Between April and September 2022, 11,496 internationally educated nurses (IENs) registered with the NMC for the first time, which is 606 less than those domestically educated within the same timeframe [1]. To register, IENs must pass OSCEs and although globally assessed, there is no specific communication skills assessment [2]. A literature review identified challenges associated with integration into culturally different healthcare systems, most notably communication barriers; however, it found that with good support it is possible for IENs to achieve their full career potential [3].
To support local healthcare trusts and IENs, our organization designed a simulation-based educational programme to address the aforementioned barriers. To ensure a non-paternalistic approach, IENs lived experiences allowed the development of authentic, co-produced simulated scenarios. Actors were trained for the roles, and learning outcomes and debriefing processes were shared in advance. To assist participants with their skills, a model of communication was introduced, enabling them reference to a framework whilst participating and observing. Eight groups of six IENs have participated over eight months.
Thematic analysis identified themes in which IENs wanted to be upskilled, these were integrated into multi-faceted simulated scenarios:
Distressed relatives – IENs reported struggling setting appropriate boundaries and dealing with conflict with emotive relatives. Difficult conversations with patients – IENs felt ill equipped to communicate with challenging patients due to anxiety through language and cultural barriers leading to avoidance of engagement, further exacerbating the issues. Differing patient agenda – IENs struggled to manage patients who were not engaging with recommended multi-disciplinary interventions, due to a poor understanding of the MDT agenda. Hierarchical adjustment – IENs typically came from countries with a more established hierarchy and did not feel confident clarifying doctor’s decisions even if concerned.
Evaluation linked to the learning outcomes; a rating scale from 1 (no ability/confidence) to 5 (excellent ability/confidence). 48 IENs have undertaken this training and all report progression in ability and confidence, with ongoing applicability of their learning within the workplace.
The number of IENs is increasing within the NHS with recent records indicating NMC registrations being equal between domestic and internationally educated nursing staff. A repeatable simulation-based communication skills workshop has been developed based upon the lived experiences reported by IENs. Further deliveries are planned with subsequent quantitative and qualitative analysis.
Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.
1. Nursing and midwifery register grows and becomes more ethnically diverse - The Nursing and Midwifery Council [Internet].
2. Test of competence 2021 Nursing OSCE information booklet V1.6 [Internet]. [cited 2022 Oct 1]. Available from:
3. Pung LX., Goh YS. Challenges faced by international nurses when migrating: an integrative literature review. International Nursing Review. 2016 Aug 8;64(1):146–65.