Non-Clinical Employment as an Indicator of Language Proficiency for Nursing: International Evidence

Abstract Issue/problem An in-depth review of the regulatory landscape surrounding language proficiency assessment for Internationally Educated Nurses (IENs) and Internationally Educated Midwives (IEMs) was conducted. The study critically evaluates the potential of non-clinical employment as a measure of language proficiency in the context of the European Union free movement agreement and the need to safeguard patient safety and healthcare sustainability. Description of the problem This desk-based review examined policies from 39 countries, including Ireland, five majority English-speaking countries, 26 EU member states, and seven high-income non-EU nations. Additionally, a systematic literature review adhering to Joanna Briggs Institute guidelines, synthesised evidence from 113 studies on language and communication in healthcare. Results Findings reveal insufficient evidence to use non-clinical employment as a safe or reliable indicator of language skills. Instead, stringent language assessment standards are universally upheld by regulators globally, with proficiency typically required at B2 or C1 levels according to the Common European Framework of Reference for Languages (CEFR). Lessons Evidence from the research literature shows that effective communication is foundational to patient safety and care quality. It extends beyond linguistic proficiency to include professional communication competencies, such as therapeutic and interprofessional communication, cultural competence, and technical relational skills. The key findings highlight the interplay between language proficiency, professional communication competencies, and healthcare quality and sustainability, with implications for other professional groups and countries. Key messages • The review underscores the risks to healthcare outcomes posed by potentially relaxing language assessment standards and highlights the critical importance of evidence-based regulatory practices. • The key findings highlight the interplay between language proficiency, professional communication competencies, and healthcare quality and sustainability.