CLINICAL WOMEN’S ISSUES
Minority ethnic women and nursing Sian Maslin-Prothero RGN, RM. Dip.N, Cert Ed, is Nurse Teacher, Avon and Gloucestershire College of Health.
This, tlx second ofthree articles, looks at why so many black and minority ethnic \women are to befound in tlx NHS, and offers possible explanations of w!yy they are to be found in the lower echelons of nursing and the less prestigious branches ofthe profession.
The black and minority ethnic groups in Britain have a played a major role in the development of the National Health Service (NHS) (1, 2, 3). Immigration of such groups into Britain began as a consequence of British trade expansion into Caribbean and Asian markets over a period of centuries (4). Immigration now occurs by other means and for a variety of reasons: social, political and economic. During the Fifties and Sixties, local selection committees were set up in Common wealth countries, to recruit actively minority ethnic workers to Britain’s health service, factories and transport services (5, 6). They were expect ed to do the jobs that the indigenous population were reluctant to undertake and were seen as a cheap form of labour, working long hours and for low pay. Although this included other workers in the NHS, such as cleaners and caterers, the emphasis in this article will be on nursing.
Lower echelons Black and minority ethnic people are well repre sented in nursing, and some have produced this as evidence to prove that black and minority eth nic staff are not discriminated against in the NHS (7). Nonetheless, black and ethnic minor ity workers are to be found in the lower echeloas of the organisation, undertaking work which is frequently underskilled and poorly paid. Many black and minority ethnic women were directed towards enrolled nurse training and the less prestigious specialties when they first entered the nursing profession (2). Many were not told about different levels of training and were given no choice about which course they undertook. Many minority ethnic staff work in what are percieved as the less prestigious areas of nursing, such as mental health, learning disabilities and care of the elderly. An explanation for this may be the stereotypes surrounding black and 28 Nursing Standard November 11 Volume 7^Number & 1992
minority ethnic nurses: they make good bedside nurses; they are strong and can control aggres sive patients; and they lack both spoken and written English skills (8). But stereotypes are attempts to generalise and are often based on prejudiced views. As individ uals, we do not wish to be put into ‘pigeon holes’ according to our colour, gender, ability or sexual orientation. There is often a failure in organisa tions to recognise the part racism plays in the position of black and minority ethnic staff. At present the NHS docs not publish statis tics on black and minority ethnic workers (8), and there is a need to identify where black and minority ethnic staff are to be found in the NHS. As Akinsanya (9) asserts, ‘if no counting is done, then no measurement is possible’. In the absence of accurate measurement, the management strategy for ensuring equal opportunities for all staff is likely to be ineffective. The method of measurement is by ethnic monitoring, which has been endorsed by numer ous individuals and organisations (9, 10, 11). These figures can then be used to develop and apply more appropriate equal opportunity poli cies, and create change. They can then also be compared through equality targets, positive action and demonstrable improvement within a certain time scale (10). There may be opposition to the introduction of ethnic monitoring for a number of reasons: An opposition to equal opportunities in general • Misunderstanding and suspicion about the collection of these data • Fear of how these statistics will be used, such as reverse discrimination. This can be reduced by information-giving ses sions, where discussions can take place about the introduction of ethnic monitoring, and explana tions of who will have access to this information. Black and minority ethnic nurses who have achieved positions in the higher echelons of nurs ing and occupy positions of status and power are not ‘tokens’; they have achieved their position through merit, and often in spite of racial dis crimination. The enhanced position of a few, however, does not deflect the impact of the racial discrimination that they and other black or
CLINICAL WOMEN’S ISSUES minority ethnic people experience daily. Torkington (12) comments on the overt and covert racism within the NHS: staff who are openly racist in the handling of patients or who are 'liberals’, enthusiastic about raising awareness regarding black issues but quick to find fault with black people when white people are accused of being racist. Helman (13) states there is a need to recognise how the culture of the health work er can affect his or her relationship with the patient, such as the misinterpretation of cultural or religious behaviours. Several studies have iden tified that black and minority ethnic people experience greater ill health in comparison with white people (12, 14, 15).
Proportional representation In areas where there are high numbers of black people, they should be proportionally represent ed by black and ethnic minority health workers. Individuals who already possess skills and know ledge appropriate to these communities can use them to the advantage of the community. This can reduce the likelihood of misdiagnosis and provide a more appropriate service for black and
Nursing is a multi-ethnic profession.
minority ethnic groups within Britain. One way of improving the experience of black and minority ethnic staff and patients is to chal lenge white people’s beliefs and misconceptions concerning black and minority ethnic people (16,17). This could be achieved through the education and awareness raising of all health workers, but this cannot be carried out in isola tion, and needs to be integrated into all courses including pre- and post-registration nursing and courses concerning reemitment and selection of staff and students. There is a need to recognise that black and minority ethnic women’s work experiences are not the same as those of white women. Black and minority ethnic women experience a ‘triple oppression’ - class, race and gender (18, 19, 20). There is a tendency to see culture as the problem, rather than recognising the part race and racism contribute to their access to jobs and where they are to be found in organisations. Black women are also less likely to take a career break when they have children than are white women. They can find themselves caught in a ‘Catch 22’ situation, where they need the work in order to support the family and yet are
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.
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N V
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November 11 /Volume 7/Number 8 1992 Nursing Standard 29
CLINICAL WOMEN’S ISSUES nic women from competing on ecjual terms with other employees (10, 21). Positive action is a means of enabling women, but not discriminating in their favour. There should be no fear of tokenism; they will have reached the employment positions that they occupy because of the qualities and skills they possess, qualities and skills which are appropriate for the job.
v
\
Positive action is required to help black and minority ethnic women compete on equal terms with other employees.
L
criticised for not staying at home with their chil dren. There is little support with child care or flexibility in shift patterns. Positive action Positive action is a means of redressing the barriers which arc encountered by black and minority ethnic women, but it has been seen as weak in comparison to posi tive discrimination, which has been practised in the United States. Consequently, positive action is only effective if it breaks down the obstacles that prevent black and minority eth References 1. Bryan B el al. The Heart of the Race: Black Women's Lives in Britain. Lon don, Virago Press. 1985. 2. Baxter C. The Black Nurse: An Endangered Species. A Case for Equal Opportunities in Nursing. Cambridge,
National Extension College. 1988. 3. King Edward’s Hospital Fund for London. Racial Equality: The Nursing Profession. London, Kings Fund. 1990. 4. Husband C (Ed). Britain: Continuity and Change. Second edition. London, Hutchinson. 1987. 5. Baxter C. Trainer’s handbook for Multiracial Health Care. Cambridge, National Extension College. 1985. 6. Doyal L et al. Your life in their hands: migrant workers in the NI IS. Critical Social Policy. 1981. 1,2,54 - 71. 7. Commission for Racial Equality. Ethnic Minority Hospital Staff. London, CRE. 1983-
8. Equal Opportunities Commission.
Asians. Oxford, Oxford University-
Equality Management: Women's
Press. 1990. 14. Townsend P, Davidson N. (Eds). Inequalities in Health. London, Penguin. 1988. 15. Whitehead M. The health divide. In Townsend P, Davidson N (Eds). Inequalities in Health. London, Pen guin. 1988. 16. Pearson M. The politics of ethnic minority health studies. In Rathwell T, Philips D (Eds). Health. Race and Ethnicity. London, Croom Helm. 1986. 17. Torkington P. The racist and sex ist delivery' of the NHS - the experience of black women. In O’Sul livan S (Ed). Women’s Health: A Spare Rib Reader. London, Pandora Press. 1987. 18. Abbott P, Wallace C. An Intro
Employment in the NHS. Manchester,
EOC. 1991. 9. Akinsanya J A. Ethnic minority nurses, midwives and health visitors: what role for them in the NI IS.-' New Community. 1988. 14, 5. 10. Cockburn C. In the Way of Women: Men’s Resistance to Sex Equality in Organisations. London, MacMillian.
1991. 11. King Edward’s Hospital Fund for London. Equal Opportunities Employ ment Policies in tlx: NHS: Ethnic Monitoring. London, King’s Fund.
198912. Torkington P. Black Health A Political Issue. Liverpool, Catholic Association for Racial Justice. 1992. 13- Helman C. Cultural factors in health and illness. In McAvoy B R, Donaldson L J (Eds). Health Care for
30 Nursing Standard November 11 Volume 7 Number 8.1992
19. Allen S. Gender, race and class in 1980s. In Ilusband C (Ed). Race in Britain: Continuity and Change. Second edition. London, Hutchinson. 1987. 20. Phizacklea A. Migrant women and waged labour: the case of West Indian women in Britain. In West J (Ed). Work: Women and the Labour Market. London, Routledge & Kegan Paul. 1982. 21. Gregory J. Sex. Race and the Law: legislating for Equality. London, Sage. 1988. 22. NHS Regional Manpower Plan ners Group. 2001 'The Black Hole: An Examination of Labour Market Trends in Relation to the NHS.London, HMSO. 1988. 23. Greater London Action for Racial Equality. No Alibi. No Excuse: Progress Towards Race Equality in Employment in
duction to Sociology: Feminist Perspectives.
London's Health Authorities. London,
London, Routledge. 1990-
GLARE. 1987.
JOHN HEHhTS
Falling numbers 'ITie number of black and minority ethnic groups applying for nurse training has been falling in recent years (22). There are a number of possible explanations for this, including changes in the Immigration Act and the withdrawal of work permits. Baxter (5) postulates that many poten tial recruits are being discouraged by family and friends who have experienced both personal and institutional racism in the NHS. If the NHS is to be an equal opportunities employer and provide relevant and appropriate care to its clients, there is a need to recruit and retain black and minority ethnic staff. To achieve this, recruitment officers should attend schools and clubs in black and minority ethnic areas to attract staff. In addition, access courses must become more widely available to help those who wish to enter nursing, but might not have the qualifications or confidence to do so through more traditional means (23). There is also a need for more conversion courses, particularly flexible courses for enrolled nurses who wish to register as first level nurses. The implications for nursing will be discussed in more detail in next week’s article •
Minority ethnic women and nursing Sian Maslin-Prothero RGN, RM. Dip.N, Cert Ed, is Nurse Teacher, Avon and Gloucestershire College of Health.
This, tlx second ofthree articles, looks at why so many black and minority ethnic \women are to befound in tlx NHS, and offers possible explanations of w!yy they are to be found in the lower echelons of nursing and the less prestigious branches ofthe profession.
The black and minority ethnic groups in Britain have a played a major role in the development of the National Health Service (NHS) (1, 2, 3). Immigration of such groups into Britain began as a consequence of British trade expansion into Caribbean and Asian markets over a period of centuries (4). Immigration now occurs by other means and for a variety of reasons: social, political and economic. During the Fifties and Sixties, local selection committees were set up in Common wealth countries, to recruit actively minority ethnic workers to Britain’s health service, factories and transport services (5, 6). They were expect ed to do the jobs that the indigenous population were reluctant to undertake and were seen as a cheap form of labour, working long hours and for low pay. Although this included other workers in the NHS, such as cleaners and caterers, the emphasis in this article will be on nursing.
Lower echelons Black and minority ethnic people are well repre sented in nursing, and some have produced this as evidence to prove that black and minority eth nic staff are not discriminated against in the NHS (7). Nonetheless, black and ethnic minor ity workers are to be found in the lower echeloas of the organisation, undertaking work which is frequently underskilled and poorly paid. Many black and minority ethnic women were directed towards enrolled nurse training and the less prestigious specialties when they first entered the nursing profession (2). Many were not told about different levels of training and were given no choice about which course they undertook. Many minority ethnic staff work in what are percieved as the less prestigious areas of nursing, such as mental health, learning disabilities and care of the elderly. An explanation for this may be the stereotypes surrounding black and 28 Nursing Standard November 11 Volume 7^Number & 1992
minority ethnic nurses: they make good bedside nurses; they are strong and can control aggres sive patients; and they lack both spoken and written English skills (8). But stereotypes are attempts to generalise and are often based on prejudiced views. As individ uals, we do not wish to be put into ‘pigeon holes’ according to our colour, gender, ability or sexual orientation. There is often a failure in organisa tions to recognise the part racism plays in the position of black and minority ethnic staff. At present the NHS docs not publish statis tics on black and minority ethnic workers (8), and there is a need to identify where black and minority ethnic staff are to be found in the NHS. As Akinsanya (9) asserts, ‘if no counting is done, then no measurement is possible’. In the absence of accurate measurement, the management strategy for ensuring equal opportunities for all staff is likely to be ineffective. The method of measurement is by ethnic monitoring, which has been endorsed by numer ous individuals and organisations (9, 10, 11). These figures can then be used to develop and apply more appropriate equal opportunity poli cies, and create change. They can then also be compared through equality targets, positive action and demonstrable improvement within a certain time scale (10). There may be opposition to the introduction of ethnic monitoring for a number of reasons: An opposition to equal opportunities in general • Misunderstanding and suspicion about the collection of these data • Fear of how these statistics will be used, such as reverse discrimination. This can be reduced by information-giving ses sions, where discussions can take place about the introduction of ethnic monitoring, and explana tions of who will have access to this information. Black and minority ethnic nurses who have achieved positions in the higher echelons of nurs ing and occupy positions of status and power are not ‘tokens’; they have achieved their position through merit, and often in spite of racial dis crimination. The enhanced position of a few, however, does not deflect the impact of the racial discrimination that they and other black or
CLINICAL WOMEN’S ISSUES minority ethnic people experience daily. Torkington (12) comments on the overt and covert racism within the NHS: staff who are openly racist in the handling of patients or who are 'liberals’, enthusiastic about raising awareness regarding black issues but quick to find fault with black people when white people are accused of being racist. Helman (13) states there is a need to recognise how the culture of the health work er can affect his or her relationship with the patient, such as the misinterpretation of cultural or religious behaviours. Several studies have iden tified that black and minority ethnic people experience greater ill health in comparison with white people (12, 14, 15).
Proportional representation In areas where there are high numbers of black people, they should be proportionally represent ed by black and ethnic minority health workers. Individuals who already possess skills and know ledge appropriate to these communities can use them to the advantage of the community. This can reduce the likelihood of misdiagnosis and provide a more appropriate service for black and
Nursing is a multi-ethnic profession.
minority ethnic groups within Britain. One way of improving the experience of black and minority ethnic staff and patients is to chal lenge white people’s beliefs and misconceptions concerning black and minority ethnic people (16,17). This could be achieved through the education and awareness raising of all health workers, but this cannot be carried out in isola tion, and needs to be integrated into all courses including pre- and post-registration nursing and courses concerning reemitment and selection of staff and students. There is a need to recognise that black and minority ethnic women’s work experiences are not the same as those of white women. Black and minority ethnic women experience a ‘triple oppression’ - class, race and gender (18, 19, 20). There is a tendency to see culture as the problem, rather than recognising the part race and racism contribute to their access to jobs and where they are to be found in organisations. Black women are also less likely to take a career break when they have children than are white women. They can find themselves caught in a ‘Catch 22’ situation, where they need the work in order to support the family and yet are
Flfl.
r
£
£
.m
7
w
.
^
N V
ivn
4
I
-1
November 11 /Volume 7/Number 8 1992 Nursing Standard 29
CLINICAL WOMEN’S ISSUES nic women from competing on ecjual terms with other employees (10, 21). Positive action is a means of enabling women, but not discriminating in their favour. There should be no fear of tokenism; they will have reached the employment positions that they occupy because of the qualities and skills they possess, qualities and skills which are appropriate for the job.
v
\
Positive action is required to help black and minority ethnic women compete on equal terms with other employees.
L
criticised for not staying at home with their chil dren. There is little support with child care or flexibility in shift patterns. Positive action Positive action is a means of redressing the barriers which arc encountered by black and minority ethnic women, but it has been seen as weak in comparison to posi tive discrimination, which has been practised in the United States. Consequently, positive action is only effective if it breaks down the obstacles that prevent black and minority eth References 1. Bryan B el al. The Heart of the Race: Black Women's Lives in Britain. Lon don, Virago Press. 1985. 2. Baxter C. The Black Nurse: An Endangered Species. A Case for Equal Opportunities in Nursing. Cambridge,
National Extension College. 1988. 3. King Edward’s Hospital Fund for London. Racial Equality: The Nursing Profession. London, Kings Fund. 1990. 4. Husband C (Ed). Britain: Continuity and Change. Second edition. London, Hutchinson. 1987. 5. Baxter C. Trainer’s handbook for Multiracial Health Care. Cambridge, National Extension College. 1985. 6. Doyal L et al. Your life in their hands: migrant workers in the NI IS. Critical Social Policy. 1981. 1,2,54 - 71. 7. Commission for Racial Equality. Ethnic Minority Hospital Staff. London, CRE. 1983-
8. Equal Opportunities Commission.
Asians. Oxford, Oxford University-
Equality Management: Women's
Press. 1990. 14. Townsend P, Davidson N. (Eds). Inequalities in Health. London, Penguin. 1988. 15. Whitehead M. The health divide. In Townsend P, Davidson N (Eds). Inequalities in Health. London, Pen guin. 1988. 16. Pearson M. The politics of ethnic minority health studies. In Rathwell T, Philips D (Eds). Health. Race and Ethnicity. London, Croom Helm. 1986. 17. Torkington P. The racist and sex ist delivery' of the NHS - the experience of black women. In O’Sul livan S (Ed). Women’s Health: A Spare Rib Reader. London, Pandora Press. 1987. 18. Abbott P, Wallace C. An Intro
Employment in the NHS. Manchester,
EOC. 1991. 9. Akinsanya J A. Ethnic minority nurses, midwives and health visitors: what role for them in the NI IS.-' New Community. 1988. 14, 5. 10. Cockburn C. In the Way of Women: Men’s Resistance to Sex Equality in Organisations. London, MacMillian.
1991. 11. King Edward’s Hospital Fund for London. Equal Opportunities Employ ment Policies in tlx: NHS: Ethnic Monitoring. London, King’s Fund.
198912. Torkington P. Black Health A Political Issue. Liverpool, Catholic Association for Racial Justice. 1992. 13- Helman C. Cultural factors in health and illness. In McAvoy B R, Donaldson L J (Eds). Health Care for
30 Nursing Standard November 11 Volume 7 Number 8.1992
19. Allen S. Gender, race and class in 1980s. In Ilusband C (Ed). Race in Britain: Continuity and Change. Second edition. London, Hutchinson. 1987. 20. Phizacklea A. Migrant women and waged labour: the case of West Indian women in Britain. In West J (Ed). Work: Women and the Labour Market. London, Routledge & Kegan Paul. 1982. 21. Gregory J. Sex. Race and the Law: legislating for Equality. London, Sage. 1988. 22. NHS Regional Manpower Plan ners Group. 2001 'The Black Hole: An Examination of Labour Market Trends in Relation to the NHS.London, HMSO. 1988. 23. Greater London Action for Racial Equality. No Alibi. No Excuse: Progress Towards Race Equality in Employment in
duction to Sociology: Feminist Perspectives.
London's Health Authorities. London,
London, Routledge. 1990-
GLARE. 1987.
JOHN HEHhTS
Falling numbers 'ITie number of black and minority ethnic groups applying for nurse training has been falling in recent years (22). There are a number of possible explanations for this, including changes in the Immigration Act and the withdrawal of work permits. Baxter (5) postulates that many poten tial recruits are being discouraged by family and friends who have experienced both personal and institutional racism in the NHS. If the NHS is to be an equal opportunities employer and provide relevant and appropriate care to its clients, there is a need to recruit and retain black and minority ethnic staff. To achieve this, recruitment officers should attend schools and clubs in black and minority ethnic areas to attract staff. In addition, access courses must become more widely available to help those who wish to enter nursing, but might not have the qualifications or confidence to do so through more traditional means (23). There is also a need for more conversion courses, particularly flexible courses for enrolled nurses who wish to register as first level nurses. The implications for nursing will be discussed in more detail in next week’s article •
![Intimate Partner Violence and its Health Impact on Ethnic Minority Women [corrected].](/assets/img/hold.png)
