Forms of racism and discrimination in career progression in the NHS: Evidence from Ghanaian nurses and midwives

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Forms of racism and discrimination in career
progression in the NHSEvidence from Ghanaian
nurses and midwives

• Leroi Henry
• Department of Economics
• The Open University
• l.w.henry_at_open.ac.uk

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Aims

• Explore and conceptualise discriminatory
  practices in career progression in the NHS
• Examine and contextualise how some responses to
  perceived racism entrench rather than resist
  marginalisation

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The REOH ProjectBackground

• Researching Equal Opportunities for
  Overseas-trained Healthcare professionals
• Open University and University of Surrey
• Sponsored by European Social Fund
• Interviews with over 100 overseas-trained
  healthcare professionals
• Case study of Ghanaian trained healthcare
  professionals.
• Interviews with NHS Trust and clinical managers
• Interviews with local and national stakeholders
• http//portal.surrey.ac.uk/reoh

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The REOH ProjectResearch Team

• Dr Helen Allan, EIHMS, University of Surrey
• Dr Leroi Henry, Economics, Open University
• Dr John Larsen, EIHMS, University of Surrey
• Professor Maureen Mackintosh, Economics, Open
  University
• Professor Pam Smith, EIHMS, University of Surrey

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The REOH Project Key areas of interest

• Accreditation and use of overseas skills and
  experiences
• The factors affecting career progression
• Relationships with colleagues and patients
• Adaptations to UK work environment
• Systems of social, economic and professional
  support
• Influence of relationships with countries of
  origin on careers

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Methods

• Case study of Ghanaian trained healthcare
  professionals
• Conducted in London and South-east England
• Individual semi structured interviews and
  ethnographic research with the Ghanaian Diaspora.
  
• Informant led interviews focusing on their stated
  concerns

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Selection of informants

• Participation in previous studies
• Contacts with Ghanaian community groups
• Activists in Ghanaian and other minority ethnic
  community and professional associations
• Case study visits to workplaces
• Snowballing through the above routes
• Interviewing thirty healthcare professionals at
  the two largest hospitals in Ghana.
• Observation at Diaspora meetings

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Characteristics of informants

• Thirty nurses and midwives
• Mostly F and G grade
• Most resident in the UK for over 15 years
• Mostly joint nationality
• Supplemented by more recent migrants and lower
  grades.
• Not representative of Ghanaian nurses in the UK

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Background Lack of transparency in promotion in
the NHS

• Henry, L. (2006 forthcoming) Institutionalised
  disadvantage Older Ghanaian nurses and midwives
  reflections on career progression and stagnation
  in the NHS, Journal of Clinical Nursing Special
  Issue

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Background Lack of transparency in promotion in
the NHS

• Difficulties adapting to career progression
  initially attributed to socio-cultural
  differences
• Disadvantage entrenched and institutionalised by
  a lack of support
• In promotion into senior roles informants
  experienced differential access to training and
  opportunities to gain experience
• Discrimination in the quality of support given to
  candidates particularly interview preparation and
  feedback.
• Systems of patronage based on meeting subjective
  criteria rather than meritocratic.

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Forms of discrimination in career progression
within the NHS

• Discriminatory acts
• Discriminatory omissions
• Cultures of discrimination
• Marginalising oneself
• Narratives of discrimination

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Marginalising oneself becoming an agent in
discrimination

• Response to racism and a form of discrimination
• In context of racism nurses balance careers with
  other commitments and interests
• Instrumental attitude towards professional life
• Withdraw from career development

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Alienation leading to withdrawal from career
progression

• Demoralisation after long periods of career
  stagnation
• Caused by endemic racial or ethnic discrimination
  
• Reinforced by a perception of a lack of support
  or interest from managers
• Avoiding humiliating processes ending in failure

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Redefining success

• Withdrawal accompanied by a redefinition being a
  successful migrant
• Immediate family in the UK
• Dual identities Living here and there
• Extended family
• Property and investments in Ghana
• Retirement and or returning to Ghana
• Return to migrants original aims

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Being an agent in ones own marginalisation

• Trauma and frustration engendered by
  discrimination are internalised
• Victims seek to avoid exposing themselves to
  further humiliation
• Response to racism that reproduces the effects of
  discrimination through inhibiting career
  progression

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Political implications of this analysis

• Not blaming these black professionals for their
  predicament
• Understandable response based on their original
  aims as migrants and current obligations
• Does not let the NHS off the hook for the
  discriminatory practices which provoked these
  responses
• Explains why withdrawal from career progression
  is common in some overseas trained staff

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Narratives of discrimination

• Perception that ethnicism and racism are endemic
  not the substance of claims of discrimination
• Power lies in the ways that this perception
  affects responses to situations and relationships
  in the workplace

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Narratives of discrimination

• Discriminatory practises conceptualised through a
  collective narrative of discrimination and
  exclusion
• Context
• lack of transparency in career progression
• Few black and African nurses in senior positions
• Informants understand their relative lack of
  career success as a result of being Africans
• Africans at the bottom of a racial and ethnic
  hierarchy which largely determines ones status
  within the NHS

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Narratives of discrimination as a lens

• Narrative can become a lens through which
  experiences in the workplace are interpreted
• Form of racism existing within the mind of the
  victim which affects responses in the workplace
• Most negative experiences are regarded as racism
  irrespective of alternative explanations
• In an environment lacking transparency, racism is
  easiest explanation for negative experiences

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Narratives of discrimination

• Not questioning the validity of nurses claims of
  discrimination
• Not claiming that racism only exists in the mind

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Collective narratives of discrimination and
marginalisation

• Interpretations of shared experiences as
  discrimination become self sustaining
• Little evidence supporting alternative
  explanations
• Expectation of racism due to history of perceived
  racism
• Demoralised staff become marginalised
• Not adopted by all

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Resisting racism through avoiding racialisation

• Discourses of successful black nurses and
  midwives
• Progression built upon not labelling every
  negative experience and incident as racist
• Various interpretations of this discourse

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Limitations

• Current analysis only relates to Ghanaian nurses
  and midwives attempting promotion above grade F
• Some nurses have resisted these processes
• Demoralised nurses careers can be resurrected

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Conclusions

• Overseas trained nurses experience a range of
  discriminatory practices that take three guises
• Discriminatory acts
• Discriminatory omissions
• Cultures of discrimination
• Responses to perceived racist or ethnic
  discrimination can intensify its effects through
  encouraging individual and possibly collective
  withdrawal from career progression