International recruitment best practice - OSCE webinar

29 August 2019Adele Bunch, Programme Lead for workforce

supply

Poll questions

University Hospital Southampton

International Nurse Experience

Rachel Palmer

Education Lead / International Nurse Lead

University Hospital Southampton

• Fourth largest teaching hospital in Europe

• 13,000+ staff

• Major trauma centre

• Regional centre for cancer care, neurosciences, cardiothoracic & vascular and children’s hospital

• Innovative research facility

What we offer

• Relocation assistance

• Support with applying to

register with the NMC

• Meet & greet

• Comprehensive induction – week

one

• Support with OSCE preparation –

commences week two

• Adapted preceptorship program

• Pastoral support

University Hospital Southampton –

International Nurse Experience

• Long established history of international recruitment with a strong Filipino community in the area

• Supported by HR, education team, clinical managers and their peer community

• 207 international nurses recruited since 2016 – arriving from 2017 onwards and going forward to OSCE

• OSCE pass rate 99% overall, 75% first attempt

• Retention rate 99% – (1 after second fail and 2 before receiving decision letters)

• No repatriations to date

University Hospital Southampton –

International Nurse Experience

Recruitment streams

• Currently work with: -– two key international agencies recruiting predominantly in the

Philippines

– one agency in terms of EU applicants

• UHS recruitment via international job fairs i.e. Australia and direct applicants from a range of countries and our surrounding area locally

• International nurses working in non-registered posts

• Staff referring friends and family to UHS or via agencies

University Hospital Southampton –

International Nurse Experience

Recruitment streams

• Agency streams – Normally have already achieved language requirement at point of interview

– Agency support with NMC application process

• UHS direct recruits – Advise on the NMC application process

– Monitor their progress with the NMC stages of application

– Liaise with the NMC via Third Party Access to understand any delays in application process

– Liaise with Universities

– Commence staff in pre-registration B4 post once they have an NMC OSCE decision letter

• Time frame risks dependent upon visa situation

University Hospital Southampton –

International Nurse Experience• UHS staff with international qualifications

– Scope staff with international qualifications and interest in progressing to NMC registration

– Advice on routes to registration

– English language requirements -sign post to support. • UHS previously tried a pilot with a language school but poor outcomes

– NMC Test of Competence Stage 1: - CBT – once sign posted on route to registration, staff who achieve the English language requirement do not seem to have issues achieving CBT independently

– NMC Test of Competence Stage 2: - OSCE – once staff receive an NMC OSCE decision letter they are allocated to an OSCE preparation cohort

• Study leave

• UHS fund the OSCE

OSCE Preparation

• Delivered by our various Care Group Education Teams working

collaboratively together – we do not have a specific OSCE education

team

• Since 2017 we have reduced the number of days in the OSCE prep

program

– Previously 10 study days over 5 weeks and a mock OSCE – time to first OSCE 12-

13 weeks

– Currently 4 taught days covering APIE and skill stations over two weeks (will be

reviewed with new curriculum impact)• For large cohorts use of an external company to provide training on occasions

– Mock OSCE

– First attempt OSCE ideally within four to six weeks depending on availability at

exam centres

– Bespoke support for those who fail OSCE based on individual need

– Supernumerary in their clinical area up to first OSCE. If unsuccessful at first

attempt this is then reviewed locally with the individual, education team and clinical

manager in line with a bespoke individual plan

OSCE Prep - UHS

OSCE Preparation Program Indicative Content – Adult OSCE

Day 1 Day 2 Day 3 Day 4 Day 5

Expectations for us and them Intro into different parts of OSCE• APIE• Skills

PaperworkAssessment & Planning

Homework:Look at Neuro obs in Marsden

ImplementationEvaluationScenariosSkills:• Wound Care• Peak Flow

Homework: Look through BNF info to search and increase drug knowledge and feed back to group for next session, each person – different group of drugs look at NCM guidelines on administrationLook up WHO pain ladderLook up pain assessment scales

Skills:• BLS• Subcut/IM• Cath Removal• CSU• Fluid Balance• MUST• Inhaled Medicines

Homework: Evaluate learning. Prepare to undertake APIEPracticePHQ9 Write a care plan for a depressed patient

A, P, I, E,Complete run through

Homework: Practice Neuro observations assessment

MOCK OSCEWith detailed feedback to the candidates

OSCE ChallengesThe early days…..at a time with nationally high fail rates

• Understanding the OSCE content

– Early days little information from the OSCE centres

– Shared experience from other Trusts crucial

– Now an OSCE facilitators network and national meetings with OSCE centre and

NMC representation

• Pastoral care

– Along way from home

– Exam anxiety

– Failing OSCE

• Cohort size / frequency

– Small numbers initially

– Adapting to larger cohorts

– Managing staff still in progress once next cohort commences

OSCE Challenges• Suitable teaching space & resources

– Taught program

– Independent and peer practice

– Out of hours teaching

• Administrative elements of OSCE prep program:

– Booking OSCEs

– Capturing results from candidates

– Reporting results to the UKVI Border Agency and

– Reporting results to the Recruitment agencies

• Adapting OSCE prep program as new aspects introduced

• Flagging variation in local practice to OSCE environment

Nursing & Midwifery Workforce

International Recruitment

Linda GilmourMatron Practice Development & Education

linda.gilmour2@nhs.net

Mobile 07770335909

Starting point

• Autumn 2014

• Vacancies: 337 wte in October ‘14

• Maternity Leave – not covered

• Bank Office – unable to fill shifts

• Agency expenditure: highest 900k May 2015

• Rostering – rosters not effective, unallocated hours, imbalance days of the week

• Recruitment – slow

• Business case for International Recruitment approved

Business Case

• Needed to recruit from

– Local

– Regional

– Europe

– Non-Europe

Overseas

• Interviews in Philippines November 2014, March 2015 & September 2017

• Total appointed 350

• May 2015 Overseas Nurse Programme on site

• April 2016 OSCEs

Senior Nurse International Recruitment

• Started January 2015

• First programme in December 2014

• Evaluation from programme

• Devised new programme

• Close links with the existing Filipino community

THOUGHTS AND FEELINGS BEFORE START

• Where are we going to live?

• How is it going to be working in the UK?

• Are we going to be alone?

• Who is going to support us?

• What about the paperwork?

• Are we going to feel comfortable?

• Are we ready to work in UK?

• Nursing in our countries and UK?

Content… initially

• Two days admin – bank, NIN, trust recruitment, understanding area –accommodation, welcome to the NHS, ID badges, rosterpro, email account

• Three days - Mandatory training e.g. fire, infection control, resus, conflict management, safeguarding, blood hound, sepsis, diabetes

Competencies

• IV + workbooks

• Documentation – Safety booklet, discharge, NEWS and SBAR,

• Blood monitoring

• Simulation days – OSCE

• Medicines management – including pod

• Professional body / Unions

• BA & ME

• NMC

Competencies continued• Whistleblowing

• Library

• E learning – NEWS, infection control, information governance

• Dementia

• End of life care

• Consent

• Hopes and fears

• Survival toolkit

• OSCE prep & exam within 8 weeks

Valuable learning

• Hierarchy –mentors

• Relationship with ward managers

• Support of NHS staff

• ‘Mother, friend, manager’

• Expectation of ward staff

• Understanding ward expectation

• Extended support, understanding, patience

Valuable learning continued

• Allocated recruitment personal

• Full time coach

• International nurses able to coach each other

• Extended supportive community off site support & social

• Local cross Trust working advice, support & peer assessment

• MOCK OSCE

• Facilitators cross country network

Ongoing support

• Open door to Lead Nurse and Coach

• Phone / email support 24/7

• One to one meetings

• Time in clinical practice with recruits

• Book in sessions for competencies on the ward

• Review if concerns

Ongoing support continued

• Drop in visit round the wards

• Practice educators in majority of clinical areas

• BSUH community Facebook page

• Yearly International Conference

• Career development clinics

• Preceptorship Year 1 Enhanced Year 2

Developments

• Links with NMC & Home office

• Test centres x 1/2/3

• Local support –peer assessment

• OSCE Mock

• Peer training on wards

• Assessment criteria

• Re-takes

• Expanding facilitators networking group

We Love

Innovation in the NHS

Picture from conference

Q&A session

Stay in touch

Adele Bunch

Programme Lead

adele.bunch@nhsemployers.org

workforcesupply@nhsemployers.org

@NHSE_WFS