WESolutions
The UK healthcare system has been relying on skilled nursing staff for patients to get the safest and effective healthcare. In recent years, the demand for these professionals has grown exponentially compared to what the domestic supply can provide. The pressure created by an ageing population, rising chronic illness rates, and the effects of the COVID-19 pandemic have made staffing shortages a persistent challenge.
To bridge these gaps, hiring international nurses has become a central strategy for NHS trusts and private healthcare providers. This approach does have many benefits, where you increase the workforce, which also improves the diversity in the workplace and culture, as well as better patient outcomes; however, it has its own set of ethical and logistical challenges that need careful consideration.
We’re exploring the expanse of the current state of the UK nursing workforce and what are the potential benefits of international nurses vs. what are the challenges that come with out-of-state recruitment, considering the role of international policies, ethical and sustainable practices.
Current State of the UK Healthcare Workforce
The UK’s nursing workforce is at a critical juncture. Demand continues to grow, but recruitment and retention have not kept pace. As of March 2024, there were more than 38,000 nursing vacancies in England alone, which equates to roughly one in ten nursing posts being unfilled (Nuffield Trust). These shortages directly impact patient care, increasing waiting times, delaying treatments, and placing extra pressure on existing staff.
The Nursing and Midwifery Council (NMC) shows that the total number of nurses and midwives on the UK register has reached a record high of more than 853,000 professionals in 2024 (NMC). While this might appear to be good news, a closer look will tell you that most of this growth is being driven by international recruitment. Nearly half of the new nurses joining the register qualified overseas, a stark contrast to a decade ago, when most new registrants were trained in the UK.
International recruitment has historically been crucial to the NHS, especially during times of crisis. During the COVID-19 pandemic, overseas nurses were fast-tracked into roles to meet urgent needs. However, reliance on global recruitment has steadily increased over the last five years. In some hospital trusts, overseas-trained nurses now make up more than a third of the workforce.
At the same time, recent government policies have aimed to increase the number of domestically trained nurses. The NHS Long Term Workforce Plan set a target of 50,000 more nurses by 2025 (NHS England). However, training a nurse takes at least three years, and early indications suggest that domestic recruitment alone will not be enough to close the staffing gap. This reality makes international nurse recruitment an essential part of workforce strategy for the foreseeable future.
Benefits of Hiring International Nurses
International nurses play an important role in strengthening the UK healthcare system, bringing with them skills, experience, and diverse perspectives. Their recruitment has become vital for hospitals and NHS trusts facing persistent staffing challenges.
1. Addressing Urgent Gaps in the Workforce
One of the biggest advantages of hiring international nurses is the rapid reduction of vacancies. Domestic training programmes cannot meet short-term demand, particularly when large numbers of UK-trained nurses retire or leave the profession. Overseas recruitment enables NHS trusts to quickly bring skilled professionals into critical roles, ensuring wards are safely staffed and patient care is not compromised.
For example, in London, collaborative programmes such as the CapitalNurse International Recruitment Consortium have successfully placed hundreds of overseas nurses each year, directly reducing vacancy rates (HEE).
2. Enhancing Workforce Diversity
International nurses come from a wide range of cultural and educational backgrounds. This diversity brings valuable perspectives, particularly in areas with multicultural patient populations. Research suggests that diverse healthcare teams are better equipped to understand and meet the needs of different communities, which can lead to improved patient outcomes and higher satisfaction levels (Health Foundation).
3. Bringing Specialist Skills and Experience
Many overseas nurses arrive with advanced clinical skills and years of experience in areas such as critical care, paediatrics, or surgical nursing. This not only strengthens the workforce but also provides opportunities for skill-sharing and professional development among UK staff. These nurses often have leadership experience, which can support mentoring and team development.
4. Improved Retention Rates
Evidence shows that international nurses often stay longer in their roles compared to some UK-trained nurses. A Nuffield Trust report found that 93% of overseas nurses remained in the NHS after their first year, compared with 90% of UK-trained nurses (Nuffield Trust). This stability helps reduce turnover costs and provides continuity of care for patients.
5. Economic Efficiency
While recruiting internationally involves costs such as relocation, visa sponsorship, and training for UK practice standards, the long-term benefits often outweigh these expenses. A single vacancy can cost the NHS thousands of pounds in overtime and temporary agency fees. By hiring permanent international nurses, trusts can reduce their reliance on costly agency staff and deliver care more sustainably.
Challenges and Concerns
While the benefits are clear, international nurse recruitment also brings challenges that must be addressed for the strategy to be truly effective.
1. Ethical Recruitment
One of the most pressing concerns is the ethical impact of recruiting nurses from countries with their own severe healthcare shortages. The UK government uses a red list to identify countries where active recruitment is not permitted unless there is a government-to-government agreement (Gov.uk).
Despite these safeguards, there have been reports of recruitment from red list countries such as Nigeria and Zimbabwe, sparking criticism from both UK and international health leaders. Balancing the UK’s needs with global health equity remains a complex challenge.
2. Integration and Support
Adjusting to life and work in a new country can be daunting. Even when nurses are recruited ethically, integration remains a key challenge in the process as international nurses often face cultural differences, language barriers, and difficulties navigating UK systems. Without proper induction and support, these nurses may struggle to integrate, which can impact their performance and well-being. Trusts that provide robust pastoral care and mentorship programmes tend to see better retention and satisfaction rates.
3. Visa and Immigration Barriers
According to a new RCN report, 42% of internationally educated nurses plan to leave the UK, citing low pay, high living costs, and restrictive immigration policies. Many face financial hardship due to no recourse to public funds (NRPF), while 64% report workplace discrimination. Proposals to extend the wait for indefinite leave to remain from five to ten years risk worsening them leaving the UK, as other countries offer faster, cheaper settlement routes (NHE).
4. Workplace Discrimination
Unfortunately, discrimination and racism remain challenges for some international nurses. A report by the Royal College of Nursing (RCN) highlighted that overseas-trained nurses are more likely to experience bullying or unfair treatment in the workplace. Addressing these issues is essential to creating an inclusive and supportive environment (RCN).
5. Dependence on International Recruitment
Relying too heavily on overseas recruitment carries long-term risks. Global events such as pandemics, economic crises, or changes in international mobility can quickly disrupt the supply of nurses. The recent 30% drop in international recruitment between 2024 and 2025 demonstrates how vulnerable this pipeline can be (Nursing in Practice).
Policy and Regulation in International Recruitment
Policies and regulations play a crucial role in balancing the benefits and risks of hiring international nurses.
The UK government has established a Code of Practice to ensure that recruitment is ethical, transparent, and aligned with global health priorities (Gov.uk). This code outlines the responsibilities of NHS trusts, recruitment agencies, and international partners.
The NHS International Recruitment Toolkit provides practical guidance for employers on everything from candidate selection to onboarding and pastoral support. It encourages best practices that prioritise the well-being of international recruits.
There are also ongoing initiatives to strengthen partnerships with countries that train large numbers of nurses. For instance, collaborations with nursing schools in India and the Philippines create structured pathways for recruitment while supporting workforce development in those countries.
Finally, the government’s long-term workforce strategy emphasises reducing overreliance on international recruitment by expanding domestic training and improving retention among UK-trained nurses. This dual approach aims to create a more sustainable workforce over time.
Conclusion
The recruitment of international nurses is both a lifeline and a challenge for the UK healthcare system. Overseas nurses play a vital role in maintaining safe staffing levels, improving diversity, and bringing valuable skills to NHS trusts and other healthcare providers.
However, this reliance must be carefully managed. Ethical recruitment practices, strong integration support, and fair workplace policies are essential to ensure that international nurses are treated with respect and valued for their contributions.
At the same time, investment in domestic training and retention remains crucial. By balancing international and domestic strategies, the UK can build a resilient, skilled nursing workforce capable of meeting future healthcare demands.
