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The Nursing and Midwifery Council has pledged to take action to help drive out discrimination and enforce “positive, long-lasting change” across the nursing profession, in the wake of new research.
The nursing regulator has today published a new report exploring the impact of its processes on different groups of nurses, midwives and nursing associates.
“Today’s research has shown that people are still treated differently throughout our processes, depending on who they are – and that’s got to change”
It forms part of a wider programme of work which strives to identify and change the way an individual’s protected characteristics such as gender, ethnicity or age, affect their experience.
Findings showed that nurses and midwives are “still treated differently…depending on who they are”, said NMC chief executive and registrar Andrea Sutcliffe.
The report, titled: Ambitious for change: research into NMC processes and people’s protected characteristics, identified several disparities in people’s experiences and outcomes throughout education, overseas registration, revalidation and fitness to practise (FtP) processes, by using analysis of NMC data and wider evidence.
The experience of nurses recruited from overseas was highlighted as a cause for concern as research showed these individuals faced challenges around “cultural differences, communication issues and unequal opportunities”.
International nurses working in the UK also experienced “racism, denial of training and career development opportunities, and overrepresentation in disciplinary proceedings”, noted the report.
The NMC pointed to findings from the 2019 NHS staff survey which flagged almost a third of ethnic minority NHS staff in England had experienced bullying, harassment or abuse from colleagues in the 12 months previous, compared with 24.2% of White staff.
It also highlighted that disabled staff were 8.7% more likely to experience harassment, bullying and abuse from colleagues compared with non-disabled staff.
Other findings from the report showed Black applicants were less likely to complete the NMC’s overseas registration process compared to those of other ethnicities.
The NMC’s independent evaluation of revalidation “suggests that men, those aged over 65 years, Black and minority groups and disabled nurses and midwives may find it more difficult to complete the requirements”.
Revalidation may also be “a particular issue” for older nurses, noted the NMC, which cited a separate research study that warned out of a survey of 506 primary care nurses, a fifth had considered retirement over revalidation.
The report pointed to previous research commissioned in 2017 which showed the NMC received “higher proportions of referrals” to FtP for nurses and midwives who were aged 40-60, male, Black or whose ethnicity was unknown to the regulator, or who trained in Africa, compared with the numbers on the register as a whole.
In addition, Black and Asian nurses and midwives were “referred in higher proportions by their employers” to the FtP process, whilst White staff were more likely to be referred by the public, the report added.
The NMC went on to explore “the factors that influence the likelihood” of a professional’s case being closed across the different stages of the FtP process including: screening, investigation and adjudication finding which allows practise to continue or adjudication finding which prevents continued practise.
Between April 2016 to March 2019, the regulator said Black professionals were more likely to see their case go to an adjudication stage and White staff had the “highest proportion” of cases closed at the screening stage.
Meanwhile, disabled and male nurses and midwives were more likely to end up at the adjudication stage of FtP and be struck off from the register compared with non-disabled and female professionals.
In terms of education, the regulator identified that Black and Asian students made up a “lower proportion of acceptances onto NMC-approved courses compared to the proportion that apply” in the UK.
This was “largely driven” by the fact that universities made “less offers” to Black applicants in comparison to those from other ethnicities, according to the report.
In 2019/20 around one in 11 students enrolled onto an NMC-approved nursing or midwifery course were male, just over a third were from a Black, Asian and minority ethnic background and one in nine were disabled, it said.
Commenting on the findings, Ms Sutcliffe said: “We all deserve to be treated with respect and kindness and to live without fear of discrimination, no matter our race, religion, gender or any other aspect of our identity.
“Today’s research has shown that people are still treated differently throughout our processes, depending on who they are – and that’s got to change.”
She recognised that whilst the NMC did not yet “fully understand all the reasons why” this was the case, it was “committed to being a driving force for positive change”.
“It is vitally important that where there are concerns about performance those involved are properly supported through a just process”
The regulator will now carry out further research to “understand the reasons behind the disparities we’ve identified so far so we can take appropriate action”, said Ms Sutcliffe.
However, said said the NMC “won’t be able to solve everything on our own”.
Commenting on the report, Jude Diggins, deputy director of nursing at the Royal College of Nursing, said: “Being referred to the NMC is hugely distressing for registrants.
“We welcome that the NMC has acknowledged more must be done to prevent BAME nursing staff being disproportionately referred to FtP.
“Similarly, we must seek to understand why male nurses and midwives as well as disabled nurses and midwives are more likely to be removed from the register.
“It is vitally important that where there are concerns about performance those involved are properly supported through a just process that is applied fairly, whatever their background.”
The report findings come as calls are being made for a new strategy to tackle racism and discrimination across the health and care system in response to inequalities exposed and exacerbated by the coronavirus pandemic.