To All Concerned:
The Nursing and Midwifery
Council (NMC) has launched a consultation on new standards they have proposed
for registration of nurses trained outside the European Economic Area (EEA).
New standards that aim to streamline the process, avoid wasteful and expensive
bureaucracy and most importantly of all ensure nurses practicing in the UK
maintain the high standards the NMC expects and patients deserve is welcome.
Keep in mind, before
regulations that went into effect in 2007-2009 that included the requirement
that nurses come to the UK and take a pointless 20 day course before being
approved to work, the UK welcomed more than 2000 nurses a year. That number plummeted
to less than 400 immediately and has never recovered. This is why it’s
essential we speak out now. We need to create a system that maintains our
standards without unnecessarily deterring qualified nurses from working in the
UK.
However, the two alternate
plans they suggest are flawed and add to waste, expense and bureaucracy. We
urge you to read their proposals online, read our opinion and weigh in with
your comments to the NMC. Now is the time when you can have the most
significant impact in the formulation of policy and regulations that will
affect you, your work and the health care quality in the UK for many years to
come.
The NMC has two proposals.
The first option includes an English exam, three years of university training,
a board exam and an in-country clinical exam. The second option includes all of
those elements plus a period of supervised practice.
Here’s our opinion; we urge
you to share yours with the NMC. Links
to their website and further information can be found at the bottom.
*As mandated by the EU,
overseas nurses must have a minimum of a three-year degree in nursing.
*Nurses must demonstrate
competency in English; we fully support this. The NMC says all overseas nurses
must take an English competency exam. We believe those nurses who have earned
their degree in an English-speaking institution should be considered competent.
It is a waste of time and money – for example -- to ask an Australian nurse to
take an English proficiency exam. Keep in mind, all nurses will be taking a
board exam in English.
*We recommend overseas nurses
who did not earn their degree at an English-speaking institution take an
English language exam. However, the one and only test approved by the NMC has
standards set so high that most English-speaking, born and bred subjects of the
UK would fail it. The NMC requires a minimum of 7 (which is the equivalent to a
Masters degree) in all four areas of testing. We recommend either a minimum of
6.0 in the four categories or a 6.5 overall as a reasonable standard. This
would not constitute “lowering” standards but setting them at an appropriate,
high level.
*The NMC says nurses who meet
the training and English competency standards will be given a board exam in their
home country to demonstrate competency in nursing, including a clinical testing
component. We fully agree; this practice is in place in other countries and is
effective. The board exam should be robust and include critical thinking and
clinical scenarios. Since this test is administered in English, it’s also a de
facto English language competency exam.
*The NMC proposes a separate exam
on clinical testing to be done in the UK after nurses arrive but before they’re
cleared to practice. We strongly disagree. This is wasteful, hugely expensive
for the NMC, time-consuming, an operational nightmare and would be made
unnecessary by a properly designed board exam that was thorough and robust.
*The NMC proposes a period
of “supervised practice” – a period of many
months where nurses are forced to work below their skill level and hospitals
must squander precious man-hours and money. We strongly disagree. “Supervised
practice” is a wasteful, extremely expensive hurdle that has led to the
exploitation of overseas nurses. It fulfills no purpose and does not weed out
unfit nurses. Finally, “supervised practice” is a solution in search of a
problem. If it served any purpose, why doesn’t the UK require its own nurses to
undergo the same time-consuming and expensive process? We don’t recommend this
for doing so would not improve quality in any way and would do nothing but
encourage the exploitation of newly graduated UK nurses. All nurses require
orientation, whether they were trained in Sheffield or Sydney; this is already
provided by their employers and “supervised practice” is a redundant and
wasteful extension of what already occurs at every medical institution.
If you agree with us, it’s
essential you contact the NMC and let them know right now while your voice
matters most. You can email them directly below. You can cut and paste our
proposals above or put them into your own words. Just make sure you influence
the debate before these proposals are locked in stone and we have to live with
them and their potentially damaging effects on the UK health care system for
years to come.
THREE WAYS FOR YOU TO RESPOND
AND LET YOUR VOICE BE HEARD:
Write them to directly at:
NMC
Consultation on Overseas
Competency Test
23 Portland Place
London W1B 1PZ
Take their online survey about
the proposals:
(This is the least satisfying
because it limits you at certain key points to their flawed plans.)
The NMC Launches Consultation
link:
Now here’s the issue laid out
in more depth.
THE ISSUE: Nurses are trained
all over the world. The European Union has established standards for what it
considers qualified training in nursing. Since every country establishes credentials
in varying ways, the EU standards include requirements that many nurses in the
rest of the world do not exactly match. We know from long experience that the
nurses in highly developed countries have training equal to our own; indeed,
the UK has recently raised its degree requirement to match the standards set
before by other countries like Australia, Canada, New Zealand and the United
States.
What to do with the nurses
whose training measurements invariably do not match up exactly with EU
requirements?
THE NMC PROPOSED OPTIONS
As mandated by the EU, all
nurses must demonstrate a minimum of a three-year degree in nursing. The NMC
then states that those nurses must also pass an English competency test known
as an IELTS. Those nurses that achieve these standards will then proceed to the
following step.
The NMC offers two options
for consideration, both of which have flaws.
Option one includes what is
commonly understood as a board exam in their home country, a thorough testing
of the nurse’s competence to ensure they meet the same standards expected of
our entry level nurses who have just achieved their three year degree and are
ready to begin working. This would be followed by a clinical testing exam in
the UK.
Option two would include the
board exam in their home country, the clinical testing in the UK and a lengthy
period of supervised practice with standards set by the NMC.
OUR PROPOSAL
*As mandated by the EU, all
nurses must have achieved a minimum of a three-year degree in nursing.
* Nurses must demonstrate
competency in English; we fully support this. The NMC says all overseas nurses
must take an English competency exam. We believe those nurses who have earned
their degree in an English-speaking institution should be considered competent.
It is a waste of time and money – for example -- to ask an Australian nurse to
take an English proficiency exam. Keep in mind, all nurses will be taking a
board exam in English.
* We recommend overseas
nurses who did not earn their degree at an English-speaking institution take an
English language exam. However, the one and only test approved by the NMC has
standards set so high that most English-speaking, born and bred subjects of the
UK would fail it. The NMC requires a minimum of 7 (which is the equivalent to a
Masters degree) in all four areas of testing. We recommend either a minimum of
6.0 in the four categories or a 6.5 overall as a reasonable standard. This
would not constitute “lowering” standards but setting them at an appropriate,
high level.
* The NMC says nurses who
meet the training and English competency standards will be given a board exam
in their home country to demonstrate competency in nursing, including a
clinical testing component. We fully agree; this practice is in place in other
countries and is effective. The board exam should be robust and include
critical thinking and clinical scenarios. Since this test is administered in
English, it’s also a de facto English language competency exam.
* The NMC proposes a separate
exam on clinical testing to be done in the UK after nurses arrive but before
they’re cleared to practice. We strongly disagree. This is wasteful, hugely expensive
for the NMC, time-consuming, an operational nightmare and would be made
unnecessary by a properly designed board exam that was thorough and robust.
* The NMC proposes a period
of “supervised practice” – a period of
many months where nurses are forced to work below their skill level and
hospitals must squander precious man-hours and money. We strongly disagree.
“Supervised practice” is a wasteful, extremely expensive hurdle that has led to
the exploitation of overseas nurses. It fulfills no purpose and does not weed
out unfit nurses. Finally, “supervised practice” is a solution in search of a
problem. If it served any purpose, why doesn’t the UK require its own nurses to
undergo the same time-consuming and expensive process? We don’t recommend this for
doing so would not improve quality in any way and would do nothing but
encourage the exploitation of newly graduated UK nurses. All nurses require
orientation, whether they were trained in Sheffield or Sydney; this is already
provided by their employers and “supervised practice” is a redundant and
wasteful extension of what already occurs at every medical institution.
WHY THE NMC’S PROPOSALS ARE
FLAWED, ONEROUS, AND EXPENSIVE
The Board Exam – this is a
vital reform and long overdue. Other countries use a board exam to ascertain
incoming nurses meet their standards. It should be rigorous and thorough and
include critical thinking and clinical scenarios. Properly designed, it can and
will weed out any nurses whose training has been subpar and does not meet the
standards expected by highly developed nations, the NMC, the UK and the EU. We
applaud the NMC and trust that this exam – which will be administered in the
nurse’s home country and is a practical and reasonable step before coming to
the UK – will offer the quality control we all desire and expect.
The Clinical Testing – This
is proposed as a further test the nurses must take after coming to the UK and
before being certified to practice. Any good board exam will incorporate
clinical situations. Adding this step creates unnecessary expense and
bureaucracy. Asking for it to take place in the UK creates an almost
insurmountable bureaucratic hurdle.
Supervised Practice – this
proposal that all nurses undergo supervised practice for a lengthy period (suggestions
have ranged from six months to nine months) is unacceptable on many levels.
1.
Supervised
Practice is exceptionally expensive – we estimate that if 2000 nurses a year
underwent Supervised Practice, it would incur costs of tens of millions of
pounds a year. All estimates say the UK will be 50,000 nurses short in just a
few years time. So the number of nurses coming in and this expense this will
incur would rise dramatically.
2.
Supervised
Practice amounts to slave labor – fully trained nurses would be forced to work
as nursing assistants for an extended period of time, far underneath the skill
level for which they are trained. This is an opportunity for exploitation by
unscrupulous employers.
3.
Supervised
Practice does not improve quality or weed out poor nurses – Over time, we’ve
seen virtually every nurse that has entered Supervised Practice has “passed”
it, though saying they “passed” it implies some standards which do not exist.
It is merely a professional limbo that no new UK nursing graduate is asked to
undergo. It incurs huge costs in lost manpower, lost money and lost time; it
has no purpose, achieves no goal, fulfills no need.
Everyone’s goal is to
maintain the highest standards for health care. We should keep in mind that the
standard we are asking these nurses to meet is the same standard of a new UK
nursing graduate that is about to start their first day on the job.
All nurses must have a
minimum of a three-year degree in nursing. All nurses must demonstrate
competency in English, either by the fact that they have achieved that degree
in an English-speaking setting or by passing an English exam.
All nurses meeting these
requirements who do not meet the exact specifications laid out by the EEA must
then take a rigorous and thorough board exam. Those that pass the exam to the
NMC’s satisfaction will be certified as meeting our standards and qualified to
practice in the UK.
Like every UK nurse, they
will begin their jobs with an orientation, a meds test and then be supervised until the
hospital or other medical facility has used its judgment to determine they are
competent to fulfill their duties. Those decisions are best made by the
employer working directly with the nurse, whether that nurse was trained in
Manchester or Manila.
These responsibilities of the
employer would always be present. Therefore we shouldn’t fool ourselves into
thinking wasteful, expensive and time-consuming testing and “supervised
practice” achieve anything other than waste, expense and time-consumption.
A separate clinical test in
the UK would be pointless with a properly designed board exam. It would add
extraordinary expense and a bureaucratic hurdle few nurses would tackle.
Supervised practice achieves
absolutely nothing, encourages exploitation of overseas workers and was created
out of whole cloth without any need or express purpose. The simple fact that
new UK nursing graduates are not asked to undergo nine months of “supervised
practice” is enough to demonstrate its pointlessness. If it served any purpose (which
it does not) then every UK nurse who enters the workforce would undergo
supervised practice as well. That would achieve nothing other than to make them
ripe for exploitation as well by unscrupulous employers.
The two proposed options by
the NMC both contain major flaws. However, a board exam taken by nurses in
their home country is a “best practice” instituted by other countries around
the world. It is a valuable final test that can weed out nurses whose training
does not meet UK standards. It is a direct and meaningful way to ascertain that
nurses with training outside the EEA are competent to enter the workforce with
the same certification as new UK nursing graduates.
Employers are best placed to
provide the level or orientation, testing (such as the “meds” test required by
all UK hospitals) and supervision necessary for EVERY nurse, whether they were
trained in Stratford or Sydney.
A streamlined reform of the
overseas competency test that includes a minimum of a three year degree in
nursing, demonstration of competency in English (via the degree being achieved
in an English speaking institution or via an English exam) and the passing of a
thorough and rigorous board exam that includes critical thinking in clinical
situations will achieve the essential goal of ensuring the UK’s and EEA’s high
standards of training are met without inviting unnecessary bureaucracy,
wasteful testing, onerous expense or the exploitation of international nurses
via so-called “supervised practice.”
The NMC Launches Consultation
link:
More NMC Consultation
Information link:
The Full NMC “Overseas
Competency Test for United Kingdom Registration” Document link:
Three WAYS FOR YOU TO RESPOND
AND LET YOUR VOICE BE HEARD:
Take their online survey
about the proposals:
(This is the least satisfying
because it limits you at certain key points to their flawed plans.)
Write them to directly at:
NMC
Consultation on Overseas
Competency Test
23 Portland Place
London W1B 1PZ
Per the NMC: If you would
like further information about this consultation, or information in an
alternative format, please contact Anne Trotter by email:
Anne.Trotter@nmc-uk.org or telephone 020 7681 5779.
