UK Professional Practice for Internationally Educated Nurses and Midwives

This course for internationally educated nurses in the UK, and for midwives and nursing associates educated abroad, explains the professional, legal and cultural expectations that registrants most often find new once they start work here. It suits nurses and midwives in their first year of UK practice, those in preceptorship, and the practice educators, preceptors and managers who support international recruits.

Passing the NMC's test of competence shows you meet the same standards of proficiency as a nurse or midwife educated in the UK. From that point you are held to exactly the same Code. The adjustment is rarely about clinical skill. It is about accountability that cannot be passed to a doctor or manager, questioning an unsafe instruction, delegating to support workers whose roles vary between employers, respecting a capable adult's refusal, being candid about errors in a system that treats concealment far more seriously than an honest mistake, and writing reflections that count towards revalidation.

The course is designed to take approximately 2 hours, including reading, reflection points, a written reflective account and a 15-question assessment. It is self-paced, so you can fit it around shifts or OSCE preparation. Buy and take it on our course portal; the course catalogue lists related titles. Healthcare Practise UK is an independent provider. We are not affiliated with any UK regulator or the NHS, and no regulator has reviewed this course.

The course is organised around the Code's four themes and the duties that sit beneath them.

It also draws on the NMC standards of proficiency for registered nurses (2018) and midwives (2019), revalidation requirements, the joint GMC and NMC guidance on the professional duty of candour, the RPS and RCN guidance on administering medicines, capacity law in each nation, the Equality Act 2010, and UK GDPR with the Data Protection Act 2018. The course notes that the NMC announced a consultation on a new Code and changes to revalidation, running from September to December 2026; until a new Code takes effect, the 2018 Code is the standard. Our NMC page and the NMC Code course cover the Code in more depth.

Module 1, the NMC, registration and revalidation. What the NMC does, the four themes and 25 standards of the Code, and what revalidation needs every three years: 450 practice hours (900 for dual nurse and midwife registration), 35 hours of CPD including 20 participatory, five pieces of feedback, five written reflective accounts, a reflective discussion, a health and character declaration and confirmation. It explains why skills you performed at home, such as cannulation or prescribing, may need local training and sign-off here, and that UK prescribing needs an NMC-approved programme and an annotation on the register.

Module 2, accountability, delegation and teamwork. Accountability versus responsibility, why "I was told to" is not a defence, and a five-question check before you delegate to a healthcare assistant or nursing associate. A case shows a nurse escalating twice, with a clear "I need you to review him now", when a NEWS2 score rises from 6 to 8. It also covers Martha's Rule in England and using read-back on the phone.

Module 3, person-centred care, consent and capacity. Dignity in personal care, consent that is informed and voluntary, Montgomery v Lanarkshire Health Board (2015), why covert medication is lawful only in narrow circumstances, consent by 16 and 17-year-olds and Gillick competence, and capacity law in England and Wales, Scotland and Northern Ireland. A worked example shows why giving a transfusion to a drowsy patient who refused it would be unlawful.

Module 4, medicines, records and patient safety. Since the NMC withdrew its medicines management standards in 2019, nurses follow RPS and RCN guidance and local policy. The module covers safe administration checks, look-alike drugs, time-critical medicines, controlled drugs, honest late entries rather than back-dated records, and candour after an insulin double-dose.

Module 5, midwifery practice in the UK. The UK midwife is an autonomous practitioner and lead professional for uncomplicated pregnancies, which may be broader than the role in some countries. Statutory supervision ended in 2017; in England the A-EQUIP model provides restorative supervision through professional midwifery advocates. The module covers informed choice (including a woman at 41 weeks declining induction), confirming a woman's own wishes privately, and lessons from the Ockenden and East Kent reviews and MBRRACE-UK. Nurses in maternity, neonatal and women's health roles will find it relevant too.

Module 6, law, ethics and professional boundaries. Confidentiality and the Caldicott guardian, safeguarding law in each nation, the FGM reporting duty in England and Wales, equality duties, and a case about bruising and a withdrawn older woman. It also covers social media (a ward photo with a patient's name on a whiteboard), gifts, conduct outside work, and why dishonesty in timesheets, training records or revalidation evidence is treated very seriously.

Module 7, thriving in UK practice. Feeling deskilled at first, preceptorship, international staff networks, ethical recruitment under England's code of practice, responding to discrimination, speaking up, and planning a career under Agenda for Change.

Each module includes key points, and most have a reflection point, a worked example and an "apply it" task, such as checking your revalidation date on NMC Online and setting up a simple portfolio, or writing down your escalation thresholds for an adult, a child and a pregnant woman. A quick-reference guide summarises the Code, revalidation, accountability, consent, medicines, escalation, candour, safeguarding and boundaries.

Your reflective account answers three prompts: which standard of the Code has felt most different from your previous practice; a time you questioned an instruction, escalated a concern or supported someone's choice; and what you will do in the next six months to strengthen your practice and build revalidation evidence. The account stays on your device.

The assessment has 15 scenario-based questions with a pass mark of 12 (80%), and you can revisit sections and retry. You then receive a certificate of completion from Healthcare Practise UK.

For NMC revalidation, self-directed online learning usually counts as individual CPD rather than participatory learning, unless you complete it with colleagues, for example in a facilitated group. The reflective account can be one of your five written reflective accounts if it relates to the Code. The CPD and revalidation tracker helps you keep hours and reflections in one place.

Individual nurses and midwives use it in the first months after joining the register, then take the reflection into a preceptor meeting or reflective discussion.

Practice educators and international recruitment leads use it as pre-reading so that cohorts arrive at a classroom session with a shared understanding of accountability, delegation and candour, leaving teaching time for local systems and simulation. Employers can buy team credits for a cohort; see for organisations.

The course supports awareness and preceptorship. It does not replace your employer's induction, local competency sign-off or mandatory training, so check what your employer requires.

This course is part of our international and returning professionals collection. Related titles:

• Communicating with Patients in the UK, for idioms, plain English, teach-back and interpreters;
• UK Healthcare Law Essentials for International Professionals, for a fuller four-nation guide to consent, capacity, confidentiality and candour;
• Working in the NHS: UK Practice for International Doctors, the companion course for doctors.

Not sure where to start? Try which course do I need.