NURSES WHO WERE recruited to Ireland from overseas to work for the HSE and private nursing homes are calling for training to be introduced before they sit a costly aptitude test, as those who fail the exam are left feeling “abandoned” afterwards.
Calls for increased oversight of international recruitment come after the Government and top HSE officials gave mixed messages this week about whether the health service will be slowing down or increasing its overseas recruitment activities.
After international nurses get job offers and contracts from health providers in Ireland, they must travel here to complete an aptitude exam that costs €2,800 to sit, which they are not reimbursed for if they fail, in which case they also have their job offers revoked.
For most nurses who make it their ambition to come Ireland, the recruitment process starts with gaining an English language qualification, and then involves working with either an Irish agency or one based in their home country
Two nurses who failed the exam, and were left in debt and unsure what to do next have spoken to The Journal about their experience.
One nurse, who left behind her family to take up a job in a neonatal ward in a children’s hospital, said that she had “thoughts of suicide” when she was told via email that she had failed the aptitude test, and that she should go back to her home country.
Another nurse who did not realise she was pregnant when she came to work in a private nursing home in South Dublin paid out the equivalent of €10,000 for exam costs, flight tickets, and ‘paperwork services’ to an agency based in India.
She also failed the test, and ended up unemployed in Ireland after working in hospitals for 15 years in Delhi and Kerala.
Sherin* – the nurse who was offered a job in the children’s hospital - is 33 years old, and originally from Tamil Madu.
She completed a BSC in nursing in 2010, and started working in the neonatal ward of a government hospital. She later worked for several years in neonatal intensive care in a hospital in Saudi Arabia.
“I work with tiny babies mostly. They are newborns who are born prematurely. I love what I do but it is a difficult job.
“When babies get better and it is time for them to go home we are so happy, but we will also miss them because you become attached.
“But when babies are not going to make it, there is nothing more difficult in the world than telling the parents. It is extremely sad,” Sherin said.
She wanted to move to a European country to work as a nurse to give her seven-year-old daughter “a better life and a better education”.
Sherin got her job offer in Ireland by working with both an Indian and an Irish agency that are “connected”.
After starting the process in September 2021, she got approved by the Nursing and Midwifery Board of Ireland (NMBI) a year later. There were a lot of costs involved, which her family paid for through borrowing money from a family friend, and through selling a jewel that she owned.
“I paid half of the €2,800 upfront for the test, and €1,000 for the interview process, and then the money for the flights, the agency said they would reimburse me,” she explained.
Sherin was given six weeks free accommodation when she arrived in Ireland in March, and was due to sit her exam four days later.
“The Irish agency did not help me find the accommodation, I was scared to get in a taxi alone – this is not something I would do at home. The Indian agency became much less communicative once I got here,” she explained.
Sherin passed the theory element of the aptitude test, but failed her first practical test.
“I was not familiar with the Irish system, everything is different including the way you read prescriptions.
“There are resources online for us to read, but there is no place, or introduction to anything before sitting the test, it is very difficult. We have 10 minutes at 14 different stations where we complete different tasks.
“The exam coordinator made me nervous. She said she didn’t want us to apologise if we made mistakes, and not to make excuses. I felt very anxious, and a lot of pressure as my family invested so much in me coming here. The exam is based on care for adults, after working with infants for so many years, a lot of it was based on things I have not done in a long time,” Sherin said.
Despite failing the exam and being due to sit it again in two weeks, she claims she was called to duty and started working shifts in a ward for post-operative ward for babies.
“We had fire safety courses, IV therapy courses, and different certificates we had to complete online. After four shifts, on my fifth duty, I was given two patients and told that I would be the one to take care of them on my 8am to 8pm shifts.
“No one spoke to me about my test. These were babies who had operations. I am an experienced paediatric nurse, but it was very different for me to be in a setting where the parents have access to the ward 24 hours a day. This was very stressful.
“I was getting to know a new country and culture, and finding barely anytime to speak with my daughter. I should have been given some time to adapt to the protocols here. My friend in the UK was given training, and time to settle in, I think we should have the same here,” she said.
Sherin received an email on 18 April informing her that she had failed the test, having lost marks on the 13th station. The email informed her that she would not be able to continue her registration with the NMBI, and that she couldn’t continue her duties at the hospital.
“It said that I should contact my agency and see about going home to India. I was standing on the street in the city centre and, it is hard to say, but I did have thoughts of suicide,” Sherin said.
“I had spent so much money, borrowed so much. My daughter and husband were waiting to come here. I didn’t have the money to go back – and if I did go back – everyone would know I lost the job, all of these things overwhelmed me,” she said.
“I am now going to try and get work as a healthcare assistant in a nursing home. After this week, I will have to vacate my accommodation. The agencies, they have stopped contacting me. It is hard because, I won awards for my abilities in Saudi Arabia in training other nurses, and for being the best neonatal nurse in 2012 in my hospital in India.
“How many babies and families have I worked with, how many medicines have I administered, and now it has come to this,” she added.
Maya is 38 years old and has a nine-year-old daughter. Originally from Kerala, she has worked as a nurse since 2006.
When she spoke to The Journal in May, her temporary work permit had expired the day before, and she was waiting to hear back from immigration services on whether she could get an extension to stay on, in the hopes of finding a healthcare assistant job in a nursing home.
She had just borrowed money from another nurse in Ireland to pay for that month’s rent, as she had completely ran out of money, and did not think it would be possible for her to go back home.
Maya described her situation as “desperate” and “in God’s hands now”.
She came to Ireland in November of last year to work in a private nursing home, having paid an Indian agency the equivalent of €10,000 to help her in the process, and to cover the costs.
The agency put her in touch with an Indian family in Dublin, who she paid €550 per month for a room that she shared with another nurse, who she had to share a bed with.
“The exam is very difficult, and we don’t get any help beforehand. You can read things online, but it is hard to get your head around these different protocols and the settings when there is no training. I know I am a good, experienced nurse, but I failed. It was very disappointing,” she said.
Maya planned to stay in Ireland and find a healthcare assistant job, but a couple of months after arriving, she found out that she was pregnant.
“It was a complicated pregnancy. The doctors told me that there were serious problems with my baby’s lungs and kidneys, it was not developing properly, and I opted for a termination,” she said.
Maya went through this while still sharing a bed with another nurse.
“I do not know how I handled it away from my family, when something like this happens, you just do. It took me some time to go back to looking for a job,” she said.
The private nursing home in Dublin that had offered Maya a job as a nurse interviewed her for a healthcare assistant job, but told her that they couldn’t offer it to her, because her working permit was set to expire.
“What do I do now? I cannot go back home. My husband wants me to stay here and find a job. I am hoping immigration will help me. I hope that God will help me.
“When I speak to my daughter she asks me ‘Mama, when am I coming to you?’ It has been six months now, and I still cannot tell her, because I do not know,” she said.
A spokesperson for the HSE said that practicing nurses in Ireland must be registered with the NMBI fully.
On preparation provided to applicants for the aptitude test, the spokesperson said that the Royal College of Surgeons (which runs the test) provides information that helps candidates to prepare on its website.
Commenting more widely on its international recruitment practises, the HSE said there “gaps between the demand for healthcare and the supply of healthcare workers needed to deliver it are common” around the world because of ageing populations and “increased healthcare utilisation”.
A spokesperson said the HSE follows a number of recruitment and retention solutions concurrently such as: the provision of clinical training places required for professional training; the recruitment of graduates from the recognised training courses in the Republic of Ireland; and international recruitment.
“All recruitment activity in the HSE is carried out in line with best practice guidelines such as the Commission for Public Service Appointments Code of Practice and the WHO Global Code of Practice on the International Recruitment of Health Personnel. The HSE does not actively recruit candidates from the WHO Health Workforce Support and Safeguards List,” they added.
As healthcare professionals educated in Ireland, including nurses, have left in increasing numbers to work in Australia and other countries in recent years, recruitment companies working for the HSE have turned to places like India and the Philippines to fill empty positions.
There are over 12,000 Indian nurses in Ireland at present, and Indian nurses are being recruited more so than any other overseas nationality.
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*The nurses interviewed by The Journal have been given alternative names as they had concerns on the impact speaking out could have on their employment prospects.
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