As talks take place between health service management and nursing unions in an attempt to avert strike action, The Irish Times asked Irish-trained nurses now working abroad about why they left, how pay and conditions compare where they live, and what they think can be done to address recruitment and retention difficulties in Ireland.
Kate Keenan, Dublin (returned from Sydney): ‘It’s awful, it’s sad, it’s depressing, it’s wrong’
I moved back to Dublin in July after five years in Sydney. I am an emergency department nurse. I started work in St Vincent's in August, having previously worked there seven years ago. I've been horrified and saddened every day since, so much that I have handed in my notice. I finish up at the end of this month. It's awful, it's sad, it's depressing, it's wrong... and all of those statements are about patient conditions, not just nursing conditions.
Every day I leave work feeling like I haven’t done enough, haven’t been able to properly care and treat the sick and vulnerable who arrive at our door. Every day I comfort junior nurses who are crying because of the conditions, for both patients and nurses. I’m getting out because I know there is something better out there; I have experienced how a health system can work and work well for everyone involved, both healthcare providers and recipients.
My job in Sydney was not perfect; it was crazy busy at times but at least I finished my shift knowing I had done the best I could for a patient. I knew if I had a problem I could escalate it and it would be dealt with, as there was management to turn to when you were overwhelmed or if you felt patients weren’t getting the best care. In Ireland, there is nowhere to turn. In emergency you feel isolated, like you are fighting a battle without support. Battling for patients, battling to make sure they get the best care in the worst of environments, battling to find a trolley in a corner or a corridor that is quiet, battling to ensure the junior staff members don’t get burnt out, battling every minute of every day. I’ve had enough.
Good nurses know how to treat your pain, your illness, your life threatening condition ... but they are leaving and they are treating and caring for people in foreign countries because they can, because they are respected for doing so, because they don’t finish their day there sad and sick because they can’t do their job.
We need change, massive change. It may seem that nurses are looking for money in a time when there isn’t money to spare, but that’s not what this is really about. They are asking for a decent salary to retain new graduates who will care and treat our sick and vulnerable, rather than going to other countries where they can get better wages and conditions. An increase in wages means a greater chance to attract newly qualified, excited, keen nurses, and retain already well qualified, experienced nurses.
Since I came back to Ireland so many patients have said “you poor thing, working like this” and I have turned to them and said “you poor thing, being treated like this”. We need to retain staff to provide adequate care to our people and the first step is letting nurses know that they are appreciated and valued. Not one nurse I know went in to this profession to earn great money, but they also didn’t become a nurse to feel taken for granted.
One day we will all need a nurse, and I want my nurse to be confident and experienced and knowledgeable and caring ... If nothing changes, that nurse won't be here, they'll be abroad bring confident and knowledgeable and caring to some woman in Saudi Arabia or Perth or Vancouver!
Nicola Costello, Western Australia; ‘Conditions aren’t reasonable or realistic in Ireland’
I left Ireland in 2015 after qualifying in 2014 as a nurse. I moved to London for work along with half my classmates, as prospects for work in Ireland were very poor and there were very few jobs on offer. I had worked briefly in Dublin when I qualified and witnessed sheer stress and overworked staff; everyone I met seemed so unhappy and burnt out. They were being crushed under staff shortages, poor pay, terrible working conditions and owing extra hours each month to the Haddington Road agreement.
They say that nursing is a calling but the conditions aren’t reasonable or realistic in Ireland. On moving to London I worked in a very busy teaching hospital where I received regular study days, which were paid for, and lots of support as a newly qualified nurse. I worked less hours in the week and received a good wage. The environment was much happier, despite being very busy.
On my ward, the majority of nurses were Irish. I had the option to transfer to a different ward for more experience; I had a say in where I chose to work. I would get paid for overtime instead of just doing it as a favour.
After three years in London, I moved to Australia. Nursing is a well respected profession here and once again there is lots of support. The work is plentiful and well paid, and hospitals are very well staffed. The system is more efficient, not only because there is a lot more money in the health system but also because staff are treated with utmost respect.
I intend to move back to Ireland this year to settle, but I am nervous about my career prospects and my future wellbeing in my job. I really hope this strike goes ahead and that positive changes are made to staffing, retention and pay rates. We as nurses deserve the standards that other nurses receive in other countries.
Aisling M, London: ‘Your education and skills are a priority here’
My undergrad was in mental health nursing. Even as a student, the pressure to take on more responsibility than I was capable of at that stage was beyond reasonable. But that was the normal experience for student nurses.
Even as a qualified nurse, there was a dismissive attitude towards concerns or suggestions, despite being a qualified member of the team. The only time you were told you were “valued” was when you handed in your notice!
I wanted to do my general training, but this course didn’t exist in Ireland. So I had to go to the UK, where I got a free PGdip, first rate placements, and more support than I ever knew existed to develop my career. On qualifying, all hospitals offered 6-12 months mentoring and support to help you adjust.
I worked at the same time as I studied, where I felt valued and treated equally, even though I wasn’t on a permanent or stationary contract. In Ireland I felt like a pawn, only there to take over a massive allocation of patients and be quiet or I wouldn’t get any good shifts in the next rota.
They don’t have endless budgets or staffing here, but jaws still drop when I tell my colleagues about the number of patients on trolleys in Irish hospitals, and the (insane and unsafe) staffing ratios.
On qualifying as a general nurse, people asked me here would I go home. But I knew I would have a better career in London. Your education and skills are a priority here, because the hospital knows they benefit if staff are better supported and trained.
I work with a lot of other Irish nurses. It’s not that we are paid especially well here, and our shift patterns are intense and burnout still exists. But the experience and training we get here is attracting staff, and retaining them long-term.
I don’t want to stay here in the UK forever, but I know I won’t be going home.
Ciarán Fitzpatrick, Sydney: ‘Nurse-to-patient ratios are safe here’
When I graduated in 2008 there was an embargo on recruiting staff. I worked agency for two years. I finally got a job in the private sector in 2010. The cost of living and rent in Dublin had gone through the roof. My partner is a doctor, and we decided to move to Sydney in January last year. It was a difficult decision for us leaving family and friends. But living in Dublin was unsustainable. Rents were out of control and I was working longer hours for less pay.
Conditions here in Sydney are far better. Nurse-to-patient ratios are at a safe level. I work two jobs, one in the emergency department where the ratio is one to four patients, and my second job is in Sydney Opera House, which I love. The pay and lifestyle here is 100 per cent better than Ireland, and my heart breaks to hear about the conditions my colleagues still working in Ireland have to endure.
Patients deserve better than lying on trolleys for days at a time. That would not be tolerated here and hospitals get fined if there is not safe nurse/patient ratios or if a person is left in an emergency department on trolleys. I wish all my colleagues all the best with their strike.
Laura Egan, Qatar: ‘In the Middle East I literally earn double’
I qualified as a midwife in 2015. I left Ireland in 2018. I love midwifery but when you are looking after nine women and nine newborn infants (essentially 18 patients) it quickly becomes overwhelming. Low staffing levels and high sick leave (often due to stress) meant work was draining and stressful. My days off were spent recovering.
I earned €2,200 a month after tax most months. My husband earned slightly less. Paying rent, bills, a car loan, insurance and childcare for our two-year-old meant no savings and no money to buy a home.
In the Middle East I literally earn double than at home, and it is tax free. I pay no rent or bills, as it’s all covered by my employer. My family are also given health insurance, life insurance and flight allowances. Private schooling is paid for. These are things I could not consider at home.
My caseload here is three patients to one nurse, compared to between six and nine at home, meaning I don’t leave work wrecked, starving from no break, or in pain. I can enjoy my time off. There is no comparison.
Money and staffing needs to be increased in Ireland if the health service wants to retain nurses. The cost of living in Ireland is very high, and we were worked to the bone and barely able to afford to live.
Roisin Scully, Perth: ‘As nurses here we always have support’
It was the heavy patient load with minimal senior staff that made me not want to work on the wards in Ireland. On the ward where I work now in Perth, we have an average 4-6 patients per nurse with a good mix of junior and senior staff per shift. We also have a nurse coordinator, who assists in early discharges and getting patients from the emergency department into beds quickly. We aim for a maximum four-hour wait for a bed in ED. If patients are deteriorating we have a MET team of senior doctors and nurses who assess and treat the patient as needed. This means that as nurses, we always have support. I didn’t feel I had this in Ireland, where overworked and understaffed junior doctors are not able to complete the massive amount of work assigned to them.
On my ward, we always try and take our breaks in a timely manner and assist each other to get to break and finish work on time. Nurses are not angels, we do not have super powers. We are human beings who like the rest of the workforce deserve breaks, holidays, adequate rest days, to finish work on time, and earn decent pay.
