Is UK Asking Overseas Nurses to Jump Through Too Many Hoops?

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.

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.

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.
Credit: Nursing Times

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