Celebrating and Supporting Internationally Qualified Nurses

By: Dr Gloria Likupe

For this NHS Overseas Workers Day, we focus on Internationally Qualified Nurses working in the NHS; their contributions, challenges and how our work is addressing this.

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As we celebrate this year’s NHS Overseas Workers Day, it is good to reflect on the contribution that internationally qualified nurses (IQNs) make in the UK. The UK National Health Service (NHS) estimates that around 1 in 8 nurses (12%) are trained outside the EU. In NHS hospitals and community services in England specifically, nearly one in five (18.5%) nurses are overseas nationals, this rises to 2 in 5 nurses working in social care settings (Palmer et al 2021).

This number is projected to increase further as in recent years overseas nationals have accounted for around a quarter of nurse joiners on the Nursing and Midwifery Council (NMC) register. As the largest employer, the NHS has always benefited from overseas recruitment and from nurses coming from other countries to live and work in the United Kingdom. This is in line with the NHS Long Term Plan 2021/2022 that set out the ambitions for the NHS over the next 10 years, identifying ethical international recruitment as a workforce priority.

Worldwide, internationally educated nurses make an invaluable contribution to health systems by providing diverse skills and promoting cultural sensitivity in patient care. As the demand for care and for nurses is increasing, the necessity to attract, and importantly, retain IQNs is vital.

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Challenges

However, IQNs working in the UK often face challenges related to cultural integration, communication barriers, a perceived lack of recognition for their prior experience, and potential discrimination. Many report feelings of being treated like novice nurses despite having years of experience in their home countries, leading to challenges in adapting to the professional culture and sometimes feeling undervalued (Sheeny et al. 2023). In addition, many felt they were not being used in roles that matched their prior experience and qualifications, and that integration during their initial spell of employment was often found to be challenging (Devereux 2023). These and other factors from the research show why retaining international nurses is proving to be a challenge at a time when the NHS needs nursing staff more than ever.

Dr Pamela Cipriano points out that these challenges are faced by internationally recruited nurses worldwide by stating “Nurses face numerous challenges: physical, mental, emotional and ethical, and it is imperative that we address these challenges in a way that promotes their overall health” (Church 2025) These challenges can impact their effectiveness at work as well as their personal and family lives. Nurses can fall into depression, burnout and stress which could result in suicidal ideation.

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Support

NHS trusts in England have put together a range of support for IQNs which include but are not limited to:

• Financial support to trusts for international nurse recruitment, sharing learning and best practice to ensure consistent, high-quality offers and interventions.

• A small grants scheme, offering diaspora groups the opportunity to apply for funding to strengthen their pastoral support offer for international nurses in the UK.

• Refugee nurse support pilot programme being delivered in partnership with the Department of Health and Social Care, Liverpool John Moores University (LJMU), RefuAid and Talent Beyond Boundaries (TBB), supports refugees who are qualified as nurses in their home country to resume their nursing careers in the NHS.

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Our work

Despite these challenges, many IQNs also find opportunities for professional development and positive experiences within the NHS, especially with adequate support systems in place. Pamela Cipriano has stated “By prioritising the wellbeing of nurses, we are ensuring that they can continue to provide the high-quality care that is critical to the health of our communities" (Church 2025). These opportunities can only be realised by health care systems recognising and addressing facilitators and barriers to IQNs’ success and wellbeing.

The Nurse Suicide Project is contributing to this end by conducting ground-breaking research that addresses IQNs’ experiences, some of which may lead to suicidal distress. We are using an intersectional critical feminist lens and storytelling methods to create a safe space for nurses to express these experiences. In doing this, we are supporting the recognition and utilization of IQNs' specialist skills by the world’s healthcare systems. In conducting this research, we are acknowledging that all health systems benefit from a more diverse and better-skilled healthcare workforce, ultimately leading to improved patient outcomes and a more inclusive healthcare system. The project team recognise that most research on suicidal distress is colour-blind and has overlooked the experiences of nurses from the global ethnic majority, including IQNs. The team are proactively working with nursing communities across the spectrum to ensure their views and voices are represented in their research.

In the UK, the Nurses and Midwives Council calls for health and care employers to fully support IQNs into UK practice to create the most inclusive environment possible.  We further this call by highlighting that collaboration among policymakers, healthcare organizations and regulatory bodies is crucial in developing strategies for the integration and utilization of IQNs' specialist skills.

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Study 3 will be recruiting internationally qualified and ethnically diverse nurses from spring 2026. You can find more information on the study page or get in touch using the contact form.

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References

Devereux, E (2023) NHS must recognise overseas nurses’ prior experience, urges report. Available at: NHS must recognise overseas nurses’ prior experience, urges report | Nursing Times

Church, E (2025) International Nurses day 2025 theme revealed. Available at: https://www.nursingtimes.net/nurse-wellbeing/international-nurses-day-2025-theme-revealed-10-01-2025  

Palmer, B  Leone, C and Appleby, J (2021) Return on investment of overseas nurse recruitment: lessons for the NHS. Nuffield Trust Available at: www.nuffieldtrust.org.uk/sites/default/files/2021-10/1633336126_recruitment-of-nurses-lessons-briefing-web.pdf

Sheeny, L Crawford, T and River, J (2023) The reported experiences of internationally qualified nurses in aged care: A scoping review, DOI: 10.1111/jan.15913

Your views matter

By: Karen Shaw

We want to hear different viewpoints on why there are higher rates of suicide in women nurses.

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This new year marks an exciting milestone for our project. We are now inviting nurses and stakeholders to take part in interviews or focus groups for the first of our five studies.  Our aim is to understand how distress and suicidality are characterised in current policy and research, and what the impact of this is.

We’ve been working on Study 1 since June 2024, reviewing existing policy and research relating to suicide. We will now take these findings and ask how they reflect the reality of nurses working in health and social care.

First, stakeholders will take part in interviews to give their views as employers, policy makers, nursing charities, researchers or union leaders. After this, nurses are invited to join focus groups to discuss how the narrative in suicide policy and research matches their own experiences.  These interviews and groups will be run by experienced researchers and are safe spaces to express your views.

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An important milestone

Reaching this milestone is incredibly important to the team as it is the aim at the heart of our research: to capture and to amplify voices and experiences.  We believe that research should be carried out collaboratively with the people who will be impacted by it.  After all, who understands a situation better than those experiencing it?

Nurses have shaped our work from the very start: we have a dedicated nurse advisory group who contribute to designing, planning and implementing the research.

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How to get involved

If you are a registered woman nurse working in the UK, in any sector of nursing, and would like more information about getting involved please look at the study webpage, email us or get in touch via our website. We’re particularly keen to speak to a diverse group of nurses who reflect the breadth of the nursing workforce in the UK and to hear how experiences differ.

We are a team working with nurses, for nurses. This is a chance to be part of something truly impactful—an opportunity to help shape the direction of future research and policy to improve the wellbeing of healthcare staff for years to come.

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Study 1: Multi-stakeholder perspectives on distress and suicidality in women nurses: UK has received a Favourable Ethical Opinion from the University of Surrey: ref 0347

Why ‘only’ women nurses?

by Dr Hilary Causer

We have been asked why our research focuses solely on women nurses.

Firstly, let me clarify that when we talk about women in the context of our research, we are referring to anyone who identifies as a woman. This definition has been developed in collaboration with nurses who have experience of suicidality, and we will use it when recruiting nurse participants into our studies.

We made the decision to focus specifically on women nurses for a range of reasons:

1. In response to the statistics regarding suicide rates by women nurses

2. Because women’s and men’s experiences of being a nurse are different

3. Because suicide is a gendered experience and there is a notable lack of research that specifically explores women’s experiences.

4. Because historically, women’s experiences and distress are more likely to be understood as medical problems.

5. Solutions and interventions to address women’s distress and suicidality have been individualised. This suggests that women are seen as being responsible for their own problems, whereas the root cause may lie in the ways that society and the workplace are organised.

In this blog I will focus on the first three.

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Women nurses have a heightened rate of dying by suicide

This project came to fruition in response to the heightened rate of suicide among women nurses who have a 23% greater risk of dying by suicide than women in other professions. This statistic is echoed in other western countries such as Australia and the USA. However, male nurses, health care assistants, or midwives do not demonstrate a similarly heightened rate.

“women nurses have a 23% greater risk of dying by suicide than women in other professions”

Whilst the statistics tell us ‘what’ is happening, we don’t currently understand ‘why’ it is happening. Therefore, we are undertaking five distinct studies, using qualitative and mixed research methods, that focus on the experiences of women nurses. Our research findings will not only add to current knowledge, but also identify necessary changes to the working lives and environments of women nurses to address this longstanding anomaly.  

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Gendered experiences of being a nurse

Research tells us that there are distinct differences in the experience of being a nurse according to gender. Almost 90% of UK nurses are women, thus nursing is a female majority profession. Despite this, women nurses are less likely to progress to senior roles than male nurses and are paid less on average than male nurses.

They are also more likely than their male counterparts to experience discrimination, bullying, and harassment at work and are significantly more likely to experience gender-based violence inside the workplace and intimate partner violence, a known risk factor for suicide outside the workplace. Women health staff, including nurses, were also more likely to experience anxiety, depression, and sleep disorders after working through the Covid-19 pandemic. A recent report on suicide in female nurses in England states that of nurses who were in contact with mental health services 18% percent reported problems at work compared with 6% of women in other occupations.

“Almost 90% of UK nurses are women”

For some women nurses these gendered experiences occur at the intersection with other factors, which further complicate their experiences. For instance, 40% of the NHS workforce, and 60% in social care, are workers from the global majority, many of whom gained their nursing qualifications before migrating to work in the UK. Nurses who identify as Black are disproportionately referred to the nursing regulator.

It is clear, that while the experiences of male nurses are valid and important, they will not helpfully contribute toward growing our understanding of what is happening for women nurses.

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Gendered experiences of suicide and gendered suicide research

There are also gendered differences in suicidal experience. The most significant being that nearly three quarters of all people who die by suicide are men. Paradoxically, incidents of self-harm and suicidal thoughts and attempts are more frequent for women. The means by which people die by suicide also differ between men and women, as do the most likely age at which people die by suicide.

These differences have shaped the research agenda. Specifically, as most deaths by suicide are men, research has focused on seeking to understand risk factors and preventative factors that pertain to men. This has resulted in a dearth of research into women’s suicide in any cohort.

“suicide research has focussed on risk factors and preventative factors that pertain to men”

This is problematic as it means that certain contexts or life events which are specific to women remain unexplored. These include the care burden and the ‘second shift’; menstruation, pregnancy/infertility and menopause; dominance of patriarchal messaging and systems in society and workplaces; sexual and domestic violence and coercive control; violence in the workplace; and experiences of working in female majority professions.

Our research, by focusing on women nurses, will provide novel and valuable evidence that will grow our collective understanding about how suicide might be experienced differently for women.

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Our answer to your question

We have given a great deal of consideration to the design of the studies within this project, including consulting with nurses and our project stakeholders. Our answer to your question, ‘why only women nurses?’, is, because they face greater risk of dying by suicide, and have distinctly different experiences to men nurses, and because women’s experiences around suicide are currently under-researched and poorly understood.

To learn more about the approach that we will be taking in our research, and the feminist and critical arguments that underpin our approach, take a look at our previous blog post by our Principal Investigator Dr Ruth Riley.

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Supporting bereaved healthcare workers.

by Jules Lewis RGN MSc

My name is Jules Lewis and I am a Swan End of Life Care Lead Nurse at The Shrewsbury and Telford Hospital NHS Trust and PhD Student at Staffordshire University. I am also bereaved by suicide, my beautiful best friend Janet took her own life in February 2019 aged 47, a caring and compassionate friend and nurse for over 20 years.

I set up, with the support from our lead volunteer & our administrator, a staff bereavement support service at the hospital where I work. This intervention includes 1-2-1 support sessions, a safe space to be heard, with compassion, kindness, understanding, support and signposting to other support services as required.

Funding for this service was gained from Health Education England following a successful business case application. This money is used to backfill my hours to allow me to do this work for a few hours per week, and to cover the cost of room bookings to ensure we have a safe space to support staff. We are lucky enough to have a perfect venue on the hospital site but not in the main building. 

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Bereavement support cafes.

We also offer an ongoing peer support group, in the form of staff bereavement support cafes, these run every few months throughout the year.  This support is for all bereaved staff who work at the hospital, it is to support staff with personal bereavement or professional deaths (the death of a person they cared for). This can range from expected, unexpected, traumatic & bereaved by suicide. I am currently supporting several staff who have been bereaved by suicide.

“It has proved more valuable than I ever thought. Just to have the space and time to process and talk about my feelings following my bereavement I have found incredibly helpful.”

Bereavement café attendee    

At the December café each year we have a tree of hope where staff who attend the café and others can write a bereavement memory tag and place it on the tree in memory of their loved one. It remains in our conference centre for several weeks over the Christmas and New Year period.

“Having a safe, secure and confidential person to speak with has really helped me work through some of the difficulties of my recent bereavement.”

Bereavement café attendee

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The aim of my PhD pilot project is to evaluate the effect a bereavement intervention has on healthcare staff’s health and wellbeing.

In addition to our bereavement support we have also set up a walk and talk session, available to all staff, once a month at lunchtime. On a 20–30 minute walk we offer a listening ear and kindness. Signposting to further support as appropriate and required. We aim to encourage staff to get into nature and boost their health and wellbeing.

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Poetry.

I’d like to share two poems by my friend Brendon Feeley. We gift the first beautiful poem – ‘No Judgement Here’ to staff at our bereavement cafes.

Jules Lewis and Brendan Feeley

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No Judgement Here

This is a safe environment.

There is nothing for you to fear.

There is no need to worry.

There is no judgement here.

If you feel you need a friend,

reach out and you will find

this world can be incredible,

with people caring and kind.     

By Brendon Feeley

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This 2nd poem is one that I hope will give nurses and others the hope to get help and support for the future.

Not Today

When the darkness falls around you

and the light has all but gone,

it’s then that you dig deepest

for the strength to carry on.

With the biggest smile you can muster,

stare into the darkness and say,

I’ve bested darker days than this,

and you won’t win today. 

By Brendon Feeley

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Thank you for reading this blog, we hope it makes a difference at the hardest of times.

Best wishes,

Jules and Brendon.

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On the death of a colleague.

by Leah Hosie RMN

Working with individuals who experience suicidal ideation or intent is an integral aspect of mental health, and it is probable that all registered nurses working in this field will come across a person in this situation at some point, irrespective of the specific area in which they develop their career.

As an RMN working in a crisis resolution team, this was a common concern. Whether borne out of situational crisis, a deterioration in a mental health condition, or any other number of contributing factors, a thread to the narrative of these service users was a sense of feeling hopeless and overwhelmed. Initially, when doing my risk assessments and asking people what had got them to this point, this decision, I would tread carefully with my language, use euphemisms and metaphors and be so tentative as to be ineffectual.

But my nursing skills developed, and my confidence grew. Towards the end of my clinical career, I was able to say to a service user ‘Death comes to us all, why rush that process?’ and feel competent that I could manage the response, whatever it might be. I became skilled at navigating emotions and attuned to subtle shifts in body language, I know when to speak and when to remain silent. I took professional pride in my ability to assess risk and provide something of use to that person based on their need at that precise moment.

A colleague suicide.

And then I had a colleague and friend end her life. Suddenly, abruptly, without warning. She was a fellow mental health nurse, and we had worked together on the crisis team before parting ways when this service was disbanded. We stayed connected though, largely through messaging and social media. A few weeks before her death, we had spent an evening talking about her desire to explore other avenues of nursing, and perhaps consider health visiting.

For all my skill, for all my competence, for all my confidence – I never saw this coming. I had never envisioned it, never thought or felt for a second that she was at any risk. I was devastated. All my crisis team colleagues were… What could we have said? What could we have done? How did we not know?! What did we miss?

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Practice what we preach.

I do not understand why she didn’t reach out for help, but I wonder if it was because as mental health nurses, there is the expectation that we have our sh*t together so that we are able to help others. So, what then happens to those of us that are also struggling, overwhelmed or hopeless? How easy is it for us to practice what we preach? To reach out for support from the mental health professionals in our lives? Even if we work alongside them, rather than in a patient-provider capacity.

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Reach out.

I would like to be able to write this blog post as a nurse who has gone through this experience and be able to say here is what I would do differently… but I cannot. I do not know. I do not know what went wrong, and I don’t know how (or if) I could have helped. Heaven knows I have contemplated this for hours, but I am none the wiser.

So instead, I write this blog as a person who grieves and who may never get the answers. But as for you, dear reader, if you see something of yourself in my friend and colleague’s story, please, please, please, do not suffer alone. Do not suffer in silence. There are barriers thrown up in life and there can be days, weeks, months or longer when it is all just too much. But with love and support might come the option to break those barriers down, to master that which overwhelms us. Professionally, I have witnessed remarkable transformations when people in need engage with that support. And personally, I have been devastated by the effects when people do not.

Please ask for help if you are in need. Please.

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If you are experiencing distress or suicidal thoughts, please take a look at our support page.

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