Nursing and Midwifery Internship Student Survey 2017 - Prepared by the Irish Nurses and Midwives Organisation, in conjunction with the Executive ...

 
Nursing and Midwifery Internship Student Survey 2017 - Prepared by the Irish Nurses and Midwives Organisation, in conjunction with the Executive ...
Nursing and
 Midwifery Internship
 Student Survey 2017

Prepared by the Irish Nurses and Midwives Organisation, in conjunction with the Executive
Council Industrial Relations subcommittee.
Nursing and Midwifery Internship Student Survey 2017 - Prepared by the Irish Nurses and Midwives Organisation, in conjunction with the Executive ...
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 2017. The
combined Children’s and General group are due to qualify from February 2018.
Due to ongoing staff shortages, the Irish Nurses and Midwives Organisation (INMO) undertook
a survey1 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 4th year.
                       The main findings of the survey are as follow:

                                   78.1% of respondents are
                                  considering emigrating from
                                    Ireland upon qualifying.

                                                         70.2% of the respondents had been
        78.78% of respondents stated that                  approached by overseas nursing
        they would consider staying in the               companies to recruit them into their
         public service for at least a year                  service versus 29.8% of the
            upon qualifying if offered                  respondents being offered permanent
         guaranteed permanent contracts.                  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. 58.92% 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 4th Year Student members who had a current email 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.
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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:

                                                                               Require a consequent
                                                                                 expensive overseas
                                                                              recruitment campaigns
                                            Lead to falling                    to recruit non–EU and
   Promote emigration                   employment numbers                         EU nurses and
  among new graduates;                    in the Irish Public                 midwives, to fill vacant
                                            health service                       posts in Ireland in a
                                                                                time of a worldwide
                                                                                shortage of qualified
                                                                                nurses (WHO, 2006).

 NURSING AND MIDWIFERY INTERNSHIP STUDENT SURVEY             IRISH NURSES AND MIDWIVES ORGANISATION
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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 4th 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 2015. 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 2011-2016, 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 2007 — 2016 (Health Service
Executive)

         Year              Number of Whole         Annual Net Gain           Change since 2011
                           Time Equivalent         /Loss WTE
                               (WTE)
         2011                  35,902
         2012                  34,637                      -1,265                   -1265
         2013                  33,768                       -869                    -2134
         2014                  34,504                       +736                    -1398
         2015                  35,353                       +849                     -549
         2016                  35,835                       +482                      -67
 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 2016.

It is important to determine whether the HSE can meet the nursing and midwifery staffing
requirements to maintain our current health services.

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  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.

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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).

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2.2 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 2013. 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?

         66.37% of the respondents are 23 years of age or younger.
   1
         50% of male respondents were 23 years or younger.
   2
         67% of female respondents were 23 years of age or younger. *
   3

*Question 1 and Question 2 are cross referenced to determine age profiles of male and female
respondents.

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2.3 Emigration after Qualification
Figure 3 ‐ Question 3 Are you thinking about emigrating when you qualify as a nurse or midwife?

          78.1% of the respondents are considering emigrating. From the respondents
  1               older than 23 years, 54.36% would also consider emigrating.

          21.9% are not considering emigrating.
  2

          Of the 78.1% considering emigrating, 90.14% are 23 years or younger.
  3

          From the 23 years and younger age group, 60.54% would consider staying if
  4       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
  5       6).

          75.84% of respondents in the over 23 years old group would consider working
  6       for at least 12 months if offered permanent positions (as per Question 6).

          81.49% of the total respondents placed pay, staffing levels and working
          conditions as the major reason for considering leaving the Irish public health
  7       service. (Comparing responses with Question 4).

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2.4 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.

              Improved staffing levels and working conditions received the most
              number 1 preferences (42.44%).
    1

              39.05% of respondents ranked pay as the number one priority
    2
              If you combined the 1st and 2nd priority incentives selected by
              respondents for increase in pay, 75.39% of respondents suggested an
    3         increase in pay is needed to keep them within the public service.

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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:

           74.14% have put pay as the most important incentive.
   1

           This is followed closely by improved staffing levels and working conditions
   2       with 71.77% ranking this as the 2nd most important incentive.

           Access to post-graduate education was ranked third, with 56.8%
   3

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

                                                                     Somewhat likely
               27.3%

                                            46.7%

                                                                     No as I wish to travel but will
                                                                     consider returning to work in
                                                                     Ireland if conditions improved.

                    23.7%
                                                                     Unlikely

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            46.73% of respondents would consider remaining within the Irish public
   1        health service if incentives were given.

            23.7% are somewhat likely to remain if incentives are given.
   2
            2.26% have decided that they are unlikely to work within the public
   3        health sector of the Republic of Ireland even if incentives were given.

            27.31% of respondents are considering travelling but will consider
   4        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
   5        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

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              78.78% of the respondents would delay leaving the public health service
              for at least a year upon qualifying if guaranteed employment for at least
    1         one year.

                 Of the 21.22%, 64.89% of these respondents would likely consider
    2            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?

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               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 2017.

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?

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                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%                                                               Yes
                                                                                                  No
                                                       58.9%

            58.9% of respondents confirmed that they would consider moving to the
   1        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.

            70.47% of the respondents aged over 23 would considering moving to
   1        the private sector.

            However, 75.84% of this age profile would consider taking up
   2        employment in the public sector if offered postgraduate employment for
            at least one year.

            53.06% of the respondents aged 23 or younger are considering moving
   3        to the private health sector.

            80.27% of this age profile would consider taking up employment in the
   4        public sector if offered postgraduate employment for at least one year.

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2.9 Working in Teaching Hospital Post‐Qualification
Figure 9 – Question 9 – How likely are you to stay in your teaching hospital after qualifying?

            This is consistent with Question 3, with 74.49% stating that they are unlikely to
   1        stay within their current teaching hospital without incentives.

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2.10 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%

                                                                     If Yes: Full Time Permanent
                                              10.4%                  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

             As of the 4/4/17, the closing date of the survey, 71.6% of respondents have
             not been offered permanent posts.
   1

            Only 15.31% of the respondents, 23 years of age or younger have been offered
   2        permanent posts.

            18.12% of the age profile older than 23 years of age have been offered
   3        permanent posts.

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   2.11 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

                                       31.2%                      Yes: You would prefer to live
                   36.4%
                                                                  closer to/at home

                                                                  Yes: You are not enjoying your
                                                                  current work place and/or where
                                                                  you are living
                                                                  No not yet
                       7.7%        24.7%

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           31.40% of the respondents 23 years of age or younger are considering moving
   1       closer to home due to cost.

           30.87% of the respondents over the age of 23 are considering moving closer to
   2       home due to cost.

   2.12 Information on Portfolios and Interviews
Figure 12 – Question 12 Have you been provided with information regarding portfolios or interviews
by your employer?

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2.13 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?

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2.15 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.

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  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 2015.

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 2007. 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 2015. 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 2007 — 2016
(Health Service Executive)
                               Year         Number
                                            WTE
                               2007         39,006
                               2008         38,108
                               2009         37,466
                               2010         36,503
                               2011        35,902
                               2012        34,637
                               2013        33,768
                               2014        34,504
                               2015        35,353
                               2016        35,835

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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

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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 2016. 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.

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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.

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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 2nd 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 €1000-€1500 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.

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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
              €1500                       1st Sign on Bonus                      €3000
      €1500 WRC Proposal                One year loyalty bonus                   €3000
     Receipted from the €1500                   Flights                           €250
          signing bonus
                 N/A                       Accommodation                         ≃€14302
                €300                           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 2016.
This price is set to rise when the 1st quarterly report is released from Daft in May 2017.

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           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)

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‘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)

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‘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 + €1000-euro deposit for continued accommodation’ (Survey
respondent on 3/24/2017)

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‘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)
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‘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)

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                     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.

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 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
 2017. 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).

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 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.

                                70.20% 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.
                                          71.56% 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).

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5.4 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 5.1 - Nevin Economic Research Institute- Research for new economic policies- 21st
   edition of the NERI Quarterly Economic Observer.
                 Average Monthly Rent as a Percentage of Average Monthly Earnings

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                        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 population3 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                   Improve nursing and                     Offer real competitive
     availability of post                  midwifery pay – (Parity                incentives to stay in Ireland
   graduate education and                   of pay and Hours with                 and to return to work in the
  specialization courses of                 comparable therapeutic                Irish public health services,
   education, this is very                  grades employed in the                these must at the very least
    necessary to compete                  Irish public health service               match offers available in
     with UK and other                      has been sought by the                   the Irish Private health
          markets;                                 INMO);                                    services;

                                                                                     At the very least start
    Provide contracts that                 Provide for career breaks                 recruiting students on
         guarantee post                   within the contract to allow              commencement of their
  qualification employment                   travel for a period but               internship year, to ensure
                                           maintain the employment
  to all training nursing and                                                            their long term
                                               link to entice those
   midwifery students, this               travelling abroad to return                    commitment to
    will render recruitment               to a long-term job with an                employment in the Irish
      from overseas less                     attractive future in the              Health service to counter
            effective;                      nursing profession; and                 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 2046. (CSO,
2017)
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                                     7. 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 4th 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: www.nurseireland.com
      Alliance Health Recruitment Agency. Jane Cunningham MIRP Cert RP, Recruitment
       Consultant Ireland & United Kingdom. Web: www.alliancehealth.com.au
      Head Hunt International, Maria O’ Dwyer, Recruitment Consultant. Web:
       http://www.headhuntinternational.com/

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                                     Appendix 1.
The confidence level of this survey was 95%. The margin of error was 4%. z-Score = 1.96.
                                            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 03.03.17 and closed on the 04.04.17.
Responses were collected by email 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

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                                                   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)
                                                                                                                                              Rating Response
Answer Options                                          1            2              3             4                5              6
                                                                                                                                             Average Count
Increase in pay                                        173          161            58            20               19             12            2.07          443
Reduction in number of hours worked within a week i.e. 16           56             90            122              136            23            3.85          443
Improved staf ing levels and working conditions        188          125            66            28               22             14            2.13          443
Rent allowances for staf working in major urban areas 12            35             64            127              168            37            4.16          443
Access to funded Post-Graduate education               24           58             157           132              58             14            3.42          443
Other                                                  30            8              8            14               40             343           5.38          443
                                                                                                                                     answered question           443
                                                                                                                                       skipped question            0
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.

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                                       Appendix 3.
Methodology
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 4th 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 03rd March 2017. Closing date was identified as the 04th April 2017.
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 4th 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 e-mail to their current and active email 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.

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