Examining the barriers and enablers for British South Asian men in NHS nursing careers in England

Abstract

Background Addressing the shortage and increasing the ‘home grown’ NHS workforce is a key aspect of the Government’s Widening Participation agenda British South Asians (BSA) and men are underrepresented within the nursing workforce. Existing evidence highlights some salient barriers (and enablers) for underrepresented groups entering and progressing in nursing careers. There is however little evidence exploring the experiences of ‘home grown’ BSA men. Therefore, this study aimed to take an intersectional approach to examining the barriers and enablers for BSA men entering and progressing in NHS nursing careers in England. Methods A convergent parallel mixed methods approach was adopted. A quantitative secondary descriptive analysis (using proportion ratios, for comparison between BSA and White men, using confidence intervals to test statistical significance) was conducted on national data on applications (n=150,445 applicants over 3 year period), acceptances and attrition rates (n=416,457 total enrolled students over 3 year period) in relation to nursing pre-registration courses in England and NHS nursing workforce (n=1,254,368 full time equivalent staff posts) from 2013-2016 inclusive. Qualitative focus groups were conducted in Luton, with BSA young men (n=22) and BSA parents (n=35). One to one interviews were conducted nationally with professionals and stakeholders (n=5 nurses, 5 other professionals) to ascertain their views. A Framework Approach was used for analysis purposes. Results and Findings The review of national data showed that BSA men are twice as likely to apply for nursing pre-registration courses than their British White male counterparts (PR=2.32: 95% CI: 2.22-2.42); half as likely to be accepted on nursing pre-registration courses (PR=0.54: 95% CI: 0.47-0.62); 18% more likely to leave their nursing course without achieving the intended award (PR=1.18: CI 95%: 1.15-1.21); and underrepresented in senior, management or specialist roles within the workforce (PR=0.35: CI 95%: 0.30- 0.40). The focus groups and interviews revealed a number of themes. Barriers included poor pay and conditions negative family views, negative media representations, ethnicity including culture; religion; masculinity and gender, a lack of knowledge and awareness of the nursing profession, and less favourable comparison of nursing with medical doctors as a profession. Enablers included personal circumstances, role models including friends and family, ethnicity including religion and masculinity and nursing as a noble profession. Conclusion and Recommendations Quantitative results suggest variation in nursing education outcomes based upon ethnicity which merit further enquiry via qualitative research to identify institutional barriers in selection practices. Difficulties in identifying ‘home grown’ BSA nurses (as opposed to internationally recruited nurses in the NHS workforce) highlight a significant challenge for benchmarking aspirations to develop a ‘home grown’ workforce. Data capture systems should be reviewed in the light of this finding. Qualitative findings suggest the need for culturally specific interventions to reduce the stigma associated with nursing in the BSA community to attract a more diverse nursing workforce, including an emphasis on the values common to BSA masculinities and aspects of the nursing profession. BSA male nurses experience institutional racism, which impedes their career progression, therefore NHS employer organisations should review relevant recruitment and retention policy and practice for this group.