A critical race analysis of structural and institutional racism: Rethinking overseas registered nurses' recruitment to and working conditions in the United Kingdom

Abstract

Language tests for overseas registered nurses (ORN) working outside their home country are essential for patient safety, as communication competency needs to be established in any workforce. We argue that the current employment of existing language tests is structurally and institutionally racist and disadvantages ORNs from non-European Union (EU) and non-White countries seeking to work in the United Kingdom. Using Critical Race Theory (CRT), we argue that existing English language tests for ORNs seeking registration in the United Kingdom are discriminatory due to the UK's racist migration policies and a regulatory body for nursing and midwifery that fails to acknowledge and understand its own institutionally racist practices.

Language as a proxy for race: Language and literacy and the nursing profession

“…They are also the only province that list 30 countries of origin that they exempt from language testing. Notably, African former British colonial countries such as Nigeria and Ghana are not on this exemption list-an exclusion that was also reported in Ugiagbe et al (2023) in the United Kingdom.…”

“…Third, the Nursing regulators in Canada and in Western countries around the world, must gain an evidence base for their decision to use standardized language testing to screen internationally educated nurses. In light of the potential lack of contextual validity of the language tests and the evident lack of relationship between the language usage tested in the exams and the language used in professional practice (Ugiagbe et al, 2023), alternative methods of protecting the public from potential language-related communication safety issues is worth considering. It is likely that the damage caused to migrant nurses from the racist implications from these flawed MITCHELL | 7 of 10 exams is far more serious than the potential risk to patient safety.…”

“…Shortages of nurses in Western countries have led to an influx of internationally educated nurses to fill nursing positions worldwide (Tweedie & Johnson, 2022; Ugiagbe et al, 2023). As most of these nurses immigrate from countries where English is not the primary language of communication, almost immediately concerns for patient safety became part of the discourse when talking about migrant nurses.…”

“…Protection of the public is a noble rationale that is hard to argue with, nevertheless the exams are controversial with the primary complaints against the use of standardized language tests including test discrimination. The tests appear to bear little relationship to the kind of communication that is expected within professional nursing practice contexts (Müller, 2016; Ugiagbe et al, 2023). Others assert that language tests are gatekeeping exercises that instead of testing language, test willingness to integrate.…”

“…The deficit perspective and concerns about language in multilingual students have inevitably impacted the nursing profession in other ways. Studies about internationally educated nurses identify they face the same use of deficit discourse describing their clinical communication challenges that multilingual students face (Ugiagbe et al, 2023). With poor communication, a key threat to patient safety (Hillege et al, 2014; Tweedie & Johnson, 2022), and nursing shortages in English‐speaking countries leading to the recruitment of internationally educated nurses from countries where English was not the primary language, a necessary extension to my discussion is the language testing of internationally educated nurses for the purposes of nursing regulation.…”