I am writing in this issue about some key insight work from the Nursing and Midwifery Council (NMC) published this August. I am hopeful that this first ‘Spotlight’ report, which aims to support sector-wide learning and improvement for the benefit of people who receive care, is shared widely and provokes professional debate (NMC, 2023). We all need to consider what our personal professional response is, and how we will influence the teams in which we work to make the improvements that we really cannot deny are needed.
Alongside a powerful context landscape, the report focuses on three key areas:
- International professionals experiencing discrimination
- Inconsistent support for new recruits
- Recurring themes when maternity care goes wrong.
Although there is learning for nursing in all three areas, my focus for this piece is the first two. The recruitment of internationally educated nurses is no new thing. I have written, as have many, about the issues that are highlighted in this report, including colleagues' experiences of:
- Not feeling respected or treated the same as colleagues
- Racist and derogatory language
- Feeling misled during recruitment processes.
The ‘Spotlight’ report (NMC, 2023) states that discrimination exists in health and care, and there is evidence that it undermines the care that people receive.
My reflections are that we have got to move forward to action. We do not need any more diagnostics to share what we know. We know that racism is present in healthcare, and we need to take a stronger anti-racism stance.
I see a huge focus on supporting colleagues who are new to practising in the UK and feel that our responsibilities need to extend wider to any colleague who is experiencing discrimination. A nurse said to one of my colleagues last week: ‘When do you stop referring to me as an internationally educated nurse? I have practised here for 17 years …’
One example of work that I am progressing is the opportunity to proactively explore, alongside our advanced practice work, what employers can do to ensure that registrants who did not train in the UK experience equality in career progression.
The NMC (2020a) has published a Principles for Preceptorship guide to support employers. The ‘Spotlight’ research focused on the theme of inconsistent support for new recruits. Whereas the research affirmed that the benefits of a well delivered preceptorship programme were positive, it found that there is variance in delivery, resulting in only a minority of new professionals feeling highly satisfied with their preceptorship experience.
For me, there is a direct link with some of the context observations in the report, and again something I have previously written about – the need for senior leadership in clinical practice placements. In the report, there were examples of poor planning and oversight of placements, and students being deployed inappropriately as substitutes for qualified professionals. The report quoted a newly qualified nurse as saying (NMC, 2023):
‘There was a constant repetition of placement areas for me and many of my cohort. The placement team seemed unable to ensure a broad and balanced experience for students and were unwilling to look into this despite repeated requests from students and their personal tutors.’
Some spoke about a lack of support from employers, other professionals, or universities, which translated into hostile or unwelcoming working environments. Many colleagues felt alone and undervalued during their placements, and were more likely to be ‘unhappy and underconfident’ about their role and their ability to do well in it. In contrast, where placements worked well, the outcome was more positive.
Most newly registered professionals shared their intent to spend a good period of time in the profession. They shared a range of future career goals, including progressing in their current position up the bands; moving into a different field of specialism; and completing further education, which is where the opportunity for us all lies.
The main driver that led most nurses to join our profession was to deliver high-quality care and make a difference. This is becoming increasingly difficult in the current landscape, as outlined in the ‘Spotlight’ report, and the variation across the country seems to be increasing. To change this will take action from us all in various forms.
We all have opportunities to proactively deliver the actions that will make improvements in care delivery and the wellbeing of our profession and wider teams. The NMC has committed to action through our Ambitious for Change work (NMC, 2020b). We will also be taking a candid look at practice learning, and how the right actions taken now will support the delivery of the actions required for the future.