If you spend any time in the nursing staff rooms of London’s major teaching hospitals, you will notice something fairly quickly: the ICU seems to have a disproportionate number of Australians in it. Not just at Guy’s and St Thomas’, where I work, but at King’s College Hospital, University College London, St George’s, and across the major NHS trusts throughout the city. There are historical reasons for this, structural reasons, and a few reasons that say something interesting about the particular kind of nurse that tends to pack up and move to the other side of the world in the first place. I work on an ICU now. I did not start my career there – I came to intensive care after four years in a surgical ward back in Sydney – and the transition has been one of the most demanding and most rewarding things I have done professionally. This article is for the Aussie nurses who are wondering whether London’s ICUs are calling their name, and for those who are not yet sure whether intensive care is the right direction at all.
Why London’s ICUs Are Full of Australians – and New Zealanders
The short answer is that the NHS has been actively recruiting internationally educated nurses for decades, and Australian and New Zealand nurses sit in a particularly advantageous position within that pipeline. English is our first language, which removes one of the larger administrative hurdles in the NMC registration process. Our training standards are well regarded and map reasonably cleanly onto the NHS competency frameworks. And the cultural adjustment, while real – as I wrote about in my last piece – is considerably less steep than it is for nurses arriving from non-English-speaking countries.
But the concentration of Australians specifically in ICU settings is not purely about recruitment logistics. It also reflects the broader nursing workforce patterns in Australia, where intensive care has long been a popular and well-resourced specialisation. Australian ICU training programmes are rigorous, and the graduate certificate and graduate diploma pathways through universities like Sydney, Melbourne, and Monash produce nurses who arrive in London with both theoretical grounding and substantial clinical hours already behind them. London’s ICU hiring managers know this, and they recruit accordingly.
There is also, honestly, a self-selection effect. The nurses who choose to move abroad tend to be the ones who are already looking for a challenge – who have already pushed into specialisation, who are comfortable with complexity and ambiguity, and who are seeking clinical environments that will stretch them further. Intensive care attracts that personality type. London’s ICUs attract that personality type. The overlap is not a coincidence.
The Skills Match – Why ICU-Trained Aussies Are So Sought After
A nurse arriving from an Australian ICU with a completed post-graduate qualification will typically enter the NHS at Band 6, rather than the Band 5 entry point that most general nurses start on. This is a meaningful difference – both in salary and in the clinical autonomy and responsibility attached to the role. NHS ICUs operate under a staffing model that places significant weight on the experience and judgement of the bedside nurse, and a Band 6 nurse in intensive care carries a level of accountability that reflects that.
The specific skills that translate most directly are ventilator management, haemodynamic monitoring, arterial and central line care, renal replacement therapy, and the kind of continuous patient assessment that ICU demands. If you have solid experience across these areas from an Australian context, you will recognise the clinical environment in a London ICU almost immediately, even while the paperwork, the terminology, and the organisational culture are all doing their best to disorient you.
What ICU Nursing in London Actually Looks Like
The ICUs at GSTT and the other major London trusts are large, high-acuity, and frequently operating close to capacity. The patient cohort is complex – post-operative surgical patients, medical patients with multi-organ failure, trauma, sepsis, post-cardiac arrest care, and a range of acute presentations that reflect the catchment area of a central London teaching hospital. The clinical exposure is extraordinary by most standards. You will see presentations and interventions here that you might wait years to encounter in a more suburban or regional setting.
Staffing ratios in NHS ICUs are typically one nurse to one patient, or one to two in high-dependency settings, which aligns with what most Australian ICU nurses will be accustomed to. The multidisciplinary team model is strong – doctors, physiotherapists, pharmacists, dietitians, and speech therapists are all active participants in the ICU round, and nurses are expected to contribute meaningfully to that process.
The NHS ICU Environment – Staffing Ratios, Acuity, and What’s Different
The differences from Australian ICU practice tend to cluster around documentation systems, prescribing culture, and the particular way that clinical decision-making is communicated within the team. Electronic patient records are used across most NHS trusts, though the specific systems vary – GSTT uses systems that will be unfamiliar when you first sit down at them but are learnable within a few weeks. The prescribing model is more consultant-led than what many Australians are used to, and the escalation pathways for deteriorating patients follow a structured format – familiarise yourself with the local early warning score system and escalation protocol in your first week.
The emotional weight of ICU nursing is also worth naming plainly. This is not unique to London or to the NHS – intensive care is psychologically demanding everywhere – but working in a large urban ICU, where the patient turnover is high and the outcomes are not always the ones you are working towards, requires active attention to your own wellbeing. GSTT has occupational health and staff support services, and I would encourage anyone moving into ICU nursing to engage with those structures rather than waiting until they feel they need to.
The Pathways In – How to Get an ICU Role in London as an Australian Nurse
If you already hold a post-graduate qualification in critical care and have two or more years of ICU experience, the pathway is relatively direct. Most major London trusts recruit internationally educated ICU nurses on an ongoing basis, and roles are advertised through NHS Jobs, individual trust websites, and specialist nursing recruitment agencies. A number of agencies focus specifically on placing Australian and New Zealand nurses in NHS ICU roles, and while I would encourage you to do your due diligence on any agency you work with, they can be useful for navigating the initial application and relocation process.
If you are coming through a trust-sponsored visa pathway, your employer will guide the immigration process, but the NMC registration remains your responsibility and your timeline – do not allow anyone to suggest otherwise.
Coming In Without ICU Experience – Is It Possible?
This is the question I get most often from nurses who are interested in intensive care but have not worked in it yet. The answer is: yes, but with realistic expectations about the pathway. Transferring directly into an ICU Band 6 role without ICU experience is unlikely. What is possible is entering at Band 5 into a high-dependency unit or a step-down ICU environment, completing a post-graduate critical care programme – several London universities offer these part-time alongside NHS employment – and progressing from there.
Some trusts also run structured ICU transition programmes for experienced ward nurses, and it is worth asking about these during any recruitment conversation. Demonstrating prior experience in high-acuity environments – a busy surgical ward, an emergency department, a cardiac care unit – will strengthen your case considerably. The move is achievable; it just takes a deliberate approach and, usually, a year or two of groundwork.
The Honest Realities of Intensive Care Nursing
I want to be careful here not to romanticise this specialty, because ICU nursing is not for everyone and there is no shame in that. The sustained concentration it demands is unlike most other nursing environments. The pace is different – slower in some respects, but unrelentingly intense in others. You will form close, rapid bonds with patients and families during some of the most frightening periods of their lives, and you will not always be there for a positive outcome. Grief, in ICU nursing, is a recurring professional companion, and managing that reality in a way that is sustainable requires deliberate effort and good support structures around you.
When ICU Is Not the Right Fit – and How to Know
If you are drawn to ICU primarily because it sounds impressive, or because someone told you it was where the best nurses end up, I would gently push back on that framing. ICU nursing is one path within a profession that has many extraordinary specialisations. The nurses doing remarkable work in oncology, paediatrics, community health, theatre, and mental health are not on a lesser track – they are on a different one.
The indicators that ICU tends to suit, in my experience: you are energised rather than drained by high-acuity complexity; you are comfortable sitting with uncertainty and updating your clinical picture continuously; you find the technology and physiology of critical illness genuinely interesting rather than merely manageable; and you have the emotional resilience – or the commitment to building it – to work in an environment where outcomes are sometimes very hard. If that description feels like a reasonable portrait of you, intensive care is likely worth pursuing. If it creates more anxiety than recognition, that is useful information too.
Is ICU Right for You? A Framework for the Decision
Before you apply for a London ICU role, I would suggest asking yourself three questions. First: do you have the clinical foundation? An ICU is not the right place to consolidate basic nursing skills – it assumes competence and builds from there. Second: have you sought out honest feedback from ICU nurses about what the day-to-day experience is actually like? Not the version in the recruitment material, but the real one. And third: are you moving into intensive care because it aligns with who you are as a clinician, or because it seems like the obvious next step in a trajectory you have not fully examined?
London’s ICUs are extraordinary environments. The clinical learning curve is steep and genuinely thrilling if this is your direction. But the same city that has some of the world’s best intensive care units also has exceptional opportunities in almost every other nursing specialisation. Know why you are choosing this path before you commit to it – and if the answer is honest and considered, then get your NMC sorted and come and join us.