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Hundreds of internationally trained nurses who have lived in the UK for years cannot work as a nurse because they are struggling to meet English language requirements, research has warned.
A survey of 857 overseas nurses living in the UK but not on the NMC register – of which 629 were British citizens and 207 had permanent residency or right to remain – found many were ‘caught in a pre-registration void’ working as a healthcare assistant or support worker because they had not achieved the required English language test scores.
Currently, to register as a nurse in the UK, overseas nurses must score 7 overall, 6.5 in writing and 7 in reading, listening and speaking in the International English Language Test System (IELTS), or a C+ in writing and B in reading, listening and speaking in the Occupational English Test (OET).
But the study authors are calling on the NMC to no longer require the IELTS as proof of language proficiency from nurses who have completed a degree or master’s from a UK university.
They also recommended the removal of the IELTS requirements for overseas nurses who have three or more years of work experience in the healthcare sector in the UK or has undertaken substantial period of study at graduate or postgraduate level in UK.
Most (79%) respondents had been living in the UK for more than 10 years, while only 1% had been in the country for less than a year. Meanwhile, 75% had undergone three years of nurse education (equivalent to a diploma), 19% were educated to degree level and 2% to master’s level.
The authors said: ‘If the concern was about the communication with patients’ not being in English, living in the UK for more than five years and working in healthcare should be evidence enough…
‘No provision has been made by the NMC to harness this unseen and unheard group of unregistered professionals – nurses with British Citizenship working as health care assistants for more than 5 years – to date, where they are in a pre-registration limbo.’
It highlighted many internationally trained nurses – most of whom are women and many of whom are from a minority ethnic background – are working as healthcare assistants or support workers ‘for a decreased wage without scope for professional development’.
They added: ‘This is an opportunity to enhance the role of ethnically diverse women within the NHS workforce, empowering them to take on greater clinical and leadership roles.’
The report also argued nurses from India, which it said is reported to be the second largest exporter of nurses to some developed countries after the Philippines, often had ‘good levels of spoken and written English’ and proficiency in the language is a ‘competitive advantage’ for them.
Although the NMC acknowledged to an author of the report that it had not ‘considered/identified this specific group with their experience of working in English-speaking country,’ it argued many nurses may not have communicated with patients in English even if they are proficient.
One nurse, who had five years’ experience in accident and emergency as a registered nurse in India, told the survey authors they had attempted the IELTS and OET over 14 times.
They continued: ‘I have achieved the NMC-required scores for each module on different occasions, but I have not gained the required score in a single set of exams. This has meant that I have not been able to complete my NMC registration.
‘At the moment, I am working as a healthcare assistant with a GP, which I have been doing for the last four years. I attend to over 40 patients every day and I have not received any complaints about my English language from patients or my colleagues.
‘Now, my employer is looking to offer me a practice nurse job as soon I can complete my NMC registration, but this lingering, tough process has hindered my progress.’
In a statement, the NMC said it was reviewing it language requirements to ensure the approach was fair. It has set up an advisory group and scheduled a public consultation for the summer.
Matthew McClelland, executive director of strategy, said: ‘It’s essential that everyone joining our register can communicate well in English, wherever they trained.
‘Nurses and midwives spend the most time with patients and people who use services, and effective communication is fundamental to high quality, person-centred care.
‘Over 17,500 professionals who trained outside the UK joined our register in the 12 months to the end of September 2021 alone, and the vast majority of them have taken one of the English language tests.’
This comes after the RCN warned last month that an overseas recruitment drive for nurses by NHS Scotland won’t solve the country’s staff shortage.
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