pros and cons of being an American nurse in the UK part 2

Pros and Cons of being an American nurse in the UK

I want to begin this post with an apology. This will not be a happy post. In fact it will be decidedly negative. And so soon after the New Year, too… What more could you expect from a list of cons? To make it slightly less painful, I’ll try not to go on and on. It will be like ripping off a Band-Aid in one swift motion (please don’t do that, it’s not evidenced-based practice).

But as you read and get more and more discouraged, remember this: In the end I STILL decided to move to the UK and I don’t regret it one bit.

In the end I STILL decided to move

to the UK and I don’t regret it one bit.

Rachel Cutshall

If you haven’t yet, you may want to read last week’s post Part 1: The Pros to see what makes it all worth it.

Part 2: The Cons

Lower salary

This is perhaps the worst one in this list. Though, let’s be frank, they’re all pretty bad.

For the sake of brevity, I will just be talking about gross pay in this section. I promise to expand upon the topic of salaries in the future. It is an extremely important consideration when moving abroad. One which is the cause of great consternation among most of us. It’s no wonder, we all need to know we will be able to sustain ourselves.

The current average, entry-level pay of a nurse in the US is $26.80/hr. Expanded based on full time hours of 36 hrs/wk that’s $50,170/year. Not so bad for a new grad, really.

In the UK the current entry-level salary for a nurse is £24,907. Using the average conversion rate for 2020 (1.28) that is $31,881. Divided into hourly pay for full time work of 37.5 hrs/wk that is $16.35/hr.

It’s difficult to swallow. I found myself disheartened by the realization. I questioned my sanity. Who in their right mind would take such a reduction in salary?

After some frantic saving in the US, and a good deal of research, I concluded I could just about make it work. I’m sure there are more sound financial decisions which could have been made in my life. It’s not great, but I do manage to get by without worrying too much.

Your previous experience means nothing

When you decide to move abroad, you generally aren’t freshly out of nursing school. Though the rules have recently changed to allow new grads from around the world to register with the NMC. That being said, all of the American nurses I know who have moved to the UK have at least some experience nursing in America.

Unfortunately, that experience gained in the US means very little in the UK. I would expect any nurse who moves from abroad to start in a Band 5 role with the lowest Band 5 salary. This is especially the case if you are moving on a tier 2 working visa due to resident market tests.

Previously it wasn’t impossible to negotiate a higher salary based on your nursing experience in America. But I’ve heard that this is no longer happening and that your salary within your band will be based only on previous NHS experience.

Having said that, perhaps you’re already resident in the UK. Maybe you’re in a position to take risks and spend loads of time going through the process of getting an interview. Maybe you aren’t desperate for a job contract right now. If that’s you, then there’s nothing stopping you from applying for a job in a higher band. Just be prepared for them to say they can’t hire you.

Though you may have to start in a band 5 position, once you’re employed by the trust, you can apply for other positions at a higher band level. If you are on a tier 2 visa, however, you must be mindful of the restrictions that come along with that. There is guidance on the UKVI website about changing jobs which must be followed. If you are uncertain it’s best to speak with your trust’s HR and/or an immigration lawyer.

Slow professional advancement and less respect

The birth of nursing famously sits with Florence Nightingale when she went to Turkey in 1854 during the Crimean War. The Nightingale Training School, one of the first training schools for nurses, opened in London in 1860. It sought to teach nursing and midwifery as formal professions. The education at this point was strictly hands on. Nurses would learn on-the-job and didn’t learn much about the theory behind the practice. They say the first students only really learned how to be obedient.

More schools developed throughout the country to train nurses. In fact, any hospital could develop their own program which resulted in widely varying standards. In 1919, the Nurses Registration Act was passed which established a national standard for nursing. Once nurses passed their program, they received the professional qualification of State Registered Nurse.

The 1980s seemed to be momentous for nursing. In 1983 a new professional register was set up with 4 branches of nursing which continue to this day: adult, children’s, mental health, and learning disability. And in 1986 the idea formed to move nursing from certifications received in hospital-based schools to diplomas earned in colleges and universities.

But it wasn’t until 2009 that all nurses in the UK were required to get degrees. 2009! It was only from that point on that all nurses needed a university education to become a nurse.

I think this brief overview of the history of British nursing reveals a lot about the current relationship that the British culture has with the nursing profession. Respect for nurses in the UK has grown over the last decade especially recently with the pandemic. But nursing here isn’t seen as s highly esteemed a profession.

Perhaps it’s a result of the welfare state. Or perhaps it’s because it’s a job which fulfills a public service. Unfortunately it’s not just apparent in the wider British culture. Within the hospitals as well there is an obvious hierarchy and nursing doesn’t yet feel as professional a career as it is in the States. In spite of recent advances in nursing in Britain, such as requiring a 3 year degree and increasing salaries, it still feels more like a vocation and arguably is treated as such.

Maybe it is because nursing in America has aligned itself more with the study of medicine. There it seems it has become a profession which delicately balances academia, science, and the arts. In the US, a nursing degree is considered to be one of the most difficult to achieve. When you do finally achieve the title of registered nurse, it comes with a hint of pride and it commands respect from the public.

Timeline

	The History of Nursing in the United Kingdom
1854	Florence Nightingale goes to Turkey during the Crimean War
1860	The Nightingale Training School, one of the first training schools for nurses, opens in London
1919	The Nurse’s Registration Act is passed establishing a national standard for nurses
1983	Nursing training & qualifications are divided into 4 branches: adult, children, mental health, learning disability
1986	Idea first emerges to move nursing from hospital-based certifications to diplomas earned in colleges and universities
2009	All nurses are required to get a degree

Smaller scope of practice and less autonomy

Following that same line of thought, it won’t be entirely surprising to learn that the scope of practice of a nurse is significantly smaller in the UK than it is in the US.

It was disorienting when I first arrived to realize that most nurses didn’t carry around a stethoscope or feel confident listening to breath sounds or taking an apex pulse. Even now I would have to be signed off for every little thing. After 3 years here, I still do not have the “required training” to place male urinary catheters, insert an IV (cannulate), take blood samples (bleed a patient), or give IV drugs. There are in-hospital courses which a nurse must take before doing these, and many other, nursing interventions.

As nurses, this may be the most frustrating aspect of it all professionally. We begin to feel underutilized, overworked, underpaid, and entirely overqualified for the job. I certainly don’t feel like I’m using my BSN at all. Many would compare nursing here to being closer to a CNA or LPN in the States.

Over the last year there has been a restructuring of the NMC Standards of Nursing. I’ve not yet wrapped my mind around what this means for the profession, but it could be an indication that the NMC is trying to bring British nursing into the 21^st century. We can only hope.

One of the last things my mom, a fellow nurse, said to me before leaving America was, “Don’t forget how to be a nurse.” I’m trying my best. One thing I’ve found that has helped me cope with this is getting more involved with professional development. I attend as much training as I can and I’ve taken advantage of the online CEs that come with my AWHONN (Association of Women’s Health, Obstetric and Neonatal Nurses) membership.

Minimal Opportunity for career advancement

Though I keep an eye out for any additional training that’s available to me, it is never really anything terribly new or challenging. I had aspirations of getting a Masters degree in nursing, but I have had to put that on hold since moving to the UK. Being on a tier 2 working visa makes going to school practically impossible. I would still be required to pay international tuition and I’d likely have to study part time outside of my full time job. It’s just not feasible, especially with all the added stress of a pandemic.

After indefinite leave, I may be able to find a program which interests me (either here or in America). I certainly wouldn’t have as many rules to keep track of. I wouldn’t have to worry as much about where I travel or for how long… how many hours I work… how much money I earn…

Getting a Band 6 position is still an option for many. I’m trying to see these sorts of vaguely horizontal career shifts as opportunities to learn and gain new skills. Most of the time, though, work feels like the obligation I’m bound to as a Tier 2 immigrant.

Distance from Family

For me, being 4,000 miles away from my family is by far the biggest con of being an American nurse in the UK. The inability to travel home because of coronavirus makes what was already a difficult situation that much harder. Even though this might not apply to everyone, I would be remiss if I didn’t include it in this list of cons.

It’s a risk living so far away. I miss family events and celebrations, births and deaths. When things go wrong, there’s no greater sense of helplessness than being so far removed from family emergencies. Though my life in the UK has provided me with a greater sense of balance in my day to day affairs, something is still missing.

My hope is to one day spend large chunks of time nearer my family. Though I don’t quite know how to work it out logistically, I am determined to make it happen. Perhaps making this promise to myself is the only way I manage to get through such a prolonged separation.

Coping with the Cons of Being and American Nurse in the UK

It’s hard to end this kind of post on a positive note. After nearly 2000 words all about the negative aspects of my life choices, I’m tempted to just leave it at that.

My search for balance will continue both personally and professionally. I fear the longer I stay the more complicated it will become.

If you’re an American nurse in the UK, please share what your biggest frustrations are in the comments below.

Part 1: The Pros

If you haven’t yet, check out Part 1: The Pros, especially after all this this negativity. There you’ll find out what makes this journey worth it in spite of all these cons.

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