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'Are we asking overseas nurses to jump through too many hoops?'

  • 7 Comments

Nurses who trained outside the European Union or European Economic Area must pass the Nursing and Midwifery Council’s competency test to practise in the UK.

Are we asking overseas nurses to jump through too many hoops?

Are we asking overseas nurses to jump through too many hoops?

Phil Jevon

The NMC says the test is based on current UK pre-registration standards and aims to ensure overseas nurses can practise safely and effectively.

The regulator’s quest to ensure high standards and protect the public must be commended. However, it is vital that the standards required of overseas nurses really are the same as those expected of nurses trained in the UK.

The second part of the competency test is the objective structured clinical examination (OSCE). In the first three months of this year 1,499 OSCE examinations were undertaken by nurses in the UK, with a pass rate of only 51%.

This suggests that either half the nurses applying to register in the UK are unsafe and ineffective practitioners or perhaps the standardised marking criteria used to assess their performance is not fit for purpose.In my experience the latter is the case; it is too rigid, unreasonable and unrealistic.

At Walsall Hospitals Trust, we have a cohort of nurses from the Philippines, who I have been teaching cardiopulmonary resuscitation (CPR) in preparation for their OSCE.

While I was disappointed that some subsequently failed, I was dismayed when I learnt of the reasons why they failed – for example, one nurse’s chest compression rate was 95/minute (instead of 100-120/minute). Does this really mean the nurse is an unsafe and ineffective practitioner?

I have been teaching CPR for 25 years, but I would be very nervous about sitting the NMC’s CPR OSCE because frankly, I probably wouldn’t pass.

“High standards are important but we do need to ensure that the assessment process is fair, realistic and not pedantic”

The other clinical skills assessed in the OSCEs also appear to be very strictly and – some would argue – pedantically assessed. It would be interesting to see how nurses trained at our local university faired if they undertook the NMC’s competency test OSCEs.

High standards are important but we do need to ensure that the assessment process is fair, realistic and not pedantic – and that nurses from overseas are not held to higher standards than those trained in the UK.

Lisa Hamilton, our professional development nurse told me: “These nurses from the Philippines are excellent. Their culture demonstrates the very best in humanity of care, compassion and empathy to patients, colleagues and to each other.”

Before applying for their visa each of these nurses had to pass international English language tests and computer-based competency tests, paid for by themselves on a very small salary or none at all. Having jumped through those hoops to get here they are then made to jump through more when they arrive.

As a trust we have spent thousands of pounds in OSCE fees and preparing the nurses to sit the OSCEs. We want to ensure they are capable of practising to the required standards, and to help them secure NMC registration so that they can work for us and look after our local population.

Like other trusts, we are struggling to recruit safe and effective nurses, and the shortage in the UK means we have to look abroad.

If we apply our standards too rigidly not only are we being unfair to the nurses who come here in good faith to work in the NHS but we are denying our patients the opportunity to be cared for in fully staffed wards by compassionate and effective nurses who just happen to have trained overseas.

Phil Jevon is academy manager, medical education, Walsall Hospitals NHS Trust, Walsall 

Conflict of interest: Walsall Hospitals NHS Trust’s application to become an approved test centre for the NMC’s Competency Test OSCEs was unsuccessful.

  • 7 Comments

Readers' comments (7)

  • At Southend hospital nurses from the Philippines speak their own language when working with colleagues from their country ... they address patients not by their name listed at every bedside but as 'sweet pea', I thought we had moved away from demeaning titles ... we don't want them unless they speak our language at all times and treat us with respect.
    I feel the more important issue is why do we have to depend on foreign nurses, what is wrong with our system that our folk don't want to train in this country, the same applies to doctors.
    We should make nursing a job that offers great opportunities, with the right pay and conditions so that lads and lassies at home choose to be nurses for the right reason.
    We employ foreign nurses / doctors because the pay fro them in Britain is better than in their own country so we get them 'on the cheap' and with 'cheap' comes inferior services.
    Give our folk the right pay and conditions to become nurses, that speak our language, and treat us with respect!

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  • Elmon Paul

    The article says the truth and the effect probably positive for the overseas nurses. Even though I agree OSCE was the toughest part in the competitive nursing exams, I think the most craziest challenge foreign nurses face from another exam called IELTS. Needless to say, many foreign nurses where stuck with 6.5 in writing module. In fact, it seems so crude and demoralising for the youngsters who seek betterment in life. Clearly, a 0.5 margin is playing the trick in this controversial exam especially in writing module.

    Because of the relentless campaigns, NMC decided to opt and add one more exam as an option for these nurses and I think it seems working. Now let me explore where the new exam known as OET stands when compared to IELTS.


    Today, the number of OET winners is rising sharply in India and people find it rather easier to score mandatory level in these days. Although OET is expensive than Ielts, it is gaining huge welcome and popularity. It is a truth.

    I have talked to many OET winners about the exam and system. I was surprised that many says OET is no way closer to IELTS in terms of standard. IELTS is a whole new level and benchmark scores are very unrealistic.

    One of my IELTS trainer who also train OET students told me that OET is difficult but it is not a herculean task at all. Where as, IELTS need persistent practice as well as has to be omnipotent and omniscient. Also, need some Luck definitely.

    He also said me many IELTS loosers are nowadays appears on OET and scores what they want in single attempt which seems fascinating as well as underline the fact that how tough is IELTS and how easy is oet.

    It is observed by one of the students who attended both exam says , OET seems way to simpler than Ielts when it comes with speaking and writing. However, she find it little difficult to deal with reading. Nevertheless, C± in reading perhaps not a big deal as per her concern.

    How IELTS score is different with OET particularly band 7 and Band B.

    Many says that if a person who can score 6.5 consistently can attain OET band B in writting and speaking without much stress or frestration. Moreover, grammatical range and accuracy is one of the main problems for IELTS aspirants which comes only the last assessment tool in OET that makes OET is more cooler to score than IELTS.

    Apart from this, score 6.5 in IELTS means you are scoring more than 73 percent marks in English which says you are good at the use of English language use. Meanwhile , OET band B ( consider as equally to 7 IELTS) seems to me that it is equivalent to 6 or 6.5 only. Even that score match with only 60 or 65 percent in English language. Clearly, it makes sense that OET is unparalleled to IELTS.

    In terms of knowledge base I am sure that IELTS band 6.5 would stand way above on OET band B that they consider as equivalent. Don't you think it is bizzare ? I think likewise.

    Most importantly, it may be the reasons the number of nurses who seeks overseas life is rapidly shifting to OET from IELTS. Therefore, the number of nurses who attended IELTS classes is declining drastically in most of the institutes. At the same time, the number is on a rise in OET classes.

    It is clearer that OET and IELTS are not equal at all. Sadly, NMC is barely understanding the difference. It is important to tell and make it clear to them that lion and goat are not the same or they cannot be live under one roof. Sadly, they are now for NMC. If anybody attend the meeting please do tell them.

    I think IELTS and OET serves same purpose just like how an iPhone and Chinese android does work. In fact, IELTS has quality which is very high and unrealistic. OET on the other hand is expensive, but, less in quality. Interestingly, NMC and RCSi uses both completely distinct tool to assess the level of English language level. I can't believe this ? Using two extremely different yardsticks in different lengths and widths is used to assess one common aspect. It is wierd. Isn't .. I believe yes and it is unfair.

    Thank you.

    To note, bare my grammatical mistakes and if you find it good update this. Moreover, it is just my observations, findings and opinions.

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  • I think it is important to remember the extremely valuable contributions that our international colleagues have made, and continue to make, regarding health care provisions in the UK. I understand some of the points raised by anonymous but don't agree with all of the views expressed. The retention of trained nurses is a historical issue and contributes significantly to the nursing shortages. A shortfall of applicants for nurse training has been evident recently due to the changes in funding arrangements, but also the number of training places available through local contracts can add to the difficulties of nurse recruitment in the long run. Currently there are not enough places for all those wanting to study medicine, so training opportunities abroad have become popular.

    Everyone is entitled to respect, no matter where an individual hails from. Stating 'we don't want them unless they speak our language at all times and treat us with respect' is perhaps somewhat harsh and reflects a culture of disrespect and discrimination. Pay, conditions and opportunities may be better in the UK in comparison to other countries, but I don't see how 'we get them on the cheap'. I have worked with many highly skilled and knowledgeable colleagues who have opted to live in the UK and they certainly have not been 'inferior' members of staff, quite the opposite. To refer to a community of nurses being inferior is insulting.

    The hoops are time consuming,difficult and expensive to jump through, and I agree with the notion that the standards for pass rates are not the most realistic. The standards do need addressing but also the UK needs to address the shortfalls in quality, and attitude applicable to the UK nurses undertaking

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  • I am from Yorkshire, moved to New Zealand, obtained my nursing degree and post grad dip here. If i wanted to move back home, i would have to through the whole process including IELTS and at great cost. It would make far more sense for New Zealand, Australia and the Uk to have a reciprical agreement. New Zealand and Australia do already

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  • This article said and I quote “High standards are important but we do need to ensure that the assessment process is fair, realistic and not pedantic”
    Talking about how Applicants are been assessed, so many of us foreign Nurse have Nursing related Degrees here in the UK Universities and work as senior carers and team leader in the NHS and Other Care homes if the assessment is fair why do we have to prove English competence with our UK Degrees if the assessment is fair after we’ve passed the Nursing based CBT In one sitting and we are struggling between 6.5 scores in IETLS and struggling with Expensive OET. I think people that fall into these categories should be assessed in a certain way different from people from outside the UK.

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  • Money making scheme. Simple. I am an Australian nurse with 14 years experience as a NUM, has to sit an IELTS exam - which is my first language is quite frankly ridiculous.

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  • NurseNdy

    Money making venture is what it is!
    In the past foreign nurses work without all these criteria in the UK and they performed extremely well.

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