Are Repayment Clauses Causing Retention Issues For International Nurses?

Could repayment clauses, used to underwrite the incurred costs from recruiting international Nurses be creating retention problems?

The RCN has warned that the imposition of repayment clauses on Nurses recruited internationally is ‘flourishing’ amid chronic understaffing and with health services increasingly reliant on overseas staff.

It can cost up to £12,000 to recruit a Nurse from abroad, and repayment clauses are designed to recover the balance of recruitment costs incurred in the event that the Nurse coming from overseas doesn’t complete their contract.

RCN England director Patricia Marquis admitted the college is ‘very concerned’ about the practice.

‘We are aware some employers include punitive clauses in the contracts of employment for overseas workers. This can result in healthcare staff being forced to pay thousands if they decide they want to work elsewhere if their visa allows’ she explained.

Do you think the practice of enforcing repayment clauses for international Nurses if they don’t fulfil their contract is justified, and if so, should there be a legal limit on the amount a Nurse can be required to repay?

Stuart Tuckwood, a Unison nursing officer said the union was aware of cases where Nurses were “trapped by unethical contracts."

Unison cited the example of a Nurse from Zimbabwe who, when wishing to quit her role in a care home, was told she had to pay nearly £11,000. The Nurse related how the Care Home Manager attempted to deny her a reference unless the full amount was settled.

Examples of employers using the threat of deportation to coerce Nurses into staying in their roles have also been reported.

The Department of Health issued a statement saying that whilst it was aware of the use of such clauses, it would be “concerned” if repayment costs when candidates do not meet the terms of their contract were “disproportionate or punitive."

As more examples of this sort inevitably come to light, do you think the number of Nurses willing to be subject to these types of clauses will decline, or is the attraction of coming to the UK to work too much of an inducement?

NHS Employers, which represents NHS trusts, said they valued “the very important contribution” of overseas Nurses and recognised that “to help staff make the move from abroad, supporting them with some of the associated costs is also important."

A report commissioned by the Nuffield Trust argued that international nursing recruitment provides a more sustainable solution than reliance on agency staff. The report concluded: ‘Any initial savings by filling the post instead with an agency nurse would typically be exceeded by the cost of the likely higher hourly rate of agency staff within six months to two and a half years.’

To obviate the need for contractual repayment mechanisms going forward, do you think that the government and healthcare leaders should concentrate on addressing the causes of high staff turnover, such as poor pay and unsafe staffing levels, so that a greater percentage of those Nurses that are recruited from abroad don’t leave their roles early, thus reducing the requirement to safeguard incurred costs through repayment clauses?

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