Having recently joined the Nursing and Midwifery Council (NMC) in my new role, I am confident that all the discussions that are central to our professional agenda are happening at the Council table. The NMC is not responsible for recruitment of professionals to the register – the Department of Health and Social Care (DHSC) has a code of practice for international recruitment to make sure employers recruit ethically. The NMC role is to make sure that people who meet the standards, and can join the register, do so quickly and safely. Although one of my development areas will be fully understanding the regulatory sector, to progress our professional agenda, I think that we have a Venn diagram with overlaps requiring joint working between the NMC, the DHSC, employers and the professionals on the register.
In 2022, the NMC highlighted a rise in the number of professionals joining the register for the first time, with almost half the nurses (23 444) having trained outside the UK. This equated to a 135% increase from the previous year's 9962 international joiners (NMC 2022a; 2022b).
The NMC is calling on health and care employers to fully support internationally trained professionals into UK practice and join with UK-trained nurses and midwives to create the most inclusive environment possible. One of the resources developed to support this is a new NMC workshop for professionals and employers, titled ‘Welcome to the UK Workforce’. This aims to:
- Prepare internationally recruited nurses and midwives for the cultural and ethical differences of working in the UK
- Set the tone for a positive regulatory relationship and raise awareness of the NMC's role
- Improve retention of internationally recruited nurses and midwives
- Reduce the number of NMC referrals of internationally recruited nurses and midwives.
This workshop is important, as identified in several emerging studies. NMC (2020) research, Ambitious for Change, found that professionals who are men and those who are Black are disproportionately referred into the NMC fitness-to-practise process by employers. Most of the professionals that the NMC spoke to said they thought that one or more of their diversity characteristics played a part in their referral from their employer and said an ‘insider/outsider’ culture left them feeling unsupported.
The University of Huddersfield has just published the results of an international nurse population analysis, the primary aim of which is to gain a deeper insight into international nurses' experience of recruitment, onboarding and starting careers within the NHS (Garside et al, 2023). In terms of some of the high-level demographics:
- 655 nurses from 33 countries, who were in their first 4 months of employment in England, responded to the survey
- Three-quarters of respondents were under the age of 36 years
- 78% had been qualified for more than 5 years and almost half (48%) for more than 10 years before migration to England
- Many respondents had previously worked in senior nursing positions and 62% had worked as a nurse in one or two different countries, mainly in the Middle East region.
Among the areas explored were motivation for migration, and how prepared colleagues felt to make the move to England. Integration into new cultures and environments was described as ‘sometimes difficult’, with some nurses feeling isolated, anxious and stressed.
Several themes emerged for consideration:
- Accommodation (after the initial employer-provided accommodation)
- Gaps in explanation of nursing routines, terminology, abbreviations, specialist equipment and complex processes
- Communication, including conversation speed, accents, abbreviations and local slang, were described as the main barriers.
The evidence will enable identification of the opportunities to strengthen local programmes. Specifically, I can see that, at local level, a more personalised approach would yield greater satisfaction, considering that 25% of respondents thought that their previous knowledge and experience were not recognised (Garside et al, 2023). Many were limited in choosing their specialty, finding that experienced international nurses were often recruited at the same pay level as new domestically trained nurses, leaving some international nurses feeling unsettled, dissatisfied and frustrated.
Although the study stated that for many support exceeded expectations, others experienced limited support, which was described as creating negative mental health outcomes such as ‘stress’, ‘depression’ and ‘anxiety’. Overall, the conclusions reflect that, professionally, we must not be complacent and must increase our focus on retention strategies to ensure international recruits can attain their migration motivation aspirations and establish a fulfilling life living and working in England.