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An American nurse in London: Is it worth it?

By: Mary Costello

Fresh off the boat was a term I’d heard once or twice amongst my former travels, usually referring to an immigrant who had recently arrived in a new country of chosen inhabitance. Fresh off the boat instantly became my joking term to explain my newfound situation to random UK citizens who felt the need to ask where I was from and when I arrived. Here’s a shocker: There aren’t many Americans working in London, or anywhere really outside of the United States.I was commonly asked, “Where is that accent from? Are you Canadian? Why did you come here?”

When asked why I came to London to try nursing, all I could really think to answer is that I came for the experience and to see what it is like living outside of the United States. I had travelled on my own a-plenty, to many countries around the world, so I wanted to know what it was like to live in one of them. London, UK just happened to be the easiest one for me, and lucky for me, I have learned why.

When you have a system of free health care such as in the National Health Service of the UK, better known as the NHS, and too many people are in frequent need of healthcare, there is naturally going to be a lot of stress placed on workers. Frankly, it’s stressful working for the NHS, or any healthcare system, really. People in need and who are sick, injured, mentally stressed, et cetera, are going to want good healthcare, and they’re going to want it then and not later. The NHS is “free”, so people are going to come no matter what, even if it means waiting in line for seven hours.

However, despite the stress and relentless determination that it takes to work in one of the largest cities in the world, equipped with the most widely recognized free health system, you have to be ready to handle the stress, ready to learn quite a lot, and ready to use both this stress and newfound knowledge to your advantage. When asked if working in the UK as a nurse has been worth it? Yes, it has been, without a doubt.

I moved to London, and as those who have lived in London are aware, London is not the friendliest of cities. It is unique, and it will challenge you on its own. Don’t get me wrong; it’s a lovely city, incredibly fun and interesting, and the people are undeniably fantastic, but the city in general is intense and testing. You have constant weather changes, the ongoing persona of people on the go, every culture within close proximity, non-stop public transportation to every corner, and the overall accumulation of parks, buildings, history, et cetera. It’s madness so intricately combined that it somehow works, and this is London.

Of course, moving to London alone required adaptation, but coming to London to work as a nurse required something else, like, durability. It was hard. It was honestly very hard, because the system is not set up to favor those pretentious nurses that come from America, like me. Can it be done, yes, but it is quite the test. First, the non-EU nurse has to go through a set of steps to enter the country to be able to work. That’s pretty standard when wanting to move abroad for work. Once that’s completed, the non-EU nurse is then able to start working, but only as a nurse assistant until a clinical test called the OSCE is completed. Okay, also pretty standard. This may seem rather bleak and programmatic, but it’s harder than it seems for the already trained nurse because it’s essentially like having to go backwards. I kept wanting to do more than I was legally able to do because I had not yet completed the OSCE. It took about 2 months from my time of arrival to the UK to be trained well enough for the OSCE, because each NHS hospital has its own ways of training, and that takes about 2 months.

There is also the fact that your skill set is bound to change. As a former American medical surgical/ICU nurse who had training in a number of tough skills, I had to accept that those skills meant nothing, that I was equivalent to a new nurse fresh out of nursing school. Talk about self-deprecating. I had to learn the UK way of assessment and performance, and basically had to become retrained and signed off on skills that I already knew and had excelled at. Obviously completing the requirements was easy; accepting that I had to repeat training was more difficult.

Then, there is the fact that the hospital you will work for is going to be an NHS hospital, which means it’s a “free, public hospital”. Yes, there are private hospitals, but these are not easy to get on board with initially. Usually private hospitals look for at least 6 months to a year of UK experience, so the NHS it is until then. The NHS is a beautiful thing, really. It’s an extremely generous and fair system, and the UK citizens are quite in favor, as they should be. It is a stressful system to work for, but it is also a good system to work for. The NHS has some highly recognizable university hospitals that produce exceptional research and training programs. Nearly all of the care is evidence-based and sound. Once you find your place in the NHS, I guarantee that you will enjoy the knowledge and challenges.

Essentially, moving to London for work as a nurse is like throwing oneself into deep water. The learning curve is steep, and the direct teaching is sparse; but the expectations are still high. You have to adapt quickly and figure out how things work with limited support within months, and that is challenging. If you are able to make it through the first months, you will eventually witness yourself change as a nurse, more accepting of challenges, and overall more independent.

I believe the best part of coming to London to work as a nurse has been just that—coming to London to work as a nurse. It has been life changing, and has really helped me to become a stronger, wiser, braver, more self-assured, not just nurse, but person. It also has helped me to become a better nurse, for it has helped me to grow independently. It is has helped me to be more considerate of others, to be mindful of various cultures and races. Surprisingly, it has also made me more confident in initiating the nurse-leader role. I have never been so confident in wanting to lead others in experience and knowledge.

Coming abroad as a nurse has not been easy, but it has been fun, and so worth it. If I could suggest to other nurses to consider trying nursing in another country, whether it be the UK, Australia, Dubai, or anywhere else in the world, I would say one hundred percent, go for it!

Mary Costello is a nurse living in London.

61 Comments. Leave new

  • I am an RN who did my training in Uk then repatriated to the W.I. Where I worked as a staff nurse for 3 years and nurse supervisor for 3 years. Soon after that I moved to NY where I had to apply to the State University Ed Dept and take the NCLEX (State Board exam).
    I was a little torn at first but, after working in the US as an RN. I understand fully the reason behind the process. Nursing is nursing all over the world but we use different terminology, abbreviations, etc. although the medications may in some cases be the same the names are very different and sometimes the reasoning that facilitates treatment are also different. Therefore, it takes time to get used to that particular country’s method of reasoning & also their rationale. However, once you have that down Pat it is pretty much 2nd nature. I completed my BSN & MSN here in the USA. I love the practical knowledge I got in UK but appreciate so very much the theory that was pumped into my brain cells here in USA. In addition there are so much more opportunities here in the USA for nurses. The British system is impeccable and I am glad for my exposure to both. I have only gained from this and say nothing negative about either. I have lived in The US too long and my children are American so I guess with that I am all in. I would not choose to do it any other way even if I could. I Love London UK & I love NY USA.

  • Been a nurse in the UK for 3 years now and I think that’s a fair amount of time to know what I really want. Back home in PH, our accreditation and hospital system is more of American, at the end of the day I still wanted to work in an American health care. A month from now, I am moving to the US and I can’t wait to finally fulfil my dream since nursing school. UKRN to USRN.

  • Am a Ghanaian RN planning to either relocate to the UK or US. This article has really given me the final nod as to what to do. Thanks a lot for sharing.

  • Am a kenya registered nurse currently working in the U.K. for one and half years .Am in the process of applying to the US with Avant healthcare professionals.is it a great idea or should I remain in the U.K.?

  • Amazing article! I can relate as a UKRN working in the NHS ( Geriatric Ward) for 2 years now.
    However, I am contemplating applying to the US. What do you think is the difference with regards to salary, living expenses and patient: ratio/workload? Where do you think should I start to have an easy transition as a USRN? Thank you!

  • Valentine D. HND, Bsc Msc
    April 3, 2021 5:10 pm

    Hi there ,I’m a Romanian Medical Assistant in General Medicine (Registered Nurse) and this is my 5th year in the UK.
    Had done a Bsc top up and now finishing my Msc in Advanced Nursing Practice .
    Is there anyone knowing 🤔 if and how can I transfer as Nurse Practitioner from UK to 🇺🇸US ???I know the education is not at the same level (as I have a aunt there as Doctor of Nursing Practice 🇺🇸 ).Here for qualifying as a prescriber you need 78 hrs of placement for prescribing vs 1200 hrs in US .
    I contacted the BON Texas and they said as long as I have Advanced Physical Assessment, Advanced Pharmacology and Advanced Pathophysiology (which we don’t do that much in the Msc) is ok but they weren’t sure as they never registered a British Nurse practitioner.

  • Born and raised in San Francisco, I started my nurse training in London in 1967. I lived and worked as a nurse in the Ik for twenty years before retiring to the US. Both countries have very different cultural styles for nurses.
    I am forever grateful to have current friendships with both English and American ladies that I went to nursing school with over fifty years ago. So proud of my nursing career.

    Nursing is a special career and wherever it is practiced is a gift to patients and their families.

  • Mary Costello, you don’t know how I understand you. Very empathetic writing.

  • Candace Rouse
    January 28, 2021 3:02 pm

    Great article: found completely by accident! I will retire soon (hopefully) here in the US and thought about a job in the UK for a while. Great info: thanks for writing.

  • Hi, Mary!
    How about the salary you get being a Nurse in UK and before in US? Was there are big difference? Do find UK Nurses are well compensated compared to US?
    Thank you

    • As of now 10/18/2021, the starting salary in New York is $90,000. excluding the shift differential, BSN, Masters, 16 sick time, 12 holiday pay,4 weeks vacation.Union dues for your retirement, hospital retirement, free health care blah blah blah. Good luck.

      • Alexandra O'Brien
        November 20, 2021 1:21 pm

        I have a BSN from NYU. My first RN job was in Brooklyn. The starting pay was around what you describe but we had to pay for health, vision, dental (not much, but it was not free). I lived in West Harlem at the time so it was a commute of around 3 to 4 hours daily. I then worked in central PA where the pay was less (no surprise) but a weak union meant only 25% or so of the RNs were full-time, the rest of us were “part-time” but almost full-time hours. Our schedule changed weekly and there were rotating shifts. It was horrible. I went back to school and became a school nurse: way better conditions and regular hours.

  • I don’t know if this is still live.. as in if anyone will reply, but I’m a year 2 nurse in the UK and desperately want to go over to the US / Canada for a year or two to work and travel, however every where I look you have to have 2 year min experience! I guess my question is A) Does anyone know if this is set in stone or are there ways to move there with either just 1 year or a few months experience, and B) how difficult is the NCLEX, I may be wrong but with the NHS being so desperate for staff I have seen loads of people flying through OSCE with ease. I hope that makes sense, and any other tips for the US / CAN/ EU travelling plan would be HUGELY appreciated!

    • I meant Yr 2 Nursing Student!

      • I thought the NCLEX was easy, so I guess it depends on your study skills and commons sense. Truly that’s how you pass the NCLEX, if you have common sense you will pass it. Nursing 101. I didn’t study, I was last one to enter exam room, and first one to finish. My NCLEX stopped at 85 questions which meant I got enough right in a short time that I passed, NCLEX goes up to over 200 questions depending on how many you get right in a time period but have to get to at least 85 questions.

        • Michelle Loose
          March 2, 2022 2:57 pm

          NCLEX is hard but it’s meant to be. Common sense is a flower that does not grow in everyone’s garden. Work through as many NCLEX practice questions as possible and you will be fine.
          In general, most positions are not for new grads. Those are far fewer and far between but they do exist! You may need to look at different cities at different times of the year to find them.

    • The NCLEX is difficult in that it is not a straight forward exam. You arent gonna get any questions that follow
      “You patient presents with A, and has a history of B, and you do C”
      I was in a mental pretzel doing it and felt like I had no idea how I was doing, but passed in the minimum amount of questions, meaning I could not have done better. I really recommend using Uworld to study, once you learn how to take a Nclex test, it becomes easier.

    • Alexandra O'Brien
      November 20, 2021 1:23 pm

      If you do the study prep through Kaplan etc and are diligent with that, the NCLEX is OK.

  • This is a fantastic article. However, I’m a UKRN wanting to work in the US. I have worked for more than 2 years here and still I can’t let go of all the learnings I learned when I was in the Philippines, which is basically like an American health system. And for which I miss it a lot, being an independent nurse.

  • Angela Bridgett Sanders
    November 22, 2020 9:08 am

    Kudos to you Mary on your new journey! I want to move to the UK as a nurse. This article helps alot.Thank You very much for the information!

  • Triana N Gorman
    October 22, 2020 12:23 am

    Hello! I am graduating with a BSN next Spring. Would I be eligible to work as a new grad in London? Do you know where I could start looking for these entry level hospital positions? Thanks so much!

    • Hello, yes, I have a friend who recently did this to be with her partner who is British. It is surely possible. Good luck.

    • Alexandra O'Brien
      November 20, 2021 1:25 pm

      I’m pretty sure you have to have a year’s working experience as an RN in order to start the process for getting on the NMC register. I am a US trained RN but a UK citizen and I have looked into working in the UK.

  • Mary, can you tell me if in the UK the American LPN equivalent exists? Thank you

  • Dana Denaris
    August 5, 2020 5:36 am

    I am in the beginning process of applying for my license. I am gathering the info for the eligibility application but I am unsure what they mean by qualification certificate, registration certificate, and name of my regulator. Could you tell me what documents they mean for me to go from American paperwork?


  • I really liked your article. It definitely helped me out because I have read both good and bad reviews. However, I am not looking to live in London. Are there any other cities that people would suggest? Did you use an agency to get over there? what were your first steps to begin the process to move there? Thanks again!

    • I would begin with applying to the country/state nursing board, because you can’t work without their approval. Agencies can help a lot in the process, so finding a good one is ideal, too. Thanks for reading!

    • Hi Brittney, I am a registered nurse in the UK. My place of work is a city called Birmingham. Its the 2nd largest city, it has good travel links and is considered more friendly than London.
      It has both large and small hospitals with outlying counties that also have good size hospitals. Worcester, is also within a reasonable distance of Birmingham with a more countryside feeling to it.
      Its relatively safe here if pick a decent area to live in. You can work agency within the hospital system itself, where you can pick shifts to suit yourself. Wherever you choose good luck.

  • Well.. I cannot keep quiet and would like to mention some things. I am an European trained nurse over 20 years ago. I moved to London 15 years ago and then came to US 5 years ago.. that is such a story itself.
    I disagree with that “free” NHS since contributing so much myself and everyone living there. I can actually post a corner of my pay check form 2014. So, NHS is not free people. I pay less in US for my insurance with a small deductible and not only better, WAY better services in here. Secondly, the nurses training in Europe is tough. American schools have you “ ready “ in 18 months to be an RN. Come on .. I have been in school 4 years to be an RN. Is a confusion. LPN, RN, BSN. A money making industry. So as you can see I am not on either side. But let’s be honest here. NHS ain’t free. And the testing for American nurses moving to UK over it s easy.
    I did both. UK and US /famous NCLEX.
    So please American people, consider yourself lucky!
    Happy 4th July!

    • You’re correct. It’s not technically free at all. Pros and cons to each. Thank you for your opinion! 🙂

    • Hey Ana! My name is Tatiana. I just moved to UK from US. I have Associates degree in Nursing (Completed in US) with 20 months of experience in med-surg unit. I ‘m planning to apply to become a nurse in England. Do you know if UK board will accept my with Associates degree? On one website I’ve read that only Bachelor’s degree is acceptable.

      • You do not need a BSN, but you have to prove that your classwork/degree requirements match what is required in the UK. Good luck!

    • Hi Ana, can I ask for your opinion on which is better: UKRN or USRN in terms of workload, cost of living and earnings. Could you briefly discuss the steps on shifting from UKRN to USRN? Thanks!?

  • Kristiana Daily
    June 28, 2020 10:40 am

    Mary, thank you for the article. It was very helpful. I am looking to work in London, I am an RN with 7 years experience, BSN, and Oncology Certification. Should I allow COVID-19 travel restrictions to put off the process of starting to get on the registry or just continue to move forward?

    • I would do as much as you can and continue with the process. However, I’d doubt the UK would let an American in now, even to work. You may have to wait until they remove the restrictions. I would check with the UK embassy, they’ll be able to tell you more.

  • Hey Mary!
    I was wondering, how many years of nursing experience does it take to apply with the NMC to work in the UK. I will be graduating in 2021 and would love to start nursing directly in the UK. Also, did you do everything through the NMC or was there another registry that you applied to?

    • You’ll have to check with NMC requirements. If I remember correctly, I believe 2 years was the minimum when I applied.

  • Cayaana Knipfer
    March 20, 2020 12:53 pm

    Hi Mary!

    Did you still need to take the CBT and the OSCE or jus the OSCE? I am currently working in the NHS as a part of an IPC team in Birmingham and I totally understood what you meant when you mentioned the step back and how different the NHS mentality is than US-based healthcare!

  • Alexandra Beard
    February 10, 2020 11:55 pm

    This is a great article Mary, truly! It is exactly what I’ve been looking for to gain some knowledge on the America to London transition. I work in sales with a BA in another subject and I’m considering going back to school for an Associates in Nursing just to go off to work and live in London. I’ve been there several times and it takes you out of the entitled American mindset almost immediately. It’s tough but the people are fantastic! As far as schooling, would you recommend going back to school in America or just going to school in London? Thanks for your feedback! I hope you make more inspiring articles like this. It’s hard to find any first hand content on this subject.

    • Thank you. Yes, it is good to expand your horizon so to speak and try other places. It was difficult but worth it. Good luck in your endeavorers.

  • Hey Mary! Is there any way I can contact you about getting a visa/studying for their exam? And what other credentials you’d need to move over there from the US? I have so many questions

    • Definitely check with the NMC website and see what they currently require. They also have studying advice. I would start there. Thanks for reading!

  • Hi! Thanks for the article. By ‘nurse’ do you mean RN with Associates degree or a BSN?
    I have a Bachelors degree in Business Administration, but I am also an RN with an Associates degree only…. not the BSN. (yes, I went backwards getting a BA first then Associates)… Can you tell me if England accepts RNs with associates only?
    Thank you!

    • They do! I had only an ASN degree when I moved there, and finished my BSN while overseas. You have to show that all credits/hours match the UK system’s. Good luck!

  • Hi Mary,

    I’m a California nurse looking at a potential move with family in tow. This post scares, but excites me (I mean, c’mon…California ratios to NHS?!). My husband is a British citizen, but we’re worried about the time and money to move a family with two small children. I’ve visited many times and we have family on the outskirts of London with a potential place to stay..makes things a little easier. Are there any particular links you would recommend I look at to prepare myself or to help us understand such a move (and nursing) better? Thanks in advance!

    • Great questions! There were very few links/advice that helped me to understand the transition and what would be ahead. Look at the NMC website and see what they require. Talking to locals is also a great idea!

    • What are the differences in ratios?

  • Jacinta Ukah-ogbonna
    September 5, 2019 7:05 am

    Well done and much respect Mary.
    I definitely agree that nurses trained in the USA should try working abroad.
    It is totally empowering with some learning curve. I am a US experienced nurse executive working in Saudi Arabia for almost 8 years.

    • Lysandra dePadua
      May 2, 2020 3:43 pm

      Hi! I have dreamed about moving to England for basically my entire life, I’ve been going every summer since I was 11 because we have family there.

      I was just wondering if you have any idea if it would be possible to get a job there fresh out of nursing school? I am in school in the US right now and graduate in May 2021. Do you think I should work in the US for a year and then try and get a job? I would love to just go straight there!

      You’re article was very helpful and informative. Thank you!

      • This is a great question. I would check with the NMC and they’ll be able to tell you more about the requirements. I believe it is possible, but you will still have to pass the CBT and OSCE tests. Check with the NMC, first. Good luck!

  • Great article!
    Well said, especially about the mental struggle going backward in training.
    I was in similar situation coming to US with MD diploma .
    Nothing I I have done mattered and counted.
    It is not easy to wrap your mind around it.

    Good luck to you!

  • Mohammad Khattab
    September 5, 2019 1:50 am

    Good luck to the summit ??

  • Kimberley johnson
    September 4, 2019 5:17 pm

    I’m so proud of you Mary and miss you!!


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