Experiences of foreign European nurses in The Netherlands

doi:10.1016/j.healthpol.2003.08.006

Health Policy

Volume 68, Issue 1, April 2004, Pages 55-61

https://doi.org/10.1016/j.healthpol.2003.08.006 Get rights and content

Abstract

As a result of the shortage of nurses, Dutch health care organizations want to recruit nurses from outside Europe (e.g. Indonesia, South Africa). The Dutch government, however, is not encouraging this policy and prefers to recruit within the European Union. In order to better support such nurses, it is important to know the problems European nurses encounter in The Netherlands. This study is about the experience of nurses from other European countries in The Netherlands. This paper addresses itself to three principal questions. First, how many nurses qualified in other EU or EU candidate states are starting to work in The Netherlands. Second, why do they come to The Netherlands. And finally what problems do they encounter when working in The Netherlands.

A questionnaire has been send to all registered nurses trained in another EU or EU candidate state. The response has been 987 or 67%.

Thus, far approximately 1500 nurses from other EU/candidate states have come to The Netherlands. Personal reasons, including marriage, are the most important reasons for their coming here. Half of the nurses took one or more courses before starting work in nursing in The Netherlands. These were often Dutch language courses. The nurses had to make a number of adjustments. Major difficulties were unfamiliarity with Dutch laws and the fiscal and social security systems, recognition of their qualifications and application for permits. Some basic issues, such as how to write a letter of application, caused problems. The language and unfamiliarity with the Dutch health care system made it difficult to find a job. When they had gained employment in nursing these problems remained the most serious.

The conclusion is that international employment mobility in nursing is rather low in the case of The Netherlands. If the Dutch government decides to encourage the employment of nurses from abroad, several measures can be taken to make working in The Netherlands more attractive.

Introduction

This paper focuses on the experiences of foreign European nurses who have been working in The Netherlands or have been searching for a job as a nurse. In The Netherlands and in many other countries, shortages of nursing staff exist [1]. Several hospitals started to recruit personnel from abroad, such as South Africa and the Philippines [2], [3]. The Ministry of Health, the Ministry of social affairs and the Dutch parliament are critical about this development [4]. They wanted to investigate the possibilities to recruit in other member states of the European Union. One of the elements they wanted to know was the experience of European nurses in The Netherlands.

Section snippets

Other EU-countries recruiting nurses

Citizens of European member states, Norway, Iceland and Liechtenstein may work in any of these states without applying for work and residence permits. In the future, these rules may also apply to nurses from EU/candidate member states [5]. Attracting nurses from abroad is not a new phenomenon for other European countries. For example, Sweden has a policy of employing people from EU-countries and in particular from Germany [6]. Denmark attracts most foreign nurses (85%) from other Scandinavian

Policy of Dutch stakeholders

The policy of the Dutch government is not directed at actively recruiting staff from other EU member states. In general, recruitment is considered as being the responsibility of employers and employees [4]. Representatives of employees also do not stimulate recruitment in other countries, whereas employers primarily want to find staff. In 1998, the Dutch government, representatives of employers and of employees made appointments to regulate the recruitment of personnel from abroad [4].

Recognition of professional nursing qualifications

There are several directives that regulate the criteria for professional recognition within the European Union. In 1977, a directive (77/452/EEC) was issued for nurses in general care to facilitate reciprocal recognition. This directive describes training specifications for nurses to qualify as a general care nurse. Training programmes have not yet been harmonized between the member states. Accordingly, only qualifications on the official list are eligible for mandatory and automatic

Research questions

The aim of this study is to answer the following questions:

1.
How many nurses, qualified in other European countries, migrated to The Netherlands?
2.
Why do they migrate to The Netherlands?
3.
How do they prepare for work in The Netherlands? What problems do they encounter when looking for a job? How do they assess their experience of working in The Netherlands?

Methods

The BIG register contains the addresses of all registered nurses (RN) in The Netherlands. The country in which the person has received her nursing diploma is not being registered. Therefore, a structured questionnaire was sent to all 2654 nurses in this register in November 2001 with a EU/candidate nationality other than Dutch. The response rate was 67% or 1768. Of this group, 987 nurses indicated that they had received their training in a EU/candidate country other than The Netherlands. The

Migration of staff qualified elsewhere in Europe

The flow of nursing staff to The Netherlands is small and has been diminishing since 1996 (Table 2). In 2000, only 139 nurses from member states (and Norway, Liechtenstein, and Iceland) were registered as general care nurses. Compared with the overall intake of registered nurses at about 6000 per year [12], this is approximately 2.3%. The intake of nurses from candidate member states in the official register was even smaller: 20 in 2000. At the end of 2001, only 83 nurses trained in a candidate

Reasons for migrating to The Netherlands

Personal circumstances, such as marriage and a spouse’s employment, are the main reasons for coming to The Netherlands (Table 3). Nurses trained in France rate this reason most often as important (96%). For those from Belgium, personal circumstances are of less importance (42%). This is mainly due to the fact that the majority of the Belgian nurses (58%) were working in The Netherlands while still living in Belgium (cross border employment). This does not account for German nurses, who also

Experience of nurses in The Netherlands

Half of the nurses (52%) followed one or more courses before starting work in nursing in The Netherlands. These were often Dutch language courses. Almost all Belgian nurses came from Flanders and spoke Dutch; so language was no problem for them. One-third (32%) of the non-Belgian respondents had already learned some Dutch before moving to The Netherlands. Only a small number prepared for work in The Netherlands by taking professional courses. Those most often mentioned were courses on

Conclusion

Attempts to make labour markets more fluid within the EU has not resulted in more nurses coming to The Netherlands. The influx of European nurses to The Netherlands has been rather low and even shows a fall from 310 nurses registered as trained in other EU countries in 1996 to 139 in 2000. It is difficult to attract nurses from abroad as most EU-countries suffer from shortages [13], making it a global problem. Recently, the Dutch labour market for nurses is expected to change because of an

Acknowledgements

The authors acknowledge Institute for Labour Studies (OSA) for commissioning and financing.

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