International paramedic recruitment: A mixed method exploratory study into experiences of Polish paramedics transitioning into roles in NHS Ambulance Trusts in England


Student thesis: Doctoral Thesis


In the 2010s, ambulance services in England faced a shortage of paramedics for the first time in history, leading to an increase in overseas recruitment to address workforce recruitment pressures. International recruitment of healthcare professionals is an important component of the NHS workforce plan, and with a shortage of qualified paramedics, overseas recruitment is more important than ever. The first internationally-trained paramedics (ITPs) joined English ambulance services in 2015, but little is known about their transition experience or how best to support integration into the service.

1. To explore and characterise the experiences of Polish internationally-trained paramedics transitioning into roles in NHS ambulance services in England.
2. To identify potential facilitators and barriers to effective transition and the limitations of current training provisions.
3. To develop recommendations for the training needs of overse3as paramedics to facilitate a smooth transition into the English service.

A mixed-methods design was adopted, with a two-stage sequential process. The first exploratory stage used a qualitative approach to elicit themes through structured focus groups with current ITPs, UK-trained peers and supervisors. The themes were then used as the basis for development of a quantitative questionnaire in the second stage, to establish validity of the stage 1 findings in the wider population of internationally trained paramedics. Participants were recruited from the three ambulance services employing the majority of ITPs in England.

Results and Conclusions:
Focus groups captured ITPs' transition experiences under three dominant themes; communication, cultural variety and support. The survey demonstrated confidence levels in communicating with various stakeholders; measured the perceived difficulty in communicating in paramedic practice-related settings and over various media; and language tuition uptake. Socio-cultural findings included areas in which ITPs reported feeling sufficiently and insufficiently prepared; how they adapted their communication style; and areas related to leadership culture and experiences surrounding differences in patient diversity and consent processes. Findings associated with the theme support incorporated experiences of the induction programme and how effective it was perceived to be. Also, the survey demonstrated how well ITPs felt supported when they began operational work.

Original Contribution to Knowledge:
This study informs healthcare organisations' future recruitment plans and their policy on international recruitment, including how best to support transition from the perspective of both international workforce and UK-based stakeholders.
Date of Award22 Jun 2023
Original languageEnglish
Awarding Institution
  • Edge Hill University
SupervisorSALLY SPENCER (Director of Studies), JEREMY BROWN (Supervisor) & PARESH WANKHADE (Supervisor)


  • International recruitment
  • transition experiences
  • Paramedics
  • National Health Service
  • healthcare staff
  • mixed methods design

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