INTERNATION RECRUITMENT: Overseas nurses are an essential component of the NHS workforce. But some are being exploited. Fiona Johnson and Maggie Oldham report on a programme to address the issue.

Recruitment abroad continues to be a key strategy for tackling nursing shortages, both in the NHS and the private sector. Many of these nurses and midwives are from the Philippines, and although there is guidance on a period of adjustment, there are some problems to address. Nurses who have completed their training and are fully registered in their own country can apply for admission to the UK Council for Nursing, Midwifery and Health Visiting. In the case of Filipino nurses, this is only granted after a threemonth adaptation period. NHS guidance in 1999 outlined what is required in this period.

It says:

a nurse must have a specific job description for the adaptation period;

the development needs of each recruit must be identified in meeting the UKCC requirements;

there must be support for the recruit in preparing a personal development plan;

all mandatory training must be arranged;

a list of competencies to be achieved must be compiled;

a mentoring programme should be established;

the training and competencies achieved by the recruit should be documented to satisfy the UKCC requirement.

We set up a project in Manchester in February, funded by the local training and education consortium to integrate Filipino nurses into the UK healthcare system which found that some of these requirements were not being met. More than 30 nurses have taken part.

The project team heard reports of problems with the adaptation period and variations in the quality of the programme provided.

Variations seem to stem from lack of guidance both centrally and from the UKCC, with employers left to determine the format of their programmes.

The project team was asked by a London organisation to interview seven Filipino nurses for places on adaptation programmes in Manchester.

Problems reported by these skilled nurses included:

no structure or training formality to the adaptation programme;

contracts of employment being changed;

payments of£400£500 a month for adaptation programmes being made to the employer from a salary of£11,000 a year.

inappropriate use of the skills of the nurses;

no job descriptions;

use of nurses for jobs outside job description;

threats of having to pay significant sums if nurses did not complete contracts;

no payment for periods of the employment.

high levels of fear among nurses about being sent home and not completing adaptation programme.

The nurses interviewed had come to the UK to develop professionally, earn money and improve their career prospects, but their initial experiences had not supported this. The nurses had been treated unfairly and their expectations had not been met.

The lessons to be learned are significant.

Loopholes and poor management are allowing bad practice. Ethical recruitment processes and fair treatment of international nurses are needed, both during the adaptation period and once nurses are on the register.

There is such pressure on both the NHS and the private sector to fill vacancies and continue to deliver essential services that international recruitment is sometimes carried out without adequate planning and preparation.

A core adaptation programme needs to be developed that can be varied slightly according to local needs. Job descriptions and status need to be agreed for the induction period. Guidance on international recruitment needs to be considered in nursing homes as well as in the NHS.

International recruitment must not be seen as a quick fix. It can bring many benefits to an organisation, but time has to be invested to ensure that it is effective.