ADAPTATION INFORMATION |
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Overseas Nurses in the UK
Up until very recently there was a great shortage of qualified nurses in the UK (in both the NHS and the independent sector). There were two contributing factors; the age of the current nursing work force; and the fact that the UK was losing qualified nurses to other countries, notably the USA. Although Australia also now is seeking to recruit from the UK.
Ethical Recruitment
Nursing in the UK has historically been attractive to nurses from developing countries. Since the late 1990's This resulted in a drain on skilled healthcare workers from developing countries. This was considered to be such a significant problem in the UK and internationally that the Department of Health (DH) went as far as issuing a "Code of Practice for the international recruitment of healthcare professionals" (pdf download 95.2kb). The DH has a list of developing countries that the NHS, and any agencies that have signed up to this Code of Practice, must not actively recruit from.
More recently there has been a change in the financial management of the NHS with drastically reduced support from central government. The biggest cost across the NHS is the cost of staffing. Trusts across the UK are making huge cuts in the provision of planned and ongoing healthcare services. This has resulted in nursing redundancies and posts simply not being advertised along with a squeeze on the use of nursing agencies.
Band 5 and 6 Nurses removed from the Shortage Occupation List
The effect on overseas nursing applicants is, that outside of particualr specialities, nursing has been taken off of the "shortage occupation list". This means that employers with Band 5 and 6 nursing posts have to prove that they could not fill the vacancy from nurses already resident in the UK or nationals of the wider European Economic Area (EEA)
The RCN (The Royal College of Nursing), one of the main nursing unions, is currently campaigning against the "Deficit-inspired cost savings and the loss of NHS posts" including the affect on overseas nurses. For information about their "Keep nurses working: keep patients safe" campaign click here.
Overseas nurses on an existing contract will not be affected until their contract or visa become due for renewal. The DH state on their website "There are arrangements within the work permit rules to allow an employer to seek an extension of a work permit without needing to test the resident labour market. However, employers will not be able to recruit to a vacant post without first placing an advert within the UK."
Overseas Nursing Programme (ONP)
The Nursing & Midwifery Council (NMC) is the nursing registration body for the UK. The NMC is bringing in a new process to allow overseas nurses to have their nursing qualifications recognised so they are able to practice in the UK.
These changes will undoubtedly improve the quality of the adaptation training and supervised experience and bring to an end many of the less than satisfactory practices. In the short term, however, those changes are likely to make it more difficult for overseas nurses to register and may be seen by many in the independent sector as too complex.
The following case studies examine the implications of this situation for overseas nurses, particularly the impact of the changes being introduced by NMC; and looks at the potential benefits for Nursing Homes in providing supervised experience placements.
OVERSEAS NURSES WANTING TO REGISTER AND WORK IN UK
Nurses with an existing NMC Decision Letter
Nurses who have an existing decision letter need to be aware that they must complete their period of supervised experience by August 31 2006 if they want to avoid meeting the new requirements, which means that it is necessary to start your supervised experience programme by March 2006. This applies whatever the date of the decision letter.
NMC say in their decision letters that it is difficult to find placements for supervised experience. This has never been more so than at present!
Although it is still possible to get your registration through the old system the NMC advise that you should undertake an Overseas Nurses Programme - involving the 20 days of “Protected Learning”. That is good advice! It will give you a better understanding of the role and working environment of nurses in the UK. The disadvantage is that almost certainly you will have to pay for that training – NMC say that nurses should not have to pay ( the Nursing Home should pay) – but it has to be said that they are being unrealistic .Very few employers in the independent sector will pay for the training course. Many will pay the fees initially and allow the nurse to repay the fee over several months. No nursing Home should charge you for providing supervised experience placement.
Nurses getting their decision letters after September 1st 2005
All new decision letters will require overseas nurses to undertake the Overseas Nurses Programme which will have two components; 20 days of “protected learning” and for most (nearly all) nurses a period of supervised experience of 3-6 months ( in most cases it will take 6 months to complete).It will also be necessary to have taken the IELTS ( English language test) and have scored 6.5 in that test. That is quite a high standard (6.0 is the score required by universities to enter an undergraduate course).
You must ensure that you register with a university/higher education institute for your Overseas Nurses Programme. You may well have to attend the university for a number of days during your supervised experience period – probably one day per week. Sometimes, however, the taught programme will be delivered in the Home where you are working (or in a nearby Home). There are advantages in such an arrangement because it means the tutor will spend more time with you giving advice and support in your workplace.
A problem for many nurses will be how to achieve the required standard of English. There will be English language courses in your home country but your English language skills will improve much more quickly when you are living and working in the UK. One way to do that is to get a job as a Senior Carer or Senior Healthcare Assistant and work in that position for, perhaps , a year and then take your IELTS test before looking for a placement. You must be aware that it will still be difficult to find placements. If you want to follow this route you will find that there are a few agencies who will assist you in finding a job as a Senior Carer, help you arrange language training, and assist you to move on to a supervised placement. Some are also looking into the possibility of combining language training in your home country with teaching of part of the adaptation course. These are new ideas that are only just being developed but you should look out for these opportunities as they become available.
Things all Overseas Nurses should be aware of!!
Unless you are lucky enough to be offered a placement in an NHS hospital you will need to find a placement in an approved Nursing Home /private hospital. The important word here is approved. You must make sure that the Home where you are offered a placement for supervised experience is on the NMC approved list.
Unfortunately there have been too many cases of nurses being recruited with the promise of a supervised experience placement only to find the Home is not approved .
Be careful if you are offered a placement in Home on the basis that it is going to get approval to provide placements - in many cases it doesn` t get approved and you will be left working as Carer and having to try and find somewhere else for your placement.
You must also spend the whole of your supervised experience in the same Home - another device used by some employers is to have a nurses working in Homes which is not approved and then move them to an approved Home where they will be signed off from their supervised experience. This is not acceptable to NMC and if it is found that a nurse obtained their registration in this way it will be taken away.
Some agencies who recruit overseas nurses and some Homes who offer supervised placements do so on the basis that the nurse comes on a student visa for the period of the supervised experience. This is not an acceptable practice. Because you are on a student visa, you can work only 20 hours per week so you cannot get in the necessary “practice” and what happens in many cases is that the nurse works extra hours without pay. You should make sure that you have a Work Permit and are employed on a full time basis.
Not all Homes will be able to offer you a position as a Registered Nurse when you get your registration .That is not a big problem. You will be able to apply for many jobs that are vacant or in many cases the agency who recruited you should be able to find employment for you.
These are only some of the problems for overseas nurses coming to UK but if you get the right advice and assistance it will be a rewarding experience in all respects.
Nursing Homes Can Benefit from Providing Supervised Placements for Overseas Nurses!
Research shows that in Nursing Homes the average length of stay in a job for a nurse is about 6 years; and so a Nursing Home with 12 nurses is going to lose an average of 2 nurses per year.
Discussions with Nursing Homes shows that the cost of having to replace a nurse – including the cost of temporary agency staff, fee to a recruitment agency or advertising etc. - can be as much as £10,000.
For the Home with 12 nurses, therefore, the cost of replacing nurses could be £20,000 per year.
Some Homes have eliminated this cost by providing supervised experience placements for overseas nurses. The following case study shows how this worked for a Home who had not previously provided supervised experience placements and so had to start from scratch.
The first step was to have a mentor trained .The qualification chosen was City and Guilds NVQ 3 Mini-Award. The total cost was about £500 including the City and Guilds registration fee. Ideally a Home should have two mentors.
Having begun the training of a Mentor the educational audit can be arranged with a local university. In this case it was undertaken by a consultant on behalf of the university. The cost of an education audit is now about £1000.
Two overseas nurses were now recruited; they were selected from a number of CVs which were provided; all the nurses had been interviewed in their home country by a UK registered nurse. They were to be employed as Senior Healthcare Assistants (full time) during their supervised experience period and so work permits were required.
The Nursing Home’s only involvement in obtaining the work permits was to sign the necessary forms and provide copies of their care certificate, and confirmation of their audit - all the administration was done for them. The cost to the Nursing Home was £306 (£153 for each permit).All arrangements (including visa application and travel arrangements) from this point were undertaken by the consultants who advised and assisted them. Their next involvement, having been advised of the time the nurses were arriving, was to collect them from the airport. This Home provided accommodation on the premises for the nurses and charged a modest rent. In other cases Homes have found rented accommodation for the nurses.
During their period of supervised experience the nurses attended the local university for a taught adaptation course on one day per week for 15 weeks and in addition had 5 supervised study days which meets the requirements of the new NMC Overseas Nurses Programme. This Home arranged the rota so that the nurses attended the university on one of their days off – others more generously have treated it as a work day.
There was continuing support in managing the supervised experience period- with a complete pack of information including guidance for students, guidance for mentors including standard forms for assessing and recording competencies and a professional portfolio for the nurses to keep their own records.
Both nurses successfully completed their supervised experience. One was retained by the Home but they didn’t have a vacancy for the other one. She was placed by an agency who paid £1000 of the placement fee to the Nursing Home.
Some Homes undoubtedly have had bad experiences with overseas nurses, mainly language and cultural problems. Others see the whole process which involves getting an audit and providing mentorship, not to mention applying for work permits, as too time consuming and costly. As this study shows, by obtaining the right advice and assistance, it is possible to avoid these problems and turn it into a beneficial experience for all concerned.
