I was saying to Helen12 earlier about the UKCC programme that the path that you go through is a straightforward competency based thing that you have to fill out. There’s nothing in the competency, there’s nothing in the package that makes you compare your competencies from wherever you come from, wherever you trained. If you know how to do intravenous canulation in the Philippines and in Africa there is nothing in the pack that says “okay, the reason why British nurses are not allowed to do this is because” so and so. “But we recognise that you have these skills, you have been trained to do these skills and there will come a point in your career we can leap forward from this, we can use your experience.”
(female, 46 years old, Zimbabwe, black, D grade)
Most of the time what I have noticed here in England is like when you come with your experience you’re just going to last because most of the things you are limited to do like he has already mentioned, a simple intravenous infusion, when you are supposed to do they’ll ask you have you trained in England and when you say no then they will tell you that you are not allowed to do that. A simple thing that you can do to save the life of the patients.
(female, 46 years old, South Africa, black, D grade)
It should be personal like a whole group. Like now I attend study days with people who just qualified, I’m in the same group as them, but I would say I’ve been here for two years old, sometimes I feel worse than I came here because most of the [inaudible]... some of the skills I had they’re dead because I don’t have a chance to use them. I just have to go according to how it’s written down and the support might be good for somebody who’s new, but I think it’s destroying me
(female, 31 years old, Kenya, black, D grade)
They [the carers] determine your fate and … to continue to be a carer because you cannot imagine a situation where you are being, you are being handled by an untrained person supervising your own job as a qualified nurse from another country, because these are the people the matron will call to the office and start asking about you as a person that [inaudible]... the matron himself who could sign the paper [NMC mentorship]
(male, 39 years old, Nigeria, black, D grade)
IRNs in the focus groups suggested that what was needed were explanations as to the rationale for the registration process as well as the adaptation course. In particular, they appreciated the need for an adaptation course that introduced them to British nursing and new technology but were unconvinced that it was appropriate that these were undertaken in independent care homes while caring for the elderly. They evidently understood this as a method of filling shortages in care homes. This exchange from a focus group in Leeds shows their understanding of the adaptation course quite clearly:
It’s like clarifying what you can do and what you cannot do and making him understand why you cannot start a drip, why you cannot canulate, giving you a reason why you cannot do that, because of litigation. But we weren’t told about that. This was supposed to be covered during the adaptation period.
Yeah.
But instead of cover it’s actually put in issues with letting us do care work. That’s not a nurse’s job, they should give us clear cut information about why we cannot catheterise when I have been trained for twenty years to doing catheterisation, but now I can’t do it.
Another IRN described her feelings of working as a carer while waiting for her PIN number from the NMC as humiliating even though she appreciated the reason for having to undergo some form of adaptation to work in the UK:
Well my experiences working in the UK as a nurse I felt my motivation from my country has not been met. Like I told you I’ve been here for the past eight months or seven months and I’ve not got my pin number. Yeah, and so I feel I’m still working as a carer, you know, as a qualified nurse. I graduated from school of nursing 1987 and up to now I’m still working as a carer here and that wasn’t my, you know INTENTION?
Yeah, my intention of what it looks like in the UK even before coming here. I felt if one has to undergo adaptation whichever being, you know, whether NHS or in a nursing home it should be purely nursing practice and much so your qualification as a nurse should be respected and maybe, you know, making you, subjecting you under the carers or what they call it. It’s not carers, it’s actually humiliating. (female, 34 years old, Zimbabwe, black, D grade)
Given the extent of IRNs’ negative feelings towards, and poor experiences of, their adaptation courses, this issue could also be seen in the context of the discrimination reported by IRNs (see chapter 9). That is, their experiences of their adaptation courses may have been worsened by the lack of nursing on many of the adaptation courses and their experiences of
We African nurses come into this country. It’s to work in a challenging
environment, but when you come on adaptation you are expecting to be adapted as a nurse, not adapt as a carer. If you’re going to work in a home if you’re working under supervision of a nurse that’s much better, but when a senior carer
[inaudible]... allocate duties to you it’s actually really humiliating. You feel like “well, where is the nursing …here?” And, as she says, when you actually get your pin number then you have to work in that home, will the senior carer recognise you and acknowledge you? I don’t think so because they’ll still think: “She was a carer here and how can she be a qualified nurse today?” And: “We used to show her what to do.”
(female, 36 years old, Nigeria, black, D grade)