Overseas nurses fear speaking up due to concerns about retaliation, including dismissal or stalled career progression, a new report has revealed.
A review published this month by the National Guardian’s Office, which oversees England’s Freedom to Speak Up guardians scheme, has identified some of the barriers faced by overseas nurses and other healthcare workers when raising concerns.
“I’m hoping that this report will strengthen processes in organisations so that staff aren’t persecuted and they’re not left vulnerable”
Felicia Kwaku
The findings draw from surveys and focus groups with more than 850 overseas-trained workers and 150 Freedom to Speak Up guardians.
The report revealed significant hurdles faced by international recruits in adapting to life and work in England, including complex visa and immigration processes, language barriers and lack of recognition for qualifications and prior experience.
It noted that the responsibility for adapting, including implications around speaking up, were often left to overseas-trained workers to deal with, highlighting a need for greater support from employers.
Meanwhile, the National Guardian’s Office found that perceptions of speaking up among overseas staff were often influenced by the “cultural and societal norms” from their home countries.
Some workers described England’s speaking up culture as markedly different from their own experiences.
For instance, some said that “deference and agreeability” in their home cultures made speaking up uncomfortable for them, while others found England’s approach “restrictive”.
Most concerningly, the review found that speaking up was deterred by fears of retaliation, including potential dismissal and jeopardised career progression.
This was echoed by Felicia Kwaku, lead for education and training at the Nigerian Nurses Charitable Association UK (NNCAUK), who told Nursing Times that overseas nurses “have vulnerabilities” when they come to the UK.
“If you’re on a working visa, with conditions, if you’re a junior member of staff, if you don’t have union representation, then the staff can feel vulnerable,” she said.
Felicia Kwaku
Ms Kwaku said the NNCAUK had raised “disproportionate issues around HR procedures for overseas staff”.
“In some of the sectors, they are threatening staff with pulling visas when they have spoken up and spoken out,” she added.
Ms Kwaku called for better protection for overseas nursing staff who want to speak up.
She said: “Although the system calls for really strong whistleblowing policies and speaking out frameworks, it is not as robust as protecting people when they do that.
“That’s the key message, and I’m hoping that this report will strengthen processes in organisations so that staff aren’t persecuted and they’re not left vulnerable.
“Because if they’re left vulnerable, they’re not protected and [this] impacts significantly on their mental health and their ability to deliver care to the patient.”
While many workers who contributed to the review were aware of the Freedom to Speak Up guardian role, the report found that many did not understand its purpose.
Workers also felt guardians might not fully understand their concerns, particularly those unique to overseas staff.
A lack of representation of overseas-trained workers among Freedom to Speak Up guardians and champions further hindered confidence in seeking support.
Overall, the review identified examples of good practice and increasing recognition at local and national levels of the challenges faced by overseas-trained workers.
However, it noted that efforts were often reliant on limited funding sources and were “sometimes abandoned” when resources were withdrawn.
Rohit Sagoo, founder and director of the British Sikh Nurses group, welcomed the findings of the report.
Rohit Sagoo
“It sheds light on the systemic barriers that overseas-trained staff face when raising concerns, a reality many live with daily,” he told Nursing Times.
Mr Sagoo argued that speaking up must be “safe, inclusive and culturally sensitive”.
He added: “We need tailored support from recruitment through to leadership, ensuring these nurses are heard, protected and empowered.
“Diversity enriches the NHS, but representation without voice is insufficient.
“This report is a much-needed catalyst for change, and something we will consider for our organisation.”
The National Guardian’s Office set out several recommendations to support overseas staff to speak up:
Reviewing and enhancing international recruitment and retention guides – ensuring these include explicit reference to Freedom to Speak Up and are regularly updated;
Tailoring Freedom to Speak Up arrangements to all workers – including improving diversity among Freedom to Speak Up guardians;
Improving data collection and categorisation of overseas-trained workers – developing better ways to identify and categorise overseas-trained workers to track speaking-up progress;
Addressing cultural barriers – introducing cultural intelligence training for NHS staff, leaders and guardians.
Sam Bereket, national lead for intelligence and learning at the National Guardian’s Office, said: “Overseas-trained workers make a vital contribution to patient care. But too often, they face extra barriers to speaking up.
“If we want safer, more inclusive care, we must make sure every voice is heard. This review shows how leaders can take practical steps to make that happen.”
