Self-sufficiency in the healthcare workforce: a system dynamics model of the domestic and foreign educated nursing and midwifery workforce in Ireland.

Background: World Health Organization (WHO) projections point to an increasing global demand for nurses and midwives, leading to shortages in many countries, particularly in less developed regions. Ireland, the context for this study, currently relies heavily on foreign educated nurses and midwives to meet its demand, with Government policy moving towards a domestic recruitment model. This paper estimates the recruitment requirement and associated nursing and midwifery student intake over time under different reform scenarios. It also highlights policy considerations for countries, like Ireland, aiming to comply with the WHO Code of Conduct on the International Recruitment of Health Personnel.

Methods: This paper develops and applies a system dynamics model of the domestic and foreign educated workforce supply by age and gender and is based on regulatory data on stocks and flows from the national professional regulator for nurses and midwives. The model scope and design was informed by a problem statement developed in a series of workshops with officials in the Office of the Chief Nursing Officer. A range of scenario and sensitivity analyses are also undertaken.

Results: In 2021, the base year of our projection horizon, we estimate that Ireland needed to recruit 3019 professionally active whole-time-equivalent (WTE) nurses and midwives. This would have required 3965 student places four years earlier in 2017 to meet this demand domestically. This is 153% higher than the 1570 student places that were available in that year. The recruitment requirement rises to 4497 by 2051, a 49% increase on 2021 levels. Foreign educated nurses and midwives, in terms of WTEs, start at 45% of projected demand in 2021 and range from 57% in the baseline scenario to 16% in the most ambitious reform scenario in 2051.

Conclusions: The analysis suggests that Ireland requires a significant increase in nursing and midwifery student places to achieve self-sufficiency and that this will take time to achieve. Moreover, in addition to a sufficient domestic supply of nurses and midwives, self-sufficiency will also depend on managing demand volatility. Finally, countries anticipating a shift to a predominantly older population should ensure they have enough student places available before the demographic transition occurs to meet the associated health workforce requirements through the domestic education system.