The International Nurse: Culture and Communication in the NHS

Abstract

Background: The National Health Service (NHS) in the UK has been reliant on an international workforce since its conception in 1948. Previous research has shown that our international workforce has experienced racism, discrimination, inequalities in pay and under-representation in the workplace.

Methods: Between September 2022 and December 2022, six international nurses were interviewed on a 1:1 basis via MS Teams. Of the six nurses, four were Filipino, one was Kenyan, and one was Indian, three were male and three were female.

Results: Using Braun and Clarke (2022) Reflexive Thematic Analysis, five main themes emerged with a further 15 subthemes. Theme 1. Migration came with three sub-themes: motivation, preparation and expectations. Theme 2. Culture and Country saw two sub themes recognised: food and humour. Theme 3. Culture and the workplace were highlighted with four sub-themes: work environment, racism and discrimination, nurse-to-doctor relations and nurse-to-patient relations. Theme 4. Communication, and with this came five sub-themes, namely, mother tongue to English, mother tongue to mother tongue, accents, idioms and slang. Finally Theme 5. Differences in nurse education and training.

Conclusion: The NHS will forever be reliant on its international workforce; yet this study has shown that the international workforce remains under-represented, face racial discrimination in the workplace and experiences inequality in pay when compared with less experienced white, UK-born counterparts. I believe the gap in the research literature lies with nurse education. Could pre-registration nurse education be the vehicle for educating the next generation of nurses about the inequalities and challenges our international workforce face? We need to develop a diverse workforce that is not just representative but will also have both the confidence and the felt sense of mutual support to be able to challenge the status quo.

Date of Award	25 Jun 2025
Original language	English
Awarding Institution	University of Bath
Supervisor	Gail Forey (Supervisor) & Trevor Grimshaw (Supervisor)