Health Sciences and Practice Subject Centre Ethics Special Interest Group 24 th April 2009 Helen Allan, Pam Smith

Mentoring overseas nurses: a cautionary tale of managing diversity Helen Allan, Pam Smith http//:portal.surrey.ac.uk/reoh Allan, Henry, Larsen, Mackintosh & Smith

What do we teach in ethics and why? Unconnected episodes during data collection in two projects suggest that nurses find managing diversity in clinical practice difficult and that they don’t know where to ‘talk’ about it.

Data – clinical learning study funded by GNC Trust and REOH study Nurse Director reflected on her lack of understanding of ethnic monitoring (REOH); Lack of awareness or at the very least accommodation of cultural difference in clinical learning (REOH); Clinical nurse leads, practice educators, ward managers reflected on how difficult being honest about different learning styles was (GNC study)

Three: “ … people just don’t seem to do as much in handover, or [ask] why we are doing that. It’s not just because of people’s hesitation to that but I think it’s the also the response they get for doing that. I’ve got a couple of Sisters who work very much in that way and that’s the way I used to work. I don’t know rightly or wrongly. I guess you are putting people on the spot but as long you don’t humiliate them in that circumstance. But some of the staff have not reacted very well and as a pack have really affected the way the system now works. I think that’s got a lot to do with the challenging as well. R: And why is that? Three: I guess because they feel slightly threatened. R: But they presumably have been educated within the same system. All: No.

Three: A lot of our workforce haven’t been educated in the same system and that is something that culturally there are differences and training wise, it’s not a question of knowledge base or anything like that, but it is a system that is different and I think for a lot of the staff they haven’t experienced that so therefore if somebody… in the workforce that feel very hierarchical, if the Matron knows something and [it’s] not for you to be part of a team. … And breaking down those barriers and preconceived ideas has actually been quite difficult, to get a team that’s gelled and feel that yes, you can challenge, you can approach, you can do all of those things, and that’s never really been an issue for me. You go up to the Ward Sister, you talk to her, believe you me in our day when we trained some of them were pretty scary people, but you would go up and you would approach and you’d be part of a team; and that’s been quite difficult for some of our staff and I know that’s been a difficulty.

Four: I think there’s a huge under-estimation of differences in communication terms, everything. I think there are huge differences and it makes a hell of a difference to the care we’re delivering, and I don’t think people take that on board”.

Background 1 Evidence –Overseas nurses face discrimination & barriers to employment (Allan & Larsen 2003; Back 2003) We lack respect! –Fail to access learning opportunities & CPD (Allan & Larsen 2003)

Background 2 Induction courses fail to meet ONs’ training or/and educational needs –“culture shock” Lack of preparatory materials about British life Language and communication courses fail to meet ONs’ needs –Tests make this organisationally more difficult now Expectation on ONS to adapt not UK workforce

Researching Equal Opportunities for Overseas Nurses Project European Social Fund –January 2004 – June 2006 Structured qualitative interviews –3 case study regions N, Wales & SE 72 ONs; 38 British mentors & managers –Ghanaian case SE 25 ONs

Main finding Learning in the workforce –Lack of organisational thinking around how cultural differences affect mentoring and learning for both overseas nurses and their mentors I just wondered, you mentioned cultural awareness, I just wondered if you’d thought about mentor preparation. Mentor preparation, well mentorship is already within the organisation because we have pre registration students, so as a part of fitness for practice, which is the programme all pre reg students are following currently, they have mentorship preparation. At the end of the day, we cannot wrap them up in cotton wool, they are qualified nurses in their own right, from their own Country, but we need to assess and they will be provided with effective support.

Barriers to lifelong learning Mentoring Cultural differences Racism The British way Skills Standards of British nursing Induction

What do we teach and why? Another question might be where? Linking theory and practice for students at pre- reg and post reg levels Re-contexualising professional knowledge across education and workplace

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