‘Internationally educated nurses face unique hurdles and need specific support’

They bring years of experience and a wealth of knowledge, yet often find themselves struggling with new protocols, technologies, and unspoken expectations.

“IENs have been left to navigate the complexities of new healthcare systems with minimal assistance”

These challenges can lead to feelings of inadequacy, frustration, and isolation. Although they are experienced, IENs face unique hurdles that demand more structured support than a simple orientation.

Without this, many feel the burden of an unspoken expectation: “You should know what to do because you are an experienced nurse.”

Despite their expertise, IENs require a supportive pathway to thrive in an unfamiliar environment. This lack of proper induction often means that IENs are left to navigate new systems and expectations with minimal guidance, creating an environment where they may hesitate to ask questions out of fear of appearing unqualified.

According to the Nursing and Midwifery Council (NMC), this challenge is well-documented, with many IENs finding it difficult to adjust to regulatory, professional, and cultural expectations within the UK healthcare system.

A significant issue for IENs is the unrealistic expectation that they should adapt almost instantly. On their first shifts, many encounter unfamiliar systems and processes, from electronic health records to patient assessment protocols.

This assumption that experienced nurses should be able to “figure it out” can hinder open communication and discourage IENs from seeking help, ultimately affecting their mental health.

Research from the Royal College of Nursing (RCN) and the Department of Health and Social Care (DHSC) highlights the adverse mental health impact on healthcare professionals facing these stresses.

This pressure, compounded by unfamiliar environments, can lead to heightened anxiety and, in some cases, depression.

Both the RCN and DHSC acknowledge that stress from transitioning into a new healthcare system can result in burnout and attrition, urging healthcare providers to provide tailored support that could prevent these outcomes.

Furthermore, the World Health Organization (WHO) has recognised the importance of mental health support in its Global Strategy on Human Resources for Health, stressing the need for culturally appropriate resources for internationally deployed healthcare professionals.

To prevent these issues, healthcare organisations need to develop a clear and structured induction pathway.

“Cultural orientation and communication training are vital investments for healthcare organisations”

A brief orientation simply is not enough; IENs require a tiered approach to learning that spans months, not days, to ensure full integration.

A pathway with ongoing mentorship, competency-based training, and support from local staff can bridge the gap in expectations and knowledge.

The NMC’s 2022 guidelines stress that IENs benefit significantly from “competency-based induction programmes” tailored to their unique needs.

This structured approach aligns with findings from the King’s Fund, which demonstrated that a thorough induction programme and peer support can improve retention and patient outcomes, while building a more cohesive and confident nursing team.

One essential aspect of a successful induction programme is peer mentorship. Pairing IENs with experienced local staff fosters knowledge-sharing in a supportive, non-judgemental setting.

The RCN advocates for mentorship as a “crucial element in supporting workforce transition,” not only facilitating professional development but also providing a sense of inclusion.

For IENs, having a trusted mentor can make all the difference, helping them adapt both professionally and socially to their new roles.

Cultural orientation is equally crucial. Many IENs face the dual challenge of learning new clinical practices while adapting to UK workplace norms.

Cultural orientation and communication training are vital investments for healthcare organisations. The NMC recommends that healthcare organisations provide resources and structured training to aid in cultural adaptation.

Understanding the subtleties of workplace dynamics is as vital to success as clinical skills, and institutions should integrate formal cultural orientation sessions into their induction programmes.

The mental health impact of starting anew in a high-pressure healthcare environment should not be underestimated.

The RCN’s 2023 survey on workforce wellbeing found that IENs experience added stress due to language barriers, cultural differences, and the pressures of a new clinical environment, making them more vulnerable to anxiety and depression.

According to the WHO, healthcare workplaces must provide accessible mental health support for all staff, especially IENs, who often face compounded stress during the transition.

Healthcare organisations can help by proactively offering resources tailored to the needs of IENs, such as employee assistance programmes and regular check-ins with managers or mentors.

Providing these resources shows commitment to staff well-being, creating an environment where IENs feel valued and supported.

Supporting IENs through a structured induction pathway benefits both individual nurses and the entire healthcare team.

A well-supported IEN brings fresh perspectives, unique skills, and dedication to patient care, all of which enhance team cohesion and improve patient outcomes.

According to NHS Employers, well-integrated IENs contribute positively to workplace morale and resilience, furthering the mission of quality patient care.

Ultimately, a structured induction programme is not only an investment in individual nurses but also in the overall strength of healthcare teams.

It allows IENs to transition smoothly, develop their skills, and feel empowered in their roles. In doing so, organisations foster a workplace culture that values inclusivity, empathy, and support.

For too long, IENs have been left to navigate the complexities of new healthcare systems with minimal assistance, and the personal toll is often substantial.

By creating structured pathways, healthcare providers can not only enhance IEN retention but also create a stronger, more inclusive workforce that is well-prepared to deliver high-quality patient care.

It is time to move away from the assumption that experience alone is enough and recognise that even the most skilled nurses need support when adapting to new environments.

Dr Josephine NwaAmaka Bardi is a mental health nurse and associate dean for education and student experience, London South Bank University, and founder of Raise Awareness of Mental Health in Higher Education