How long does an internationally educated nurse or midwife remain one? Does the term ever expire? How long will that label be ascribed to me and my colleagues who emigrated from low- and middle-income countries (LMICs) to work in high-income countries (HICs)?
These were the questions posed to me by a nurse who was trained outside the UK and has been working in the UK for over five years. I interviewed her recently during a webinar on nurse and midwife migration and exploitation.
“Many continue to be described as IENs/IEMs many more years after working in the UK”
The terms internationally educated nurse (IEN)/internationally educated midwife (IEM) refer to a nurse/midwife who has received their nursing or midwifery education and training in a country other than the one in which they are seeking registration and/or employment as a nurse or midwife.
It emerged as a descriptive term to differentiate nurses and midwives who were trained abroad from those educated domestically.
Many countries have diverse healthcare workforces, recognising the globalisation of healthcare, increased mobility of healthcare professionals, and the demand for nurses and midwives in countries facing nursing and/or midwifery shortages.
The term has become commonplace in countries like the US, Canada and the UK where there is a significant reliance on foreign-educated nurses to fill gaps in the healthcare workforce.
It is recognised that nurses and midwives who trained abroad can bring valuable skills and experiences to the healthcare system but also need to meet certain criteria to ensure patient safety and the delivery of high-quality care in the host country.
These countries often have specific regulatory processes and requirements for IENs/IEMs to ensure they meet the necessary standards and qualifications to practise nursing and midwifery safely and effectively.
The length of time IENs and IEMs takes to become fully registered with the Nursing and Midwifery Council (NMC) and integrated into the nursing and midwifery workforce in the UK varies.
The NMC requires applicants who trained outside the UK to demonstrate that they are capable of practising safely and effectively, taking into account their qualification, training and experience. They must also demonstrate they have the necessary knowledge of English to communicate effectively.
Once registered, with the right induction and preceptorship, pastoral and educational support, clinical supervision, and continuous professional development, most IEN/IEMs assimilate into the UK healthcare system and complete the entire process within three months to two years.
Despite this, many continue to be described as IENs/IEMs many more years after working in the UK, even beyond five years.
When should a nurse/midwife no longer referred to as an internationally educated nurse or midwife? Is originally being an IEN/IEM a permanent part of their identity?
The nurse who posed the above questions is a very experienced one. She had 10 years post qualification experience in her home country, an expert in infection prevention and control, who assisted with managing the Ebola crisis in West Africa, provided specialist nursing care as a senior nurse and worked as a healthcare manager before relocating to the UK.
She has worked as a nurse in the UK for over five years having passed her OSCEs within three months of arriving in England and completed her NMC registration within six months.
“When should a nurse/midwife no longer referred to as an internationally educated nurse or midwife?”
I do not have answers posed to the questions above. However, I believe the same approach used for newly registered nurses (NRN) and newly qualified midwives (NQMs) should be adopted for IENs and IEMs.
The term newly registered/qualified nurse or midwife typically applies to nurses/midwives in the early stages of their nursing/midwifery careers, and the duration of this period can vary depending on multiple factors, including the healthcare setting, the nurse/midwife’s clinical competence, and the presence of formal orientation and preceptorship programmes.
Most NRNs/NQMs complete their preceptorship programmes within 12 months and are often no longer described as newly registered or qualified after two years. I think it is time to redefine the terms ‘IENs’ and ‘IEMs’.
They need to include a time-frame to prevent the potential stigma and labelling of nursing and midwifery colleagues who trained outside the UK, and have integrated into the health and social care workforce.
I implore the nation’s most senior nursing and midwifery leaders and our regulator, the NMC, to consider doing this.
Ruth Oshikanlu is a nurse entrepreneur and executive director of Goal Mind and Abule CIC. She is a Coach on the NHS Looking After You Too programme