New registration process for overseas nurses Professor Alan Glasper discusses the new NMC processes for the registration of nurses who have trained outside the European Economic Area, designed to enhance public protection.
862
to 6 months full-time or pro-rata part time, or longer in some cases. This period allows for flexibility for the overseas nurse to meet the programme proficiencies. The period of supervised practice is not defined in terms of hours, but in terms of what must be achieved; that is, the prescribed proficiencies. For the moment the existing ONP programme, offered by a number of universities across the county, will run concurrently with the new system. Applications received before October 2014 will continue to be processed using the current arrangements and applicants will receive a decision letter requiring them to complete the ONP or an adaptation to midwifery programme (AMP) within 2 years of the date of the decision letter (NMC, 2014b). Gerrish and Griffith (2004) undertook an evaluation of the pre-2005 adaptation programmes. They concluded that the world nursing economy needed to more fully invest in supporting overseas nurses to better equip them for nursing in a different healthcare system, with a full appreciation of the social and cultural context of the country and health service they are expected to operate in.
Background The NMC recognises the major contribution that overseas nurses and midwives make to patient care and the profile of the UK healthcare workforce. As a consequence it believes it important that the new application process is robust and fair. In addition to enhancing public protection, the planned changes to the current system offer an improved applicant journey and demonstrate the NMC’s commitment to equality, fairness and transparency throughout the application process. There has been much anxiety about an over-reliance in the NHS on nurses who have not been trained in this county. Concurrent cuts to student nurse commissions in many UK universities have alarmed bodies such as the Royal College of Nursing (RCN). Dr
Peter Carter, Chief Executive of the RCN, claims that there has been an overall cut of 15% in the number of nursing student places commissioned since 2009–10 while pressures on the health service have continued to increase. However the 9% increase in adult nurse training commissions announced by Health Education England for 2014–15 may go some way to addressing the cumulative cuts made in previous years (RCN, 2013). Importantly, and in light of the Francis Inquiry and the new draft guideline from the National Institute for Health and Care Excellence (NICE) (2014) on safe staffing levels for nurses, a long-term, sustainable approach to workforce planning is vital. This is to ensure that the NHS has access to sufficient trained nurses to match what is a spiralling demand for them as patient acuity increases. It is against this backdrop that critics accuse the government of being overly dependent on overseas-trained nurses rather than improving its own manpower planning.
Competency-based assessment The NMC will introduce the new registration process for nurses who trained outside the EU/EEA in the autumn of 2014 and it is designed to enhance public protection. The new process will be underpinned by an online application process and a two-part competence test. Overseas applicants to the register will be required to: ■■ Apply online to join the NMC register ■■ Sit a computer-based examination at one of the global centres local to them ■■ Complete a variation of an objective structured clinical examination (OSCE)— this will be a practical test, taken in the UK, of conduct and competence in a simulated practice environment ■■ Present documentation to the NMC including identification, university transcripts and International English Language Testing System (IELTS) certificates (the industry standard for measuring English language ability (IELTS, 2014)). (NMC, 2014b)
© 2014 MA Healthcare Ltd
I
n February 2013 the Nursing and Midwifery Council (NMC) suspended applications to the register from overseas nurses, in order to carry out a review of its processes surrounding overseas applications. After due consideration, the NMC recommenced accepting applications from overseas nurses in April 2013. During this interim period the NMC made some changes to strengthen its procedures, which included more stringent checks on identification documents, such as only accepting first copies and requiring the copy to be signed by a professional to confirm an individual’s identity. The NMC suspended the registration of overseas nurses because of a warning that there was a tangible risk that the overseas registration policy and related processes were not sufficiently robust to ensure that the prime mission of the regulator, which is protecting the public, could be assured. However, it is important to stress that the NMC reported no overseas nurses were found to be fraudulently registered (Glasper, 2013). Despite this, the NMC announced its intention to conduct a further review of overseas nurses’ registration with the aim of developing a robust gold standard policy by 2014.The NMC considered proposals such as: ■■ On identity, requiring applicants to attend in person with their identity documents ■■ On assessing skills and experience, to administer written, oral or practical tests, as permitted under existing NMC legislation, for some or all applicants. After consultation, the NMC has implemented new procedures, which were announced in late June 2014 (NMC, 2014a). Currently nurses from countries who are not part of the EU or the European Economic Area (EEA) can undertake an overseas nursing programme (ONP) consisting of 20 days of protected learning time (consecutive days or part time over a longer period). Where a period of supervised practice is required, this together with the 20 days protected learning time will be at least 3 months and can extend
British Journal of Nursing, 2014, Vol 23, No 15
British Journal of Nursing. Downloaded from magonlinelibrary.com by 137.189.170.231 on November 20, 2015. For personal use only. No other uses without permission. . All rights reserved.
© 2014 MA Healthcare Ltd
HEALTHCARE POLICY The NMC is confident that this more robust application process will be fit for purpose. At its core, it is based on the current nursing and midwifery pre-registration education and competency standards (NMC, 2010a; 2010b). The computer-based test will be accessible in many countries around the world including those where significant numbers of nonEU/EEA-educated nurses and midwives are recruited to the UK. As part of the new process the NMC plans to publish a list of available locations. Nurses and midwives eligible for the test who currently live in the UK will be able to access it in the UK. The NMC has commissioned Pearson Vue, a company that specialises in secure computerbased testing, to administer the first part of the assessment. The practical part of the assessment will be based on a type of examination widely used by universities educating health professionals. It usually consists of a series of cognitive and practical tasks known as stations, allowing a wide variety of competencies to be tested. This second test will always be held in the UK and initially the University of Northampton has been designated as the national test centre (NMC, 2014b).
issue a candidate number for the computerbased test. The applicant will contact the computer-based test centre in their own country to book a test date and time. The test centre staff (Pearson Vue) will seek formal assurances and conduct identity checks to ensure that the person is the correct applicant sitting the test. The applicant will then complete the multiplechoice examination under secure conditions (NMC, 2014b). After the candidate successfully completes the computer-based test, the NMC then plans to assess their education, training, registration and employment history to confirm they meet all eligibility requirements. If these are met, the candidate will be put forward to take the nursing or midwifery OSCE test of competence. The applicant will book the date of the OSCE directly with the UK test centre. This will allow the applicant to plan their financial and domestic arrangements for coming to the UK. The cost of the tests has yet to be finally agreed, but they will be clearly identified by both local and UK test providers and published before the changes are made. Future changes to test costs approved by the NMC will be published by both providers before they are implemented.
New application process
Sitting the OSCE
For all applications from overseas nurses and midwives received from October 2014, the test of competence will be the only route to UK registration. Non-EU/EEAeducated nurses and midwives will complete an online application confirming they have met all eligibility requirements including the following and can provide the required evidence: ■■ IELTS 7.0 (academic version) or above in all sections ■■ Successful completion of a 3-year (or equivalent) undergraduate education and training programme (but not necessarily leading to a degree) ■■ 12 months’ post-registration practice experience ■■ A self-declaration that they are of good health and good character. The following items will be required at a later stage in the process: ■■ Digital copies of identity documents ■■ Evidence of training (in that country) ■■ Evidence of registration (in that country) ■■ Two employment references ■■ Evidence of good health and good character. (NMC, 2014b) After this confirmation has been received by the NMC, the online registration system will
The NMC will ensure that the university makes available materials to help candidates prepare for the OSCE. This will include access to any documentation that may be used in the OSCE. Before the test, candidates will have access to: ■■ Outline videos of OSCEs ■■ Details of behaviours that indicate active listening and caring ■■ Details of how they will be observed and assessed by examiners. (NMC, 2014b) Candidates will also be able to book a visit to the test centre to familiarise themselves with the setting and equipment that may be used. All candidates will be assessed in the same manner,
British Journal of Nursing, 2014, Vol 23, No 15
against the same set of standards. Each OSCE station will have one examiner present and the examination will be video-recorded for quality-assurance purposes. All candidates will sit OSCEs that are of an overall standardised level of difficulty. Successful applications will be processed by the NMC who will complete all final identification and documentation checks required for registration (NMC, 2014b).
Conclusion All non-EU/EEA-educated applicants will be assessed in the same manner against either the standards for pre-registration nursing education or standards for pre-registration midwifery education. The new application process will enable applicants to prepare for the test of competence in their own country before relocating to the UK. This means that candidates can take the computer-based test near to home without disrupting their domestic life or existing nursing or midwifery role. Importantly, applicants may not require a sponsor or employer to complete the process, and so will be at less risk of exploitation and the poor recruitment practices that have been reported BJN to the NMC in the past. Gerrish K, GriffithV (2004) Integration of overseas Registered Nurses: evaluation of an adaptation programme. J Adv Nurs 45(6): 579–87 Glasper A (2013) NMC reviews registration of nurses trained outside the EU. Br J Nurs 22(10): 586-7 International English Language Testing System (IELTS) (2014) What is IELTS? http://tinyurl.com/oqok85n. (accessed 22 July 2014) National Institute for Health and Care Excellence (2014) Safe nurse staffing of adult wards in acute hospitals. http://tinyurl.com/ pg5btkx (accessed 22 July 2014) Nursing and Midwifery Council (2010a) Standards for preregistration nursing education. http://tinyurl.com/n9pdhmn (accessed 22 July 2014) Nursing and Midwifery Council (2010b) Standards for competence for registered nurses. http://tinyurl.com/mvtutvu (accessed 22 July 2014) Nursing and Midwifery Council (2014a) New overseas registration process will enhance public protection. http://tinyurl.com/ltcjjas (accessed 22 July 2014) Nursing and Midwifery Council (2014b) Changes to overseas registration. http://tinyurl.com/pyomw73 Royal College of Nursing (2013) RCN responds to increase in nursing training commissions. http://tinyurl.com/kdqpa75 (accessed 29 July 2014)
KEY POINTS n The Nursing and Midwifery Council (NMC) will introduce a new registration process for nurses who trained outside the European Economic Area (EEA) in the autumn of 2014 n The new process will be underpinned by an online application process and a two-part competence test n To asses their eligibility to register in the UK, overseas nurses will now sit an online examination at a centre local to them and subsequently take an objective structured clinical examination (OSCE) at the University of Northampton n The NMC is confident that this more robust application process, based on its 2010 undergraduate pre-registration education and competence standards, will be fit for purpose
863
British Journal of Nursing. Downloaded from magonlinelibrary.com by 137.189.170.231 on November 20, 2015. For personal use only. No other uses without permission. . All rights reserved.
862
to 6 months full-time or pro-rata part time, or longer in some cases. This period allows for flexibility for the overseas nurse to meet the programme proficiencies. The period of supervised practice is not defined in terms of hours, but in terms of what must be achieved; that is, the prescribed proficiencies. For the moment the existing ONP programme, offered by a number of universities across the county, will run concurrently with the new system. Applications received before October 2014 will continue to be processed using the current arrangements and applicants will receive a decision letter requiring them to complete the ONP or an adaptation to midwifery programme (AMP) within 2 years of the date of the decision letter (NMC, 2014b). Gerrish and Griffith (2004) undertook an evaluation of the pre-2005 adaptation programmes. They concluded that the world nursing economy needed to more fully invest in supporting overseas nurses to better equip them for nursing in a different healthcare system, with a full appreciation of the social and cultural context of the country and health service they are expected to operate in.
Background The NMC recognises the major contribution that overseas nurses and midwives make to patient care and the profile of the UK healthcare workforce. As a consequence it believes it important that the new application process is robust and fair. In addition to enhancing public protection, the planned changes to the current system offer an improved applicant journey and demonstrate the NMC’s commitment to equality, fairness and transparency throughout the application process. There has been much anxiety about an over-reliance in the NHS on nurses who have not been trained in this county. Concurrent cuts to student nurse commissions in many UK universities have alarmed bodies such as the Royal College of Nursing (RCN). Dr
Peter Carter, Chief Executive of the RCN, claims that there has been an overall cut of 15% in the number of nursing student places commissioned since 2009–10 while pressures on the health service have continued to increase. However the 9% increase in adult nurse training commissions announced by Health Education England for 2014–15 may go some way to addressing the cumulative cuts made in previous years (RCN, 2013). Importantly, and in light of the Francis Inquiry and the new draft guideline from the National Institute for Health and Care Excellence (NICE) (2014) on safe staffing levels for nurses, a long-term, sustainable approach to workforce planning is vital. This is to ensure that the NHS has access to sufficient trained nurses to match what is a spiralling demand for them as patient acuity increases. It is against this backdrop that critics accuse the government of being overly dependent on overseas-trained nurses rather than improving its own manpower planning.
Competency-based assessment The NMC will introduce the new registration process for nurses who trained outside the EU/EEA in the autumn of 2014 and it is designed to enhance public protection. The new process will be underpinned by an online application process and a two-part competence test. Overseas applicants to the register will be required to: ■■ Apply online to join the NMC register ■■ Sit a computer-based examination at one of the global centres local to them ■■ Complete a variation of an objective structured clinical examination (OSCE)— this will be a practical test, taken in the UK, of conduct and competence in a simulated practice environment ■■ Present documentation to the NMC including identification, university transcripts and International English Language Testing System (IELTS) certificates (the industry standard for measuring English language ability (IELTS, 2014)). (NMC, 2014b)
© 2014 MA Healthcare Ltd
I
n February 2013 the Nursing and Midwifery Council (NMC) suspended applications to the register from overseas nurses, in order to carry out a review of its processes surrounding overseas applications. After due consideration, the NMC recommenced accepting applications from overseas nurses in April 2013. During this interim period the NMC made some changes to strengthen its procedures, which included more stringent checks on identification documents, such as only accepting first copies and requiring the copy to be signed by a professional to confirm an individual’s identity. The NMC suspended the registration of overseas nurses because of a warning that there was a tangible risk that the overseas registration policy and related processes were not sufficiently robust to ensure that the prime mission of the regulator, which is protecting the public, could be assured. However, it is important to stress that the NMC reported no overseas nurses were found to be fraudulently registered (Glasper, 2013). Despite this, the NMC announced its intention to conduct a further review of overseas nurses’ registration with the aim of developing a robust gold standard policy by 2014.The NMC considered proposals such as: ■■ On identity, requiring applicants to attend in person with their identity documents ■■ On assessing skills and experience, to administer written, oral or practical tests, as permitted under existing NMC legislation, for some or all applicants. After consultation, the NMC has implemented new procedures, which were announced in late June 2014 (NMC, 2014a). Currently nurses from countries who are not part of the EU or the European Economic Area (EEA) can undertake an overseas nursing programme (ONP) consisting of 20 days of protected learning time (consecutive days or part time over a longer period). Where a period of supervised practice is required, this together with the 20 days protected learning time will be at least 3 months and can extend
British Journal of Nursing, 2014, Vol 23, No 15
British Journal of Nursing. Downloaded from magonlinelibrary.com by 137.189.170.231 on November 20, 2015. For personal use only. No other uses without permission. . All rights reserved.
© 2014 MA Healthcare Ltd
HEALTHCARE POLICY The NMC is confident that this more robust application process will be fit for purpose. At its core, it is based on the current nursing and midwifery pre-registration education and competency standards (NMC, 2010a; 2010b). The computer-based test will be accessible in many countries around the world including those where significant numbers of nonEU/EEA-educated nurses and midwives are recruited to the UK. As part of the new process the NMC plans to publish a list of available locations. Nurses and midwives eligible for the test who currently live in the UK will be able to access it in the UK. The NMC has commissioned Pearson Vue, a company that specialises in secure computerbased testing, to administer the first part of the assessment. The practical part of the assessment will be based on a type of examination widely used by universities educating health professionals. It usually consists of a series of cognitive and practical tasks known as stations, allowing a wide variety of competencies to be tested. This second test will always be held in the UK and initially the University of Northampton has been designated as the national test centre (NMC, 2014b).
issue a candidate number for the computerbased test. The applicant will contact the computer-based test centre in their own country to book a test date and time. The test centre staff (Pearson Vue) will seek formal assurances and conduct identity checks to ensure that the person is the correct applicant sitting the test. The applicant will then complete the multiplechoice examination under secure conditions (NMC, 2014b). After the candidate successfully completes the computer-based test, the NMC then plans to assess their education, training, registration and employment history to confirm they meet all eligibility requirements. If these are met, the candidate will be put forward to take the nursing or midwifery OSCE test of competence. The applicant will book the date of the OSCE directly with the UK test centre. This will allow the applicant to plan their financial and domestic arrangements for coming to the UK. The cost of the tests has yet to be finally agreed, but they will be clearly identified by both local and UK test providers and published before the changes are made. Future changes to test costs approved by the NMC will be published by both providers before they are implemented.
New application process
Sitting the OSCE
For all applications from overseas nurses and midwives received from October 2014, the test of competence will be the only route to UK registration. Non-EU/EEAeducated nurses and midwives will complete an online application confirming they have met all eligibility requirements including the following and can provide the required evidence: ■■ IELTS 7.0 (academic version) or above in all sections ■■ Successful completion of a 3-year (or equivalent) undergraduate education and training programme (but not necessarily leading to a degree) ■■ 12 months’ post-registration practice experience ■■ A self-declaration that they are of good health and good character. The following items will be required at a later stage in the process: ■■ Digital copies of identity documents ■■ Evidence of training (in that country) ■■ Evidence of registration (in that country) ■■ Two employment references ■■ Evidence of good health and good character. (NMC, 2014b) After this confirmation has been received by the NMC, the online registration system will
The NMC will ensure that the university makes available materials to help candidates prepare for the OSCE. This will include access to any documentation that may be used in the OSCE. Before the test, candidates will have access to: ■■ Outline videos of OSCEs ■■ Details of behaviours that indicate active listening and caring ■■ Details of how they will be observed and assessed by examiners. (NMC, 2014b) Candidates will also be able to book a visit to the test centre to familiarise themselves with the setting and equipment that may be used. All candidates will be assessed in the same manner,
British Journal of Nursing, 2014, Vol 23, No 15
against the same set of standards. Each OSCE station will have one examiner present and the examination will be video-recorded for quality-assurance purposes. All candidates will sit OSCEs that are of an overall standardised level of difficulty. Successful applications will be processed by the NMC who will complete all final identification and documentation checks required for registration (NMC, 2014b).
Conclusion All non-EU/EEA-educated applicants will be assessed in the same manner against either the standards for pre-registration nursing education or standards for pre-registration midwifery education. The new application process will enable applicants to prepare for the test of competence in their own country before relocating to the UK. This means that candidates can take the computer-based test near to home without disrupting their domestic life or existing nursing or midwifery role. Importantly, applicants may not require a sponsor or employer to complete the process, and so will be at less risk of exploitation and the poor recruitment practices that have been reported BJN to the NMC in the past. Gerrish K, GriffithV (2004) Integration of overseas Registered Nurses: evaluation of an adaptation programme. J Adv Nurs 45(6): 579–87 Glasper A (2013) NMC reviews registration of nurses trained outside the EU. Br J Nurs 22(10): 586-7 International English Language Testing System (IELTS) (2014) What is IELTS? http://tinyurl.com/oqok85n. (accessed 22 July 2014) National Institute for Health and Care Excellence (2014) Safe nurse staffing of adult wards in acute hospitals. http://tinyurl.com/ pg5btkx (accessed 22 July 2014) Nursing and Midwifery Council (2010a) Standards for preregistration nursing education. http://tinyurl.com/n9pdhmn (accessed 22 July 2014) Nursing and Midwifery Council (2010b) Standards for competence for registered nurses. http://tinyurl.com/mvtutvu (accessed 22 July 2014) Nursing and Midwifery Council (2014a) New overseas registration process will enhance public protection. http://tinyurl.com/ltcjjas (accessed 22 July 2014) Nursing and Midwifery Council (2014b) Changes to overseas registration. http://tinyurl.com/pyomw73 Royal College of Nursing (2013) RCN responds to increase in nursing training commissions. http://tinyurl.com/kdqpa75 (accessed 29 July 2014)
KEY POINTS n The Nursing and Midwifery Council (NMC) will introduce a new registration process for nurses who trained outside the European Economic Area (EEA) in the autumn of 2014 n The new process will be underpinned by an online application process and a two-part competence test n To asses their eligibility to register in the UK, overseas nurses will now sit an online examination at a centre local to them and subsequently take an objective structured clinical examination (OSCE) at the University of Northampton n The NMC is confident that this more robust application process, based on its 2010 undergraduate pre-registration education and competence standards, will be fit for purpose
863
British Journal of Nursing. Downloaded from magonlinelibrary.com by 137.189.170.231 on November 20, 2015. For personal use only. No other uses without permission. . All rights reserved.
