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We are fortunate to have Philippines nurse Chester write for us about his transition from the Philippines to Australia including the who, what, when, where and why’s of his journey. Chester goes into the step-by-step process involved for someone keen to nurse in Australia! He currently works in Tasmania in a busy public hospital ICU.
Introduction
Hi, I’m Chester! I am an Internationally Qualified Nurse working in the beautiful state of Tasmania! I am here to share my journey as an internationally qualified and trained nurse — hopefully to inspire my fellow overseas nurses and help other colleagues to understand our journey to be part of the Australian Health Service.
I have been a nurse for more than 10 years now. I completed my Bachelor of Science in Nursing way back in 2008 in a state university from my home country, the Philippines. I passed my Nursing Board examination right after my graduation and started to do my post-grad training in a tertiary hospital. I have always dreamt of working in Emergency and Critical Care Units – probably influenced by the tv series and movies I usually watched before, seeing how doctors and nurses respond to emergencies and saving people’s lives.
Luckily, I was able to get a chance to do my two years of paid work in the Philippines working in these units- Neonatal, Paediatric, Surgical and Medical ICUs, PACU and even in ED. This earned me the foundation of what I have on hand and brain. One day, I thought to further hone my skills and seek for better renumeration, I then decided to work in the Middle East – in the Kingdom of Saudi Arabia.
Saudi Arabia – a very unique country….and conservative. The best part of working there: it was tax-free, so you can literally have all the money you have worked for! Apart from that, I was not wrong that I can further enhance my clinical skills and knowledge. I worked in a JCI-Accredited private tertiary hospital as an Intensive Care Unit Nurse for 5 years.
I became a Senior ICU Nurse and had the opportunity to hold the roles of a Clinical Resource Nurse – who oversees the competency, skills and education of the staff in their units and a Quality Improvement Facilitator – one who assists nursing leaders to conduct quality improvement activities.
After few years, I realised that I am ready to work in more exciting, less conservative and challenging environment and thought of where I can better raise my own family. I initially planned to apply for USA and Canada (which most of the Nurses in the Philippines would prefer to work and settle, I think!) but that didn’t end up well and I ended up going back home. After some months of hiatus, I heard the opportunity to be an Internationally Qualified Nurse (IQN) in Australia from a friend and my journey to the Down Under started.
Why Australia?
Honestly, I didn’t know much about Australia. What I knew was Sydney is the capital city, but I was even wrong! I did my research to understand how I will be a qualified nurse in the famous Down Under. Apparently, it’s a long process and would definitely needs lots of effort and patience (and enough money), which genuinely I did! So why Australia?!
- “Australia is a travel spot and has a laidback lifestyle” – that’s what you would usually hear and read in the internet! Indeed! It’s one of the best destinations in the world! Travel and life experience here are incomparable from the countries I’ve worked and I enjoyed what I saw, learned and experienced in the past five years…. and still exploring! I arrived in Brisbane in 2017 and I’m kind of not have to adjust much to the environment as the tropical vibe is almost the same as the Philippines.
- Australia has a huge demand for Nurses across all specialities and pay rates are some of the best in the world. As an outcome of the high demand for nurses and effect of an ageing population, there is security in jobs. Benefits are also highly regarded and of course, who would not be awed to the Employer Funded Retirement Program.
- Aside from having modern facilities of major health employers, Australia has one of the highest standards of nursing in the world!
- Lastly, my eligibility to become a Permanent Resident.
So there, to summarise, I decided to come to work and live in Australia to experience a better life and to have a good work-life balance.
How to become a Nurse in Australia when you’re from overseas?
I find it really complicated before on what options I have to choose in order for Australia to recognise my qualifications overseas and be a Registered Nurse. In this section, I will try to explain it brief and simple.
Long before, Australia has been accepting overseas nurses through the Bridging Program. This program is a program study approved by the NMBA that enables overseas nurses and midwives to qualify under the provision of the National Law by completing a 3- or 6-month course. By completing and passing the program, you will be able to fully meet the requirements of registration. The referral of Bridging programs has ended following the introduction and launching of the new assessment model back in March 2020. By the way, Bridging Program is very expensive!
If you are from overseas and haven’t completed any qualification, the only way to become a nurse is to complete an NMBA Approved study program of a Diploma (1.5 years for EN) and Bachelor (3 years for RN) as an International Student. If you are an overseas nurse or completed a qualification overseas and in to less-stressful process, you can do a Bachelor or Masters – Graduate entry program. This is a 2-year course which many Australian Universities offer. Admission requirements apply such as English Tests or Financial Capability.
The good thing about this pathway is you will be eligible for Post-Graduate Temporary Visa and can work full time for 2-3 years. Another popular option is the Conversion Program for Nursing. Many Australian universities also offer a one-year program for overseas nurses. After completing the program, you will be eligible for registration. The only thing about Conversion is that you are not eligible for post study visas. Also, Admission Requirements apply.
How did you become a Registered Nurse in Australia?
Aside from the options I have talked about previously, I will discuss about the new assessment model for Internationally Qualified Nurses/Midwives. So Yes, I completed this new assessment model and made me eligible to become a Registered Nurse in Australia – it is called the Outcome-Based Assessment (OBA) Model. Actually, I am one of the first group of candidates to complete the assessment model and qualify to be a RN.
In March 2020, NMBA transitioned to this assessment model for overseas nurses who hold a qualification that is relevant but not considerably equivalent to an Australian qualification and thus replacing the Bridging Program. The main aim of OBA is to assess both your cognitive and behavioural skills. So here is the step by step process I did:
Self-Check and Portfolio
Before anything else, you have to do a self-check through the AHPRA website. All Internationally Qualified Nurses/Midwives (IQNM) must submit their qualification in this stage. You then will be advised to which stream you must complete. There are 3 streams:
- Stream A – a qualification that is substantially equivalent – which means you may not need to do the cognitive and behavioural assessment and may register straight away.Stream B – a qualification that is relevant but not substantially equivalent – this is where I was sitting, having a qualification but not equivalent to Australian qualification thus needing to undergo the OBA. Stream B – do not hold a relevant qualification – this means you need to complete an approved study program in Australia in order to qualify and able to register as a Nurse/Midwife.
There is no fee to use the Self Check. For me under Stream B, after Self-Checking, I was directed to pay a specific amount for assessment fee (640 AUD at that time). Once paid, you will have access to the Orientation Part 1, this is an online learning course that talks about introduction to Australia and Australian Healthcare context. After this, they will require you to complete your Portfolio – you just have to provide the details of qualification and identification and documentation.
The OBA – (MCQ and OSCE)
Once AHPRA completes the assessment of your qualifications, you will be contacted on what next steps you need to do. As I was in Stream B, the first advice was to take my computer-based exam or the Multiple-Choice Question (MCQ) Exam or better known as NCLEX. Yes, AHPRA has chosen this platform to assess the IQNMs professional knowledge. You will need to pay fees (total of 350 USD). You might wonder how I prepared for this exam, I subscribed to a review platform called Uworld – it’s a perfect program as it is as close as how the NCLEX questions are formulated.
After few days, I was contacted again by AHPRA that I passed the NCLEX and can proceed to OSCE (Objective Structured Clinical Exam). OSCE is a clinical exam to assess your behavioural skills, meaning – how you demonstrate your knowledge, clinical skills and competence as expected to a graduate-level nurse in Australia. I paid 4,000 AUD to be able to secure a slot for the exam. Due to the pandemic, exam dates kept on changing in 2020 and I was only able to sit the exam on February 2021.
The exam was very difficult, I must admit. I was assessed based on practical and communication skills, including Medication Calculation & administration, ANTT, Risk Management in Clinical Setting, Wound Management, Vital Signs, Infection Control, BLS, etc. I completed the 10 stations, and you will have to 10-minutes time to finish – 2 minute for reading time and 8 minutes for the performance. The patients involved in the exam are either an actor or a manikin and each station have an RN OSCE Examiner who will be there to observe you.
The exam is only held in Adelaide, South Australia at University of Adelaide – Adelaide Health Simulation. As I am bound to maintain the confidentiality of the examination content and processes – all important information is in the AHPRA website. In order to pass the OSCE, you will be required to pass at least 7 out of the 10 stations.
Fortunately, I passed all the stations! Yoohoo! If you’ll ask me if I had to enrol in review programs, I simply didn’t. My reason was that, no one literally knew the exam contents and processes as we are the first examinees. I just had an extensive reading of the resources that AHPRA provided, a little bit of YouTube clips and did some demonstrations alone in my room and it worked!
The Registration
It took 6 weeks for me to wait for the result of the exam and so on March 19, 2021, I received the very good news of passing the OSCE and then eligible to register as a professional nurse! The registration application form is made available in the dashboard of your AHPRA Account after 1-3 business days after receiving the positive result of your OSCE.
As to registration, the following information and documentations are needed: official documentation of your qualification, Proof of Identity, Statement of Service or Employment certificates in the last 5 years, a signed detailed CV, Proof of Language Skills (in my case, I have done the PTE), Payment of Application and Registration Fees, Certificate of Good Standing from every jurisdiction outside Australia where you practised as a Nurse and Criminal Check.
It took me almost two months to complete the process of registration and by May 15, 2021, I became full fledge RN in Australia! Once registered, you will have to do the Part 2 Orientation – another online course that details a more in-depth introduction to Australia and its healthcare system.
What did you do next when you became an AU RN?
Starting to become a Registered Nurse in a new environment is always difficult and speaking for myself, it was a bit of challenge to start in the Australian healthcare setting, especially to a person like me who’s:
1) English is my second language
2) Studied with a different Curriculum and,
3) With nursing practices/experience more patterned to that of the USA. But that didn’t stop me from moving forward!
I applied to different hospitals in Queensland but had no luck and the next thing I did is to move interstate and started working in Rural and Remote Area.
Luckily, I was able to land a job in a district hospital in Westcoast, Tasmania. I truly appreciate the trust of my managers and giving me opportunities to work in the ED, Aged Care and Acute ward. I had the chance to work as an Acting Clinical Nurse Consultant for 3 months too!
Working in rural and remote is exciting! I learned to introduce myself to the Australian healthcare setting step by step. And as months passed by, I again saw myself confidently responding to emergencies, getting familiar with policies, procedures, pathways and protocols, managing patients, took all the opportunities to learn new things, etc. – these all resulted from the desire to not give up on my goals!
After 9 months working in Westcoast District Hospital, I felt the desire to step up and work in bigger hospital then gambled if I can go back working in ICU again. I applied in Launceston General Hospital – ICU and fortunately, I was accepted! As to this day whilst writing this article, I already completed my two-weeks of orientation period.
I am again in a new environment and yes, it is again challenging! But you can’t do wrong when you know/understand what you’re doing, right? So, condition your mind that learning is always fun! Thankful to have very supportive colleagues and mentors too!
What do you think are the misconceptions about International Nurses?
There was a time when I assumed the post as the Acting Clinical Nurse Consultant, a colleague told me sarcastically, “do you even know the scope of your post?”. So there, one of the issues I think is that sometimes, others think of us as less capable. We are all different, yes. But for most of us nurses, if not all, do not accept responsibilities which we think we can’t stand to.
Please don’t think that International Nurses are less educated. We also completed a 3 or 4-year university degree, may it be in a different language or standards, Nursing Principles are the same world-wide and if there maybe practices that are different of how it was taught to us, I am sure that we all want to learn and understand them too.
Lastly, we didn’t come here to steal jobs. Australia is openly accepting IQNMs to fill the gaps in the workforce. We are here to help, and we appreciate your help in return.
What was your greatest fear when you started working as AU RN?
To be honest, I feared of not being competent to work in a hospital setting. It has been more than 4 years when I went back to work in a clinical area, and I thought I’ve lost my clinical skills. The secret ingredient to confidently go back is the desire to learn and open for constructive criticisms from your mentors.
What were the big challenges transitioning?
I arrived in Australia back in 2017 as an International Student, my initial plan was to study a vocational course and when the time is right, I will enrol for the Bridging Program to qualify as a Registered Nurse. It was then the time that we had financial issues in the family, and so I set aside the plan of doing the Bridging Program. From 2017-2019, I ended up completing 3 vocational courses and had multiple jobs – I worked as an AIN in Aged Care Facility, a support worker in a Disability Service Provider and a cleaner in a Child Care Centre at night.
It was also the time that AHPRA is planning to replace the Bridging Program to a new assessment model, so the Bridging Program was on its highest demand as many IQNMs are rushing to be accepted by schools and the fees skyrocketed too! I was on the lowest point of my life and felt so hopeless to become a RN in Australia. But hey, there is always a bright side! I convinced myself to wait for the new assessment model and here I am now, a full fledge. You just have to wait for the right time!
Finances were a big issue for me back then, I was still adjusting to the way of life different from how I was raised. I was lucky that in 2019, I was hired to work as a Quality Management Officer in a disability company- this helped me a lot of my finances. Being away from family and loved ones is a thing you will need to handle every day too. I was away from my family for 2 years and was able to go back to Philippines before the pandemic hit then came back and then being away again for two years as I wasn’t able to visit them due to travel restrictions.
When COVID hit, it was again a test. My visa was about to expire, and I haven’t completed my OBA. It was a blessing that the government made a visa available to those affected by the pandemic, aka COVID Visa (408 Visa). This allowed me to stay in Australia and work in the critical sector. Within this time, I managed to work and completed OBA.
What are the challenges of working in an Australian ICU?
A lot. But here’s what I think are the major ones:
- Working in an unfamiliar environment – I felt really anxious in my first day as how I can adapt working to an environment that feels familiar to me yet a new space to learn. Good thing is LGH-ICU orientation period is exceptional, you have the full support of all staff especially the Clinical Nurse Educators.
- Expectation to People- We all have been there, the stress of expecting what type of people we have to deal and work with. In addition, employed in a multi-language or multicultural environment may not only be challenging for us but also for the Australian staff who often not aware about our own cultural backgrounds. It is significant that these issues be discussed during your orientation periods.
- Patients’ Cases and Procedures– there is huge difference of procedures and patients’ cases from where I worked before. There are lots of protocols and pathways that are new to me. But again, day by day – you just have to learn and digest them.
- Equipment- It could be funny to some, but yes there are big differences of the types of equipment in where I am working now compared to my previous workplaces. This gives you some stress but the only solution is to ASK and BE HONEST when you don’t know how to use one.
What is your advice to future Internationally Qualified Nurses and Midwives?
Hi future IQNMs! Some of these may not be appropriate for you but these pieces of advice are based from my personal experience chasing my goal to be an AU RN.
- You may feel it’s hard to fit in especially in your new workplace or if you’re new to a country (especially for nurses coming from a non-English speaking countries like me),– that’s NORMAL, but it actually depends on how you deal with this challenge and how you build your self-confidence. It’s achieved by your desire to LEARN. You just have to be open minded and as part of your learning, expect constructive criticisms.
- Even how much experienced we are, know that you are in a different part of the world to practice nursing. In saying that – you need to follow the standards set by Australia for Nursing Practice. It’s important to know the professional codes and guidelines especially the Standards of Practice. Part of this is learning and respecting cultural differences.
- Gear up and be prepared. It is very important to be ready and being ready means, you must know the processes and steps of the things that you want to pursue. Expect some difficulties and sometimes, failures on the way. But gear yourself up with a plan, we nurses are good at making effective plans!
- Celebrate small successes. When we accomplish a small objective, buy yourself a good meal or a beer, treat yourself to a movie house or pamper yourself to whichever you like. I often do this as this gets me more excited to pursue my next step or plan.
- Lastly, embrace challenges. They make us grow!
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