One of the pillars globalisation stands upon is free movement of workforce across borders. In healthcare, it is especially relevant to nursing, with its notorious global workforce deficit. At the same time, while ‘cross-border employment opportunities’ may sound good in politics, for a particular nurse to move abroad for work may be one of the greatest challenges in their life. But it’s still worth it, says a nurse who knows first-hand how difficult but at the same time exciting working in another country is.
- One usually needs a life-changing experience to decide to work abroad.
- In a new country, many new skills need to be acquired and supported through life-long learning, as in the UK.
- Communication in nursing is very important, so one needs to invest heavily in developing their language skills.
- In nursing, curbing opportunities for foreign employment benefits no one, Brexit being one example here.
- The experience of working abroad and learning something new there is a win-win for any health professional.
- Nursing is an amazing profession, which allows one to work and be appreciated by people anywhere in the world.
I am a 47-year-old registered nurse (RN) originally from Germany. I have been living and working in Bristol, a city that I love, in the southwest of England, for the last 17 years. Having first qualified as a nurse in 1997 in Bremen, Germany, I worked as a staff nurse at the Red Cross Hospital for six years before making the decision to live abroad.
Why did I become an overseas nurse? One does not decide to go abroad without a good reason. When people become overseas nurses, it is generally because they have had an experience, which changed the way they see the world. In my case, this happened in Sydney, a city 16,000km from my home town.
I studied international nursing management at University of Applied Sciences in 1999-2003. In our fourth semester, we had the opportunity to study abroad, so I decided to travel to the University of Sydney. During my time there, I had an amazing insight into the Australian healthcare system. The nursing culture was so unlike my own professional experience in Germany. I saw how nursing in Australia is treated as being on a much higher level; it was a profession. I was so impressed to see my Australian colleagues working so independently.
While I was being ‘brain-washed’ (in a good way, of course!) by all these amazing nursing experiences, I met my partner in Sydney. She is English and a healthcare professional too. After we returned to Europe, we decided to begin our life together in the UK, so I finished my studies in 2003 and moved to Bristol.
Nursing in UK
Before that, I had had two years to get to know the British nursing culture. Since it is a Commonwealth country, Australia’s nursing culture is actually very similar to the UK’s in the way the two countries approach nursing.
So, what does it mean to be RN in the UK? The short answer is ‘a lot’! As with many other countries, nursing in the UK is a profession. First, there is The Nursing and Midwifery Council (NMC) and you must be registered with it before you can practice as a nurse. Second, we have our own union, the Royal College of Nurses (RCN), which represents and fights for our interests at a high level. Third, our nursing education consists of a 100% academic pathway, which means that we have undergraduate and postgraduate study courses. In Germany these three core elements have not yet been fully implemented. However, it’s getting there, and I can see the changes happening.
When you work as RN in the UK, you are fully accountable for your actions and have to follow the code of conduct set by the NMC. In the UK, I had to learn new nursing skills, many of which are still carried out by doctors in Germany. Here are some examples of the new skills I had to acquire:
• Taking blood
• Inserting a cannula
• Giving blood units and doing the monitoring
• Doing a bladder scan
• Changing a tracheal cannula and giving full care of the tracheostoma
• Changing a suprapubic catheter
• Having full accountability by giving the first IV antibiotics dose
• Starting an IV programme after a PICC line has been inserted by a colleague (a nurse) and they have checked the x-ray for the procedure and then given me the go-ahead
• Working with senior nurses called advance nurse practitioners (ANP) who nurse on an even higher level than I do
• And many, many other skills!
The phrase ‘I can’t do it, because I don’t know how to do it’ does not exist in British nursing. A culture of lifelong learning is part of the profession and the reason why nurses are so highly skilled in the UK. To maintain our registration with the NMC, we all have to do annual continuing professional development (CPD) to demonstrate that we are up-to-date with our knowledge and clinical skills. These are just some examples of how highly skilled the U.K. nurses are.
I owe so much of my nursing career to the ANPs I have worked with. They are the nurses who run clinics, do endoscopic procedures, run wards, prescribe medication, and even run community hospitals at a consultant level without any medical staff. After 17 years, I still feel blessed to be part of this culture and community.
The UK has also taught me how to organise my workspace in the right way and how to take on full accountability as a nurse. I have had to overwrite medical discharges and speak for my patients as a primary nurse. I have had to (and will continue to) ensure patient safety to a high level. I have learnt that nurses in the UK stand eye-to-eye with other healthcare professionals.
Language Skills Are a Must!
Obviously, starting a new life in the UK was almost like walking into a completely different space for me. It took me a good year to get my head around everything, like how the National Health Service (NHS) is run and who’s who, and see the need to continue improving my clinical and colloquial English. When I decided to move to the UK, I said to myself: “I want to laugh when the Brits are laughing, I want to cry when the Brits are crying.” This thought has helped me throughout my life here in Bristol.
Learning English and becoming bilingual is a tough path, but it’s worth it. The more my English improved, the more confident I felt as a nurse on the wards. In time, I was able to joke with my patients, lead meetings and run shifts. English language skills are a must!
As a nurse, you need to be able to communicate effectively with your colleagues, patients, of course, and their families. This is critical for being able to perform your role effectively and safely.
If you can’t communicate on a professional level, you can’t nurse. Communication is one of the most important skills you need as a nurse, whether you are working in your home country or abroad.
Restrictions Are No Good
During my 17 years in the UK, I have met many other overseas nurses and doctors. We all agree that anything is possible and that if your will is strong enough, it will help you achieve your goals.
Brexit, however, is an enormous burden for the NHS and the private health sector in the UK as well as for foreign healthcare staff. As a European citizen, I have never thought that one day I would need a visa to be able to live and work abroad. Even when one gets all the paperwork done (in my case, the EU settlement, which allows me to stay and work in the UK as a nurse), the mental stress is tremendous.
Certainly no country in the world can afford a ban on healthcare professionals. Anybody who supports this new system doesn’t understand that healthcare workers (nurses, midwives, paramedics, carers, medics, etc.) are in short supply globally. We, healthcare professionals and especially nurses, are gold nuggets in the labour market, so there is a strong argument for us to have the right to work anywhere in the world.
Knowing that governments are willing to put us under restrictions makes your heart quite heavy. Times for Empire thinking are over. The UK would not be the country I love so much without the many different cultural influences that complement the British culture. I will always be a foreigner in the UK, and I don’t need a reminder with paperwork that I have this special status. My home is where my heart is, that is in the UK, but due to Brexit my love relationship with the country has a dark mark now. Whether I can live with this mark, I’ll know in the next few years.
Benefits and Opportunities
I always support the idea of working abroad for a while, this is why I have been involved in the Erasmus project for German student nurses for eight years already. To get an insight into another work culture and to see how healthcare systems function in different countries is a win-win situation for every healthcare professional. One can take the new knowledge, skills and views and apply them in their home healthcare system. Overseas experiences broaden each person’s horizon on both sides – it is as beneficial for German nurses to learn from their British colleagues, as for British nurses to meet student nurses from Germany.
Exchanging views, knowledge and skills is fundamental in healthcare, whether you learn something new or start appreciating your own culture. If you never step out of your framework, which is a kind of a safe place, you will never have the great opportunity to work interculturally. You will never face any challenges that help your personality grow even more, e.g. mastering a new language, getting to know colleagues from other cultural backgrounds, learning different standards, etc.
So, should you try and work abroad? If you are happy to try new life paths, then do it. If you have the courage to jump in to new waters, then do it. Even if you are shy and self-conscious, do it anyway. You will not regret it. Even if after two days you realise this new chapter might not be a chapter of your amazing life, you can always say, “At least I tried!” As I have learnt from the British culture, when one door closes, another one opens. There is no failure here.
In conclusion, I’d like to say a few things that are very important to me. I work in the most progressive nursing culture in Europe and I am very proud of it. If I were 18 again, I would have chosen to become a nurse. Being a nurse has opened up my world and my life, and has shown me how wonderful nursing is. I think nursing profession is unique in all the possibilities it gives us.
As nurses, we can work all over the world. We can work with people and become a part of their life stories, which personally for me is such a gift. People place their trust in us and believe in our skills and knowledge. It can all feel quite overwhelming.
Conflict of Interest