Want to work as a nurse in the UK? Here’s what you need to know
Advice on employment contracts, language tests and money issues for nurses hoping to leave their home countries to practise in the UK
- Nurses educated overseas are an essential part of the UK’s nursing workforce, and the NHS and social care sectors offer attractive career opportunities to nurses recruited from other nations
- Read practical tips to help you understand what to expect and the steps to take to ensure your move is as smooth as possible
- Advice from nurses who have come to the UK to work – what they have learned about settling in and how their careers are advancing
In 2019, Sybil Rodrigues left behind her family and friends in India and came to the UK to work as a band five nurse on a surgical ward in an East Midlands trust.
‘I travelled here on my own. It took a lot of courage, but I was mentally prepared to face a new challenge,’ she says.
Growing number of nurses making the move
Now in her first year of training to be an advanced nurse practitioner, she says: ‘Working as a nurse in the UK was a dream of mine – and it’s where I’ve found huge professional rewards and job satisfaction.’
For internationally educated nurses like Ms Rodrigues, nursing in the UK opens up many opportunities to further their careers and to develop a greater range of proficiencies. And a growing number are making that move.
According to the Nursing and Midwifery Council (NMC), between April 2021 and March 2022, a total of 23,444 people who trained outside the UK joined its register for the first time – 13,482 more than in the previous year. Almost half (42%) trained in India and a quarter (25%) in the Philippines.
Why nurses come to the UK
Nurses are drawn to work in the UK for many reasons.
‘The UK is seen as a desirable country in which to work and live’, while the NHS is seen as ‘a very good employer, with world-class facilities, educational support, and diverse career pathways’, says Queen’s Nursing Institute (QNI) project manager Agnes Fanning.
‘More is now being done by NHS employers to give proper value to the qualifications and experience of overseas nurses, and to recognise their skills and potential to progress.’
Internationally educated nurses may also want to provide a better quality of life for themselves and their children, says British Indian Nurses Association (BINA) co-founder Suresh Packiam.
But along with the high hopes and positive expectations for UK working, there can be difficulties. Racism can be an issue. A major inequalities review found that international nurses described feeling distressed, confused and humiliated because of ‘the covert and overt discrimination’ they experienced in the NHS .
There has also been the practice of rogue employers trying to impose unfair fees on recruits from overseas to prevent them from leaving, an issue now being addressed by the government’s updated code of practice.
‘Ensure the agency you are dealing with is legitimate and ethical. Search their details, or speak to nurses who have had experience of using these agencies, or to organisations like us’
Paulette Lewis is president of the Caribbean Nurses and Midwives Association (UK)
And some overseas nurses have been trapped in contracts that make them liable to pay thousands of pounds if they try to move jobs, with some employers frightening people with threats of deportation.
To help ensure that the process of moving to work in the UK is safe and fair, the Department of Health and Social Care (DHSC) has issued new guidance with information about what people should expect when applying for work.
How to choose an ethical recruitment agency
The two main ways nurses are recruited to the UK are directly by an employer and via a recruitment agency or organisation.
NHS Employers has an ethical recruiters list of recruiting organisations in the UK and overseas that agree to act in accordance with the code of practice for international recruitment.
Paulette Lewis, president of the Caribbean Nurses and Midwives Association (UK), which provides support to its members, says: ‘Ensure the agency you are dealing with is legitimate and ethical. Search their details, or speak to nurses who have had experience of using these agencies, or to organisations like us.’
Crucially, no agency should take money from nurses to find them work in the UK, in fact this is illegal under UK law.
The DHSC advises nurses to be beware scams and job offers that sound too good to be true, for example, being offered a position with no experience needed.
Look out for employment scams, and other tips to protect you
- Check that a recruitment agency you are considering using is on the NHS Employers ethical recruiters list. Agencies on this list have signed up to act in line with a code of practice
- Beware of scams and job offers that sound too good to be true
- Do not pay an agency any money to find you work in the UK – this is illegal under UK law
- Before accepting a job and travelling to the UK, make sure you get a job offer letter from your employer that details the salary, hours, location and any repayment clauses
- Check that the job offer includes a reasonable salary for the skills and experience you are providing. The RCN has information on 2022-23 pay in the NHS
- Check with the employer what pastoral support it will provide
- Join a trade union or international nurses’ organisation. They can support in many ways, including employment and immigration advice, providing access to legal services and other professional services
English language tests and offers of employment
Employers should give nurses a letter that details the salary, hours, location, and any repayment clauses, before the individual accepts a job and travels to the UK.
‘Nurses need to read their employment offer closely,’ advises Mr Packiam.
They should check the cost of any repayment clause in their contract – the amount of money they will have to pay back to their employer if they leave their job within a certain period. And no nurse should feel under pressure to sign a contract until they are comfortable with what is included in it, the DHSC guidance states.
To work in the UK, nurses coming from overseas will need to meet the NMC’s English language requirements. The NMC accepts two different tests: the International English Language Test System (IELTS) and the Occupational English Test (OET).
‘Working as a nurse in the UK, you will need to learn new skills and it can feel like being a student again. You also need to prepare for a culture shock’
Naveen Karpur, nurse from India who works in Hampshire
From 2023, the NMC is changing the rules so that an IELTS 6 or an OET C in writing would not disqualify the applicant from being able to combine test results. Previously, to combine scores, an applicant had to retake their test within six months of the first test, but this period has been extended to 12 months.
The NMC is also relaxing the rules to allow a dispensation from passing the test for those who have trained and been assessed in English in a country where English is not the majority language, or for those who narrowly fail the test.
Exploitation of foreign nurses: spot the signs
RCN regional director for the south west region and internationally educated nurse Lucy Muchina says: ‘We have to ensure nurses’ recruitment is done in an ethical manner – to avoid them being taken advantage of.’
She advises nurses look at information available from organisations representing international nurses, and the RCN.
Nurses should be aware of the signs of exploitation, such as being forced to work under poor conditions, working excessive hours over prolonged periods, with no breaks or time off, and for little or no payment.
The Spot the Signs booklet has more information on exploitation.
Anyone who feels as if they are being exploited should seek help urgently from their union or diaspora group.
Financial considerations: how do I know whether my salary will be enough?
Finances are an important consideration for nurses moving to the UK.
Those working in the NHS will be paid in line with nationally agreed pay bands. Non-NHS jobs, for example in the private health or care home sectors, are not covered by these pay scales. However, all employers are bound by minimum wage law.
The cost of living in the UK varies between regions. ‘Rent in London is much more expensive than in the north of England,’ points out Mr Packiam.
A salary may seem high, but things cost more in the UK compared with many other countries and nurses should consider living costs including rent, council tax and utility bills. Employers can help by providing information on typical living costs in their area.
My advice to other nurses hoping to practise in the UK
Naveen Karpur is a nurse from India, working in the UK. He has a band 5 role in an intensive care unit in Hampshire. He writes:
‘I completed my degree in nursing in 2009 in India, and in 2011 went to Nottingham University for a year to do a master’s in advanced nursing practice.
‘In 2019, I returned to the UK to work in adult nursing at a hospital in Hampshire. The easiest way to apply for a post was through an agency – their staff were the bridge between me as a candidate and the employer. I sent them my CV and they organised my interviews, which were via Zoom. When I received a job offer, they guided me through all the paperwork and formalities, such as my visa.
‘My sponsorship letter from my new UK employer included details of my salary, what my day-to-day living expenses might be, that my flights would be paid for by the trust, and that I’d have accommodation for three months, after which I’d need to find my own.
‘I arrived as part of a group of 15 nurses from India and the Philippines – it was comforting that I wasn’t alone.
‘I had one month of training preparation for the Objective Structured Clinical Examination (OSCE), including training simulations and mock exams, which helped me feel more confident when taking the final exam.
Be prepared for change and remember, support is available
‘Working as a nurse in the UK you will need to learn new skills and it can feel like being a student again. You also need to prepare for a culture shock. There’s the weather – you can have four seasons in one day here – and the different way of living.
‘My advice for newcomers to the UK is to identify your strengths and work on them. If you feel you are having any problems, discuss them with your line manager or senior colleagues because they are there to help you.
‘And join an association such as British Indian Nurses Association (BINA), and a union. I’m a member of BINA and the RCN – as nursing organisations are always there to support you.’
Immigration and regulatory processes
Most health and social care professionals coming to work in the UK do so on a health and care worker visa.
Nurses will be given a certificate of sponsorship by their employer – their sponsor – which they need to apply for their visa. They must make the visa application within three months of receiving their certificate, and before they leave their home country.
‘Some days will be challenging, and you’ll need to learn to leave your comfort zone. But there are many pathways to progress your career. So live your dreams’
Sybil Rodrigues, nurse from India working in the East Midlands and taking an advanced nurse practitioner programme
Threats of deportation by employers are unacceptable – employers do not have this power. Nurses must tell the Home Office if their employer stops sponsoring them. It is the Home Office that will decide whether to cancel the visa or not.
Partners and children may be eligible to join nurses in the UK if they meet certain conditions.
Nurses will also need to take Objective Structured Clinical Examination (OSCE) training to register with the NMC. They have to sit their first OSCE examination within 12 weeks of arriving in the UK, and must pass the OSCE and get their NMC registration PIN within eight months of the start of their health and care worker visa.
Applicants for health and care visas no longer have to the immigration health surcharge, which covers them and their dependants’ healthcare costs. Any overseas nurses who have paid immigration health surcharges on or after 31 March 2020 are eligible for refunds.
Pastoral support, induction, and learning to thrive as a nurse in the UK
The package of support provided to nurses will differ by employer and may include relocation costs such as flights and accommodation.
For example, Royal Surrey NHS Foundation Trust senior practice development sister and preceptorship lead Alison Oram says her trust runs a bespoke three-week training and support programme for internationally educated nurses.
‘Our programme is designed to help nurses prepare for the OSCE exam, and to showcase their knowledge and experience. It also focuses on introducing them to the NHS structure, and incorporates a lot of cultural adaptation.’
Chelsea and Westminster Hospital NHS Foundation Trust lead nurse for workforce Aibhin Burke says support is crucial to the retention of nurses, not only until they have settled in and obtained their PIN, but throughout their career.
‘Our international nurse committee meets every six weeks. We also have a pastoral care facilitator nurse who provides additional support to international nurses.’
The trust also runs a buddy system, in which the nurse is partnered with someone from their home country, to give them support, adds Ms Burke.
Support from a union or professional association
Trade unions and professional associations can support nurses in various ways, including employment and immigration advice, providing access to legal and other professional services.
‘All internationally educated nurses coming to the UK need to join a union that can represent and advise them,’ adds Paulette Lewis of Caribbean Nurses and Midwives Association (UK). ‘It’s also important for them to be part of a diaspora association like ours, that can listen to any issues they might have.’
Self-belief is a key ingredient too.
‘Some days will be challenging, and you’ll need to learn to leave your comfort zone’, says Ms Rodrigues. ‘But there are many pathways you can take to progress your career. So live your dreams, and don’t let anything stop you from achieving them.’
Further information
- Department of Health and Social Care (2022) Code of practice for the international recruitment of health and social care personnel in England
- NHS Employers (2023) Ethical recruiters list
- Nursing and Midwifery Council (2023) English language requirements
- GOV.UK – Health and care worker visa
- Gangmasters & Labour Abuse Authority – Spot the Signs booklet