US RN moving to London UK

yam, BSN, RN · Aug 20, 2019

I cannot thank you enough for such a great and thorough response! I've spent loads of time searching for and reading blogs, forums, ect to gain a better insight on nursing in/moving to the UK, and yours was the most helpful.

You answered many questions I had, including scope of practice. I've watched videos where junior doctors are apparently ones who start IV's in the UK (perhaps generalized, but the video made it seem for common cases), but I couldn't imagine our docs in the states doing that for general pts unless they had to. I think critical thinking is one of the beauties and expectations of nursing in the states . I´ve contemplated the idea of moving to the UK for too long and have been wanting to move to Europe since studying abroad in 2014.

As a volunteer working full time for free for 8 months I can say money isn't the most important thing to me, but it seems like despite making less money it is above the minimal wage and enough to live comfortably. As far as agency, it's awesome that you knew exactly where you wanted to be! I was thinking perhaps London or Bristol, so once I do some research and gather more info I'll be reaching out to the agency.

I've been away from clinical nursing for over a yr and look forward to jump back into it. I'm glad you are a having a positive experience and can recommend it!

Best regards,

Yamilet

kaitfinder, BSN, RN · Aug 21, 2019

7 hours ago, yamilet said:
@kaitfinder,
I cannot thank you enough for such a great and thorough response! I've spent loads of time searching for and reading blogs, forums, ect to gain a better insight on nursing in/moving to the UK, and yours was the most helpful.
You answered many questions I had, including scope of practice. I've watched videos where junior doctors are apparently ones who start IV's in the UK (perhaps generalized, but the video made it seem for common cases), but I couldn't imagine our docs in the states doing that for general pts unless they had to. I think critical thinking is one of the beauties and expectations of nursing in the states . I´ve contemplated the idea of moving to the UK for too long and have been wanting to move to Europe since studying abroad in 2014.
As a volunteer working full time for free for 8 months I can say money isn't the most important thing to me, but it seems like despite making less money it is above the minimal wage and enough to live comfortably. As far as agency, it's awesome that you knew exactly where you wanted to be! I was thinking perhaps London or Bristol, so once I do some research and gather more info I'll be reaching out to the agency.
I've been away from clinical nursing for over a yr and look forward to jump back into it. I'm glad you are a having a positive experience and can recommend it!
Best regards,
Yamilet

@yamilet

Yea the info available is minimal and outdated at best. I found it unbelievably frustrating during my process, so I'm glad I can shed some light on it from the other end. It is also difficult to find USA -> UK nursing info as most nurses go the other way around lol

As far as scope of practice, it's as I've said before and doctors do take more of a role in performing skills than I was used to. Where I worked, you didn't call a doctor to place an IV because the nurse was the most skilled at placing them; we even were receiving training for ultrasound-guided IV placement. You only called a doctor if you needed a central line or sometimes an IJ (some states don't legally consider this within the scope of practice for an RN). Here, nurses mostly put them in if you work in a higher acuity area like A&E (ED), ICU, etc. but otherwise it seems doctors place them. To be fair, this is similar to my experience with American ward nursing as nurses on wards rarely placed IVs and usually called an IV team, ED nurse, or junior doctor to place them. So not much different from my personal experience, but you may have a different perspective. Nurses aren't allowed to do ABGs here either, so doctors will be called for that as well. VBGs are extremely common and done by nurses.

UK nursing does emphasize critical thinking (and is absolutely expected in higher acuity areas) but they focus more on identifying poor presentation and quickly notifying the doctors rather than necessarily expecting the nurse to know what's going. From what I can understand, UK nursing programs are more and more de-clinicalizing (losing as much emphasis on anatomy and physiology, pharmacology, pathophysiology, etc and placing more emphasis on social care, "patient centered care" etc), much to the frustration, I am finding, of most nursing students that I see on my unit. It seems possible they are doing this in an effort to squeeze out more nurses, possibly by lowering the difficulty threshold, due to the nursing shortage. Not sure if this is actually the case since they state it's as a result of trying to make it more of a degree-based program (???), but there you have it. Frustrating because from my experience, the NHS is staffed by about 50% foreign (EU or outside EU) nurses who pretty much all base their nursing standards of practice and nursing programs on American guidelines. Remains to be seen how the NHS will fair post-Brexit purely from the standpoint of many of my fellow EU nurse coworkers are choosing to return to their home countries.

Nursing in the UK is definitely above minimum wage, just not by as much as I was used to in the US. You can also make more money - if you apply for a more advanced nursing position. You don't make more money based on your years of experience, only if you move up in Band (here's a link that briefly describes the way pay works in the NHS https://www.healthstaffrecruitment.co.uk/news/different-nhs-nursing-bands-scales/ )

To be honest, anywhere in the south of England is a good choice. The NHS is better funded in the south, there are more resources/advanced hospitals, and the weather is better. London is good, but cost of living is higher there as well. Up to you to decide what you prefer: bigger city life with higher cost of living and only slightly higher pay, or vice versa.

One other thing about agencies: try to find one that gives you the most benefits with the hospitals they represent. You want to find one that offers to pay for OSCe and visa, mine also paid for my flight over and the first 3 months of housing. Feel free to branch out to several and see what they can offer you; much like job hunting anywhere else, it's good to have options. I can't see them turning you down because they desperately need nurses and love American nurses so as long as your qualifications are good and your interview/references are good, you should be fine. They focus heavily on "patient centered care" here so make sure you prepare for your interviews with that in mind.

-Kaitlyn

canadian.j, MSN, RN, NP · Aug 30, 2019

On 8/20/2019 at 1:41 AM, kaitfinder said:
Hey @yamilet ! No problem, I don't mind the questions!
Some things I have learned about working for the NHS from a USA-prepared nurse perspective:
The NHS is short staffed. Likely more short staffed than the USA. However, nursing is short staffed pretty much the world over, indicated by the fact that many countries include nursing on a short list of occupations that will easily earn you a work visa since they're needed so badly (https://www.gov.uk/guidance/immigration-rules/immigration-rules-appendix-k-shortage-occupation-list here's the list for the UK, in case you're curious, just scroll to table 1). Pretty much every area of nursing in the UK is short staffed, but some are worse than others. Truthfully, it doesn't feel that much worse off than my experience in the US. I work in a major hospital in Emergency care.
The NHS does pay its nurses less than most countries; you can get paid significantly more if you work in a nursing home that is privatized or private hospital, but any sort of acute hospital nursing is not really available in private facilities and those patients will often get transferred to NHS run hospitals for acute management, so it depends on your personal interest. There are public health/community nurses in the UK and they do an extensive amount of work, but as I work in the hospital I have minimal knowledge/understanding for how that type of nursing is and how it compares to my (limited) understanding of community nursing in America. Many hospitals have a bank/pool system where you can pick up "short" shifts that the hospital releases and will pay an increased hourly rate to fill need for, so there is some opportunity to make more money if you need to.
The short staffing is at times frustrating, but I find myself in situations where we are short staffed to the point where it causes a detriment to my ability to function as a nurse minimal, and roughly at the same amount as I did in America.
What I do find frustrating is the scope of practice for nurses in the UK is below that of most other countries (many countries in the EU base their nursing programs and guidelines on American guidelines and nursing standards of practice, whereas the UK writes their own). Nurses in the UK are more social care than they are clinical; bear in mind that I work in Emergency and thus am used to a higher degree of clinical scope and management than a general ward/unit nurse. From what I have seen, ward nursing appears to be roughly the same in the UK as in America, with the exception that nurses in the UK are ubiquitously not trained or expected to use a stethoscope and generally are expected to be less clinically prepared/knowledgeable. I find this very frustrating but other USA nurses do not always feel the same.
Personally, however, I do find it easier to work for the NHS/UK in general as the healthcare system is public and thus accessible to all patients regardless of income or ability to pay, something I have much respect for. Social care and community care is far more advanced and managed better than in the USA, as the NHS has a vested interest in spending as little money as possible. They accomplish this in part by focusing on primary care and care at home, in an attempt to prevent patients from having to come to the hospital in the first place, and thus GPs, social workers, home health care, nursing homes, etc. have significant support systems in place to help manage their load. Perhaps this is just the area I work in (Oxford) but I get the impression this is a nationwide motivation. CT scans cost more than regular GP visits and packages of care.
My timeline for coming to the UK is roughly thus:
May-June-ish 2018: research/looking for job opportunities and travel agencies
June-July 2018: applying to nursing agencies and interviewing/sending resume and rough credentials (I knew I wanted to work at a specific hospital in Oxford so this made my search easier since I knew where to look). July, after pre-screening and interviews with the agency they passed my information on to the hospital recruiting team where I interviewed via Skype with the hospital I currently work at. I was offered a position a few days later and signed a preliminary contract of employment. Then, I took the CBT (if I had failed the CBT more than a few times or was unable to pass, my contract would be void).
August 2018: gathering documents to send to UK Visas & Immigration to apply for my visa, as well as receiving Certificate of Sponsorship from the hospital I work for. My hospital also paid for my visa application ($780 I believe?) and the Immigration Health Surcharge fee (£200 per year of the visa, work visas are 3 years so £600). From what I understand most hospitals will pay these fees but will not pay for CBT ($120? I forget).
September 2018: visa applied for, documents sent, etc.
December 2018: I had an issue with my visa where they forgot/lost some documents and took about 2 months longer than the maximum wait time to get me my visa; it was originaly planned to arrive October 2018. Visa arrived sometime December and I flew out at the end of December to start work January 6th. My hospital also paid for my one way ticket over.
January 2019: work start, hospital mandated training for OSCE, very minimal attendance in a clinical area until the end of training.
February 17 2019: pass OSCE, PIN received some days later, precepting for a few more days and then independent from there.
The agency I went through was very good so I don't mind recommending them. I worked with NEU Professionals. From what I can tell, they service a variety of different areas, mostly in the south of England, but you can see where on their website under the "existing and historic trusts" tab. There are any number of agencies out there and it will make it easier to find them if you narrow down where in the country you'd like to work (a specific city, or area of the country like, southern, northern, etc.). I highly recommend going through an agency as they were very helpful with securing an interview with the hospital (and the hospital is likely more amenable to hiring through a trusted agency rather than someone who approaches them blind) and imperative to me filling out my visa paperwork and liasing with the hospital recruitment team. I wouldn't really advise not using an agency, but that's up to you. None of the agencies expect anything from you compensation-wise and they shouldn't require a commitment time either. The hospital will understandably require a commitment of time to them but that makes sense. If an agency is requesting you pay for their services or dedicate a certain amount of time to working through htem, I would recommend you find another agency as most agencies likely make money by getting paid a finder's fee by the hospitals they refer to.
Overall I would say it's a good experience to work in another country, but it is different. I wouldn't recommend putting off regular nursing as your skills get rusty with time. Feel free to ask any other questions you have!
-Kaitlyn

Hey Kaitlyn!! @kaitfinder

Do you mind if I ask you a quick question - how long did it take for you to complete your application with NMC, with sending all the supporting documentation from your nursing university, etc. over to them? I've passed my CBT and now in the process of this, however I'm finding that my uni is taking 4-6 weeks to send documents, then I'll have to wait for NMC to review and let me know if they're willing to license me. I just feel that this is a never ended waiting game!

-Jenna

onemoreday, BSN, RN · Sep 3, 2019

I am following this thread closely because I will be moving to the UK from the US in about a year and a half! But I'll be coming as a new grad ?

My spouse was offered a US government job in Suffolk and they'll be moving there this week. I had already gotten into nursing school... so I'm finishing my schooling here. I didn't want to put off my degree even more (I already had, for a few years) and figured I could get better work with an RN-BSN than my CNA certificate.

thanks @kaitfinder for your super thorough response and timeline. Hope you keep us updated @jenna_m with your progress.

kaitfinder, BSN, RN · Sep 9, 2019

Hey @jenna_m!

Uhhh yeah the process of sending all the documents to the NMC is a HUGE pain, if only because, like you, getting the documents from my university and state board of nursing (I was only licensed in Georgia, so luckily only had to get them to send the documents to the NMC, but if you've worked in multiple states or held a nursing license in multiple states, they will need documentation from EACH board of nursing in each state). It definitely took me several months and a lot of emails and calls to stay on top of my university about it. My board of nursing was pretty good about getting things done and I included my contact info in case they had any questions, but it was never an issue and I could call them from time to time to see where they were in the process. It might have taken 2-3 weeks I guess? But I'm not sure as I don't know exactly when they completed everything.

My university took WAY longer, but they also completely forgot about my stuff and I had to go down there in person several times to bother them about it (I was doing this during the off season [summer] but luckily I still lived in Atlanta where I went to nursing school so I could actually go to the school itself if I needed to). They completely lost my first set of documentation and so it took maybe 4-5 weeks for them. Then it takes maybe a week or two to get the documents TO the NMC by mail, and have them processed and entered in the system. You can check the status of your NMC application online and I think you can also call them to see which paper documents they've received. I think they also send you an email when they've received anything and what else they need? Definitely call the NMC if you have any questions, they're very good.

You still need to complete the OSCE so you won't find a complete answer from them, and you'll need to bring the originals of several documents (birth certificate, school of nursing diploma, nursing license, etc.) after you complete your OSCE for them to confirm with the documents you've sent them. Also, my board of nursing (Georgia) doesn't provide an actual official Nursing License paper? You can check the status online and print a paper one yourself from online, but there's no official piece of original documentation that's sent to you, and the NMC was unhappy about that but every state does it differently so if you don't have something like that, don't worry, they'll just check to make sure that doesn't actually exist and it won't be a problem.

Start early rather than later, keep hounding and keep track of who still needs to provide what documents and don't be afraid to call them about it, because people WILL forget and it can get lost. It's a waiting game, but don't get discouraged! Good luck!

Hey @onemoreday!

You're correct in that you're more likely to get a job as an RN than a CNA! Learn a lot in school and start asking around for jobs now to see if they'd be willing to hire new grads in the UK! They didn't used to (requiring 1-2yrs minimum experience) however that's changing and some places are starting to offer new grad international programs that are worth investigating.

KDRN1212, BSN, RN · Sep 13, 2019

I just wanted to say thank you @kaitfinder for your helpful information! I am in the process of moving from the US to the UK, and started with taking the CBT in May, getting hired for a job in London in August...and STILL waiting on the NMC to issue my decision letter! Feels like I’ve been waiting so long, and constantly chasing people down for the documents I need! One of my issues was not having a license card from the state I live in (Missouri) as they don’t issue actual cards, but verification reports instead. I’ve explained this to my assessment officer, who I have yet to hear from, which started making me nervous!

It’s jusy really encouraging to hear from someone who’s been through this and successfully transferred and started working there, as there’s not a lot of information out there on this process! So just wanted to say thank you for sharing!

kaitfinder, BSN, RN · Sep 13, 2019

@KDRN1212 Hey! Yeah, it's definitely frustrating with the NMC. They didn't take umbridge with not having an actual certificate because the GA board of nursing issues a document but you just print it out from online and they wanted an official piece of documentation, which Georgia doesn't issue. It will be fine and they will accept it, as long as there isn't an actual piece of official documentation. Basically, it's the equivalent of only having a digital certificate for your degree. They want to see the actual certificate, but if it doesn't exist, they'll accept the digital printed version. They delayed my OSCE results while they researched it to ensure Georgia's board of nursing didn't offer such a document, but otherwise gave me no issues. The issue just stems from the fact that SOME states do offer genuine certificates, and others don't. You'll get there eventually! They can't reject you just because your state's board of nursing doesn't offer that type of documentation.

Also, no problem! It was really frustrating for me and I was operating in the dark most of the time, so I'm happy to help!

-Kaitlyn

Kara Flowers, BSN, MSN, RN · Oct 18, 2019

Hello all! I’ve been working on this process for a little over a year now. And like many of you have found it unclear and frustrating! I just got my decision letter last month. I’ve completely struck out on finding a job or a good agency to work with. I’m at the point I’m considering giving it up as a bad job. ?‍♀️ I’m an L&D nurse and I think that might be the problem. I’ve had agencies drop me like a hot potato when they find that out! The agencies suggest I apply directly to the hospitals and the hospitals say use an agency. ?I had thought with the shortage, they’d still be willing to work with me as many of my skills, such as surgical nursing, would transfer over. I’ve also taught first year nursing students. Anybody have any thoughts or ideas for me on getting a job/sponsorship/visa? tIA!

Silverdragon102, BSN · Oct 18, 2019

1 hour ago, Kara Flowers said:
Hello all! I’ve been working on this process for a little over a year now. And like many of you have found it unclear and frustrating! I just got my decision letter last month. I’ve completely struck out on finding a job or a good agency to work with. I’m at the point I’m considering giving it up as a bad job. ?‍♀️ I’m an L&D nurse and I think that might be the problem. I’ve had agencies drop me like a hot potato when they find that out! The agencies suggest I apply directly to the hospitals and the hospitals say use an agency. ?I had thought with the shortage, they’d still be willing to work with me as many of my skills, such as surgical nursing, would transfer over. I’ve also taught first year nursing students. Anybody have any thoughts or ideas for me on getting a job/sponsorship/visa? tIA!

The UK uses midwives so I would suggest checking jobs.nhs.uk out there are hospitals that hire direct. I guess a lot may depend on where you want to live and work

UkboundRN · Oct 18, 2019

4 hours ago, Kara Flowers said:
Hello all! I’ve been working on this process for a little over a year now. And like many of you have found it unclear and frustrating! I just got my decision letter last month. I’ve completely struck out on finding a job or a good agency to work with. I’m at the point I’m considering giving it up as a bad job. ?‍♀️ I’m an L&D nurse and I think that might be the problem. I’ve had agencies drop me like a hot potato when they find that out! The agencies suggest I apply directly to the hospitals and the hospitals say use an agency. ?I had thought with the shortage, they’d still be willing to work with me as many of my skills, such as surgical nursing, would transfer over. I’ve also taught first year nursing students. Anybody have any thoughts or ideas for me on getting a job/sponsorship/visa? tIA!

Are you a labor and delivery nurse or learning and disability nurse. This will determine where to apply to. Most nhs will take a midwife but apply for a mental health nurse role if learning and disability

Kara Flowers, BSN, MSN, RN · Oct 20, 2019

Thanks for your replies. I’m a labor and delivery nurse. I knew the UK uses midwives and I’m not qualified as a midwife. I took the Adult Nursing CBT. It seems like this is sadly not going to work for me. ?

app22 · Apr 17, 2020

On 9/12/2019 at 9:50 PM, kaitfinder said:
@KDRN1212 Hey! Yeah, it's definitely frustrating with the NMC. They didn't take umbridge with not having an actual certificate because the GA board of nursing issues a document but you just print it out from online and they wanted an official piece of documentation, which Georgia doesn't issue. It will be fine and they will accept it, as long as there isn't an actual piece of official documentation. Basically, it's the equivalent of only having a digital certificate for your degree. They want to see the actual certificate, but if it doesn't exist, they'll accept the digital printed version. They delayed my OSCE results while they researched it to ensure Georgia's board of nursing didn't offer such a document, but otherwise gave me no issues. The issue just stems from the fact that SOME states do offer genuine certificates, and others don't. You'll get there eventually! They can't reject you just because your state's board of nursing doesn't offer that type of documentation.
Also, no problem! It was really frustrating for me and I was operating in the dark most of the time, so I'm happy to help!
-Kaitlyn

Hi Kaitlyn! I read your posts and saw that you work in A&E. I'm a US nurse and I'm interviewing for a large A&E in the UK in a few weeks. I'm assuming you probably had a skype interview? I'll be asking for one since I'm in the US right now. How did that go? Anything specific I should ask about? Thanks in advance!