How to Successfully Recruit and Integrate International AHPRA-Certified Nurses for Australian Employers
How to Successfully Recruit and Integrate International AHPRA-Certified Nurses for Australian Employers
Australia’s aged care sector faces a growing workforce crisis, but international recruitment offers a scalable, sustainable solution for providers of all sizes.
It’s no secret that the Australian aged care industry is in the midst of a critical workforce shortage, which will turn into a freight train for the sector in the next 10 years (Bernard Salt- Demographer, ACCPA 2023). However, there is a viable option that promises a sustainable pathway at a scale that providers of all sizes can tap into - International Recruitment.
The challenge is that many Providers, large and small, don’t know where to start or have the resources to benefit from this global trend. This Comprehensive Guide will hopefully provide a useful resource to those wanting to use this method to create a sustainable workforce.
So, what is the problem?
To try and quantify the dire situation we’re all facing, the Department of Health and Aged Care’s ‘Nursing Supply and Demand Study for 2023 to 2035’ released last year is just one of many global studies that paint a worrying picture of the nursing sector on the brink of a 70,000-nurse shortage, and that's just Australia. The global number is in the range of 350,000 to 600,000, depending on which study you read.
“Regardless of which developed country you are in, the entire trained global nurse pool is not large enough current and expected demand.”
The study highlights the urgent need to fill nurse rosters, particularly in the acute nursing sector, where 26,665 nurses are needed right now to meet the current minimum regulatory requirements, let alone the care expectations of the sector providers and their clients and families.
The future is even more grim for primary healthcare and aged care facilities in rural and remote areas, where professional nurse staffing needs have been a perennial problem pre-COVID and accelerated immensely since the pandemic.
Faced with an ageing population and shrinking workforce, rising vacancy rates, and increasing demand for quality care, there is no better solution for Australian employers than hiring foreign professionals for the healthcare industry.
Why are we in this mess?
No, it’s not salaries, nor is it that the sector or the role isn’t cool compared to an IT role or finance. And it’s not even the reputation that the sector has for burning out workers, leaving them with little option but to leave the career in care they love for less stressful careers.
It’s a much deeper structural problem that can't be fixed by the usual short-term levers.
“There are simply not enough young workers entering high-incomethe workforce, regardless of sector, in all developed (high income) countries around the world. Shifting workers from one segment of society into others is like shifting deck chairs on the Titanic.”
The global population collapse, or population decay, as some optimists phrase it, began decades earlier. People are living longer (which we all selfishly want), and our social-cultural expectations mean we are all working (dual careers) to support our lifestyle and have fewer babies.
While admirable and entirely with merit, it means that the usual Dependency Ratio (the percentage of the population dependent on the workforce) has skewed from children/youth, as we saw with the post-World War II population explosion to a record Aged Care dependency ratio. We need to have a high Youth Dependency Ratio as it means that there are future workers entering the workforce in the next decade. But now the Aged Care dependency ratios has flipped to a record 28.6% of the aged care population depending on a shrinking workforce to support.
While a skewed Dependency Ratio causes long-term systemic economic productivity issues for the entire economy in developed countries, the real impact hits us at a societal level, in caring for the sick, the infirm, and the elderly. Our expectations for quality, universal health, and aged care are simply not keeping up with the reality of a workforce that resembles a western ghost town, especially in Regional & Remote areas.
“My advice for aged care providers about international recruitment is they need to start it now! Start it now. Because there are shortages are going to continue. We're going through that phase in Australia where those baby boomers are all retiring, and we've lost a lot of our workforce over the last five years through retirements." - Errol Curran, CEO, Bushland Health Group Ltd.
Health Care Talent is more global than ever before - it's time to prepare
So, what’s the solution? If we can’t get enough skilled local workers, we cast our eyes abroad. Australia has been doing this successfully for generations, with many retired Australians living in Aged Care homes regaling with their stories of emigration into a country of bounty and opportunity.
The skilled immigration debate often focuses on IT workers and engineers and overlooks the middle and bottom half of the care workforce pyramid entirely. While a country with poor IT skills may not compete on the world stage, a country with poor Health and Aged Care is considered a blight on its society.
But, despite all of the immigration rhetoric, talent is still on the move. Healthcare talent is even faster than the general migration of other occupations.
A simple example, the Organisation for Economic Co-operation and Development (OECD), stated that the number of foreign-trained doctors alone in OECD countries increased by around 60% in the past decade.
“As an Australian Health or Aged Care provider, you are not alone, and you are now competing for a global talent pool.”
Why are Providers turning to International Recruitment in greater numbers than ever?
While many Providers initially turn to international recruitment to solve their workforce gaps that local recruitment can’t fill, many are finding that leveraging a well-trained international workforce has several other advantages. These workers are very committed to settling in their new country and local community, even if the region is in regional or remote Australia. Providers also find these nurses are open to working in Aged Care, while local nurses often tend to prefer Primary Care due to higher pay (not always), career opportunities, and the type of work can be more clinically challenging.
It’s not just about filling the workforce gap; international nurses often stay for 5+ years, building new lives with their young families, which stops the leaky bucket of high turnover among local nurses and care workers. Providers also typically enjoy a retention rate above 95% for these international workers.
What is an ‘International AHPRA nurse and how does it differ from a 'local AHPRA Nurse’?
AHPRA (Australian Health Practitioner Regulation Agency), the body that registers Nurses in Australia, has deemed that only five ‘Stream A’ countries (Canada, Hong Kong, the Republic of Ireland, the United Kingdom, New Zealand, and United States of America) meet the accreditation requirements of an Australian RN qualification. All other countries, Stream B & C countries, need to do other training and pass exams to be considered for registration as an AHPRA registered Nurse.
While some Providers are successfully recruiting from these countries to meet their needs, the scale remains small because the global nurse pool from Stream A countries is very small and extremely competitive.
Providers are having much more success with recruiting talent from Stream B countries like the Philippines and India. In the Philippines alone, the majority of migrants (55.5%) in the last five years moved only once, according to a local study, which suggests that Filipino nurses and caregivers have settled in their communities after their first move.
These nurses often find work in other countries like the UK, Singapore, South Africa, or New Zealand where they complete the testing and other requirements to become an AHPRA nurse before making their final Australian destination. This is the length that nurses from these countries go to just to live their dream life in Australia.
Other providers bring in Filipino Registered Nurses as EN or AINs in the Aged Care sector, then upgrade the Nurse with the help of a local specialist partner to “Upgrade” their qualification within the first year.
A new AHPRA announcement may mean that this process can be reduced from 8-12 months to 1-6 months, depending on circumstances. While this may be helpful, there are other alternatives.
Regardless of whether the nurse obtains their AHPRA qualification while overseas or comes as a Stream B RN from the Philippines and upgrades when in the country, the result is the same. Highly committed workers who can fill the gap are now available, whether the demand is for 2 or 200 nurses for each provider.
Delving into the realm of international recruitment, migration,the and relocation is like the main character avoiding prison in a Kafka novel. The dizzying arrays of legislation that can vary based on your location, the role, the source country, the credentials, and the experience level of each candidate. It’s not just about finding talent that best fits your clinical and cultural needs, providers have to think about accommodation, language, health checks and physical checks (they are different!), international police checks, travel, settlement, Cultural & Linguistic Diversity (CALD) etc.
Some providers go to migration agents, only to be told they need to find the candidates first, while local recruiters will always defer to migration agents for employer and employee migration services.
All but the largest providers have the resources, skills and appetite to tap into this rich vein of talent. There are a few global manpower specialists in healthcare, like Groworx, that are solving this issue. They have had the most success with both the nuances of International Recruitment and the Healthcare Recruitment to make it truly easy and low risk for Providers, regardless of size.
Key Considerations for Tapping into International Talent
Here is a short list of considerations for your team to leverage when embarking on this workforce strategy. This checklist applies to whether your organisation does this program DIY or finds a single or multiple partners to deliver the solution.
International Healthcare Recruitment & Assessment
One Stop Shop - for Global Integration. Do they have the capability and real-world experience to manage all aspects of global recruitment and deployment in the healthcare sector?
Speed - Do they have a pre-vetted and committed pool of workers ready to go?
Offshore In Country Reputation - Do they have the local country that we can trust to attract the best talent from?
Healthcare Expertise - Does your international partner have a clinical recruiting team that knows how to recruit for the nuances of the Health and Aged Care sector needs?
Multi-factor Assessment - Ability to assess physical, health, police, VISA, English language, cultural fit, sector fit (Aged Care or Health care), and qualification checks (AHPRA Certificate & relevant experience).
Offshore Assessment capability for Nurses and Allied Health roles.
Ensure Sector Fit - So that your international workers are prepared to work in Primary or Aged Care. Assess their aptitude for actually working in the sector you are in. This reduces attrition.
Training & Enablement
Have an upgrade program for those Stream B Nurses requiring additional training and preparation for assessment, whether offshore on onshore when in Australia.
Have courses to support IELTS preparation for Stream B nurses to ensure high pass rates.
Run CALD (Cultural and Linguistic Diversity) training for Stream B to ensure strong integration with workers.
Put in a training and accreditation process to ensure nurses not only comply with minimum standards but your specific provider’s custom training requirements. This should apply before arrival and during their first year in the country.
Have a LATA (Living and Thriving Abroad) training module to help prospective workers thrive in their new environment.
Migration & VISA
Who will manage your Migration? Does your partner have healthcare expertise and understand the accreditation and visa pathways for all healthcare roles?
Do they pass the English Language requirements for the VISA?
Have the workers sign the International Worker Contract to protect your collective rights and reduce attrition.
Deployment & Mobility
Create a strong Deployment, Relocation, and International Mobility plan.
Create a strong communication and deployment plan, providing essential information about Australian healthcare, cultural integration, and settling in.
Does your partner have a travel desk to manage the entire process cost-effectively and comfortably for the provider and workers?
Embed a local Community Manager to greet deployed nurses at the airport and manage their first week for orientation and accommodation settlement.
Engage your local community (Mayor and other local bodies) to welcome the new workers.
“We sponsored in 2 lots 26 care workers, 8 of those are registered nurses who are currently working on their pathway to their Australian Registration. And we find it very smooth and very encouraging really about the quality of the workers. We interviewed every one of them remotely
They already have a professional demeanor, I must say. They are professionally trained. These recruits are very well trained when they come to work with us, they know what they're doing. Their nature is towards caring, accountability and responsibility. And that's another side to people that you don't always see. For us it's been a great success thus far, and I see it will continue. All recruits have plans to bring their family. They love the regional area.”
- Wendy Rocks, Managing Director, Lutheran Aged Care
Support & Monitoring
Who will manage Pastoral support during their crucial first year?
Accommodation - Where will you house them? Who will manage this?
Does your partner have an omnichannel Global Service Centre that provides assistance and support to all kinds of challenges and issues faced by foreign workers? The global service centre offers 24/7 virtual support that can be accessed by both nurses and employers for seamless screening to deployment to integration support.
A comprehensive orientation program covering workplace specifics and settling-in resources (transport, banking, housing, localisation of technologies, apps, etc.)
Mentorship programs and community integration assistance to AHPRA-registered RNs also offer valuable peer and senior staff support for the foreign workers joining the healthcare facility.
Regular programmed check-ins and surveys are organised as part of continued support to address any work-related, cultural, or personal challenges for Aussie employers.
I love the support that is being provided to the Filipino workers as they are training and then connecting with the providers that they were going to be working. That I think is the biggest seller for me.”
- Simone Fuller, Operations Head, Allawah Lodge
Collaboration & Ethical practices in Modern Slavery
Do they have transparency across their entire workflow pipeline for easy reference and collaboration?
Do they have modern slavery and policies and processes that protect the workers during the lifecycle that meet the ethical standards of global labour standards?
Do they have KYC (Know Your Customer) practices that assess the Provider to ensure the worker is protected?
Do they meet the 4S Framework of International Worker Mobility: Safety, Settlement, Supported, and Stay (in destination country)
Benefits of a single global manpower partner
While providers can do some or all of this themselves, many providers are finding the complexities and drain on their recruitment teams just too high to consider these options.
Global Manpower organisations like Groworx are now popular partners as they act as the system integrator across any region around the world.
What you need to get started
Want to consider International Recruitment as a workforce strategy and not just a quick fix.
An ability to be the headlessor for accommodation for the workers for 3-6 months.
Open to considering staff housing paid by the worker. While not mandatory, many are implementing this as an option for long-term workforce needs.
Ability to provide Full-time positions
Willingness to sponsor international workers - this means a Standard Business Sponsorship or willingness to obtain one. It's easy to get, but it is a requirement for every sponsoring employer.
Tips from Groworx Providers
“It was a strategic and tactical move to look at which countries we are drawing our staff from now and hence, we looked at the Philippines. I looked at the scale of the program and this is truly the first transnational education of this scale. Nearly 200 workers trained offshore to an Australian qualification using Groworx’s own academy.”
- Patrick Reid, CEO, Illawara Retirement Trust
“I think the fact that we are getting qualified, trained people coming out, the opportunity we have with the Filipino community is a really good one as well. I think it is a good opportunity not just short term fix for staffing but a long term solution.”
- Ben Levesque, CEO, Finley Regional Care
“The first thing was reputation, that thing is very important to us. If we are partnering with someone, we need to partner with a company that has good reputation and has good integrity. We felt that we have great responsibility for the people that are coming in and we want that company to have a shared responsibility with us and we found that in Groworx.”
- Donna Dobson, Director of Aged Care and Disability Services, Gilgandra Shire Council
Robots or International Workers - you choose
With the gap between a shrinking workforce and the accelerating health and aged care needs, the local-only solution won't work. There are two options to fill the gap of that local recruitment, or you will fall short in filling your roster. International workers or the new generation of AI-powered Robots?
While this may be a simplification of a complex problem, some providers have yet to grasp the reality or urgency of the situation. The structural problems will not be changed in our lifetime. That’s the reality.
For any developed economy, creating a sustainable workforce will not be found in local workforces alone. It's either international talent or robot workers. Or maybe it's a mix of both solutions. At least, International Talent is available today.
With falling birth rates & aging societies, population collapse triggers a silent aged care crisis. International talent is eyed as a key solution for sustainable elderly care worldwide.
Leading aged care provider IRT implements innovative workforce strategy with Groworx International Recruitment Program by hiring Filipino care workers and nurses to overcome critical staffing shortages.
It’s no secret that the Australian aged care industry is in the midst of a critical workforce shortage, which will turn into a freight train for the sector in the next 10 years (Bernard Salt- Demographer, ACCPA 2023). However, there is a viable option that promises a sustainable pathway at a scale that providers of all sizes can tap into - International Recruitment.
The challenge is that many Providers, large and small, don’t know where to start or have the resources to benefit from this global trend. This Comprehensive Guide will hopefully provide a useful resource to those wanting to use this method to create a sustainable workforce.
So, what is the problem?
To try and quantify the dire situation we’re all facing, the Department of Health and Aged Care’s ‘Nursing Supply and Demand Study for 2023 to 2035’ released last year is just one of many global studies that paint a worrying picture of the nursing sector on the brink of a 70,000-nurse shortage, and that's just Australia. The global number is in the range of 350,000 to 600,000, depending on which study you read.
“Regardless of which developed country you are in, the entire trained global nurse pool is not large enough current and expected demand.”
The study highlights the urgent need to fill nurse rosters, particularly in the acute nursing sector, where 26,665 nurses are needed right now to meet the current minimum regulatory requirements, let alone the care expectations of the sector providers and their clients and families.
The future is even more grim for primary healthcare and aged care facilities in rural and remote areas, where professional nurse staffing needs have been a perennial problem pre-COVID and accelerated immensely since the pandemic.
Faced with an ageing population and shrinking workforce, rising vacancy rates, and increasing demand for quality care, there is no better solution for Australian employers than hiring foreign professionals for the healthcare industry.
Why are we in this mess?
No, it’s not salaries, nor is it that the sector or the role isn’t cool compared to an IT role or finance. And it’s not even the reputation that the sector has for burning out workers, leaving them with little option but to leave the career in care they love for less stressful careers.
It’s a much deeper structural problem that can't be fixed by the usual short-term levers.
“There are simply not enough young workers entering high-incomethe workforce, regardless of sector, in all developed (high income) countries around the world. Shifting workers from one segment of society into others is like shifting deck chairs on the Titanic.”
The global population collapse, or population decay, as some optimists phrase it, began decades earlier. People are living longer (which we all selfishly want), and our social-cultural expectations mean we are all working (dual careers) to support our lifestyle and have fewer babies.
While admirable and entirely with merit, it means that the usual Dependency Ratio (the percentage of the population dependent on the workforce) has skewed from children/youth, as we saw with the post-World War II population explosion to a record Aged Care dependency ratio. We need to have a high Youth Dependency Ratio as it means that there are future workers entering the workforce in the next decade. But now the Aged Care dependency ratios has flipped to a record 28.6% of the aged care population depending on a shrinking workforce to support.
While a skewed Dependency Ratio causes long-term systemic economic productivity issues for the entire economy in developed countries, the real impact hits us at a societal level, in caring for the sick, the infirm, and the elderly. Our expectations for quality, universal health, and aged care are simply not keeping up with the reality of a workforce that resembles a western ghost town, especially in Regional & Remote areas.
Health Care Talent is more global than ever before - it's time to prepare
So, what’s the solution? If we can’t get enough skilled local workers, we cast our eyes abroad. Australia has been doing this successfully for generations, with many retired Australians living in Aged Care homes regaling with their stories of emigration into a country of bounty and opportunity.
The skilled immigration debate often focuses on IT workers and engineers and overlooks the middle and bottom half of the care workforce pyramid entirely. While a country with poor IT skills may not compete on the world stage, a country with poor Health and Aged Care is considered a blight on its society.
But, despite all of the immigration rhetoric, talent is still on the move. Healthcare talent is even faster than the general migration of other occupations.
A simple example, the Organisation for Economic Co-operation and Development (OECD), stated that the number of foreign-trained doctors alone in OECD countries increased by around 60% in the past decade.
“As an Australian Health or Aged Care provider, you are not alone, and you are now competing for a global talent pool.”
Why are Providers turning to International Recruitment in greater numbers than ever?
While many Providers initially turn to international recruitment to solve their workforce gaps that local recruitment can’t fill, many are finding that leveraging a well-trained international workforce has several other advantages. These workers are very committed to settling in their new country and local community, even if the region is in regional or remote Australia. Providers also find these nurses are open to working in Aged Care, while local nurses often tend to prefer Primary Care due to higher pay (not always), career opportunities, and the type of work can be more clinically challenging.
It’s not just about filling the workforce gap; international nurses often stay for 5+ years, building new lives with their young families, which stops the leaky bucket of high turnover among local nurses and care workers. Providers also typically enjoy a retention rate above 95% for these international workers.
What is an ‘International AHPRA nurse and how does it differ from a 'local AHPRA Nurse’?
AHPRA (Australian Health Practitioner Regulation Agency), the body that registers Nurses in Australia, has deemed that only five ‘Stream A’ countries (Canada, Hong Kong, the Republic of Ireland, the United Kingdom, New Zealand, and United States of America) meet the accreditation requirements of an Australian RN qualification. All other countries, Stream B & C countries, need to do other training and pass exams to be considered for registration as an AHPRA registered Nurse.
While some Providers are successfully recruiting from these countries to meet their needs, the scale remains small because the global nurse pool from Stream A countries is very small and extremely competitive.
Providers are having much more success with recruiting talent from Stream B countries like the Philippines and India. In the Philippines alone, the majority of migrants (55.5%) in the last five years moved only once, according to a local study, which suggests that Filipino nurses and caregivers have settled in their communities after their first move.
These nurses often find work in other countries like the UK, Singapore, South Africa, or New Zealand where they complete the testing and other requirements to become an AHPRA nurse before making their final Australian destination. This is the length that nurses from these countries go to just to live their dream life in Australia.
Other providers bring in Filipino Registered Nurses as EN or AINs in the Aged Care sector, then upgrade the Nurse with the help of a local specialist partner to “Upgrade” their qualification within the first year.
A new AHPRA announcement may mean that this process can be reduced from 8-12 months to 1-6 months, depending on circumstances. While this may be helpful, there are other alternatives.
Regardless of whether the nurse obtains their AHPRA qualification while overseas or comes as a Stream B RN from the Philippines and upgrades when in the country, the result is the same. Highly committed workers who can fill the gap are now available, whether the demand is for 2 or 200 nurses for each provider.
The challenge with International Recruitment
Delving into the realm of international recruitment, migration,the and relocation is like the main character avoiding prison in a Kafka novel. The dizzying arrays of legislation that can vary based on your location, the role, the source country, the credentials, and the experience level of each candidate. It’s not just about finding talent that best fits your clinical and cultural needs, providers have to think about accommodation, language, health checks and physical checks (they are different!), international police checks, travel, settlement, Cultural & Linguistic Diversity (CALD) etc.
Some providers go to migration agents, only to be told they need to find the candidates first, while local recruiters will always defer to migration agents for employer and employee migration services.
All but the largest providers have the resources, skills and appetite to tap into this rich vein of talent. There are a few global manpower specialists in healthcare, like Groworx, that are solving this issue. They have had the most success with both the nuances of International Recruitment and the Healthcare Recruitment to make it truly easy and low risk for Providers, regardless of size.
Key Considerations for Tapping into International Talent
Here is a short list of considerations for your team to leverage when embarking on this workforce strategy. This checklist applies to whether your organisation does this program DIY or finds a single or multiple partners to deliver the solution.
International Healthcare Recruitment & Assessment
Training & Enablement
Migration & VISA
Deployment & Mobility
Support & Monitoring
Collaboration & Ethical practices in Modern Slavery
Benefits of a single global manpower partner
While providers can do some or all of this themselves, many providers are finding the complexities and drain on their recruitment teams just too high to consider these options.
Global Manpower organisations like Groworx are now popular partners as they act as the system integrator across any region around the world.
What you need to get started
Tips from Groworx Providers
Robots or International Workers - you choose
With the gap between a shrinking workforce and the accelerating health and aged care needs, the local-only solution won't work. There are two options to fill the gap of that local recruitment, or you will fall short in filling your roster. International workers or the new generation of AI-powered Robots?
While this may be a simplification of a complex problem, some providers have yet to grasp the reality or urgency of the situation. The structural problems will not be changed in our lifetime. That’s the reality.
For any developed economy, creating a sustainable workforce will not be found in local workforces alone. It's either international talent or robot workers. Or maybe it's a mix of both solutions. At least, International Talent is available today.
Start Creating a Sustainable Workforce Today
Dan is the Co Founder & CEO of Groworx, A self-made entrepreneur from Australia, he speaks around the world on global demographic, political and workforce issues hat impact healthcare worldwide.
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