Overseas nurses feel their skills are underused and they aren't valued or respected

Researchers from the University of Northampton also found that discrimination and racism still exist in the National Health Service and that the reality of first-world UK nursing is often very different to what overseas nurses expect.

Senior lecturer and nurse Julia Nichols and Professor of Neurophysiology Jackie Campbell carried out an in-depth research review of 30 papers, surveys and Government strategy documents published since 1997, covering the views of nearly 4,000 overseas nurses.

"If overseas nurses chose to leave the UK in large numbers, health services could face a severe staffing shortage" says Julia Nichols. "It is important that we listen carefully to their experiences to help identify priorities for policies and practice so that we can improve migrant nurses' job satisfaction and articulate the value that they bring to UK nursing.

"Although some positive experiences are described, significant numbers of nurses describe not feeling personally or professionally valued by the UK nursing establishment and common emotions include disappointment and unmet expectations."

The UK has a long established tradition of employing overseas nurses, particularly from the Republic of Ireland and the Commonwealth. This dates back to the Colonial Nursing Service, which was established in the 1940s to unify the administration of nursing appointments across Britain and its overseas dependencies.

Since 1997 approximately 100,000 international nurses from 50 countries have obtained UK registration, with the largest numbers coming from the Philippines, India, South Africa and Australia. However, the Nursing and Midwifery Council reports that almost a fifth of the nurses who joined the register between 1997 and 2006 did not renew their registration.

The research review carried out by Nichols and Campbell provides a number of clues about why retention is an ongoing issue, including:

• Highly skilled and proficient nurses being used in junior positions where their expertise and experience went unrecognised. Some nurses even felt the need to hide their skills to avoid alienating the less experienced staff they reported to.
  
• Racism and discrimination. One study even went as far as to suggest that the NHS was institutionally racist, with overseas nurses being socially excluded and having their career progression blocked.
  
• Particular problems working in elderly care homes, where nurses felt their nursing skills were replaced by unfamiliar and basic personal care, such as feeding, washing and toileting. They also reported poor working relationships, a lack of respect and feeling humiliating and degraded by the attitudes of some colleagues.
  
• Disappointment when they discovered that their expectation of working in advanced first-world health care – with high-tech equipment, clean hospitals, high standards of care, good staff-patient ratios and positive working conditions – were not realised. And frustration that following policies and protocols made nurses risk adverse.

The review has prompted the authors to make a number of suggestions as to how retention could be improved. These include:

• Managing nurses' expectations more effectively by not over-selling UK nursing in a way that can only lead to disappointment.
  
• Not recruiting the most senior staff for junior positions, as this will lead to professional frustration.
  
• Valuing the skills and expertise that overseas nurses bring to the UK through appropriate and timely professional development.
  
• Learning from other healthcare systems, and being open to new ideas, rather than trying to impose the 'our way is the only way' style of nursing.
  
• Making it clear that racism and prejudice have no place in UK healthcare and will not be tolerated, in any form, by organisations that respond swiftly and effectively to any problems.
  
• Providing equality and diversity training with staff required to demonstrate their awareness of issues and commitment to good practice.
  
• Monitoring equal opportunities through transparent processes to ensure fair treatment and career progression.
  
• Providing qualified and enthusiastic mentors who can enhance the early experiences and orientation of newly arrived overseas nurses.

"The key themes that emerged from our research review suggest that, while there are many positive accounts of working in the UK, many overseas nurses find it a negative, frustrating experience" concludes Julia Nichols.

"Managing nurses' expectations and respecting their expertise are vital if we are to make best use of their skills and knowledge. We need to put caring back into the heart of nursing and this extends to supporting and nurturing overseas nurses."

More information: The experiences of internationally recruited nurses in the UK (1995-2007): an integrative review. Nichols J and Campbell J. Journal of Clinical Nursing.19, 2814-2823. (October 2010). DOI: 10.1111/j.1365-2702.2009.03119.x

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