Settling in as an international nursing student: tips and support
The support that can help overseas nursing students transition to their new workplace and life in the UK, including cultural events, peer support and orientation
The number of international students arriving in the UK to study nursing is on the rise.
Statistics from the Universities and Colleges Admissions service (UCAS) show there were 895 accepted international applicants in 2023, and while this is only a small part of the overall nursing student cohort, the number has increased almost every year since 2019, when 600 successfully applied.
University lecturers say students from overseas bring new skills and culture
This change may be happening more rapidly in Wales, thanks to a three-year pilot study that is funding some international nursing students to train in the country in return for a commitment to work for the NHS for two years.
Other international students generally have to pay high fees to study in the UK, with tuition costs of around £20,000 a year not unusual.
Growing international markets for UK nursing courses include Nigeria, India and Hong Kong, with a steady appetite from Ireland, according to a joint NHS England and UCAS report in 2021.
University lecturers say that those arriving from overseas to start their course at a UK university bring new skills, culture and experience. But it is often a major transition that can bring challenges as well.
‘We try to create a sense of belonging for our students’
International nursing student numbers are rocketing at the University of Worcester, jumping from 13 in 2021 to 463 this year.
The university has made a concerted effort to ask students what would help smooth the transition when they arrive – and to implement their suggestions.
Helping students prepare for a different culture
Senior lecturer in adult nursing and international lead for preregistration nursing Kevin Fernandez holds introductory sessions in the home countries of students before they travel to the UK. He talks about living in the UK and the structure of the NHS to help students prepare for a different culture.
‘We do a lot to create a sense of belonging for our students,’ says Mr Fernandez. ‘We focus particularly on the first year, to help students have a good start.’
Once students arrive, there is a team-building day for all nursing students, home and international, with activities including bushcraft and kayaking.
Cultural exchange enhances delivery of the nursing curriculum
There is also a transition module for international students – who pay around £16,000 a year – that involves a series of sessions to ‘help them prepare for certain pinch points’, says Mr Fernandez.
This covers aspects such as writing and referencing essays and preparing for their first placement. After the placement, there are debriefing sessions to reflect on what they experienced.
Sadly not all of this is positive, as there can be discrimination, racism and microaggressions directed their way, says Mr Fernandez.
But diversifying the student cohort has been a positive experience for the university, he says.
‘The cultural exchange and different lived experiences that all our students bring enhances our delivery of the nursing curriculum. They bring so much to the university, the city and the NHS.’
‘Culture shock’ for nursing students on arrival
University of Worcester senior lecturer Paul John Alegado says there can be a certain level of culture shock for newly arrived students.
‘Adjusting to a new culture can be overwhelming, especially when it comes to understanding local customs, norms and communication styles,’ says Dr Alegado. ‘This could potentially impact interactions with their colleagues, service users and educators.’
Cultural orientation programmes, and ongoing support specially tailored for international nursing students, can help support them through this, he says.
Adapting to different academic expectations can prove difficult
Swansea University nursing lecturer Jyoti Shrestha has also seen how adapting to a new culture can be tricky for international students.
The number of international students at Swansea has risen rapidly, from around 4-8 per cohort to more than 50 as part of the new Welsh pilot. The vast majority come from India and Nigeria, with small numbers from Hong Kong and countries including Nepal and Singapore.
Adapting to different academic expectations can prove difficult for some students, Ms Shrestha says. ‘We find that the expectations are quite different here in the UK from what students are used to. Many have not written essays before, for example. They are all bright, committed and have high grades, but it is a completely different system.’
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‘My advice: do your research and do ask for help’
Devansh Chiralayath-Njalil-Baburaj, a second-year student at Swansea University, is one of a growing number of international students arriving in the UK to study nursing.
Devansh, from Tamil Nadu in India, was studying medicine in Ukraine when the country was invaded by Russia. After seeking a new career direction, he chose to study adult nursing in Wales, as a UK qualification is widely recognised around the world.
He says both the university and the city have been welcoming – but there have been challenges in moving to a new country. ‘There have been ups and downs along the way,’ he says.
‘It was quite overwhelming and the first week, when I was mainly in my room, I did feel very homesick. But once I started forming connections and making friends that started to fade away.’
Resources and support are available for international students
He encourages other students to take up the resources available to support them. ‘International students can push back, and that includes me, when it comes to asking for help,’ he says.
‘We’ve come from an education system where we need to fend for ourselves and succeed all the time, so saying you’re not able to do something can be hard. But there are a lot of resources available from universities, and they really care about supporting our well-being and mental health. So don’t hesitate to ask for help.’
Before he arrived, Devansh watched YouTube videos made by other international students studying in the UK, including students at Swansea, which he says are a useful source of information on accommodation and other aspects of student life.
He encourages other international students to study in the UK, and to ride out initial feelings of homesickness. ‘Do lots of research into where you may study,’ he says. ‘Be confident that it will work. It will take time but everything will fall into place.’
The range of university support services available
Universities offer a range of support services for international students, says Ms Shrestha. There are health and well-being services and the academic support unit provides help for students struggling academically, with one-to-one and group support from personal tutors.
Students may also need support with barriers related to language. While they will have passed the exams for the expected standard of English, regional accents, idioms and terms used in healthcare can all prove tricky.
The RCN has a guide to common English expressions often used in healthcare but that may be baffling to students from overseas, such as ‘a clean bill of health’, ‘we will cross that bridge when we come to it’ and ‘fit as a fiddle’.
Nuances in how people from different cultures and contexts communicate
Dr Alegado says communication is heavily rooted in culture, and there are nuances in how people from different cultures and contexts communicate, with some aspects lost in translation. ‘Not only in verbal or written communication but also in learning or adapting non-verbal cues, like gestures, body language, tone and delivery,’ he says.
‘Understanding British-specific slang, accents and distinct terminologies, as well as effectively communicating with patients and multidisciplinary teams, can be especially challenging.’
Linguistic barriers can be a source of misunderstanding and discrimination. Dr Alegado says: ‘As an internationally educated nurse myself, I have experienced being ridiculed because of speaking my own language or saying things in a “weird” way.
‘There needs to be a tougher anti-racism and bullying strategy, both in their educational institutions and NHS practice placements.’
Being far from family and friends can lead to feelings of loneliness and isolation
International students may not always take up the help available at universities, for various reasons.
‘We find that international students don’t tend to access the services available,’ Ms Shrestha says. ‘Students may come from a culture where there is a very formal relationship between students and staff, so don’t want to come to us for help. I stress to them that as a personal tutor, I am here to provide pastoral as well as academic support, but they rarely come to see me.’
She has started sending individual invitations to students, reiterating that anything they tell her will be kept confidential. ‘I want to ensure that students feel safe that what they tell me will not leave the room, and encourage them to discuss issues at an earlier stage with me,’ she says.
Unsurprisingly after such a big move, students often feel homesick. Being far away from family and friends can lead to feelings of loneliness and isolation, which can take a heavy toll on mental health and well-being.
Encouraging students to integrate socially as well as educationally
One difficulty that the university is finding hard to overcome is how to encourage and support students across the cohort to integrate.
‘We want students to learn the UK culture, and for home and other international students to find out more about their culture’
Jyoti Shrestha, nursing lecturer at Swansea University
Ms Shrestha says: ‘Often students from different countries feel most comfortable staying with students from their own communities. This is fine, but it does prevent them integrating socially and educationally with other students, which is slightly concerning.
‘We want students to learn the UK culture, and for home and other international students to find out more about their culture.’
Dr Alegado says establishing peer support networks, organising cultural events and offering counselling services are crucial in tackling these challenges. Encouraging integration between home and international students brings benefits to all, he says.
‘Cultivating a culture of inclusivity and empathy among local students is vital in supporting international nursing students. Promoting cross-cultural interactions and mutual understanding can bring forth a supportive learning environment, where all students can feel they belong and are seen and valued while they are here in the UK.’