Examining the Barriers and Enablers for British South Asian Men in NHS Nursing Careers in England

Examining the barriers and enablers for British South Asian men in NHS nursing careers in England Dr. Irtiza Qureshi This is a digitised version of a dissertation submitted to the University of Bedfordshire. It is available to view only. This item is subject to copyright. Examining the barriers and enablers for British South Asian men in NHS nursing careers in England By Irtiza Qureshi A thesis submitted to the University of Bedfordshire, in fulfilment of the requirements for the degree of Doctor of Philosophy February 2021 i Author’s declaration I, Irtiza Qureshi, declare that this thesis and the work presented in it are my own and has been generated by me as the result of my own original research. Examining the barriers and enablers for British South Asian men in NHS nursing careers in England I confirm that: 1. This work was done wholly or mainly while in candidature for a research degree at this University; 2. Where any part of this thesis has previously been submitted for a degree or any other qualification at this University or any other institution, this has been clearly stated; 3. Where I have cited the published work of others, this is always clearly attributed; 4. Where I have quoted from the work of others, the source is always given. With the exception of such quotations, this thesis is entirely my own work; 5. I have acknowledged all main sources of help; 6. Where the thesis is based on work done by myself jointly with others, I have made clear exactly what was done by others and what I have contributed myself; 7. Either none of this work has been published before submission, or parts of this work have been published as indicated on page vi. ii 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 iii 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. iv Acknowledgements I am grateful to a number of people who were critical in supporting me academically, professionally and personally on this journey. Firstly, I must thank my supervisory team, Dr Nasreen Ali and Professor Gurch Randhawa for their academic guidance, challenge and support. I thank my fellow students and staff at the Institute of Health Research, especially Professor David Hewson, for their input to this study. I thank all the research participants in Luton and across England, without whom this study would not have been possible. Secondly, I would like to thank Mr Jan Hardy, Mr Justin Donovan and Mrs Deborah Sheppard for the key roles they have played in supporting my professional development to a point where I was willing and able to take up this PhD study opportunity. You have each helped me develop my skills, experience and knowledge to a point where I had the confidence to achieve this career aspiration. Thirdly, I would like to thank my parents for teaching me what the important things are in life and showing me how to work hard to achieve them. I am deeply grateful to my family who have nurtured me through this journey with their love. I thank my wife Parv, who has stood shoulder to shoulder throughout, always gifting me her love, patience and unfaltering belief. I dedicate this study to my parents Professor G.D. Qureshi and Mrs. Naseem Qureshi. v Publications to date Qureshi, I., Ali, N., Hewson, D. and Randhawa, G. (2018) What the Numbers Tell Us: A Review of Nursing Course Applications, Acceptances and Attrition Rates for British South Asian Men. Diversity and Equality in Health and Care, (15) 6: 247-253 Qureshi, I. et al. (2020) ‘Interventions to Widen Participation for Black, Asian and Minority Ethnic Men into the Nursing Profession: A Scoping Review’, Review Article Diversity and Equality in Health and Care, 17(2), pp. 107–114. doi: 10.36648/2049- 5471.17.2.200. Qureshi, I., Ali, N. and Randhawa, G. (2020) ‘British South Asian male nurses’ views on the barriers and enablers to entering and progressing in nursing careers’, Journal of Nursing Management, 28(4), pp. 892–902. doi: 10.1111/jonm.13017. vi Table of Contents Chapter 1: Introduction 1.1 Introduction……………………………………………………………………...1 1.2 Rationale………………………………………………………………………..6 1.3 Research question, aim and objectives……………………………..………14 1.3.1 Research question……. .…………………………………………..14 1.3.2 Aim……………………………......................................................14 1.3.3 Objectives……………………………............................................14 1.3.4 Outline of thesis…………………………………………………..…15 1.4 Chapter summary…………………………………………………………...…16 Chapter 2: Contextualising men in nursing and the nursing discourse 2.1 Introduction……………………………………………………………….…….17 2.2 The history of nursing and workforce policy in the NHS……………….….20 2.2.1 Race and international recruitment in the NHS………………….23 2.2.2 Institutional racism and unconscious bias…………………….….24 2.2.3 Moving from international recruitment to a ‘home grown’ workforce……………………………………………………………………31 2.3 Gender and the nursing discourse……………..........................................35 2.3.1 The history of men in nursing………………………………………36 2.3.2 Florence Nightingale’s influence on nursing……………………...39 2.3.3 Representing men in nursing………………………………………42 2.3.4 Representing Black and Asian minority ethnic men in nursing……………………………………………………………………....49 2.4 The problem of ethnicity and ethnic categorisation…………………………52 2.4.1 Ethnicity and ethnic categorisation as contested concepts……..52 2.5 Chapter summary……………………………………………………………...57 vii Chapter 3: Conceptual framework 3.1 Introduction…………………………………………………………………….58 3.2 Decisions about application of theory: choosing intersectionalism………58 3.2.1 The evidence base leading to intersectionalism…………………59 3.2.2 Quantitative studies on nursing student and workforce numbers……………………………………………………………………..60 3.2.3 Qualitative and mixed methods studies focussing on barriers and enablers...............................................................................................61 3.3 Intersectionalism as the appropriate conceptual framework ……………..65 3.3.1 Acknowledging the limitations of intersectionalism………...……72 3.4 Chapter summary……………………………………………………………...74 Chapter 4: Methodology 4.1 Introduction

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