Between Borders & Bedside: The Sacrifices of International Nurses in the NHS
Each year, thousands of nurses leave familiar streets, loved ones and homes to pursue a vocation within the NHS.
Some will call it opportunity, others will call it sacrifice.
But for all, the act of migration begins in hope, and it often unfolds in hardship.
They are caretakers of two homes, the one they left and the one they serve.
This is their story.
This is the cost of caring beyond borders!!!
In 2022, 24,000 new international nurse registrants joined the UK Register, the highest such growth on record.
The NHS, already stretched, is increasingly reliant on these transnational workforce.
Yet, beyond the recruitment headlines lie stories untold of distance, duty, identity and cost toughness.
Experience reflects some of the huge sacrifices international nurses make when they migrate from their home country to serve elsewhere.
For many,
the biggest sacrifice that I made was leaving my only child behind and of course my position as a Chief Nursing officer.
I thought my family would be able to join me in a short while but that did not materialize until a decade of my relocation.
I worked in a teaching hospital in Nigeria as head of Lagos.
With ambulance service.
I was respected and surrounded by family and part of a tight knit community but had limited resources to work with.
I left for UK for professional growth and technical advancement in Nursing practice.
However, all that glitters were not gold.
Though experienced and highly skilled in Nigeria from being a respectable senior nurse, I felt like a newcomer here in the UK and I had to start all over again with lower band.
What surprises me is Toyin’s calm and collected nature and how cheerfully she smiles while she narrates her story.
For
International nurses, the decision to move is not impulsive.
It is a calculated risk, a wager on a new life.
But what is gained in one domain is often lost in another.
Research into the first two years post-migration reveals that separation from family is one of the most frequently reported burdens.
To God be the glory.
He’s made me stronger, resilient and optimistic.
I was so lonely.
and isolated with my early years in UK.
But faith found me.
I gave my life to Jesus after three years of relocation and since then my joy is in Him.
I may be very weary and unhappy at times but Jesus’ love always sustained me.
Jeremiah.
31:3 says, the Lord appeared to us saying, I have loved you with an everlasting love.
I have drawn you with unfailing kindness.
This experience shaped me to be more empathetic, compassionate and helped me to relate deeply with patients who are also away from loved ones.
Truly, it looks like Toyin’s faith and spiritual life have helped her to become more resilient over time.
But there are still people like her who are still yet to fill in the emotional void associated with migration.
That emotional void becomes a constant companion.
The will to persist is steeled by the belief in a better tomorrow.
Beyond the hospital walls, life becomes a juggling act of video calls, missed milestones and fading connections.
The University of Huddersfield study on international nurses working in England found that housing instability, loneliness and adjustment stressheavily shaped life outside work.
Many respondents reported moving multiple times, paying a large portion of their salary to rent, and lacking a local social network.
Mental well-being scores were significantly lower in nurses who felt unsupported.
Or isolated, they often inhabit a life in limbo, not fully present at home, not fully at ease in their adopted land.
Many international nurses serve as their financial lifeline for their families back home, a connection sustained through remittances
Culturally, we look after each other.
We have obligatory responsibilities towards parents, children and extended family.
It’s what I grew up with and it’s just part and parcel of my identity.
I have to set aside part of my salary every month to meet up with the obligation At times I do extra shifts to meet up, which is OK by me.
God is providing for all my needs through His riches in glory.
In the Humphries et al., study, Migrant nurses described remittance as both a duty and a burden affecting their mental health, forcing extra shifts and limiting career mobility.
This is part of a broader phenomenon known as the Global Care Chain, where migration of care workers redistributes not only labour but emotional and financial obligations across borders.
“The Double Bind is stark”, to care for patients in the UK and to carry the financial hopes of a family abroad.
In many ways, international nurses become cultural navigators, bridging home and host in their daily lives.
Research on internationally educated nurses points to the challenges of accents, slang, colloquialisms, and workplace norms as recurring obstacles.
Some workers describe feeling tolerated rather than embraced where non UK nurses report experiences of unwelcomeness.
Between rituals, languages, food and expectation, this dual identity is often both strength and strain.
Curious about what many often complain about, I asked Toyin if she feels torn between her home country’s identity and adapting to the NHS culture.
Almost like living in 2 worlds.
Yes, absolutely. At times, I wonder where I belong to.
At home, I speak my language, eat my Nigerian dishes and dress as one.
At work, I try hard to adapt to NHS system and adjust my accents so that people will understand me.
I travel on holiday to Nigeria once a year and because the weather is so hot, I dress lightly.
People call me, UK Mummy.
Here in UK, I’m being seen as an immigrant; so it’s like having two identities depending on where I am.
When the glare of sacrifice deems what remains is cost paid in loneliness, grief, identity and deferred dreams.
In Presley’s study of international nurses’ first two years in England, many participants.
Noted high levels of stress, burnout and a sense of underappreciation.
The same study found that nurses who perceived their migration as positive had higher well-being scores.
Those struggling with adaptation often reported depressive symptoms.
Globally, many migrant nurses report being placed in lower pay bands than their experience would merit, effectively losing years of professional capital.
The Ledger of loss is often invisible, caried in quiet rooms, folded into sighs, and threaded through their devotion
Toyin, so looking back, what do you feel migration has cost you the most?
Migration has cost me a lot emotionally.
Separation from loved ones, especially my only child.
I missed most of our milestones.
Our birthdays and graduation.
Socially, I miss the deep sense of connection within family and community which come naturally to us Nigerians.
Economically, ugh, the cost is huge.
I disposed most of my assets to pay for my adaptation training and I started at very low band despite my years of experience and skill.
However, I’m grateful to God Almighty because all is well with me and my entire family.
God is faithful.
He saw us through.
Like the Israelites, we are more than conquerors.
To those who shape policy, these voices are more than data points.
They are custodians of care who ask to be cared for in return.
In the ICN’s 2024 reporting on The Who Global Code of Practice, experts note the ethical dimensions of international recruitment, emphasizing that destination countries have responsibilities to fairness, equity and retention.
UK nurses on temporary visas are often excluded from welfare support under the “No recourse to public funds” rule, forcing many into debt or hardship despite paying taxes.
Nurses make NHS more inclusive.
Our adaptability and resilience enrich NHS workforce and enhance quality of care.
We gave up not just money but family, community, professional recognition to keep NHS running.
Our commitment strengthens the core value of NHS.
I’m grateful to God Almighty.
My skill and nursing education in Nigeria shaped me to bring clinical expertise to my present working environment in the UK.
It also equipped me to provide culturally sensitive care to support that that group of population of people we serve and.
To support newly recruited international educated nurses to build their confidence and to practice safely and effectively.
If privileged, I would ask that our experience should be recognized so that we don’t have to start from the bottom ladder.
I will also ask for continued effort to make NHS.
an inclusive workplace not only in policy but in action, Where nurses of every background, feel valued, respected, safe and acknowledged.
Inequality in professional progression should be addressed proactively.
Though diversity is increasing, representation drops off markedly as senior band and leadership level.
Family reunification should also be extended to our parents as most of us are the only child of our parents.
Real change would require structural empathy, supporting integration, offering progression and honoring the human cost behind every shift.
They came to heal, to serve, to give.
Yet in that giving, they left pieces of themselves behind.
Their sacrifice is stitched into every life they touch, every patient they tend every hour they labour.
More than migrant workers, they
They are caretakers of two homes, the one they left and the one they serve.
This is their story.
This is the cost of caring beyond borders!!!
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