Retaining international nurses

Posted on 28 September 2016

In 2005 when Mediclinic South Africa first considered recruiting specialist nurses from India to address a dire shortage of specialist registered nurses, questions were asked: Why India? What about local job creation? What about training?

These questions have been answered over the years with only one major concern remaining: How will Mediclinic retain the services of international nurses for as long as they’re needed? Mediclinic Nursing Executive, Estelle Coustas, has researched the sustainability of the international recruitment programme in depth.

Her recent doctoral dissertation explores the factors that impact international nurse retention in South Africa. It highlights financial wellbeing and the provision of quality of work life and quality of private life as the critical factors in retaining these recruits.

Looking back

The shortage of specialist nurses, particularly ICU and theatre nurses, remains a challenge not only in South Africa, but globally. Coustas says, ‘South African nurses were highly sought-after until the 1990s, but many factors, including a reduction in the number and quality of nursing training facilities, have led to critical skills shortages.’

By 2005, Mediclinic had become increasingly concerned about the negative impact of the local nursing shortage on the communities it serves. ‘Patients were being turned away and ambulances were warned to bypass hospitals that had no Critical Care staff,’ says Coustas.

‘We could see that the shortage of nurses was going to become critical and a decision was made to investigate the possibility of recruiting international Registered Nurses. We needed to find nurses that were well trained, proficient in English and affordable.’

They looked into a number of options. ‘We thought of Eastern Europe, but it would have been difficult to attract them given they were about to gain access to the European Union. We considered the Philippines, but there were concerns over their recruitment practices and the quality of their training (a significant proportion of which was done in simulation).

However, when we looked at India, we found nurses that were well educated, they had done the majority of their training in hospitals, they placed their patients at the centre of all they do, and they had been taught using an English syllabus. A good solution.’

A pilot project was launched to test the strategy and in 2006 Mediclinic offered 30 Indian nurses two-year contracts.

In 2015, as part of Coustas’s research, an independent researcher explored management’s perception of the contribution these nurses have been making towards the functioning of hospitals. The earlier findings were re-confirmed: these nurses were adding value in a number of ways, specifically through their clinical skills, leadership and professionalism and they were serving as mentors and role models for their South African counterparts.

Looking ahead

Mediclinic SA now employs over 300 international nurses. Their knowledge and experience has been shared at industry conferences and many bureaucratic hurdles have been cleared, which means other South African private healthcare facilities can now follow the same route.

The initial two-year contracts have been extended to three years and thought is going into making the interim strategy more permanent. It’s a necessary step towards maintaining the quality of specialist clinical care in Mediclinic SA hospitals while measures are being taken to improve the skills of local nurses.

‘Without our international nurses, we would have had to close some units,’ says Coustas. ‘But if the exchange rate continues to deteriorate we run the risk of these nurses wanting to return to India. They are essentially coming to South Africa to earn money to send home. The best way to mitigate this risk is to encourage them to bring their families across once they’re settled at the hospitals. In one of our hospitals where we employ more than 40 international nurses, we are considering the purchase of land to build housing for them.’

In her research, Coustas encountered a strong desire among the international nurses to live together as a community. ‘They want to be able to cook together and help one another with childcare. It’s their way of life,’ she says.

While recruiting and retaining international Registered Nurses is essential, it is not the only means Mediclinic has of addressing the critical nursing skills shortage in South Africa. The organisation is also investing in intensive training of local nursing recruits for the future of healthcare in South Africa.