Career advice

Overseas nurse recruitment: how to ease the transition for staff who are far from home

A nurturing approach from employers makes acclimatisation easier for new recruits

A nurturing approach from employers and colleagues makes acclimatisation easier for new nursing recruits

For Beverley Sawer, involving nurses in the process of recruiting colleagues from overseas is fundamental to any employers success.

As a nurse, youre able to give realistic and up-to-date feedback of what its like to work in our trust, says recruitment nurse Ms Sawer, who is also senior intern team lead at Barking, Havering and Redbridge University Hospitals NHS Trust.

You can answer lots of in-depth questions candidates might have. Its integral that nurses interview nurses.

Virtual interviews during the pandemic

A nurturing approach from employers and colleagues makes acclimatisation easier for new nursing recruits

Recruitment of nurses from overseas systems enriches the UK workforce but individuals’ transition to their new life needs to be supported by employers Picture: Neil O’Connor

For Beverley Sawer, involving nurses in the process of recruiting colleagues from overseas is fundamental to any employer’s success.

‘As a nurse, you’re able to give realistic and up-to-date feedback of what it’s like to work in our trust,’ says recruitment nurse Ms Sawer, who is also senior intern team lead at Barking, Havering and Redbridge University Hospitals NHS Trust.

‘You can answer lots of in-depth questions candidates might have. It’s integral that nurses interview nurses.’

Virtual interviews during the pandemic

Beverley Sawer

Ms Sawer has been involved in her trust’s international recruitment since it began looking overseas to recruit band 5 nurses two-and-a-half years ago, taking part in the first interviews in the Philippines in 2019.

Recruitment has continued on a virtual basis since the COVID-19 pandemic began, with more than 200 interviews happening with nurses in India, the Caribbean, and nine African countries, as well as the Philippines.

‘We have 311 nurses who have landed already, with around another 80 to come once interviews are completed,’ says Ms Sawer. ‘They are so happy to be interviewed and offered the chance to come to the UK.’

Initially, the trust had sought general medical and surgical nurses to plug staffing gaps at its two hospitals. More recently, it has been looking for nurses in critical care – recruiting 60 – along with paediatrics and stroke services.

The trust works with a company that carries out the initial advertising, vetting and shortlisting, providing candidate profiles before interviews take place and collecting references. The agency also organise the practicalities once someone is offered a position, including arranging visas and flights.

Support package to help overseas staff settle in

Making sure new recruits settle in and feel happy is paramount. ‘I think we have an amazing process here,’ says Ms Sawer. ‘We’ve built it from the ground up.’

Groups of 30 to 40 nurses arrive together and have free accommodation, often in four-bedroom flats with shared kitchens, for the first two months. They are provided with food that reflects their cultures and needs, including from local markets, alongside kitchen gadgets such as rice cookers, so they can prepare meals in a familiar way.

‘Homesickness is the biggest problem. New recruits can get low in mood, which is exacerbated at the moment by having to quarantine’

Beverley Sawer, senior intern lead, Barking, Havering and Redbridge University Hospitals NHS Trust

‘We give them absolutely everything they need,’ says Ms Sawer. ‘We’ve developed lists of what we need to buy. We love looking after them.’ Anyone without a laptop is given one on loan, so that during their period of quarantine, they can be introduced online to mandatory training and the objective structured clinical examination (OSCE) process – a competency test which overseas nurses are required to pass to register with the Nursing and Midwifery Council (NMC).

Each cohort has its own WhatsApp group and is given information about the area before their flight, plus a welcome pack, including details of local faith groups.

Support to settle in – advice for nurse employers

In February, NHS Employers published a briefing on international recruitment during COVID-19. This highlighted best practice examples of how trusts across the NHS have adapted, and has a section on pastoral care. Advice includes:

  • Involve existing staff from the same background to help new recruits feel welcome
  • Provide personal and consistent communication, especially in the first few days, to help alleviate anxieties
  • Create a handbook with the main points of contact
  • Provide a welcome hamper, including a SIM card and some familiar meal ingredients and treats

On-site induction, and reminders of home

Once out of isolation, the new recruits come into the trust for an induction day, visiting the various departments. The trust also arranges to open bank accounts for them, with each given a £500 advance on their salary.

Next, they meet the staff on the wards where they will be working, spending a couple of days there. Preparation for the OSCE then begins in earnest, with the expectation they will take their test around eight weeks after arriving in the UK. Currently around 95% pass first time.

‘Homesickness is the biggest problem,’ says Ms Sawer. ‘They can get low in mood, which is exacerbated at the moment by having to quarantine. But once they are out and about, we find it gets better.’

Gaining Nursing and Midwifery Council registration

Nurses who have qualified overseas may have to complete various exams before they can register with the Nursing and Midwifery Council (NMC). This includes demonstrating English language competence, which may involve passing the international English language test system (IELTS) or the occupational English test (OET).

Those who trained outside the EU or the EEA also have to complete an NMC test of competence, consisting of two parts: a computer-based test (CBT) and the objective structured clinical examination (OSCE).

Dedicated support team

To help resolve any difficulties quickly, the trust has an intern team, made up of Ms Sawer and four other experienced nurses and an allied healthcare professional. ‘We touch base with recruits regularly, asking if there is anything we can help with,’ says Ms Sawer.

‘It takes a couple of times of seeing us and then they will open up. It works very well.’ A survey carried out after the first couple of groups arrived showed that 99% were happy working for the trust.

The intern team also looks after the pastoral needs of those recruited in the UK – including newly registered nurses – with the aim of reducing attrition.

For Ms Sawer, international recruits have much more value than simply filling posts. ‘We have employed overseas nurses now from 14 different countries and they bring such a wealth of experience with them,’ she says.

‘Some have come from war-torn countries and what they have lived through is beyond anything we will ever know. They teach us things every day.’

Making a fresh start and finding acceptance in the UK

Angel Toledo

For Angel Toledo, leaving the Philippines to work at Barking, Havering and Redbridge University Hospitals NHS Trust has meant acceptance that she is transgender.

‘I experienced discrimination in the Philippines,’ says Ms Toledo, who arrived in the UK in January 2020 to take up a staff nurse post. ‘At an interview, I was told that my birth certificate said I was male, so I had to wear a male uniform and cut my hair short.

‘I didn’t understand why. Here I can be whatever I want and live as a woman. I look in the mirror and think “this is me”.’

Since working in the UK, she has begun to make links with others in the trust who are transgender, with her story shared as part of transgender visibility day. ‘It’s helped others to know there is acceptance,’ says Ms Toledo, who qualified as a nurse in 2013.

‘I met another transgender person who also came from the Philippines. She told me I was one of the reasons she applied here.’

Ms Toledo’s original motivation to move to the UK was to be able to afford to pay for medical treatment for her mother, who was diagnosed with breast cancer in 2019. Sadly, she died two months before Ms Toledo left to begin her new job on a trauma and orthopaedic surgical ward.

‘In the Philippines, we don’t have anything like the NHS,’ she says. ‘It can be a hard life every day. I wanted to be able to provide support for my family. But since my mum isn’t there anymore, it didn’t make sense to go back.

‘Life is better here. I can start anew.’

Overseas recruitment tailored to a critical care setting

As a small specialist hospital, Royal Papworth NHS Foundation Trust in Cambridge needed a bespoke solution to its international recruitment. In 2017, it tried to recruit alongside the much larger Addenbrooke’s Hospital, but the outcome was disappointing, with just four nurses arriving.

Adopting a different approach, it worked with two agencies to recruit nurses from India and the Philippines, and after interviewing around 70 nurses in early 2020, 18 were recruited for the hospital’s critical care unit. ‘We knew exactly what we wanted and set very stiff criteria,’ says lead nurse for recruitment and retention Cora McKeown.

‘These staff are giving everything up to come and work for us’

Lynn Roberts, head of resourcing, Royal Papworth NHS Foundation Trust

Candidates needed at least two years’ very recent experience of working in critical care. ‘Some may have worked in critical care but with only three beds,’ says Ms McKeown. ‘We have the potential for 60, so the difference would be a huge shock. Once the criteria were in place, we had a much stronger group.’

Unfortunately, the pandemic scuppered the original timetable. ‘The plan was that they would start coming from March through to about June 2020,’ says the trust’s head of resourcing Lynn Roberts. ‘Everything was looking great, then COVID-19 arrived and there was nothing we could do.’

The nurses eventually began to arrive in groups of six in October. ‘It’s been a big challenge for them as once they have their IELTS, they only have two years to take their OSCE. The clock is ticking,’ she says.

Creating a nurturing environment for foreign recruits

Arriving in small groups means the trust can give everyone a personal welcome, including a bespoke pack of information and a WhatsApp group for each cohort. ‘I feel responsible for them and want them to feel that someone is looking out for them,’ says Ms Roberts.

Cora McKeown

When they pass their OSCE, each nurse receives a hand-written congratulations card from the chief nurse. ‘It’s a simple gesture that doesn’t cost anything, but they are so proud to receive it,’ says Ms Roberts.

Both she and Ms McKeown see the initiative as a win-win. ‘They could go anywhere, so at every arrival I thank them for choosing us,’ says Ms Roberts. ‘They are giving everything up to come and work for us, and the feedback we have is that they feel they have chosen the right hospital.’

There is a real sense of gratitude from both sides, believes Ms McKeown. ‘In their minds, we’ve changed their lives for the better and given them an opening,’ she says. ‘The trust is renowned for giving nurses training, development and support so they can progress academically and in promotion terms – so in a way, we have.’


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