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As ICU cases rise, nurses trained overseas face frustrating delays in Australian certification

A supplied image of an ICU Registered Nurse caring for a COVID-19 positive patient in the ICU of St Vincent’s Hospital in Sydney. Source: AAP

Overseas-trained nurses say delays in the certification process mean they will be forced to watch from the sidelines as the health crisis in Australia deepens.

As hospital admittance numbers grow in NSW and Victoria as both states battle to contain outbreaks of the Delta variant, the need to bolster nursing numbers has again been thrust into the spotlight.

Health authorities in NSW are trying to contain the country's worst outbreak as Premier Gladys Berejiklian warns that intensive care units across the state are likely to face a surge of up to three times their usual capacity in October.

In Victoria, modelling suggests that by the middle of December there could be between 462 and 953 coronavirus patients needing intensive care, exceeding the system’s current capacity.

According to the official list of qualified occupations for priority migration, Australia needs more nurses to join a number of health sectors, including critical and emergency care, among other areas.

However, an open letter with more than 23,000 signatories argues that there is already a cohort of health professionals in Australia that can be called upon.

But delays in the evaluation process for nursing certification has left scores of overseas qualified health professionals in administrative “limbo", preventing them from joining an industry that desperately needs them.

This is the case for Juan*, a Latin American who came to Australia more than eight years ago with a bachelor's degree in nursing and more than 12 years of nursing experience under his belt, including two years in a hospital ICU ward in Europe.

He tells SBS Spanish that “bureaucratic factors” have placed obstacles in his way of getting certified in Australia, a process he kickstarted in 2019.

Key points:

  • While nursing is considered a priority profession for migration, overseas-trained nurses in Australia say they are unable to fill the gap due to delays in certification testing.
  • One of the certification exams is carried out at an Adelaide institution, but travel restrictions are preventing many from attending.
  • A cohort of overseas-trained nurses is calling on the AHPRA to urgently find an alternative that allows them to continue the certification process.

In the years following his migration, Juan dedicated his time to advancing his English language skills, while completing a Master's degree in Public Health and various diplomas in aged care.

“When the pandemic was declared and the demand for people with my knowledge grew, I decided to try to standardise my career and return to work as a professional nurse. I've been trying for a year, but it hasn't been possible,” Juan explains, though his case is not an isolated one.

Currently, SBS Spanish is aware of scores of foreign-trained male and female nurses living in Australia, who have had their accreditation process halted due to restrictions brought on by the pandemic.

A single location to take the exam

In January 2020, the Nursing and Midwifery Board of Australia (NMBA) implemented a new assessment model to grant certification to nurses with relevant qualifications obtained abroad.

Under the model, candidates are evaluated in two phases, the first being an online multiple-choice exam.

“This exam has up to 170 questions. And they test you on all areas of nursing, including paediatrics, gynaecology ... rather, they test you on everything related to the profession,” Juan says.

“It is a very, very difficult exam. Even for someone like me who has been working as a nurse in the hospital or in the health sector for many years, it was difficult because it was very technical.”

Once a candidate passes the theory exam, they move on to the Objective Structured Clinical Exam (OSCE), which is carried out at a health simulation facility in Adelaide, where real-life medical scenarios are recreated to assess how a candidate responds.

But lockdowns and travel restrictions imposed by state authorities are preventing many nurses from advancing to the second phase, after completing the first.

The “bureaucratic barrier” leading to limbo

For the overseas-trained nurses that SBS Spanish has spoken to, the decision to offer candidates just one location in which to complete the second exam is a “bureaucratic barrier” that is hindering their progress and leaving many in limbo, as bans on travel have prevented them from reaching the testing destination.

“The only existing headquarters is in Adelaide, and the exam costs $4000. I already paid [for the exam], but I've been waiting for two months for the exam date," Juan explains.

“There are people who have been waiting six to eight months for an exam date, but because of the pandemic and the lockdowns, the date keeps getting postponed.

“There is no definitive date for when these tests will be scheduled.”

The open letter is calling on the Federal Health Minister Greg Hunt, state health ministers and the Australian Health Professionals' Regulation Agency (AHPRA) to find a temporary alternative “urgently” in order to allow candidates to advance towards the completion of their certification processes.

“What is being asked is for the certification process to be revaluated. Many nurses are already in the country, I'm not the only one [in this situation]. Due to the delays in these processes they have not been able to homologate their studies,” Juan says.

“So, what is also being asked is that they revaluate the way in which they are granting certification, in order to enable us to help in this pandemic.”

The signatories of this letter claim there are more than a thousand nurses ready to take the second exam, and while they are not asking to eliminate testing, they are demanding more location options to proceed to the second exam.

"Another option is to assess the resumes of each candidate and grant them registration through an internship in a hospital, that way they can homologate their career” Juan suggests.

Frustration at not being able to help during the pandemic

According to Juan, a further option out of the bureaucratic mayhem would be to go back to university and start over, while hoping that the university would take into account a candidate’s previous studies.

“Another option that AHPRA approves is to study the degree a second time. [But] I have years of nursing studies under my belt, I think enough is enough,” he says.

“Plus, courses for international students can cost up to $ 40,000 a year, and here we're talking three years.”

When contacted by SBS Spanish, AHPRA and the Nursing and Midwifery Board noted that they are aware of the delays faced by some internationally qualified nurses and midwives who want to be registered to work in Australia.

However a spokesperson defended the processes of both entities through a statement that read: “It is an important part of the role of the Australian Nursing and Midwifery Board to ensure that all registered nurses and midwives in Australia meet the level of training and qualification expected by the Australian public. It is a matter of public safety.”

NMBA assured that they will provide OSCE assessment dates for internationally qualified nurses and midwives whenever possible.

“The Australian Board of Nursing and Midwifery and AHPRA are closely monitoring the COVID-19 situation and are adapting our regulatory requirements to meet emergency health service needs and support health service delivery while continuing to protect to the public,” the spokesperson concluded.

Juan has been told he would most likely be contacted in December with an examination date that is likely to be sometime in mid-2022.

Meanwhile, all he can do is sit on his couch and watch the health crisis unfold.

“It is deeply frustrating to know that you have the knowledge, that you can help people, but instead I'm sitting on a couch at home, watching the numbers of people dying. I feel totally helpless because I can't do anything.”

Read this story in Spanish here.

*Name withheld for privacy reasons at the request of the interviewee.