English language skills requirements for internationally educated nurses working in the care industry: Barriers to UK registration or institutionalised discrimination?

As has been highlighted in recent papers in the International Journal of Nursing Studies, there are many significant challenges associated with the growing need for internationally educated nurses in many countries (Xiao, Willis and Jeffers 2014). In the United Kingdom, for example, in 2013/14 there were 6,228 nursing registrations from abroad – an increase of nearly 45% on the previous year, with more nurses arriving in the UK than leaving to work overseas, meaning that the United Kingdom has become a net importer of nurses for the first time in eight years and 'showing the extent of the reliance on overseas staff as hospitals desperately struggle to recruit enough staff to keep patients safe.' 1 Despite this net increase, there remains a shortfall in qualified nurses (NHS Employers 2014) with associated implications for quality of patient care, safety and outcomes (Rogers et al 2014). At the same time, many internationally educated nurses are working as unqualified healthcare assistants (also referred to as Nursing Assistants, Nursing Auxiliaries, Care Assistants, Care Aides, Health Aides and Support Workers), and often constrained by the need to pass the English language skills testing required for nurse registration in their host country. In the UK such testing is mandatory for nurses educated outside of the European Union and European Economic Area but, because of European Union employment law, it is not mandatory nurses educated within the European Union and European Economic Area. This means that there is a two tier registration system for internationally educated nurses in the United Kingdom (Jordan and Brown 2011), with a higher requirement for non-European Union and European Economic Area educated nurses. At the very least this poses additional barriers to registration at a time of great need for qualified nurses. At worst, it might be argued to constitute institutionalised discrimination, i.e. structurally disadvantaging nurses from outside of the European Union and European Economic Area, who are also more likely to be from Black and minority ethnic backgrounds (Allan et al 2004; Alexis, Vydelingum & Robbins 2007). This editorial highlights the need to provide adequate English language skills training in order to avoid under-usage of internationally qualified nurses and prevent the disadvantaging of nurses who are not from the European Union and European Economic Area. Many internationally educated nurses arriving in a new country where they will be required to speak in a language other than their first language, experience a …