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