Worked one day in a nursing home. Care assistants pleaded with me to take action regarding the condition of a resident’s legs. They had been like it for 6 weeks and no doctor had been rung by the nurses, who happened to be from overseas. I rang the doctor who came and also expresed alarm that she had not been contacted, Of course I made full records.This tale tells us a few facts. Care assistants do report to nurses (not always we know) . When no action is taken, the care assistants are at a loss regarding what to do. I knew nothing about the manager in this case. If they too were registered, it may well place on them additional responsibility and awareness- hopefully by standardised education .Overseas nurses are inadequately trained when they arrive in the UK (Dimon 2013). Regulations, procedures and culture differ. In some countries pain patches do not exist for example, nor do specilaised nurses such as tissue viability nurses. Pressure care equipment and procedures will differ in many countries. Indeed in some, doctors are not involved at all in nursing homes (have references). Apart from that, attitudes differ to eg pain . This all warrants further research but nobody will do it. Far easier to ignore the situation and blame overseas staff by requiring their attendance at NMC hearings.