British Journal of Nursing - Regulation and support for international registrants practising at advanced level

Abstract

Sam Foster, Executive Director of Professional Practice, Nursing and Midwifery Council, reports on research that explored the views and experiences of overseas nurses with advanced practice qualifications working in the UK

When the Nursing and Midwifery Council (NMC) approved work to progress towards additional regulation for registrants working at an advanced practice (AP) level, it also committed to undertake research to understand any potential impacts of additional AP regulation for internationally educated nurses and midwives (IENMs) in the UK. This comprehensive research, which was commissioned from the Florence Nightingale Foundation (FNF), has now concluded and will be published this month.

The study shows that advanced nursing and midwifery talent is being lost within the health and social care systems, with two-thirds of IENMs reporting that their AP experience goes unrecognised. The full report includes responses from over 1500 IENMs and multiple focus groups, offering detailed insight into the experiences of IENMs at various stages of their AP journey in the UK, for example:

‘I have previously done a master's in nursing with modules in advanced leadership, advanced pathophysiology, research methods, curriculum design and documentation, dissertation, health assessment, and decision-making. Yet I am unable to use these as most advanced practice roles require a band experience and I have been unsuccessful in securing that so far. This is making me feel I am rusting away and not giving my best to patients and my trust.’

Nurse with an AP qualification obtained in the Philippines, working in London

The study also uncovered significant barriers for IENMs interested in practising at an advanced level, including financial constraints (70%), lack of knowledge about the pathway (61%) and workplace discrimination (23%).

However, it also found compelling evidence of success when the right support systems are in place. Among the IENMs who completed UK AP education, 66% reported positive experiences. The research identified several key enablers: strong employer support (cited by 82% of nursing and midwifery advanced practitioners who completed their education programmes), dedicated funding and flexible training routes).

Key findings

Two-thirds of IENMs reported that their UK employer does not recognise or only slightly recognises their AP skills

Over 60% of professionals with international AP qualifications described a lack of opportunities in the UK to maintain their skills

Knowledge among IENMs in the UK about becoming an advanced practitioner is generally low, with significant confusion over its definition and the access pathways

One-quarter of those interested in pursuing AP roles felt hindered in accessing this opportunity due to their visa or immigration status

Most IENMs who had gained an AP qualification in the UK reported positive experiences and equal access to training opportunities

Nearly one-quarter who became advanced practitioners experienced workplace discrimination and bias during their education programmes

Key enablers for those who accessed AP education or roles in the UK included employer support and funding, flexible training routes and programmes, and accreditation.

In discussions with the NMC, the report's author, Lisa Plotkin, Head of Policy and Influence at the FNF, said that, despite their valuable AP experience, many IENMs face challenges in having their skills recognised and gaining access to training and development opportunities. She pointed out that with the NHS increasingly relyin on international recruitment:

‘…it's crucial that any future regulation of advanced practice creates clear, accessible pathways that recognise and build upon the valuable expertise these professionals bring… supportive employers, flexible training routes, and proper recognition of prior learning consistently leads to successful outcomes.’

In light of the challenges, the study found stron support among IENMs (69%) for the NMC to take a stronger approach towards AP regulation The report recommends putting in place:

A consistent framework for assessin internationally acquired AP skills and experienc alongside flexible pathways to ensur international qualifications meet UK standard

Entry requirements for AP education programmes should focus on core competencie with a review of language proficienc requirements to ensure appropriateness

Improving the transparency of qualification routes, including timelines and costs

Mentorship programmes and support network should be implemented to support IENM during their education. Ongoing professiona development opportunities should be created to help them maintain and update their AP skills, with cultural competence incorporated in any future AP framework

Employer guidelines should be developed to improve the experience of workplac integration for international AP professional and the implementation of anti-discrimination policies in health and care settings