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Nursing in Australia: could you relocate “Down Under”?

Carole O'Connor
RGN
Practice Nurse
Harold Road Surgery
Hastings
East Sussex

Disillusionment, budget restraints, too much paperwork, lack of jobs when first qualified and the British weather are some of the reasons why our nurses have decided to take their skills abroad. So, has the thought ever crossed your mind about working in Australia, either temporarily or permanently? A word of warning - while the weather and free and easy lifestyle may tempt you to take your nursing skills abroad, applying to work in the land of plenty can be a journey through a minefield.

Levels of nursing
As in the UK, Australia has two levels of nurses: registered (RGNs) and enrolled (ENs) (it is worth noting that Australia still has training for enrolled nurses!).

There are six states and two territories in Australia, and each of these has their own nurse regulatory body, which maintains a register of nurses. Wherever you intend to practise, you must apply to that particular state or territory. Nurses are in great demand in Australia, so visa applications usually receive priority. A list of "Occupations in Demand" is reviewed every six months.

Nurses in Australia are not required to maintain postregistration education and practice (PREP), but the Royal College of Nursing, Australia (RCNA) runs a lifelong learning programme (3LP), which adds to your portfolio.

UK Royal College of Nursing statement
Peter Carter, General Secretary for the RCN, issued the following statement to the Times newspaper last year: "Many nurses feel they are asked to do more with less, with the many cutbacks." He reported that he knew of at least 100 nurses in the West Midlands who had left for Australia in one week. He predicted that 180,000 nurses would retire over the next 10 years, and that by 2010, the UK would have a shortfall of 14,000 nurses. He added, "With the imposed recruitment freeze in the NHS, comparable salaries, [and] a high quality of life in Australia, it is easy to see why our nurses are leaving the UK, especially with the past high-profile drive that Australia has had in Britain."

Getting the ball rolling
To migrate and work as an RGN (Level 1) in Australia, first, you will need a qualification assessment, which is undertaken by the Australian Nursing and Midwifery Council (ANMC). This will give you points, which are then needed when you apply to the Australian Government Department of Immigration and Citizenship. ENs (Level 2) do not require this assessment and should apply directly to the state or territory.

Assessment and other fees
Migrating can be expensive and there are a few fees to consider. If you are an RGN, an assessment fee of AUS$670 (approx. £280) is payable to the ANMC before obtaining a "Full Migration Assessment". If your application fails, you lose this money. You can appeal, but you are then required to pay a review fee of AUS$365 (approx. £153), which is nonrefundable. That review decision is final.

ENs do not escape fees! A certificate of enrolment through the individual state or territory will cost AUS$115 (approx. £48) and a further initial enrolment fee is required, which is then paid annually.

Timescales for initial nursing applications
For RGNs, depending on demand, the application process for a Migrations Skills Assessment can sometimes take six to 10 weeks, but the ANMC states it is likely to be longer for overseas applicants. For ENs, the Nursing and Midwifery Regulatory Authority (NMRA) allows a timescale of approximately three months.

[[Box 1 aust]]

Visa options
Some states, such as South Australia, Victoria and Western Australia, have a current shortage of nursing and midwifery skills, and are willing to sponsor visas for these professionals. The visa options for nurses are as follows.

  • Employer Nomination Scheme. If after your three years of training you have a further two years' experience working in Australia as a nurse (before applying for the visa), you may be suitable for a permanent visa under this scheme if your employer is unable to fill their vacancy in Australia. You must be under 45 years of age.
  • Labour Agreements. The government and employer allow recruitment of nurses on a permanent basis when vacant positions arise.
  • Regional Sponsored Migration Scheme. Skilled overseas nurses are employed on a permanent basis when employers in regional or low population growth areas cannot fill the vacancies locally. You must be able to prove that the employer has offered you a fixed-term contract of at least two years to apply for this. You must be under 45 years of age.
  • Skill Matching visa. For nursing skills in demand, a state, territory or employer will nominate for a visa. To be added to the Skills Matching Database, certain criteria must be met such as skills, age and English language ability.
  • Temporary Business (Long Stay) visa. This is popular with nurses who are not sure about emigrating definitely. Stays can be from three months to four years. You can work temporarily with full work rights for yourself and accompanying family. Again, you must have been sponsored by an employer to fill a nominated position.
  • Australian Skilled Sponsored visa. If you have a close relative already living permanently in the country, you may be eligible to apply if they agree to sponsor you and financially support you should you need it. Alternatively, you may also be sponsored by a state or territory. This only applies to certain regions.
  • Skilled Independent visa. This is a points test visa for nurses who apply independently without a sponsor, or who choose not to be sponsored. Points are awarded on skills, work experience, English language and occupation. If you have Australian work experience or qualifications this will add points.
  • Working Holiday Maker visa. This allows you to stay for up to 12 months, providing your work is incidental to your holiday. This only applies to those aged 18-30 years. You are allowed to work with an employer for a maximum of three months.

Migration agents
All this may seem very daunting, which is why there are many migration agents listed on the internet and in the Yellow Pages (under embassies and consulates). For a fee, they will advise and guide you through migration to Australia. Most will have a free information pack for guidance, although many actually have a free, online initial assessment, which will give you a basic guide as to your suitability.

In most cases, to migrate to Australia, you must be under 45 years of age (they like you to pay 20 years into their pension). However, some migration agents have been able to achieve visas for clients over this age limit, depending on their specific nursing skills.

Practice nurses taking a core role
The Australian Practice Nurses Association (APNA) reports that in 2007 there were approximately 8,000 practice nurses working in GP practices. This figure may have to drastically increase. The APNA state there is a shortage of GPs in rural and outer urban areas. In a recent study, they highlighted that central Sydney has also seen a decline in GPs. President of the APNA, Anne Matyear, said, "With many GPs retiring, or cutting hours, and patients living longer and the increase of generally unhealthy patients, the training of new doctors is slow to meet this need." This critical care shortage may be lightened with the practice nurse taking a core role in the multidisciplinary practice teams.

Nurses in 60% of general practices in Australia are now key members of the health team. It is one of the fastest-growing areas of nursing in the country.

Nurse practitioners have been around in Australia for some years now. In New South Wales the first Practitioner Committee convened in October 1990, and the first nurse practitioners were authorised in December 2000. The Australian Medical Council of General Practice has stated, " Independent nurse practitioners cannot and should not replace the expertise and care of general practitioners". There do appear to be some grey areas for nurse practitioners in certain states, so further information on this role can be found online (www.nursepractitioners.org.au).

Practice nurses in Australia work from three to 50 hours per week, with a mean average of 27 hours per week, and working hours are comparable to the UK. Twenty-four percent work full-time, 58.9% work part-time and 16.4% on a casual basis.
Practice nurses have not existed in Australia for as long as they have in the UK, and for emigration purposes you would be assessed on your RGN status and then would need to apply to the individual state you are moving to. Training and support for practice nurses appear to vary from state to state. Rural scholarships and network mentoring seem to happen, and 56.7% of practice nurses receive partial or no practice support, but 18.9% have courses included in their contracts. More information can be found on the Australian Practice Nurses Association website (www.see Resources).

Full-time wages
Wages are generally higher for casual employment. You are paid a "leave loading" of 15% on top of your wage. This amounts to any leave that you would normally accrue. Salaries may appear slightly lower than the UK, but the quality and standard of living are thought to be generally higher in Australia (see Box 2).

[[Box 2 aust]]

Conclusion
While moving to Australia does not appear to be straightforward, the public health system has comparable shift patterns and drug names, and the waiting lists and budget restrictions are very alike.

Advantages to nursing in Australia include that there is no mandatory PREP, and that training is given for ENs. Otherwise, nursing is very similar. Using the services of migration agents may be helpful to guide you through the minefield of information and data required by both the nursing bodies and immigration department. A working holiday may give more insight to disenchanted UK nurses. At the time of writing no figures were available for nurses returning home to the UK permanently, but they do! Being homesick is a major disadvantage to living in Australia. So, is the grass greener? You will have to decide!

Resources
Australian Nursing and Midwifery Council
W: www.anmc.org.au
Australian Government Department of Immigration and Citizenship
W: www.immi.gov.au
Australian Practice Nurses Association
W: www.apna.asn.au
Royal College of Nursing, Australia
W: www.rcna.org.au
Nurses Board of South Australia
W: www.nursesboard.sa.gov.au
Emigrate
W: www.emigrate2.co.uk

We asked you to tell us what you think about relocating. Your comments: (Terms and conditions apply)

"I've been nursing in Queensland, Australia, for a little over 3 years, in a rural hospital ... I love it. My family have all settled really well, it was the best thing I've ever done. I've had lots of opportunities to learn new skills, and on the rare occasion I have a difficult day ... I finish my shift and it's sunny!" - Joy Matthews, Queensland, Australia

"I nursed in South Africa many years ago before I came back to do my HV training and marry. I used the 20 mths as a gap time, travelling in between my work committments, I have never regretted my decision to go, I saw many parts of Africa but had more time than an ordinary tourist would have done in 2 weeks or so. I viewed my nursing qualification as a gateway
to the world, and that was nearly 40 yrs ago!" - Anne Evans, West Sussex