The Interim NHS People Plan (NHS England et al, 2019) dedicates a chapter to tackling the nursing crisis, citing shortages in nursing as ‘the single biggest and most urgent we need to address’. The multifaceted strategy to close the gap identifies the need to reach a supply balance for nursing that meets the demands of health and care services, centred on a domestically grown workforce. However, it recognises that, given the lead times for training nurses, in the short to medium term we need to increase international recruitment of nurses to the UK.
I have just returned from Kerala in Southern India. This was the third time that my Trust has been to recruit nurses in this region and, while NHS England and NHS Improvement and Healthcare Education England advance plans to co-ordinate system recruitment, and develop a national procurement framework and toolkit, I wanted to share my views and reflections on the trip.
I was keen to join our recruitment team, to gain an understanding of the culture that existing and future colleagues come from. We interviewed over 4 days, sharing talks and videos from the Trust prior to our panel interviews.
We found that, in contrast to previous years, our applicants came to interview having already passed their prerequisite English language testing, and many had also completed their computer-based tests (CBT) required by the Nursing and Midwifery Council (NMC). The 250 applicants interviewed fell essentially into three groups: newly qualified graduates, nurses who had 5-15 years of experience, and nurses who had been working in the Middle East for a number of years.
The interviews were fascinating, with candidates sharing their pride in the ‘noble’ profession of nursing. In addition, from the known culture of care towards one's own family, there was a strong theme that nursing was nursing, wherever it was delivered.
Many of the questions asked by candidates related to OSCE (objective structured clinical examination) preparation, questions around the opportunities for professional development and the options for families to come to the UK to live.
In terms of organisational readiness, my trust has been building an international nursing workforce for the past decade, predominantly recruiting nurses from India and the Philippines. We have also recruited nurses from other nations including USA, Nigeria, South Africa, Kenya and the Caribbean, through interviews over Skype.
Support programme
Our support programme commences at the nurse's arrival in the Trust where they are settled into their hospital accommodation and provided with a welcome pack. The following day a welcome morning is held where ward leaders and mentors have the opportunity to meet with nurses who have been through the support programme, who come and speak openly offering advice and support on how they adapted to life in the UK. We have a dedicated overseas nurses programme team, which has developed an intense but supportive programme that initially runs over 6 weeks to support the nurses to pass their OSCE.
Challenges faced by our overseas nurses largely relate to adapting to the NHS, UK weather and culture, passing the NMC test of competence and, of course, homesickness and longer term accommodation. We have just launched an international nurses group run by a small team of UK and international nurses, providing a source of ongoing pastoral support and advice, to ensure that the feeling of being part of the team continues long after the initial support phase.
While out in Kerala, we visited two hospitals. At a large hospital and school of nursing we spent most of the day visiting wards and conversing with the Director of Nursing—despite the heat, there was a feeling of familiarity, in our observations and discussions around the challenges facing the profession. We also visited a smaller hospital in the city, which was run by a Catholic charity. Both institutions operated at around 80% occupancy, and did not have urgent care or flow issues due to the family-centred approach to care. Nursing ratios were largely similar to the UK, as were the approaches to harm reduction, infection control, patient safety and patient experience.
Politically, there are agreements with the Indian Government to continue our recruitment plans in India. Many of the nurses interviewed were working on a voluntary basis, because there were no jobs for them, and both institutions had increased their pre-registration intake, providing jobs for faculty, and increased income for the schools of nursing.
It was an amazing experience to be part of the recruitment team. I have no concerns regarding the technical ability of our new colleagues. We will be reviewing both the academic and the pastoral support that we provide, to enable our colleagues to practice at their best. We will also need to review at which pay point we assimilate our colleagues to after, say, 12 months to ensure that we recognise their experience, and we will undertake this in collaboration with our existing and new overseas colleagues, and our mentors and ward leaders.