Racialised Inequities in Career Progression among the Healthcare Workforce: A Qualitative Study
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Aims
To explore how workplace environments and racialised hierarchies shape racial inequities in career progression and how the Covid-19 pandemic response influenced these inequities.
Design
Longitudinal and cross-sectional qualitative study using semi-structured interviews.
Methods
Semi-structured interviews were conducted with 27 student nurses, healthcare assistants and qualified nurses and 24 senior leaders and management staff recruited in England between January 2019 and March 2021. Data were analysed using thematic analysis.
Results
Data from 51 healthcare professionals were included in the analysis. Guided by sociological theory on inequality diversions and racialised organisations, three main themes were identified: (1) ‘hidden pipelines to career progression’ highlights how racial positioning influences unequal career trajectories shaped by informal networks, organisational norms and perceptions of competence; (2) ‘impact of the response to the Covid-19 pandemic’ illustrates how the pandemic disrupted and reinforced racialised career barriers and (3) ‘psychological effects of racialised inequities on racially minoritised staff’ captures the emotional burden of navigating these inequities.
Conclusion
NHS staff perspectives on racialised inequities in career progression highlight the power informal networks have in staff accessing managers who control opportunities. While some staff found new opportunities during the Covid-19 response, others, particularly senior racially minoritised staff, felt redeployments and remote working further hindered their development.
Impact
Persistent racial inequities in NHS career progression must be addressed to improve staff retention and psychological wellbeing. Repeated exclusion and stalled progression, while advantaging white staff, negatively impacts racially minoritised staff, leading to fatigue, pessimism and reduced staff retention. Tackling these inequities requires confronting structural advantages for white staff, implementing mandatory anti-racism training for managers, carrying out robust evaluations of current organisational processes, embedding inclusive practices and offering targeted psychological support for racially minoritised staff.
Patient or Public Contribution
Input from national advisory and stakeholder opinion groups of healthcare professionals.
