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More testing for European nurses post Brexit mooted


Patient safety could improve following Brexit, because European nurses coming to work in the UK may be required to take more skills tests in the same way applicants from the rest of the world do, the head of the nursing regulator has said.

The Nursing and Midwifery Council’s chief executive told MPs that leaving the European Union provided the opportunity to consider having a “consistent approach” for all applicants from outside the UK that “enables us to put people on the register to deliver care to UK standards”.

“One issue that we have as a professional regulator is our ability to be able to test the skills and competence of applicants wherever they come from”

Jackie Smith

Currently, under EU legislation, the NMC is unable to test European nurses on their nursing skills and competencies.

Instead, the law – required by the EU’s Mutual Recognition of Professional Qualifications Directive – allows European nurses to work in the UK if they have gained a qualification in nursing that meets minimum standards agreed by EU countries.

Meanwhile, recent changes to this legislation have meant the NMC can check for communication skills – by requiring evidence of the International English Language Test (IELTS) if applicants are unable to assure them they have this ability.

In contrast, nurses from the rest of the world are required to take both a computer-based test of their nursing knowledge, followed by an “objective structured clinical examination” in the UK, which involves them acting out scenarios of assessing, planning, carry out and evaluating care.

They must also have passed the IELTS with a minimum score of 7.0

“What… Brexit gives us is the opportunity to think about having a consistent approach that enables us to put people on a register to deliver care to UK standards”

Jackie Smith

During a Commons’ health select committee session last week on the priorities for the health and care sector during Brexit negotiations, NMC chief executive and registrar Jackie Smith was asked how patient safety could be improved if the EU legislation no longer applied.

“One issue that we have as a professional regulator is our ability to be able to test the skills and competence of applicants wherever they come from,” said Ms Smith.

“With the current directive, we can test English language, which we do for applicants coming from Europe, but we have a system in place whereby we recognise their education and training,” she told the MPs on the cross-bench committee.

“I suppose what Europe and Brexit give us is the opportunity to think about having a consistent approach that enables us to put people on a register to deliver care to UK standards,” she said.

“That is not to say that is not what is happening now, but we have a different system in place for nurses and midwives who come from the Philippines, India and the States, as opposed to from within Europe,” she added.

Jackie Smith

Jackie Smith

Jackie Smith

Ms Smith later suggested the current scenario was a problem if a European nurse had been out of practice for several years, because the NMC had no way to test if their skills were up-to-date.

When asked whether the NMC would like to see in the future all nurses applying from outside of the UK being subjected to the same tests currently used for non-European nurses, Ms Smith confirmed this was the case.

The NMC currently has around 38,000 European nurses and midwives on its register.

In January, the NMC released figures showing the number of EU nurses being admitted onto the register had dropped significantly since the summer – from 1,304 in July, to only 101 joining in December.

It said it was too early to say whether the reduction was due to the Brexit vote in June, the introduction of English language testing which came fully into effect by July, or a combination of both.


Readers' comments (6)

  • Another enhanced money making scheme for the NMC. Not to mention those working in the independent sector are being penalised at the OSCE test centres as the equipment being used is NHS focused. There is no need for this equipment in the community sector and pre registration nurses do not even so why is the test centre NHS focused still. What happened to the good old sphygmomanometer no instead we have high level technological computers being used to test competence

    Money making scheme at its finest

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  • I feel the above comment is a little over the top: there should be a minimum standard of competency which all nurses working in the U.K. should meet, no matter where they originally gained their qualification, in order that the public is safe and can have confidence in the profession.

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  • One standard for all is fair and sensible.

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  • I agree that one testing standard is important but I do not think that the current NMC application process or OSCE testing meets this needed standard.
    As a US trained nurse practitioner with specialties in Wounds and Continence (hoped to work in the UK community), I have struggled with NMC processes for 18 months now. I found the NMC application process VERY confusing, with two guidlines posted on their website undistinguised for the SAME process! There was inadequate NMC staff assistance to establish understanding of terminology (we use terms like 'license' and 'certification' in the US while 'registration' is used in the UK. I'm happy to learn new terms but the NMC application process assumed that I already understood). I was taught in my nursing training to never 'assume'. The NMC could benefit from that idea unless their goal is to hinder entry of foreign trained nurses.
    The OSCE testing was bias to UK trained nurses and to the acute care/hospital setting. This is a choice the NMC has the right to make but the applicant should be alerted to this fact at the very beginning of the process (before all the monies are paid). From this persection, I completely understand the first reader's comment. Use of hospital based equipment can create bias against a community focused applicant. Yet community nurses are sorely needed in this country! This testing did not serve as an objective marker of nursing knowledge or of critical thinking skills. I was expected to work within UK nursing theory (Roper, Logan, Tierney) when I spent years learning Orem. I was expected to have a working understanding of the APIE (assessment, plan, intervention, evaluation) acronym when I spent years learning ADPIE (D = nursing diagnosis). I was also expected to follow testing guidelines not consistent with national recommendations (NICE) and perform other processes and use equipment which were either not clearly defined or for which I was never provided with venue for clear understanding in the first place.
    I think that one High standard should be assessed and maintained for all UK nurses. The UK is facing some major patient care challenges associated with the aging population, diabetes, obesity, etc. A well trained nurse is a profoundly valuable and cost effective member of any team involved in managing these challenges for our country. I was happy to take the IELTS, which I easily passed, because I understand how problematic it is to not be able to understand my healthcare provider; something I've too often experienced since moving to the UK. But I think that the NMC application process and OSCE testing should be more clearly organized, more clearly communicated, and much more objectively formated. It is my opinion that current NMC processes do not meet the criteria required to create the One High Standard of nursing that this country needs to meet current and future needs.

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  • Possibly one of the most insightful comments from an oversees nurse I have read. Her level of expertise is obvious.
    Generally I think it fair to say that the UK attracts nurses where the training is not quite on a par.
    This is obviously due to the fact that the UK is seen as a favorable destination - possibly like the US where nurses must pass a exam before entering could be considered.

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  • I do not think the UK is that favorable for nurses..most immigrants come here as a second option or due to family ties. The nursing atmosphere here for minorities here is highly discriminatory from my experience...its not worth the trouble....

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