Ethnic inequalities during clinical placement: a qualitative study of student nurses’ experiences within the London National Health Service

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Abstract Aim To understand how student nurse experiences on clinical placement, within NHS hospitals, differ for ethnic minority and White British groups. Design A qualitative thematic analysis with an inductive approach. Methods Data from semi-structured interviews with 21 London (United Kingdom) hospital-based student nurses were examined using thematic analysis. Participants were interviewed as part of the Tackling Inequalities and Discrimination Experiences in health Services (TIDES) study and asked about their experiences during clinical placement. Results Five main themes were identified: 1) Role of mentors, 2) Discrimination and unfair treatment, 3) Speaking up/out, 4) Career progression, and 5) Consequences of adverse experiences. All themes were linked, with the social dynamics and workplace environment (referred to as ‘ward culture’) providing a context that normalises mistreatment experienced by nursing students. Students from ethnic minority backgrounds reported racism as well as cultural and/or religious microaggressions. While being valued for their race and ethnicity, White British students also experienced discrimination and inequity due to their age, sex, gender, and sexual orientation. Students from both White British and ethnic minority groups acknowledged that being treated badly was a barrier to career progression. Ethnic minority students also noted that the lack of diverse representation within senior nursing positions discouraged career progression within the UK National Health Service (NHS). Conclusion These initial experiences of inequality and discrimination are liable to shape a student’s perspective of their profession and ability to progress within nursing. The NHS is responsible for ensuring that student nurses’ developmental opportunities are equal, irrespective of ethnicity. Impact Ward culture is perpetuated through the action of others to normalise mistreatment and concurrently disadvantage ethnic minority students making them feel unvalued, which in turn impacts both staff retention and career progression within the NHS. Training assessors should be aware of the existing culture of discrimination within clinical placements and work to eradicate it.

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