Emergency on the wards

Well-trained and motivated nursing workforce is a key component in quality healthcare, but in much of the Middle East nurses are a transient workforce in short supply. In the first of a two-part series, Jo Hartley investigates the future of nurse recruitment and the moves to attract local talent.

Globally nurses make up the largest chunk of healthcare professionals and the middle east is no exception. Across the six member countries of the GCC there are around 130,000 nurses and midwives - about double the number of physicians.

In a region facing rapid population growth and soaring rates of chronic diseases, the need for qualified nurses and midwives is set to explode. Set this against the ambitions of some arab states to become world-renowned health hubs, add a worldwide shortage of nurses that has existed for more than 20 years, and the problem of nurse staffing becomes abundantly clear.

Official figures show there is already a 100,000 strong nurse shortage in Saudi Arabia. A study published in human resources for health in march 2007 shows that the density of people working in health in the eastern mediterranean region is the second lowest in the world.

A quick Google search for ‘nursing jobs in the Middle East' brings up listings of recruitment websites offering all manner of nursing positions. These are hallmarks of an industry fuelled by international recruitment, the main method for shoring up nurse numbers in the region's shortage-plagued countries.

Saudi Arabia is a case in point. Seventy six percent of the nursing and midwifery workforce is made up of overseas recruits - just last month the government recruited another 2,000 Filipino nurses. The United Arab Emirates has 85% foreign nurses, while Qatar takes the number one spot with more than 95% of its nursing workforce recruited overseas, according to nurse sources.

Favoured countries for mass recruitment are the Philippines and India with Malaysia, Indonesia and China being the latest countries to join the nurse exporter list. More senior nurses typically come from the UK, South Africa and Australia. Even Middle East countries such as Jordon, Lebanon and Egypt export homegrown nurses to their neighbours.

As a result, the UAE hosts more than 50 nurse nationalities, according to Fatima Al Rifai, chief nurse at the UAE's Ministry of Health (MoH), who went to south India and the Philippines in June to recruit 800 nurses to work in hospital and clinics.

"We have a shortage of nurses that has to do with our culture and we always have to recruit from outside. So we really very much depend on what is happening around us in the whole world, as everyone is competing for nurses," she explains.

However, Bothyna Murshid, assistant professor at the school of nursing at King Saud University of Health Sciences, Riyadh, says it is getting harder to attract quality nurses. "I tried to recruit teaching staff for our college from everywhere but we had difficulty recruiting because of salaries."

Poor exchange rates mean Saudi Arabia is no longer as attractive a destination for Western nurses as it once was, Murshid adds, but it is still highly profitable for nurses recruited from less developed countries.

"The Filipino nurses are underpaid," she admits. "They get maybe 5,000 to 7,000 Saudi riyals a month compared with new Saudi graduates who get 10,000 riyals. But the exchange rate it is still good for them."

Money moves

As the worldwide shortage of nurses grows exponentially alongside demand, the issue of wages will become a crucial issue for Middle Eastern governments looking to attract nursing and midwifery staff.

Nurses in the UAE responding to an MT salary survey say they are thinking of resigning from their jobs because of low pay. A Filipino paediatric staff nurse with 16 years of experience says she earns under AED 5,000 per month.

"They are not paying me for my performance but for my nationality. I am looking for another job."

It's not only nurses from lower income countries that move for money - pay is the key driver for all nationalities when it comes to nurse migration, says Fadi El-Jardali, assistant professor at the department of a health policy and management at the American University in Beruit Lebanon.

A study of Lebanese nurses headed by Jardali, published in March 2007 in the International Journal of Nursing Studies, found that 19% of nurse graduates from the country's four leading nursing schools were working abroad.

The main reason for leaving Lebanon was financial, with 57% of nurses citing this as the key driver, closely followed by the desire to develop professionally at 42%.

"Many of the people that graduate in Lebanon migrate for different reasons; social, economic, political and workplace; to go to rich countries that can offer better opportunities for professional development and salaries and benefits," El-Jardali explains.

Jordan is another nurse exporter. The government marks nurse training and supply as an important part of its economic policy, says Osama Diadat.

Diadat left his native Jordon for Dubai 12 years ago and now works as a practice development nurse in mental health at the city's Rashid Hospital.

"Unemployment is a common problem, and in Jordon there is nurse exporting. They have made nurses a resource because Jordon is acknowledged throughout the world as having a good healthcare service," he explains. "All the good nurses depart abroad and they are playing an important role in our economic status."

The situation, however, is now starting to have an impact on the quality of nursing care on offer in Lebanon. "It is at a very critical point," warns El-Jardali. "Talking to those people working at the front line they say the quality [of care] and patient outcomes have been suffering as a result."

El-Jardali believes that if workforce planning is not addressed at national levels in the Middle East, both exporting and importing countries could find themselves desperately short of nurses, and totally reliant on staff from less developed countries - while countries such as Lebanon will start having to import nurses themselves.

"Nurse migration is one of the critical challenges many countries in the region are facing," he tells MT.

"The problem here is there is no human resource planning in these countries; there is only a minimal database covering existing staff.

"There needs to be a plan because everyone is competing for the same existing nurses."

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