Trying to solve the nursing shortage has led one trust to develop a tailored programme to help nurses trained overseas to gain UK registration. Jackie Hulse and colleagues report

The shortage of trained nurses calls for increasingly imaginative solutions: one is to employ overseas trained nurses who are seeking to register with the UK Central Council for Nursing Midwifery and Health Visiting.

UKCC regulations on registration of overseas trained nurses make it clear that it is not essential to follow a structured course or programme, but rather to have a successful supervised experience in an appropriate setting. But there are no guidelines on how this should be done.

Since last summer, Mount Vernon and Watford Hospitals trust and Hertfordshire University have offered a structured programme for overseas nurses seeking to register (see box), with benefits for all concerned.

Participants have told us they value being part of a group that is working, learning and, in many cases, socialising together.

Their biggest challenge is to work in a new culture of healthcare delivery. Historically, such induction programmes were called 'adaptation courses'. While we prefer to call them 'supervised placement programmes', the notion of adapting to new roles and working practices is apt.

A CV might suggest that the nurse is an expert practitioner in a specialty, but it is vital to explore how they are used to working and their level of awareness of differences and challenges. Each is asked to write a brief 'day in the life' essay, describing a typical working day. This is more revealing than a CV and application form alone, ensuring that nurses are placed in the most suitable clinical area.

Most participants need to learn new skills and expand the scope of their roles, but this is not always so. One 'occupational health' nurse fresh from dealing with the trauma and drama of an isolated African mining community found accident and emergency rather quiet.

Many overseas nurses with experience outside large cities seem accustomed to working with minimal medical involvement and initially find their roles here quite restrictive.

Many are mature and long qualified, with invaluable experience, but they must be offered an appropriate placement to flourish. They cannot always be put in the area of greatest staff shortage - this is a longer-term investment rather than a quick-fix solution to the recruitment crisis.

Candidates who do not have English as a first language are required to pass the Cambridge test or the international English language test. All are offered a personal interview in which we can explore expectations and motivation, aspects that also contribute to success.

Human resources backing is vital to ensure candidates' entry status is clear and that advice is given to those needing work permits once the course is completed. A robust employment contract allows for regular performance review, as participants are sometimes unable to settle and prove unsuitable for UKCC registration. Several participants (and their families) make great sacrifices to pursue registration here, and there is a pastoral component in the management of the programme.

Participants are asked to undertake assessments in drug administration and management of care, and to compile a reflective diary which focuses on meeting the competencies required by the Department of Health.

1The latter is the most valuable assessment tool as it encourages individual and group exploration of the new roles and situations participants are encountering, while allowing them to transfer their existing skills and knowledge.

Preparation of all ward staff, particularly assessors, is vital if participants are to gain the support and guidance they need.

At Mount Vernon the cost works out at about£1,250 a course, with a maximum of 12 participants. Around 34 nurses have been through the programme, including 12 applicants from another trust. There is a waiting list and we are receiving enquiries from nursing homes as well as hospitals.

Most of the successful participants plan to settle in the UK, with 60 to 70 per cent staying on in the units where they did their placements. These nurses will form a valuable part of the workforce for the future.


1 Department of Health. Nurses, midwives and health visitors. Rules Approved Order No 873, Rule 18(1).

Localtime: the supervised placement programme

The course takes seven days, and consists of an induction day, two or three days' specialist English tuition, introduction to local policies and procedures and trust-approved training in resuscitation, moving and handling, fire procedures and health and safety.

Participants then start clinical placements and attend a weekly study day. Most valuable has been reflective time for teachers and participants to discuss the week's activities and identify any difficulties early.

There is a period of supervised practice, tailored to the individual. Unless particular difficulties arise, people should not spend more than six months preparing to register.