Background: Many of the overseas qualified nurses educated work as health care assistants and support workers for a decreased wage without scope for professional advancement. There is an imperative to ease their entry to the nursing register.Aim: To gather and provide evidence to the regulatory bodies regarding the demographics of this cohort of nurses and the challenges they face in attempting to register as a nurse.Design: This study used a mixed-method explanatory sequential design. The survey was completed by 857 unregistered nurses followed by five in-depth interviews. Results from both phases were triangulated.Results: The results signpost to the characteristics and challenges of these nurses working as unqualified grades of staff for a decreased wage without scope for professional advance.Discussion and conclusion: The downward occupational spiral of internationally educated nurses underscores the paradoxical nature of the pedagogical application of transition theory, as these nurses are compelled to revert to a novice status.

People with diabetes who are housebound often fall between services and, therefore, do not always receive all of their key care processes, including insulin delivery. As part of a review of all such patients within a clinical commissioning group (CCG) in Kent, this project was conducted to train unregistered practitioners to carry out annual review. The aim was to improve knowledge and competencies among unregistered practitioners in order for them to be able to carry out some components of the diabetes annual review. Six unregistered practitioners employed by the GP practice or the community health trust participated in the project. Each practitioner achieved nine competencies, based on the TREND-UK competency framework. Competencies were achieved through classroom-based learning delivered by a nurse consultant in diabetes, as well as practical supervision of tasks and skills associated with carrying out an annual review. Reflective work and discussion demonstrated not only new skills learned but also how to put these into practice. It is hoped that the training of unregistered practitioners as part of the overall project not only improved their understanding and knowledge but also improved the standard of care delivered to this vulnerable group of people with diabetes.

An increasing number of people require insulin to manage their diabetes, many of them in supported environments such as residential care homes. Community nursing teams are likely to have a growing caseload of care home residents who require diabetes care, including insulin injections, and many unregistered practitioners are being asked to take on this role. If community nurse leads, matrons, frailty teams and pharmacy teams work together to provide training to staff in care homes (particularly unregistered practitioners), diabetes care can be improved. This has to be suitable for groups and for people with different levels of understanding, and supported by written resources. Courses are interactive to engage and motivate all learners, and methods of teaching include group work, visual teaching aids and games. Self-assessment around competencies, using a competency framework, not only demonstrates the development of staff but also highlights key areas of diabetes care.

This article describes how unregistered practitioners, such as healthcare assistants and community-based mental health workers, can contribute to the learning, support and development of pre-registration nursing students in clinical practice. It presents the results of an unregistered practitioner co-mentoring scheme piloted in a mental health trust, and demonstrates its benefits for nursing students, unregistered practitioners and nurse mentors. The scheme delivers training and supervision for unregistered practitioners who are starting a formal role in clinical learning. It aims to recognise and develop the contribution of unregistered practitioners to student learning, and to enhance the learning environments in which nursing students train.