Barriers and facilitators to career progression and leadership among internationally educated nurses and midwives in the UK: a mixed methods systematic review

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.