Over one in three internationally recruited nurses have had to pay fees to their employer or a recruitment agency to work in the UK (1). Over a third (37%) of Filipino nurses had to pay commission after securing their job and for half of them this was between 163500 and 1632,000. These findings come from the first survey of the experiences of internationally recruited nurses from a range of countries working in the UK, conducted by MORI's Social Research Institute on behalf of the Royal College of Nursing.
The survey was designed by MORI in close collaboration with the RCN and was conducted between 11 January and 7 February 2002 with 1,119 internationally recruited nurses responding.
Plans to continue working in the UK
Around half (51%) of internationally recruited nurses would like to stay in the UK on a long-term basis, i.e. more than 4 years. Few (5%) intend to stay two years or less. Three in ten (30%) are undecided about their length of stay.
There is a breadth of experience among internationally recruited nurses, with nearly nine in ten (85%) having more than five years' experience and around a fifth (18%) with more than 20 years' experience.
Payments to Gain Registration in the UK
Just over one in three had to pay something to their employer and/or a recruitment agency to come and work, and gain registration in the UK. Payments include: air fares (22% of internationally recruited nurses), a commission after securing work (13%), education and training (11%), an introductory fee (11%), an information pack (7%).
A third (37%) of Filipino nurses had to pay a commission after securing their job, and for half of them this was between 163500 and 1632,000. This practice has been outlawed in the Philippines.
Two-thirds (67%) earn between 16315,500 and around 16320,000 per year. Only 3% earn less than 16312,500, whilst 15% earn around 16320,000 or more. The average salary is approximately 16317,900 per year (around 1639.20 per hour).
International nurses with more experience tend to be paid more, compared with those with less experience. Whilst only around three in ten (31%) of those with up to 5 years' experience are paid between 16317,055 and 16330,720 per year, this rises to around half (54%) of those with more than 20 years' experience.
Experiences of Nursing
Around half (48%) feel that UK colleagues are treated better than they are. A third (33%) feel that their UK colleagues do not respect their qualifications.
A quarter of internationally recruited nurses do not feel that they are well supervised at work, and a similar proportion (24%) say that colleagues do not have the time to help or answer questions.
In general, internationally recruited nurses with lower salaries and those with more years' experience are more likely to feel that UK colleagues are treated better than they are. Those with more experience are also more likely to feel that colleagues do not have time to help them or answer questions, and that colleagues do not respect their qualifications. Internationally recruited nurses from Nigeria (43%), South Africa (46%) and Zimbabwe (56%) (2) are much more likely to feel their qualifications are not respected by colleagues, compared with those from Europe (excluding Spain), the Philippines (23% for each) and Australia (18%) (3).
Internationally recruited nurses are much more positive overall about how they are treated by patients. Seven times as many say the patients they care for treat them with respect (71%) compared with those who say they do not (10%). Internationally recruited nurses from Africa are much less likely to feel that patients treat them with respect. Half of nurses from Nigeria (50%) and three-fifths of those from Zimbabwe (60%) agree that their patients treat them with respect. While nurses from Nigeria and Zimbabwe are more likely to disagree that patients treat them with respect, those from Nigeria are also more likely than average to be neutral on this question. Agreement that 'patients treat me with respect' rises to four-fifths of those from the Philippines who agreed that patients treat them with respect.
The best and worst aspects of living and working in the UK
The opportunity for professional development is much more commonly seen as the single best thing about living and working in the UK with one in four citing this. No single factor dominates as the single worst thing about living and working in the UK but both the weather (15%) and racism (14%) were cited most frequently.
Racism and lack of support
Fourteen per cent (the second most frequently cited response to this question) said racism/racial discrimination was the worst aspect of living and working in the UK.
Eight per cent describes the attitude of colleagues as the single worst thing about living and working in the UK. This is sometimes expressed through a perceived lack of recognition. This may be made worse by the isolation that internationally recruited nurses can feel, living away from home and with less access to friends and family.
It is difficult to divide some factors -- such as racial discrimination -- between the work place and outside the workplace because they cross over this divide. Around half (52%) cite work-related factors -- specifically, low pay, lack of recognition, low support from colleagues, heavy workload, staff shortages, bureaucracy, poor working environment, under-funding, the attitudes of patients and relatives, or lack of promotion prospects -- as the single worst thing about living and working in the UK, although no individual category is mentioned by more than one in ten.
Racial discrimination is more likely to be felt by those on lower salaries and those with less experience. This suggests a link between racism and social status -- those in lower status occupations being more likely to experience racial discrimination, whether this is felt inside or outside the workplace.
Pay and cost of living
Fourteen per cent cited better pay as the best thing about working in the UK while 9% said low pay was the worst aspect. Those on lower salaries are more likely to feel that their pay is better than in their country of origin. Many others (11%) cited high cost of living as the worst aspect.
One in four (25%) internationally recruited nurses cited professional development as the best thing about living and working in the UK. A tenth (11%) said experiencing a different culture was the best aspect. The potential for professional development through working in the UK is cited in relation to the experience gained of using modern technology and procedures, and the opportunities for continuing education and training.
Some see the UK's cultural attractions, personal freedom and lifestyle opportunities as the single best thing about living and working in the UK (11%), and others describe the opportunities to travel and visit other European countries (9%).
- MORI conducted this research with a random sample of internationally recruited nurses from the RCN's database, using postal self-completion methodology from 11 January to 7 February 2002. The response rate was 35%. Data are unweighted. The overall findings are accurate to within +/- 3%.
- Nurses surveyed -- The nurses surveyed are members of the RCN from a range of countries including Philippines (24%), Europe (excluding Spain) (13%), Nigeria (11%), South Africa (11%), Australia (7%), Zimbabwe (7%), West Indies (5%), New Zealand (4%), Ghana (3%), India (3%) and Canada (2%). Nearly two-thirds (63%) work in NHS hospitals, 17% work in nursing homes, 7% in private hospitals, 1% in GP Practices and 4% in NHS community settings. Most of those surveyed (93%) are registered as adult/general nurses, whilst 3% are mental health nurses, 2% are children's nurses and 1% are health visitors. The vast majority (93%) of internationally recruited nurses work in England. More than half (53%) have worked in the UK for more than two years.
- Recruitment -- Almost half (48%) were recruited through recruitment agencies. A quarter made applications directly to an employer. Sometimes, NHS employers visit international countries in order to recruit international nurses, and this is responsible for recruiting about one in ten (9%) of the sample of internationally recruited nurses working in the UK. 5% were recruited through arrangements made by friends or relatives already living and/or working in the UK, while only 1% mentioned a joint agreement between the UK government and their home country's government.
- Most commonly this was for their air fares (22%)
- Please note the small base for Zimbabwe (75 nurses). Caution should therefore be exercised when drawing conclusions from this finding.
- Please note the small base for Australia (80 nurses). Caution should therefore be exercised when drawing conclusions from this finding.