Originally published here.
Racial inequalities in career progression have been identified across organisational sectors inter-nationally. A US report found that Black and Hispanic workers earned 15–19% less than Whiteworkers in science, technology, engineering and math (STEM) careers and the gap was evenhigher (27–33%) in non-STEM jobs (PRC, 2018). In Europe, a report including multiplecountries found Black, Asian and Minority Ethnic workers have a broadly lower chance ofbeing recruited than White workers and tend to have jobs lower in workplace hierarchies withconcomitant lower wages (ENAR, 2017).
Similar to other sectors, racial inequalities in employment are present in healthcare systems(WRES, 2019a). Due to significant nurse and midwifery shortages and corresponding inter-national recruitment strategies (WHO, 2014), recent years have seen a growing interest regardingthese groups in particular (Phillips & Malone, 2014; West & Nayar, 2016). Empirical studieshave reported concerning findings, suggesting that Black, Asian, Minority Ethnic and migrantnurses perceive fewer career development opportunities in their work (Likupe et al., 2014)and receive lower pay (Pittman et al., 2014).
The reasons for these inequalities are unclear, indi-cating the presence of discrimination (Moore & Continelli, 2016). The need to address theseissues is imperative for two main reasons. First, workplace discrimination has been associatedwith a range of negative outcomes including poorer health, retention and performance inworkers (Jones et al., 2016) and lower patient satisfaction (West & Dawson, 2011). Second,due to global workforce shortages, the diversity of the healthcare workforce in developednations is increasing (Aluttis et al., 2014) and these increases are likely to continue (WHO,2014).
As such, these issues could become ever-more pertinent in coming years.To address inequalities in nursing and midwifery career progression, the mechanismswhich underly these need to be understood. As indicated above, discrimination is a likelycause, but only a limited number of studies have investigated the nature of career progressionbarriers in nursing and midwifery groups.
The majority of these have used a qualitativeapproach and have reported that Black, Asian and Minority Ethnic and migrant nurses perceivediscriminatory practices regarding their seniority within the nursing hierarchy, their pay andthe tasks they are assigned (Deegan & Simkin, 2010;Larsen,2007). As such, further quanti-tative research is needed to understand broader patterns in career progression-related experi-ences, behaviours and perceptions. First, there is a need to establish whether Black, Asianand Minority Ethnic nurses and midwives experience a career “delay”, spending more timein entry-level roles.
Second, there is a need to explore whether Black, Asian and MinorityEthnic nurses and midwives are more reluctant to apply for promotion than White nursesand midwives, and whether this could be compounding any discriminatory practices tofurther increase progression delays (Alexis et al., 2006;Larsen,2007).
Third, perceptionsthat Black, Asian and Minority Ethnic nurses are less motivated to progress persist (Deegan&Simkin,2010); understanding application submission patterns and levels of career aspirationcould help establish whether these account for progression gaps. Understanding these issuescould indicate whether interventions should aim to support Black, Asian and MinorityEthnic nurses and midwives with submitting applications for promotion.Another area where barriers may occur is in reduced access to training opportunities. A UKreport found that overall, White NHS employees were 15% more likely to access professionaldevelopment training than Black, Asian and Minority Ethnic staff (WRES, 2019a). The datafor this report was collected at the organisation level and the authors warn it should be interpretedcautiously due to likely recording inaccuracies. However, similar patterns have also been100 J. Johnson et al. identified in qualitative studies. For example, Alexis et al. (2006) reported that migrant nursesperceived discrimination by managers in allocating such opportunities between their staff, butfurther research is needed to confirm and explore this.
Our study identified two key areas for equality interventions to target, (1) parity of access toprofessional training and (2) fairness of recruitment procedures. One suggestion for tacklingdiscrimination has been “unconscious bias training”which aims to address underlying biaseswhich may lead to unintentional racism, subtle acts which those who perpetrate it are notaware of. However, the appropriateness of this has been disputed, with the implication thatif biases are “unconscious”, they are outside of individual’s control (Noon, 2018). Alternativesuggestions including making managers more accountable for their actions; monitoring theirdecisions and ensuring they are fair and free of discrimination (WRES, 2019b).
In the current context, this may be closer monitoring of the allocation of professional training opportunitiesand appointment procedures, with managers being called to account in the event of unequalbehaviour. It has also been suggested that opportunity for biases should be removed whereverpossible, for example by having applications anonymised and screened for stigmatising infor-mation before they are delivered to decision makers (Lindsey et al., 2013). Using highly struc-tured interviews with diverse panels may also be beneficial (Lindsey et al., 2013;WRES,2019b). Black, Asian and Minority Ethnic nurses and midwives are disadvantaged regarding careerdevelopment opportunities and the resulting career delay they experience is significant. Interven-tions to address this should focus on improving their access to professional training opportunitiesand reducing bias in recruitment procedures.
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