Royal College of Nursing publishes guide for migrant nurses to help understand British slang in hospitals

LONDON Aug 22: The Royal College of Nursing (RCN) has issued a guide for foreign-trained nurses explaining 50 common sayings or expressions.

A patient telling a foreign trained nurse they were ‘feeling under the weather’ could create an ‘obstacle when assessing a patient’s health and wellbeing’, the union said.

It comes at a time when the NHS is increasingly relying on overseas-trained nurses to fill long-running staff shortages.

Analysis suggests international nurse recruits, from nations like India, Nigeria, and the Philippines, accounted for two-thirds of all new nurses in the UK in recent years.

The latest data, published in May, found that about half of new nurses registering in the UK in 2022/23 were originally trained overseas.

And a rule change enacted last year means those who fail their English language test to come work in the UK could still get a job as long as their employer vouches for their English, a move criticised by patient safety campaigners.

They warned that good communication is vital for patient safety and there was a risk some UK health and care employers desperate for staff could be tempted to vouch for workers English skills to shore up their staff numbers.

Some campaigners have now called for the RCN slang guide to be formally adopted by the NHS as an induction tool for overseas-trained medics to help break down potential communication barriers with patients.

Speaking about the launch of the RCN guide, one nurse, Adekola, described how he was left confused when a patient told him she was feeling sick.

‘I was confused, because in my mind I was like “come on, I know you are sick, that’s why you are here”,’ he said.

It was only when he saw a colleague reach for a sick bowl that he realised the phrase meant that a patient may be about to vomit.

An RCN spokesperson said: ‘People all over the world use figurative expressions to describe their circumstances and emotions.

‘Often, the words used in these expressions don’t appear to have any connection to what they’re describing.

‘If you were raised and educated in a different country, you may find these expressions to be an additional obstacle when assessing a patient’s health and well-being.

‘The aim of the guide is to help you feel more confident when having important conversations with the people you care for.’

Dennis Reed, director of Silver Voices, which campaigns for elderly Britons, welcomed the guide to help nurses new to Britain understand ‘common vernacular’.

‘We have such a reliance on overseas health professionals that I think it’s important to address any cultural barriers and break down any language barriers,’ he said.

‘For the next few years we’re going to have to rely on thousands of medical professionals trained overseas so anything that can be done to ease that transition is fantastic.’

He called for the guide to be adopted by the NHS so that more internationally-trained staff could access it.

International nurse numbers in the UK have exploded in the past five years.

In 2017/18 less than 5,000 new nurses in the UK were originally trained overseas, but this has soared to over 20,000 per year following the Covid pandemic.

Experts have repeatedly raised the alarm about the UK’s over-reliance on overseas-trained nursing recruits to shore up staff shortages in the NHS, which they say leaves the health service vulnerable to sudden shifts in international demand.

Some experts even warned such ‘poaching’ from developing nations could lead to a dangerous ‘brain drain’ of medical staff from countries that desperately need them.

Medics trained in places like India, the Philippines and Nigeria, accounted for two-thirds of all new recruits between 2019 and 2022, official figures suggest.

But some are recruited from places like Ghana, classified as a ‘red-list’ nation for nurse recruitment by the World Health Organization.

Red-list status indicates nurse shortages are severe so wealthy countries should not poach its staff.

While UK rules forbid ‘active recruitment’ from places like Ghana medics can still independently apply for vacancies, which can be shared by NHS trusts on social media.

There are 40,000 nursing vacancies in the NHS in England alone according to the latest official data.

Here is the full list of British sayings and slang words the RCN believes could be an obstacle to an overseas trained nurse treating a patient:

‘A bitter pill to swallow’

Meaning: A difficult truth to have to accept.

Example of how it could be used in a clinical setting: ‘Learning that my appointment had been cancelled was a bitter pill to swallow after waiting so long.’

’24/7′

Meaning: All the time. 24 hours a day, seven days a week.

Example of how it could be used in a clinical setting: ‘My mother seems to be in pain 24/7.’

‘A clean bill of health’

Meaning: Confirmation that a person is in good health.

Example of how it could be used in a clinical setting: ‘The practice nurse gave me a clean bill of health at my last appointment.’

‘A new lease of life’

Meaning: A new energetic and positive approach towards life, commonly after a difficult time.

Example of how it could be used in a clinical setting: ‘The new medication is working well. It’s given me a new lease of life.’

‘All ears’

Meaning: Listening intently.

Example of how it could be used in a clinical setting: ‘If you have any advice about how to stop the swelling in my leg, I’m all ears.’

‘Beat around the bush’

Meaning: To avoid saying something difficult or uncomfortable directly by saying it vaguely instead.

Example of how it could be used in a clinical setting: ‘Please don’t beat around the bush when talking about my condition with me.’

‘Bigger fish to fry’

Meaning: There are more important things to do or people to see.

Example of how it could be used in a clinical setting: ‘Don’t worry about me and my cough. I’m sure you have bigger fish to fry.’

‘Bite the bullet’

Meaning: Making the difficult decision to do something you’re not looking forward to.

Example of how it could be used in a clinical setting: ‘I’ve decided to bite the bullet and go ahead with the biopsy as soon as possible.’

‘Blessing in disguise’

Meaning: Something that seems bad initially, but in the end provides a positive outcome.

Example of how it could be used in a clinical setting: ‘The endoscopy was uncomfortable, but it was a blessing in disguise because it gave me the answers I needed about my condition.’

‘Burying my head in the sand’

Meaning: Delaying addressing a problem in the hope that it will resolve itself, while knowing that it won’t.

Example of how it could be used in a clinical setting: ‘I’ve been burying my head in the sand about my raised blood pressure and hoping it would get better by itself.’

‘Cold turkey’

Meaning: To quit suddenly without assistance.

Example of how it could be used in a clinical setting: ‘I gave up smoking cold turkey last year.’

‘Cross that bridge when we come to it’

Meaning: Avoid making a decision until later.

Example of how it could be used in a clinical setting: ‘I know I might need surgery eventually, but let’s cross that bridge when we come to it.’

‘Cut to the chase’

Meaning: Get directly to the meaning of what you’re saying.

Example of how it could be used in a clinical setting: ‘I don’t understand medical language, so please cut to the chase about my results.’

‘Don’t put all your eggs in one basket’

Meaning: Don’t rely on one option only in case something changes and you haven’t got a second option.

Example of how it could be used in a clinical setting: ‘I’d like to have two birth plans because I don’t want to put all my eggs in one basket.’

‘Fit as a fiddle’ OR ‘Right as rain’

Meaning: Very well, fit and healthy.

Example of how it could be used in a clinical setting:

‘I was fit as a fiddle throughout my 40s, but now I’m in my 50s, I don’t feel as healthy.’

‘Since the procedure, I’ve been feeling as right as rain.’

‘Giving me gyp’ (pronounced ‘jip’) OR ‘Playing up’ OR ‘Flaring up’

Meaning: Causing pain or discomfort, often recurring over a prolonged time.

Example of how it could be used in a clinical setting:

‘My hip is always giving me gyp in the winter.’

‘My knee has been playing up since I started running again.’

‘My arthritis flares up when I take this medication.’

‘Hanging in there’

Meaning: Continuing to move forward each day, despite difficult circumstances.

Example of how it could be used in a clinical setting: ‘I’m feeling very unwell but I’m hanging in there.’

‘In the dark’

Meaning: Not having information about something.

Example of how it could be used in a clinical setting: ‘For a while, I was in the dark about the treatment options available to me.’

‘Sitting on the fence’ OR ‘On the fence’

Meaning: Undecided.

Example of how it could be used in a clinical setting: ‘I’m on the fence about whether I should have the counselling the hospital has offered me.’

‘On the mend’

Meaning: Recovering.

Example of how it could be used in a clinical setting: ‘I’m finally on the mend since the accident.’

‘Out of shape’

Meaning: Unfit. In poor physical condition.

Example of how it could be used in a clinical setting: ‘I was out of shape until I began taking regular exercise.’

‘Play it by ear’

Meaning: To make decisions as things happen with little information.

Example of how it could be used in a clinical setting: ‘I don’t know when I’ll next be able to attend an appointment. I’ll need to play it by ear.’

‘Putting it off’

Meaning: Delaying something intentionally.

Example of how it could be used in a clinical setting: ‘I know I should have booked an appointment earlier, but I’ve been putting it off because I was worried.’

‘Skin and bones’

Meaning: Very thin.

Example of how it could be used in a clinical setting: ‘One of the symptoms of my cancer was extreme weight loss. I was skin and bone.’

‘Spend a penny’

Meaning: Using a toilet to urinate

Example of how it could be used: ‘Where is the toilet? I need to spend a penny.’

‘Throwing up’ OR ‘feeling sick’

Meaning: Vomiting

Example of how it could be used in a clinical setting: ‘I feel like throwing up every time I sit up’ OR ‘I feel sick every time I use that medication.’

‘Under the weather’

Meaning: Unwell.

Example of how it could be used in a clinical setting: ‘I’ve been feeling under the weather ever since I started this new medication.’

‘Wrap my head around it’ OR ‘Come to terms with it’

Meaning: To understand and accept something that might take time and emotional effort.

Example of how it could be used in a clinical setting: ‘I’m finding it difficult to wrap my head around my cancer diagnosis.’

‘I’m beginning to come to terms with what the test results mean.’

‘Barmy/Bonkers’

Meaning: Crazy

Example of how it could be used in a clinical setting: ‘I thought I was going bonkers until my GP confirmed it was a common side effect.’

‘Bloke’

Meaning: A man

Example of how it could be used in a clinical setting: ‘That bloke on reception was very helpful.’

‘Botch job’

Meaning: A badly done job

Example of how it could be used in a clinical setting: ‘My previous surgeon did a botch job on my hip. I hope I don’t have the same experience this time.’

‘Chuffed’

Meaning: Very happy

Example of how it could be used in a clinical setting: ‘I was chuffed when my results came back negative.’

‘Cuppa’

Meaning: Cup of tea

Example of how it could be used in a clinical setting: ‘A cuppa might help to comfort that patient.’

‘Doddle’

Meaning: Something that is easy

Example of how it could be used in a clinical setting: ‘I went to donate blood today. The process was a doddle.’

‘Dodgy’

Meaning: Something is not right

Example of how it could be used in a clinical setting: ‘My stomach is feeling a bit dodgy.’

‘Gobsmacked’

Meaning: Shocked or surprised

Example of how it could be used in a clinical setting: ‘I saw the pregnancy test and I was gobsmacked.’

‘Gutted’

Meaning: Very disappointed

Example of how it could be used in a clinical setting: ‘I’m not being discharged until next week. I’m so gutted.’

‘Faff’

Meaning: Overly complicated or time consuming

Example of how it could be used in a clinical setting: ‘Booking this appointment is quite a faff.’

‘Knackered’

Meaning: Tired/exhausted

Example of how it could be used in a clinical setting: ‘I was knackered after my last shift.’

‘Loo’

Meaning: Toilet

Example of how it could be used in a clinical setting: ‘I need the loo. Where is it?’

‘Mate’

Meaning: Friend

Example of how it could be used in a clinical setting: ‘I’m here to see my mate. His name is John Parker.’

‘Rubbish’

Meaning: Something untrue; of poor quality; bad.

Example of how it could be used in a clinical setting: ‘They are talking rubbish about my poor health. I feel fine.’

‘The food is a bit rubbish.’

‘I’m feeling rubbish.’

‘Shambles OR a dog’s dinner’

Meaning: A mess; badly handled.

Example of how it could be used in a clinical setting: ‘The backlog of NHS appointments is a bit of a shambles.’

‘Skint’

Meaning: To be without money

Example of how it could be used in a clinical setting: ‘I can’t afford to get private healthcare. I’m totally skint.’

‘Strop’

Meaning: To be in a bad mood

Example of how it could be used in a clinical setting: ‘I was having a strop because I’m tired and uncomfortable after the procedure.’

‘Taking the mick/taking the mickey’

Meaning: To take advantage

Example of how it could be used: ‘My appointment is over 30 minutes late. They are taking the mickey.’