This chapter identifies some of the barriers that prevent overseas nurses from achieving registration and employment in NSW. This chapter make particular reference to Filipino, Indonesian and Indian nurses. The second section provides three strategies to overcome the barriers outlined.
5.1.1 Barrier: Education Status and Role
Many overseas countries have a variety of different professional nursing regulatory systems. These countries also have dramatically varied levels of education within the countries. This variation in standards of regulatory systems and education levels is a major issue for the registration of nurses in NSW. Countries like the Philippines have over the past few years had a major increase in the opening of nursing schools. Some nursing schools in the Philippines, Indonesia and India may be excellent but many do not meet the standard that NMB expects.
Nursing courses in the Philippines, Indonesia and India are more closely aligned to the Australian certificate IV level qualification, which is currently the level of enrolled nurses in NSW. School education in the Philippines is of ten years duration. The first two years of degree level studies in the Philippines approximate to year 11 and 12 of high school in NSW. Graduates of these courses would frequently be eligible for recognition as enrolled nurses if they demonstrated competence and safe practice at enrolled nurse level in the special The College of Nursing assessment program for enrolled nurses. Alternatively they would be required to undertake further formal education by enrolling in a recognised course at a university in New South Wales and upgrading skills to the equivalent of an RN.
For overseas educated nurses from countries including the Philippines, Indonesia and India, even when academic standards might approximate those of Australian universities, students’ clinical experience is far removed from the environment to be encountered in clinical practice in New South Wales. Applicants, whose education is at lower than the New South Wales standard, are required to satisfy additional requirements in order to be eligible for registration. This is applicable whether the course was undertaken in Australia or another country.
Some educational institutions in India and Indonesia are obtaining assistance from Australian educational institutions towards the improvement of standards in the education of nurses. These countries are making their own arrangements with Australian universities to allow nurses to undertake further education that is necessary for registration by the NMB.
One Indonesian college has a relationship where after seven semesters and appropriate English language proficiency they are entering a program at a Sydney- based university. This program is equivalent to two semesters of education and practice needed for registration by the NMB NSW.
6. Recommendation:
That NaMO explore with other educational providers the delivery of additional opportunities for overseas educated nurses to access assessment programs, which meet the requirements of the Nurses and Midwives Board NSW and provide CRICOS accreditation, thus allowing overseas nurses to apply for student visas for the purpose of the assessment of their qualifications.
5.1.2 Barrier: Integration in NSW Health Care System
Overseas nurses are coming to Australia from a variety of health systems. Once employed in Australia, overseas educated nurses may find it difficult to integrate into the health care system. This is due to broader cultural differences that can see their skills not being trusted or respected by fellow colleagues and patients. There is a need for continual support and protection of overseas educated nurses who enter into the NSW health care system.
7. Recommendation:
That NSW Health develops strategies for the integration of overseas educated nurses who are employed in NSW hospitals.
5.1.3 Barrier: Registration Process
The Australian Nurses and Midwives Council provides advice to overseas nurses and midwives wishing to enter and work in the various State and Territory jurisdictions. The NSW Department of Health also provides a career advising service which includes contact with overseas educated nurses, either while they are overseas or once they have arrived in NSW. The relevant government and nursing organisations’ websites direct the nurses to organisations including NMB, DIMA and the individual Area Health Services for information.
Overseas educated nurses must then find the way themselves through the migration and registration process outlined in chapter four. This process can be difficult for two groups of overseas nurses: the nurses who do not receive immediate registration and individuals who migrate independently. There is a need for the nursing profession to provide streamlined information about recruitment and employment in NSW. This will allow individual overseas nurses to make accurate decisions about relocating to NSW.
8. Recommendation:
That there is the streamlining of information provided to overseas educated nurses seeking registration in NSW. That the Nurses and Midwives Board NSW consider the delivery of regular overseas educated nurse information sessions.
5.1.4 Barrier: English Language ‘Offshore’ Programs
The process for overseas educated nurses to register in New South Wales requires that applicants meet the standard required for registration in this state. This requirement for English language is specified in legislation (section 31 of the Nurses and Midwives Act 1991). The proficiency of English language is a major barrier for Nurses from non-English speaking backgrounds. Nurses from non-English speaking backgrounds may have a high quality of nursing qualifications, however they may be unable to meet English proficiency standards. This issue is complex as proficiency in English is a key requirement for the high standards and safety of NSW hospitals.
The NSW Department of Health has experienced a delay in the recruitment and employment of overseas educated nurses as they have to travel long distances within their own respective countries to undertake English language tests at short notice. In some locations tests are held only two or three times a year, whereas other locations may conduct tests two or three times each month.
9. Recommendation:
In view of the reported difficulty overseas nurses have had in accessing English skills assessments in overseas locations, it is recommended that the Community Relations Commission be authorised to discuss with international providers an increase in the number of ‘offshore’ English testing opportunities for nurses seeking to come to work in NSW hospitals.
5.1.5 Barrier: Cost of Undertaking Assessment Programs/
Further Education
For applicants undertaking competence assessment or further education, the cost for living and the course fees may deter them from coming to Australia. Applicants who enter Australia on a student visa can only work a maximum of 20 hours per week. NaMo provides funding directly to The College of Nursing for places in the competence assessment programs. During 2004/05 NaMO funded 110 places at The College of Nursing. However, other applicants have reported that they cannot afford the cost of the assessment program and have been discouraged from coming to NSW to have their qualifications recognised by the NMB.
NMB has been working with NSW Health to look at ways to supplement and expand The College of Nursing Competence Assessment Program, which nurses educated in countries such as the Philippines, Indonesia and India are required to take. Currently the program can only be taken in Sydney. The Committee is recommending the possibility that overseas educated nurses take the theoretical component overseas. This would help reduce the cost of the assessment program.
10. Recommendation:
To overcome the barriers that prevent overseas educated nurses undertaking employment in NSW, additional funding needs to be produced for implementation of all the recommendations and strategies in this report.
5.1.6 Barrier: Temporary Visa Holder Education Levy
The Department of Education and Training requires temporary visa holders to pay an education levy when children attend schools in NSW. This levy is not applied in other States and Territories.
The annual education levy fee ranges between $4,500 and $5,500 when the children attend a school. It would appear that teachers on temporary visas for exchange programs through DET are exempt from the fee.
A previous Health Minister requested exemption from the fee for nurses in September 2001. Letters have been sent to previous Ministers for Education and Training on this matter. A blanket automatic exemption for nurses was initially approved and then withdrawn in 2001.
A brief to the Cabinet Office was provided in November 2001. Submissions have been sent to the Premier from nurses, and stories have appeared in newspapers telling how the fees are impacting on rural medical staff.
Exemptions from the fee are considered by DET on a case-by-case basis. Applications for exemptions can be made off shore, however some of the documentation required for the application is not available until the overseas nurses are on shore e.g. school enrolment applications, arrival visas, and copies of financial institution statements.
Exemption is not guaranteed and for this reason several nurses recruited from overseas to fill specialty vacancies have withdrawn due to the fee. Other nurses have moved interstate where the fee is not applied. Not many nurses have school age children, however those that do have children mostly have more than one child. The fee is also impacting on other health professionals e.g. doctors and radiographers.
11. Recommendation:
That the Premier request the Minister of Education to direct the Department of Education and Training to provide nurses holding temporary visas and working in NSW Public Hospitals with automatic exemption from the payment of the Temporary Visa Education levy for children attending schools in NSW.
5.1.7 Barrier: Short Term Accommodation
NSW Health and NaMO believe that the lack of access to adequate short-term accommodation for nurses with families or partners (close to hospitals) is a barrier to the recruitment of overseas nurses. The availability of basic, affordable accommodation on-site or close to the hospital is attractive for single nurses.
12. Recommendation:
That NSW Area Health Services develop strategies to assist with family and single short-term accommodation for nurses including overseas nurses.