Using overseas registered nurses to fill employment gaps in rural health services: Quick fix or sustainable strategy? Karen Francis, 1 Ysanne Chapman, 1 Glenn Doolan, 2 Ken Sellick 1 and Tony Barnett 1 1 School of Nursing and Midwifery, Monash University, Churchill, and 2 Department of Epidemiology and Preventative Medicine, Monash University, Burnett Tower, Alfred Hospital, Prahan, Victoria, Australia Abstract Objective: This study sought to identify and evaluate approaches used to attract internationally trained nurses from traditional and non-traditional countries and incentives employed to retain them in small rural hospitals in Gippsland, Victoria. Design: An exploratory descriptive design. Setting: Small rural hospitals in Gippsland, Victoria. Participants: Hospital staff responsible for recruitment of nurses and overseas trained nurses from traditional and non-traditional sources (e.g. England, Scotland, India, Zimbabwe, Holland, Singapore, Malaysia). Results and Conclusion: Recruitment of married over- seas trained nurses is more sustainable than that of single registered nurses, however, the process of recruit- ment for the hospital and potential employees is costly. Rural hospitality diffuses some of these expenses by the employing hospitals providing emergency accommoda- tion and necessary furnishings. Cultural differences and dissonance regarding practice create barriers for some of the overseas trained nurses to move towards a more sanguine position. On the positive side, single overseas registered nurses use the opportunity to work in rural Australian hospitals as an effective working holiday that promotes employment in larger, more specialized hospi- tals. Overall both the registered nurses and the employ- ees believe the experience to be beneficial rather than detrimental. KEY WORDS: recruitment, retention, overseas regis- tered nurse, rural. Introduction A shortage of rural registered nurses (RNs) now exists in most countries across the world. Australia, North America and Europe are some of the industrialised nations experiencing escalating nursing shortages and an associated significant upward trend in the inflow of overseas-born nurses. Australia, the United Kingdom (UK) and the United States of America (USA) are the countries receiving the largest number of overseas trained nurses (OTNs). Registration data from the Australian Nursing Mid- wifery Council, 1 the Department of Immigration and Multicultural Affairs (DIMA) and state nursing boards indicate that the overall trend in inflow of nurses to Australia has been upwards in recent years, but with significant variation between states. 2,3 There appears to be a current heavy reliance on recruitment from the Europe, Scandinavia, North America and Pacific coun- tries. 4 Between 1995 and 2000 Australia received 11 757 foreign nurses, possibly outstripping even USA, which received more than 10 000. UK is even further ahead, admitting 26 286 foreign nurses between 1998 and 2003. 5 By 1996 almost 25% of nurses employed in Australia were born outside Australia: 11.2% in UK or Ireland, 3.9% in Asian countries, 2.8% in New Zealand, 2.5% in ‘other Europe’ and 3.3% in ‘other’ countries. 6 Of late rural hospitals in Victoria have had difficulties recruiting nurses from the more traditional countries such as USA and UK and successful recruit- ment has occurred with nurses from other (non- traditional) countries such as Malaysia, Singapore and African countries. Potential barriers to international nurse recruitment and mobility form part of the international debate, and are discussed in the literature by Seccombe and Buchan 7 and Snyder and Bunkers. 8 There is relatively little pub- lished research on the motivation of nurses for moving between countries, and a need has been identified to explore the factors which determine the choice of des- tination for English-speaking nurses, who have several options. 9 There is growing body of literature available on overseas trained medical doctor recruitment and retention. 10–14 This body of literature highlights positive and negative features of working in rural environments that impact on medical doctor recruitment and reten- tion. Issues such as being able to maintain cultural Correspondence: Associate Professor Ysanne Chapman, School of Nursing and Midwifery, Monash University, North- ways Road, Churchill, Victoria, 3842, Australia. Email: ysanne.chapman@med.monash.edu.au Accepted for publication 1 June 2007. Aust. J. Rural Health (2008) 16, 164–169 © 2008 The Authors Journal Compilation © 2008 National Rural Health Alliance Inc. doi: 10.1111/j.1440-1584.2008.00967.x