Hospital trusts are failing to keep hold of nurses recruited from abroad, with some losing the majority within just a year of hiring them, an investigation by Nursing Times has revealed.
We found that 13 organisations saw at least half of the overseas nurses they actively recruited leave within two years of being hired. In some cases, none of the nurses now work at the trusts that originally recruited them.
Recruitment trips to Europe by senior nurses have become increasing common over the last couple of years, following the scramble to hire more nurses in the wake of the Francis report combined with a shortage of home-grown staff.
Just last week Cambridge University Hospitals Foundation Trust announced that is had been joined by over 100 nurses in January, after a successful overseas recruitment drive.
In the past, the NHS tended to take nurses from further afield – notably India, Australia and the Philippines – but now the majority of overseas nurses currently joining are from EU countries hit hard by the financial pressures of recent years.
Nursing Times collected workforce data from 95% of the 158 acute trusts in England using the Freedom of Information Act, asking trusts how many overseas nurses they had actively recruited and how many remained in post.
By the end of 2014 – within a year of recruitment – Surrey and Sussex Healthcare Trust lost around 60% of the 104 nurses it recruited from Portugal, Poland and the Republic of Ireland.
“The fact trusts are reporting none, or relatively few internationally recruited nurses have remained points to either retention problems or that it was always regarded as a short-term stop-gap”
In the same period, East Kent Hospitals University Foundation Trust saw more than 80% of the 26 nurses it recruited from Portugal leave the organisation, while Aintree University Hospital Foundation Trust now has none of the 14 Spanish nurses it hired still working on its wards.
Fiona Allsop, chief nurse at Surrey and Sussex Healthcare Trust, said it was “vital” for the organisation to recruit widely to ensure it has nurses with a mix of skills.
Commenting on the figures showing the trust had lost many of its overseas nurses recruited in the past year, she said: “We have found that with our close proximity to London that many of our newly recruited nurses have chosen to stay in the NHS and move to hospitals in the capital and recently this included all of the nurses from Ireland.
“More junior members of our nursing teams will often move on to other opportunities as they seek to gain experience and develop their skills.”
Ms Allsop said the trust was now working with a specialist recruitment firm to secure nurses from overseas who have been specifically trained to the high standards required in the UK.
Royal Devon and Exeter NHS Foundation Trust has just 38% of the 78 EU nurses it hired in the year leading up to September 2013 still in its establishment.
Its deputy chief nurse Tracey Reeves acknowledged that the trust’s retention rates were “disappointing”, but highlighted that figures had improved in the following year.
“Retaining nurses recruited from overseas is challenging, but we are committed to supporting individuals with their transition into the NHS. We have put in place a series of measures to encourage them to develop a long-term career with the trust,” she said.
Ms Reeves confirmed the trust would continue to actively recruit staff from abroad to ensure patient safety and quality of care.
Meanwhile, Colchester Hospital University Foundation Trust hired 67 Spanish nurses in the 12 months before September 2013, but 60% have since left the organisation, and Royal Surrey County Foundation Trust has lost all four of the Portuguese nurses it actively recruited.
A spokesman for the Essex trust said nurses largely left either to return home to Spain, because they felt homesick, or went to London where there were more established Spanish communities.
He said the trust was “disappointed” so many staff had left Colchester and it had subsequently improved its support programme to make a smoother transition to living in England. For example, it now ensured overseas nurses had good accommodation and could open a bank account.
Not all of the trusts contacted by Nursing Times held records on what had happened to overseas recruits. However, at the 38 trusts that had kept a record, 28% of the 1,426 overseas nurses recruited from September 2012 to September 2013 no longer worked for them.
“Retaining nurses recruited from overseas is challenging, but we are committed to supporting individuals with their transition into the NHS”
Meanwhile, 13% of the 4,254 overseas nurses hired across 93 trusts in the 12 months leading up to September 2014 have already departed from these organisations. Within one or two years, these trusts lost in total 943 – or 17% – of the nurses they had hired through overseas campaigns.
However, this may only be the tip of the iceberg. Trusts – including King’s College Hospital Foundation Trust and St George’s Healthcare Trust in London, which recruited around 600 overseas nurses between them in the past two years – said they did not hold data that could be easily provided on whether staff had stayed with them, indicating the total number of lost nurses could be higher.
Professor James Buchan, a nursing workforce expert from Edinburgh’s Queen Margaret University, highlighted that turnover of overseas nurse found by Nursing Times was more than double the norm. Data from the Health and Social Care Information Centre showed the average turnover of all NHS nurses in the year up to October 2014 was around 8%.
Professor Buchan said: “The fact that some of the trusts who responded to the FOI are reporting that none, or relatively few internationally recruited nurses have remained in the employment of that trust one year after recruitment points to either retention problems or that it was always regarded as a short-term stop-gap.”
In a recent edition of BBC Radio 4’s File on 4 programme, Pat Read, chief nurse at Luton and Dunstable University Hospital Foundation Trust, said it cost around £2,500 to actively recruit a nurse from Portugal before wages were taken into account.
“The collection of more accurate data… to learn lessons as to why people are choosing to leave is really vital”
Unions warned that money used by trusts to recruit overseas nurses was being wasted if nurses are not staying within the NHS. But they acknowledged the current shortage of home-grown nurses meant overseas recruitment would be needed for several years to come before the domestic workforce was rebuilt.
More should be done by trusts and national bodies to understand turnover patterns, what was causing nurses to leave and how to ensure more were retained, unions told Nursing Times.
Unison head of nursing Gail Adams said: “Although these nurses have been lost to these organisations, we don’t know if they have been lost to the NHS. The collection of more accurate data and also exit interviews… to learn lessons as to why people are choosing to leave is really vital.”
As revealed in October, nearly half of the nurses that Plymouth Hospitals Trust recruited from Spain and Portugal left, with some citing the lack of a local airport as a reason. A number had moved to Bristol, because its airport provides direct flights to the Iberian peninsular.
Ms Adams called on Health Education England to monitor the situation across the country and pay particular attention to the reasons why people were leaving.
Royal College of Nursing head of policy Howard Catton said: “People may come here and may get homesick, the situation in their country may improve so they may decide to go home, they may not enjoy the experience – either from a nursing perspective or just from living in the UK.
“Or people may be deliberately using the UK as a stepping stone as part of their development and onto another country or job,” he said.
“There should be conversations at a regional level, but that should also be supported by national work, so we understand better the flows of people coming in and out,” he added.
Mr Catton also suggested that the shortage of nurses globally was making it more difficult for trusts to retain them.
He said he expected trusts would have to work harder in future to attract and retain them, coming together locally to offer overseas nurses a more varied role in which they could practise across a range of settings.