Dáil debates
Wednesday, 24 June 2015
Topical Issue Debate
Nursing Staff Recruitment
1:00 pm
Paul Connaughton (Galway East, Fine Gael)
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This Government is fully committed to job creation and ironing out the red tape that prevents employers from taking on staff, yet at the moment there are 300 vacancies in the private sector nursing homes across Ireland largely due to the delays experienced in registering nurses with the Nursing and Midwifery Board of Ireland.
This issue has been raised with me on a number of occasions, particularly by nursing home owners in County Galway, who struggle to replace nurses when they leave. Currently, there are nursing home beds in County Galway that are closed awaiting the registration of nurses.
Nursing home beds in County Galway have been withdrawn from service as the homes await the registration of nurses. This delay in registering nurses has knock-on effects, including the possibility that further nursing home beds will be withdrawn, leading to difficulties in discharging patients from acute settings and placing pressure on accident and emergency departments. The lack of registered nurses means that many owners of nursing homes must use recruitment agencies or engage directly in recruiting nurses internationally. This creates a significant cost burden for nursing home owners, who, in addition to experiencing difficulties in registering nurses, face costs of between €8,000 and €10,000.
The current waiting time is listed as 90 days. Up to 700 applications are before the Nursing and Midwifery Board of Ireland, NMBI, awaiting processing. If a query is raised about an application, as is common for applications from foreign-registered nurses, the application is placed at the bottom of the list and the nurse in question may not be registered for 90 days, six months or 12 months. This is a bureaucratic nightmare. Nursing home owners have informed me that it is very unusual for foreign-registered nurses to have registrations successfully concluded within 90 days. Six months is too long for any business to have to wait for registration. The Nursing and Midwifery Board of Ireland will cite a lack of resources as the reason for delays in the registration process. I also note that the board failed in its attempt to have the nurse registration fee increased by 50%. The current impasse and the delays experienced by nurses and nursing home owners must be addressed.
Rigorous procedures for the registration of nurses are necessary, and I do not propose any relaxation in current procedures. However, faster turnaround times for registration are required, and if additional resources are required, they must be found. Approximately 300 vacant posts could be filled and the additional taxes that would result could be used to offset any additional resources needed.
The lack of available nurses in Ireland is resulting in ever-increasing recruitment and retention costs for nursing homes. Nursing homes in rural areas are at a particular disadvantage because it is assumed that they have lower costs, and this assumption is reflected in the much lower fees they are allowed to charge by the National Treatment Purchase Fund. The fees paid to many nursing homes in rural areas have remained static for the past five years, during which time the crisis in nurse recruitment has greatly increased the cost of recruitment and resulted in offers of ever-increasing salary packages in an effort to retain qualified registered nurses.
The Government has adopted a common-sense approach to job creation. The current delays being experienced in nurse registration could be addressed through simple action that would allow 300 vacant posts to be filled and remove a bottleneck in the health system. I look forward to the Minister's response.
1:10 pm
Leo Varadkar (Dublin West, Fine Gael)
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I thank Deputy Connaughton for raising this issue. Delays in processing nurse registration applications are directly connected to the volume of requests arising from current initiatives to attract and retain nurses. My Department and the Health Service Executive are collaborating in sourcing several solutions to the issues affecting nurse recruitment and retention.
The background is that nurses who trained in a country outside Ireland and wish to work in Ireland are required to apply to register as nurses with the Nursing and Midwifery Board of Ireland, formerly known as An Bord Altranais. In assessing an applicant for registration, the board seeks evidence from applicants of comparable standards of education and practice to protect the public, as nursing qualifications vary significantly from country to country. According to the NMBI, the timeframe for completion of the assessment of qualifications for registration is up to 90 days, provided all necessary documentation has been supplied by the applicant. The main difficulty in expediting timely applications, as reported by the NMBI, is delay or failure by the applicant or third parties to furnish the necessary documentation required to assess eligibility for registration.
The NMBI, following the assessment of an applicant's qualifications, may require the applicant to undertake a six- to 12-week period of adaptation and assessment. A period of adaptation is designed to make up for differences in education and ensure competence for working in the Irish health service. If this adaptation is required, it must be successfully completed as a prerequisite to registration. Two HSE adaptation courses are still available this year - in June and August - and these courses are between six and 12 weeks in duration. They facilitate the integration of overseas nurses into nursing in an Irish context. It may be of interest to the Deputy to know that since the nationally co-ordinated pilot adaptation programme commenced in June 2014, 151 candidates have completed the programme, 58 candidates are currently undergoing assessment and 126 candidates are due for assessment up to the final programme in August 2015. In addition to the current provision for placements in 2015, 293 requests for placements have been received from employers. These numbers are not reflective of a national total, as some hospitals have also run independent adaptation programmes.
A collaborative group, including my Department, the Health Service Executive and Nursing Homes Ireland representatives, continues to explore options to facilitate adaptation and thereby registration with the NMBI. It is important to acknowledge that the NMBI is dealing with a significant volume of applications. The board is processing all applications as quickly as possible while ensuring appropriate procedures and checks which are designed to protect of the public. I should also advise the Deputy that the NMBI has been allocated additional resources to address these issues.
Notwithstanding the real challenges we are facing in nurse recruitment and retention, 500 more nurses are working in the public health system than at this time last year and more than 1,000 additional beds will be provided under the Fair Deal scheme this year, all of which will be staffed by nurses.
Paul Connaughton (Galway East, Fine Gael)
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I thank the Minister for his response. The issue raised with me by nursing home owners is that is taking a long time to inform nurses of problems with their registration applications. Applications are being placed at the bottom of the pile when problems are identified. A similar approach was taken some years ago in respect of student grant applications to Student Universal Support Ireland, and the same practice has been evident n local authorities for many years. Surely, if an application is found to be incorrect, a call should be made to the applicant within one hour informing him or her what documentation needs to be submitted. The NMBI can only deal with the applications it receives. However, if it takes six or eight weeks to request further information from applicants, the entire process slows down, which is extremely frustrating for owners of nursing homes, who must wait six, nine or 12 months before a nurse can start work.
While I accept the Minister's comments on changes to the Fair Deal scheme and the increase in the number of nurses as the economy improves, this issue is entirely a matter of red tape and bureaucracy. As I stated, no one wants to cut corners in the recruitment process. We expect nothing less than the best trained, most skilled and most qualified staff in our nursing homes and hospitals. Surely it would be possible, with some additional resources and further consultations with the relevant stakeholders, to inform applicants of problems with a registration application much sooner than is currently the case. I am informed that this process can take six or eight weeks, during which time the application does not advance, which is extremely frustrating for the nurse seeking registration. I expect that nurses in many of the countries from which we are recruiting are able to move to other countries with much more efficient systems for recruiting nurses. If we want to recruit the best nurses, we must clean up this minor bureaucratic mess.
Leo Varadkar (Dublin West, Fine Gael)
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Additional resources have been provided and consultations are taking place on the matter with stakeholders, including Nursing Homes Ireland. The Deputy makes a valid point about efficiency. While I am not sure precisely how applications are processed, I would be concerned if applications were allowed to mount before being examined one by one. In such circumstances, an application could be left in a pile for several weeks before an administrator identifies that something is missing. It would make sense to carry out an initial check to ensure all the documents are in order. Any steps that would make the process more efficient would be welcome. I meet periodically with representatives of the NMBI, and the chief nursing officer in the Department meets them more regularly than I do. We will definitely raise this matter in our conversations.