Integration framework for internationally educated nurses

Guidance framework for essential information to support the integration of internationally educated nurses into NHS Wales.

The NHS is one of the largest employers in Wales and has long benefited from the contributions of Internationally Educated Nurses (IENs), who play a vital role in delivering healthcare across the country. Despite efforts to attract, employ, and train more nurses locally, university graduate numbers educated have not been able to keep pace with increasing demand. The growing pressures on NHS services, exacerbated by the ongoing effects of the covid pandemic, have further intensified workforce shortages, making international recruitment essential to addressing these gaps.

Much work continues to be done to attract, employ, invest in and train more nurses to work in our NHS. International recruitment is one part of a comprehensive workforce strategy and is not intended to serve as a standalone, long-term solution.

The 'once for Wales' ethical international recruitment programme supports our NHS with a consistent approach to delivering an ethical and sustainable recruitment model. Whilst individual health boards are responsible for their own workforce planning, through the introduction of this framework and launch of the dedicated App, we will establish a consistent approach to support and wellbeing through information provided for IENs who join the NHS Wales workforce.

This guidance framework establishes a clear approach for how all NHS organisations employing IENs will provide information via a dedicated App. The app has been centrally funded for 1,500 licenses over a three-year period, after which the central international recruitment team will review and evaluate the need for continued licensing. The framework outlines essential sections that must be included in local support materials to ensure a consistent, equitable approach to information provided supporting professional integration and personal adjustment to life in Wales for IENs.

The core examples provided within the framework are not exhaustive, allowing organisations flexibility to build upon and adapt them where necessary. Given the evolving nature of life and healthcare, the information provided must remain dynamic and be regularly updated to reflect changes in support systems and key policies.

IENs who have secured a contract with NHS Wales will be granted access to an app license, enabling them to receive information prior to their arrival.

The framework and the app

Rather than creating a stand-alone support package for Wales, the pastoral app supports the guidance framework by enabling organisations to customise and add supplementary information tailored to their local context having an accessible, agile support package. The app will offer easy access to a comprehensive range of work-related and community-focused information, helping IENs to integrate smoothly into both their professional roles and the local community.

In addition to the key areas outlined in the framework, each NHS organisation is required to provide specific information regarding key Welsh national policies. Organisational induction programmes will support IENs in understanding and adhering to Welsh professional practices, policies and standards, recognising the differing policy positions and practices across the globe such as Infection, Prevention and Control (IPC), safeguarding and reporting arrangements.

The app's governance structure is designed to ensure clear responsibility for content management and updates. The homepage of the app will be managed centrally by NHS Wales Shared Services Partnership. Each organisation that recruits IENs will be responsible for managing and updating their respective pages linked from the homepage. Whilst Welsh Government has supported the development and introduction of the app, it will not hold responsibility for ongoing information management. The responsibility for maintaining and updating the content lies with the individual organisations.

NHS Wales

Core policy areas

The framework highlights key policies that will be featured prominently on the “landing page” of the app for NHS Wales. Whilst the list below is not exhaustive, it provides examples of the types of information that will be accessible to IENs, ensuring they are well-informed and supported as they begin their careers in Wales:

• Welsh national policy and guidelines
• professional standards and practices
• safeguarding protocols
• reporting and governance frameworks
• immigration and legal information
• local embassy or consulate information

As stated the information required is not exhaustive but provides examples of policies which will feature on the “landing page” of the App for NHS Wales. Policies such as: 

• 'a healthier Wales', our long term plan for health and social care
• 'the anti-racist Wales action plan' setting out the Welsh Government’s stance to make Wales an anti-racist nation
• Health Education and Improvement Wales (HEIW) 10 year workforce strategy for health and social care
• national workforce implementation plan
• NHS Wales speaking up safely framework
• Welsh language strategy, Cymraeg 2050: Welsh language strategy | GOV.WALES 
• NHS Wales human resources policies 
• NHS Wales practice related policies 
• Chief Nursing Officer Wales priorities

General background information about the health board, working in Wales and the surrounding area

To be included:-

• overview of Wales (culture, geography, Welsh Language)
• introduction to the Welsh NHS system
• overview of general rules / regulation / culturally acceptable behaviours to live and work in Wales such as rules of highway code, from a broad legal and criminal perspective
• map of the local health board / trust area including key locations
• professional guidance
• general geographics – population, services provided, that is primary, acute, tertiary services and so on
• number of hospitals and types / services provided / population served
• staffing numbers across the health board, both nursing and general
• key teams / individuals working across the health board and contact details including:-
  • education
  • human resources
  • line manager
  • mentor/supervisor
  • international nurses’ forum/team

Pastoral social support

To be included:

• pre-arrival contact
• airport pick-up and support
• emergency contacts (police, fire, ambulance)
• NHS helplines and services
• living essentials: accommodation:
  • support provided and over what period
  • estate agent details – to rent and to buy (post initial support)
  • other general information such as council tax; water rates; setting up utilities; TV licence and so on
• healthcare support / provision services
  • occupational health assessment including vaccination requirements
  • GP registration
  • dentist registration
  • optometrist
  • pharmacies
• public transport
  • organisational support provision
  • bus services
  • train services
  • taxis
• financial and banking services
  • banking services in the area
  • required documentation to open an account
• shopping and retail
  • grocery (supermarkets/local stores)
  • clothes
  • household goods
• leisure
  • libraries
  • fitness clubs
  • leisure centres
  • community hubs
• faith / religion / spiritual needs and networks
  • chaplaincy services
  • churches / mosques / synagogues / temples / Buddhist centres / Hindu centres and so on
  • networks – both organisational specific and external associations such as global majority, British Indian Nurses Association (BINA), Filipino Nurses Association and so on
• culture information/sessions including safeguarding position in Wales
• education and family support
• schools and childcare facilities
  • schools
  • nurseries and childcare
• places to eat
  • restaurants, cafes, coffee shops

Organisational induction

To be included:

• Induction/orientation programme
  • all staff induction programme
  • development plan in place within 6 months of start date
  • all Wales dress code; national nursing uniforms in NHS Wales
  • pay and pensions
  • speak up safely policy
  • general resources and links such as Nursing and Midwifery Council (NMC), 111, Welsh Government health policies, Royal College of Nursing (RCN), local government

OSCE (Observed Structured Clinical Examination) preparation

To be included:

• Details of the OSCE preparation programme such as:
  • the length of the programme
  • who will support health board delivery including contact details
  • programme content including online training versus face-to-face learning; consider including NHS Wales specific information such as abbreviations and terminology
  • post registration support and what to expect
  • provide details about NMC test centres and procedures