Internationally educated nurses and midwives account for 23.8% of the UK nursing and midwifery workforce, making the barriers relevant to a substantial group of professionals whose prior experience may be underused. The review, published in Frontiers in Health Services in 2026, included studies of internationally educated nurses and midwives registered with the Nursing and Midwifery Council and working in UK healthcare settings. The authors searched CINAHL, MEDLINE, PubMed, the Cochrane Library and Embase for literature published from January 2005 to March 2025.

They also examined grey literature, searched Google Scholar and checked reference lists. Methodological quality was assessed with the Joanna Briggs Institute qualitative checklist and the Mixed Methods Appraisal Tool. Quantitative results were converted into narrative descriptions, or “qualitised data,” before being integrated with qualitative findings through the Joanna Briggs Institute’s convergent approach, allowing numerical patterns and reported experiences to be considered together.

Eight articles met the inclusion criteria: five were predominantly qualitative and three used mixed methods. Six examined internationally educated nurses, one examined internationally educated midwives and one included both professions. The studies represented approximately 1,745 nurses and seven midwives from countries including Nepal, Ghana and European Union nations, as well as regions across the Middle East, Africa, Asia and Australasia.

Settings included NHS hospitals and trusts, healthcare education organisations, higher education institutions and other parts of the UK healthcare sector. The imbalance is important because most large quantitative datasets concerned nurses, limiting what can be concluded specifically about midwifery or compared statistically between nursing and midwifery. One of the clearest quantitative findings concerned movement through NHS pay bands.

Pressley and colleagues reported a median time to promotion of 6.8 years for internationally educated nurses, compared with 5.8 years for UK-trained colleagues. Fewer internationally educated nurses in that study progressed beyond Band 6. Qualitative accounts supplied context for this difference.

Participants described promotion pathways as unclear and insufficiently transparent, while managerial discretion, interview preparation, patronage and subjective assessments of leadership potential could influence who was considered ready for senior roles. Inequalities in access to organisational knowledge, feedback and endorsement meant that the visibility of formal criteria did not necessarily produce equal access to promotion. The evidence therefore documents a difference in progression between the groups studied, rather than establishing a universal rate across the entire UK workforce.

The synthesis produced five interconnected themes: career progression and structural barriers; early-career scaffolding and development support; skill mismatch and de-skilling; mentoring, sponsorship and leadership access; and organisational culture and inclusion. A barrier was defined as a structural, institutional, social or individual factor that obstructed or delayed access to progression, professional development or leadership. A facilitator enabled or accelerated those processes.

Some factors could operate in both directions: supportive line management, continuing professional development and structured induction facilitated progression when consistently available, but became barriers when absent, limited or selectively allocated. This distinction shows why an isolated programme may not remove disadvantages embedded in wider promotion and workforce systems. Early-career support emerged as a particularly important influence.

Structured induction helped internationally educated professionals understand NHS expectations, while supportive line managers facilitated learning, feedback and integration into professional networks. Career-development conversations helped staff identify existing expertise and understand routes into advanced roles, but these discussions were not routinely embedded in the first years of employment. In one mixed-methods study, fewer than half of respondents had participated in formal career-development conversations during their first two years.

Annual appraisals and informal discussions often did not provide sufficient guidance, leaving some internationally educated staff uncertain about their prospects. Equitable continuing professional development was associated in the synthesised evidence with stronger confidence, professional identity, career commitment and intentions to remain, whereas restricted access contributed to dissatisfaction and skill underuse. Recognition of prior competence was another central theme.

Qualitative studies described internationally educated professionals entering roles that did not make full use of their clinical knowledge, qualifications or leadership experience. Nepali nurses recruited to residential care homes reported being assigned routine personal care and catering tasks during adaptation rather than clinical nursing work that matched their expectations. Participants associated these experiences with skill underuse, reduced confidence and erosion of professional identity.

Other studies found that overseas qualifications and previous experience were undervalued in NHS career structures, with many internationally educated nurses remaining at Band 5 despite substantial prior experience. The synthesis interprets these observations in relation to recruitment, deployment and competence-recognition practices, rather than as evidence that individual professionals lacked capability. Mentoring and sponsorship appeared in the review as complementary but distinct forms of support.

Mentoring provided guidance, encouragement, reflective learning, organisational knowledge and confidence, helping internationally educated professionals navigate unfamiliar career systems. Sponsorship involved senior colleagues actively advocating for individuals, creating opportunities and increasing their visibility within organisational networks. Leadership programmes that incorporated sponsorship and inclusive leadership increased confidence and created opportunities for career progression.

Internationally educated nurses who advanced into leadership positions also became visible role models and sources of support for colleagues. Yet the review found that mentorship alone was insufficient where sponsorship, transparent promotion criteria and equitable development opportunities were absent. Selectively distributed informal sponsorship could also reproduce the advantages already enjoyed by other staff groups rather than widen access to leadership.

Organisational culture connected formal systems to everyday professional experience. Inclusive leadership, psychological safety and a sense of being valued were associated with confidence, teamwork, engagement, wellbeing and stronger organisational commitment. Practical support involving peer relationships, housing, family circumstances and financial security also influenced integration and intentions to remain.

Conversely, bias, favouritism and exclusion weakened confidence and could discourage internationally educated staff from seeking feedback or applying for promotion. Participants in one study described becoming so demoralised by perceived discrimination that they withdrew from career development, stopped applying for promotion and experienced career stagnation. These findings do not establish that workplace culture alone causes retention or progression, but the convergence of quantitative patterns and qualitative accounts indicates that organisational practices shape both the availability of opportunities and staff members’ willingness to pursue them.

Leadership development programmes offered benefits, but the evidence indicates that they could not independently remove broader structural barriers. The findings must be interpreted within a small and uneven evidence base. Only eight studies were included, some provided limited detail about researcher positionality or analytic procedures, and several date from periods before major changes in NHS workforce and migration policy.

The 2005–2025 search window also spans the Equality Act 2010, the NHS People Plan, changes associated with the post-COVID recovery and other workforce reforms, making direct comparisons across time difficult. Quantitative evidence for internationally educated midwives was especially sparse, and the available data did not permit statistically meaningful comparisons between professions or between NHS and private-sector settings. The review therefore identifies recurring barriers and facilitators across the studies included, while leaving their frequency and uniformity across every organisation, profession and career stage uncertain.

Its policy implications connect transparent promotion pathways, recognition of international competence, equitable development access, mentoring and sponsorship within broader workforce systems rather than treating any one as a stand-alone solution.

Subject of Research: Systematic review of career progression and leadership barriers among internationally educated nurses and midwives in the UK

Article Title: Barriers and facilitators to career progression and leadership among internationally educated nurses and midwives in the UK: a mixed methods systematic review

Article References: Sagoo, R., Merriman, C., Mukherjee, T., Gondo, N., & Baldwin, S. (2026). Barriers and facilitators to career progression and leadership among internationally educated nurses and midwives in the UK: a mixed methods systematic review. Frontiers in Health Services, 6, Article 1854601. https://doi.org/10.3389/frhs.2026.1854601

Image Credits: AI Generated

DOI: 10.3389/frhs.2026.1854601

Keywords: internationally educated nurses, internationally educated midwives, career progression, healthcare leadership, NHS workforce, promotion inequity, professional development, mentorship and sponsorship, de-skilling, organisational culture, systematic review, Barriers

The study, conducted by Asma Alnuaimi of Rabdan Academy in Abu Dhabi, interviewed fifteen married working women living in Abu Dhabi and Dubai, all of whom were at least two hours’ travel from their nearest extended family. Using a six-phase thematic analysis guided by Social Support Theory and Role Strain Theory, the research identified four interlocking themes: sustained emotional strain, coping strategies that helped but did not resolve the underlying deficit, organizational support that depended on individual managers rather than policy, and cultural expectations that refused to shrink even as the resources available to meet them disappeared.

The setting matters. Female labor force participation in the UAE now stands at just over 54 percent of the working-age female population, according to World Bank data cited in the study, and women’s participation increased by roughly 20.9 percent in 2024 alone. Women hold positions across government, the professions, and private enterprise at rates that would have been unusual a generation ago, and they make up a growing share of STEM graduates. Yet internal migration and urban concentration have pulled many of these women away from the kin networks their professional participation implicitly depended on. Grandparents, siblings, aunts, and cousins who once lived within walking distance now sit hours away by car, unreachable for the spontaneous school pickup or the emergency hospital stay.

The theoretical architecture of the study draws on two complementary frameworks. Social Support Theory, developed by researchers including Cobb, Cassel, and House, holds that relationships buffer individuals against stress by providing four distinct resources: emotional support that communicates being cared for, informational support that offers guidance, instrumental support that supplies tangible help such as childcare, and companionship support that conveys belonging. Cohen and Wills established in a landmark 1985 review that the protective effect of support is greatest when the form of support matches the demand the stressor creates. For married working women in the UAE, extended family historically provided all four forms simultaneously and without transaction. A paid nanny can supply instrumental support; she cannot easily supply the relational certainty that kin-based care carries, the unconditional availability that arrives without negotiation or fee.

Role Strain Theory, formulated by Goode in 1960, explains what happens when that buffer is removed. Goode identified three forms of strain: role overload, when the total volume of demands exceeds available time and energy; role conflict, when the expectations of two roles are fundamentally incompatible; and role captivity, when an individual feels obligated to remain in a role from which she would prefer to withdraw. All three are present in the lives of the women Alnuaimi studied. Without proximate family, caregiving and household tasks fall entirely to the woman and her spouse, creating overload. The cultural expectation that she will meet Emirati standards of family devotion while also meeting professional standards creates conflict, because the resources required to satisfy both simultaneously do not exist. And many of these women cannot leave their jobs without severe financial consequences, nor can they openly reduce their family engagement without social cost, producing captivity.

The interviews revealed how this plays out in practice. One participant described seeing her family only once or twice a month, a frequency that represents a substantial departure from the near-daily contact that is normal in Emirati family culture. Another said she sometimes felt so overwhelmed that she considered quitting her job just to regain balance, a sentiment consistent with research showing that turnover intention rises sharply among employees whose family circumstances are not adequately supported by their organizations. One woman had acted on those feelings, moving closer to her family even though it meant living apart from her husband, who still worked in Abu Dhabi. Another described entering emergency surgery without any family member by her side, relying completely on herself both emotionally and financially while raising children as a single mother in effect if not in law.

Notably, the absence of extended family did not always weaken marriages; in several cases it intensified them. Couples became more dependent on one another and more deliberately attentive to their relationship. One participant described how she and her husband had become more of a team, talking more, planning more, and growing closer because they had to rely on each other. Another described going out for coffee with her husband after the children fell asleep, a small ritual of deliberate protection that reflects the degree to which the relationship required active maintenance under pressure. This finding aligns with research on spousal resource-sharing under external stress, though the relational benefit arrived alongside an increased domestic burden that the couple now carried without external help.

The coping strategies participants employed were varied and, on their own terms, often genuinely adaptive. Problem-focused approaches included redistributing household and caregiving work between spouses through explicit schedules, relying on paid daycare, and delegating tasks to trusted nannies. Emotion-focused approaches included regular phone calls to family, building new social networks that became like family, prayer, daily gym sessions, and short trips with close friends. These practices align with a substantial evidence base: a 2022 systematic review and meta-analysis found that even brief restorative breaks during the working day reliably improve wellbeing and performance, and daily diary research has confirmed that micro-breaks enhance performance when overall work engagement is maintained. But the consistent limitation, stated by participants themselves, was that none of these strategies fully replaced what family proximity had provided. Paid childcare introduced transaction costs, financial and emotional, that kin care did not carry. Spousal collaboration was available only at the end of a working day that had already depleted both partners. Physical self-care provided temporary restoration without structural change.

Workplace support emerged as occasionally helpful and systematically insufficient. Some managers allowed early departure for family emergencies; one organization introduced one online day per week with flexible working hours, an intervention that one participant credited with keeping her in post after she had been on the edge of quitting multiple times. But the help was informal, unpredictable, and dependent on who the line manager happened to be. No participant described policies specifically designed to support women living without proximate family. This matches what Hammer and colleagues identified in their work on family-supportive supervisor behavior: such behavior, however effective when it occurs, is not a reliable organizational resource because it is not an organizational commitment. The gap between goodwill and policy was present across the entire sample.

Perhaps the most distinctive finding concerns culture. In the UAE, as in other collectivist societies, a woman’s obligations to her family are not negotiable in proportion to her circumstances. One participant put it directly: culturally, people assume there is always family support, but when you do not have it, you are still expected to manage everything perfectly. What she describes is precisely the role conflict and role captivity that Goode theorized, but in a more severe form than the theory was originally designed to capture, because it removes the possibility of legitimate renegotiation. Women in the UAE cannot openly reduce their family commitments without social cost; they cannot fully meet them without practical resources they do not have. The result is a form of strain that is structurally irresolvable at the individual level, which is why the study argues that institutional and policy responses are not optional supplements to individual coping but necessary preconditions for it.

The stakes extend beyond individual wellbeing. A meta-analytic review of seventy studies found that chronic loneliness and social isolation increase all-cause mortality by twenty-six percent, a risk comparable to smoking fifteen cigarettes per day. Work-health imbalance independently predicts reduced wellbeing. Against this backdrop, the study’s practical implications are concrete: UAE employers should treat family-supportive arrangements, including remote working, predictable flexible scheduling, and subsidized childcare, as structural features of employment rather than discretionary concessions. Policymakers should expand access to affordable, high-quality childcare so that women without proximate family are not solely reliant on costly private provision. Community organizations should develop peer networks explicitly designed to replicate the relational, not merely the functional, character of kinship solidarity. With women constituting forty-five point four percent of the skilled female workforce but holding only sixteen point six percent of private-sector leadership positions, retaining women who are considering leaving because their domestic circumstances are inadequately supported is among the more practical things UAE employers can do to close the gap. The study is bounded by its sample size, geographic focus on Abu Dhabi and Dubai, and cross-sectional design, and the author calls for comparative and longitudinal research across Gulf Cooperation Council states to establish whether the mechanism identified here is specific to the UAE or more widely distributed across collectivist societies undergoing rapid economic transformation.

Subject of Research: The impact of geographic distance from extended family on social support, role strain, and wellbeing among married working women in the United Arab Emirates

Article Title: Extended family distance, social support, and wellbeing among married working women in the United Arab Emirates

Article References: Alnuaimi, A. (2026). Extended family distance, social support, and wellbeing among married working women in the United Arab Emirates. Frontiers in Behavioral Economics, 5, Article 1872079. https://doi.org/10.3389/frbhe.2026.1872079

Image Credits: AI Generated

DOI: 10.3389/frbhe.2026.1872079

Keywords: extended family distance, social support, role strain, work-family conflict, UAE working women, collectivist culture, wellbeing, thematic analysis, workplace flexibility, childcare, Abu Dhabi, Dubai