The evidence indicates that recent HSE initiatives to recruit much-needed nurses to our health services have not worked. The piecemeal and minimalist approach to nursing recruitment adopted by the HSE will not reverse the internal nursing perception and image of the nursing profession created in recent years.

On the back of patterns of unstable employment for nurses, there have been up to three nursing pay cuts since 2009, coupled with working hours increased by six hours each month.

Such unplanned actions have created disillusionment and disrupted the cycle of positive nursing developments and upgrading arising from the 1998 Commission Report on Nursing. The Commission of Nursing, the chairmanship of the late Justice Mella Carroll, set out a blueprint for the future, and was the most important overall upgrade of nursing in the history of the profession.

It is significant to note that the commission was established following a national strike by nurses in pursuit of better terms/conditions and the strengthening of career and educational pathways.

The worldwide nursing shortages and ageing workforce highlight the importance of improving the recruitment and retention of nurses within the health care systems. The World Health Organisation in 2006 reported a shortage of 4.3 million healthcare workers globally and estimated this figure would increase by 20 per cent over the next two decades. Nursing is an international profession and nurses, in particular Irish nurses, can obtain employment anywhere in the world, and in business world parlance, nurses would be regarded as a scare commodity with a premium value.

Sustaining a nursing workforce is fundamental to all health care systems and the quality of patient care. The importance of adequate nursing manpower was highlighted in a recent Lancet journal, which showed that increasing a nurse’s workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7 per cent (Aiken et al. 2014).

Context

The understanding of those graduates was that employment opportunities would be available following graduation and the reality was that no employment opportunities were made available and so international recruitment agencies came to Ireland and recruited graduating nursing classes en mass.

The dismantling of the customary permanent and pensionable job was a body blow to newly qualified nurses.

The fragility of strategic nursing manpower planning in Ireland was exposed, as our new Irish graduates were being recruited outside of Ireland, while at the same time our health agencies entered into elaborate schemes for overseas nursing recruitment in places such as India and the Philippines and South Africa.

Arising from the golden nursing period following the commission report, Ireland’s decision to introduce a university graduate nursing programme in 2002 was perceived internationally as forward thinking and was designed to bring Irish nursing education into line with other countries such as the US and Australia.

The introduction of a four-year pre-registration BSc honours nursing degree placed Ireland in a flagship position in Europe, with a government-backed guaranteed financial investment in Irish nursing. This created a very positive direction for nursing careers, and the role of the nurse extended into new areas. Sadly, much of the inventiveness of this period which had created a new dynamic for the profession was lost in the subsequent years with a failure to sustain the developmental ethos and enhanced professionalisation of nursing and midwifery.

The challenge now for the HSE and the health service employers is to attract back the nursing and midwifery graduates. In foreign jurisdictions Irish nurses and midwives have been initiated into a new scope of nursing and midwifery practice with exciting careers. In the current Irish health care culture there are concerns that nurses are not sufficiently involved in policy decisions related to health care and therefore it may be time to review and build on the nursing developments of the early part of this century. The acceptance that nurses as front-line health services workers can be transformational in supporting the healthcare objectives of a nation must be top of any developmental agenda along with targeted efforts at cultivating and promoting nursing leaders.

Empowerment

The way forward in recruitment and retention of nurses is to review the current development of the nursing profession.

The first step is to establish a national strategic nursing committee along the lines of the commission report. A root and branch analysis of nursing and health care might create the necessary impetus to restore pride among nurses and provide the positive foundation that will attract them back to Ireland.

Policymakers and health service employers must learn from the sequence of events of the last 10 years that has fragmented the development of the nursing and midwifery professions. The public places its trust in nursing and in the US the nursing profession has ranked at the top of the 2014 Gallup polls when it comes to the public perception of honesty and ethical standards in professions.

Dr Seamus Cowman is Professor of Nursing at the Royal College of Surgeons in Ireland