International Retention Toolkit

Introduction

As employers focus on growing and sustaining ethical recruitment pipelines for internationally recruited staff, it is equally important that we retain as much of this workforce as possible. In the six months to September 2023, almost half of new nursing registrants in England were trained overseas and of the doctors who joined the UK workforce in 2021, 50 per cent were international medical graduates. However, a UK systematic review suggests international nurses face challenges in integrating into their roles when recruited to work in the UK. These challenges are not exclusive to international nurses and may be experienced by other international staff groups in the workforce. 

Based on a framework of four pillars, this toolkit brings information, good practice examples and resources together in one place and focuses on what organisations, systems and regions are already doing to create the conditions for all international staff to thrive in the NHS. These four pillars align with the four key actions for internationally recruited staff set out in NHS England’s Equality, Diversity and Inclusion (EDI) Improvement Plan. The end of each section provides an opportunity to reflect on what you have read and consider how you or your team will play your part.

This resource has been produced by NHS Employers, in collaboration with NHS England, employers, staff and stakeholders from across the sector.

NHS Long Term Workforce Plan

The NHS Long Term Workforce Plan (NHS LTWP) is the first comprehensive workforce plan for the NHS, putting staffing on a sustainable footing and improving patient care. It focuses on retaining existing talent and making the best use of new technology alongside the biggest recruitment drive in health service history.

It builds on the NHS People Plan and the NHS People Promise which commits to creating compassionate and inclusive cultures in organisations and systems. 

The EDI Improvement Plan supports the NHS LTWP by improving the culture of our workplaces and the experiences of our workforce, to boost staff retention and attract diverse new talent to the NHS. Leaders and managers should continue to encourage cultures that champion the experience and voice of all staff and ensure a focus on listening, learning and compassion. 

Getting started

There is no single action that will improve retention. Retaining staff is a result of the combined actions that are taken by an organisation or system at each stage outlined in this toolkit, aligned to the People Promise and the NHS LTWP. As an integral part of your international recruitment process teams, organisations and systems should work collaboratively to support retention activities and share good practice.

For systems working towards a collaborative approach to international recruitment, this toolkit provides resources to initiate and support preliminary discussions. For further information on working across systems, go to the International Recruitment Toolkit for advice on where and how to start, and see a useful checklist on how to become a lead recruiter from overseas in your region or system.

It may be useful to consider how you can use your workforce data to learn more about the experience(s) of international staff currently working within your organisation. 

Our self-assessment checklist below will enable you to check your progress against the key factors that are known to support the retention of international staff.

Understanding your data

The NHS LTWP highlights the opportunity for organisations to make better use of national tools to more regularly use employee engagement metrics to inform improvement plans. 

NHS Staff Survey data has been aligned to the seven People Promise elements and two themes: staff engagement and morale. This provides a comprehensive overview of employee experience and is consistent across the NHS in England. The results dashboard can be broken down to provide results for international staff. You may wish to use this data to spot trends and follow up on what your staff are telling you. 

How to find the data breakdown:

• Access the NHS Staff Survey website.
• Click interactive results.
• Using the local or national dashboard option, click on the ‘Breakdown – scores’ or ‘Breakdown – questions’ tab.
• On the ‘Select breakdown’ dropdown menu, click ‘Recruited from outside UK (International recruitment)’.

The NHS Staff Survey interactive dashboard allows users to filter data by two demographics simultaneously at a national, regional and ICS level. For example, nurses and doctors recruited from outside of the UK. 

The People Pulse allows access to more frequent data to identify experiences of colleagues who were recruited from outside of the UK. Additionally, if organisations use the People Pulse as their data collection method for the National Quarterly Pulse Survey, they will also benefit from the breakdown of employee engagement scores by internationally recruited staff, on quarterly basis.

The Workforce Race Equality Standard (WRES) report 2022 highlights the experience of black and minority ethnic (BME) people working in the NHS (which may include a high proportion of internationally recruited staff) and will enable you to compare your organisation’s performance with others in the region and can support collaboration and improvements locally or regionally.

Make use of tools such as the Electronic Staff Record (ESR) to collect data on career progression rates for your international staff and compare with domestic staff. Are there any disparities? ESR has also refreshed the exit interview questionnaire, which allows staff who are leaving to self-report their reasons and state what, if anything, would have kept them in the organisation. 

Local workforce data may hold information on the experience of international staff in your organisation and can potentially help you to identify and tackle any issues they may face.

• Locally designed surveys or conversations with existing international staff can highlight any issues or challenges and ensure they are addressed early.
• If international staff do decide to leave, seek honest feedback either as part of your normal leaving process, or have specific discussions on their experience to improve the experience of existing and future international staff.

Insights from employee listening methods, whether they are led nationally or locally, should be maximised to gain an insight into employee experience in a holistic way. See the Listening Well Guide, which provides organisations with a blueprint for developing a comprehensive employee listening strategy.

​​​​​Other tools

See Understanding your data in the Improving Staff Retention Guide for further guidance. 

NHS England has developed an interactive and practical Civility and Respect Toolkit with a framework for organisations to help tackle bullying and harassment and to create a civil and respectful workplace culture.

Organisations are encouraged to use the Violence Prevention and Reduction Standard, to look at how they address violence against our workforce.

NHS England’s NHS Health and Wellbeing Framework includes a diagnostic tool to self-assess your organisation and provides a high-level culture change toolkit aimed at health and wellbeing staff, human resources (HR) and organisational development (OD) staff, and anyone with an interest in health and wellbeing.

In addition NHS England’s team health and wellbeing guide, a range of simple activities designed to enable teams to look after their own health and wellbeing more effectively.

NHS Employers’ eight elements of positive staff experience, created in collaboration with health and wellbeing, staff experience, HR and equality, diversity and inclusion (EDI) leads, outlines the critical steps and considerations for achieving a robust and sustainable staff experience programme/initiative to support people to stay well in work.

Self-assessment

Our self-assessment checklist below will enable you to measure how well your organisation is currently supporting international staff and where you might need further information or to take action. The questions are based on research by the University of Huddersfield on the factors that are known to support the retention of international nurses but can apply to all professions in your internationally recruited workforce.

It is important to be as open as possible when completing the survey, as this will provide you with an idea of where your organisation may need to focus. Where you identify areas for further development, please visit the relevant section in this toolkit for more information, helpful tips, practical good practice examples, and signposts to useful resources.

Key:

• Red - We have not addressed this area in our organisation or system.
• Amber - We need to do further work in this area in our organisation or system.
• Green - We have addressed this area effectively in our organisation or system.

Self-assessment questions

1. We have a robust approach to understanding our international data in our organisation, which gives us useful insight into the experience of international staff, including reasons for leaving. (Go to Understanding your data)
2. We proactively engage with new international staff in the months before they arrive in the UK to understand their motivations for migration and provide pre-arrival information and support. (Go to Creating strong foundations)
3. We acknowledge and recognise the depth of experience that international colleagues bring to our organisation and consider this when considering their starting salary.  The NHS terms and conditions of service handbook, Annex 23 Point 11 relates to starting salary.  However, Annex 23 Point 17 and Section 12.2 states that ‘employers have the discretion to take into account any period or periods of employment outside the NHS, where these are judged to be relevant to NHS employment’. (Go to Creating strong foundations)
4. We have a comprehensive approach to welcoming new international staff so that they feel settled in their new role and local community. (Go to Making new recruits feel welcome)
5. We understand cultural differences and celebrate the cultures of our international staff, so they feel a sense of true belonging within our organisation. (Go to Building belonging)
6. We acknowledge the depth of experience that international staff bring to our organisation and actively support their personal and professional growth (Go to Maximising personal and professional growth)

While this self-assessment focuses on retaining internationally recruited staff in the NHS, other tools are available to complement retention strategies across your whole workforce:

• NHS Employers Improving staff retention web resource contains an interactive traffic-light tool to help you understand where you might want to focus your efforts first.
• NHS England’s nursing and midwifery self-assessment tool supports you in retaining your nursing and midwifery staff and encourages trusts to develop and implement local evidence-based retention improvement plans.

Pillar one: Creating strong foundations

The first pillar focuses on creating strong foundations in the months before your new recruits arrive in the UK. First impressions are important for anyone starting a new job, but consider how internationally recruited colleagues might feel as they prepare to leave behind friends and family, familiar surroundings, language, and cultures to start a new life in a different country.

Review your recruitment timeline to consider where and when your organisation can offer support. The International Recruitment Toolkit contains a useful recruitment timeline for overseas nurse and midwife recruitment and overseas doctors.

As well as the support you offer locally, diaspora groups can also provide the pastoral and professional support your international nurses and midwives will need. A list of diaspora groups can be found in the International Recruitment Toolkit  and can be shared with your new recruits so they can find out about the support available to them before they arrive.

How to create strong foundations

For international staff

Maintaining contact

You should engage with new recruits early and often. This could include a one-to-one pre-arrival welcome call to get to know them personally, identify what support they may need, and to introduce them to key colleagues they will be working with. Getting to know their reasons for coming to work in the UK at this stage will help to support their personal and professional development, build trust and their attachment to their job, team, organisation, and the life they are seeking in the UK. 

Welcome packs

It is good practice to provide your new recruits with a welcome pack. These can be shared prior to arrival and could include information about the UK, the organisation, local area and dialect, how to register with a GP and emergency contacts (including information for if things go wrong). You can also include details of staff networks, diaspora groups and how your new recruits can access support if they observe or experience bullying or harassment or need support with their own health and wellbeing. 

Go to the International Recruitment Toolkit to use our welcome pack checklist.

Map skillsets and qualification

Research shows 78 per cent of international nurses had been qualified for over five years, and nearly half (48 per cent) had been qualified for more than ten years prior to migrating. On joining the NHS, many are placed on the first pay band for registered nurses and assigned to work in areas overlooking prior skills and experience. A University of Huddersfield study of international nurses’ experience shares how acknowledging previous expertise would improve their experiences of working and living in England. 

It is important to consider the number of years an internationally recruited colleague has been qualified as part of your recruitment process and where possible, to take this into account with their starting salary as per the guidance in the NHS terms and conditions of service handbook. Meet with them to understand the skills and experience they have gained from working in international healthcare settings. Placing them in their preferred clinical area acknowledges their experience and will support their growth and help them feel valued. If this isn’t possible, open and honest discussions about next steps and the possibility of internal transfers should be initiated.

Furthermore, encouraging mutual learning by understanding prior experience and approaches to healthcare used around the world enhances integration and collaboration within teams. 

Cost of living

The University of Huddersfield study of international nurses’ experience of working and living in England describes feelings of surprise or shock at the cost of living related to tax, rising inflation and the cost of fuel and food. Consider providing short-term solutions such as discounts and vouchers or subsidised food. Providing long-term solutions through your employment package can provide stability, reassurance, shows your commitment and will contribute to retaining valuable talent.

Accommodation

It can be complex and challenging for new recruits to independently find suitable and affordable housing. Consider your local accommodation offer and/or work as a system to find suitable accommodation for people before they arrive.  Some organisations with limited accommodation have found it beneficial to make links with local university accommodation providers. 

Internally, engage with staff to find out if any can offer a spare room in their home. Those who can help may be eligible for the government’s rent-a-room scheme, which lets people earn up to £7,500 per year tax free from letting out furnished accommodation in their home.

For leaders, managers and the wider workforce

Manager guide

A managers’ guide can help to prepare managers and team members for working with overseas staff and can include information that will help your new recruits transition smoothly into their new roles. Take a look at the Managers Guide for Overseas Nurses produced by the Capital Nurse international recruitment consortium. You might find it a helpful resource to support the objective structured clinical exam (OSCE) preparation and pastoral support of your international nurses.

Engage existing staff

Encourage your existing international staff to share their lived experience of relocating to the UK with new recruits. They will also have a unique understanding of the support new recruits may need to adapt to the cultural and working differences of the NHS and can provide you with key insights as you develop your support offer.

Good practice examples

Tools and further reading

• This NHS Employers Working and Training in the NHS Guide can be shared with IMGs as part of your recruitment and induction material.
• See NHS England’s tools to support managers with onboarding international AHPs and NHS Employers’ page of useful resources to support international AHPs. 
• The Chartered Society of Physiotherapy provides professional support and information for internationally trained physiotherapists about working in the UK. 
• The Royal College of Occupational Therapy has an international recruitment hub to enable good practices and processes for international recruitment of occupational therapists. 
• The British Dietetic Association has information for employers and overseas applicants who have undertaken recognised training in nutrition and dietetics outside the UK.
• This NHS Employers page provides a collection of national resources and guidance to support your international nurses and midwives.
• The overseas nurses and midwife recruitment section of the International Recruitment Toolkit has further information on UK professional registration requirements.
• UK ENIC (European Network of Information Centres) is the designated national agency for the recognition and comparison of international qualifications and skills. NHS trusts in England can register two staff per trust who will be able to check staff member’s international certificate/s through ENIC. To register up to two members of staff to use the service please email england.nhsapprenticeships@nhs.net.
• NHS Employers cost of living hub draws together resources and good practice to support employees with the rising cost of living. NHS England also provides resources and signposting to support colleagues with financial wellbeing.
• For information on the registration process and associated timescales of the relevant professional regulator see the International Recruitment Toolkit.
• For further information on repayment clauses should your international recruits decide to leave employment early, please see the International Recruitment Toolkit. 

How will you play your part?

Pillar two: Making new recruits feel welcome

The second pillar is about ensuring new recruits feel welcome when they arrive by helping them settle into their new communities and pointing them towards local services.

Consider what they will need during their first few months in the UK to establish themselves to live, work and beyond, such as bank accounts, national insurance numbers, registering with a GP, somewhere to live, UK sim cards, access to shopping, schools, navigating public transport and other amenities. Helping them with these arrangements will make a big difference to how well they ease into life in the UK. Introducing some coordinated social activities can also prove very helpful in encouraging integration into teams.

This supportive approach during the recruitment and onboarding stages means you are more likely to retain staff.

How to make new recruits feel welcome

For international staff

Pastoral support

It is important to provide pastoral care for your overseas staff as soon as they arrive to support them as they adjust to a new culture. You should continue this offer as they move beyond their initial induction period.  

As part of your pastoral care, check in with colleagues and offer them a wellbeing conversation to explore how they are feeling. Your existing international staff are often best placed to provide this support as they know first-hand how hard it can be to adjust to living in a new country. You should also build relationships with local community groups and share details with new recruits to enable them to build social support networks outside of work. Continue to signpost your new recruits to diaspora groups to supplement your current support offer. A full list of diaspora groups can be found in the International Recruitment Toolkit. Your staff networks can also provide a safe space for your international staff to share ideas, raise awareness of challenges and provide support.

A detailed checklist to assess your pastoral offer can be found in the International Recruitment Toolkit as well as further tips, good practice examples and a checklist for more pastoral support ideas. 

Buddying

A buddy can help build relationships between your new international staff and existing staff and help them to feel more settled. Existing staff with lived experience of relocating to the UK could become a buddy for a new overseas recruit. Your local trade union representatives may also be able to help set up peer networks in the workplace.

Induction

Your organisation may already have a well-established corporate induction programme, but it is worth considering what additional support or information might be beneficial for your new international staff. For example, introducing a programme of social adaptation will help your overseas staff to learn about the NHS and the cultural and working differences. A programme like this will also enhance English language levels, particularly in areas such as typical local dialect and phrases. You could also consider designing a bespoke induction programme based on country of origin, such as a comparison of commonly used medications in home countries. Other support offers can include role preparation, for example supernumerary time or OSCE preparation. It is also important to familiarise new international recruits with HR processes bespoke to working in England and the NHS and to share information on pay, terms and conditions and contracts. 

Consider incorporating the induction support available from professional regulators, professional associations and trade unions such as the Royal College of Nursing (RCN), British Medical Association (BMA), the Chartered Society of Physiotherapy, the Royal College of Occupational Therapy, the British Dietetic Association, UNISON, and Unite, and via the Occupational English Test (OET). The General Medical Council (GMC) runs a free workshop for overseas-trained doctors designed to help them settle into medical careers in the UK (see tools and further reading below for more information).

For leaders, managers and the wider workforce

Welcome event

Many organisations hold welcome events or celebrations throughout the year to celebrate the arrival of new international colleagues or to congratulate individuals or groups who have passed their OSCE for example. You may wish to consider working in collaboration as a system to organise events, which would allow for sharing of resources but also would introduce internationally recruited staff across organisations. Including existing international staff, ward or department teams, local faith leaders and senior leaders can help them to feel included, welcomed and supported in your organisation. Your communications team can also get involved in sharing the good news of international staff through internal news stories or newsletters, although it is important to be aware of the Code of Practice red and amber list of countries. 

Health and wellbeing offer

As part of your induction, signpost new recruits to the health and wellbeing offer provided by your trust and/or system and encourage completion of an associated occupational health assessment or risk assessment where required. You should signpost and encourage new recruits to seek support when needed and offer advice on how to do so. You can also encourage them to make links with professional and personal networks and diaspora groups to support their wellbeing and create friendships and peer networks.

Many NHS organisations have introduced networks of health and wellbeing champions to support the health and wellbeing of colleagues across the organisation. NHS Employers’ health and wellbeing champions webpage has guidance for health and wellbeing leads on what they need to do to introduce wellbeing champions as part of the NHS People Plan.

Link with your local HR and OD teams to find out how champions have been introduced, and how you can signpost recruits to access the champions network, an online community of practice, accessible through the NHS Futures site. If you’re managing a team, NHS England’s Looking after your team health and wellbeing guide can help you identify how to best support your team and identify areas of need. 

Flexible working

Line managers are encouraged to discuss flexible working with direct reports during your regular health and wellbeing conversations, appraisals, or via one-to-one discussions. The NHS Staff Council has worked collaboratively with NHS England and Timewise to develop two new guides to support NHS line managers and staff to work more flexibly.

Good practice examples

Tools and further reading

• NHS England’s resource on combatting racial discrimination against minority ethnic nurses, midwives and nursing associates provides advice on the action you can take if you witness or experience racism. It also supports those in leadership roles to be inclusive leaders.
• The King’s Fund runs a free, short course to learn about the history of the NHS and how it all works and fits together. 
• OET has the Living the Language resource to help new recruits overcome common communication challenges. 
• This guidance document sets out minimum standards and detailed guidance for employers to provide an effective induction for IMGs entering the NHS. Access further information and resources on the NHS Induction Programme. 
• The GMC runs a free workshop for overseas-trained doctors designed to help them settle into medical careers in the UK. 
• The Health and Care Professions Council, the regulator for AHPs, provides information for internally trained clinicians wanting to join the UK register. 
• The BMA has a guide to working in the UK for internationally educated doctors, including information about how the NHS works. 
• Consider how working with groups such as the Academy of Medical Royal Colleges, can support international doctors should they choose to join as members.
• See NHS Employers’ quick guide to support your understanding of the Code of Practice for the International Recruitment of Health and Social Care Personnel.
•  NHS England’s national preceptorship framework for nursing sets national standards for preceptorship for nurses and establishes good practice. Further information and resources are available on the NHS Employers preceptorship page.
• NHS England’s allied health professional (AHP) preceptorship standards and framework. This resource aligns with the Health and Care Professions Council’s (HCPC’s) principles for preceptorship. The NHS Pastoral Care Quality Award is a scheme that supports NHS trusts to provide high-quality pastoral care to internationally educated nurses and midwives.
• NHS Employers’ health and wellbeing hub provides advice and guidance on stress, sickness absence and financial wellbeing for NHS provider organisations. The health and wellbeing network is free to join and enables health and wellbeing leads to connect, share good practice and find out what’s happening across NHS wellbeing.
• NHS England has a number of health and wellbeing programmes for NHS staff, to support a range of health and wellbeing needs. 
• See the International Recruitment Toolkit for information on:
  • considerations if you are employing refugee healthcare professionals
  • language support to prepare overseas recruits for their English language tests, and watch this NHS Employers webinar for more ideas. 

How will you play your part?

Pillar three: Building belonging

Pillar three focuses on building belonging. This relies on cultural sensitivity and an awareness of how it feels to be working and living in a different country.

Research shows that having English as a second language can impact on an international nurse’s sense of personal and professional belonging. Accents, abbreviations, local turns of phrase and conversational speeds can result in international staff feeling left out of workplace small talk or deskilled despite years of professional experience. Enabling your international staff to build social networks, to share stories and solutions to these challenges can help to reduce feelings of isolation and support them to bring their passions, culture, and personality to their role. You should also consider the role of leaders, managers and the wider workforce and what support or training they will need to raise awareness and support their international colleagues with these challenges.

How to build belonging

For international staff

Safe spaces

Establish active shared decision-making councils, international recruit forums or staff networks to listen to the voices and experiences of international staff. These safe spaces can become a driving force for change and improvement as international staff feedback on their experiences and develop solutions to any barriers or challenges they may be facing. 

Personal integration

A study of international nurses’ experience of the first two years working and living in England found that personal integration and life outside of work is just as important as professional integration. 

Overseas staff arriving in the UK with their families will need further support and signposting to increase integration into the wider community. Identifying and building relationships with local faith leaders, schools, colleges, and services to provide support will be key to making the transition to a new culture easier for the whole family. Equally consider those who have been separated from their families due to financial constraint or visa processing issues. Adjusting in a different culture without family is known to be one of the most difficult factors of migration. 

Professional integration

Professional support from line managers, clinical educators and mentors is also key to successful integration and can help ease uncertainty and anxiety. Ensuring international nurses have access to restorative clinical supervision by professional nurse advocates will support them to feel less stressed and isolated, increasing their confidence to develop personally and professionally.

Additional support

Consider signposting staff to support available from the relevant professional regulators, professional associations and trade unions, such as the Royal College of Nursing (RCN), the British Medical Association (BMA), the Chartered Society of Physiotherapy, the Royal College of Occupational Therapy, the British Dietetic Association, UNISON, and Unite the union.

For leaders, managers and the wider workforce

Cultural awareness training

Cultural awareness is an important skill for existing staff and managers of internationally educated staff. It increases awareness of different cultural norms, enabling teams to communicate more effectively, avoid misunderstandings, and build stronger relationships with colleagues from different cultures to their own. Where possible you should undertake learning about the cultures of international colleagues. This could be through a social event or more formal training. 

Cultural awareness is also important in both the recruitment and disciplinary process to prevent unconscious bias impacting decisions and outcomes. NHS England has developed online training with Culture in Health for the line managers of internationally recruited staff. The training will help line managers to build and improve the skills they need to better recognise, understand, and meet the needs of their international colleagues. To find out more about the training and other resources which are available, visit the Culture in Health website. 

Celebrations

Acknowledging cultural holidays and events celebrated by international staff, or celebrating their achievements, can help to build a sense of belonging and connection to your organisation and enables them to share their culture and traditions with colleagues.

Health and wellbeing conversations

Line managers should have regular supportive health and wellbeing coversations or check-ins with all of their team, including international staff as they settle into living and working in the UK. Health and wellbeing conversations are regular, supportive, coaching-style one to one conversations that focus on the health and wellbeing of staff. By encouraging organisations to embed health and wellbeing conversations across their system, staff feel heard and valued, and in which diversity is respected. 

Health and wellbeing conversations should consider the whole wellbeing of an individual and identify areas where the individual may need support, signpost them to that support, and regularly monitor their health and wellbeing over time.

NHS Employers’ health and wellbeing conversations webpage has some ideas for things you might consider to ensure that quality health and wellbeing conversations and plans that best meet the needs of our diverse workforce are embedded within your organisation.

See the health and wellbeing section of the Improving Staff Retention Guide for more information on supporting workforce wellbeing.  

Good practice examples

Tools and further reading

• NHS England’s report The expectations of line managers in relation to people management includes a new framework for line managers which creates a clear view on the expectations of line managers in the service in relation to people management and the implications for provision of people services.
• NHS Employers’ health and wellbeing hub provides advice and guidance on stress, sickness absence and financial wellbeing for NHS provider organisations. The health and wellbeing network is free to join and enables health and wellbeing leads to connect, share good practice and find out what’s happening across NHS wellbeing.
• NHS England has a number of health and wellbeing programmes for NHS staff signposting to support for a range of health and wellbeing needs.
• NHS England’s NHS Health and Wellbeing Framework can support you in creating a wellbeing culture in your organisation and also has information on supporting our NHS people.
• NHS England’s guidance on health and wellbeing conversations provides good practice advice and guidance on having safe and effective health and wellbeing conversations. 
• Keep up to date with interventions and practical solutions on NHS England’s retention hub.
• NHS England’s resource on combatting racial discrimination against minority ethnic nurses, midwives and nursing associates is designed to help them recognise and challenge racial discrimination and by doing so, it supports staff wellbeing, physical and psychological safety. It also supports those in leadership roles to be inclusive leaders.

How will you play your part?

Pillar four: Maximising personal and professional growth

The fourth pillar is about maximising personal and professional growth to ensure that all internationally recruited staff can fully realise their potential. 

Research shows that a common driver for international nurses to migrate to the UK is career progression and professional development. However, analysis reveals that progression is slower and less frequent for international nurses than for domestic nurses at all bands. The WRES 2022 report also highlights that just 44.4 per cent of BME NHS staff (which may include internationally recruited staff) believe their trust provides equal opportunities for career progression or promotion. 

Consider the skills and prior experience of your international staff. Once they have transitioned to working in the NHS, implement processes and opportunities to facilitate and accelerate their development. 

Your retention strategy should focus on enabling all international staff to achieve their career aspirations. Their ongoing personal and professional development will also lead to job satisfaction and in-turn a feeling of being valued by their employer. International staff should have access to the same personal and professional development opportunities as your UK workforce and should be tailored to each individual’s preferences and career aspirations. As part of this process, they should be offered an annual personal development review, and a personal development plan should be agreed.

How to maximise personal and professional growth

For international staff

Career conversations

Line managers should hold regular career conversations with international staff to understand future aspirations and how they can be supported through clear career pathways. Holding career clinics with groups of international staff can widen their understanding of available career pathways, where to find roles, how to access education and successfully applying and interviewing for roles in the NHS. Also consider how to use interview feedback to support future applications.

Many international colleagues move to the UK with their spouses and families. There are many career opportunities within the NHS which may be suitable for spouses/partners/ family members of internationally recruited colleagues, and you may wish to make them aware of career clinics.

Coaching 

While managers play an important role in supporting the development of staff, professional coaching can be effective in providing the specialised training and expertise in career development, personal growth, and leadership that managers may not possess. Coaching can be tailored to the specific needs and goals of the individual and does not replace day-to-day managerial support but complements it with longer-term career planning and self-development. See the Leadership Academy for further information and support.

Leadership programmes

Some organisations run leadership programmes to support career progression for international staff and to increase the number of those moving into management positions.

In 2022, NHS England provided funding through its Accelerated Development Transformation Fund to support trusts to scope and develop innovation and transformation projects that focus on ways to recognise prior experience of internationally educated nurses and midwives; provide ethical opportunities to directly recruit into Band 6+ roles; and to accelerate the development of international nurse/midwife talent identified within the workforce. 22 trusts and systems across the country successfully bid for this funding and are delivering these projects. Insights and case studies will be shared via NHS England’s Futures platform.

Financial wellbeing

Health and wellbeing includes financial wellbeing. After five years of living and working in the UK, international colleagues have the right to apply for indefinite leave to remain. This can be a costly process, particularly for colleagues with families. Having the right to stay can support feelings of belonging so it is important to support international colleagues through this process by directing them to where they can receive financial advice or support. Some organisations have developed a loan scheme for eligible staff applying for indefinite leave to remain, helping to ease the financial burden of this process. NHS Employers’ financial wellbeing web page supports you to develop a robust approach to support your staff with financial wellbeing in the workplace. 

For leaders, managers and the wider workforce

Role models

Research shows that following successful career progression, senior international nurses use their positions to influence change and lead and inspire other international and domestic nurses to maximise their potential. Sharing these career success stories on a regular basis will inspire new staff, provide an opportunity to hear about their experience and challenges and showcase the career pathways available.

Mentors

A mentor can support your international staff to develop and take their next career steps, by providing access to their networks and championing on their behalf.

Watch the video of Jeni’s story below to hear how, in her current role as international recruitment and ethnic minorities nurse adviser at NHS England, she has championed the ethnic minority workforce and been an inspirational figure for international recruitment.

Good practice examples

Tools and further reading

• NHS England’s Health Careers web page includes links to resources and support to help international staff to plan their next career steps. Hear from six internationally recruited nurses at different stages of their career about how the NHS has supported them to achieve their ambitions. 
• Resources are available on the campaign resource centre for NHS and local authorities to help support the retention of internationally recruited nurses.
• The Medical Workforce Race Equality Standard (MWRES) report 2021 identified that BME doctors have a poorer experience of medicine than their white colleagues, feeling less supported, less included and less able to prosper. NHS England has announced a First Five programme of priority domains intended to help tackle these racial disparities.
• Direct your international nurses to the CNO Nursing Professional Development Programme, which is a central repository and signposting platform for information on national and regional nursing professional development programmes for all nurses. 
• The RCN offers members a careers service with information and resources to support professional development.
• The BMA offers overseas doctors a range of webinars, coaching courses, workshops and e-learning modules for professional development.
• UNISON offers members a range of courses and workshops to support professional development.
• Take a look at the Professional Development Guidebook produced by the CapitalNurse international recruitment consortium. You might find it a helpful resource to support the professional development of your international nurses.
• NHS England’s report The expectations of line managers in relation to people management creates a clear view on the expectations of line managers in the service in relation to people management and the implications for provision of people services.

How will you play your part?

International retention checklist

International retention podcasts

To support employers, there are a number of audio resources that explore the subject of international retention. 

#StayAndThrive series

To support #StayAndThrive programme, the team has developed a podcast series exploring the experiences of internationally educated NHS professionals of transitioning to living and working in the NHS workforce in England.

Host, Katy McDonald, a former fellow for international retention at NHS England North East and Yorkshire region, speaks directly to international nurses, midwifes, allied health professionals, and to managers and team leaders trying to make those transitions as smooth as possible. The series highlights personal stories of challenges and triumphs, as well as offering advice on how we can all ensure everyone is truly able to stay and thrive.

You can find all episodes on the dedicated podcast website.

As part of the development of this toolkit NHS Employers, working with NHS England, produced a podcast on the #StayAndThrive programme. The voices you’ll hear are members of the community of action, each bringing their own unique perspectives to the challenges international staff face in the NHS. You’ll hear advice on how often simple, practical actions can support international staff to stay and thrive and how working collaboratively has enabled the community to share knowledge and practice across different regions.

Next steps

Now you’ve worked through this toolkit, you may find it helpful to refer back to the self-assessment checklist and consider what action or actions you will take forward locally or in collaboration with system partners.

It is important to build your retention activity into the overall evaluation of your international recruitment work to measure impact and identify improvements. See the evaluation section of the International Recruitment Toolkit to get started (page 55).

More information and contact