A comprehensive study released today by the Florence Nightingale Foundation FNF, and commissioned by the Nursing and Midwifery Council (NMC), shows that advanced nursing and midwifery talent is being lost within the health and social care system.
The report comes at a crucial time as the NMC develops approaches for the additional regulation of advanced practice (AP) for nurses and midwives. Findings show that internationally educated professionals struggle to have their expertise recognised, but regulatory changes could transform the landscape for nurses and midwives practising at an advanced level.
The research reveals that the health and social care system is missing opportunities to utilise its international talent: two-thirds of internationally educated nurses and midwives (IENMs) report that their AP experience goes unrecognised.
“I have previously done a master’s in nursing with modules in advanced leadership, advanced pathophysiology, research methods, curriculum design and documentation, dissertation, health assessment, and decision-making. Yet I am unable to use these as most advanced practice roles require a band experience and I have been unsuccessful in securing that so far. This is making me feel I am rusting away and not giving my best to patients and my trust.”
Nurse who obtained an AP qualification in the Philippines, now working in London
The study also uncovered significant barriers for IENMs interested in practising at an advanced level, including financial constraints (70 percent), a lack of knowledge about the pathway (61 percent), and workplace discrimination (23 percent).
However, there is also compelling evidence of success when the right support systems are in place. Among IENMs who completed UK advanced practice education, 66 percent reported positive experiences. The research identified several key enablers: strong employer support (cited by 82 percent of nursing and midwifery advanced practitioners who completed their education programmes), dedicated funding, and flexible training routes such as the innovative ePortfolio pathway (for professionals in England).
Key findings from the research:
- Two-thirds of internationally educated advanced practitioners reported that their UK employer does not or only slightly recognises their AP skills.
- More than 60 percent of nursing and midwifery professionals with international AP qualifications and/or roles describe a lack of opportunities in the UK to maintain their AP skills.
- Knowledge amongst IENMs in the UK about becoming an advanced practitioner is generally low, with significant confusion over its definition and access pathways.
- A quarter of those interested in pursuing AP roles felt hindered in accessing this opportunity due to their visa or immigration status.
- The majority of IENMs who obtained an AP qualification in the UK reported positive experiences and equal access to training opportunities.
- However, nearly a quarter who became advanced practitioners in the UK experienced workplace discrimination and bias during their education programmes.
- Key enablers for those who accessed AP education or roles in the UK included employer support and funding, flexible training routes and programmes, and credentialing.
Dr Lisa Plotkin, Head of Policy and Influence at FNF, said:
“This research reveals that while IENMs bring valuable AP experience to the UK health and care system, many face substantial challenges in having their expertise recognised and in accessing further training and career development opportunities. With the NHS increasingly reliant on international recruitment, it’s crucial that any future regulation of advanced practice creates clear, accessible pathways that recognise and build upon the valuable expertise these professionals bring. The good news is that our research clearly shows what works – supportive employers, flexible training routes, and proper recognition of prior learning consistently leads to successful outcomes.”
Next steps and recommendations
In light of the challenges, the study found strong support amongst IENMs (69 percent) for the NMC to take a stronger approach towards AP regulation. The report therefore recommends several actions:
- A consistent framework for assessing internationally acquired AP skills and experience, alongside flexible pathways to ensure international qualifications meet UK standards.
- Entry requirements for AP education programmes should be redesigned to focus on core competencies, with a review of language proficiency requirements to ensure appropriateness.
- Improving the transparency of qualification routes, including clear steps, timelines, and costs, and clarifying the responsibilities of universities and employers in supporting IENMs.
- Mentorship programmes and support networks should be implemented to support IENMs during their education. Ongoing professional development opportunities should be created to help IENMs maintain and update their AP skills, with cultural competence incorporated into any future AP framework.
- Employer guidelines should be developed to improve the experience of workplace integration for international AP professionals, and the implementation of anti-discrimination policies in health and care settings.
Sam Foster, Executive Nurse Director of Professional Practice at the NMC, said:
“Every day, nurses and midwives carry out complex, autonomous and expert roles which are vital to the health and wellbeing of people across the UK.
“Internationally educated professionals are crucial to delivering this care, and we welcome the Florence Nightingale Foundation’s report as we progress our ongoing review. These findings will help us to develop a model of advanced practice regulation that is supportive and fair for every nurse and midwife, wherever they were educated.
“We encourage employers and educators to use these recommendations to support internationally educated professionals on their advanced practice journeys. By working together, we can ensure these nurses and midwives can deliver the best possible care for the public, both now and in the future.”
The full report, which includes survey responses from over 1,500 IENMs and multiple focus groups, provides detailed insight into the experiences of IENMs at various stages of their advanced practice journey in the UK. Click here to read all the findings and recommendations.
For more information about the NMC’s review of advanced practice please visit: Advanced practice review – The Nursing and Midwifery Council
Lisa Plotkin discusses the research in depth with Paula McLaren, NMC Senior Advanced Practice Adviser, in this podcast.
