How Ireland Became One of the Most Migration Dependent Nursing Systems

A two decade study finds that Ireland has become heavily reliant on internationally trained nurses, with more than half of new entrants to the workforce coming from abroad between 2003 and 2022. Researchers warn that without expanding domestic training and improving retention, Ireland’s health system will remain vulnerable to global labour market shocks.

For decades, Irish nurses were known for leaving home to work in the United Kingdom, the United States and Australia. Today, the trend has reversed. Ireland has become one of the most dependent countries in the developed world on nurses trained abroad.

A major two-decade study by researchers at the Royal College of Surgeons in Ireland, including its School of Nursing and Midwifery and Graduate School of Healthcare Management, along with collaborators from Manipal College of Nursing in India, shows just how deep that reliance runs. Using data from the Nursing and Midwifery Board of Ireland and the Central Statistics Office, the researchers tracked changes in Ireland’s nursing workforce between 2003 and 2022.

Their findings reveal a clear shift: international recruitment is no longer a backup plan. It is now a core part of how Ireland keeps its health system functioning.

A Growing Health System, But Not Enough Local Nurses

Ireland’s demand for healthcare has risen steadily over the past 20 years. People are living longer, chronic illnesses are more common, and the population continues to grow. All of this increases the need for nurses in hospitals, care homes and community services.

But the number of Irish-trained nurses has not grown fast enough to meet this demand. Over the study period, more than half of all new nurses joining the Irish register were trained outside the country. By 2022, about half of practising nurses in Ireland had received their main qualification abroad.

While Ireland does produce around 1,500 nursing graduates each year, this has not been enough to close the gap. Compared to countries such as Norway, which has significantly expanded nursing education places in recent years, Ireland’s growth in training capacity has been modest.

The Rise of International Recruitment

International hiring has gone through waves. During the economic boom of the early 2000s, Ireland actively recruited nurses from countries such as India and the Philippines. The expansion of the European Union in 2004 also brought nurses from Eastern Europe.

Then the 2008 financial crisis changed everything. A public sector recruitment freeze made permanent jobs scarce. Many Irish nurses emigrated once again in search of stable work. International recruitment slowed, not because the need disappeared, but because hiring was restricted.

As the economy recovered, overseas recruitment picked up. EU-trained nurses surged in 2017, but their numbers later fell. In recent years, most new international recruits have come from outside the EU. In 2022, nearly two-thirds of new nurses joining the Irish register were trained in non-EU countries.

This pattern shows that Ireland increasingly depends on nurses from outside Europe to maintain staffing levels.

Keeping Pace With Population Growth

Even though the total number of nurses in Ireland has increased, the improvement has been modest when compared to population growth. Nurse-to-population ratios have stayed fairly stable over the last two decades.

This means the system has largely been keeping up, but not pulling ahead. When nurse numbers dip, international recruitment tends to rise the following year. In particular, the inflow of non-EU nurses has played a crucial role in preventing staffing levels from falling further.

The COVID-19 pandemic highlighted both the importance and fragility of the workforce. Emergency recruitment boosted numbers in 2020 and 2021. However, the stress and burnout experienced by nurses during the crisis also exposed weaknesses in retention and long-term planning.

The Challenge of Building a Sustainable Workforce

The study argues that relying heavily on migrant nurses may not be sustainable forever. Many of the countries supplying nurses to Ireland face their own shortages. Global competition for healthcare workers is increasing.

The real issue is not just about producing more nurses, but also about keeping them. Better working conditions, career progression opportunities and long-term workforce planning are essential. If newly qualified nurses continue to leave for better opportunities abroad, the cycle will repeat.

Researchers recommend expanding nursing education places, investing in training facilities and improving retention strategies. Workforce planning must be aligned with Ireland’s long-term health reforms and demographic changes.

Ireland’s health system has benefited greatly from internationally trained nurses. They are central to patient care across the country. But the study makes one message clear: without stronger domestic training and retention efforts, Ireland will remain vulnerable to global labour market shifts.

The country once known for exporting nurses now depends on importing them. The next challenge is ensuring that this reliance does not become a permanent weakness.