An excerpt of the presentation by Dr. Saafi Mousa
The Webinar on Nursing Opportunities in the United Kingdom (US) and United States of America (USA) held on Friday, 3rd March 2023, exposed Karatina University Nursing students to international work opportunities for Kenyan nurses. Organized by the Directorate of Resource Mobilization and International Programmes, in conjunction with the School of Nursing, the session tackled issues to do with Work and Study options, Visas and Scholarships as well as Impact on Wellbeing and Self Care.
The Facilitator, Dr Saafi Mousa, from the University of Sheffield in the UK articulated that Nursing in the UK is made up of separate and distinct fields of practice, each requiring three years of pre-registration undergraduate education. These fields are adult nursing, children’s nursing, learning disabilities nursing and mental health nursing.
Despite these opportunities, however, as of 11th November 2021, the Department of Health and Social Care (DHSC) in the UK announced that Kenya had been added to the amber list of countries in the Code of Practice for the International Recruitment of Health and Social Care Personnel in England. This means that employers and recruitment agencies, including NHS trusts, stopped all active recruitment of health and social care personnel from Kenya to the UK with immediate effect.
“The list does not, however, prevent individual health and social care personnel from independently applying to health and social care employers for employment in the UK, of their own accord and without being targeted by a third party, such as a recruitment agency or employer (known as a direct application)’ said Dr. Moussa.
According to her, while Kenya is not on the WHO Health Workforce Support & Safeguards List, it remains a country with significant health workforce challenges adding that having Kenya on the amber list in the Code will protect Kenya from unmanaged international recruitment which could exacerbate existing health and social care workforce shortages.
The requirements for working as a Nurse in the UK entail the acquisition of the International English Language Testing System (IELTS) or an Occupational English Test also referred to as an OET. This is because English language tests are specified for all international healthcare professionals and should, therefore, achieve 6.5/C+ in writing and 7/B in Reading, Speaking & Listening.
“As expected, the two tests vary in difficulty. The OET is easier in some ways because it is more specific to healthcare, so you can make use of your healthcare knowledge, vocabulary and experiences. This means that you’d find the writing and speaking portions of the test a little easier, as you’d be used to the situations provided. During the written test, you’ll be asked to write a referral letter for a patient, and for the speaking test, you’ll need to interact with the examiner, who will be playing the role of a patient.”
Other educational requirements include, at minimum, a Nursing degree or Diploma that allows one to be qualified in their country of origin, at least 1 Year of nursing experience and a valid Registered Nurse License. In addition, all nurses in the UK must be registered with the Nursing and Midwifery Council (NMC).There will also be need to provide documentation that shows proof of education and work experience. In order to be registered by the NMC, one needs to take a Computer Based Test (CBT) and Objective Structured Clinical Examination (OSCE). The Computer-Based Test (CBT) is the first part of the registration and comprises of one hundred and fifteen (115) questions, marked either correct or incorrect (no partial marks). This test can be completed at centres around the world. Part A is a Numeracy assessment while Part B is a Theory test (multiple choice). The tests can last up to three hours, including breaks.
Objective Structured Clinical Examination (OSCE), on the other hand, is a practical nursing examination which can only be completed in the UK. It is conducted in a mock hospital set-up and tests for experience and skills required at point of registering – not on advanced skills or knowledge. This includes how you care for patients, how you retain and apply information among others.
Tier 2 Visa Requirements
In order to get a Visa to the UK, one may need to have booked OSCE prior to starting the application of the Visa. He/she must also be offered a job by the National Health Service (NHS) or other healthcare organizations. You must request Certificate of Sponsorship (CoS) from the hospital’s human resource team and then have three (3) months to apply for the Visa.
“The NHS Trust may ask you to provide personal information and evidencing the following before they can make your CoS Application; Passport, Proof of Address, Certificate of Good Standing, General Medical Council (GMC) Registration status and Reference. Sometime, it may be the case where you have accepted a role, had your CoS issued and now you want to take another opportunity. You need to be very careful here, as the NHS trust who has applied for your CoS has spent £1000 on the application and it is lawful to ask for that money back.”
What are the cost implications? An applicant will require to pay an Application fee as follows: < 3 years – £247 per person or > 3 years – £479 per person. One will also usually need to have at least £1,270 available to support oneself and take care of flights and initial accommodation unless an employer pays for it.
There are a number of Scholarships in the UK including Chevening Scholarship (full funding for Masters), GREAT Scholarship (for 1 year postgraduate course), Commonwealth Scholarships for Masters and PhDs, University of Birmingham KAPLAN Scholarships, Global Development Institute at Manchester University, Manchester University Masters Scholarship, University of Stirling Postgraduate Scholarship, University of Cambridge Gates Cambridge Scholarships, University of Oxford Rhodes Scholarship, University of Edinburgh Global Research PhD Scholarship, University College London Denys Holland BSc/BA Scholarship, University of Westminster Full International Scholarships BSc/BA and University of Nottingham Developing Solutions Scholarships.
THE USA REQUIREMENTS
Dr. Mousa also shared on the requirements for the USA option. A prospective applicant needs to, first, have a US Nurse License. As opposed to the UK, in the US, instead of nationwide requirements, they have different requirements in each state. Kenyan nurses will need to be licensed by the relevant State’s Board of Nursing, which may be more limiting than other countries where you are able to seek national registration.
Other broad requirements are; must have studied with a recognized institution offering accredited Nursing program, must be registered with the Nursing Council of Kenya and must have at least two years of post-qualification experience as a nurse.
The first step involves contacting the Commission on Graduates of Foreign Nursing Schools (CGFNS) for screening process. They will check if one meets the requirements and registration as a nurse, including IELTS. They will also undertake a predictor’s test to check the nurse’s ability to pass the U.S. National Licensure Exam (NCLEX). The second step involves completing the computerized U.S. National Licensure Exam (NCLEX), a written test using mostly case-studies. Questions will be presented in a variety of formats such as multiple choice, multiple response or Select All That Apply. Some states do not require NCLEX, however, this information changes frequently. The third and last step is the application for a permanent work visa, also known as a Green Card through the US Embassy. Here, one may need to find an international US–based nursing recruiting agency or employer for assistance. They are much more likely to provide overall support than independent hospitals, that is, with immigration, accommodation, bank account among others.
Some scholarships in the US include Aga Khan Foundation’s Scholarship Programme, Fulbright Program for Foreign Students, Franklin Mosher Baldwin Memorial Fellowship, Lupu-Willock Endowed Scholarship, Afya Bora Global Health Fellowships, AAUW International Fellowship, P.E.O. International Peace Scholarship, Campbell Fellowships for Transformative Research, Margaret McNamara Memorial Fund and Schlumberger Foundation Faculty for the Future Awards.
ADJUSTING TO LIFE ABROAD
Dr. Mousa informed the Nursing students to be aware of racism in the NHS. She said that Black health professionals are more likely to be disciplined and dismissed and less likely to be promoted or offered further developments.
“The Francis Report found that Black health professionals are more likely to be victimized by management and less likely to be praised for raising concern,” she stated.
While researching on life as a Black Nurse in the NHS, a review by the NHS Race and Health Observatory found that Black African nurses in the NHS experienced racism not only from White British colleagues but also overseas nurses, as well as patients and managers. Black African nurses were prohibited from carrying out certain procedures, even when they were competent. Black African nurses felt that their experience and knowledge in nursing were not respected.
In Patient Care, there is over-representation of black people in mental health services as a direct consequence of the economic and social disadvantages. There is also racism of Black and minority ethnic patients as a common explanation for excess detentions and alienation from services leading to mistrust and dissatisfaction. Black women are also four times more likely to die in childbirth.
IMPACT ON WELLBEING AND SELF-CARE
Dr. Mousa stated that regular experiences of racism can lead to significant psychological and physical health consequences. This has been found to lead to symptoms in line with PTSD and contribute to development of psychosis. Also, racism directly causes depression, is a predictor of anxiety, impaired sleep and suicidal ideation.
Prospective nurses can, nevertheless, meet their basic needs by ensuring that they get quality sleep, eat regularly and ensure variety of food intake, engage in regular movement that feels natural and enjoyable, spend time with loved ones, spend time in nature or with pets, connect with their family/cultural traditions and immerse themselves in activities they enjoy. Dr. Mousa also stated that social identification with a local community can provide many psychological resources with positive impacts. Social groups also provide contexts for members to feel supported and reduce loneliness. Psychological sense of community are also extensively associated with health and well-being.