New support for overseas nurses to reduce OSCE anxiety

ShinyMind, an app co-designed with nurses aimed at improving staff wellbeing, is set to launch a pastoral and educational support programme for nurses entering the English NHS from abroad from April.

"OSCEs are there to help you know you can achieve, you can fly, you have the confidence"

Rebecca Howard

This programme, ShinyMind chief executive and founder Rebecca Howard said, is one of “psychological development” for participants that hopes to improve testing success rates among overseas nurses as well as their longer-term rentention.

Staff enrolled on the NHS England-backed programme will take part in four weekly two-hour sessions, via video call, on how to improve their confidence and preparedness for the Objective Structured Clinical Examination (OSCE).

The OSCE is the final part of the test of competence that some overseas nurses need to complete in order to join the Nursing and Midwifery Council register.

Ms Howard said the Shinymind sessions would allow people to air any worries they may have about the exams in a psychologically safe space with other internationally educated nurses.

“People can hear from each other’s experiences, which builds up that they are not alone. They can realise: 'It’s not just me finding this difficult',” she told Nurisng Times.

In between sessions, they will be given work to be completed on the ShinyMind app to improve their “psychological preparedness” for the OCSE.

They will also get access to an ‘international educated nursing interactive toolkit’ of further resources as well as the app’s other modules on mental health and wellbeing more broadly.

Ms Howard said international nurses her team spoke with said going through OSCEs came with "some pressure" from families in their country of origin, as well as on themselves to succeed. 

“Every single one we spoke to was so passionate about doing a great job, and being there to be absolutely the best they can be," she added.

“Patient care is alive and kicking in this cohort, they want this support and to have confidence coming through the OSCE to continue succeeding.”

She continued: “We asked what’s going on with how they’re feeling about the perceptions of the OSCE exam.

"There is a need for OSCEs to be difficult at that level to allow people to practise safely, and understanding when you do something like this and go on a brave journey, nerves will be a part of that – and if they weren’t that would be worrying.

“But the topic that they are difficult was becoming pervasive, in terms of their experiences even before they came into the country; that kind of talk was perhaps creating more anxiety than less.”

As a result of this initial research, Ms Howard added, the programme would be partly focused on re-framing OSCEs in the minds of internationally educated nurses as something positive – rather than a terrifying and daunting endeavour.

“You can see people starting to think that it can be done, that I can do this"

Xolani Viki

“We know about the placebo effect, but there is also the nocebo effect: a negative belief causing a negative feeling,” she continued.

“If we continue to tell the story of ‘OSCE is negative and difficult’, then we build that up and that’s how people will behave.

“We want to change the story; OSCEs are there to help you know you can achieve, you can fly, you have the confidence.

"Turning that into a positive takes away the negative expectation, will improve results and people will have a softer landing.”

She further said that while the focus is on these exams, the resources will also aim to aid retention in the long run by building up internationally educated nurses’ confidence to take steps to progress in their careers.

Ms Howard worked with NHS England South East to trial the programme, which is intended to be rolled out starting from April.

NHS England South East programmes manager Xolani Viki, who worked with the trial cohorts, said he noticed “positive” energy during the sessions, and echoed the optimism that it could help reduce anxiety around OSCEs.

Mr Viki told Nursing Times: “You can see people starting to think that it can be done, that I can do this, I can do it rather than about how OSCE is difficult and hard.”

Debbie Knight, head of clinical quality at NHS England South East, praised the results of the trials in her region and said: “Internationally educated nurses say going through OSCE is very difficult, there’s a lot of fear and anxiety in taking it – they see it as their whole new lives are associated with passing those exams.

“We wanted to think about the nurses as a person, and how to help their preparedness and self-belief to go through it.

"We have to recognise the people who choose to come here are already nurses and know what they’re doing, the OSCE is learning to nurse in the UK to a safe standard.

“We want them to not lose sight that they are already nurses.”

Ms Knight said she hoped the app could improve retention among international nurses, particularly in light of the large increase in recruitment from overseas in recent years due to the 50,000 additional nurses target by the UK Government.