors: Liam Conway, INMO Student/New Graduate Officer, Phil Ni Sheaghdha, Director of Industrial Relations, INMO. Questionnaire Peer Reviewer: Dr. Amanda Phelan, Associate Dean Global Engagement, UCD School of Nursing, Midwifery and Health Systems. Graphics/Design and Editing: Jude Maher and Aileen Rohan A Special thanks to all of the 4 th year student nurses and midwives who participated in this study by completing the questionnaire and submitting comments. Note of thanks for support to: The INMO Executive Council Industrial Relations subcommittee members. INMO President and Members of the Executive Council and INMO team. Dr. Amanda Phelan: Associate Dean Global Engagement, UCD School of Nursing, Midwifery and Health Systems. The following companies for providing information and trends in the current market: NurseIreland, Paolo Lacovelli MPSI, Managing Director. Suite 330- The Capel Building Mary s Abbey, Dublin 7, Ireland. Web: Alliance Health Recruitment Agency. Jane Cunningham MIRP Cert RP, Recruitment Consultant Ireland & United Kingdom. Web: Head Hunt International, Maria O Dwyer, Recruitment Consultant. Web:

38 Page 38 Appendix 1. The confidence level of this survey was 95%. The margin of error was 4%. z-score = Table 1.1 Population Size 1096 Confidence level 95% Sample Size 443 Margin of Error 4% Response Rate 40.42% This survey accurately assesses the population values (in this case, nursing and midwifery interns who will graduate from September 2017 onwards). There were no abandonments, break-offs, drop-outs or partial responses in this survey. All 443 respondents completed the 14 questions and 123 respondents (28%) chose to take the option of question 15 where by respondents had the option to state any comments, questions or concerns. This survey followed the survey disclosure checklist in accordance with minimum disclosure requirements of the AAPOR Code of Professional Ethics and Practice (2009). This survey was opened on the and closed on the Responses were collected by web link sent to the population from the INMO, text message (sms) containing the web link and a small number of manual entries by the population (9 in total). Table 1.2

39 Page 39 Appendix 2. What incentives/changes would prompt you to staying in the public health service? (Choose in order of priority to you 1-6, 1 being the most important & 6 less important to you) Answer Options Increase in pay Reduction in number of hours worked within a week i.e. Improved staffing levels and working conditions Rent allowances for staff working in major urban areas Access to funded Post-Graduate education Other Rating Average The table above illustrates the rankings and ratings of each incentive. Increase in pay was selected overall as the most important incentive by receiving the lowest rating average. Response Count answered question skipped question 443 0

40 Page 40 Methodology Appendix 3. The Nursing and Midwifery Interns questionnaire was drafted on the 25/1/17 by Phil Ni Sheaghdha, Director of Industrial Relations of the INMO, and Liam Conway, Student/New Graduate Officer. This draft was reviewed by Dr. Amanda Phelan, (Associate Dean of Global Engagement, University College Dublin, School of Nursing, Midwifery & Health sciences). Dr. Phelan s expertise was vital to ensure the questionnaire purposed for the survey was non-leading and non-biased to validate, verify and support the collected data. The selected method to reach the target audience was a web based tool, as the 4 th year internship students were currently on their placements as part of their 36-week internship. The selected web software chosen was Survey Monkey based on user friendliness and the software s data analysis capabilities (Corey & Brown-Wetly, 2009). A sample survey was undertaken which was issued to a random group of 20 INMO representatives. This did not lead to any changes to the Questionnaire format and it was then formally launched on 03 rd March Closing date was identified as the 04 th April We aimed to have this survey completed for the INMO Annual Delegate Conference (ADC) where findings would be advised to delegates, as part of the Industrial Relations report. All third level 4 th Year Internship Nursing and Midwifery Students in the Republic of Ireland were invited to participate in this survey. Psychiatric Nursing students were excluded on the basis that the INMO does not represent most qualified psychiatric nurses. General, Children s and General, Intellectual Disability and Midwifery Interns were included. This led to a sample size of 1096 internship students out of 1292 in membership. This group were contacted by to their current and active addresses. The survey was sent to each of the 1096 students. The age of each respondent was determined in the second question of the survey. The INMO could then compare the respondents age (i.e 23 years of age or > 23) with their replies to the majority of remaining questions in the survey. All the data collected was from anonymous respondents from the 443-sample size. The overall response rate on closing was 40.42%. The average response rates to external surveys is 10-15% (Surveygizmo, 2017). The high response rate from our members and population size support the claim that this survey was well designed, targeted & focused. Appendix 1 includes survey details.

41 Page 41 References American Association for Public Opinion Research (2016) Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys. 9 th Edition, AAPOR, USA. Central Statistics Office (2013) Press Release Population and Labour Force Projections, Available online: dlabourforceprojections / [accessed 3/4/17] Central Statistics Office (2017) Average Earnings, Hours Worked, Employment and Labour Costs by Economic Sector NACE Rev 2, Type of Employee, Quarter and Statistic. Dublin: CSO. Government of Ireland (2015) Financial Emergency Measures in the Public Interest Act (FEMPI). Available online: Greenlaw, C. & Brown-Welty, S. (2009) A comparison of web-based and paper based Survey Methods: Testing Assumptions of Survey Mode and Response Cost. 33(5), pp Health Sector Workforce (2017) Health Services People Strategy Leaders in People. Irish Nurses and Midwives Organisation (2017) Submission to the Public Service Pay Commission Available online: Labour Relations Commission (2013) Public Service Stability Agreement [The Lansdowne Road Agreement]. Available online: Service-Stability-Agreement pdf