An American nurse in London: Is it worth it?

Author(s): Mary Costello, BSN, RN

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 System 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.


  1. 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?

  2. 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!

  3. 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.

  4. 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

  5. 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!

  6. 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!

  7. 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.

    • 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!

  8. 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!


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