Low pay, lack of career advancement and poor working conditions are among the reasons nurses have left or are leaving Trinidad and Tobago to seek employment abroad.
Last weekend, the Sunday Express interviewed three nurses by phone who left to work in the United States and the United Kingdom. All three secured their positions through agencies and said it was more affordable and efficient that way.
‘EASIER TO TRANSITION ROLES IN UK’: Former NWRHA psychiatric nurse Darius Mollineau.
In the first interview, former North West Regional Health Authority (NWRHA) psychiatric nurse Darius Mollineau said the lack of professional growth was mainly what compelled him to leave T&T for the United Kingdom.
He said before leaving Trinidad, he was trained as a District Health Visitor but had been acting in the post for three years. It was only after he migrated in 2021 that the position was offered as a permanent role to someone else, but by then it was too late, he said.
Mollineau said he was most troubled by colleagues holding acting positions for up to nine years without being confirmed in the position.
He said: “I was like, I’m not going to be in that position for that time. Even though it’s not me, I don’t want to be that guy, five, six years down the road, I am still acting!”
He noted that in his current job at a hospital near Birmingham, England, he had become a manager and moved up the ranks within three years, “which is something that you would never see happening in Trinidad”.
While admitting that the training and experience he gained while working at the NWRHA played a significant role in his advancement and development, he pointed out that in the UK it was easier to transition into roles such as nursing assessor or prescriber, with more accessible opportunities available.
Better salaries needed
Asked if he would return to Trinidad and Tobago, Mollineau said he would like to, but first needed to see improvements in nurses’ salaries.
He said it was a shame that since he left in 2021, nurses were still being paid on a 2013 salary scale.
‘So, I’ve left for five years now and the issue is still there. So, that will be one of the issues. If the salary is made what it should be for nurses, that might be an incentive to come back,” Mollineau said, adding that he has experienced racism many times while working in the UK, but his salary makes up for the disrespect he signed up for.
He argued that in Trinidad and Tobago, nurses were not valued by patients and visitors to hospitals, and they earn far less.
Another change he said was necessary before he would consider returning home was greater professional development for nurses.
He explained that in the UK, nurses are required every three years to complete specific clinical experience and training to continue practising.
Financial stability
Meanwhile, former South West Regional Health Authority (SWRHA) nurse Marcia Baptiste, who worked in Trinidad for 17 years, said her decision to migrate in 2023 was influenced by the need for better employment opportunities, financial stability, and a desire to experience another healthcare system. She now works at a hospital in New York.
Explaining her decision from a financial perspective, she said: “It was like you get pay and money finish. So, I was looking for more financial stability. So, I think making a decision to come here would have helped my situation.”
Apart from higher salaries, Baptiste said working conditions were better in New York. However, she noted that the 30-minute lunch break in New York was a downside, compared to the one-hour break at the SWRHA.
However, Baptiste pointed out that in New York City nurses a few months ago had also engaged in industrial action. She was referring to a strike in January where about 15,000 nurses across three New York hospitals walked off the job demanding safe staff-to-patient ratios, healthcare benefits and workplace violence protections. Baptiste noted that there were indeed similarities, but reinforced that at the same time for her it was easier to advance professionally in New York.
“Not like Trinidad where you had to go through a lot of red tape. Once you have your certification you can move up the ladder very quickly in the US,” she added
As a single parent with two children, she admitted the transition was initially challenging.
She said before moving to New York, in a predominantly “white state”, her qualifications were sometimes questioned because of her skin colour.
“They would ask, ‘is she competent enough to take care of me’?”
Baptiste said the stigma and negative perceptions nurses encountered in Trinidad mirrored the racism nurses experienced in the United States.
She noted that specialisation certifications are partially funded in New York and said she plans to pursue qualification in chemotherapy administration.
She pointed out that nurses in Trinidad have more limited skills compared to their counterparts abroad, where advanced training is more common and easier to attain.
“Really and truly, nurses are in control here (New York) unlike back home, you rely on doctors. Nurses have a lot of autonomy here and that is a big difference. Nurses here have every single skill. If you are certified to do it, then you do it,” Baptiste said, adding: “The hospital will teach you to do it.”
She also noted nurses can become nurse practitioners and prescribe medication. According to online sources: “A nurse practitioner (NP) is an advanced practice registered nurse (APRN) who has completed Master’s or doctoral-level education to provide comprehensive healthcare, including diagnosing and treating acute/chronic conditions, ordering tests, and prescribing medication. NPs act as primary or specialty care providers, focusing on health promotion and disease prevention with full practice authority in many regions.”
According to Baptiste, in New York and by extension the United States: “You do not really see doctors here except (when) there is a real emergency. It is nurse-led.”
Asked if she would return home, Baptiste said: “I am a Trinidadian and I will like to return home, but in a managerial role. As I told you, that was one of the reasons I left. To see the differences in healthcare. I will be coming back.”
However, she too stressed that inadequate pay would discourage her return if it does not reflect her skills and specialisations.
Asked whether she would encourage others to seek work abroad, Baptiste said while she does not support brain drain, she would encourage younger nurses to gain experience outside of Trinidad and Tobago.
“So, come out, gain the exposure, and you can go back home and impart that knowledge to others,” she said.
Nepotism and favouritism
Another former North Central Regional Health Authority (NCRHA) nurse, who asked to remain anonymous and is now seeking employment in the United States after working in the UK, said she left Trinidad one year after graduating from the University of the Southern Caribbean (USC) around 2019.
Some of the reasons she gave for seeking employment outside T&T were the challenge of gaining permanent employment at the different RHAs, and what she called a culture of nepotism and favouritism.
She explained that the ability to gain employment did not come down to credentials, “so, whether you have a Bachelor over someone with an associate degree, that did not matter. What mattered was who you know”.
The woman, now married and seeking employment at a hospital in the southwest United States, said what bothered her about the NCRHA was the fact that the management always complained that more staff was needed, but at the same time was also insisting there were no vacancies.
She said after a wait she was offered a contract, but lamented it was for ten months.
Describing her early nursing experience in Trinidad as daunting, she said: “One of the things that just turned me off was that when I went to the wards, it was like one or two nurses working and I was a fresh nurse and there was no support system for me to lean on. As a new nurse, certain things, even if you had done it as a student nurse, you still had someone watching over you and guiding you. Now you were solely responsible for the decisions you made as a nurse.”
She said in her first two days at the hospital it was just herself and two other nurses. She recalled: “On my third or fourth day, I found myself on the night shift and I was going to be working alone.” She pointed out that she had asked about it, and they said sometimes you might find two nurses working but if they are short, they can move one to another place.”
Pointing out that she was on a cardiac ward, she admitted that reality scared her “and I actually gave up the position”.
By comparison, she said in the UK as well as in the US there are four to six patients under the care of one nurse.
Asked if she would return to T&T, she said she would not, citing crime as one of her main concerns.
She advised nurses to take the opportunity to work abroad as it is one of the best opportunities they could give to themselves. Using herself as an example, she said: “Next year, by God’s grace, I am going to do my nurse practitioner programme. In Trinidad that would not have been possible and then when you try to do higher education programme in Trinidad, let’s say you try to go for your Master’s or PhD or something, sometimes you do not find management facilitative.”
