New advice for overseas midwives

By Barbara Kuypers and Polly Kettenacker, Nursing and Midwifery Council

Upping sticks and moving to a new country can be a tricky process - not least for overseas healthcare professionals hoping to take up employment within their respective fields. Overseas midwives applying from outside the EU in particular face tough tests before being allowed to practice in the UK ( meaning that, currently, out of a hundred midwives submitting an application to join the Nursing and Midwifery Council's (NMC) register, fewer than five are successful.

We want to help reduce the disappointment caused as a result of unsuccessful applications by simplifying the guidance available to overseas applicants. Our aim is not to increase the number of overseas midwives joining the register ( we expect that figure to remain fairly low (for example, in the year ending June 2006, only twenty-five overseas-trained midwives passed initial registration and were put forward for midwifery adaptation courses in the UK). It is rather to make sure only those midwives who objectively qualify for registration actually apply.
    
We are therefore publishing a new Advice Booklet for Overseas Nurses and Midwives, which sets out exactly what kind of qualifications professionals will need to hold before they can apply to join the register. For instance, the guidance makes clear that overseas professionals wishing to join the register as midwives must have completed either a three-year full-time course focussed entirely on midwifery, or, if already registered as a nurse in the UK, an 18-month course focussed entirely on midwifery. Among other areas, their practical and theoretical training must have covered advising pregnant women, managing a minimum of forty births, taking part in breech births, and caring for one hundred post-natal women and their healthy new-born babies. Furthermore, applicants must prove that they have been working in their field on a full-time basis for at least a year since having qualified.

The NMC's English language requirements as regards midwifery applicants are also changing.  Candidates will now have to reach an overall IELTS1 pass score of 7, out of a possible 9. They will also have to reach at least 7 in each of the four test areas covering reading, writing, speaking and listening. Previously, candidates were only required to reach 6.5 overall, and were permitted lower individual scores for the separate categories. However, extensive consultations have produced a consensus that the overall academic score of 7 should be the minimum, given the vital role communication plays in effective care giving. Applicants will now also have to submit language test scores before they apply to register. Formerly, midwives were able to supply proof of their language proficiency once they had already jumped the first hurdle - i.e. whilst taking, or following completion of an Adaptation to Midwifery Programme. The new rules will bring the systems for midwife and nurse applications in line. 

The new advice will also, for the first time, be making reference to the NMC's "Code of professional conduct: standards for conduct, performance and ethics", to which all midwives on the register are required to conform. The Code is in the process of being revised, with the aim of making it clearer and easier to navigate, but the basic messages contained within the present version will remain. Those include the need for all registrants to take full responsibility for their actions, omissions, and for the care they give ( even in cases where they have been delegated tasks by doctors. A central principle within the UK is that midwives work in partnership with women. This enables women to be full partners in their care and make informed choices about the type of care they want. This approach may be unfamiliar to registrants from countries in which a more top-down approach is common.
   
In summary, the NMC is working towards making sure all overseas midwives know what to expect before they begin the process of applying to join the register. That way, we're fulfilling our duty to protect the public and the high standards of the midwifery profession, while reducing the chances of disappointment on the part of overseas applicants.

1 The British Council's International English Language Testing System