The numbers on nurse recruitment just don't add up – Nursing in Practice

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Marilyn Eveleigh

27 Jun 2022

Over-reliance on recruitment of nurses from overseas isn’t the right formula for success for so many reasons, says Marilyn Eveleigh
The recent NMC report¹ finding that more than 27,000 nurses, midwives and nurse associates left the register in 2021-22 is depressing, but not a surprise. The top reasons cited were pressures of work, retirement and personal circumstances. Interestingly, not pay. 
I wonder how long that will remain the case. Galloping inflation and energy costs are expected to bite in the autumn, making the pending 2022/23 nursing pay award key to retention. The 3% currently on offer will do little to help. The UK has its largest number of job vacancies for decades, with more than 39,000 registered nurse vacancies – a 10% vacancy rate. Many other employers are offering higher salaries that may persuade nurses to take their transferable skills to a role outside nursing, despite the traditionally attractive benefits and pension schemes of the public sector.  
The good news in the NMC workforce report is that the register is the largest it has ever been, with 758,303 nurses, midwives and nurse associates. In excess of 48,000 joined the register for the first time, a significant increase on the previous year. With soaring healthcare demand, the country needs more of us.
The bad news is that just 25,028 of those nurses were trained in the UK; the other 23,000 were recruits from overseas. This indicates an unhealthy reliance on an international workforce that is vulnerable to global events – it is undoubtedly helpful in the short term but reinforces the imperative to grow our own. This quick workforce fix must not be a substitute for investment in UK nurse training.
International recruitment is part of the Government’s 2019 manifesto target to secure 50,000 more nurses by 2025. Presently, 18.5% of the NHS hospital and community nursing workforce are from overseas, with others employed in the independent and social care sectors. Overseas recruitment is big business for large NHS trusts and private companies but is not always ethically undertaken or justified. The pandemic highlighted the need for countries to have their own workforce to meet their healthcare needs and UK overseas aid has been directed specifically towards health programmes; it is ironic and ethically dubious that we are recruiting from countries that need their own trained nurses.
With a worldwide shortage of nurses, international recruitment is getting more competitive, with salaries to match. If overseas nurses migrate here for better pay, quality of life and career opportunities, UK nurses remain in post for the same reasons. 
The Nuffield Trust found that in the short term, the upfront recruitment costs of £10,000-12,000 per overseas nurse represent better value than the use of agency nurses to fill vacancies.² Really? If so, has someone done the maths? To recruit and retain experienced nurses, could the NHS add the eyewatering agency nursing costs to the stopgap overseas nurse recruitment costs and use the total to improve nursing pay? In the long term, might this be a better investment? I’m afraid this calculation is beyond my pay grade.
Marilyn Eveleigh, nurse adviser and independent trainer in East Sussex
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