THOUSANDS OF NURSES and midwives across the country will strike today from 8am.

The 24-hour strike will be the first of a number of industrial action days in protest against pay, recruitment and retention issues in the sector.

A number of claims have been made in relation to the issues in this dispute, including in relation to how much Irish nurses are actually being paid and how that compares internationally.

THE CLAIM: Nurses in Ireland are among the highest paid in the world.

Since the start of this dispute, a number of versions of this claim have been expressed online, usually including links to articles such as these:

It is important to point out that two of these articles did not provide any sources for their information. One did, but the sole source was another one of the articles listed above.

Much of the commentary from the government has also described nurses’ and midwives’ pay here as being “competitive” or “comparatively high”.

Last year the Department of Public Expenditure and Reform published a spending review in relation to nursing the midwifery.

It states: “International evidence suggest that nursing and midwifery remuneration in the Irish Public Health system is high comparatively.”

THE DEPARTMENT’S EVIDENCE

In a response to queries from TheJournal.ie, the department noted that it has not claimed that nurses and midwives are amongst the best paid in the world.

“It has however pointed out that the salaries are competitive domestically and internationally,” a spokesperson said.

Its review does say the basic pay of a nurse at the top of the HSE staff nurse scale would be 39% higher than a nurse at the top of the NHS England Band 5 scale. And it states a new entrant nurse in Ireland earns 21% more in basic pay than a new entrant in England.

Source: Department of Public Expenditure and Reform

The review also references data from the Organisation for Economic Co-operation and Development (OECD), which it says shows Irish nursing pay, in purchasing power parity terms, between 2007 and 2017 was “consistently on a par with Australia and higher than New Zealand, Canada and the UK”.

[The purchasing power of wages is the quantity of goods and services that can be bought with a wage unit in that country. If prices increase, for example, and wages remain constant, the purchasing power will drop.]

Here’s more from that departmental review:

“Data on nursing remuneration (excluding midwives) compiled by the OECD from 2007 to 2016 shows the average pay of a nurse including allowances and premia payments. This is presented in Figure 9 below which situates Ireland in an internationally comparable context.”

The department said Anglophone countries were isolated as these “are assumed to the principal competitors in the global nursing labour market”.

Expressed in purchasing power, average remuneration for Irish nurses has been consistently higher than in Canada, the UK and New Zealand. The absence of recent data on Australia hinders any comparison but prior to 2014 it appears that Irish pay compared favourably.

Though the department acknowledges in the report that OECD is not conclusive, because of the differing systems in jurisdictions, it states that it is “indicative”.

In a statement to TheJournal.ie, it added: “While other countries provide data on a different basis, the 2017 figure of US$ PPP 63,464 remains an accurate estimate of what an average nurse earns in Ireland. While international comparisons are difficult, due to differences in how the figures are compiled, the OECD is the best source of data and the actual salary figures reported by the OECD do not suggest that nurses are low paid.”

THE INMO’S EVIDENCE

Spokesperson for the union Michael Pidgeon pointed out that nurses in Ireland work longer hours than others in English-speaking countries. Here they do a 39-hour week, compared with 37.5 in the UK and Canada, 38 in Australia and 37 in the US.

“That’s rarely taken into account when comparing salaries, which is why we often use hourly rates.”

Pidgeon shared the INMO’s submission to the government, in which it looked at pay levels in England, Canada, Australia and the US. Similar to the OECD data the department used, the union used purchasing power parity, but focused on hourly rate rather than yearly salaries.

Its comparison of pay levels for new nurses puts the US, Canada, Australia ahead of Ireland.

It ranks slightly higher than the UK, but the €16.56 an hour figure for UK nurses does not include their high cost area supplement, which can range from 5% of salary to 20% depending on there they are based. At the highest rate of this supplement, a newly qualified NHS nurse could earn €19.87 an hour.

Source: INMO

Their submission included similar data for nurses on the midpoint [Band 5 referred to by the department in its review] of the scale:

Source: INMO

And for the most experienced nurses:

Source: INMO

These figures do not include overtime and allowances. The spokesperson said the INMO’s reasoning for not including them is because there is too much variance across the systems to compare them.

EVIDENCE ON RECRUITMENT AND RETENTION

The INMO has also collected migration evidence which it believes supports its view of pay and conditions. Pidgeon said:

Ireland trains 1,700 nurses and midwives a year. In 2017 (latest figures), 1,343 nurses in Ireland registered with the NMBI (the nursing regulator) to work overseas. Between 2007 and 2017, 19,386 nurses left Ireland

“In 2018, we asked 4th year nursing and midwifery students if they were considering leaving. 71% said yes, with pay as the runaway main reason for leaving.

This wouldn’t be happening if Irish nurses were well paid compared to other countries.

Although there is no solid data on this, he said anecdotally the INMO regularly hears of nurses in Sydney, Melbourne, London, Qatar and Saudi Arabia who want to return home but “can’t justify the pay cut”.

Source: INMO

On the same issue, the Department of Public Expenditure and Reform said that between December 2013 and December 2018, the number of nurses and midwives employed in the public service has grown from 33,768 to 37,644.

The Public Service Pay Commission found turnover rates, including retirements and moves between hospitals, of 6.8% in 2017. This increases to 7.3% for the staff nurse/midwife grades, where the majority are categorised.

On retention claims it said: “The Commission considers that the national levels of nursing and midwifery turnover rates do not indicate a generalised retention crisis, but that the retention challenge is of an order which would justify some additional measures to reduce voluntary staff departures as far as possible.”

The Department also said that the Commission had found that there was an average of 1.86 applicants per panel size (or nearly two applicants for every potential job).

However, the Commission’s own analysis is more complicated. It said in its report:

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“HBS Recruit provided data for applicants per nursing panel between 2013 and 2017. This data suggests there was an average of 1.86 applicants per panel size over the previous five years. It should be noted that consistent data was only available for each panel, which in most cases will exceed the number of actual available positions, and this data only includes competitions managed by HBS Recruit.

“It excludes the Voluntary health agencies and a smaller number of local recruitment programmes managed by individual health organisations. The Commission considers that this is another important area where data should be collected and analysed centrally to facilitate comprehensive, in-depth analysis of recruitment requirements, trends and other relevant indicators. For example, the absence of central data means that the three large Dublin based maternity hospitals and the three children’s hospitals are not represented in the above analysis.”

ADDITIONAL EVIDENCE

A spokesperson for the OECD explained there is an overestimation in the data for remuneration of nurses in Ireland, the US, and Chile.

This is because data for all other countries includes less qualified nurses who would earn less, therefore dragging the averages down.

So countries like Ireland, the US and Chile who do not collate this data to include unregistered nursing graduates are naturally higher up on this list.

Nurses in countries like Belgium, Denmark and Israel that are close to Ireland on the list are actually likely to be earning more than Irish nurses, as their averages in this chart include non-professional lower paid nurses.

Source: OECD

“This makes the data for nurses’ salaries in Ireland, Chile and US harder to compare – and I’m not sure anyone could say to what extent as their share is likely to vary a lot between countries,” the spokesperson said.

What this means is that the OECD data, which is widely used in commentary around nurses’ pay in Ireland, is not reliable for comparison purposes.

They also pointed out that while Irish nurses appear close to the top of the list when compared to other nurses around the world, they are not high up when compared with the general average wage of workers in Ireland.

Source: OECD

This chart shows the ratio of nurses’ pay to the average wage in each country.

Mexico tops the list – its nurses earn almost twice the average wage in that country. In Israel, nurses earn 1.5 times the average wage.

In Ireland, nurses earn about the average wage which the Central Statistics Office last year put at €39,000.

So while Irish nurse’s salary may appear higher when compared to that of their peers in other jurisdictions, those same nurses in other countries may be earning significantly more than the average wage in their country, which is not the case in Ireland.

VERDICT

It is clear that the data available for nurses’ salaries contains so many variables that it is difficult to accurately compare them.

Some countries include a large cohort of non-professional and therefore lower paid workers in their numbers. Much of the data does not – and probably could never – take in the different overtime rate systems and specific allowances that exist in each of the healthcare systems.

And it is important to point out that the OECD data on nurses’ remuneration, which is frequently used as an indication of where Irish nurses fall on the scale, is not (by the OECD’s own admission) a reliable source.

We rate this claim: UNPROVEN

As per our verdict guide, this means: “The evidence available is insufficient to support or refute the claim, but it is logically possible.”

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