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Recruiting overseas nurses 'may negatively impact quality of care'

Published 03/12/2015

Patients report that being treated by overseas nurses results in lower levels of satisfaction
Patients report that being treated by overseas nurses results in lower levels of satisfaction

Patients treated by nurses educated abroad are less likely to feel confident in the care they receive and report less satisfaction, according to a new study.

Experts behind the research - the first evidence of its kind - said recruiting more nurses from overseas instead of from the UK may "negatively impact quality of care".

For every 10% increase in the number of non-UK education nurses, there was a 12% decrease in the likelihood of patients across England rating their hospital good or excellent, the study found.

There was also a 13% drop in the odds of patients agreeing that they always had confidence and trust in nurses.

Patients in hospitals with more nurses trained abroad were also less likely to report being treated with respect and dignity.

Furthermore, they were less likely to say they got answers to their questions that were easy to understand, or to have the purpose of their medications explained.

The Government announced in October that nurses will be added to the Government's shortage occupation list on an interim basis.

This means nurses from outside the European Economic Area who apply to work in the UK will have their applications for nursing posts prioritised.

Health Secretary Jeremy Hunt said safe staffing across hospitals and care homes was "a crucial priority", but stressed the UK was "recruiting more home-grown nurses than ever".

The Royal College of Nursing (RCN) and Unison believe put students will be put off applying for nurse training in the UK after the Government pledged to replace bursaries with laons.

As of July, there were 29,629 nurses and midwives from the EU registered for work in the UK, and 66,329 from non-EEA countries.

In the new study, published in the journal BMJ Open, more than 12,000 patients from 46 hospitals completed a satisfaction survey, while almost 3,000 "bedside care" nurses completed a nurse survey.

The results showed that the percentage of non-UK educated nurses was "significantly" linked to how the patients, who were all aged over 66, felt about their care.

The experts concluded: "Use of non-UK educated nurses in English NHS hospitals is associated with lower patient satisfaction. Importing nurses from abroad to substitute for domestically-educated nurses may negatively impact quality of care."

The proportion of overseas nurses working in NHS trusts ranged from 1% to 52%. They were educated in the Philippines and India, as well as African and European countries.

Professor Anne Marie Rafferty, study co-author from King's College London, said: "Language differences, cultural expectations, and professional norms of different countries may all contribute to patients' perceptions and create challenges for rapid and effective decision-making for acutely ill hospitalised patients."

Professor Peter Griffiths, chair of health services research at the University of Southampton and a co-author of the study, said: "National workforce planning in England has failed to consistently deliver enough trained nurses to work in the NHS.

"Relying on bringing in large numbers of foreign educated nurses to make up the shortfall is not a simple solution and may not be effective. Foreign educated nurses clearly need more support than they currently receive to adapt to work in the UK."

NHS trusts have reportedly spent at least £2.5 million in the past two years recruiting nurses from Portugal, Spain and Romania, as well as from the Philippines and India, they added.

All applicants from outside the EEA must be able to show that they can communicate clearly and effectively in English through the International English Language Testing System.

From next year, European Union nurses who want to work in the UK will also be required to pass the test if they cannot prove they are proficient in using English.

A Department of Health spokeswoman said: "Overseas nurses are a crucial part of the NHS team but they must be highly qualified, demonstrate care and compassion and have good communication skills.

"The aim of our plans set out in the spending review is to increase the number of additional home-grown nurses we have in our hospitals - we expect 23,000 more by 2020."

Janet Davies, chief executive of the Royal College of Nursing, said: "Since its birth, the NHS has been enhanced by the contribution of overseas nurses.

"The Government's cuts led to a critical nursing shortage and foreign trained nurses are essential in maintaining safe staffing levels and providing the care our patients need."

A previous US study found higher mortality for patients in US hospitals that employed non-US educated nurses.

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