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Overseas nurses admit they don’t always have the 'right' language skills

Nurses arriving from the European Union to take up jobs in the NHS admit they may not have the “right” language skills to work effectively, and often have difficulty slotting into the healthcare system.

These were among findings from a study by the National Nursing Research Unit at King’s College London, which reinforces the need for strong induction and ongoing support for overseas nurses.

“Being generally competent in English did not mean they had the ‘right’ language skills”

Ruth Young

The NNRU’s review shows recruitment of nurses from other European countries has risen sharply, as more exercise their right to work across the EU and because of tighter controls on nurses coming from developing countries.

It has been driven even more strongly over the last 18 months by trusts seeking nurses to sure up shortages in the wake of the Francis report into care failings at Mid Staffordshire Foundation Trust.

A recent investigation by Nursing Times found at least a third of trusts were actively recruiting overseas, with Spain and Portugal particularly popular. Most trusts have stipulated that recruits are thoroughly checked and then put on induction schemes.


The Iberian Peninsular

The fact nurses could already speak English was one of the key factors that drew them to the UK, according to the latest study, which involved an online survey and in-depth interviews with nurses from a range of EU countries, such as Bulgaria, Greece, Poland and Romania.

“Once here respondents felt being generally competent in English did not mean they had the ‘right’ language skills to work effectively in the health service,” said the report. “This was also a concern shared by professional regulators who have been unable to test language as a pre-requisite for registering EU migrants.”

In addition, the research highlighted overseas nurses’ concerns about their training, and the social and cultural issues, that can make fitting into a “very different UK health system far from straightforward”.

Study author Ruth Young, a reader in health policy evaluation at King’s College London, said the language issues often had a regional link. “It’s things like words for different types of pain or colloquialisms and ways of speaking that are not part of the standard English you have learned in your home country,” she said.

“Like any new job, it’s a learning process when you first start and the organisations that are receiving migrant nurses need to take account of that kind of thing in their induction and the support they give people when they first arrive.”

Employers also needed to recognise the differences between the many EU countries, she added.

“Each has their own professional culture and people come here with different experiences,” she said. “There’s a huge variety and you need to recognise that in the induction process, be flexible and adapt to what people need.”

The study also revealed that some overseas nurses struggled to get their qualifications recognised in the UK and so took on healthcare assistant roles or ended up working as housekeepers and cleaners. They could benefit from “additional training to get them up to speed”, said Ms Young.

Another key issue highlighted by the research – part of the wide-ranging PROMeTHEUS study of the movement of health professionals around the EU – was the difficulty overseas nurses had in returning home.

“People don’t necessarily come thinking it will be long-term but life happens and it becomes long-term,” noted Ms Young. “They stay because they have more career opportunities in the UK.”

Poorer European countries in particular were likely to suffer from a drain of nursing talent, warned the report.

However, as reported by Nursing Times last week, nurses trained in the UK could themselves be the target of recruitment efforts by the US soon, as public healthcare provision is set to expand massively under “Obamacare”.

Readers' comments (34)

  • michael stone

    Nurses arriving from the European Union to take up jobs in the NHS admit they may not have the “right” language skills to work effectively

    I'm fairly sure, that knowingly lacking the language skills to nurse effectively, would breach the NMC's Code ? So how come ?

    I realise that 'so how come' is a very 'demotic question' - but I'm sure that anyone capable of answering it, will get the question.

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  • Also happening in Australia. Healthcare is a very particular "culture", I know, but since communication is at the core of our business we may benefit from ensuring that language skills are adequately assessed prior to allowing entry into the system. Nursing assessment and clinical skills performance rely
    on a very thorough knowledge of pure and colloquial language in any culture/setting. Nursing documentation needs to be legible, concise and accurate. Healthcare teams achieve optimal outcomes where collaboration is clear and unambiguous. Finally, patient input, cooperation and informed consent all rely on clear communication.

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  • Michael, that is a really good point. Surely the precedent that was set with the Chief Nurse at Mid-Staffs show that top level management effectively lowering standards is not compatible with the standards expected of a Registrant.

    Being unable to carry out the role in a safe and professional manner has to be a reason for barring from practice, so those who appoint through these overseas strategies are effectively setting people up to fail and should perhaps be more aware of the potential pitfalls at a personal level?

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  • Im working with 2 Romanians. Their knowledge of accountability & responsibility is non existant. They have told me they're more active and dont do paperwork in Romania.
    When questioned they didnt know if people in Romania complained as the hospitals dealt with it! Their English is just basic Its a constant battle to get paperwork done and usually twice the work as you end up doing it yourself to make sure its done.
    I am fearful for the future

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  • Poor or non-existant language skills don't seem to stop thousands of UK nurses travelling to developing countries to work. Anyway, if the NHS now has to recruit nurses from other parts of the EU to replace the ones they sacked when making huge cuts, they should take the responsibility to make sure the nurses are given help with the specialised language needed to look after patients. Mabye we could also learn from the Romanian sample mentioned above and have more clerical staff to do the paperwork rather than highly trained nurses.

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  • I am EU nurse, working in the UK for 14 years. I have completed a fool time nursing diploma course for 3 years in the UK too. I strongly believe, that every medical professional should take an adaptation- skills and terminology course in the UK. We are dealing with humans life every day, so we can not risking not to know how to comunicate. And this is not only about EU nurses, its for every one coming from all over the world, even from english spoken countries.

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  • Comment removed

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  • Removed due to personally offensive nature. Please refer to this site's terms and condition before posting further:

  • I am not suprised this is happening because when I got my pin number the NMC didn't ask me for any english qualification. In other countries like US or Australia you need a score above 7 in the IELTS test, here in UK you just need to have enough english to pass an interview.
    Anyway nursing here is pretty basic and I don't think you need to be an expert at english to develop your work safely.

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  • By the way, UK nurses make spelling and grammatical mistakes as well or are you going to tell me that all of you write perfectly?
    Despite I am an overseas nurse I have had to help my colleagues to spell and pronunce some words especially the technical ones.

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  • Well said, some of the comments in this area leave a lot to be desired.

    For example, is this supposed to be English?

    I can see why EU nurses need to be assessed for language competency. In the above comment from the writer spelling and grammatical error is a "woe"

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  • Another NMC fail.

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  • By the way, UK nurses make spelling and grammatical mistakes as well or are you going to tell me that all of you write perfectly?
    Despite I am an overseas nurse I have had to help my colleagues to spell and pronunce some words especially the technical ones.

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  • The International and English Language Testing System (IELTS) had been implemented by NMC for nurses and midwives coming over to work in UK, with an Academic overall score of 7.
    If only the employers having language barrier problems with their existing nurses could recommened for them to take IELTS.

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  • The discrimination against EU nurses here is an utter disgrace. they will bring high qualifications, advanced nursing skills and hard work to transform the NHS and should be welcomed with open arms.

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  • I do agree we all have to have the right language skills to be able to practice safely, whether you are from the U.K, E.U or any other country that nurses are recruited from. how many times have I had to correct the spelling mistakes of our English nurses? I am an overseas nurse but the way forward is to offer the English language to anyone whose standard is not safe for practice. discriminating against the EU nurses will just create tensions.

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  • I am a 32 yr old student nurse in my 2nd year. Before pursuing nursing, I trained as an actor for 3 yrs, and trained as a Primary school teacher.

    Firstly, my Drama school taught me how to get rid of my thick Cantonese accent. I now speak RP (Received Pronunciation/Standard English). Every pt I have come across love my accent and my clarity. They compare me to the other 'foreign' nurses, and they wished that those foreign nurses would speak good clear Oxford English like me.

    A good idea would be for the NHS to pay voice teachers from the Royal Central School of Speech & Drama (or any accredited drama school) to come and teach the communication/ RP accent skills to our foreign nurses.

    Secondly, training as a Primary school teacher, I was given a cursive handwriting practice workbook. I wish all doctors and RN's practiced neat cursive handwriting.

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  • I think all foreign Nurses should be made to pass English test before they can be admitted on the Register,regardless where they are coming from.Let us put politics aside,language
    barrier can put lives at risk.

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  • tinkerbell

    Anonymous | 28-May-2014 9:59 pm

    Agree, if you cannot understand what people are saying or be understood by others and your are looking after patients it's dangerous. This should be obvious. I would not expect to nurse in another country with another language I couldn't speak fluently and would understand if that eliminated me from working as a nurse/doctor in the country. Come on this is basic stuff.

    Unless we can speak about these matters in an open honest way and get to the heart of the matter we are just burying our heads in the sand by trying to be pc.

    With the best will in the world, where English is our first language, we still have problems understanding each other on occasions.

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  • Helen Riess, M.D. is Associate Clinical Professor of Psychiatry,
    Harvard Medical School and Director of the Empathy and Relational Science Program at Massachusetts General Hospital.

    E - eye contact
    eye gauze
    Zulu - I see you

    M - muscles of facial expression
    we read facial emotions

    P - posture - conveys connection

    A - affect - expressed emotions
    naming the feelings

    T - tone of voice -

    H - hearing the whole person - don't judge

    Y - your response

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  • All the EU Nurses coming to work to UK without any English skills and they don't even ask them to do the IELTS or English exam.
    But those Nurses who is from Asia who is very good and skills in English communication they are asking them to take an English exam..
    Do we consider this as a races or discrimination...

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