Nigerian nurses in the UK ‘suffering’ following CBT fraud allegations

Internationally educated nurses have said they feel “thrown out into the cold” by the UK nursing regulator, amid ongoing investigations into widespread fraud that took place at a test centre in Nigeria.

Almost 2,000 internationally educated Nigerian nurses were impacted by the incident, first flagged to the Nursing and Midwifery Council (NMC) last year.

“We have a number of vulnerable people that have lost jobs and lost their livelihoods”

Felicia Kwaku

Nursing Times has been told by those affected that their “whole lives are on pause” while they await outcomes of hearings and appeals.

Some have been fired by their employers, had visas revoked and have landed into debt and emotional turmoil as a result of the situation.

It comes as part of an ongoing investigation by the NMC into fraud concerns at a Pearson VUE testing site in Ibadan, Nigeria.

Analysis of data coming from the Yunnik Technologies Test Centre revealed that nurses were sitting their computer-based test (CBT) in record time.

The CBT is one of two parts of a test of competence that some international nurses must complete as part of their NMC application and is usually sat in their home countries.

The NMC concluded that hundreds of nurses, including registrants and applicants, had obtained their CBT fraudulently.

So far, 16 people have admitted that a proxy was involved in achieving their CBT at Yunnik.

Meanwhile, seven registrants have been removed from the register and 185 applications have been refused.

Campaigning groups have warned of the negative impact the investigations have had on affected nurses, some of whom dispute the claims against them.

Some have even threatened the NMC with legal action, asking them to reconsider, while others have contacted the government pleading for ministerial intervention.

Nursing Times has spoken to some of the affected nurses about their situation, and how they are hoping to move forward. The nurses all wanted to remain anonymous.

‘When I had that rejection letter, I thought I had died’
Nurse A was “not scared initially” when she found out the NMC would be investigating fraud at the Yunnik test centre.

“I was even happy it was happening in the UK,” she told Nursing Times.

“I had confidence in [the NMC] that they were going to fish out the people who did it.”

Nurse A completed her CBT at Yunnik in October 2022.

She then moved to the UK, passed her objective structured clinical examination (OSCE), applied to join the register and was working as a healthcare assistant while waiting for a response.

Nurse A had told her manager and HR about the NMC investigation when it was first announced in May 2023, as a precaution, not thinking she would be the subject of the allegations.

But in September 2023 all of this changed when the regulator notified her that her application to join the register had been rejected on the basis that the NMC believed her CBT had been obtained fraudulently.

“When I had that rejection letter, I thought I had died,” she said.

“I could not breathe. I was literally given an inhaler for the first time in my life because [of] the panic attack.”

Despite retaking her CBT in a quick time in the UK, and providing evidence from her current employer, previous employer and school that she was a capable and trustworthy worker, the assistant registrar (AR) who reviewed Nurse A’s case concluded that it was more likely than not that she obtained her CBT fraudulently.

The impact of this decision has been immense, she explained.

“We’re sort of like collateral damage between the NMC and Pearson VUE”

Nurse A

After she got her rejection letter, her employer had to switch her visa from a skilled worker visa to a different type of visa, which led to her having to stop working as a HCA.

“All this is affecting me financially,” explained Nurse A.

“Yesterday I had to call someone to help me with some money to pay my rent.

“I can’t go to school now, I can’t go back and do my master’s, I can’t earn a decent living.

“I’m still paying the debts I incurred through the process of coming here.”

Nurse A also warned that the decision by the NMC would affect her applications to other countries.

“Every country… is going to ask me, ‘Have you been investigated for any professional concern?’ Of course I will not lie,” she explained.

“Imagine that following me for the rest of my life, any career progression or advancement I will make in the future, that’s going to follow me.

“That’s why I’m fighting this, because that’s not who I am.”

One defence put forward by some Nigerian nurses to explain the fast test times was that there were readily available practice papers online that were very similar to the actual tests they sat.

Nurse A said she had accessed these past papers online, on Whatsapp and even the Pearson VUE website.

“I practiced for eight months [and] at some points, just reading the first two words you already know the answer,” she said.

“Sometimes just looking at the options, without even reading the questions, you know the answer because there were a plethora of past questions everywhere.”

An NMC spokesperson told Nursing Times that the questions in online material, whether official or unofficial, were not the same as those in the actual test the candidates sat.

Meanwhile, Nurse A called for there to be greater accountability from Pearson VUE, which was responsible for overseeing the Yunnik test centre.

In a recent webinar hosted by the NMC, in collaboration with the Nigerian Nurses Charitable Association UK (NNCAUK), representatives from the regulator said it had not been monitoring the Yunnik test centre as frequently as it should have.

NMC representatives noted that while a ‘secret shopper’ had visited the test site when it first opened, to inspect the internal workings of the centre, nobody had inspected it since.

The Yunnik centre was set up as part of a move to have test centres in places where a high number of tests were likely to be taken, which the NMC said allowed equity of access to CBTs globally.

However, NMC representatives said during the webinar that, with the benefit of hindsight, it would not allow this model of centre to operate in the future.

This is because the level of risk assessment in place did not consider the possibility of widespread fraud, nor did it have proper security measures in place to prevent fraud, such as CCTV or biometric verification – a non-invasive way of verifying a test-taker’s identity.

Nurse A called on Pearson VUE to “take accountability for their inadequacies”.

“We’re sort of like collateral damage between the NMC and Pearson VUE,” she said.

“Nigerian nurses feel scammed that the NMC took us to a centre that was not meeting standard and then we are getting blamed for what happened.”

Pearson VUE upgrades security protocols following investigation
A spokesperson for Pearson VUE confirmed to Nursing Times that the Yunnik test centre did not implement CCTV as a security measure.

They said: “Sometimes the owners of third-party sites install and operate their own CCTV but fail to register the cameras with Pearson VUE.

“In these instances, we do not have knowledge of, nor access to, the footage recorded, even though candidates may have seen cameras at the test centre.”

Pearson VUE sometimes uses ‘palm vein scan technology’ as a mechanism to confirm candidate identity.

This ID verification scans the veins inside a candidate’s hand and creates a digital template representing their unique vein pattern.

However, the spokesperson confirmed that the Yunnik test centre did not implement palm vein pattern recognition as a security measure.

The spokesperson added: “Pearson VUE invests significantly in developing and implementing state-of-the-art technical and operational security measures across each of our delivery channels.

“However, in situations such as the Yunnik Technologies incident, test centre employees who choose to commit criminal acts of misconduct can find ways to bypass these capabilities.

“These “insider threats” are an issue for many industries as well as government agencies.”

The spokesperson noted that Yunnik Technologies was part of a “small group of third-party test centres that had been authorised to administer the test on behalf of the NMC”.

They said: “As a precautionary measure, testing was suspended at 55 of the third-party test centres in May 2023.

“Fifteen of these test centres have resumed test delivery after having upgraded their security protocols.”

‘I should have never left if I knew what was going to happen’
Nurse B was a dual registered nurse and midwife in Nigeria before he came to the UK.

It was only a few months after he passed his OSCE that he found out the NMC would be investigating his CBT result and whether it had been obtained fraudulently.

Like others, Nurse B was asked to re-sit his CBT in the UK, for which he achieved a similarly fast time.

However, his application was still refused by the AR.

In his rejection letter, seeing by Nursing Times, the AR acknowledged that Nurse B was a “quick test taker” but argued that it was because he had sat the test on three occasions and had been working in the UK in a healthcare setting for some time.

However, he told Nursing Times that this reasoning “doesn’t make sense” because he had not been working as a nurse while in the UK.

Nurse B submitted a wide range of evidence to the AR to contest the allegations, including two references from current and previous employers in the UK and Nigeria.

One reference from a matron in the UK described nurse B as someone who was able to be kind and thoughtful to his patients and colleagues, despite working on a busy admission unit and working in challenging situations.

“This has tarnished my career”

Nurse B

The matron said he was hardworking, reliable and safe and could demonstrate working with honesty and integrity.

However, this was not enough to change the AR’s mind.

Nurse B said his “whole life is on pause” due to his job instability.

“This has tarnished my career, it’s a whole lot of mess,” he said.

He said he wanted to return to Nigeria, but that he felt there would be “a lot of stigma” around doing so.

“Going back is shameful. I should have never left if I knew what was going to happen,” Nurse B added.

An NMC spokesperson said: “We identified that highly improbable test times were achieved on a widespread basis at one test site only, in stark contrast to the testing pattern at other sites in Nigeria and globally.

“The data indicated that proxy testing was happening at this site, and we have now received information from numerous individuals who attended Yunnik which corroborates this.

“A small number of individuals have achieved a retest time which may appear ‘similar’ to their Yunnik time, but which is nonetheless slower and in a different category of probability than their original time.”

‘This is not the kind of life I wanted to live’
Nurse C was working in the largest psychiatric hospital in Nigeria, across drug rehabilitation, outpatients and A&E.

He was encouraged to come to the UK by a private mental health provider, with whom he had been working closely to support Nigerian nurses to go and work there.

He told Nursing Times the organisation was “eager” to bring him in, owing to the 18 years of clinical experience he had in mental health.

Over that time, Nurse C had mentored several nurses, some of whom had gone on to be managers in the NHS and private hospitals.

“They threw me into the cold, they don’t care if I die, and that is terrible”

Nurse C

However, when the NMC contacted him to say his application had been refused on the basis that it believed he had obtained his CBT fraudulently, his career came to a standstill.

Just six days after his application to join the register was refused, he was sacked by his employer.

Since then, he has been unable to get a reference to work as a healthcare assistant and, as such, remains unemployed.

“I’ve been home suffering. This is not the kind of life I wanted to live, but NMC have made life so terrible for me,” Nurse C explained.

“I’m just trying to struggle to cope, because the unfortunate thing is that there is nowhere for me to go.”

Nurse C said the environment being cultivated through the investigations was “not supportive and not accommodating”.

“They threw me into the cold, they don’t care if I die, and that is terrible,” he added.

Charitable association hopes ‘the end is near’
NNCAUK has been organising itself around the affected nurses since last year, providing pastoral and professional support to relieve some of the anxieties they are facing.

Felicia Kwaku, lead for education and training at NNCAUK, told Nursing Times that the group felt really strongly about “getting the messages out to employees not to sack people and not to discipline them until the full investigation is completed”.

“Several employers have done the opposite,” she explained.

“We have a number of vulnerable people who have lost jobs and lost their livelihoods, and that’s been something that we’ve been very vociferous about in terms of trying to protect them and safeguarding.

“Some people are in really dire, dire situations.”

Ms Kwaku acknowledged that there were irregularities coming from the Yunnik test centre and that there may have been “vulnerable people who probably have been taken advantage of”.

Felicia Kwaku

She added: “I don’t think it’s for us to really say about people’s innocence or not, because we can’t do that.

“But if the intelligence looks like they’ve got a really strong case to answer, then we will signpost them and we will support them.

“It’s not for us to be judging them, it’s for us to advise and support them through that.”

Looking forward, the NNCAUK wants the NMC to “fast-track” the process so that hearings and appeals can be concluded as soon as possible.

Wendy Olayiwola, president of the organisation, told Nursing Times it had been “painful” to watch colleagues go through the process.

She acknowledged that the NMC could not lower its standards of regulation for these nurses.

However, she said: “They really need to follow the process, the due process, to ensure that the public safety is not compromised but also to ensure that those who are going through this process are also well looked after in the right way and manner as they go through the fitness to practise process.”

Ms Olayiwola added that the investigations had been “a journey” for the organisation and for colleagues.

She said: “We are still on that journey, we haven’t come to the end of it, and I’m just truly hoping that the end is near.

“I’m hoping the end is near for them, so that they can move on with their life, they can settle well, they can get on with what they really want to do – they want to be a nurse.”

Credit: Nursing Times