University Hospitals Dorset NHS Foundation Trust (UHD) have formed and used staff networks to help create a sense of belonging for their internationally educated workforce (IEW). Through these staff networks, UHD has implemented interventions based on the engagement and feedback from the IEW.
UHD are a multi-site acute provider, with 9,200 staff serving a population of over 800,000. The trust formed in October 2020 after the merger between Poole Hospital and Royal Bournemouth and Christchurch Hospitals (RBCH).
UHD have recruited over 400 internationally educated nurses (IENs) and 152 medical staff members at non-training grades, where the majority are international medical graduates (IMGs) working in medicine and surgical specialties. UHD have several interventions to create a greater sense of belonging for their international nurses and medics, including through their staff networks. Some examples are:
Nursing
- Ensuring the black, Asian, and ethnic minority (BAME) network meet with newly recruited IENs on induction and that they are signposted to other available staff networks.
- Providing a monthly forum for IENs and other international recruits e.g., radiographers.
- Ensuring the freedom to speak up (FTSU) guardian meets with IENs upon induction.
- Delivering an induction session by staff who have previously undertaken the objective structured clinical examinations (OSCE) and transitioned to registered nurses within the UK, empowering them as role models and support for new IENs.
- Introducing practice mentors to support IENs with their Nursing and Midwifery Council (NMC) registration and progress from agenda for change (AfC) pay band four to AfC pay band five.
Medical
- Providing a two-day induction programme from the GMC and Wessex deanery.
- Implementing a four-week shadowing programme for new recruits, led by two directors of locally employed doctors.
- Ensuring the FTSU guardian meets with IMGs on induction.
- Introducing new recruits to staff networks and the development of the international doctors support initiative (IDSI).
- Allocating a General Medical Council (GMC) recognised educational supervisor and clinical supervisor to all IMGs.
- Establishing engagement mechanisms for IMGs to raise queries with managers and board members through a doctors' forum.
- The provisioning of an exception reporting tool for IMGs to allow a trust level overview of key issues, such as inaccessibility to education and training, and work outside of rota-ed hours.
The organisation has reflected and learnt from feedback from the IEN cohort both via the networks and FTSU guardian. This has enabled the trust to provide a more effective welcome and induction process. The trust has a 100% OSCE pass rate and attributes this to the range of interventions provided to support IENs.
Through the support offer, the IMG cohort have reported better understanding of the NHS, the GMC, and the support that is available to them. The guidance provided by the IDSI, particularly regarding supervision for non-training grade junior doctors, has led to a narrowing of the differential attainment gap. Overall, these interventions have led to an improved sense of belonging, trust and understanding and sharing of problems and issues.
Picture from UHD welcome tweet for new IENs. The original caption read: "A big #TeamUHD welcome to our latest international nurse arrivals. Our newest recruits from the Philippines, India and Ghana will join recovery, interventional radiology, our emergency department and various wards across our trust. Thank you for choosing us." Image supplied by University Hospitals Dorset NHS Foundation Trust.
Hear from the trust
The Race Equality programme spoke to Karen Allman, chief people officer, at UHD about implementation of these interventions, the challenges, learning for the board, and advice for board members looking to support their IEW.
Nursing
The pastoral support nurses established the IEN forum with the endorsement of the chief nursing officer (CNO) and deputy CNOs. Collaborative working via the forum enabled staff to recognise the needs of the IENs, review the existing offer and develop additional support. As a result, the forum was able to implement the following:
- Recruitment of practice mentors to support the IENs to achieve their OSCE and NMC registrations.
- Improvement of the accommodation offer for newly arrived IENs from eight weeks to six months, allowing them to focus on settling in and preparing for the OSCE exam.
- Review of the induction programme and integrating staff networks.
- Presentations and information sessions for newly arrived IENs e.g., understanding credit scores, registering children for schools and social care.
- Specific support for IENs with pregnancy related challenges.
Medical
The deanery, working in conjunction with the GMC, was a practice that was set up having identified a gap in support for both IMGs and locally employed doctors. To support onboarding into the NHS and the ways of working at their new site, the director of medical education proposed a four-week shadowing programme which was implemented initially at RBCH. Following the merger there was recognition that the support needed to be expanded across the additional sites and capacity was increased. These actions and implementations were supported by the board.
The trust also established staff equality networks covering a range of protected characteristics, including the IDSI. The IDSI was developed with input from IMGs and other staff. This group is led by IMG junior doctors, with senior support. It provides a specific forum to support this cohort with:
- Onboarding
- Communication skills
- Access to leadership and teaching experience
- Career progression and exam support
- Governance and audit exposure required for development within their role
- Robust supervision for non-training grade junior doctors.
Implementing these interventions had some challenges, including:
- Managing staff removal from rostered shifts to attend forums and participate in shadowing (due to existing workforce shortages).
- Adequately resourcing and having the capacity to support initiatives. For example, IDSI is run by staff, this is in addition to their existing workloads.
- Navigating the trust's internal processes when compiling a business case for new interventions and additional funding.
The board has an increased understanding of the importance of supporting its IEW, and the impact this has on retention and patient care. The board has also supported further investments for the IEW.
- Provide pastoral support to facilitate the transition of the IEW into the NHS and their new life in the UK.
- Emphasise the importance of cultural readiness among staff receiving the IEW, as it is crucial for all to engage in a learning process.
- Allocate sufficient time for the IEW and adopt a compassionate approach, recognising colleagues with significant experience may face unique challenges during this transition.
- Develop comprehensive training programmes that incorporate welcome, orientation, induction, and OSCE preparation.
- Incorporate ongoing training and further professional development after achieving NMC registration.
- Facilitate the IMG induction with the GMC and deanery and have a comprehensive shadowing programme.
- Provide visible senior leadership from induction and remind staff including IEW about the importance of giving feedback and speaking up, acknowledging that it may not come naturally and may be accompanied by fear.
- Encourage teams to build individual relationships with members of the IEW, allowing them to understand their backgrounds as this helps with adaptation, future progression, and staff feeling valued.