Recruitment of Overseas Nurses and Midwives

Nurses and midwives who have trained outside the European Economic Area (EEA) and want to work in the UK as a nurse or midwife must gain professional registration with the Nursing and Midwifery Council (NMC). 

Applicants are tested for competence through a two-part process to gain registration.

• Part one - computer-based multiple-choice examination which is accessible around the world for applicants to access in their home countries.
• Part two - practical objective structured clinical examination (OSCE) which will always be held in the UK.

The immigration rules changed in March 2015 to allow for an individual nurse to come to the UK to prepare for the OSCE.  

Rules for employers and overseas nurse applicants:

• All overseas applicants need to pass a computer-based test (CBT) and comply with all other initial requirements of the NMC overseas nursing process (including achieving language capability requirements) to be eligible to sit the OSCE and complete their registration. In October 2017, the NMC issued revised guidance on how an overseas applicant can meet the required level of English language capability.  
• An individual entering the UK to take a nursing role has up to three months from the employment start date noted on the certificate of sponsorship (CoS) to sit the OSCE exam. During this period they can be legally employed as a pre-registration candidate.
• Employers must ensure that before a certificate of sponsorship is applied for:
  • the individual has passed part one of the NMC test of competence
  • the individual has been issued with an offer of employment, and
  • the individual has achieved the required level of language capabiilty.
• In any applications for restricted certificates of sponsorship, you are required to send the following evidence toTier2Limits@homeoffice.gsi.gov.uk in support of the application:
  • a copy of the employment offer letter
  • a copy of the email confirmation from the NMC to show the individual has passed the CBT, and
  • evidence that a Resident Labour Market Test (RLMT) has been carried out.
• The general Tier 2 minimum salary requirement of £20,800 is temporarily removed in these circumstances, though employers are still advised to place nurses in an interim position with a salary at least equivalent to that of a band 3 role.
• Applicants may sit the OSCE up to three times as part of one application (applies to applications started after 06 April 2017).
• If an applicant is unsuccessful at their first OSCE attempt, they must wait a minimum of 10 working days before they can take the examination again.
• If an applicant is unsuccessful at their second OSCE attempt, they must wait a minimum of three months from the date of their second attempt before they can take the OSCE for the third time.
• If the applicant is unsuccessful after their permitted attempts, the employer must stop sponsoring them and as a result their leave to remain period will be shortened.
• Upon successful completion of the OSCE and awarding of NMC registration, employers need to commit to ongoing employment of the individual as a registered nurse on a salary of at least £20,800.
• Employers must be able to provide evidence of the above arrangement if requested.  

Employers or individuals with queries about individual NMC registrations are advised to contact the NMC directly.

Nursing included on shortage occupation list

Nursing was added to the shortage occupation list on 15 October 2015 but in a change to the rules, employers have been required to still carry out a RLMT before recruiting a non-EEA nurse from 24 November 2016. Find out more information in our Tier 2 policy changes section.

The continuation of nursing on the shortage occupation list means:

• applications for restricted certificates of sponsorship (RCoS) will be prioritised by the UK Visas and Immigration (UKVI) points allocation system - increasing the likelihood of nursing applications being granted
• the requirement to earn £35,000 or more to qualify for permanent settlement in the UK (indefinite leave to remain) will not apply to individuals for whom nursing has appeared on the shortage occupation list at any time during their employment in a nursing role - they will still need to meet all the other settlement criteria.

Applying for a certificate of sponsorship - need to know

• The first allocation panel to consider nurses as a shortage occupation was in December 2015.
• The Home Office has been clear that employers must only apply for certificates when you need them and when you are certain they will be used. The individual being sponsored must have a job offer from you and either:
  • have obtained full registration with the Nursing and Midwifery Council
  • have passed the NMC's CBT of competence (part one)
  • have obtained the NMC's permission before 30 April 2015 to undertake the overseas nursing programme, and be sponsored to undertake a supervised practice placement as part of the programme, which has been approved by the Nursing and Midwifery Council.
• You are required to provide evidence of the above in any applications for restricted certificates of sponsorship. You must send a copy of the employment offer letter and a copy of the email confirmation from the NMC to show the individual has passed the CBT. This evidence should be sent to Tier2limits@homeoffice.gsi.gov.uk to support your application.

We are still working within an overall cap of certificates. The inclusion of nursing is likely to have an impact on the success of other applications from health and other business, its therefore really important that we uphold these requirements from the Home Office to ensure we do not create a surplus of unused certificates.