Blog: Working together for change

One in five of the 700,000 nurses and midwives registered with the Nursing and Midwifery Council (NMC) are of Black and Minority Ethnic (BME) heritage.

We know from the NHS Workforce Race Equality Standard data that BME staff are more likely to enter the disciplinary process than are White staff. We also know that BME staff are more likely to be referred to professional regulators.

The latest report from the NMC  is a treasure trove of useful information, enabling us to better scrutinise and change how these registrants are treated.

Building on previous research by Elizabeth West and colleagues the latest NMC report highlights several concerns for BME registrants.

Firstly, the report finds Black and Asian students make up a lower proportion of acceptances onto NMC approved courses compared to the proportion that apply. It states “This is largely driven by universities making less offers to Black applicants compared to applicants of other ethnicities.” The report helpfully cross references other research highlighting the lack of diversity in nursing and midwifery education including, the absence of nurses or midwives from different races in the curriculum and teaching resources, with the likelihood that 94 percent of body parts used in simulation exercises are White, and fewer numbers of ethnic minority professors in nursing, midwifery and higher education compared to White professors.

Secondly the report finds that Black or Muslim applicants have lower chances of registering through NMC overseas processes though it is not clear why – something that needs further scrutiny.

Thirdly it confirms (again) that BME registrants are more likely to be referred to the NMC by employers but are less likely to be referred to the NMC by members of the public, surely something employers should reflect on?

Fourthly, it found that once referred by employers, BME registrants’ cases are more likely to progress to the adjudication stage compared to White staff whose cases are more likely to be closed at the initial screening stage. But while nurses and midwives who are Black are more likely to have their case progress to adjudication stage, they are not any more likely to have a decision that prevents them from continuing to practice compared to nurses and midwives who are White, something surely for the NMC to reflect upon?

We know that referrals are immensely stressful for registrants, that inappropriate referrals can contribute to a climate of blame not learning, and may indeed embed racism within referring employers. The 6,027 employer referrals between April 2016 and March 2019 will be the tip of a larger number of disciplinary cases within those employers.

In response to the West Report, the NMC launched a new Fitness to Practice strategy in 2017 which I described at the time as a considerable improvement over previous practice which effectively colluded with employers who disproportionately referred BME registrants.

The finding of this report will need to lead to similar scrutiny of root causes and processes for the NMC. It should also lead to serious scrutiny of nursing course recruitment and support processes which universities should have addressed years ago.

The experience of BME registrants in other professions (doctors, dentists, pharmacists and social workers) is that they are also more likely than White colleagues to be referred by their employers. It therefore seems time for much closer co-operation between those regulators who are trying to tackle such problems (NMC, GMC, and GPhC) not least to ensure that some other regulators, who are way behind the curve, are obliged to follow suit. This report is a good step in that direction.

Roger Kline is Research Fellow at Middlesex University Business School, a member of the NMC’s External Advisory Group on the research.

Ambitious for change webinar

On Monday 30 November, we're hosting a webinar which will be a chance to find out more about the research and ask us any questions. 

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