Policy Projects

The Florence Nightingale Foundation is leading a policy and research project exploring how the UK can better retain, develop, and learn from internationally educated nurses and midwives (IENMs).

While political focus has shifted away from international recruitment, tens of thousands of IENMs already work in the UK – yet too many leave the Nursing and Midwifery Council register prematurely. We want to understand why, and develop practical, evidence-based solutions to: Improve retention and career progression; Unlock leadership potential; and Strengthen global learning and connections.

Our work will be solutions-focused, shining a light on what is already working well to support internationally educated nurses and midwives. By showcasing success stories and learning from positive experiences, we aim to co-create practical changes that make a real difference. This will be done in partnership with IENMs, employers, regulators, diaspora groups, and policymakers — ensuring that the voices and expertise of those most affected are at the heart of the project.

There will be a webinar to launch the project and find out more on 23 October, exclusive to FNF members, alumni and scholars (recording will be available afterwards).

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FNF has published its third national Preceptorship Pulse Check survey findings, delivering a timely insight into the experiences of nurses and midwives at a key point in their careers: the transition from education to professional practice.

Building on earlier surveys conducted in partnership with the Nursing Times and UNISON, this report brings together perspectives from four key groups: students, newly registered nurses and midwives, preceptors, and preceptorship leads and champions.

This latest survey reveals encouraging signs of progress—with 91% of newly registered nurses and midwives now being offered a preceptorship programme, up from just 61% in 2021/22. The report also underscores the importance of preceptorship in staff retention: 74% of new registrants say the quality of their preceptorship influenced their decision to stay with or leave their organisation.

Yet, the report also highlights significant variation in quality, access, and support. For example, internationally educated new registrants are 13% less likely to be offered preceptorship.

The FNF Policy and Influence Think Tank has carried out a number of consultations to bring the nursing and midwifery voice to the big health and care issues of the day. We do this by engaging with and convening our Members and the wider FNF community to get your expertise and experience. We use the expertise of our Policy team to then review and evaluate the findings to submit an FNF organisational response. Together we can shape the health and care policy agenda.

Examples of recent consultation responses are the UK government’s Change NHS consultation and the Department of Health and Social Care consultation on options for regulating NHS managers and leaders  in England, and on the possibility of introducing a professional duty of candour for NHS managers in England.

NHS England has appointed the Chartered Management Institute (CMI) to lead a project with FNF and the Faculty of Medical Leadership & Management (FMLM) to create a new NHS Management and Leadership Framework.

The new multi-disciplinary framework will provide clear expectations of managers and leaders working across the service. A Code of Practice for all NHS and social care managers and leaders will also be developed through this work.

Practice learning is a requirement for students wishing to become nurses, nursing associates and midwives in the United Kingdom. The Nursing and Midwifery Council (NMC) commissioned the Nuffield Trust, in collaboration with FNF, to undertake some research on practice learning. The research is intended to support the NMC’s aim to recognise and acknowledge innovation, and ensure that their requirements continue to equip students with the knowledge and skills to deliver the best possible care for people across a diverse range of care settings.

The main output from the work is an independent report, completed in December 2024. This revealed highly varied learning experiences and supervision, and calls for action to ensure high quality education.

The report examined the evidence relating to regulations and standards around students’ practice learning. It investigated how well NMC requirements are being implemented, and the challenges in providing optimal practice learning placements for the next generation of nurses, midwives and nursing associates.

This briefing reports on a project FNF undertook to answer the following questions:

• What are the current challenges and barriers faced by clinical educators in gaining
  recognition and status within the healthcare workforce?
• What strategies can be implemented to better support the clinical educator workforce to
  ensure their contributions are valued and recognised?
• How can the professional development of clinical educators be enhanced and supported?

To answer these questions, we undertook extensive consultation, including with FNF’s Clinical Education Improvement Fellows (CEIF). The CEIF programme was a two year initiative aimed at driving innovation and quality improvement in clinical education within local systems. Funded by Health Education England South-East, the programme was delivered in partnership between FNF and Canterbury Christchurch University.

The Nursing and Midwifery Council (NMC) commissioned FNF to undertake a programme of research to inform its future decision-making regarding additional regulation for advanced practice and its possible impact on internationally educated nurses and midwives (IENMs) on the NMC register. In particular, the NMC is interested in understanding what is known about advanced practice in the countries where the UK primarily recruits from and the extent to which IENMs on the NMC register use their experience of advanced practice gained outside of the UK.

The findings in the initial paper were primarily intended to inform planned primary data collection exercises with IENMs on the NMC register. The findings presented here and then via extensive primary data collection activity were then combined to form a single report to inform the wider NMC advanced practice review.

Click here to read the full report.

The Student Councils programme, funded by Health Education England (HEE) South East, was a two-year initiative aimed at incorporating student perspectives into the development of education and learning structures across the region. The funding was used to develop six multi- professional student councils, comprised of student nurses, trainee nursing associates, midwives, and AHPs across the six Integrated Care Systems (ICSs) in the region.

An evaluation report was published in January 2024.

A toolkit has since been developed to support organisations and individuals interested in this process. it is available exclusively to our Academy members on the member portal.

NHS England  (NHSE) convened the Acute Deterioration Board and a ‘Worry and Concern’ Task and Finish Group the latter a subgroup of the former. The issue of clinician, patient and family worry and concern was identified as a key priority for the Acute Deterioration Board, to understand and therefore improve the recognition and response to acute deterioration in patients in a range of settings, including learning disability, mental health, care homes and acute care settings. It aims to understand the barriers and enablers to escalate concerns that can affect outcomes for the patient.

FNF undertook a study to explore the influence of leadership, culture, and hierarchy on raising concerns relating to patient deterioration.

The study was published in the Journal of Patient Safety in July 2023.

Around 1 in 5 nurses in England leave NHS hospital and community services within their first two years on the NMC register3. There is a strong consensus that the first year after registration is a particularly challenging period for nurses and midwives. Preceptorship programmes provide structured starts and aim to provide support, guidance, and development to build confidence during this transition period.

To improve preceptorship, we partnered with the Nursing Times and UNISON to gather evidence about experiences of preceptorship for Newly Registered Nurses (NRNs) to advocate for change. Our campaign in 2021-22 directly contributed to the development and/or improvement of the 4 Country National preceptorship frameworks. We repeated the survey in January 2024 to continue building the evidence for high quality preceptorship for all. This showed that encouraging progress had been made since the initial survey but more still needs to be done.