Many countries are grappling with a shortage of nurses, especially since the pandemic. Canada, the United Kingdom, Denmark and Switzerland are all such countries. They have eased their requirements and are running recruitment events in other countries that have traditionally provided many immigrant nurses, notably the Philippines.
Some Canadian provinces have streamlined immigration for nurses
Among highly developed countries, Canada is the one with the most acute general labor shortage right now. As a result, the federal government has increased the immigration target for 2023 to 465,000. This number of new economic migrants should include many nurses. In fact, the Canadian provinces of Manitoba, New Brunswick, Saskatchewan, Newfoundland and Labrador have taken an extra step to make it easier for nurses to immigrate.
Manitoba has streamlined the recruitment and integration process for expat nurses. The College of Registered Nurses of Manitoba (CRNM), the province's regulator, announced its reforms to the press in February. The processing time has been reduced by at least 12 weeks, allowing applicants to complete multiple steps simultaneously before moving to Canada.
What are the requirements to become a registered nurse (an RN) in Manitoba? It's quite straightforward: have a nursing degree, have at least 450 hours of practice in the last 2 years or 1,125 hours in the last 5 years, prove B2 proficiency in English (6.5 on IELTS), apply for registration with the CRNM, take the registration examination. Some applicants may be additionally required to undertake a clinical competency assessment and a few courses (a bridging program).
Previously, applicants had to take a test like the IELTS to prove their English level. But since February, they can prove their language skills in other ways. They can submit a letter of attestation from a regulated health professional in the province. This professional needs to attest that they have supervised the applicant and can guarantee that they can use English at work. They can now also retake the clinical competency assessment if they fail it and be conditionally registered if they lack only a few hours (<100) of practice.
This increased flexibility has been coupled with recruitment drives, notably in the Philippines. Indeed, in March, the Canadian embassy in Manila even opened a dedicated center to process the immigration applications of healthcare personnel. Similar centers will soon also be opened in the Canadian embassy in various South Asian cities (New Delhi, Chandigarh, Islamabad).
During on-the-spot recruitment events, prospective applicants are informed about the application process, life in Canada and their career prospects. Representatives from nursing regulatory bodies even conduct job interviews and offer letters of intent directly there. New Brunswick, Saskatchewan and Newfoundland and Labrador are other Canadian provinces that are hosting similar recruitment drives. Newfoundland and Labrador is recruiting not only in Asian countries but also in the UK and Ireland. In Saskatchewan, the nurse shortage mainly concerns psychiatric nurses. The recruitment criteria of these provinces don't differ much from Manitoba's.
The UK is recruiting nurses from many Asian and African countries
Like Canada, the UK's nurse shortage has been exacerbated by the pandemic. Part of the country's solution has been to recruit from abroad, especially from less economically powerful Asian and African countries. India, Nepal, the Philippines, Ghana and Nigeria are the countries in question here. Nuffield Trust, a charitable trust dedicated to improving healthcare in the UK, has found that it costs less to recruit internationally than to train locally. It costs £26,000 to train one nurse in the UK but £10,000- £12,000 to recruit an expat from the aforementioned countries.
Unsurprisingly, the number of expat nurses registered in the UK has been increasing exponentially. Nursing Times reports that in the 6 months between April and September 2022, the number of expat nurses practicing in the country increased by 13,000.
The World Health Organization has labeled most of the providing countries as “red list” countries from which healthcare personnel shouldn't be recruited – because they are themselves struggling with their own staff shortages. Both Canada and the UK have been criticized for weakening these poorer countries' healthcare systems by luring away their personnel with higher salaries, but the trend doesn't seem to be stopping anytime soon. It has been suggested that these wealthier countries should at least give back in other ways – like funding the training of nurses in the Philippines.
What are the recruitment criteria? Since December 2020, both new EU and non-EU applicants have to follow roughly the same procedure. Testing-wise, applicants need to take the IELTS (English proficiency) test and a Test of Competence. They need to score at least 6.5 on the IELTS, which corresponds to a B2 or upper-intermediate level in English. They also need to take a Test of Competence for their nursing skills. This test's content will vary depending on their specialization – a general nurse takes a different test from a children's or mental health nurse. The cost of this test, together with the qualification evaluation fee, can be close to £1,200, clarifies the Nursing and Midwifery Council.
The nurse will also need a Certificate of Sponsorship (COS) from the hospital that wants to employ them. This COS is what will allow them to apply for a Work Visa. The process can be lengthy, but as St. George's Hospital, the largest public hospital in London, clarifies on its website, each hospital's HR team will do its best to assist the applicant during this process.
Denmark has relaxed its language requirements to attract more expat nurses
In February, Denmark streamlined its immigration process for expat nurses, especially for those outside the European Union or European Economic Area. The Danish healthcare system is currently under a lot of pressure, with professionals not getting enough rest and patient wait times being 50% longer than in 2019 (The Local). Faced with this situation, Denmark is also trying to attract more expat nurses.
In order to make things easier for non-EU/EEA nurses, the Ministries of the Interior and of Health have eased language requirements. Expat nurses will soon no longer need to pass a Danish language test before applying. They will first be hired on a provisional basis for 6 months. This period is called the “Employment for adaptation and training purposes” period – during it, their clinical skills will be assessed, and they will have to learn Danish on the job. After 6 months, their supervisors will attest if they can communicate well enough in Danish for the purpose of the job. They can then be offered a longer contract.
Easing the language requirement will ensure that the application process has fewer steps and that expat nurses can join Danish hospitals more quickly. Please keep in mind that while this reform has already been approved, it hasn't been implemented yet. It should be implemented within the next few months. All applicants must also have their qualifications assessed by the Danish Patient Safety Authority, which licenses them to practice in the country.
Switzerland is trying to attract more nurses from within the EU/EEA
Compared to the other three countries above, Switzerland's recruitment strategy for nurses focuses on its own region – the European Union and the European Economic Area.
The country has a high percentage of intra-EU/EEA nurses. Swiss Info reports that 30-40% of nurses in Switzerland are expats, with most of them being cross-border commuters from neighboring countries. Italy and Germany are two countries in which Switzerland carries out recruitment drives for nurses. Poland and Portugal, which do not share a border with Switzerland, are also target countries.
How to register as an expat nurse in Switzerland? This is a very linguistically complex country, so applicants need to show proof of a B2 (upper-intermediate) level in either French, German, or Italian – depending on which region they will be working in. They will then need to pay €500 to have their qualifications assessed by the Swiss Red Cross. This part is procedurally trickier for nurses trained outside the EU/EEA, which is why Switzerland focuses on recruiting regional expats, whose qualifications get more easily recognized. Non-EU/EEA nurses whose degrees are not fully recognized will have to undergo additional training in Switzerland.
