Internationally educated nurses are leaving the Nursing and Midwifery Council (NMC) register earlier than their UK counterparts and have found staffing levels and workload to be worse than expected, a new report has found.
Meanwhile, fresh concerns have been raised about the racism and discrimination faced by nurses from overseas, with latest examples seeing nurses left in tears after shifts, losing weight and feeling ‘traumatised’ and ‘misled’.
The findings come within the NMC’s inaugural ‘Spotlight on Nursing and Midwifery’ report published today, which aims to provide annual insights from its work to support ‘sector wide learning and improvement’.
According to the report, internationally educated professionals made up the greatest number of those leaving within the first five years of registration – with an ongoing increase in the proportion of these professionals leaving each year.
Data within the document showed 37.6% of nurses who trained outside the UK and EU/EEA left within the first five years of registration in 2023 – up from 7% in 2018. This was compared to 7.5% of those who left within their first five years who trained in the UK – up slightly from 6.9% in 2018.
As part of its research, the nursing regulator also found that internationally educated nurses remained on its register for less time than their UK educated counterparts.
Between April 2017 and September 2022, just under a third (28.9%) of internationally educated recruits spent only five to 10 years on the register before leaving. For comparison, 36% of UK educated professionals remained on the register for 30 to 40 years, with an additional 23% spending 40 to 50 years.
Internationally educated professionals currently make up more than one fifth of the NMC register, as well as contributing two thirds of its growth between 2019 and 2023.
This, however, has raised concerns that the UK’s health system is becoming overly dependent on international recruitment to maintain the workforce.
The number of nurses coming to the UK to work has increased steadily in recent years, however the NMC’s report suggests that the UK may be becoming a less attractive place to work.
More than half of 1,512 internationally educated professionals surveyed by the NMC said that staffing levels (59%) and workload (55%) were a reason to not recommend working in the UK.
Of those surveyed, 61% said that staffing levels in the UK were worse or much worse than expected, with a further 45% saying the workload was worse or much worse than expected.
In addition, while a large number of internationally educated professionals told the NMC they wanted to work in the UK due to the prospect of the chance to earn a better salary, they were also likely to cite low pay as a downside of working in the UK.
Pay was cited by 40% of those surveyed as a reason they would not recommend practicing in the UK, while over half (56%) cited the cost of food and bills.
Internationally educated professionals cited racism and discrimination as ‘a major challenge they had not anticipated prior to arriving in the UK’, said the report.
Feedback from 86 internationally educated professionals attending a recent ‘Welcome the UK’ pilot workshop revealed staff ‘crying at the end of shifts’ due to their experiences, as well as losing weight and feeling ‘traumatised’.
Some said they also felt ‘misled during the recruitment process’ and cited experiencing ‘explicitly racist and derogatory comments’.
Nurses from overseas also raised concerns around ‘not feeling respected or treated the same as local colleagues’ and feeling ‘as though their previous experience was not understood or valued’.
Some also highlighted experiences of ‘poor culture, gossiping, and being talked about behind their backs, and not feeling able to trust colleagues to be supportive and keep things confidential’, added the report.
NMC chief executive and registrar Andrea Sutcliffe said that international recruits had ‘shared troubling stories about their formative months in UK practice’.
Ms Sutcliffe added that ‘supporting every professional to thrive is key to retention of staff, and to ensuring high-quality care for people’.
Meanwhile, the report added that ‘excessive workloads, staffing shortages, racism and discrimination are impacting on internationally educated professionals and their ability to provide safe, effective and kind care’.
‘Without urgent action from leaders and employers, more professionals will leave earlier than planned, risking the substantial investment that has been made in overseas recruitment in recent years and further exacerbating existing staffing shortages,’ it warned.
Inconsistent support for new staff
Other issues raised in the spotlight report centred on the support given to new professionals on the register.
The NMC’s research found that preceptorship programmes – a period of structured transition and support to guide new professionals to become autonomous registrants – were being delivered ‘haphazardly’, with significant variation in how they are delivered.
‘Of the newly registered professionals that took part in our qualitative research, around three quarters had experience of preceptorship and felt it could be extremely helpful,’ said the report.
‘But only a minority (more likely to be nurses or nursing associates than midwives) felt highly satisfied with their experience, and there was a feeling that its potential was not always being met.’