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Should it be easier to join the NMC register from overseas?


A letter to NHS HR directors has revealed it would be possible for the rules on joining the UK register for overseas nurses and midwives to be changed pretty quickly.

The letter, seen by Nursing Times, hints that the controversial IELTS language test, which many claim is slowing or deterring overseas nurses from joining our healthcare system, could soon be softened.

In the letter, NHS Employers chief executive Danny Mortimer said he had been making approaches to the Nursing and Midwifery Council about the high number of overseas nurses that were failing the IELTS test.

He writes that any changes are “likely” to happen before the end of this year or start of 2018, dependent of course on the NMC’s final decision.

Last week at our Nursing Times Deputies’ Congress, employers were raising concerns about the test, which they feel is keeping them shortstaffed.

“If I were an HR director or nursing director struggling to fill shifts, I would be keen to see the gates lowered too”

And yesterday, latest NHS figures revealed there were almost 11,500 nursing and midwifery vacancies being advertised on the health service’s official jobs website in March in England – a 17% increase in a year.

At the same time, another set of official figures showed a fall in the number of nurses and midwives employed in the NHS in England. The Royal College of Nursing said the two sets of figures were a “double whammy of bad news” for the profession.

Therefore, if I were an HR director or nursing director struggling to fill shifts, I would be keen to see the gates lowered too. 

The IELTS test relies on reading and understanding a piece of text on any subject – potentially fine art and beekeeping, for example – which can seem to be irrelevant when a nurse is more commonly asked to fetch pain relief or take someone to the toilet, rather than comprehend the finer points of apiculture.

But, although I think many would argue that it is right to encourage the NMC’s stock take of the IELTS test, we must be careful it does not result in a dumbing down of nursing and the importance of communication in the profession.

The fact some trusts are not seeing such huge IELTS failure rates must prove that some organisations are able to support their prospective hires through this process.

And if they can, why can’t more organisations – we need to roll out this best practice and see it as a universal ambition to support overseas nurses communicate more accurately and effectively?

Mr Mortimer commented in his letter about making the English language skills more clinically relevant, which is also something I am in favour of. That will make them safer, which is what the NMC is concerned about after all.

“Overseas nurses also get additional training to help them understand the nuances of our language”

In some organisations, I know that overseas nurses also get additional training to help them understand the nuances of our language. This is important so that when a patient says they “want to spend a penny” the nurse does not reach for the patient’s purse or point them in the direction of the newsagent.

The NMC could make itself very popular with employers – just by turning the tap on more fully and allowing more people to enter the register. But of course, its job is to protect patients; not be popular. It is not growing new fans over its firm position on English language testing, and I am sympathetic to its position.

But we must be careful not to underestimate the importance of good communication skills.

We’ve recently made nursing a graduate-only entry profession in this country, so we must ensure that in making it easier for internationally trained registrants to join the register, we don’t dumb down the profession or underplay the skills it takes to be a nurse.

While, most readers probably think the greater danger to the public is having no nurses at all, we must retain the ability to be selective about who is on the register and that they can communicate clearly with their colleagues and their patients.

Perhaps a better starting point for a workforce strategy might be to simply pay nurses more?


Readers' comments (4)

  • Elmon Paul

    Well, good communication skill is quintessential and patients safety should be considered when overseas nurses comes to the UK.

    However, 6.5 out of 9 in writting module generally is a far good score for a nurse. In contrast, I must admit, speeking should not be lower than 7 because nurses need to communicate regularly with patients. In that context, good speaking techniques and skills are important.

    Writting on the other hand, 6.5 would be sufficient enough to to write down the tasks. Moreover, 6.5 means around 72 per cent in English aquracy. Wouldn't be sufficient? For it's far good.

    If NMC takes a favourable decision by reducing Ielts score on writting module by a half margin would be more than enough. International nurses asking only for this module and for 0.5 margin.

    In top of It, recently NHS and NMC stopped old adaptation program and chosen CBT and OSCE instead. I feel pity on both organisations. The reason is simple and clear, the 3 months adaptation program was designed to adjust and adapt with European standards, languages and nursing care. Today, these tests made easy for nurses to pass test but failed to adapt with new environment. Moreover, less supervision and theory based evaluation would only make chaos. Nevertheless, NHS and NMC call back the successful Adaptation program would facilitate and solve many issues. Along with that, overseas nurses would benefit from it in many ways like understanding standards, culture, local lingustic differences and many other factors.

    Don't you think exams based on rote learning would enable nurses work in completely new environment. I doubt So, here, in this context, I believe, adaptation is the perfect let to make successful nurses.

    All in all, IELTS 6.5 on writting module along with adaptation program would be ideal address all the issues.

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  • Communication and understanding of accents & dialects in the UK is essential. I have had to explain to an OS nurse that the pt did not want to go shopping to 'spend a penny' and to another what a 'canny bairn' was and that cann is interchangeable with any word you want it to.
    Training is vital, I have worked with African nurses who had their PINs before coming into the country and their knowledge of nursing & care was diabolical. One even wanted to know why relatives did not come and look after the patient!
    Both English & training must be given total priority before any PINs are given out. Rigorous exams in their own country and then follow up exams in the UK which verifies the candidates ability and that they are the person who took the exam abroad

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  • Well why am I not surprised, can anyone else see what is happening here? Put their own home grown and trained nurses off, and employ and validate overseas ones instead. How is that for quality care? makes a lot of sense doesn't it. Overseas nurses that come to the U.K as the pay is better than their own countries that is, except it's not as it should be in ours, and top that with the lower quality care, that is what you get. Pay us what we are worth, stop the over the re-validation process and pointing fingers, instead give much more support.

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  • It should be easier to join the NMC register for 'home grown' Nurses. We need to get this right first!

    As a registered nurse for 22 years I moved into another Health field (albeit specialist) but one that didn't require me to keep my nurse registration, so even though I kept myself updated I let my registration lapse instead of paying to keep the RGN title, not thinking I would go back to it.
    After a decade out of a clinical role I am now on the verge of returning to the Profession having completed a Return to Nursing course.

    I cannot start to tell you how difficult the process is in regard to the hoops that have to be jumped through on the administration side of things and Red tape both with the RTP course but especially with the NMC process once the course has been passed.

    Having passed my course, already payed my NMC registration fee, completed all the online process, supplied 3 x original hand written, posted references (not easy to do), I now have to wait in a queue for another 2-6 weeks until somebody gets round to looking at my details to pass me as re registered.
    This has put me at risk of loosing the job I have recently been offered. On top of all the usual new job occupational health checks, DRB check, identity checks and past work references, it is only NMC red tape that is now holding my start date up. I won't go into the details but believe me some of the trivial and petty admin red tape could easily be done differently in this day and age. It is so frustrating when we read all the time about the shortage of nurses and the thousands of vacant posts there are.

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