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NMC defends robustness of new tests for overseas nurses


The Nursing and Midwifery Council has defended a new system for the registration of overseas nurses, following claims it could put patients at risk.

Previously nurses from outside the EU who wished to work in the UK had to do at least three months’ supervised practise.

But from autumn this year – as reported previously in Nursing Times – they will simply be required to pass a multiple choice online exam before doing a day-long practical competence test in the UK.

The move, unveiled in detail by the regulator last week, looks set to make it quicker and easier for trusts struggling with nursing staff shortages to recruit abroad.

“I think we’re proposing a system the public can have confidence in and the professions can have confidence in”

Jackie Smith

However, there is concern the shorter tests will not be sufficient to assess whether someone is good enough to work in UK healthcare settings.

This week the Royal College of Nursing said it needed to know more about how nurses would be evaluated before it could judge “whether or not the system is adequate”.

Jackie Smith

Jackie Smith

But NMC chief executive Jackie Smith denied the new system was “less robust”, and said the regulator had set out to find “the best method of assessing someone’s application”.

“I think we’re proposing a system the public can have confidence in and the professions can have confidence in,” she told Nursing Times.

“What we’re doing at the moment is looking at hours, but what we’re suggesting here is better,” she said. “We’re saying ‘let’s see you in a situation and see how you translate the learning and training you have acquired in your home country to UK standards’.”

The changes follow a three-month public consultation and will bring the process in line with systems for overseas registration used by other professional regulators, such as the General Medical Council.

Ms Smith denied one of the main drivers for the change was to make it easier for trusts to recruit from overseas, though the NMC has admitted this was a benefit. “It’s not about making things easier or harder, shorter or longer, it’s about public protection and using the best approach,” she said.

“If a by-product of what we’re proposing is that the system is quicker, then that’s absolutely fantastic for employers, because we recognise they are recruiting from non-EU – as well as EU - countries at the moment,” she told Nursing Times.

NMC figures show that, as of March this year, there were just over 67,000 overseas-trained nurses on its register. The body said it had registered more than 5,000 in the past five years, with 840 joining the register in the 12 months up to March 2014.

Ms Smith said it was important to remember the key role played by employers in selecting the right staff for their organisations.

“If we decide someone is competent to be on our register, then employers must make sure they’ve got the right values and the right support and training in place to be able to deliver care to the standard required,” she said.

“We will be observing very closely how it works in practise because it is new and different”

Janet Davies

The RCN said improving registration was only a part of the changes needed, and it was vital overseas nurses were supported and monitored.

“Whether nurses come from the EU or the rest of the world, it is vital that employers are recruiting them for the right reasons,” said RCN executive director of nursing Janet Davies.

“Too often nurses are recruited from overseas to fill short term gaps and given inadequate support to care for patients as well,” she added.

The new system is due to be introduced in October this year.

Janet DaviesJanet Davies

“We will be observing very closely how it works in practise because it is new and different and therefore we need to make sure it is delivering,” said Ms Smith.

Meanwhile, she said the NMC was “still working out the finer detail of the “practical test, which will take the form of an objective structured clinical examination (OSCE) in a simulated healthcare environment.

She confirmed it would be a day-long exercise that would test skills such as communication and patient engagement. “It’s the sort of thing that should not take individuals by surprise,” she said.

As well as passing the new tests, nurses must provide relevant documentation – such as identification, university transcripts and language certificates – to show they have a good command of English.

The changes to overseas registration in the UK contrast with the new system for registering overseas nurses recently introduced in Australia. New rules have made it harder for NHS-trained nurses with diploma-level qualifications to work there, as recently reported by Nursing Times.

UK nurses struggling to get registered in Australia said they would prefer some kind of competence test, like that proposed by the NMC, as opposed to being judged on the type of qualification they held.

“Something like this would make much more sense,” one posted on Facebook.


Readers' comments (15)

  • You have to hand it to the NMC: not many regulators can boast that they have single handedly, piece by piece wrecked a profession in the way in which this lot have - if I didn't know better I would say it was done by design.

    How can the NMC possibly be safeguarding patients and the public by replacing three-months supervised practice with a few tick-box questions and a days worth of supervision? Unbelievable, actually it's totally believable.

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  • Couldn't agree more; but most the standards required of most professions now have slipped to almost zero. Such standards (and hierachies) were there for a reason, which generally only became apparent to us in a crisis/emergency situation. Now everyone wants to be on first name terms and pals, and the standards patients should expect no longer are there.

    Seems the only profession where standards (height, weight, fitness, intelligence, articulation) are still required (and no arguements if you fall short), is the Royal Marines. Everyone seems too afraid of 'upsetting' someone's human rights these days and it's turned nursing into something completely different

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  • I agree with both of the above.An overseas nurse could get anyone to take an online exam on their behalf.How does anyone know it was that particular person that took the test?
    Certificates from Universities,id documents and certificates stating competency in English can be bought, I believe, at a price on the internet.Pieces of paper don't mean a lot.Observed 3 months practice seems like a good way to judge competence and promote patient safety.

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  • As a british citizen that did their nursing training in Australia, when I wanted to register in the UK I had to sit (&pass) the IELTS before I could even get the first lot of paper work....the NMC decided after looking at my applicaiton that I only had to do the old ONP & not the 3mths of supervised practice on top of the practice assessment was always there, it just depended whether or not the NMC thought you needed it.

    But working over here as a nurse is very hard at the moment and I will admit to burning out. The NMC seems lost, can't seem to get its own house in order & has lost the respect of the nursing profession (did it ever have it in the first place?); all the Unions are a joke (though some less than others); the CNO is in fantasy land & the nursing leadership in this country is abysmal.

    And I also have grave concerns about future of british nursing because there seems to be an emphasis on quantity over quality, the RN's doing the day to day mentoring of students while their on placement do not the have the time they need because of the physical work load, and every seems to loose the ability to think for themselves and to look at situations in their context & the 'why' and not get hung up on pure numbers while keeping an extremely narrow view. Also having to keep doing more with less yet not letting standards slip is unrealisitic and unsustainable....have any of the powers that be worked that out yet?

    And don't even get me started on pay, conditions, everyone trying to get rid of AfC becuase the NHS has no money & it's nurses have no backbone or self-respect...usually becuase they are scared, terrified of the consequences, apathetic & tired of trying to changes things positively to no avail. Nurses seem to be the scapegoat for absolutely everything in this country!! Even when it has nothing to do with us!!

    So I am heading back to Oz before I burn out completely and end up hating the job I still love. But am deeply worried about my fellow nurses in Britain, unfortunately I'm not sure how to start changing things around

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  • I have retired from nursing, not brcause of age but because The Co I worked for employed 2 Romanian RNs and an African SHCA and I considered all three dangerous. None of them knew any of the drugs we uses, hardly able to pronounce the names. The risk to the resident was enormouse.
    I have worked in another home where all the foreign staff from Africa had identical certificates from RNs to cook with the relevant qualification changed. All the references were identical and it would appear from their education they all attended the same school
    The NMC are idiots

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  • Just who are the NMC here 'To protect the public'
    1 They are an independant company/organisation
    2 They are not part of the Dept of Health
    3 They are not part of the NHS
    4 The Council has only 4 nurses So much for "Judged by Peers. The rest of the council are ex diplomats, Life Coach, Natonal Lottery admin, Non exec of National Archives Kew An ad hoc crew if ever there was one

    The NMC are becoming more like 'Yes Minister' and the nurses are paying for the priviledge. Where is the evidence that they protect the public? All the cases they hear are post event. Over the last year ALL cases they have heard have been guilty. This smells of kangaroo court methods. Are there private hearings without anyone there let alone witnesses. Does it stand up to scrutiny on the EU Human Rights of a fair trial and being able to answer any allegations and question the accuser
    The list of their remit can be dealt with elsewhere either by the police or employer. Many cases are clearly passed on by the employer as it is cheaper
    What are nurses going to do about it? Sit back and do nothing as usual

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  • If the NMC are there to protect the public then why are nurses paying to protect the public? This should be paid for from taxation.
    We dont ask members of the police force, ambulance staff, fire & rescue, military personnel to pay personally for the protection of the public so why single nurses out. The one thing nurses have paid for is a nice new building in central London at a cost of £millions
    Membership of a truely professional organisation should be optional, run & controlled by nurses. The registration of nurses should be either NHS or Dept of Health department not an ad hoc collection of paid up admin shape shifters with dodgy MBAs.
    The UK people are now going to be exposed to the dangers of foreign nurses being allowed to practice without any adaptation programme. Is that 'protecting the public' ? No it is exposing the public to many risks and dangers.
    Staff are being employed with fake certificates & qualifications. Foreign staff dont know the names of drugs, the doses, reasons to withhold.
    That is without the language barrier with English having many different dialects and accents and each area having its own words.
    The Profession should intervene before patients are killed.

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  • Setting us up for another fall. It is actually terrifying.

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  • As far as I know, the NMC don't own PortlandPlace, rather have it for a peppercorn rent. Having said that (probably the only time I would stick up for the NMC!), other posts are correct - they have been begging for more nurse representation at HQ, but then take on those who are so far removed from the coal-face (in terms of time and position) they could be any Fred Bloggs off the street.

    Our fee is purely for typing our name/qualification into the register, not to pretoect the public. That accounts for about 2p. The rest goes on wages for those who don't seem to have a dolly mixture what is going on in nursing and health, and to pay lawyers to deal with conduct hearings.

    Perhaps if we revisited pre-reg training and how life is in practice, we wouldn't have so many hearings to pay for.

    But I can feel myself going into rant mode! Nurses, we need to be cohesive in our approach - only we can do somehting about this state of affairs - I'm just not sure what as yet!

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  • What is wrong at the NMC? I cannot and will not believe that this crazy scheme came out from a public consultation. This is a cost saving exercise and has nothing to do with ensuring fitness for practice and has nothing to do about protecting the public.
    I would like to point out to Ms Smith that the brevity of the scheme is not a by-product of the scheme it is an integral part of the scheme.
    What was wrong with the old Adaptation programme, through the School of Nursing, apart from the cost?.

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