Tower of Babel

Out of the ordinary

Joan Pons Laplana, RGN, Telehealth FLO Clinical Lead NHS Arden & Greater East Midlands Commissioning Support Unit.

Proud Nurse, NHS Change Day Hubbie and Care Maker


Hola, Bonjour, P?l? o, ?????

The nursing workforce is facing significant challenge. It is well known that the NHS is experiencing a shortage of nurses and, as demand for services continues to pile on pressure, the situation is only going to get worse.

Statistics are clear and showing a bleak future for recruitment. 24% of registered nurses are set to retire in the next five years and only one in eight nurses are under 30, compared to one in four 10 years ago.

Organisations are struggling to fill vacancies and to close the gap, are using expensive and unsustainable Nursing Agencies. But money is running out and they been told by the government to put a cap on their agency expenditure.

Meantime, organisations have entered on a frantic race to recruit nurses from abroad to solve the nurse shortage. Recruitment of nurses from European countries has risen sharply. It has been driven even more strongly over the last 18 months by trusts seeking nurses to shore-up shortages in the wake of the Francis report into care failings at Mid Staffordshire Foundation Trust.It is not a secret that Nurses who trained abroad have become a vital source of new entrants, making up 40% of new additions last year.

But did you know that at present there is no requirement to speak good English*. If, in this  recruitment frenzy, we recruit Nurses whose standard of English is not appropriate and consequently we will put patient safety at risk.

Applicants from outside the EEA are already required to achieve an International English Language Training System (IELTS) score of seven and currently to be accepted at university to do Nursing is pre requisite to have a GCSE in English. But if you come from the European Zone you don’t need to.

Do we need to overlook this problem for the fact it’s better to have a nurse than no one?

In my opinion patient safety should come first and care should never be compromised.

A Spaniard in Sheffield

But this is not a new problem. It happened to me 15 years ago when I landed in Sheffield on Bonfire night in 2000.  I was quite impressed by the reception and all the fireworks illuminating the sky! But my smile was wipe out of my face very quickly. A new reality hit me hard on the face the following morning when I presented myself to work. I couldn’t understand a single sentence they were telling me. I was greeted by “Aye up lads! The Spaniard is here!”.

Then the problems started;  I came to England with confidence - I had studied English, but nothing had prepared me for the mixture of accents and dialects occurring every single day in a hospital. At hand over I could not catch half of what was said. Things got worse before they got better. My confidence was shattered into million pieces. 

But I was lucky, I was working on Intensive Care and only had one patient. It took me nearly six months to fully grasp what was going on my unit. I used to spend nearly two hours every morning reading the dmedical and nursing notes about the patients. I learned to smile and nod and always asked to write things down. It was the only way I could understand basic orders and care properly to for my patients. I was also lucky that in Intensive Care patients were sedated and communication with them was not a priority. I do not want to imagine what would have happen if instead of ITU I was working on a busy ward in charge of 8 or 10 patients!! It was dangerous, not only for me for also for the patients. It was one of the most frightening experiences I had in my entire life and I do not wish anybody to go through the same.

This is why is paramount that any Nurse coming to work in the United Kingdom speaks fluent English. Think that being generally competent in English do not mean we had the “right” language skills to work effectively in the health service.

To me that is dangerous. The Code is clear that you must be able to communicate effectively with patients and colleagues. How can you Nurse somebody if you cannot communicate effectively with others? At the end of the day Communication is one of the 6Cs and part of our values. Without making sure that Nurses can function and communicate properly we are increasing exponentially the risk for the patients and other staff.



We have been overlooking this problem for a lot of years. It’s time to make sure we do something about it. How would you feel if you are lying on your bed worried about your health and the Nurse who is caring for you could not understand what you are saying?


* Since Joan submitted this article, the NMC have announced that  from the 18th  January 2016, European trained nurses and midwives wanting to join the register will need to prove that they have the necessary knowledge of English to practise safely and effectively in the UK. They will have to provide sufficient evidence of language skills – such as having trained or worked in an English-speaking country; or they will be directed to undertake an English language assessment.

This legislation aims to provide a new basis for investigating registered nurses’ or midwives’ fitness to practice relating to patient safety concerns over their ability to communicate effectively in English. The new requirements will act to together to strengthen public protection and ensure that we are compliant with recent changes in EU legislation.