Working overseas

Do your research

Check with the International Council for Nurses (ICN) and the specific nurses' association in the country where you intend to work for information on the minimum requirements and regulatory framework in place.

Obtain background information on nursing and health care in overseas countries. Learn about the culture, religious beliefs and laws of the country that you are travelling to. This will help prepare you for differences of culture and legislation, minimising the risk of you running into difficulties during your stay.

If you're interested in working within the European Union or European Economic Area, go to www.europa.eu where you'll find information on living and working in the EU/EEA.

Country profiles can also be found at the Foreign, Commonwealth & Development Office (FCDO) and the World Health Organisation

Carry out a 'working overseas' literature search of the RCN's Library of eBooks and eJournals.

Language

Communication plays a key role in the provision of health care. To effectively care for patients and practice safely, you should check if you need a basic knowledge of the language of the country where you will be working or if there will be an interpretation service available to you.

Some 'British' and 'American' hospitals abroad welcome applications for employment from UK-trained nurses and midwives. However, the working language of these hospitals is generally the language of the country in which they are located (except in the case of British Military hospitals that have their own nursing staff).

Qualifications and experience

The UK nursing qualification that is generally transferable in every other country is the 'Registered Nurse: Adult'. Not all countries have equivalents to the UK qualifications in mental health, learning disability, children’s nursing, health visiting and the enrolled nurse. If there is no equivalent to your nursing qualification in the country you would like to visit, you will not be able to work there as a qualified nurse. Please check the full qualification requirements for your chosen country with that country's regulatory body (see Useful information below).

There is no formal mechanism for recognising UK post-registration qualifications, such as, for example, intensive care nursing but employers may take them into account.

Overseas employers and recruitment companies will be specific about the experience and qualifications required for a particular role (whether paid employment or voluntary work).

The Nursing and Midwifery Council (NMC) has some really useful information on the portability of qualifications overseas, both inside the EU and outside the EU.

Experience

Many countries/employers have specific requirements around previous experience. For example, employers in the Middle East usually require at least two years’ post-registration experience for nursing roles. Voluntary Service Overseas (VSO) outline different experience requirements for a range of voluntary opportunities in health care - not all of which require NMC registration.

It is in your own best interests to gain at least six months to one year's experience in the UK after registration before working abroad as a nurse. It will be an opportunity to consolidate your pre-registration education, access preceptorship and make the transition from being a student to being a registered accountable practitioner. A prospective overseas employer will be able to request a reference relating to your ability as a qualified nurse. It will also be easier for you to provide references to overseas employers if you already have experience.

Professional registration

Most countries have their own nurse registration or licensing authorities. The NMC advises that you should always register with the appropriate regulator in the country in which you are practising.

European Union

Information about the impact of Brexit can be found on the NMC website.

Outside the EU

Nurse registration processes vary enormously from country to country and can be lengthy and time-consuming. The application process is likely to require that you submit records of your nursing education and qualifications, and may also involve passing an examination or assessment. For example, you will have to pass the English language proficiency test to register to work in Australia.

You may find that your nursing education does not fully meet the requirements of the nurse registration authority in the country where you wish to work. Making up this shortfall requires negotiation by an individual nurse with a UK university. These programmes are not universally available in all universities and courses may incur a fee. You would also normally be expected to complete the course in your own time, so use annual leave or negotiate unpaid leave for this.

Nurse registration authorities in other countries may require transcripts of your training and proof ('verification') of current NMC registration. Please contact the registering body directly for more information about their registration process.

The NMC can provide verification of registration via NMC Online. If the verification requires translation, you will be responsible for arranging this.

In addition to your verification of registration, you may also need a transcript of your training. Please contact the organisation where you completed your training for this.

Finding a job

You can find vacancies through advertisements in nursing journals such as Nursing Standard and Nursing Times. These vacancies are placed by overseas employers or their recruiting agencies. Some countries regularly run recruitment events in the UK. To subscribe to the Nursing Standard, log on to www.nursing-standard.co.uk.

Overseas employers or recruitment agents often have detailed procedures for processing your application, interviewing you and making arrangements for you to take up your post. It is still your responsibility to:

find out all you need to know in order to decide whether you want the job
assess whether you are competent to do it
confirm that you meet the legal requirements involved, such as work permits and registration as a nurse in the host country.

If you decide to send speculative letters enquiring about work overseas you will need to prepare a detailed curriculum vitae (CV) that can easily be understood by someone unfamiliar with UK nursing qualifications, scope of practice and abbreviations. Our careers service can only offer personalised feedback on CVs if you are planning on working in the UK.

Your covering letter will need to make it clear whether you need the employer to obtain a work permit on your behalf.

An interview for work abroad may be very different to interviews for work in your own country. A thorough interviewer will look for evidence that you have the personal qualities needed to cope with and successfully complete work in a foreign country, perhaps working in a foreign language. If the interview is successful, an informal job offer may be made to you. Responsible employers and recruiters will give you time to consider before making a definite commitment. The Employment contract checklist below will help you to evaluate job offers and contracts of employment.

Take at least 24 hours to reflect on the offer before you accept it - take your time to research the country, check your contract and ensure that you are happy with the details.

Taxation and salary deductions

As taxation is a complicated matter you should seek professional advice about your obligations at home and abroad. Contact Her Majesty's Revenue and Customs for further information.

Please note: if you are not paying UK tax whilst abroad you cannot claim tax relief on your RCN subscription during this time.

Visas and work permits

You should always check visa requirements when planning to undertake work abroad. This is a complicated issue which varies from country to country. Further information can be found at Foreign travel advice.

Work permits are usually obtained by the employer from the immigration authorities of the host country. Where work permits are a requirement, you will be unable to take up paid employment in that country if you cannot find an employer who is able to obtain a work permit for you.

Employment contracts: a checklist

This checklist may help you evaluate the contents of any contract of employment (or contract for voluntary work) before committing yourself. You must also ensure that any agreements made between you and the prospective employer/recruiter are confirmed in writing.

Never sign a contract until all the blank spaces have been completed.
Never sign a contract that is in a foreign language that you do not understand.
Never place any reliance on verbal promises. How would you be able to prove the commitment later?
Always ask for copies of any documents referred to within the contract and ensure that you understand these before agreeing.

1. Pre-employment agreement

You may be asked to sign a document which covers the period between accepting the job offer in the UK and taking up employment in the host country. It may commit the employer or recruiter to providing a language or examination revision course, facilitating your application to take an examination, or even paying for you to fly abroad to take the examination. In addition, it usually includes details of any financial penalty you would incur if you withdrew your application.

Think carefully before you commit yourself, as it may be expensive to change your mind later. Be clear about the kind of post you would be willing to accept and the length of time you are willing to wait for a placement. Please ensure that all of this information is contained within the pre-employment agreement.

2. Job description

The job description should be detailed enough to give you a good idea of what the job involves.

Your nursing education and experience to date should have provided you with the necessary knowledge to undertake the role. If not, will this be covered in any orientation/induction programme?

3. Orientation/induction programme

This is a crucial part of any overseas post and should include information about the new workplace, the whole health care system and nursing practices within the country.

You should ask for written confirmation of the following:

How long will the induction last?
Does it include training in tasks which you may not have done before?
Will you be on full pay during the programme and is the programme included in the time period of your contract.

4. Probationary period

Is there a probationary period?
What support will you get?
How do the termination of contract arrangements differ during this period?
Does the employer have the right to terminate the contract without any reason and with immediate effect during this time? If so, would you still be entitled to benefits such as a paid flight home?

5. Premature termination of the contract

If you terminate your contract early, you may face a penalty, such as having to pay for your own flight home or having to reimburse the employer/recruiter for your outward airfare. Under these circumstances, would your employer give you a reference and would you be given a copy of the reference for your records?

6. Changes

Does the contract state the nursing specialty and site you will be working in?
Does the contract allow the employer to change this without your agreement? Could you be required to work for the employer in any part of the host country?

7. Salaries (if applicable)

Will you be paid the same salary as a nurse originating from the host country?
Is the salary you have been offered on a scale or is it a fixed salary?
What will your net salary be?
Where will the salary be paid - in the UK, host country or part in both? If you intend to send money back to the UK on a regular basis e.g. to meet mortgage repayments, remember that currency fluctuations could affect the amount of sterling you receive.

8. Hours of work and overtime

The exact hours of work should be written into your contract. The working week is longer than 37.5 hours in many countries.
Does the contract state that you may be asked to do overtime?
What shift pattern will you work and does it include breaks?

9. Annual leave and time off

Annual leave entitlement varies widely from country to country and may be much less than you have been used to. Public holidays may or may not be included.
Will you be allowed to take your annual leave when you want, or do you have to take it after a waiting period (common in Australia) or at the end of your contract? Are you entitled to emergency or compassionate leave?

10. Length of contract

The commencement and termination date should be clearly stated on the contract. If you are signing a standard contract for permanent employment used by the host country employer, there may be no termination date. In this situation the termination date of your work permit would apply.
Is there a possibility of renewing the contract if both sides wish to do this? Would this involve a change of work permit? Would an increase of salary be offered?

11. Health care and health insurance

Does the employer/recruiter provide you with private health insurance as part of the employment package? If not, will you be required to arrange your own? How much does this cost?
Is a UK passport holder entitled to use the public health service on the same terms as residents of the country?
Does your health insurance cover the cost of repatriating you to the UK if necessary and who decides whether this is necessary?
Consider taking out personal injury accident insurance subject to the conditions of cover being applicable to your working situation.

12. Professional indemnity

Members who undertake overseas work should ensure that they have adequate indemnity and insurance cover.

Please see our Indemnity scheme terms and conditions for more information.

The RCN scheme does cover the overseas work of volunteers in certain countries to the extent that a clinical negligence claim might be brought against them.

However, there are other considerations about how a volunteer is supported, particularly if working in a dangerous environment. Any member considering volunteering should give careful thought as to what will happen if they need support with their own health whilst overseas, for example. Volunteers can be given support from organisations that arrange volunteer activity.

If you are involved in an incident overseas that you think might lead to a patient or colleague making a claim against you, you must contact us as soon as possible. You must never admit responsibility for an incident or submit a written statement about it until we have agreed for you to do so.

13. Other considerations:

You should also check your contract for the following:

sickness policy and entitlement
grievance/disciplinary procedures and trade union representation
language training
accommodation
transportation for work
responsibility of costs of the return airfare from the UK to the host country
overseas employment contracts are usually interpreted according to the laws of the host country.

Finally, look into the cost of living in that country and the laws of the host country beforehand.

Joining a union and/or nursing association

The RCN is not a trade union outside of the UK, Channel Islands and Isle of Man, and we do not have representatives in other countries. Although we may be able to provide general advice to help you deal with an employment problem, we are unable to offer formal advice or representation for matters arising in your host country. Please note UK law is applicable in the UK only and you will be bound by the laws of your chosen country.

We strongly recommend that you join a trade union or professional association as soon as you arrive in your chosen country just in case you require employment relations or legal advice. Employees of the UK armed forces are not permitted to join a trade union but may join a professional association such as the RCN.

Contact details of national nurses' associations that are members of the International Council of Nurses (ICN) can be obtained from the ICN website.

If you choose not to become a member of a trade union or professional association and you subsequently need legal or employment relations support, you should contact the national nurses' association of that country. They may be able to help or recommend an organisation that can. Please be aware that not all organisations will be able to provide advice and support if you were not in membership at the time of the incident for which you require support.

The RCN can offer support to members working for Soldiers, Sailors, Airmen and Families Association (SSAFA) working within military establishments in Europe. SSAFA recognises the RCN as a trade union. If you require employment advice, please contact us.

If you wish to maintain your RCN membership you will continue to have access to number of member benefits, for example:

The best method of paying your RCN subscription while abroad is via direct debit from your UK bank account. You can also make an annual payment by credit card.

Taking medication

If you are currently taking any medication it is useful to check the government website for information on what you need to do when abroad.

Humanitarian crises overseas

Sadly, there is nearly always a war or other humanitarian crisis happening in some part of the world. As caring professionals, it’s understandable that you may feel guilty about working in relative comfort while nursing colleagues and civilians in conflict areas are suffering, and you may have a desire to help in some way.

The best way to help with a humanitarian crisis is to donate directly to credible international and local organisations that are working around the clock to help those displaced by a conflict or other crisis. You can also help spread the word and encourage others to donate time or money in support of people living in crisis areas. You may also want to investigate what, if anything, your employer is doing.

However, if you are keen to offer your valuable skills and volunteer in a humanitarian crisis area, the information below might help.

Current crises

The following organisations maintain a list of current and ongoing healthcare emergencies:

WHO - List of emergencies

ReliefWeb - Informing humanitarians worldwide

Volunteering

There are various humanitarian agencies that you could volunteer with, including, but not limited to, UK-Med, Médecins Sans Frontières, and Nursing Beyond Borders, and often local agencies are set up to respond to a specific crisis. You should reach out to these organisations directly to get the most up-to-date information on volunteering before you decide to travel.

Be sure to verify any organisation, especially ones you aren't already familiar with. Unfortunately, while human suffering can elicit profound compassion and the desire to help, it also attracts scammers who prey on this.

Conditions may be physically stressful and emotionally overwhelming. Expect long working days, the strain of working with people who are traumatized, and insufficient supplies. Make sure you are taking care of your own emotional and physical health too. More information is available in our Wellbeing, Self Care and Resilience subject guide and on our Health, safety and wellbeing page.

The FCDO advise against all travel to Ukraine. For up-to-date information please visit the FCDO website.

Support when returning from an overseas crisis

Working in a humanitarian crisis area can be traumatic and have long-term psychological and emotional effects. If you are struggling after returning to the UK, you must seek support, and there are lots of services and resources that you can use.

For immediate support, you can call NHS 111 or the Samaritans. Mind also has its own helpline, and a list of other helplines people can call, see Helplines and listening services.

If you feel that counselling would be beneficial, you can contact your GP, or your local Employee assistance programme may offer counselling. The RCN also offers members support for your mental wellbeing and a free Counselling service.

For local mental health services, you can use Hub of hope to see what support is available near you. Enter your postcode and it returns all the key mental health support services and organisations local to you.

Above all, take care of yourself so that you can continue taking care of others.

Further resources

NHS 111 Wales - Health A-Z : Post-traumatic stress disorder (PTSD)

Mental health - NHS (www.nhs.uk)

Effects of trauma - Mind

HeadFIT - Success, it's all in your head

Togetherall

Drinkaware

For further reading, carry out a literature search of the RCN's Library of eBooks and eJournals.

NMC revalidation and working overseas

Revalidation with the NMC applies to all nurses and midwives, regardless of the role or sector in which they are operating and across all fields of practice.

If you are a nurse or midwife practising overseas and want to maintain your UK registration, you will have to comply with the revalidation process every three years and continue to pay your annual retention fee to the NMC.

If you are working overseas (or have worked overseas for part of your three-year renewal period) as a nurse or midwife, you can meet the practice hours on the basis of your registration with the NMC. The NMC advises that you should always register with the appropriate regulator in the country in which you are practising.

If you work wholly overseas you can seek confirmation from your line manager where you undertake your work. If you do not have a line manager, you will need to decide who is best placed to provide your confirmation. The NMC advises that wherever possible your confirmer is a nurse or midwife regulated where you practise, or another regulated healthcare professional. The NMC online confirmation tool provides further guidance about who can act as your confirmer.

If you are asked to provide ‘verification’ information to support your revalidation application in relation to practice hours, you need to provide information about whether you are registered with the appropriate regulating body.

It is important that the NMC has an up-to-date address for you and you should register with NMC online to ensure that you know your revalidation date and that the NMC can send you relevant information.

More information is available from the NMC on how to revalidate.

Pensions and wills

Nurses in the NHS pension scheme who leave the scheme may have their pension benefits frozen. If you are moving to a new non-NHS employer, whether in the UK or abroad, you should seek independent advice as to whether you are able to transfer your pension into your new employer’s scheme.

Contact the relevant NHS pension agency for further details about the options available as follows:

England and Wales: NHS Business Services Authority www.nhsbsa.nhs.uk

Northern Ireland: Health and Social Care Northern Ireland www.hscni.net

Scotland: Scottish Public Pensions Agency www.sppa.gov.uk

For further information, or if you have a non-NHS pension, please go to:

The Pension Service

Money and Pensions Service

The Pensions Regulator

Quilter Financial Advisers can provide free financial advice to members planning employment abroad. This is particularly useful if you have financial commitments in the UK such as a mortgage, pension, savings plan, and so on.

Wills

It is a good idea to make a will particularly if you have dependants and financial commitments. The legal situation is very complicated if a person dies overseas without having made a will. You could take advantage of the RCN’s will writing service. For further information, please see our will writing page.

Returning to the UK

Your nursing career is a long-term investment. We recommend that you plan your return to practice in the UK before you leave. You will need to consider how to present your overseas experience in a positive light to UK employers and to demonstrate that you are broadly in touch with general developments in nursing and health care in the UK. The RCN has a number of resources which may help you when you return to the UK. These include:

Add any qualifications you have obtained overseas both to your CV and your personal professional portfolio. If you have completed education equivalent to a qualification for another part of the register (for example, as a midwife) you may apply to the NMC to have the qualification registered. Your application may be assessed through the 'overseas' route and compared to the UK course and you might be required to undertake supplementary training in the UK. When you return to the UK and are planning further study, you may be able to obtain credit for this study through schemes such as Assessment of Prior Learning (APL) and Assessment of Prior Experiential Learning (APEL). General information concerning APL/APEL is available from UCAS.

The NMC is not involved with recognition of academic qualifications such as first or higher degrees. You can check the comparability of degrees obtained overseas with UK ENIC - the UK National Information Centre for the recognition and evaluation of international qualifications and skills.

**Please note: the Careers service can only check CVs for members working within the UK and are unable to provide advice about working overseas.