Avoid the UK

[Jhurlow]

nternationally trained nurses may want to consider avoiding the UK unless you are desperate, have special connections, or long for a uniquely frustrating experience.

The people of the UK are wonderful and there is a profound nursing shortage here. However, the UK's Nursing and Midwifery Council (NMC) is costly and dysfunctional, especially when it comes to evaluating the skills of internationally trained nurses YET it has been confirmed to me by the UK's Professional Standards Authority that the NMC functions without any accountability to any other UK governing body. The UK's NMC can do and decide whatever it wants.

I have moved to the UK to follow my husband who was transferred for work. I successfully completed a complex and costly immigration process to become a UK resident.

1. However, the NMC has their own far less sophistocated Immigration process. They DO NOT recognize any information collected by the county's Immigration system.

2. If you are an experienced nurse (lots of hand washing) it may be difficult for you to obtain ink fingerprints. However, digital fingerprinting in the UK is only available for criminals, not for nurses needing to prove to the UK that they are not criminals

3. If you suffer extra cost or time waste due to an NMC related error or confusion, that is simply too bad. The NMC will never apologize or even state recognition that they may have done anything wrong. If they present a hoop for you to jump through, a hoop that you have paid significant monies for, and they move the hoop so you miss it then this is your fault and you must pay to try again. Regardless of how redundant this hoop may be, it MUST be jumped simply because the NMC says it must be jumped.

4. The final qualification exam is called an Objective Structured Clinical Exam (OSCE). This exam costs 992 GBP. Most US university trained nurses passed such an exam to graduate. Typically this involves performing skills which you were taught and that you practiced during your training. However, for the NMCs OSCE, the training materials show processes that are inconsistent with the testing scenario. This is particularly problematic for International applicants who've not learned the required procedure in the first place! Further, there is no opportunity to practice prior to being tested. If you fail the NMC will tell you how sorry they are and they will offer you an opportunity to pay another 992 GBP to retest. Some candidates have paid again and passed. The challenge is that the NMC can decide just what is required to pass. There is no recourse, even if you suspect favoritism, and the NMC can be very particular.

5. I was told that the best way for an international nurse to enter the UK system is to take a job as a base level Health Care Associate (HCA). This is minimum pay and may not be particularly satisfying work for master's prepared nurses, but this role is not yet NMC regulated and will provide access to their test practice stations. This is not what I would consider an International application process.

6. Lastly, UK nursing pay is low and capped in the UK while cost of living is quite high, especially in London. And safety is become a greater and greater issue. I have fought my way through NMC processes, standing up for my rights when I've felt I was wronged but my MP (now a key member of the governing parliament) and the Professional Standards Authority have simply redirected my concerns back to the NMC, an agency which must answer to no one. I have been left with the impression that the nursing profession is not respected here in the UK. Nursing in the UK is profoundly over regulated with little autonomy and even less practice sophistocation. In fact the NMC spends most of its government funding to discipline nurses who have successfully completed their NMC testing processes. (think about that)

Yes it is possible for internationally trained nurses to enter the UK system. But, please do think twice especially if you were trained and have been practicing in the US. Certainly the US has its problems, but US trained nurses are some of the best in the world and I do believe that nursing in the US offers more opportunity to our profession than any where else on this planet. If you are bored and looking for a nursing adventure, consider getting a masters or a PhD or moving to another state or opening your own business. But whatever you do, this nurse recommends that you try everything else first and try very hard to Avoid the UK!!

[skylark, BSN, RN]

What you say is pretty much true, but also applies to other countries as well!

When I was applying for my California license they sent me a form asking for my NCLEX results and there was also a space on the form for me to write my SSN.

Nowhere did it say to actually send my SSN card.

After weeks of unanswered phone calls and emails, my husband happened to be visiting Sacramento for work so he went by the nursing license office. They told him they needed to see the card, he emailed me and I scanned it to him so they saw it and then boom I got my license.

And yes the UK has a nursing shortage but it also has a funding shortage. the last 2 ERs I worked in have both closed down now. Recruitment largely takes place in Manila, via recruitment agencies. Many of us UK nurses have gone overseas as we are tired of working in hospitals that close down. I worked 25 years in the NHS but I only see jobs listed in the Manila agencies now and could not find a job back home if I wanted to.

[Jhurlow]

i'm happy your challenges were relatively straight forward and are now resolved. California is a lovely state.

Re UK Funding: The NMC chief executive just gave herself huge pay raise yet, as you state, ERs are closing down and nurses are overworked. Elders in my village complain about not receiving basic community health support and elder care options are sorely lacking in the UK. Not sure an NMC with accountability to no one, whose big boss gives herself a raise is truly focused solving UK healthcare challenges. I've been told there are no longer nurses running the NMC, perhaps this is the problem. Also been told that nurses are leaving NHS for Private work because Private pays more, yet NHS funds are what pay more for these Private nurses. This sounds nonsensical when basic NHS funding is dwindling!

As an experienced NP I would love to help the situation here but I can't afford another 992 GBP to take an OSCE test for which I cannot receive accurate guidance to study. I think UK nursing is in particularly sad shape right now. Just my opinion.

You have great opportunities as a US nurse. All the best to you!

[Phil-on-a-bike]

Short version: Unlike State Boards, the British NMC has a monopoly on the regulation of Registered Nurses & Midwives, and exhibits all the abuse-of-privilege an unchallenged monopoly engenders.

We'd be very well-advised to introduce Regional Boards.

As much detail as my lunch break allows, in no particular order:

The UK is a HUGE employer of overseas nurses.

Your personal experience sounds bloody awful and I have every sympathy, but the numbers say that overseas nursing staff make up a large proportion (9%) of our 308,000 NHS nurses, midwives & Health Visitors.

But that's only half the story - like the US, Britain also has private healthcare, and the private sector also recruits overseas nursing staff.

So - while unnecessarily complicated - it quite obviously IS eminently achievable.

Handwashing and fingerprints? Really?

So... before digital technology, when the police relied entirely on ink fingerprinting... could RNs - and other disciplines who practiced frequent handwashing - get away with criminal activity?

When I sat the US NCLEX, there were some overseas candidates there who had done little in the way of preparation - they came every year, checked the boxes, and waited for the day a combination of actual knowledge and random chance scraped them a pass mark. One candidate told me she was on her ninth trip.

Applying for the NCLEX was so cheap that it was worth their while to do this. Note: that doesn't excuse the outrageus 992 quid OSCE fee - but it does illustrate the other end of the scale.

"it has been confirmed to me by the UK's Professional Standards Authority that the NMC functions without any accountability to any other UK governing body"

But... the NMC IS answerable to the Professional Standards Comittee itself.

As for "other UK Governing bodies", the NMC is answerable to the Government's Health Select Comittee and to the UK Charities Commission.

(Yeah, I know... as if we're not giving them enough money - they're also eligible for charitable donations!)

Safety? Oh, puh-lease.

Even during the thirty-odd year duration of the IRA insurgency, Britain's murder rate never approached that of the USA.

That's right - Britain's had actual shooting wars that were not as dangerous as what the US calls 'peacetime'.

I started out in Accident & Emergency in central London. I did just over a year there.

I saw two - count 'em, two - GSWs. Most British nurses will never see one.

(I'm aware that I'm swimming against the tide here. The US will never lose the ironclad conviction that 'foreign'='dangerous' and 'American'='safe'.)

British HCA's do not get 'minimum wage'.

UK National living wage (the 'Minimum Wage' for the over-25) is $18,974 pa at current exchange rates.

HCA's are on NHS pay band 2 or 3, depending on their role.

Band 2: $19,984 pa, rising to $23,556 in annual increments.

Band 3: $22,013 - $25,755.

It's not great, but it's not minimum wage.

Then again... talking about the cost of living in London, but significantly neglecting to mention London Weighting or Inner London Allowance? Mm-hmm.

The NMC's board getting hefty pay rises is just lemon juice in the paper-cut, but it's got absolutely ZERO to do with UK nurse funding. It does not come out of the NHS funding stream at all.

What's next... right, the NMC 'not run by nurses'?

Rubbish. Seriously, this is another 'thirty seconds and google' thing.

Chair: Medical/academic background. Board: Three lay members: one with an academic, one with a financial, and one with a government ministerial background. Seven Nursing and midwifery members - backgrounds in Oncology, Mental health, Midwifery, Community Nursing, Nurse management, & Nurse Education.

Inefficient, entitled, self-serving, bureaucratic? Yes. Non-nursing? No.

Your greivance sounds valid to me, and I would heartily second your conclusions regarding the NMC.

But the obvious factual inaccuracies in your post don't really strengthen your case.

For what it's worth, I think the recruitment shortfall, EU nurses being dissuaded from coming to Britain due to uncertainty about their post-Brexit status, the difficulties faced by foreign nurses trying to come to Britain, and the discontinuation of government subsidy for British nurse training will lead to an utterly catastrophic UK nurse shortage circa 2020.

If you still want to come then, I'm sure they'll fly you first class.

Cheers,

Phil

[Jhurlow]

Hi Phil

It sounds like my post upset you. Im sorry. Didn't mean to

Firstly I'm happy to forward to you the email I received from the Professional Standards Authority 6 days ago stating 'the NMC is the regulator and is empowered in law to make its decisions as an independent body.'

Secondly, NMC application processes for non EU trained nurses changed very significantly in 2015. I wonder how many of the foreign nurses you know entered UK practice before then

There are several posts on this site from many international nursing applicants who agree with concerns about the profound shortcoming of NMC OSCE testing process.

Thirdly, ink will fill the creases of some fingerprints making them inconclusive evidence. I do think that the UK's lack of more sophisticated digital technology may put it at risk. Local or less sophisticated regulators may mistakenly accept evidence that they should not, though I must say that UK Immigration is very professional and efficient in their processes. The US FBI found my UK taken ink prints to be unacceptable. The US requires digital prints from nurses moving even from state to state. I could have easily obtained digital prints for NMC clearance before leaving the US, if I had known of the need. But the NMC had two different and undistinguished guidances on their website. I inadvertent followed the 'old' ones which guided international applicants before the recent changes in NMC regulation.

Lastly, I agree that the US is very unsafe. I am embarrassed by the gun use and by the president. I feel much safer living here in the UK. I just profoundly miss being able to work as a nurse we while living here

All my best to you and praise for the valuable work you do

Jenny

[Phil-on-a-bike]

Oops! Re-read my post in the light of your reply, and realized... yeah, I did come across a bit snippy. (My apologies, I didn't mean to.)

Fingers crossed that you find a workable resolution that lets you get back into practice without any more hassle.

Cheers,

Phil

[Jhurlow]

Please consider submitting your thoughts about the UK NMC at the link below. Parliament is examining the ongoing nursing shortage in the UK. Perhaps you can make a difference for UK nursing and for UK patients who need nurses. Jenny

You can a submission to the Health Select Committee before 12th October:

Nursing workforce inquiry - UK Parliament

[Phil-on-a-bike]

Duly noted - I hunched over the keyboard well into the evening on Wednesday writing an Individual Submission to the Committee.

Seven points:

* 2015 NHS pension changes (from 'highest salary' to 'career average') led directly to the en-masse retirement of our most experienced staff - this was widely predicted and could easily have been avoided if the pension changes had been rolled out progressively.

*The discontinuation of the bursary for nursing students makes it financially advantageous to choose almost any other career path in preference to nursing - the timing of this measure means that even if it were reversed immediately, we have already sufferred one vastly reduced intake of students, and will likely have another short intake before any remedial measure takes effect. This will result in a catastrophic shortage of RNs circa 2020/21.

*The NMCs OSCE fees are prohibitively high and a deterrent to overseas-qualified RNs. (I compared and contrasted with other nation's fee structures, including the USA's CGFNS & NCLEX fees, to illustrate that other nations are now far more attractive prospects for overseas-qualified RNs)

I pointed out that, unlike the previous system (Overseas-qualified RNs worked in a reduced capacity, at a reduced rate-of-pay, with support & supervision, for a probationary period, on completion of which their overseas licence was recognised) the NHS workforce gains no benefit from the OSCE system.

*Concern about the deterrent effect of uncertainty about the post-Brexit status of EU-qualified RNs working in Britain is a problem without any possible solution, insofar as a degree of uncertainty is bound to persist until after the post-Brexit situation solidifies, and no amount of Pre-Brexit reassurance will change that.

The Brexit timeline means that EU-qualified nurses seeking to work in the UK is likely to reach a low point at the same time as the numbers of UK-qualified RNs reaches its low point.

*Para-nursing disciplines such as Nursing assistants, Operating Department Practitioners and Assistant Practitioners will play a far larger part in hands-on clinical care, and because said disciplines are not registered, 'sign-off' accountability for their practice will devolve to nurses whose role will change to accomodate this. RNs are likely to become managers for teams of para-nursing carers who will perform the actual hands-on care.

I pointed out that the former system of two-tier nursing - State Enrolled Nurses and Registered Nurses - was superior to this, because it provided two tiers of registered, licenced practitioners, whist reflecting the reality that not all nursing care tasks require an RN to perform.

(I also pointed out that this efficient and serviceable system was dismantled by the unjustified and needless drive to academicize British Nursing.)

*Agency staff should be recognised for their contribution and not used as scapegoats for NHS Trust's failure to recruit and retain staff. At a time when zero-hours contract workers are being portrayed as exploited and deserving of protection, zero-hours contract workers in the health sector are portrayed as parasites.

Disingenuous hospital management bemoan the higher hourly rates of agency staff, while failing to mention the saving they make in not having to pay for holidays, maternity, study leave, sickness, benefits and pension contributions.

*The future of UK nursing is Scottish. The absence of tuition fees for Scottish students means that nursing remains a vastly more attractive career option in Scotland than it does in the rest of the UK.

The implications are that well-staffed Scots hospitals will find it easier than their staffing-crisis English, Welsh & Northern Irish counterparts to acheive high CQC ratings, meet targets (and secure the funding which accompanies that) attract top clinicians, research projects and to acheive 'Centre of Excellence' status.

That - in seven assorted nutshells - is what I submitted to the Enquiry Committee.

If anybody's got any petitions they want signing now's the time to ask, because it appears I'm in concientious mood and that won't last.

[Jhurlow]

Awesome Phil!! If we don't make our concerns heard then nothing will ever change for the better. Thank you for taking your valuable time to make your voice heard. I've submitted as well.

[GrumpyRN, NP]

Wow Phil, you have done your homework and put into words exactly what is (and going to be more and more) wrong with nursing in the UK.

As a Scottish nurse who retired on a final salary pension I can do nothing but agree with you.

[madeleine]

Phil, I'm sorry but I do not consider it 'unjustified and needless to academicise British nursing'.Do you really think that nursing is just mopping fevered brows and giving out bedpans? Surely it is better that nurses know why they are doing what they do, have in-depth knowledge of pharmacology/anatomy/physiology etc. Would you want other staff, eg. physio's, paramedics, doctors, etc to have some sort of low level apprenticeship type training - I think not. Nursing has changed a lot since I started training in 1971 and it has changed for the better.

If nursing wants to be recognised as a profession in its own right then the training must be degree level and higher.

[Phil-on-a-bike]

It was unjustified and unnecessary because... and this is not rocket science... those nurses who wanted to pursue an academic path already had access to further development.

There were already existing degree paths in nursing science. Most Trusts already offerred financial support and study leave for their staff.

The UKCC - as it was then - were 'addressing a problem' which didn't actually exist.

The drive to academicize British nursing took one entirely valid career option... and tried to make it the norm for the career development of all RN's.

In doing so, they managed to eradicate the State Enrolled Nurse discipline entirely - something that should have been entirely beyond their remit to decide.

It's not just my opinion that this was a retrograde step:

The re-introduction of non-RN para-nursing disciplines shows that the genuine, real-world need for clinically trained but sub-degree nursing staff still exists.

I thought it was horrifyingly obvious right from the get-go that the workplace gap left by the needless discontinuation of SE-nursing would have to be filled.

(Maybe I'm psychic...?)

Of course, the concern remains that AP's, ODA's etc are unregistered.

And the NMC stands ready to address that by floating ideas for registration of para-nursing staff!

At which point, the wheel will have turned full circle, and we will start looking elsewhere for new ways to flush the NHS budget down the macerator.

"Mopping fevered brows and giving out bedpans"? Really? Cheap shot, Madeline.

But let's turn it around: Do you really think all nurses need to be able to identify in which respects their clinical area satisfies Kolb's defined paradigm of the 'Behaviourally Complex Learning Environment'?

Yeah. That's going to heal a whole lot of venous ulcers.

But make no mistake - I was, and remain, firmly in favour of genuine advancement of Nursing as a profession.

In my opinion, however, academia was absolutely NOT the way to go.

I think the profession, and our patients, would have been much better served by a drive to advance clinical skills.

I'm happier working with nurses who may not be able to define levels of abstraction in interactions between concepts - but who are not baffled when confronted with a vacuum-dressing set-up.

Less nursing theorists - more nurse prescribers!

Thing is, though... clinical skills are hard.

Hard to perform effectively, requiring regular practice to stay effective, taught and evaluated by highly skilled and experienced practitioners, and with actual, serious clinical repercussions when they go wrong.

Who wants that, right?

I mean, sure 'nursing wants to be taken seriously as a profession', but only insofar as we can achieve it by going and sitting in a classroom.