Gaining new knowledge, understanding a new research tool, observable evidence and the opportunity to investigate the position of ethnic minorities into nursing and midwifery National Health Services (NHS) workforce were the drivers for this dissertation topic.
The focus of this dissertation topic is of a high priority to the NHS. The NHS is struggling to attract and retain staff in nursing and midwifery profession. There is evidence of low representation of ethnic minorities into this profession and a high disparity exists between the subgroups. There are particular low visibilities of all South Asian communities in this workforce.
This dissertation uses the approaches of systematic review as a research tool to investigate the profile of ethnic minorities in particular South Asian groups into nursing and midwifery NHS workforce. Evidence of research and policy based work programmes are used to explore the barriers associated that would signify the low numbers together with the testing and impact of any interventions.
Evidence of information gathered suggest the NHS workforce does not reflect the profile of the community it serves and that position of ethnic minority staff has made little progress since 1960s in spite of race equality legislation. A few numbers of initiatives have been introduced by the government; this dissertation describes these as schemes that can work effectively at an operational level but lack of monitoring and a short time frame of their existence inhibit true measurement of their success. This review maps out the past and the current areas of work on this topic and provides implications for future work.
The Position of Ethnic Minorities into Nursing and Midwifery NHS Workforce
CHAPTER I: INTRODUCTION
1. Executive Summary
Personal curiosity of observed evidence together with national priority to improve the recruitment of ethnic minorities into nursing and midwifery NHS workforce and the opportunity to learn new research tool were the key forces for selecting this dissertation topic.
Exploring the position of ethnic minorities, in particular the South Asian groups, within the NHS nursing and midwifery workforce was the overall aim of this dissertation. I was interested in investigating the trends and characteristics of this group in the past few decades and to explore any possible barriers for this group in accessing the profession. As the topic was of a national policy priority I was also interested in examining interventions that may have been introduced to tackle this issue and whether these had made any differences to the ethnic minority workforce within the nursing and midwifery profession.
Systematic review as the research methodology was used as the dissertation topic required a comprehensive collection of research evidence. The NHS Centre for Reviews and Dissemination for conducting systematic review formed the main source of guideline for conducting this dissertation. The inclusion criteria for the systematic review included published and non-published articles based on United Kingdom (UK) population using either quantitative or qualitative research designs within the time frame from 1966 to 2008.
Of the sixty five studies originally identified as potential relevant citations to include in the systematic review, only seventeen articles were included after screening for their relevance to study inclusion criteria. Of these only six were published articles that used evidence based research work programmes to attract and gain the prospective of South Asian populations into nursing and midwifery profession.
This review provides a clear evidence of under-representation of all South Asian communities into nursing and midwifery profession. Representation is particularly low among Pakistani and Bangladeshi groups. The NHS workforce does not reflect the profile of the community it serves and evidence suggests the position of ethnic minorities in the NHS has made little progress since 1960s in spite of race equality legislation.
Some of the barriers for ethnic minorities accessing this profession lie with the inequalities imposed during recruitment and selection stage of a pre-registration nursing and midwifery course, promotion and continued learning development process, the existence of negative image of the profession by the ethnic minority communities themselves which is stimulated with the existence of discrimination and racism within the NHS itself. Cultural and religious myths deter Asian girls and boys from entering and their parents from encouraging them to choosing nursing and midwifery as a career profession.
It is encouraging to see that the NHS has introduced initiatives and schemes to attract ethnic minority communities in particular South Asian communities into nursing and midwifery workforce. However it is the outcome, rather the results that they achieve that determine their success. With no or little follow up of their progress it is difficult to evaluate the impact these have had to recruitment and on the change management of the perception of the profession by the communities themselves.
There is inadequate data on ethnic minorities into nursing and midwifery workforce. Some NHS trusts are failing to carry out even the basic ethnic monitoring functions required by the NHS Executives. Steps need to be taken to ensure that the recording of ethnic origin data of registered nurses and midwives are adequate, accurate and used in the planning and reflection of trust priorities at local and national level.
This review revealed that the studies conducted on the dissertation topic area used very small sample size and the reason for low recruitment of South Asian groups was not fully discussed. The results from these studies cannot be used as a representation of the views and experiences of the South Asian population in general. There was no detail around how ethical standards were maintained in any of the research based articles. Local action research programmes were encouraging but no details of how these programmes actually work and the success of these from the providers or the receivers prospective.
A combination of factors influenced my decision on the dissertation subject. Firstly, to explore the lack of presence of certain minority groups registering for nursing and midwifery courses within the NHS, as observed while working in a teaching university for nursing and midwifery students for seven years. This was particularly surprising given that the NHS nursing and midwifery workforce were serving in an area with a large population of ethnic minority community. Secondly, this was an opportunity to plan and develop ideas for future projects that was directly relevant to my occupational field of midwifery research at the time. Thirdly, a personal interest to use the allocated dissertation times to broaden my experiences and knowledge of a research methodology previously unknown to me and finally a topic that is of high priority to the National Health Services (Royal College of Nursing, 2005).
Evidence from literature on this topic suggests that the NHS has been experiencing difficulties in recruiting and retaining nursing and midwifery staff for a while (Finlayson et al, 2002). This has received attention at ethnicity level. As recruiting, attracting and retaining nursing and midwifery staff have been particularly low from ethnic minority groups as described by Parish (2003) and Beishon et al (1995). “About 8% of all nursing and midwifery staff is from minority ethnic groups in the NHS workforce (Beishon, 1995). Culley (2001) in her work reported “There are large differences between the representations of different minority ethnic groups. Black groups (primarily Caribbean and African) are numerically over represented in nursing, while all the South Asian groups (Indian, Pakistani, Bangladeshi and African Asian) are under-represented. Representations are particularly low amongst Pakistani and Bangladeshi group”(Culley, 2001, pp.132). A review of the UK nursing labour market in 2004 to 2005 reported that a “key policy priority for the NHS was to improve the recruitment of minority ethnic groups into nursing and midwifery workforce. However, comparatively little information is available on the ethnic composition of this workforce” (Buchan & Seccombe, 2005, pp. 39).
A diverse nursing and midwifery workforce is essential for the delivery of ethnically, culturally, and linguistically appropriate and sensitive health care. Research on the issues around nursing and midwifery profession for ethnic minority groups exists as independent research work in the UK. However, a more collective approach of all research conducted on the nursing & midwifery ethnic minority NHS workforce will help to show a clearer picture of areas studied and those still remain to be explored in order to assist with the planning and process of recruiting minority groups into this workforce.
The dissertation starts by highlighting and discussing the particular issues surrounding ethnic minorities into nursing and midwifery NHS workforce as reported by other studies . This has assisted me to clarify my dissertation aims, objectives and methods further. In the methods section I have provided details of a robust strategy I have deployed in collecting, organising and analysing secondary qualitative data. This has been followed by the results section where I have presented the collection of data and discuss the results in the light of my review objectives. Finally in the conclusion section, I have summarised the overall findings of my review and provide implications for NHS policy and future research.