Antonella Indrizzi secured a job with the Sherwood Forest Hospitals NHS Foundation Trust through an overseas recruitment campaign in Italy, in February 2015. Jean Ruxanda, a band five Romanian nurse, was hired as a scrub theatre practitioner after a Skype interview which was followed by an induction course for foreign nurses.

For both nurses, it was a dream come true – to seek better job prospects in the UK. But the dream was thwarted by their poor English language competence. English language tests for overseas nurses were introduced in 2007, but until last year, those from EU countries were exempted from the regulation.

Colleagues had to resort to gestures and miming

In the case of Italian nurse Ms Indrizzi – who worked as a healthcare support assistant at King’s Mill Hospital in Nottinghamshire – a Nursing and Midwifery Council (NMC) hearing said colleagues had to mime in order to communicate with her, and became increasingly concerned about her poor English skills.

One colleague said sometimes Ms Indrizzi would look at her like she did not understand what she was saying. As a result, she had to resort to gesturing with her hands and mime, while explaining verbally, to ensure that Ms Indrizzi understood her task as she had misinterpreted medical terms on the ward.

A ward leader at the hospital recalled an instance when a patient was desperately calling for help, but Ms Indrizzi, though trying her best to reassure the patient, was unable to find the right words, and told the patient to “be quiet” instead.

Julie Bacon, Director of Human Resources for Sherwood Forest Hospitals NHS Foundation Trust, said, "Antonella Indrizzi was recruited from Italy and has worked for the Trust for nine months during 2015 as a Healthcare Support Worker, not as a registered nurse."

"All the usual employment checks were undertaken before she took up her post. However, as an EU national she was not required to take a language test.”

She added that the Italian nurse had received regular supervision and dedicated support, and they had to refer her to the NMC.

The committee panel said Ms Indrizzi, a registered nurse, had been given chances to improve her English, but failed to take the IELTS internationally recognised English language assessment.

"As a consequence, the panel cannot be satisfied that her knowledge of English has reached or will reach the necessary standard," the panel said.

The panel added that "a striking-off order is the only appropriate order that would be sufficient to protect the public interest" – as her lack of knowledge has put patients at unwarranted risk of harm.

Romanian nurse could not understand a word from his colleagues

Jean Ruxanda’s story was similar to his Italian counterpart, Ms Indrizzi. His was a short stint lasting six months where he was terminated at the end of his probationary period.

His poor command of English was disturbing and his colleagues and consultants said he could not understand what they said. He did not know the difference between various dressings or drug doses, and was forced to try and lip read colleagues in the operating theatre in a bid to understand what was being said.

In December 2015, shortly a month after he started work in the Yeovil District Hospital, a nurse, identified as Ms 2, said she discussed the problem with Ruxanda, and even gave him suggestions to improve his language skills. She encouraged him to listen to the radio or watch television frequently so that he can be better exposed to the language – and do his job right. Ruxanda assured her he had arranged for English lessons.

The NMC had sent Ruxanda seven letters between August 2016 and April 2017, insisting that he complete an English language assessment. However, there was no response and an attempt to contact him by telephone, but to no avail.

Ruxanda was referred to the NMC on the grounds that his fitness to practice may have been impaired but “failed to engage with the NMC” throughout the whole process.

The panel concluded he did not have the necessary standard of English to work safely and suspended him for a year.

Mary Thomas, for the NMC, said, “The evidence before the panel was that Mr Ruxanda had put patients at a potential risk of harm due to his poor handovers and inadequate record keeping."

“His working as a nurse whilst being unable to communicate effectively with other staff brought the profession into a disrepute.”

If Ruxanda wishes to work in the UK again, he will have to complete a English language test, an assessment, and engage fully with the NMC, the panel ruled.

Language tests for NHS nurses

New rules introduced in January 2016 required nurses and midwives from Europe to meet basic English language requirements so as to practise safely. Subsequently, these rules were relaxed, allowing foreign nurses to do the language tests in two sittings, using the best scores from each, to achieve a ‘pass’.

Despite this concession, senior managers and commercial recruitment agencies have urged regulators to reduce the pass score as many nurses missed overseas job offers because of poor English.

While regulators are reviewing the appeal, patient groups and the Royal College expressed concern that a compromise in the language bar could jeopardise patient safety. MIMS

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