Overseas Nurses Struggle with Common British Phrases, Says Health Union

Overseas Nurses Struggle with Common British Phrases, Says Health Union


The Royal College of Nursing (RCN) has recently provided guidance indicating that overseas nurses in the UK struggle with understanding common British phrases like ‘feeling sick’ or ‘I need the loo’.

As the NHS increasingly relies on foreign-trained nurses to address staff shortages, the RCN has issued a guide outlining 50 prevalent idioms or expressions in British English.

The lack of familiarity with these phrases could hinder effective patient assessment and communication for overseas-trained nurses.

The concern arises when patients use figurative expressions like ‘feeling under the weather’, which might not directly convey their medical condition.

According to the RCN, this could pose an obstacle in comprehending the health and well-being of the patient.


The reliance on international nurse recruits, particularly from countries such as India, Nigeria, and the Philippines, has been on the rise, accounting for a significant portion of new nurses in the UK.

Recent data revealed that approximately half of the new nurses registered in the UK in 2022/23 had received their training abroad.

Interestingly, a rule change enacted last year permits individuals who fail their English language test to still secure a job in the UK, as long as their employer verifies their English proficiency.

This decision has been criticized by patient safety advocates.

Some campaigners propose the formal adoption of the RCN’s slang guide by the NHS as an induction tool for foreign-trained medical professionals, aiming to alleviate potential communication barriers with patients.


Adekola, a nurse, shared his experience of confusion when a patient told him she was feeling sick.

He initially misunderstood the phrase, thinking the patient was acknowledging her illness, only realizing its actual meaning when a colleague fetched a sick bowl.

The RCN spokesperson highlighted that these figurative expressions, common in language worldwide, could present additional challenges for nurses raised and educated in different countries.

Dennis Reed, director of Silver Voices, a group advocating for elderly individuals, welcomed the RCN guide as it could aid nurses from overseas in understanding the “common vernacular.”

Given the increasing reliance on internationally trained healthcare staff, Reed stressed the importance of addressing cultural and language barriers to ensure smooth transitions for these professionals.


The number of international nurses in the UK has seen a significant surge in recent years.

While less than 5,000 new nurses trained overseas were added to the workforce in 2017/18, the post-Covid landscape witnessed a substantial increase to over 20,000 per year.

Experts have voiced concerns over the UK’s dependency on foreign-trained nurses, emphasizing the potential vulnerability of the healthcare system to abrupt shifts in international demand.

Furthermore, the practice of recruiting medical staff from developing nations has raised ethical concerns regarding a potential “brain drain” from countries in dire need of these professionals.

The RCN guide offers explanations for British idioms and slang that could hinder effective communication between overseas-trained nurses and patients.


Some of these phrases include ‘a bitter pill to swallow,’ ’24/7,’ ‘a clean bill of health,’ ‘a new lease of life,’ ‘all ears,’ ‘beat around the bush,’ ‘bigger fish to fry,’ ‘bite the bullet,’ ‘blessing in disguise,’ and others. The goal of the guide is to increase nurses’ confidence in engaging with patients in crucial conversations about their health and well-being.

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