Case Study

Bridging preceptorship programme for international nurses

Learn how Oxford University Hospitals created an in-house bridging preceptorship programme to support IENs with working in the NHS and life in the UK.

29 June 2023

Over the past several years Oxford University Hospitals NHS Foundation Trust (OUH) has engaged in international recruitment from across the globe to help meet staffing needs. Due to a range of challenges centred around the nurses struggling to adjust, OUH introduced a preceptorship programme to support international nurses in their first year. This has led to positive feedback and improved retention.

Key benefits and outcomes

  • Following the programme, new arrivals are better adapted to the ways of working, which has improved integration of new staff members for both international and domestic staff.
  • International nurses display improved communication and cultural awareness to their patients individual needs.
  • Many of the nurses who have taken part in the programme have successfully progressed in their careers.
  • Participants of the programme felt supported and encouraged to speak about their experiences and opinions to their colleagues and facilitators.

What the organisation faced

Pre-pandemic, OUH engaged in a range of international recruitment to help it close vacancies in its nursing workforce. However, when these nurses had been deployed, the organisation recognised that there were gaps in their knowledge about certain topics, and they lacked confidence due to working in a new environment and not being aware of the local terminologies used.

The organisation hosted a preceptorship programme for its nurses; however, this was only for newly-qualified nurses who had studied in the UK and were already familiar with the NHS. International nurses were working as supernumerary nursing assistants on the wards until obtaining their Nursing and Midwifery Council (NMC) PIN. Due to this, the trust wanted the international nurses to be more familiar on the topics they lacked experience in, and to support them with adapting to working in the UK using a similar programme to its existing preceptorship programme.

What the organisation did

OUH began to develop an in-house programme to support the international nurses and help them through the adjustment of working and living in the UK. Providing the support in-house also meant that the nurses are able to build relationships with other international nurses and trust members.

The bridging preceptorship programme began in 2020 and followed a period of targeted recruitment which welcomed highly-skilled nurses from diverse clinical and geographical backgrounds. The bridging programme started separately from the preceptorship programme; however, it has now aligned and includes clinical supervision and adaptation to ensure equity and equality of opportunities for newly qualified nurses. The programme is facilitated in-house over seven-days, including study days, and a handbook with detailed information about the programme and the nurses’ development is provided. The bridging preceptorship is offered to all international nurses during the first year of employment at OUH who are newly registered to the NMC.

The practice development and education team developed and facilitated the programme to specifically include themes relevant to the IENs to educate them on topics, help them adapt, and learn the culture of working in the NHS. Some of the themes include: introduction to a reporting culture; inclusion, diversity, equality and equity; positively challenging others; health literacy; and having difficult conversations and breaking bad news.

As part of the programme, the team also provides the nurses with information about what support is on offer to them, for example Freedom to Speak Up, the LGBTQ+, BAME, disability networks, and trade unions.

Results and benefits

The current programme is now offered to all nurses from any country, including English-speaking countries, as the team has found that the programme has been valuable to all new recruits who have not lived or worked in the UK before. This allows international recruits to learn about the English culture, ways of working and local language.

Running the bridging preceptorship programme in-house has made the process more streamlined and has given the nurses additional support throughout the process. The nurses feel more guided and comfortable during and after participation.

Evaluation of individual lessons has allowed facilitators to develop their teaching skills and adapt to the needs of the nurses. Once they have completed, the nurses are more familiar with the NHS and what it is like to work in an NHS organisation. The nurses have reported feeling more confident to challenge others in practice, are more aware of the terminology around subjects, have more insight into the roles of different staff and have gained strength to speak up and report concerns.

Many IENs on the programme have taken part in other courses offered which has allowed them to progress in their careers and become senior and specialist nurses and clinical educators.

The positive feedback has been recognised, and due to being able to recruit and support international nurses, it has benefited OUH financially, as this means the trust does not need to fill staff shortages with bank or agency staff at a higher rate. There is lower staff absence overall and staff satisfaction has increased.

Overcoming obstacles

The diversity of participants has meant facilitators have had to challenge their own assumptions around how they taught and whether it was the best method for the group. This required the preceptorship team alongside international students and IENs to review and adapt some teaching strategies and approaches to ensure the IENs have the best learning experience and environment.

During the peak of international recruitment, the organisation struggled with time constraints and some capacity issues due to the volume of nurses arriving. This meant that OUH needed to ensure all nurses were enrolled onto the courses, with study days, and to be in line with the nurses receiving their NMC PINs. To help during peak times of recruitment, the organisation increased team delivery by adding extra study days and having intensive catch up sessions. It also developed a handbook for inclusive teaching strategies so that external team members could familiarise themselves with the delivery of the programme, and support the team during the peak times.

Next steps

The programme is expanding to other roles and will now be open to international allied health professionals (AHPs) and radiographers.

Following feedback from the international nurses and other colleagues within the organisation, the team is now working on merging groups of staff to help with integrating the workforce. The bridging preceptorship programme will continue to run for seven days, with days one to three supporting the new international nurses with topics on cultural awareness and differences between the NHS and other systems, and days four to seven integrating with the preceptorship programme covering topics for new registered professional such as, leadership skills and career progression.

Top tips

  • Use inclusive teaching practices for every lesson.
  • Encourage real time feedback on the programme and facilitator.
  • Give them time to ask and answer questions.
  • Give new staff a safe space to feel comfortable.
  • Appreciate and respect the different and unique journey each individual has made in joining the NHS.
  • Recognise previous experience of the individual and look to reflect this into their job role and banding.

Contact details

Daniel Hodgkins, lecturer practitioner, Oxford University Hospitals NHS Foundation Trust,