Nurse, nurse, where are you?

By Harry Keaney

Nurse, nurse, please come help.

As hospitals across the U.S. cope with an acute nursing shortage, Uncle Sam will not find much solace by looking to one of his traditional sources, Ireland.

Turns out, there’s a shortage of nurses there too.

For generations, Irish nurses toiled in hospitals around the world, particularly in Britain and the U.S., giving the profession a global reputation for its personal and caring approach. But as Irish hospitals themselves grapple with severe staff shortages, that one-time wellspring of nursing talent has now dried up.

"Better working conditions, a higher standard of living and a nursing shortage of its own has ruled Ireland out as a favorite of U.S. hospitals for nurse recruitment," said Shirley McElhatton, a nurse recruiter at Stamford Hospital, in Stamford, Conn.

Indeed, only last week, Ireland’s busiest children’s hospital, Our Lady’s Hospital in Dublin, had to send a child to England for treatment because of a shortage of specialized nurses. And the parents of another child admitted for emergency treatment decided themselves to have the patient transferred to England.

And Ireland’s top neurological hospital, the Beaumont, also in Dublin, has had to close 69 beds because it is short 120 nurses. Furthermore, nearly half the operating theaters in another large hospital, St. Vincent’s in Dublin, are idle due to the nurse shortage.

Martin McDonald, of the Health Services Employers’ Agency, described the nursing shortage as "quite serious in the Dublin area," affecting, in particular, the academic teaching hospitals as well as children’s and maternity hospitals.

McDonald said that different Irish hospitals had gone to countries such as Spain, Finland, Sweden, Australia and Britain in an effort to recruit nurses. And he added that nurses from the Philippines have recently come to Ireland in relatively large numbers.

Indeed, so unusual is it for foreign nurses to come to work in Ireland that it became a major news story last month when the first 31 Filipino nurses came to Dublin’s Mater Hospital.

McElhatton said that Ireland’s economic boom and low unemployment was unfortunate for U.S. hospitals as Irish-trained nurses were highly respected by health-care facilities and the public in general.

On the brink

In the U.S., there are fears that the nursing shortage, although not yet at crisis point, could become a major problem.

"This shortage currently isn’t as severe as we were anticipating," said Jeanette Ives Erickson, chief nurse at Massachusetts General Hospital in Boston. But, she added, "I believe we are on the brink of a very devastating and long-term nursing shortage."

She said that if one looked at the U.S. Bureau of Labor statistics, one would see that the demand for health-care professionals nationally will grow up 47 percent by the year 2005. By 2015, she added, there will be 114,000 unfilled registered nurse positions in the U.S.

McElhatton said that the U.S. shortage, which has followed a predictable path of alternating shortages and surpluses, may last as long as 10 years or more, based on decreases in the numbers entering nursing schools and other demographics.

McElhatton, from Dublin, who herself came to work as a nurse in the U.S. about 10 years ago, said that U.S. hospitals are now looking for other sources of nurses with training comparable to Ireland. These included the Philippines, which has been a long-time favorite of U.S. hospitals, Canada, although it too is now experiencing a shortage, and, more recently, South America and Puerto Rico.

However, McElhatton said the U.S. problem is compounded by the fact that U.S. immigration laws do "not reflect the need for foreign nurses."

"The only visas many hospitals can utilize for foreign nurses are permanent visas, which can take up to two years to process," McElhatton said. She added, however, that Canada is an exception in that TN-1 visas, which are U.S. visas for Canadian nurses, are easily obtained.

However, Chief Nurse Ives Erickson, at Massachusetts General, has a different outlook to some as regards recruiting abroad.

"We do not recruit internationally because we believe as an institution and as a state and as a country we need to think strategically how to solve the problem," she said. "I believe we only create a problem elsewhere if we recruit elsewhere," she said.

Indeed Ives Erickson believes nurses should seek a solution to the nursing shortage on a grander scale.

"As nurses, we should come together as an international community and look strategically at how to create new solutions. By recruiting in another country, we are only solving the problem for today, we are not looking toward the future."

However, McElhatton said some U.S. hospitals were "growing their own" by developing residency programs to train graduate nurses and preparing them to work in critical areas.

Said McElhatton, nursing needs to promote its profession by collaborating with high schools and generating interest in nursing.

Irish situation

Meanwhile, the nurse shortage in Ireland is expected to lead to longer hospital waiting lists and more delays in emergency departments.

McDonald said there were many reasons for the Irish shortage. Among them is a new college-based training program for nurses — similar to the U.S. — replacing the previous system under which nurses trained on hospital wards. Nurses now training for their diploma — about 3,000 a year — are "not counted in the workforce," he said, and their work commitment has to be replaced by qualified nurses who "soak up a large number that were in the system and had not full-time jobs."

Another factor, McDonald said, is that many nurses are not interested in working full time. "They want to work part time or job share," he said. More nurses are also working for agencies rather than for particular hospitals.

Ireland’s skyrocketing property prices, particularly in Dublin, is also contributing to the shortage. Philomena O’Shea, of the Irish Nurses Organization, said nurses outside Dublin face "huge financial consequences" if they wish to study intensive care courses in Dublin. "Obviously, it’s much dearer to rent accommodation and child-care is much more expensive, so the exodus is happening," she said.

For those in the U.S., however, it all means that the sound of new Irish accents will not be as common as they once were on the floors of American hospitals.