You have decided to spread your wings, take the plunge and find a nursing job abroad. A nursing qualification, coupled with the worldwide shortage of nurses, open up countless opportunities for nurses to work in another country. Your motivation might be to experience travel and adventure, to improve your lifestyle by earning more, or to expand your knowledge and skill.
While many nurses have found working abroad to be an enjoyable and enriching experience, others had regretted their decision when reality did not meet their expectations. To avoid disappointment, you need to do lots of research to find the best fit for you – your language and cultural background, your character and personality and your reason for wanting to work in another country.
The following are some of the downsides which have been reported in research and discussions on the web.
1. Registration and employment process
Each country has different requirements. In some, your qualification and registration in your home country may be automatically accepted. Other countries may require an examination or even additional courses before you can sit the examination. Sometimes the examination can be taken in your home country (e.g., United Kingdom’s Nursing and Midwifery Council) so that you are assured of registration before you go abroad.
There is often lack of communication between employers and recruitment agencies so that expectations created by the recruiter are not met. For example, you might be recruited as a registered nurse but be employed at a lower level and at a lower salary until you are fully registered in the host country. You might also not be employed in your area of expertise as promised by the recruiter.
You should ask questions until you get complete clarity, do your own research on the web, contact the registration authority of the country you intend to go to and even the potential employer in order to confirm all the information you have been given.
2. The working environment is entirely different.
Nurses who have been recruited to work in their area of expertise may find that there is no position available in that area and end up working in a completely different field of nursing. Job and task allocation might be below your skill level and leading to frustration at work. It could be difficult to speak up because they are contractually bound and in unfamiliar surroundings. Take it as a new learning experience.
There will be many differences in nursing and health system practices, policies and laws which you will have to adapt to. Some may conflict with what you were taught as the correct way of doing things. If you are to work in a third world country, you might feel that the equipment and supply shortages and poor staffing levels make it impossible for you to provide quality nursing care.
Many nurses working abroad report on discrimination and even racism at work. This could include being excluded from opportunities to attend courses or for job advancement. Most often below the line discrimination is felt at unit level – being allocated tasks below their level of expertise; being ignored; treated with mistrust; and even open abuse. Such discrimination appears to be less when the foreign nurse works in a country with the same language and culture as her own.
3. Language barriers are common.
If you work in a country where the native language is the same as yours, the adjustment will be a lot easier, although there will still be terms and expressions you don’t understand at all.
If you move to a country with a completely different language, this will be a barrier to effective communication with your patients and the provision of quality nursing care. Not knowing the language will also make parts of your personal life more difficult, such as dealing with government departments, to get a tax or social security number, or passing your driver’s license. Even shopping for what you need or eating at a restaurant can be tough.
Governments and agencies often require the nurse to take language courses, if this is the case, and are usually a prerequisite to obtain a work visa.
As mentioned before, you may earn less than in the contractual agreement until you are registered as a nurse in the country concerned. This may cause financial hardship, especially if you discover that you have to complete additional courses before you can sit the examination or if you don’t pass first time.
While a salary may sound great compared to what you are earning, you should also investigate what the cost of living is in the city or town you are moving to. It could be much higher than anticipated. What is the cost of an average apartment, travel and food? Make a list of what you will need to pay for and use the Internet to search prices and work out a budget which can then be compared to the salary you were offered. Even if free accommodation is offered, ask whether it will be close to your place of employment as high travel costs can become an unexpected expense.
5. Personal life
Change of residence, change of job and loss of support system all rate high on the scale of major stressors. At the same time you will have to adjust to a foreign culture, maybe even to a different language, new foods and a lower standard of accommodation.
Nurses working in other countries often report feelings of alienation, isolation and loneliness, which lead to loss of confidence and self-esteem. When culture shock kicks after the first three months, you could experience feelings of anger and resentment against those cultural practices which at first seemed like an adventure. Imagine having always the freedom of wearing clothes suited to weather conditions and driving your own car and then being forced to use public transport while being covered from head to toe in a burka in temperatures around 45 degrees Celsius!
Emotional stress can be reduced by finding people from your own country to guide and support you, for example, relatives or friends of friends. This initial support system should ideally be set up before you leave your home country. Once relocated you can broaden your support network.
6. Do your homework
The downsides discussed above are not meant to dissuade you from working abroad but to prepare you and to serve as a guideline. Ask questions, do extensive research on every aspect – from the registration process, laws and policy, nursing practices and procedures, to geography, costs and cultural practices. Learn the language and prepare for the examination with guidelines provided by your recruiter or content on the Internet. Consider strengthening your coping mechanisms by joining a life skills course.
In one study on nurses working abroad a nurse was quoted as saying: “No amount of preparation could have readied me for what awaited.” So expect unforeseen obstacles and be ready to face them head on.