There is a current NHS policy to increase recruitment of internationally educated midwives. In this article Oluwaseyi Akinlaja, Consultant Midwife, The Princess Alexandra Hospital NHS Trust, Harlow, addresses some of the needs of these midwives, with guidance on how Trusts can help.
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Supporting international midwives
Shortage of nurses and midwives is a global challenge and not only in underdeveloped countries; as recent estimates suggest that there are nine million nurse and midwifery vacancies in developed countries (World Health Organisation, 2020a; World Health Organisation, 2020b). Hence, nurses, midwives, and health practitioners are leaving their home countries for other developed countries to work (Pressley, et. al., 2022). To manage service pressures during and after the COVID-19 pandemic, developed countries depended on the international recruitment of nurses (Buchan et al., 2022).
In the past four years, there has been a significant increase in the number of internationally educated nurses and midwives recruited into the United Kingdom (UK) from outside the European Economic Area (EEA) (NHS England). The ambition of the National Health Service (NHS) over the next 10 years is to identify ethical international recruitment as a workforce priority (NHS People Plan, 2020). Hence, international recruitment plays a pivotal role in growing the nursing and midwifery workforce to 40,000 by 2024 to provide efficient and safe service for the increased demand in healthcare and reduce the substantive vacancies levels, (NHS People Plan, 2020). Historically, internationally educated nurses (IENs) have been recruited to join the UK nursing workforce, however, the midwifery workforce only started recruiting international midwives (IEMs) recently, which shows the increased need to expand the nursing and midwifery workforce. Although, there is limited evidence on the lived experience of internationally educated midwives in the United Kingdom, nevertheless, the midwifery workforce have learnt from the nursing workforce in order to ensure the retention of the these midwives.
While international recruitment of nurses and midwives is considered a short-term solution to resolving the vacancy issues across the globe, there is an increased issue of retention of these employees as they are not satisfied (Roth et al., 2021). Between 2014 and 2019, the Nursing and Midwifery Council (NMC) recorded that 23,243 international recruits left the NMC register out of 39,164 international recruits that joined the register during the same period (Nursing and Midwifery Council, 2019). Therefore, it is very clear that international recruitment is not the only solution to resolve the vacancy issue but it is crucial to identify factors that can support successful acculturation and retention of international nurses and midwives for longer periods of time (Pressley, et. al., 2022). In view of the attrition rate of internationally educated nurses and midwives, the NMC is developing a new workshop for professionals and employers called ‘Welcome to the UK Workforce’. This workshop aims to provide positive regulatory relationship and raise awareness of the NMC’s role, improve retention of internationally recruited nurses and midwives and also prepare the practitioners for the cultural and ethical differences of working in the UK (NMC, 2022).
As promising as traveling to developed countries may seem, it is important to understand that some internally recruited nurses and midwives find it difficult to leave their loved ones, as some leave young children in the quest for greener pastures with the hope to work and migrating their families later. Therefore, welcoming them warmly into the country, Trust and community are crucial to their transitioning process. As practitioners are employed from various countries, they experience multidimensional challenges and barriers that affect their adjustment to a new environment and culture (Balante, Broek, and White, 2021). These may include support with professional development, ethnocultural components, pastoral support, socialising and cultural barriers (Balante, Broek, and White, 2021). Therefore, internationally-educated midwives (IEMs) may need considerable support in adapting to new social and healthcare environments (NHS England). According to Balante, Broek, and White, (2021), internationally educated midwives experience cultural displacement, language, and communication barriers, feeling like an outsider, and differences in midwifery practices from their home country.
Henceforth, it is important to make them feel welcomed, inclusive and supported across the board right from the recruitment process till they arrive and as they adapt into the system (organisation, community and country). In organisations recruiting internationally educated midwives, it is important to assign a designated practice development midwife that would ensure the safe arrival of these midwives, support with their accommodation, plan a robust induction programme that would ease their adaptation into the system and design a personalised learning and development depending on individual’s experience and country of origin as midwifery practice differs in each country.
After the completion of the Trust induction, it is important to commence the training and preparation for the OSCE (an objective structured clinical examination); this is an examination that ensure international midwives meet the Nursing and Midwifery Council standards for registration. Once the midwife has passed the OSCE, it is important to enrol them on the preceptorship programme and continue to provide pastoral support all through. Where necessary, it is important to also help them navigate within the organisation and also the country as they adapt to the cultural and social changes.
In addition, the health, wellness and wellbeing of these group of midwives is crucial as they adapt and settle into the organisation and country. Hence, it is the responsibility of every member of the workforce to warmly welcome, support and include them so they will not feel they are alone or like an outcast. Nonetheless, the importance of having pastoral and professional support for these midwives cannot be overemphasised as it could influence their experience and informs their decision of remaining on the register or not. There is a wide range of support and training that may be provided to our diaspora midwives, that is inclusive of upskilling them and tailoring their need and support to the individual as we do for our local workforce and students.
Reference
Balante, J., van den Broek, D. and White, K., 2021. How does culture influence work experience in a foreign country? An umbrella review of the cultural challenges faced by internationally educated nurses. International Journal of Nursing Studies, 118, p.103930.
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Buchan, J., Catton, H., & Shaffer, F. A. (2022). Sustain and Retain in 2022 and Beyond.https://www.enc22.eu/wp-content/uploads/2022/01/Sustain-and-Retain-in-
2022-and-Beyond-The-global-nursing-workforce-and-the-COVID-19-pandemic.pdf
NHS England: International Nursing and Midwifery Associations. NHS England » International nursing and midwifery associations (accessed on: 28th February 2023).
Nursing and Midwifery Council. (2019). The NMC Register. nmc-register-data-march-19.pdf. Accessed 02 March 2023.
Nursing and Midwifery Council. (2022).
More support needed for international nurses and midwives – The Nursing and Midwifery Council, 2022 (nmc.org.uk). Accessed 02 March 2023.
Pressley C, Newton D, Garside J, et al (2022) Global migration and factors that support acculturation and retention of international nurses: A systematic review,
International Journal of Nursing Studies Advances, 4 https://www.sciencedirect.com/science/article/pii/S2666142X22000224
Roth, C., Berger, S., Krug, K. et al. (2021). Internationally trained nurses and host nurses’ perceptions of safety culture, work-life-balance, burnout, and job demand during workplace integration: a cross-sectional study. BMC Nurs 20, 77 https://doi.org/10.1186/s12912-021-00581-8
World Health Organisation. (2020a). State of the World’s Nursing 2020. Executive Summary. https://apps.who.int/iris/bitstream/handle/10665/331673/9789240003293-eng.pdf Accessed 26 February 2023.
World Health Organisation. (2020b). Nursing Report 2020. https://www.who.int/publications/i/item/9789240003279Â 06 March 2023
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Oluwaseyi Akinlaja
Consultant Midwife: Midwifery Led Care and Public Health, The Princess Alexandra Hospital NHS Trust, Harlow