Access provided by
London Metropolitan University
Racial diversity in senior nurse roles continues to elude the NHS, so it’s no surprise this inequality is affecting nurses recruited abroad
Nurses from minority ethnic backgrounds make up a large proportion of the UK workforce, but evidence shows they struggle to progress in their careers.
Nursing Standard. 37, 7, 29-30. doi: 10.7748/ns.37.7.29.s17
Published: 06 July 2022
The latest NHS Workforce Race Equality Standard (WRES) report shows that rather than improving, the situation is actually getting worse. And this certainly applies to those who trained overseas, many of whom were attracted to the UK by international recruitment campaigns.
In almost all trusts in England (98.6%), staff from a black or minority ethnic background were less likely to believe their employer provides equal opportunities for career progression or promotion compared to white staff. The report also reveals that the proportion of black or minority ethnic staff who believe they enjoy equal opportunities is falling – and at 69.2%, it has reached the lowest point since 2015.
Delegates at RCN congress last month backed a call to lobby employers to provide ethical and transparent HR recruitment and employment policies for international nurses.
This situation needs to change, says Florence Nightingale Foundation Academy director Gemma Stacey.
‘We now have substantial data over long periods of time from WRES that show this is a systemic and endemic issue,’ she says.
‘There’s no doubt in anyone’s mind this is something that needs action. When you look at the percentage of nurses from ethnic minorities working in the NHS, we’re one of the largest employers of people from diverse backgrounds. But the higher we go up the promotion ladder, the less representative we become. We have to address that.’
People from minority ethnic backgrounds, including those who have trained internationally, report particular barriers to career progression, she says. These include imposter syndrome – not believing they have a right to be in a particular role – and cultural differences, which mean staff are reluctant to speak up and draw attention to themselves, or do not perform best in interview situations.
Another hurdle is employers not recognising foreign nurses’ primary qualifications because their universities or level of experience are not accredited by UK ENIC – the UK National Information Centre for the recognition and evaluation of international qualifications and skills.
‘The higher we go up the promotion ladder, the less representative we become’
Gemma Stacey, Florence Nightingale Foundation Academy director
Nurses trained abroad can also be at a disadvantage when accessing postgraduate studies such as a master’s degree because they are usually classed as international students by UK universities, making them liable for higher fees.
With many senior nursing roles now requiring a qualification at master’s level, Professor Stacey says this is something that also needs to be addressed.
The Florence Nightingale Foundation runs leadership programmes and other initiatives designed to support nurses from minority ethnic backgrounds who want to progress. The Windrush Nurses and Midwives Leadership Programme is funded by Health Education England and offers bespoke leadership development for nurses and midwives from black, Asian or minority ethnic backgrounds at bands 4 to 7.
Places for staff in Scotland, Wales and Northern Ireland are funded by the Nursing and Midwifery Council (NMC).
The Florence Nightingale Foundation also runs the Mary Seacole Leadership Development Programme, which aims to address inequalities in health, particularly in minority ethnic communities.
Participants have conducted projects looking at how to improve the experience of internationally educated nurses, says Professor Stacey.
‘They’ve done things like teaching interview preparation skills or taking packages out to newly arrived international nurses to try to improve that feeling of belonging,’ she says. ‘We know that people only thrive when those very basic needs of feeling part of the community are being met.’
Leonie Brown describes the Windrush leadership programme as a lightbulb moment that gave her fantastic opportunities and transformed the way she thought about herself and her career.
Since completing the programme in 2020, she has taken on new roles and responsibilities in her trust, including a secondment as head of nursing for clinical services.
Ms Brown, pictured, who is charge nurse and education lead at the Rosehill Clinic, part of Epsom and St Helier University Hospitals NHS Trust, applied to take part in the programme because she was not progressing enough in her career.
‘I knew I had so much in me and I just felt stifled,’ she says. ‘The programme helped me to find out who I am – to appreciate myself, use my voice, and know that I am enough. After doing the programme I believed in myself more.’
Ms Brown, whose grandmother came to the UK from Jamaica on the Empire Windrush in the early 1950s and who trained as a nurse, particularly enjoyed the quality improvement elements of the programme. She was delighted when she was one of five participants chosen to present her quality improvement poster and it was named a winner.
She also enjoyed sessions with the Royal Academy of Dramatic Art.
‘The best thing about the programme is that the people really know what they’re doing,’ she says. ‘They know how to activate our belief system so we can be the best versions of ourselves.’
Having applied unsuccessfully for band 8a posts before going on the programme, she felt confident enough to apply for a band 8b secondment – and was successful. Although she decided she actually preferred her hands-on clinical role, she is keen to progress.
Ariel Lanada, president of the Filipino Nurses Association, knows how it feels to come to work and live in a strange country. He moved to the UK 20 years ago as part of an international recruitment drive.
Although he had been a chief nurse at home, he had to start work as a healthcare assistant and found the whole experience challenging.
‘I arrived in the UK in October and it was dark and cold. I was depressed for the first two months,’ he says. ‘The trust was very good at supporting me. The problem was when I had to go home to my accommodation. That’s when the homesickness and the loneliness kicked in.’
Despite having many years’ experience, it took six months for Mr Lanada to achieve registration with the NMC.
The process has now changed, with overseas-trained nurses who want to work in the UK having to complete a computer-based test and a practical objective structured clinical examination, which they can do within 6-8 weeks.
Although Mr Lanada welcomes the changes, he says internationally recruited nurses still face challenges in their career progression.
‘I know people who have been working at band 5 for nearly ten years. They have applied for band 6 posts several times but didn’t get the job,’ he says.
‘That’s one of the reasons we set up the Filipino Nurses Association – to help people with their career development and progression.’
Mr Lanada is a success story – having worked his way up from his initial band 3 post, he is now divisional lead for practice development and education at Oxford University Hospitals NHS Foundation Trust – a band 8d post.
He is one of only a handful of the estimated 40,000 Filipino nurses registered in the UK to reach a senior level.
Mr Lanada has been running interview skills courses for around six years and the Filipino Nurses Association recently received financial support from the small grants scheme – a partnership between the Florence Nightingale Foundation and NHS England and NHS Improvement, which awards between £5,000 and £12,500 to international nursing and midwifery associations to provide the support their members need.
Charge nurse Leonie Brown advises:
» Check out leadership programmes such as those offered by the Florence Nightingale Foundation
» Take up mentorship and other development opportunities run by your employer and professional organisation or union
» Connect with your international nursing association It may offer benefits and provide networking opportunities
» Approach senior colleagues and ask for their advice Even if they do not have the resources available to offer mentorship, they might be prepared to offer pointers
» Have a life outside work You will thrive best if you feel connected to the place you live
A spokesperson for NHS England and NHS Improvement said: ‘We are committed to ensuring the safe arrival, induction and well-being of our internationally-trained nurses through our close collaboration with international nursing and midwifery associations, our small grants scheme, the NHS Quality Pastoral Care Award and our Getting to Equity sponsorship programme, but we recognise there is more work to do to increase the number of [nurses from] minority ethnic backgrounds in senior roles.’
Exploited and lied to – how overseas nurses are mistreated in the NHS rcni.com/overseas-exploited