Fellow Nurses Africa Publication || Patient Safety Series || 17 June, 2025.
When Safety Becomes Personal: Navigating Your First Patient Safety Incident as an Internationally Educated Nurse in the UK – written by Aderonke Opawande
Abstract
Internationally Educated Nurses (IENs) are vital to the UK’s National Health Service (NHS), bringing diverse experiences and skills. However, their initial encounters with patient safety incidents can be particularly challenging due to cultural differences, unfamiliar systems, and the absence of nearby family, familiar social circles, and established community support. These networks typically offer emotional grounding during professional challenges. This article explores IENs’ experiences during their first patient safety incidents in the UK, examining the emotional and professional impacts, systemic barriers, and the importance of support systems.
Keywords: Internationally Educated Nurses, Patient Safety, NHS, Support Networks, Mentorship, Unions, Cultural Competence
Introduction
Internationally Educated Nurses (IENs) are integral to the UK’s National Health Service (NHS), bringing diverse experiences and skills that enrich patient care. However, their initial encounters with patient safety incidents can be particularly challenging due to cultural differences, unfamiliar systems, and the absence of immediate support networks.
The emotional toll of such incidents is intensified by the evolving patient safety landscape within the NHS. The Patient Safety Incident Response Framework (PSIRF), which replaced the Serious Incident Framework, promotes learning from incidents rather than assigning blame. However, the transition to a ‘Just Culture’ has been inconsistent across the NHS, leaving many IENs uncertain about how they will be treated during investigations. Although NHS Resolution introduced the Just and Learning Culture Charter in 2023 to support this shift, entrenched blame cultures persist in some healthcare settings, undermining the effective implementation of these principles (NHS Resolution, 2023). At its core, Just Culture prioritises learning, accountability, and system improvement over individual blame when safety incidents occur.
For IENs, navigating a patient safety incident in such an environment can be particularly daunting. The lack of established support systems, combined with the fear of punitive responses, can exacerbate feelings of isolation and vulnerability. But how does it feel to face your first safety incident, far from home, unsure whether you’ll be supported or blamed? This article delves into the experiences of IENs during their first patient safety incidents in the UK, highlighting the emotional and professional impacts, systemic barriers, and the importance of support systems. Drawing from recent studies and personal narratives, we provide recommendations to better support IENs in navigating these critical events, ultimately enhancing patient safety outcomes.
Five Key Points
- Internationally Educated Nurses (IENs) face unique challenges when navigating patient safety incidents in the UK due to cultural differences, unfamiliar systems, and the lack of established support networks.
- The emotional impact of experiencing a patient safety incident is amplified for IENs, often leading to guilt, anxiety, and self-doubt, which are intensified by the absence of familial support.
- Cultural and systemic barriers complicate the adaptation of IENs to the UK’s patient safety protocols, which may differ from those in their home countries. Understanding and effectively reporting incidents can be a source of confusion.
- Community and peer support are critical in providing emotional and practical guidance, with mentorship programmes, faith-based organisations, and ethnic minority associations offering vital networks for IENs.
- Enhanced training and support systems tailored to the specific needs of IENs, including cultural competency training and mental health resources, can improve their ability to navigate patient safety incidents and integrate into the UK healthcare system.
Understanding Patient Safety Incidents
Patient safety incidents refer to events that could have or did result in harm to a patient. In the UK, the NHS employs systems like the Patient Safety Incident Response Framework (PSIRF) to manage and learn from these events (NHS England, 2022). For IENs, understanding and navigating these systems can be daunting, especially when compounded by cultural differences and unfamiliarity with local protocols.
For instance, an IEN unfamiliar with the Datix system may struggle to report an incident promptly, leading to increased anxiety about repercussions. This delay in reporting could also delay investigations or prevent valuable learning opportunities, increasing stress and emotional impact on the nurse involved.
Cultural and Systemic Differences
IENs often come from healthcare systems with different practices, hierarchies, and communication styles. Adjusting to the UK’s emphasis on multidisciplinary teams and patient-centred care requires significant adaptation. Moreover, understanding the nuances of documentation, reporting systems like Datix, and the role of regulatory bodies such as the Nursing and Midwifery Council (NMC) can be challenging (Allan & Westwood, 2016).
Take the case of Maria, a nurse from the Philippines, who faced her first patient safety incident in the UK. In her home country, Maria was accustomed to reporting concerns directly to a senior doctor. In the UK, she was expected to formally document the issue and involve a wider multidisciplinary team, an unfamiliar process that left her feeling unsure and isolated.
The Emotional Impact
Experiencing a patient safety incident can lead to feelings of guilt, anxiety, and self-doubt. For IENs, these emotions are intensified by the absence of familial support and the pressure to prove their competence in a new environment. The concept of the “second victim” highlights the profound emotional toll such incidents can have on healthcare professionals (Wu et al., 2020). Several colleagues have verbalised not being able to sleep for days and weeks after their first incidents, wondering if they would lose their jobs and if families back home would be disappointed. The ‘second victim’ experience can leave nurses feeling as though their entire professional identity is under threat.
The Role of Community and Familial Support
For IENs in the UK, the absence of immediate familial and community support can significantly exacerbate the emotional toll of patient safety incidents. Many IENs have relocated from countries where extended family networks and close-knit communities provide a robust support system. In the UK, however, these networks are often absent, leading to feelings of isolation and vulnerability.
Faith-based organisations have traditionally served as vital support structures for many IENs, offering not only spiritual solace but also a sense of community and belonging. However, the demanding schedules of healthcare professionals, including irregular shifts and weekend work, often preclude regular participation in religious services or community gatherings. This disconnect can leave IENs without the communal reinforcement that is integral to their coping mechanisms.
While wellness programmes and therapy are increasingly recommended within the NHS framework, cultural perceptions and personal beliefs can influence their utilisation. Some IENs may perceive mental health services as stigmatising or misaligned with their cultural understanding of well-being. A systematic review by Memon et al. (2016) highlighted that ethnic minorities in the UK often underutilise mental health services due to cultural beliefs, stigma, and a lack of culturally sensitive care. Furthermore, when such services are accessed, they may not always be effective if they fail to consider the individual’s cultural context and specific needs.
In light of these challenges, alternative support mechanisms that are culturally sensitive and accessible are essential. Peer support groups, mentorship programmes, and community-based initiatives can provide IENs with the necessary support to navigate the complexities of the UK healthcare system. These structures not only offer practical guidance but also foster a sense of belonging and resilience, which are critical in managing the stress associated with patient safety incidents.
Mentorship and Peer Support
Mentorship programmes are instrumental in helping IENs acclimate to the UK healthcare system. Experienced mentors can provide guidance on clinical practices, documentation, and navigating institutional protocols. Peer support groups also offer a platform for IENs to share experiences, discuss challenges, and learn from one another. Such initiatives not only enhance professional development but also foster a sense of community and belonging (Rasheed, 2021).
The Role of Unions, Professional Bodies, and Ethnic Minority Associations
Unions and professional organisations play a pivotal role in advocating for the rights and well-being of IENs in the UK. The Royal College of Nursing (RCN), the world’s largest nursing trade union and professional body, offers a comprehensive suite of services tailored to the unique challenges faced by IENs. These include legal representation, career development resources, mental health support, and immigration advice. The RCN also hosts live events and forums specifically designed to assist IENs in navigating professional and personal challenges within the NHS.
In addition to the RCN, organisations such as Unison, Unite the Union, and the British Medical Association (BMA) (for those working in multidisciplinary roles or management positions) offer resources including workplace representation, wellbeing support, grievance handling, and guidance on employment rights. Many of these unions maintain helplines and online platforms where members can access advice on incidents, referrals, and disputes.
Ethnic minority-focused organisations have also been established to offer culturally sensitive support to internationally educated nurses. Notable examples include the Nigerian Nurses Charitable Association UK (NNCA UK), British Indian Nurses Association (BINA), and the Filipino Nurses Association UK (FNA-UK). These groups provide mentorship programmes, professional development opportunities, peer networks, and culturally tailored support services. For many IENs, being part of a community that understands their cultural background offers a vital sense of belonging, particularly during challenging times, such as navigating patient safety incidents.
Systemic Support and Advocacy
The systemic barriers that IENs face in the UK healthcare system, including the lack of familiarity with the reporting systems, language nuances, and the administrative burdens involved in patient safety incidents, can be alleviated with the right institutional support. NHS Trusts must be proactive in ensuring that IENs receive the appropriate training, mentorship, and emotional support to cope with the stresses of patient safety incidents.
One critical recommendation is the enhancement of targeted cultural competency training for NHS staff. This training should not only focus on cultural awareness but also address the specific needs of IENs, recognising the challenges they face, such as adjusting to a new healthcare system, dealing with language barriers, and navigating different patient safety cultures. By promoting an inclusive and supportive environment, NHS organisations can help reduce feelings of alienation among IENs and increase the overall safety culture within healthcare teams.
In addition, organisations like NHS Resolution’s Patient Safety Support Services can facilitate better communication between IENs and Trust leadership during safety incidents, offering a more transparent and supportive approach to incident investigations. There should also be an increased focus on psychological well-being, integrating accessible mental health resources into the support structures available to IENs, ensuring that they feel comfortable seeking help when needed.
Conclusion
Navigating a patient safety incident is an emotionally taxing experience for any healthcare professional. For IENs, these incidents can be particularly challenging, exacerbated by systemic barriers and cultural differences. However, through robust support mechanisms, such as mentorship programmes, peer support, and culturally sensitive resources, IENs can be better equipped to cope with these challenges. NHS organisations must recognise the importance of supporting IENs, not only for the well-being of these nurses but also for the overall safety and effectiveness of patient care in the NHS.
By creating a system that values and nurtures the contributions of IENs, the NHS can foster an environment of learning and improvement, ultimately benefiting both patients and healthcare professionals alike. By fostering supportive environments, we can ensure that every IEN feels empowered, valued, and resilient, even in the face of their first patient safety incident. Imagine a future where no nurse feels alone when something goes wrong.
References
Allan, H. & Westwood, J. (2016) Exploring the experiences of internationally educated nurses in the UK: The role of cultural competence in facilitating integration into the NHS workforce. Journal of Nursing Management, 24(6), pp. 719-725.
Firth-Cozens, J. & Mowbray, D. (2020) Leadership and organizational culture in healthcare: Exploring the role of psychological safety and support networks in promoting patient safety. Journal of Health Organization and Management, 34(1), pp. 43-59.
Huang, Y., Klungel, O.H., & Lee, J.H. (2019) Cultural competence in healthcare: Challenges and opportunities for international nurses in the UK. International Journal of Nursing Studies, 93, pp. 72-80.
Li, L., Lim, L., & Mok, M. (2021) Navigating cultural differences: The role of cultural intelligence in integrating internationally educated nurses into UK healthcare teams. Journal of Nursing Education and Practice, 11(4), pp. 87-95.
Memon, A., Taylor, S., & Fisher, H. (2016) Mental health services and ethnic minorities: Review of literature. International Journal of Social Psychiatry, 62(3), pp. 217-225.
NHS England (2022) Patient Safety Incident Response Framework (PSIRF). Available at: https://www.england.nhs.uk/publication/psirf/
NHS Resolution (2023) Just and Learning Culture Charter. Available at: https://resolution.nhs.uk/publications/just-and-learning-culture-charter/
Rasheed, A. (2021) The role of mentorship and peer support for internationally educated nurses in the UK. Nursing Standard, 36(14), pp. 54-58.
Tobin, C. & Collette, M. (2018) Exploring the challenges faced by internationally educated nurses during patient safety incidents in the UK healthcare system. Nursing Inquiry, 25(2), pp. 1-9.
Wu, A.W., Huang, L. & St. Andre, J. (2020) The emotional impact of patient safety incidents: The second victim. Journal of Patient Safety, 16(3), pp. 139-142.
About the Author
Aderonke Opawande is a UK-based registered nurse, healthcare analyst, and patient safety advocate with experience in Nigeria and the UK. With a master’s in healthcare management and certifications in digital health and quality improvement, she’s passionate about empowering nurses and strengthening health systems.
