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NHS trusts have been struggling to recruit nurses, with the profession remaining on the Home Office’s ‘shortage occupation list’. Many trusts are now rushing to recruit from outside the European Union – including the Philippines and India. This article looks at the recruitment and induction processes at the Royal Surrey County NHS Foundation Trust in Guildford.

Overseas nurses have always played a significant role in the NHS. From the colonial days of the British Empire to the present day, recruitment from abroad has long helped the UK meet its demand for trained nurses.

But recently, trusts have struggled to bring in the nurses they need. In March, the Migration Advisory Committee recommended nursing remained on the Home Office’s ‘shortage occupation list’. Overseas nurses are now at the head of the queue to get the all-important certificate of sponsorship to work here.

Kevin Matthews Guteirrez: ‘Here nurses have a voice’

This has prompted a rush of trusts trying to recruit outside the European Union (EU) – principally from the Philippines and India.

The Royal Surrey County NHS Foundation Trust in Guildford has been recruiting from the Philippines for more than a year, as part of a multi-pronged approach that includes recruiting from the EU and the nearby University of Surrey. The trust has 116 nurses from the Philippines, 58 in possession of a Nursing and Midwifery Council (NMC) PIN number – the rest going through the painstaking process to be able to work in the UK. A further 88 are waiting to come across.

Band five intensive care nurse Kevin Matthews Guteirrez, pictured, arrived in the UK in November and completed the last stage of the NMC process in January, gaining his PIN number shortly after.

‘In the Philippines, healthcare practice is much more doctor driven,’ he says, explaining it was hard at home to take on additional responsibilities and gain autonomy. ‘Nurses don’t have the voice to say what they would like to do and our capacity is limited by what the doctors want us to do. Here we have a voice.’

Mr Matthews Guteirrez sees himself staying at the trust for up to ten years and enjoys the quieter pace of life in Guildford, after living in the Philippines’ capital Manila. ‘I miss my family and my friends, but it’s one of the sacrifices I’m willing to make to have the opportunity to do whatever I want to do,’ he says.

Once in the UK, there is a strict time limit for nurses to complete the NMC process. This meets the requirements of the ‘certificate of sponsorship’ scheme, which governs entry to the country.

Accordingly, the trust has reworked its approach to ensure it can be completed on time. The old system took longer, and involved nurses doing an overseas programme at a university.

‘The first cohort of overseas nurses we recruited, under the old system, arrived in February 2015 but only got their PIN numbers in January 2016,’ says the trust’s deputy director of nursing Jo Embleton. Now nurses can complete the UK end of the process within three months of arrival.

From day one, nurses are made to feel welcome, as they work towards getting registration and on to the wards. The first day is spent on sorting accommodation and setting up bank accounts – followed on the second day by a welcome celebration.

Overseas nurses then go through the induction process and work as healthcare assistants on band four initially, working towards their care certificate. There is a focus on ensuring they have the skills needed for the observed structured clinical examination (OSCE), the final part of the NMC process, in which the trust has a 100% pass rate. Once nurses have a PIN number (usually now within days of completing the OSCE) they are able to move to a band five role and enter a period of preceptorship.

‘This enables them to build up confidence,’ says Ms Embleton. ‘They have integrated very well into our nursing team.’

Guildford already has a small, thriving Filipino community, which helps newcomers feel welcome. The majority work at the hospital and were recruited in the early 2000s. Incredibly, 85% of the staff recruited then still work there, often moving to senior roles – the trust has overseas nurses working from band five to eight.

They have integrated very well into our nursing team

– Jo Embleton

Venson Nuevas, who came to the trust from the Philippines in 2002 and is now a practice development charge nurse, works with new arrivals helping them to adapt to a different environment and culture. ‘If they have any challenges they have my number,’ he says.

Working with five recent cohorts of Filipino nurses has also helped the trust refine its support to EU nurses. As the recruitment process is simpler, there can be an assumption EU nurses do not need any special treatment and can hit the ground running. However, they can need extra support to feel comfortable.

Overseas nurses from outside the European Economic Area have a multistage process to gain NMC registration and work as a nurse in the UK. Applicants need to take a two-stage test of competency.

Candidates must have an International English Language Test score of 7.0, have practised in a relevant field for at least 12 months after qualifying, and hold a current unrestricted registration in the country they qualified or practised in. They need to produce proof of identity, qualification and registration certificates, and other documents.

The first part of the NMC test of competence is a multiple choice test, usually sat in their home country. The pass rate is over 80 per cent, but candidates who fail twice then have to wait another six months to retake it.

After passing this test, the employer can apply for a restricted certificate of sponsorship to allow the nurse to work in the UK. Nursing is on the government’s ‘shortage occupation list’, which means nursing applicants are given priority for the limited number of certificates available.

At this point many candidates move to the UK taking up non-registered roles. Regulations allow them to work for just three months before sitting the second part of the test – an observed structured clinical examination administered at the University of Northampton. Pass rates for this are less than 50% for a first sitting, but the Royal Surrey County NHS Foundation Trust has achieved a 100% pass rate with the process. Following this, the NMC issues the nurse a PIN.

Practice development sister Alison Oram says: ‘We have now launched a new induction programme for EU nurses to support them.’ In the past, EU nurses would have been supernumerary on the wards for a two-week period. Now there is an extra week beforehand and the nurses are offered increased ongoing support, and a preceptorship programme. This is the same level of support as would be given to any newly qualified band five nurse.

Although all new recruits are required to have a high level of English, there can still be challenges around medical terminology, colloquialisms and nuances. The trust has worked with Guildford College to provide a bespoke English course for nurses.

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