In 2015, after 30 years in the NHS, I elected to take an executive clinical leadership post in the Middle East, aiming to seek a new challenge. Nursing has always been a passport to travel (Royal College of Nursing, 2024). For some, it is a permanent move, whereas for others it's an opportunity to see more of the world.
As a family, we elected for me to work away from home, leaving my wife (an NHS matron) and grown-up daughters behind. Regardless of your circumstances, deciding to work overseas is something that needs to be carefully considered, as the impact on the family dynamic cannot be overestimated. FaceTime is no replacement for normal day-to-day contact. My wife staying in the UK had its pros and cons, as living apart was challenging (especially during COVID-19), but it did provide a ‘safety parachute’ should things not work out. Plus, relocating a family adds a level of complexity to working overseas because it involves organising schools, familyappropriate housing and possibly a hiatus in your partner's career. I also had to consider the impact on elderly parents, accepting the potential inevitability of illness or death. This is an important consideration when working abroad, because getting back home in an emergency is not as simple as jumping in your car.
International jobs are commonly obtained via recruitment agencies, and a good agency will provide support through what, at first glance, appears to be an intimidating and complex process.
Applicants often underestimate the complexities of moving overseas and the processes required to obtain nurse registration in the new country. Although the employment requirements may differ between countries, a number are pretty universal. These include a transcription of your training (available from your university), a chest X-ray (for TB), confirmation of vaccinations, hepatitis B, C and HIV status, and copies of professional and marriage certificates. These will need to be attested by a notary as original copies, then typically sent to the Legalisation Office, part of the Foreign, Commonwealth & Development Office (Gov.uk, 2024), before being sent to the embassy of the employing country. The secret is patience, being organised and finding the location of your future home embassy.
As I had an initial 3-year contract, I registered as ‘non-domiciliary for tax’ with HMRC. Understanding tax and pension implications is highly recommended, as is considering obtaining critical illness insurance before leaving the UK.
My first few weeks in the Middle East were a whirlwind of well-organised processes, and it is fair to say that moving to the region was far easier for me than for someone moving to work in the UK. This is because the bulk of health professionals within the Middle East are expats.
My new employer had a comprehensive induction programme for newly hired nurses. This was a well-oiled machine, but may be a different experience in other countries. Settling into your new job will take some time as things will definitely be different. For the Middle East, at least 2 years of post-qualification experience is required prior to application. So expat nurses arrive with a degree of seniority and, as such, a UK-trained nurse may be surprised at the model of nursing used by their new employer, which may be based on a US model, centred on doctors' orders.
A couple of really important elements to consider are language, cultural differences and possibly the weather. For example, during my first visit to a barber, I ended up having my nose and ears waxed, purely due to miscommunication! Importantly, don't underestimate the impact of the weather. I was lucky because I arrived in November, which is the Gulf winter, where the daily temperatures were a pleasant +30°C, unlike the summer months where +50°C is a possibility. Colleagues who emigrated from the Middle East to Canada left in the +30°C sun only to arrive in −30°C snow, much to the amusement of their young children and the confusion of their dog.
Finally, if you are looking to work abroad for a short period, it's important to go with a plan and set yourself some objectives, even if the objective is only to have some fun and see the world.Whereas, if it's a ‘wholescale move’ (Coronel, 2023), you need to give it a good few years before truly stating you don't like it because, to quote Dorothy from the Wizard of Oz, ‘you are not in Kansas anymore’.