A £5m campaign aimed at attracting more than 600 overseas nurses to Northern Ireland to plug a staffing crisis has "failed", a union has warned - as thousands are staff are expected to be balloted on unprecedented strike action.
Department of Health officials have admitted their pledge to have 622 recruits in post by next March has become "increasingly challenging", saying a "revised assumption" would be November 2020.
Figures obtained by The Irish News shows that less than a third (198) have been employed to work across the north's health trusts since the drive began in 2016.
Italy, Greece, Romania, India and the Philippines were among the countries visited by health service staff as well as private recruitment agencies.
The agencies received a £1.4m cut of the overall £4.9m spend and it understood concerns have been raised privately about the spiralling bill.
It comes at a time of unprecedented nursing shortages - there are 2,600 unfilled jobs - and a nursing trade union threatening strike action for the first time in its history over pay and "unsafe" staffing levels.
The Royal College of Nursing (RCN) will today hold an extraordinary board meeting where it is expected it will decide to ballot thousands of members.
It is understand staff could take to the picket lines in late September.
The union has been involved pay negotiations with senior civil servants at the Department of Health to bring members' wages into line with their NHS counterparts.
Deputy director Garrett Martin told The Irish News: "To put it in simple terms, why would a nurse from another country, who has decided to come and work in the UK, move to Northern Ireland when they can earn anything up to £2,000 per year more by choosing to move to Scotland, England or Wales?"
“In October 2017, the RCN questioned the cost-effectiveness of this international recruitment campaign and warned that it was doomed to failure unless measures were taken to ensure that Northern Ireland was perceived internationally as an attractive destination.
"Since then, the number of vacancies has almost doubled and the attendant pressures on the nursing workforce have compounded significantly. Our political system is stagnant and the negative impact of the prospect of Brexit looms over attempts to recruit internationally, as figures published by the nursing regulator demonstrate."
Mr Martin said urgent action is required by the department.
"It gives the RCN no pleasure to say 'we told you so' but the figures obtained by The Irish News graphically illustrate the failure of this campaign and the lack of return on a significant investment of public money.
"The Department of Health, as a matter of urgency, needs to address the underlying causes of the nurse staffing crisis, including pay, in order to be in a position to recruit the nurses that are so desperately needed here."
A spokeswoman for the department confirmed that "as at July 1 2019", there had been 302 "arrivals" from EU and non-EE countries since the campaign started. However, of that total, only 198 are currently registered and can work legally in Northern Ireland health trusts.
She added that 64 (of the 302 individuals) are working as healthcare assistants - which are significantly lower paid posts - until they complete full registration.
The Department of Health spokeswoman also said: "The target remains of achieving a figure of 622 arrivals in Northern Ireland by 31 March 2020.
"This is becoming increasingly challenging and our revised assumption is that we will achieve the 622 figure, but by November 2020 instead of March, under current market assumptions.
"In the meantime, we are still working within our agency framework to attain the 622 figure by the original date of March 2020, by for example, examining engagement with our reserve supplier and also refining processes with the existing supplier."
The department confirmed that a total of £4.94m has been spent to date on the campaign - with a £3.55m bill for training while £1.39m "has been paid to agencies".
Last May department health chiefs insisted the campaign was "on course" to succeed, despite meeting just 15 per cent of its target at that point.
This is the second time the department has launched an overseas nursing campaign in the past 15 years. The last one took place in the early 2000s and was largely successful, attracting many nurses from the Philippines and India.