Newly-registered nurses and midwives who were educated overseas face racism and discrimination that they had not anticipated prior to arriving in the UK, according to the Nursing and Midwifery Council (NMC).
The regulator’s first annual Spotlight on nursing and midwifery report finds that many newly-registered nurses and midwives experienced abuse and discrimination from members of the public as well as colleagues, with some suggesting that fellow professionals undermine their authority and undervalue their skills and experience.
Those who were educated outside of the UK said they experienced explicitly racist and derogatory comments, gossiping and being talked about behind their backs, and not feeling able to trust their colleagues to be supportive or keep matters they raised confidential.
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Some described crying at the end of shifts, losing weight, and being resigned to “that just being how things are here”.
Andrea Sutcliffe, NMC chief executive said: “There are more than 788,000 professionals on our register, whose knowledge and skill are vital to all our health and wellbeing.
“But on the rare occasions that care goes wrong, it’s often down to common factors getting in the way of the safe, effective and kind care people have a right to receive.
“We’re shining a light on those factors, including further evidence of racism and discrimination. We’ve spoken to some international recruits who have shared troubling stories about their formative months in UK practice. Supporting every professional to thrive is key to retention of staff, and to ensuring high-quality care for people.”
One in six internationally educated professionals had not received a preceptorship – a period of structured transition to guide and support new professionals to work autonomously. Half had an induction shorter than one month and just under one in ten had no induction at all.
Those who did not receive a preceptorship generally felt it would have aided their understanding of ways of working in the UK, and would have helped build their confidence and competence about practising in another country.
The report also identified signs of poor working cultures in midwifery, including midwives failing to escalate concerns and poor communication between colleagues and difficulties with inter-professional working.
The findings on midwifery echoed some of the cultural issues outlined in the Ockenden Review into maternity services at Shrewsbury and Telford Hospital NHS Trust.
Overall, the number of nurses and midwives leaving the profession within the first five years of registration has fallen since 2018, but internationally-educated professionals make up a great proportion of those leaving during this period and the number is increasing each year.
However, when nurses and midwives educated overseas were asked about their career intentions, 33% said they would look to stay indefinitely and 21% wanted to stay for more than five years.
Sutcliffe said: “New starters across the professions aren’t always getting the standard of support they need to feel confident in their roles. And in maternity care, there are more signs that workplace cultures aren’t always supporting midwives to escalate concerns or communicate effectively with women and families.”
Birte Harlev-Lam, executive director midwife at the Royal College of Midwives (RCM), said: “No health professional goes to work to do a bad job and we must all act when workplace cultures stop safe and high-quality care from happening. Crucial to this is supporting staff early in their careers and those from overseas. They should not face racism or discrimination from anyone, especially their colleagues, and when this does happen, we must root it out.
“The RCM – along with other organisations – is at the forefront of efforts to tackle these issues and drive change in our maternity services; so that staff can deliver the high-quality care they aspire to, and so that women and families get the care they rightly should expect and deserve.”
The Royal College of Nursing’s chief nursing officer, Nicola Ranger, said: “It is completely unacceptable that any internationally educated nurse would face abuse, racism and discrimination and all organisations need to work together to do more to protect staff.
“It is very concerning that newly qualified nurses feel unsupported and pressurised to provide care above their skill level. Early career nurses require greater support, and we must listen to their concerns and develop initiatives to improve the situation.
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“This report by the NMC is also further evidence that the government must act on our call for regulated safe staffing levels as this is essential for the retention of nurses – two-thirds of nurses trained in the UK found staffing levels worse than expected and that statistic must act as a wakeup call.”
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