Any future regulation of advanced practice must create ‘clear, accessible pathways’ for internationally educated nurses that recognises and builds upon their expertise, a study has warned.
New research from the Florence Nightingale Foundation (FNF), and the commissioned by the Nursing and Midwifery Council (NMC), has found that nurses and midwives from overseas are regularly struggling to have their past experience and advanced practice expertise recognised in the UK healthcare system.
Those behind the study, which is based on 1,500 survey responses from internationally educated nurses and midwives as well as focus groups, found that advanced nursing and midwifery talent was ‘being lost’ as a result.
Concerningly, two-thirds of respondents with advanced practice experience gained overseas reported that their UK employer ‘does not’ or ‘only slightly recognises’ their advanced practice skills.
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In addition, 64% of those with advanced practice qualifications and/or roles obtained outside of the UK described a ‘lack of opportunities’ in the UK to maintain their AP skills.
The report includes insights from several internationally educated professionals, including a nurse from the Philippines who said: ‘Every single foreign nurse regardless of background or experience is treated like newly qualified. This makes it difficult for the manager to see your potential.
‘I was passed over many times because I was foreign.’
Some 69% of the internationally educated professionals that responded to the FNF’s survey agreed that the NMC should take a greater role in regulating advanced practice.
‘Perceived benefits include greater consistency in education and training standards, employer assurance of skills, and increased patient safety,’ the report said.
Though it also noted: ‘Perceived disadvantages include additional time and expense to obtain qualifications and possible limitations on access.’
The survey also found that financial constraints (70%) and a limited understanding of the advanced practice pathway (61%) were the top barriers preventing those with an interest in pursuing advanced practice in the UK.
A quarter of internationally educated nurses and midwives interested in pursuing advanced practice in the UK felt hindered in accessing this because of their visa or immigration status, while 22% cited lack of recognition of their overseas qualification as a barrier.
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Some 11% said their overseas qualifications were considered ‘insufficient’ to qualify for an advanced practice training programme in the UK.
Dr Lisa Plotkin, head of policy and influence at the FNF, reiterated that many internationally educated nurses and midwives ‘face substantial challenges in having their expertise recognised and in accessing further training and career development opportunities’.
‘With the NHS increasingly reliant on international recruitment, it’s crucial that any future regulation of advanced practice creates clear, accessible pathways that recognise and build upon the valuable expertise these professionals bring,’ she added.
The report outlines several actions including:
- A consistent framework for assessing internationally acquired advanced practice skills and experience, alongside flexible pathways to ensure international qualifications meet UK standards.
- Entry requirements for advanced practice education programmes should be redesigned to focus on core competencies, with a review of language proficiency requirements to ensure appropriateness.
- Improving the transparency of qualification routes, including clear steps, timelines, and costs, and clarifying the responsibilities of universities and employers in supporting internationally educated professionals.
- Mentorship programmes and support networks should be implemented to support internationally educated professionals during their education.
- Ongoing professional development opportunities should be created to help internationally educated professionals maintain and update their advanced practice skills, with cultural competence incorporated into any future advanced practice framework.
- Employer guidelines should be developed to improve the experience of workplace integration for international advanced practice professionals, and the implementation of anti-discrimination policies in health and care settings.
Sam Foster, executive nurse director of professional practice at the NMC, said: ‘Every day, nurses and midwives carry out complex, autonomous and expert roles which are vital to the health and wellbeing of people across the UK.
‘Internationally educated professionals are crucial to delivering this care, and we welcome the Florence Nightingale Foundation’s report as we progress our ongoing review.
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These findings will help us to develop a model of advanced practice regulation that is supportive and fair for every nurse and midwife, wherever they were educated.’
Ms Foster encouraged employers and educators to implement the report’s recommendations and ensure internationally educated nurses and midwives can deliver the best care for the public ‘both now and in the future’.
