Wednesday 25 August 2010

Is nursing war by another means?

It has been reported by EUReferendum and by the Daily Express in the UK, that EU law is preventing safety checks (and in the caase of the Daily Express), language checks on nurses from other EU countries that want to be registered as nurses in the UK. In a follow up post, EUReferendum spelt out just how dastardly this is:

"...Seventy years ago, "foreigners" were trying to kill us. Today, largely the same bunch of foreigners are still trying to kill us. And it really does not matter whether it is a bomb or an ill-trained nurse. You are just as dead."

I'm not selectively quoting the one paragraph that has war-like imagery; read both EUReferendum articles, and you'll see that the whole affair is really just a re-run of the Battle of Britain.

The law that supposed to be the cause of these restrictions isn't mentioned in the articles, but I assume that it's Directive 2005/36/EC, or the Recognition of Professional Qualifications Directive (PDF). It's aim is to allow the free movement of professionals with equivalent qualifications in other member states, including nures (Articles 31-33). This means that if a nurse has an equivalent recognised qualification in, say, France, then s/he will be treated the same as a a UK trained nurse. Not less strictly than a UK national, as EUReferendum suggests, but the same. So the aim of the legislation is to set down rules for the recognition of qualifications so that professionals from other EU states are treated equally in the host state if they've equivalent qualifications.

You can read the list of recognised nursing qualifications from this PDF. From this, and Articles 31-33 of the Directive, it's clear that the training has to include a theoretical element and clinical experience. The recognition of qualifications are "harmonised" in that there's a list that has to be respected throughout the EU, but these have been chosen on the basis of meeting the training requirements. There are other qualifications that might be treated differently, and the member state can use "compensatory measures" (tests, etc.) to check skills not included in that qualification's training. But the list of automatically recognised qualifications is set out to include qualifications that meet these standards, and therefore there should be no further tests that would not be applied to nationals of the same professional training.

But what about recent work experience - whether the nurse has worked in healthcare recently? I've asked the Commission representation in the UK what the position is, and I got this reply:

"UK authorities require EU trained nurses without recent working experience to pass a “return to practice training”. The UK authorities are planning to drop this training for nurses who obtained their qualification in another Member State, as it might go against the Directive.

The Professional Qualifications' Directive does not forbid organising such training; it just cannot be a prior condition in view of recognition of a nurse qualification obtained in another Member State.


However, if an automatically recognised EU trained nurse has been inactive for more than three years in the home Member State, this nurse has to fulfil all obligations UK registered nurses have to respect. Thus, if Continuing Professional Development is an obligation for UK registered nurses, also these recognised nurses from other Member States must follow CPD trainings allowing them to keep their skills and competences up to date and fit to the practice in the UK while being registered and exercising the profession.

In conclusion, the "return to practice" training cannot be imposed as a requirement for the automatic recognition of an EU nurse qualification. However, the Directive does not prevent the UK requiring continuous professional training for EU trained nurses who are already registered in the UK, but do not possess recent working experience."

If UK nurses have to fulfil extra requirements if they haven't been "active" in the last three years, then so do the nurses from other EU states. In addition, further training that UK nurses have to receive can be required of other EU national nurses, though it seems that this is independent of the registration on the basis of their autonmatically recognised qualification. I will try and contact the UK Department of Health to check on the actual treatment of nurses.

When it comes to language, Article 53 of the Directive states that the professionals in question shall have knowledge of the languages necessary to do the job. The Nursing and Midwifery Council, which is the UK regulating body, says (PDF):

"Under EU law the NMC cannot require evidence of your ability to communicate in English for the purposes of registration. However, you need to make sure that you have sufficient knowledge of English in order to practise professionally (Article 53 of the Directive). Employers will expect this and have the right to require evidence of English language competence to ensure that they employ nurses and midwives who are able to communicate effectively. Therefore it is possible that any offer of employment in the UK may depend upon you being able to demonstrate competence in the English language through a test."

It's important to note that being registered doesn't automatically mean that you start working as a nurse straight away, and employers can add some extra requirements.

The Directive isn't exactly the most terrifying World War II weapon I've ever seen...


  1. Eurocentric,

    One thing EUReferendum and others seem to miss completely is that no nurse or midwife with EU qualifications will start to draw pay from British taxpayers or endanger the lives of Crown subjects without actually being hired for a job.

    Surely, recruitment procedures are in place to employ the most competent candidates(?)

    As we all know, insiders with connections usually have the inside track, so outsiders are mainly given a chance if there is a lack of qualified applicants.

    In that case, the shortage of nurses would probably kill more patients than the mistakes made by the ones hired.

    Unions and the like are hardly impartial observers when it comes to regulating employment markets.

    Has anyone checked if the RCN has any pecuniary interests in checking or supplementing qualifications?

    I have to say that parts of the UK blogosphere and mainstream media seem to compete to attain the lowest standards imaginable as soon as an issue has anything to do with the European Union.

  2. Exactly - registration just means that the regulating body says you've got the required qualifications.

    I think the 3 main points are:

    1. EU national nurses will be treated the same - not better - than UK national nurses.

    2. Automatic recognition of qualifications is limited to courses that fulfil the reqquirements for theory work and clinical work, so the qualifications are equivalent.

    3. After all this, the nurses still have to apply for and get a job, so they'll still need to be interviewed, etc.

    Sometimes I wonder if Richard North is playing a joke at the Eurosceptics' expence and pro-integrationists take him too seriously. Because in many ways it's mad to think that bringing the Second World War into every argument actually helps make his arguments sound in any way rational. Perhaps he's secretly pro-EU and wants to discredit the Eurosceptic argument by associating it with the tin-foil hat brigade... ;)