Nepali nurses now Britain-bound

Nepal’s agreement in August to supply an initial 100 nurses to Britain with an option for several thousand more in future was followed by debate in both countries about the pros and cons of the deal.

Nursing workforce managers and researchers in Nepal, Britain and in international agencies have drawn attention to the fact that the nurses are being diverted from greater need back home to fulfil the UK's shortfall. But there is support for Britain's international recruitment of healthcare professionals from nursing colleges in Nepal and the global aspirations of nurses themselves.

Presently, the UK faces a considerable shortfall in the hiring and retention of student nurses. Scotland has not been able to meet its student nurse recruitment targets, with a gap this year of over 700 student candidates. This means Scotland alone will be short of 700 nurses in three years’ time, when the current intake of students graduates. Furthermore, the student dropout rate is currently around 25%.

Across Britain, by the time the current cohort graduates there will already not be enough nurses in the UK labour market even without the previous shortfall. And there are said to be vacancies for up to 50,000 health professionals in the NHS with the post-Brexit departure of East European staffers.

Britain therefore has very little choice but to recruit nurses from other countries. In the past nurses have been hired from English-speaking countries with weaker economies like the Philippines or India (see graph).

British nurse recruitment policy now displays little concern for source countries’ workforce situations, and of World Health Organization’s ethical recruitment guidelines which bars hiring medical workforce from ‘red list’ countries that do not have sufficient nurses and doctors for their own populations. But the staffing gap is so serious that countries like the UK, Japan, the United States, Canada, Israel and other European countries are competing to attract health professionals, disregarding the WHO guideline.

For Nepal, the situation is just the opposite. There is no shortage of nursing students considering a professional education. And as a result of increased nursing education capacity, there are more students successfully graduating than Nepal’s hospitals can employ. Unlike the UK, there is no major concern about student dropout rates in Nepal, and most nursing students complete their education and graduate.

Then there is also the push-factor of low starting salaries back home that makes overseas work attractive. Many nursing graduates struggle to find suitable employment within Nepal. For them international jobs are the best option. In fact, a majority of nursing students in Nepal are pursuing their studies with the sole focus on emigration.

Given the lack of a clear and appropriate migration pathways to the international labour market, Nepali nurses are going abroad as students to further their education. The number of nurses taking this route is much higher than those going abroad directly as employees.

Because of the lack of safe and effective avenues for Nepali nurses to get jobs abroad, including in the UK, recruitment agencies in Kathmandu have found this a lucrative option. They are known to collude with international nurse recruiters to exploit nurses whose desperation to earn more makes them vulnerable.

The laws of supply and demand mean that this happens not only in Nepal and the UK, but globally. Migrant nurses seeking employment, or further education abroad, often fall victim to recruiters who charge exorbitant fees from nurses yearning to leave their home country.

To break this vicious cycle, there is an urgent need to create transparent and fair employment options for Nepali nurses for the UK's NHS.

The UK for its part should improve the working terms and conditions for all of its nurses, including retention of its own nursing students.

Nepal must also have a proper workforce plan in place, and create gainful employment for its own graduate nurses at home.  Indeed, improving the recruitment and retention of nursing workforces should be a top priority for all developing countries supplying health professionals to well-off ones.

Countries like Nepal need to improve  investment in the health sector if they are to provide Universal Health Coverage by 2030, which is a Sustainable Development Goal of the United Nations of which Nepal is a signatory.

Radha Adhikari is a Lecturer in School of Health and Life Sciences, at the University of the West of Scotland, and has published extensively on international nurse migration and global health workforce challenges. Her latest research monograph, Migrant health professionals and the global labour market: the dreams and traps of Nepali nurses, was published in 2019, by Routledge.

Read more: New UK job options for Nepalis,  Upasana Khadka