Along with a glut of doctors, Spain has an excess of qualified nurses. According to an article in the Costa Blanca News in September 2004, there are around 15,000 qualified nurses in the Valencian Community alone, and a third of those are unemployed, which is why many of them travel abroad to work.
The Spanish health service is generally excellent, health professionals are highly trained and the latest technology is available in most major hospitals.
Spain has a public health system, and anyone who contributes to the social security system receives free or low cost healthcare. Where it differs from healthcare systems in northern Europe and the US is in terms of aftercare. The Spanish health service assumes that patients have relatives and friends willing to care for them after an operation or when they become elderly or sick, which means that opportunities for nursing Spanish people are limited.
On the other hand, many expatriates, who have left family and friends behind at home, find themselves needing nursing care after an operation or when they become less mobile because of old age or illness – care that they may not be able to obtain in Spain. If you’re planning to use your nursing qualifications in Spain, you should therefore look for an area with a large expatriate population – preferably retired people – particularly if your language skills aren’t up to working in the Spanish health service.
There are nursing agencies in coastal areas, which can place English-speaking nurses to provide post-operative care and ongoing nursing assistance to expatriates. They should interview you and check your qualifications in your home country and arrange recognition of those qualifications in Spain before placing you. Agencies aren’t always easy to find, as few advertise. Medical centres and recruitment agencies may have details of local nursing agencies, which may be listed in local newspapers or the English-language press. There are online directories of agencies in certain areas, e.g. www.gomarbella.com on the Costa del Sol.
The manager of a nursing agency of long standing on the Costa del Sol said that there’s considerable demand for qualified and caring nurses: “Caring is the operative word here. It’s important to remember that most of our nursing is done in the patient’s home and patients are often old and infirm. Our nurses must be flexible and adapt to the patient’s needs. Professionalism is vital, but it isn’t like working on a hospital ward; we offer a far less clinical service.” It’s a service that’s popular with patients. The agency has been in business for 16 years and has never needed to advertise. The manager advises any nurse thinking of coming to work in Spain to do lots of research and to begin by working as part of a team, rather than going it alone. “You need the support of a medical centre or an agency so that you have other health professionals who can help if you have a problem.”
Nursing can be a precarious way to make a living in Spain and you must be prepared to do plenty of networking, advertise your services and generally sell yourself. One nurse who works on the Costa del Sol said that the most important piece of advice for those who might want to do the same is to learn Spanish: “We may be on the Costa del Sol,” she said, “and of course you can get by without learning the language, but if you really want to do a good job, you need to be able to communicate with both Spanish patients and Spanish professionals. I do have a few Spanish patients, but I cannot talk to them at the level
I’d like to. That’s vital in the medical profession and something you take for granted in your home country. I’m working very hard to learn the language. I know I will get far more professional satisfaction when I’m able to communicate with my patients on more than a superficial level.”
If you’re a nurse or a specialist nurse (which includes midwives) your qualifications will be automatically recognised under the EU’s Sectoral Directive system. However, many nurses and midwives had problems with the recognition process and so that it was difficult and unnecessarily complicated. As one British midwife, who’s practising in southern Spain, put it: “We may be used to Spanish doctors and nurses in the UK, but the authorities here have very little experience of English medical practitioners.” Problems may arise if you completed your training before the EU Directives were put in place. This happened to one experienced community midwife, who had to go back to her training school to track down a copy of the original course syllabus, which had to be translated and submitted with all her other paperwork.
The Royal College of Nursing (RCN) and the Nursing and Midwifery Council (NMC) in the UK both have international sections which may be able to help with advice about recognition of qualifications. The professional association in Spain is the Spanish Nurses’ Association ( Organización Colegial de Enfermería ). The website is only in Spanish but includes a list of the colegios throughout the country, so that you can contact your nearest one to apply for registration.
Although Spain currently has an excess of doctors and nurses, it has a shortage of midwives. Community midwives, who look after women throughout their pregnancy, don’t exist in Spain. Midwives work exclusively in the labour ward and in a few health centres offering ante-natal care. Pregnancy is generally treated as a medical condition and so obstetric care tends to be medically orientated from day one. Women are referred to an obstetrician, who’s usually male, and there’s no professionally trained woman who can answer all their questions. Giving birth is generally a more clinical process than in some other European countries, with very few home births and hardly any ‘natural’ births.
In coastal areas of Spain, the expatriate population is getting younger and more women from other European countries are having babies there. Consequently, there’s a demand for the same style of ante- and post-natal care and birthing methods that they’ve been used to in their home country. Liz Arthur, an experienced midwife who came to the Costa del Sol in 2001, offers her services to both expatriate and Spanish women and has an agreement with a hospital in Marbella, where she has created a birth centre environment, which gives women a choice about where they give birth and a more familiar style of care, whichever type of birth they have.
However, the agreement with the hospital was only achieved after a tremendous amount of hard work on Liz’s part and with the help of a Spanish consultant obstetrician and gynaecologist who works with her. Liz says that the fact that he trained in the UK and so understands both the Spanish and the British systems helps tremendously: “It has been an uphill struggle, but it’s slowly starting to pay off. My first homebirth in Spain was in a fourth floor flat in Malaga. The patient spoke no English and I spoke very little Spanish, but we got there. She was grateful that my skills enabled her to have the home birth she wanted and I felt privileged to be there. Since that first delivery, I’ve come a long way. I’m getting positive feedback from both the home and the hospital deliveries I’ve done with Spanish and expatriate women. I feel at last as if I’m achieving what I set out to do – complement the service that’s already here.”
Liz’s achievements are significant in that they were the result of persistence, hard work and extensive research, without which you won’t go far in any business in Spain.
Liz decided to go it alone, but by her own admission, it was tough going. If you’re a trained midwife, you may find it easier, certainly at the beginning, to work in a medical centre in an area with a large expatriate population. You will make valuable contacts and have the support network of other health professionals around you. Liz’s advice to those thinking of working in Spain is to research, research, research and don’t expect Spain, even the tourist areas, to be like your home country with extra sun: “I would urge anyone to make sure their professional standards are of the highest quality. Keep up your registration with your professional body in your home country. In the UK, that requires a certain amount of practical work and post-graduate training, so that you keep up to date with what’s new. Finally, wherever you choose to work, you will need to speak Spanish and forget everything you ever took for granted at home. All in all, it’s an enormous struggle to work in Spain, especially as a midwife, but I’ve found it very rewarding.”
The qualifications required for midwifery and the registration procedure are the same as for nursing – in theory. Liz Arthur describes the frustrations of trying to do things ‘by the book’: “I had to get a verification certificate from the NMC in the UK. It had to be translated into Spanish by an official translator and then stamped by the town hall closest to the area in Spain that I was planning to practise in. Then I had to go to the Department of Education and Science in Malaga to fill in an application form and everything was sent off to Madrid. The problem was that it took six months for Madrid to approve it, by which time the original verification certificate from the UK was out of date and I had to start the process all over again. I ended up making three applications and the final one had to be stamped by a UK solicitor and then sent to the Foreign Office in London for further validation. Then I could finally register with the colegio here in Spain. The whole process took 18 months. It was the proverbial nightmare.” Liz’s experiences make it clear that validation of qualifications doesn’t always go smoothly and that Spanish government departments can be rather arbitrary about their requirements.
This article is an extract from Making a Living in Spain. Click here to get a copy now.