Dáil Éireann Debate, Tuesday - 18 April 2023
1769. Deputy Róisín Shortall asked the Minister for Health if his attention has been drawn to concerns regarding the overseas aptitude test for general nursing (details supplied); the steps being taken to address these concerns and improve the test; and if he will make a statement on the matter. [18231/23]
View answerThe information requested by the Deputy is being collated by Department officials and a deferred reply will be submitted within ten working days.
As the Deputy will be aware, all nurses and midwives who practice in Ireland must be registered on the Register of Nurses and Midwives which is maintained by the Regulator, the Nursing and Midwifery Board of Ireland (NMBI). Along with the professions of midwife, doctor, pharmacist and dentist, Registered General Nurse (RGN) is one of the five health professions falling within the scope of the EU’s automatic recognition system. The relevant EU legislation obliges member states to comply with minimum training standards - S.I. No. 8/2017 - European Union (Recognition of Professional Qualifications) Regulations 2017 refers. In Ireland, the NMBI has the duty to ensure compliance. It achieves this by setting down educational standards in legislation (NMBI Rules). Similarly to Irish-trained student nurses and midwives, overseas applicants must meet the minimum training standards as a precondition to achieving registration with NMBI.
The RCSI Overseas Aptitude Test commenced in December 2015 and almost 11,000 candidates from 54 Countries have taken the test to date. It comprises two parts. Part 1 is the theory test which must be successfully completed before Part 2 can be attempted. Part 2 is the practical test or OSCE (objective structured clinical examination). Assessment of competence for practice through a range of OSCEs includes fourteen different stations that are set up as they would be in a clinical setting. There are trained assessors at each station. The OSCE assessors are experienced nurses who hold a postgraduate qualification and have been trained by RCSI as OSCE assessors.
It is important to note that there will always be some differences between countries regarding equipment and documentation used. Taking this into account, images are clearly shown on the RCSI website so candidates can take adequate time to prepare, including familiarising themselves with the equipment.
To support the applicants coming from different countries, there is an in-depth reference list, based on best international evidence, on the RCSI webpage. The references, updated as needed, strongly support the stations used in the assessment of practical competence. It is important that applicants prepare well so that they demonstrate their competence by negotiating the OSCEs and the equipment used in a professional and proficient manner. This is an important Heath and Safety aspect of the test in the context of applicants demonstrating proficiency in the use of the equipment in a clinical setting. In relation to the pass rate over the past seven years, an average of 72% of applicants passed the practical part of the test at the first attempt. On the second attempt, an average of 85% of the applicants passed.
The candidate receives an invitation in excess of three months in advance of a test. The precise dates for the test are given in the invitation as this is a requirement to obtaining the first stage in the immigration process (Atypical Working Scheme Letter of Approval). There is a choice of 54 tests on the webpage for 2023 and a choice of 9 tests so far for Q1 of 2024. The candidate, in liaison with the prospective employer, chooses the test date. (further details in relation to the test are attached below for the Deputy’s information).
Briefing note on overseas applications for nurse/midwifery registration and associated RCSI Overseas Aptitude Test: I am advised that the RCSI frequently meet with key stakeholders, including Migrant Nurses Ireland, to discuss the aptitude test and to clarify matters regarding testing. That in my view is the appropriate forum, in the first instance, for any issues of concern to be raised and discussed. I have been advised that this engagement is continuing. Additionally, I am pleased to note that the Nursing and Midwifery Board of Ireland (NMBI), regularly meets with Migrant Nurses Ireland to discuss and support the registration of nurses and midwives coming from overseas to work in Ireland. I welcome the NMBIs prioritisation of this. Finally, I have asked the Nursing and Midwifery Policy Unit in my Department to meet with Migrant Nurses Ireland. I expect this meeting will take place in the next few weeks and I look forward to being briefed following this.All nurses and midwives who practice in Ireland must be registered on the Register of Nurses and Midwives which is maintained by the Regulator, the Nursing and Midwifery Board of Ireland (NMBI). Along with the professions of midwife, doctor, pharmacist and dentist, Registered General Nurse (RGN) is one of the five health professions falling within the scope of the EU’s automatic recognition system. The relevant legislation obliges member states to comply with minimum training standards - S.I. No. 8/2017 - European Union (Recognition of Professional Qualifications) Regulations 2017 refers. In Ireland, the NMBI has the duty to ensure compliance. It achieves this by setting down educational standards in legislation (NMBI Rules). Similarly to Irish-trained student nurses and midwives, overseas applicants must meet the minimum training standards as a precondition to achieving registration with NMBI.
Nurses and midwives who qualified outside Ireland and who are seeking registration with the NMBI are required firstly to complete a recognition of qualifications process. This involves the comparison, by the NMBI, of their qualifications with the Irish education standards and requirements. The outcome of this process may be a decision by the NMBI (a Decision Letter) to register the applicant; or to refuse such registration; or, as a pre-requisite to registration, to require the applicant to successfully complete a compensation measure, either an NMBI approved aptitude test or a period of adaptation and assessment in a hospital setting. Following receipt of their Decision Letter from the NMBI advising that a compensation measure must be successfully completed as a pre-requisite to registration, an applicant can consider applying for an aptitude test. Upon satisfactory receipt of an application to sit the aptitude test, an invitation is sent within one day.
The RCSI aptitude test commenced in December 2015 and almost 11,000 candidates from 54 Countries have taken the test to date. It comprises two parts. Part 1 is the theory test which must be successfully completed before Part 2 can be attempted. Part 2 is the practical test or OSCE (objective structured clinical examination). OSCE is acknowledged internationally as an assessment methodology that enables the applicant to demonstrate competence in a simulated practice setting, known as a station. Assessment of competence for practice through a range of OSCEs includes fourteen different stations that are set up as they would be in a clinical setting. There are trained assessors at each station. The OSCE assessors are experienced nurses who hold a postgraduate qualification and have been trained by RCSI as OSCE assessors.
The test has taken place over two days: Day 1 for the theory component and Day 2 for the practical component, with the venue for both parts of the test specified on the website. It is important to note that there will always be some differences between countries regarding equipment and documentation used. Taking this into account, images are clearly shown on the RCSI website so candidates can take adequate time to prepare, including familiarising themselves with the equipment. To support the applicants coming from different countries, there is an in-depth reference list, based on best international evidence, on the RCSI webpage. The references, updated as needed, strongly support the stations used in the assessment of practical competence. This is coupled with photographs of the equipment used at the OSCEs. It is important that applicants prepare well so that they demonstrate their competence by negotiating the OSCEs and the equipment used in a professional and proficient manner. In relation to the pass rate over the past seven years, an average of 72% of applicants passed the practical part of the test at the first attempt. On the second attempt, an average of 85% of the applicants passed.
The test is designed to assess clinical competence, based on objective testing through direct observation of student performances in simulated clinical scenarios. The OSCEs are based on the NMBI standards and requirements for Irish-trained general student nurses. The NMBI’s statutory role is to the protect the public in its dealings with nurses and midwives and to protect the integrity of the practice of the professions of nursing and midwifery. Maintaining a high level of scrutiny in the assessment of application’s potential suitability is an essential element of this protection.
The candidate receives an invitation in excess of three months in advance of a test. The precise dates for the test are given in the invitation as this is a requirement to obtaining the first stage in the immigration process (Atypical Working Scheme Letter of Approval). There is a choice of 54 tests on the webpage for 2023 and a choice of 9 tests so far for Q1 of 2024. The candidate, in liaison with the prospective employer, chooses the test date.
Two attempts are allowed for each of the theory and practical parts of the test. If an applicant fails the theory test at the first attempt, the test must be repeated in full. If an applicant fails the practical test at the first attempt, only the station or stations failed need to be repeated. The RCSI has informed my Department that there is no significant waiting time to repeat the test. The applicant should allow sufficient time to prepare for the second and final attempt and a minimum of two weeks is strongly recommended by the RCSI. An applicant may avail of a longer period for preparation if they wish. There is no cost to the applicant for a second attempt at either the theory or practical part of the test.
