Barriers and facilitators to career progression and leadership among internationally educated nurses and midwives in the UK: a mixed methods systematic review
8 affiliations
- 1Corporate Nursing, London North West University Healthcare Trust, London, United Kingdom
- 2School of Nursing and Health Sciences within the Faculty of Health Sciences and Wellbeing, University of Sunderland in London, United Kingdom
- 3Institute for Health and Wellbeing Research, University of Bedfordshire, United Kingdom
- 4Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
- 5Oxford School of Nursing and Midwifery, Oxford Brookes University, United Kingdom
- 6Innovation and Research, Institute of Health Visiting, London, United Kingdom
- 7Centre for Health Services Studies, University of Kent, Canterbury, United Kingdom
- 8School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
Abstract
Background: Internationally educated nurses and midwives (IENMs) comprise almost one-quarter of the UK nursing and midwifery workforce and play a vital role in addressing workforce shortages across the National Health Service (NHS). Despite their significant contribution, evidence suggests that IENMs experience barriers to career progression and leadership development. This review aimed to synthesise evidence on the barriers and facilitators that influence career progression among IENMs working in the United Kingdom.
Methods: A mixed-methods systematic review was conducted using the Joanna Briggs Institute (JBI) methodology. Five electronic databases (CINAHL, MEDLINE, PubMed, Cochrane Library, and Embase) were searched, along with grey literature sources, for studies published between January 2005 and March 2025. Eligible studies included qualitative, quantitative, and mixed methods research involving internationally educated nurses and/or midwives practising in the UK. Methodological quality was assessed using the JBI Critical Appraisal Checklist for Qualitative Research and the Mixed Methods Appraisal Tool (MMAT). Quantitative findings were transformed into qualitative data and integrated with qualitative findings using the JBI convergent integrated approach.
Results: Eight studies met the inclusion criteria, representing at least 1,752 participants. Thirty-two qualitative findings and eight qualitised findings were synthesised into five integrated themes: (1) Career Progression and Structural Barriers; (2) Early-Career Scaffolding and Development Support; (3) Skill Mismatch and De-skilling; (4) Mentoring, Sponsorship and Leadership Access; and (5) Organisational Culture and Inclusion. IENMs experienced delayed promotion, limited recognition of prior expertise, unequal access to professional development, and inconsistent mentorship and sponsorship. Facilitators included structured induction, supportive line management, leadership development programmes, equitable access to continuing professional development, and inclusive organisational cultures. The evidence suggested that career progression was influenced more by organisational and structural factors than by individual capability.
Conclusion: IENMs continue to face significant systemic barriers to career progression and leadership development within the UK healthcare workforce. Addressing these challenges requires transparent promotion pathways, recognition of international experience, equitable access to development opportunities, and targeted mentorship and sponsorship initiatives. Strengthening inclusive organisational cultures and leadership practices may improve retention, workforce sustainability, and leadership diversity within the NHS and wider healthcare sector.
Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251006645.
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BibTeX
@article{sagoo2026barriers,
title = {{Barriers and facilitators to career progression and leadership among internationally educated nurses and midwives in the UK: a mixed methods systematic review}},
author = {Rohit Sagoo and Clair Merriman and Tricia Mukherjee and Nyarai Gondo and Sharin Baldwin},
journal = {Frontiers in Health Services},
year = {2026},
month = oct,
doi = {10.3389/frhs.2026.1854601},
url = {https://doi.org/10.3389/frhs.2026.1854601},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Barriers and facilitators to career progression and leadership among internationally educated nurses and midwives in the UK: a mixed methods systematic review
AU - Rohit Sagoo
AU - Clair Merriman
AU - Tricia Mukherjee
AU - Nyarai Gondo
AU - Sharin Baldwin
PY - 2026
DA - 2026/10/21
JO - Frontiers in Health Services
DO - 10.3389/frhs.2026.1854601
UR - https://doi.org/10.3389/frhs.2026.1854601
AB - Background: Internationally educated nurses and midwives (IENMs) comprise almost one-quarter of the UK nursing and midwifery workforce and play a vital role in addressing workforce shortages across the National Health Service (NHS). Despite their significant contribution, evidence suggests that IENMs experience barriers to career progression and leadership development. This review aimed to synthesise evidence on the barriers and facilitators that influence career progression among IENMs working in the United Kingdom. Methods: A mixed-methods systematic review was conducted using the Joanna Briggs Institute (JBI) methodology. Five electronic databases (CINAHL, MEDLINE, PubMed, Cochrane Library, and Embase) were searched, along with grey literature sources, for studies published between January 2005 and March 2025. Eligible studies included qualitative, quantitative, and mixed methods research involving internationally educated nurses and/or midwives practising in the UK. Methodological quality was assessed using the JBI Critical Appraisal Checklist for Qualitative Research and the Mixed Methods Appraisal Tool (MMAT). Quantitative findings were transformed into qualitative data and integrated with qualitative findings using the JBI convergent integrated approach. Results: Eight studies met the inclusion criteria, representing at least 1,752 participants. Thirty-two qualitative findings and eight qualitised findings were synthesised into five integrated themes: (1) Career Progression and Structural Barriers; (2) Early-Career Scaffolding and Development Support; (3) Skill Mismatch and De-skilling; (4) Mentoring, Sponsorship and Leadership Access; and (5) Organisational Culture and Inclusion. IENMs experienced delayed promotion, limited recognition of prior expertise, unequal access to professional development, and inconsistent mentorship and sponsorship. Facilitators included structured induction, supportive line management, leadership development programmes, equitable access to continuing professional development, and inclusive organisational cultures. The evidence suggested that career progression was influenced more by organisational and structural factors than by individual capability. Conclusion: IENMs continue to face significant systemic barriers to career progression and leadership development within the UK healthcare workforce. Addressing these challenges requires transparent promotion pathways, recognition of international experience, equitable access to development opportunities, and targeted mentorship and sponsorship initiatives. Strengthening inclusive organisational cultures and leadership practices may improve retention, workforce sustainability, and leadership diversity within the NHS and wider healthcare sector. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251006645.
SN - 2813-0146
ER -