Nurse Education Today 32 (2012) 545–550

Contents lists available at ScienceDirect

Nurse Education Today

j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / n e d t

Racism and the mentor-student relationship: Nurse education through a white lens
Janet M.E. Scammell a,⁎, Gillian Olumide b, 1
a
School of Health and Social Care, Bournemouth University, Christchurch Road, Bournemouth, Dorset BH1 1LH, United Kingdom
b
School of Human and Health Sciences, Swansea University, Singleton Park, Swansea SA2 8PP, United Kingdom

a r t i c l e i n f o s u m m a r y

Article history: This paper is based on a study of relationships between Internationally Recruited Nurse (IRN) mentors and
Accepted 27 June 2011 White 2 students in one nurse education department in England (Scammell, 2010). The aim of the study was
to analyse mentorship relationships, focusing on interaction in which perceptions of difference were in play.
Keywords:
The research drew upon the principles of qualitative ethnography. Data were collected through focus groups,
Racism
interviews, participant observation and documentary analysis. The purposive sample included 10 IRNs, 23
Nurse education
Whiteness
nursing students, two lecturers and five placement-based staff development nurses. The data were analysed
Qualitative research thematically.
Essentialist constructions of different ‘cultures’ emerged amongst students speaking of their experiences with
IRN mentors. These were used to explain and justify differences in practice and often to portray IRN education
as inferior. Difference was viewed as a problem, leading to the reinforcement of boundaries that differentiate
‘them’ from ‘us’. Racism was denied as a source of these views.
The findings suggest that Whiteness as a source of power was influential in the production of racism within
everyday nursing practice. Whiteness appeared to be normalised: essentially nurse education is seen through
a White lens. Students require deeper sociological understandings to better equip them to recognise and to
challenge racism and to acknowledge their own part in its reconstruction.
© 2011 Elsevier Ltd. All rights reserved.

Introduction
This paper reports on a study of the experiences of Internationally
Recruited Nurse (IRN) mentors and White nursing students in the
context of practice education (Scammell, 2010). It is asserted that
institutional racism permeates the National Health Service (NHS) in
the United Kingdom (UK) (Alexander, 1999; Blofeld, 2003). In seeking
the elusive understanding of how institutional racism remains a vital
force in the NHS, we suggest that the small acts of reiteration of
racialised discourses between people in organisations may illuminate
how ‘unwitting’, discriminatory views and practices are perpetuated.
The use of ‘unwitting’ has particular resonance in the UK context as it
is a term used in major reports of investigations of institutional racism
(for example within the police service, Macpherson, 1999) to suggest
that racism may not have been intended or actions even comprehended
as racist. In common with the Carmichael and Hamilton (1967: p5)
indication that institutionally racist organisations permit ‘respectable
people’ to ‘absolve themselves from blame’, this form of absolution
requires further investigation. It is with this in mind that we hold some of
⁎ Corresponding author. Tel.: + 44 01202 962751.
E-mail addresses: jscammell@bournemouth.ac.uk (J.M.E. Scammell),
g.m.olumide@swansea.ac.uk (G. Olumide).
1
Tel.: + 44 01792 295904.
2
The terms Black and White are given capital letters to indicate their use as proper
nouns to describe assumed identities of categories of people.
the ‘unwitting’ small acts of racism up to the light. Elsewhere (Sue et al.,
2007) such acts are termed ‘microaggressions’. This too is a very useful
concept particularly where racism in face to face encounters is the focus
of attention. In this study, reports from IRNs and White nurses are
conducted separately and particular discourses in play identified and
discussed. It is possible to identify examples of microaggression within
some of the narratives and to a more limited extent observe them in
direct encounters.
A number of studies (Frankenberg, 1993; Hobgood, 2000;
DiAngelo and Allen, 2006) show that Whiteness acts as a source of
privilege and power: the insertion of attention to Whiteness may
prove useful in the analysis of institutional racism. We are placing an
analytical focus on racism rather than on provisional notions of
‘cultural difference’ as this offers a more robust insight into the
context and particular episodes within the data.
Indicative Literature
A small number of studies concern the experience of IRNs working
in the UK (Allan and Larsen, 2003; Gerrish and Griffith, 2004; Matiti
and Taylor, 2005) and migrant nurses elsewhere, for example Yi and
Jezewski (2000). Common issues to emerge relate to communication,
work culture, deskilling and discrimination on grounds of perceived
race. Racism embodies the notion that one racially defined group is
superior or inferior to another. Our understanding of race is that it is a
social construction which leads to exclusionary practice (Miles and

0260-6917/$ – see front matter © 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.nedt.2011.06.012
546 J.M.E. Scammell, G. Olumide / Nurse Education Today 32 (2012) 545–550
Brown, 2003). Different aspects of life, for example clothing, religion
or speech, as well as selective physical attributes may become
racialised. It is a shifting discourse; racism occurs when earlier
discourses of race are used to explain presently perceived differences,
although this does not preclude the development of newer narratives
of race.
Allan and Larsen (2003) found that IRN participants described
racism as silent, covert and difficult to deal with as it was ‘in the hearts
and minds' of the indigenous population. The insidious nature of
racism is also reported in a Canadian study (Hagey et al., 2001)
involving immigrant nurses of ‘colour’. The analysis revealed
processes of marginalisation at work; they were treated differently
‘on the ground’ despite the policy rhetoric. The study concluded that
there is a denial of racism in nursing.
In a major policy review, Alexander (1999) concluded that there
was evidence of institutional racism at many levels within the NHS.
Lemos and Crane (2000) reported that 57.7% of NHS workers from
Black and Minority Ethnic (BME) communities had either experienced
or witnessed racial harassment. Significant problems are evident
including poor job satisfaction amongst BME nurses and increased
intent to leave, inequalities in terms of career progression and
concentration of BME staff in less popular nursing specialties and
locations (Ball and Pike, 2003). A number of policy initiatives have
been developed to address discrimination (Department of Health,
2005), however racism appears persistent. There is a greater focus
upon processes and procedures to tackle discrimination including the
development of race equality plans, although some argue that their
impact on racism is limited (Olumide, 2007).
Discrimination against clients from BME communities producing
an array of health inequalities, is also apparent in the UK. A study by
Bowler (1993) involving women of South Asian origin revealed highly
stereotyped staff views, leading to care that was determined by ethnic
group as opposed to need. Similarly a study of the experiences of
White nursing staff caring for patients from BME communities
(Murphy and Macleod Clark, 1993) demonstrated ethnocentric
attitudes to care. Vydelingum (2006) found that whilst nurses
responded to ‘cultural needs’, care remained constructed from the
perspective of the dominant White population and patients were
expected to fit with this approach.
Multiculturalism is a powerful discourse within nursing in the area of
ethnicity and difference. It is a contested concept and relates to essentialist
notions of culture (Culley, 2006). Multiculturalism can be conflated with
ethnicity. Ethnicity in turn is expressed within the policy literature as an
aspect of diversity and is often linked with culture and race. The terms
ethnicity, culture and race are often used interchangeably and are
infrequently defined, making their meaning rather ambiguous, resulting
in unhelpful conceptualisations of ‘difference’. Racism can be dismissed
through reference to multiculturalism—‘we treat everyone the same’. The
problem with this approach is that it is underpinned by the assumption
that by offering an equal service, everyone can access and use it
appropriately and it fails to account for the impact of structural
inequalities on social groups and the privileging of one group over
another.
White privilege is explored by DiAngelo and Allen (2006) in an
observational study of group dialogue about race amongst elementary and
secondary school teachers. They found that White participants used the
discourse of personal experience to block challenges about the reality of
racism—‘if I don't feel it, it doesn't exist’. This had the effect of preventing
exploration of the impact of inherited historical and social processes,
thereby maintaining White privilege. Indeed DiAngelo (2010:p1) argues
that individualism is so embedded in dominant society that it functions as
‘one of the primary barriers preventing well-meaning (and other) white
people from understanding racism.’ She outlines eight dynamics of racism
that are obscured by this discourse. Of particular relevance is the
assumption that success is a facet of individual effort with no
acknowledgement that our ‘starting position’, for example our social
group membership, will provide an advantage. This has the impact of
casting dominant group members (for example Whites) in a positive light
whilst simultaneously casting those groups who have achieved less
(people form BME communities) in an unfavourable light. In order for
anti-racist education to succeed, Schroeder and DiAngelo (2010: p244)
argue that ‘nurse educators need to facilitate colleagues and students to
identify, name, challenge, and transform the norms, patterns, traditions,
structures and institutions that keep white supremacy in place.’ This
inevitably involves the analysis of the role of institutional power, in this
case within nursing, as it impacts on the way power dynamics operate at
the micro level, for example between practitioners.
Duffy (2001) agrees that in nurse education, the dominant culture
is perceived as the norm. Puzan (2003) argues that White privilege is
a significant feature of nursing. Western science is linked with
Whiteness and this dominates in nursing curricula. The nursing elite
are dominated by Whites, providing little impetus to challenge the
expectation that patients conform to White norms of care (Blackford,
2003). Consequently nurse education has been criticised for failing to
address the impact of racism in nursing practice (Cortis and Law,
2005). A process of racialisation seems evident, whereby populations
are categorised according to their imagined phenotypes and other
markers of difference. This leads to essentialist constructions of
cultural groups as fixed and sharing a homogenous set of immutable
characteristics. Essentialist views of culture are often mapped onto
ethnicity, leading to the conflation of the two terms in much
professional literature (Gustafson, 2005).
Methods
The study draws upon key principles of qualitative ethnography.
Assumptions underpinning this approach include an acknowledge-
ment of multiple standpoints, including that of the researcher. The
aim of the study was to explore and interpret constructions of
difference within mentorship relationships that involve IRNs and
White English nursing students in one nurse education department in
England. Four methods of data collection were used: focus groups,
semi-structured interviews, participant observation and analysis of
documentary sources. Themes were identified in the data and,
adopting a social constructionist perspective, recognised discourse
discussed.
Central to the research were IRN mentor and White nursing
student encounters. The study was designed to capture how
institutional processes and activities intersected with nurses' experi-
ences of practice education. The prime focus was on reports of micro
social relations (everyday actions, speech and documentation)
principally between IRNs and students but recognising these were
informed by the macro practices of institutions such as the NHS and
nurse education. Key informants were therefore included to capture a
wider picture of the community. The resulting ‘texts’ were analysed
alongside relevant documentation.
In the UK, the dominant ethnic group is White British, although the
UK is one of the most multicultural societies in Europe. Diasporas of
various communities from Commonwealth countries and more
recently from central and eastern Europe, mainly in urban areas, are
evident. However the study was undertaken in a semi-rural area
where there were far higher levels of White British people compared
with other parts of the UK. In the two care provider organisations
involved in the study, 80.5% and 94% of registered nurses workforce
reported their ethnic origin as White British. 96% of undergraduate
nursing students and 91% of academic faculty from the health school
involved described themselves as White British (Scammell, 2010).
Purposive sampling was used and as themes emerged, theoretical
sampling (Denzin and Lincoln, 2005) was adopted to explicate these
further. 22 female students and one male student volunteered; all were
White British except one Black Zimbabwean. Ten IRNs participated,
seven female and three male; six were Asian, three were Black African
 J.M.E. Scammell, G. Olumide / Nurse Education Today 32 (2012) 545–550
and one White American. All were experienced registered practitioners,
having worked as nurses in the UK for a minimum of 3 years, on average
having mentored five students each. The seven key informants included
two university lecturers and five educational facilitators based in
placement provider organisations, including two males and five females
of which one was Black American and six were White British. Ethical
principles were followed throughout the research.
Three student focus groups were conducted plus individual semi-
structured interviews with IRNs and key informants. Participant
observation within two ward settings and a mentorship education
session form part of the data. Whilst a relatively small data source
within the study, documentary analysis was important in informing
the context of practice learning. The documents were selected on the
basis of local and national pertinence to the support and substance of
practice learning for nursing students in the UK (Table 1).
Data collection was continuous and simultaneous with data
processing. Within this process the culmination of one data set resulted
in the development of categories and this was then used to guide
subsequent data collection. In qualitative enquiry, the researcher is the
principal data collection tool. Being a White, female, nurse academic will
have influenced responses, and therefore self-reflexivity was central
within the research process. Adamson and Donovan (2002) argue that
the plausibility of the findings should be considered in the light of critical
reflexivity of the researcher. A reflexive diary was therefore kept
throughout the research process and the contents formed part of the
data analysis. This strengthened the rigour of the work as initial
interpretations and categorisations were repeatedly challenged in terms
of personal influences.
Rigour in qualitative research is further enhanced through within
method triangulation (Denzin and Lincoln, 2005). The study used
multiple methods of data collection to explore the topic. Concepts
derived from the focus groups were compared with those from the
interview data, participant observation and the review of documen-
tary sources. This approach aimed to better substantiate that the
findings reflected a fair picture that things really were as they seemed.
Findings
A main finding was that the nature of nursing itself appeared to be
underpinned by some universal practices although there were
certainly differences in ways of working and learning between UK
and overseas training described. Students tended to produce real (and
imagined) constructions of differences between their own experi-
ences of nursing education and that of their mentors. These perceived
differences were often essentialised and used both to identify
perceived immutable differences and, sometimes, to portray the
mentors' training and experience as inferior. The attributions of
behaviour to racialised difference suggest a failure of pre-registration
nurse education to encourage students to be aware of the value of
encountered differences between themselves and their mentors' style
of nursing. Below are examples of ways in which encounters and
practices became imbued with racialised meanings.
Table 1
Documentary sources.
● Pre-registration adult nursing curriculum extant for the students in the study.
● Revised curriculum for subsequent students
● Practice assessment tools for pre-registration adult nursing students where the
study was located
● Curricula for mentor preparation programme extant for the mentors in the study
● NMC Standards of Proficiency for Pre-registration Nurse Education (NMC, 2004) and
the NMC Standards to Support Learning and Assessment in Practice (NMC, 2006;
2008)
● QAA Subject Benchmark Statements: Nursing (QAA, 2004)
547
Building a Relationship
Some IRNs and students successfully negotiated good working
relationships. Indeed students in one focus group stated that mentor
origin was irrelevant; success was ‘just down to the personality as to
how they relate to you’ (FG2/SR7). However ethnicity is a significant
marker of difference (Frankenberg, 1993) and for some students this
factor and the associated typifications seemed to overshadow all other
considerations:
Student Emily (White): ‘Obviously their culture is totally different
anyway and the way they learnt was totally different but I had an
overseas mentor in my last placement but I just found her…
(pause) she liked sticking with her own kind (…) they just keep
themselves to themselves, they just don't… they don't build up
relationship with you.’ (FG1/SR1)
Despite the reality of multiple identities, ethnicity here is
privileged over other features such as age, experience and gender.
This excerpt reveals the impact of essentialist discourse linked with
multiculturalism, so prevalent within nurse education (Culley, 2006;
Hagey and MacKay, 2000). The mentor was viewed as part of a ‘totally
different’ cultural group when perhaps what is meant is that ‘they’ are
different from ‘us’. Ethnic minority mentors are vulnerable to negative
typification (Bowler, 1993) because of their visibility and likely
associations with racial stereotypes in wider society. ‘Own kind’
reflects the influence of historical discourses around the biological
construction of separate, hierarchically arranged races.
Covert Discrimination
Whilst several students stated that they did not behave or speak in
a racist manner, there is some evidence that mentors could be
undermined by discriminatory behaviour on the part of some of their
students. Mentors are senior to students but lack of familiarity with
the UK nurse education system sometimes changed this power
dynamic. This undermined IRN mentor and student relationships:
IRN Gino (Asian): The last student was making up her own rota
that she actually didn't have time, not even a week to spend with
me. She spent most of her time with some other nurses and she
asked me to sign [her practice assessment] and I said no. I don't
know how she did it but she managed to get some other mentors
to do it for her.’ (MB2)
The student is behaving unacceptably but Gino felt vulnerable in
challenging her practice perhaps due to lack of knowledge and
experience of the student programme. Support from colleagues would
be essential to help IRNs to build confidence and challenge the
student's behaviour; however the data indicate that this was
infrequently offered to IRNs and there seemed to be no common
understanding of the need to create a space in which such behaviour
could be discussed. Indeed White staff colluded with the actions of the
student and this constitutes covert discrimination. Repeated myriad
times, it is not difficult to understand how institutional racism may be
seen as unwitting; it is unwitting because it is unnamed, unacknow-
ledged and not discussed, in effect part of the normal run of things.
Impact of Living in Areas with Low Ethnic Diversity
Whilst nursing curricula have to adhere to national guidelines,
there is considerable scope to tailor the programme according to the
interests of the education commissioners and providers:
Lecturer Caroline (White): ‘They [students] don't come face to
face with other cultures.’ (…) ‘I think also, because we live in the
548 J.M.E. Scammell, G. Olumide / Nurse Education Today 32 (2012) 545–550
area of the country that we do, there aren't many from practice
that are, from a different culture, so therefore, it doesn't get
explored as it might have done if we were in [major city] or
wherever.’ (KR7)
There seemed to be an assumption here that all students were from
one culture (White British). Such dialogue may reflect the normalisation
of Whiteness (irrespective of social divisions such as class and gender)
in the classroom. The problem is framed as one of inexperience of
cultures other than a perceived White norm. There is a tendency for us
all to view our world from an ethnocentric perspective. In areas of less
ethnic diversity therefore, education around responses to differences
and the ability to think about social difference is particularly required.
Given the ethnic composition of nursing faculty in the study area
(predominantly White British), the topic may have little resonance as an
issue on a personal basis, undermining its pertinence even further. This
finding supports the argument presented by Schroeder and DiAngelo
(2010) that White people often believe that anti-racist education is only
necessary for those that interact regularly with BME groups. This view
serves to re-emphasise Whiteness as normal and non-whiteness as
other.
Lacking the Skills to Challenge Discrimination
When students did come across discriminatory behaviour, they
seemed unsure how to react:
Student Isobel (White): ‘We were taking staples out, and he [IRN]
was teaching us. (…) Then quite a senior staff nurse said ‘oh my
goodness me (…) he shouldn't have been allowed because you
know he may not have been trained and be showing you the
correct procedure’. (…) I said, ‘no, no the procedure was exactly
like I'd been shown’. But it was… ‘oh well I need to show you’.’
(SI1)
There is evidence here of institutional racism at several levels. The
staff nurse shows a lack of trust in the mentor based on her
perceptions about his training. In her statement that he may not ‘be
showing you the correct procedure’, the assumption was that ‘their’
practice was suspect compared to ‘ours’. The fact that such attitudes
were expressed so openly indicates that the organisational culture
tolerated this behaviour and therefore colluded with it. Whiteness
was the default ‘culture’ representing normality leading to a process
of ‘othering’ of non-White peoples. Moreover the student appeared
ill-equipped to challenge racially motivated behaviour.
Overt Discrimination
Overall Whiteness appeared to be used as a source of power to
manipulate situations:
Joyce (Black education facilitator): ‘On the ward, doctors will go ‘I
don't want a Filipino nurse, I want an English nurse.’ (KR2)
Accents can be difficult but the fact that the doctor feels able to
make such remarks indicates that this behaviour is tolerated (and
perhaps accommodated) reflecting institutional racism. IRNs and
students overhearing these racist attitudes and observing the action
or inaction that result, receive a message of what is permissible,
inevitably impacting on IRN mentor and student encounters.
Blatantly racist behaviour whilst rare was observed in one clinical
setting:
‘Samora (Black African IRN) and Paula (White student) administered
medications to Mr A (White patient) and then gave some personal
care. Whilst with another patient, Mr A called out to Samora, ‘What
you up to now, big bum! (laughing) Don't take me wrong, I'm not
harassing, just my humour!’ The other patients, Samora and Paula
apparently heard but looked away. No comments were made.’
(Observation Diary/MS3)
One can only speculate whether Mr A. would have behaved the
same way towards a White nurse and whether he felt that couching
his comment as a joke excused the latent sexism and racism. The
sexualisation of Black women's bodies is, however, a discursive theme
which has littered history from slavery through imperial endeavours
in Africa and beyond (hooks, 1981; Davis, 1982). Within colonialist
discourse, Black Africans are often constructed as sexualised objects
(Hobgood, 2000) and this may have aroused particular sensitivities
with Samora. Inaction from the staff and patients may have had the
effect of indicating disdain; on the other hand it could be interpreted
as condoning this behaviour or seen as a microaggression by default.
Certainly the man's words display aggressive racism and sexism
towards Samora. Not wishing to ‘get involved’ is discriminatory in
itself; a response is required for such unacceptable behaviours.
Discussion
The findings provide a unique insight into the micro practices of
social relations between IRN mentors and White, British nursing
students. Through the analysis of these encounters in practice
education, it appears that racialised behaviour and attitudes were
evident at the individual level, reinforced by institutional processes.
Often the option not to challenge was the one taken.
White Privilege as a Regime of Truth
Dominant discourses constitute powerful discursive formations
which privilege the truth of a set of statements or as Foucault (1980)
terms it a ‘regime of truth’. The findings indicate that the actions
and attitudes of some British nursing students and staff were, perhaps
subconsciously, dominated by a worldview that privileged White
people over ‘others’. In this way Whiteness provided a source of
power within IRN mentor-student encounters upon which students
are shown to draw in constructing their narratives. Despite the senior-
junior dynamic, the findings indicate that students drew upon
discourses of White privilege in interactions with their IRN mentors.
Whilst the mentor is theoretically ‘in charge’ of student learning, in
practice the students seemed able to side-line IRN mentors to meet
their ends and to downgrade IRN understandings and abilities in the
course of conversation. Additionally some British mentors apparently
condoned these actions. Supporting Puzan (2003) and DiAngelo
(2010), we argue that the power of Whiteness and the association
with superiority over non-Whites is so embedded within dominant
society, nursing ideology and practice, that it is an unacknowledged
but taken for granted ‘way of being’ for White nursing staff. The
‘unwitting’ nature of racism is really no excuse for not equipping
oneself with a better awareness, although it is not difficult to see the
vested interests in maintaining the status quo.
Discursive Strategies Used to Exert Power and their Effects
Analysis of the micro processes at work revealed the use of a
number of strategies by White people to undermine those perceived
as ‘other’: for example collusion, controlling situations through
‘knowing’ networks of communication, using language to include
and exclude. The effect of these strategies was to discredit, inferiorise,
marginalise, victimise and dehumanise IRNs. The findings indicate
that White privilege operated as a central regime of truth within
micro social relations involving IRN mentors and White British
students. However evidence of racialised behaviours and attitudes
are also testimony to the inter-relationship between micro and macro
 J.M.E. Scammell, G. Olumide / Nurse Education Today 32 (2012) 545–550
level practices. For individual behaviour to remain largely unchal-
lenged requires at least the tacit ‘support’ of organisations.
Supporting the findings of other studies (Allan and Larsen, 2003),
overtly and covertly acknowledged communication ‘problems’ featured
strongly within the findings. When explored, at heart lay the ‘othering’
of IRNs. This seemed to affect the perspective of some White British staff;
first to expect problems when working with IRNs and second to exert
the right to privilege their beliefs and practices over those of IRNs.
People appeared to act out of habit rather than intent. Possibly this is an
example of the ‘unwitting racism’ referred to in the Macpherson (1999)
report regarding institutional racism. If so this level of ‘unwitting’
behaviour requires further investigation if it is to be more fully exposed.
White-centric Organisations
Within placement provider organisations, the findings indicate
that meeting the needs of the majority population was a higher
priority than the needs of the ‘other’. Racism was denied by the
organisation by preventing it being named, sending a message to BME
staff as well as their White colleagues—‘we don't have a problem with
racism’. Any acknowledgement of racialised behaviour is likely to be
poorly understood and thus marginalised in this climate.
Whiteness appeared to be ‘normalised’ within the nurse education
department: education was delivered through a ‘White lens’. Overall
the curriculum failed to challenge the normalisation of White culture.
Culley (2006) argues for the need to problematise the categorisation
White British in order to help White students to perceive that they too
are part of an ethnic designation. In addition, within nursing a
discourse of ‘caring for the individual’ is also privileged. As Schroeder
and DiAngelo (2010) argue, such an approach enables the disavowal
of race in favour of treating everyone as an individual.
The Integration of Sociological Understandings into
Holistic Curricula
A holistic curriculum is commonly perceived as a key means through
which cultural issues are explored within pre-registration nurse
education. Whilst the holistic focus on individual illness experiences is
valuable, Mulholland (1995) argues that there is insufficient account
taken in nurse education of societal structures and networks of power as
they influence individual experience. Nurses should learn about
individual manifestations of cultural life ways through a holistic
approach, but they also need to consider why discrimination and
prejudice occurs and to understand their part in this.
The findings indicate that the study of societal structures such as
race was assimilated under the banner of holism within the
curriculum. However this prevented the depth of sociological analysis
required to equip nursing students to theorise and become the
independent analysts required for autonomous practice. Unsurpris-
ingly therefore students lacked the ability to challenge racism in
practice. Holism is inked in nursing to the discourse of individualism.
We argue that this tends to limit analysis to the individual or micro
level and as DiAngelo (2010:10) highlights, reinforces the ‘myth of
meritocracy’, that is that success or otherwise is accounted for entirely
by personal strengths and deficits. Unless nurses are encouraged to
explore the role of societal structures, particular social group
concentrations at either end of the ‘success scale’ remain unexplained
and ignored.
Conclusion
Institutional racism has been a feature of reports into a number of
public services in the UK (Macpherson, 1999; Blofeld, 2003) which
have tended to use the term ‘unwitting’ without providing substance
for the concept and ways in which unwitting race thinking is enacted.
Little is written of how Whiteness operates in the production and
549
enactment of racialised behaviour. Through focusing on the micro
practices of social relations between IRN mentors and students, this
study has exposed ways that Whiteness was unwittingly used as a
discourse by White students and staff to undermine IRNs within
everyday working practices. The findings have implications for
understanding relationships between White and BME nurses and
patients more generally. We suggest that the study provides some
new insights into how racialised behaviour is enacted.
The study indicates that White privilege seemed embedded in
nurse education. Health and nurse education policy is dominated by
essentialist constructions of perceived difference that ignore White-
ness and the hegemonic position occupied by those who claim
privileges accruing to Whiteness. Until this position shifts, we suggest
that no amount of anti-discriminatory policy and procedures based on
this perspective is likely to tackle racism successfully. Such policy may
help identify and deal with overtly racist practices but most racialised
behaviour was more subtle and covert as it was normalised within day
to day working relationships. It was also unwitting, not recognised by
White people who form the elite within nurse education institutions,
those in fact who create policy.
To conclude, the study shows that Whiteness as a source of power
is very influential in the reconstruction of racism within everyday
nursing practice. There are few studies which show the micro
processes through which institutional racism is enacted and as such
this study contributes to a furthering of understanding.
Acknowledgements
We would like to acknowledge valuable feedback from Dr Helen
Allan on earlier drafts of this paper.
References
Adamson, J., Donovan, J., 2002. Research in black and white. Qualitative Health Research
12 (6), 816–825.
Alexander, A., 1999. Study of Black, Asian and Ethnic Minority Issues. Department of
Health, London.
Allan, H., Larsen, J., 2003. ‘We Need Respect’: Experiences of Internationally Recruited
Nurses in the UK. RCN, London.
Ball, J., Pike, G., 2003. Stepping Stones. Results from the RCN Membership Employment
Survey. RCN, London.
Blackford, J., 2003. Cultural frameworks of nursing practice: exposing an exclusionary
healthcare culture. Nursing Inquiry 10 (4), 236–244.
Blofeld, R., 2003. Independent Inquiry into the death of David Bennett. Norfolk. Suffolk
& Cambridgeshire Strategic Health Authorityhttp://image.guardian.co.uk/sys-files/
Society/documents/2004/02/12/Bennett.pdf.
Bowler, I., 1993. ‘They're not the same as us’: midwives' stereotypes of South Asian
descent maternity patients. Sociology of Health & Illness 15 (2), 157–178.
Carmichael, S., Hamilton, C., 1967. Black Power: The Politics of Liberation in America.
Vintage Press, New York.
Cortis, J., Law, I., 2005. Anti-racist innovation and nurse education. Nurse Education
Today 25 (3), 204–213.
Culley, L., 2006. Transcending transculturalism. Race, ethnicity and healthcare. Nursing
Inquiry 13 (2), 144–152.
Davis, A., 1982. Women, Race and Class. The Women's Press Ltd, London.
Denzin, N., Lincoln, Y. (Eds.), 2005. The Sage Handbook of Qualitative research, 3rd Ed.
Sage, Thousand Oaks, CA.
Department of Health, 2005. NHS Race Equality Scheme 2005–8. HMSO, London.
DiAngelo, R., 2010. “Why can‘t we all just be individuals?” Countering the discourse of
individualism in anti-racist education. Interactions. UCLA Journal of Education and
Information Studies 6 (1) article 4.
DiAngelo, R., Allen, D., 2006. “My feelings are not about you”: personal experience as a
move of Whiteness. Interactions. UCLA Journal of Education and Information
Studies 2 (2) article 2.
Duffy, M., 2001. A critique of cultural education in nursing. Journal of Advanced Nursing
36 (4), 487–495.
Foucault, M., 1980. Michel Foucault. Power/Knowledge: Selected Interviews and Other
Writings, 1972–1977. Harvester Press.
Frankenberg, R. (Ed.), 1993. The Social Construction of Whiteness. White Women, Race
Matters. Routledge, London.
Gerrish, K., Griffith, V., 2004. Integration of overseas registered nurses: evaluation of an
adaptation programme. Journal of Advanced Nursing 45 (6), 579–587.
Gustafson, D., 2005. Transcultural nursing theory from a critical cultural perspective.
Advances in Nursing Science 28 (1), 2–16.
Hagey, R., MacKay, R., 2000. Qualitative research to identify racialist discourse: towards
equity in nursing curricula. International Journal of Nursing Studies 37 (1), 45–56.
550 J.M.E. Scammell, G. Olumide / Nurse Education Today 32 (2012) 545–550
Hagey, R., Choudhry, U., Guruge, S., Turrittin, J., 2001. Immigrant nurses' experience of
racism. Journal of Nursing Scholarship 33 (4), 389–394.
Hobgood, M., 2000. Dismantling privilege. An Ethics of Accountability. Pilgrim Press, Ohio.
Hooks, B., 1981. Ain't I a Woman: Black Women and Feminism. South End Press, Boston MA.
Lemos, P., Crane, G., 2000. Tackling Racial Harassment in the NHS: Evaluating Black and
Minority Ethnic Staff's Attitudes and Experiences. http://www.dh.gov.uk/
prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/
dh_4074524.pdf2000.
Macpherson, W., 1999. The Stephen Lawrence Inquiry (The Lawrence Report). Cm
4262-I. HMSO, London.
Matiti, M., Taylor, D., 2005. The cultural lived experience of internationally recruited
nurses: a phenomenological study. Diversity in Health & Social Care 2 (1), 7–15.
Miles, R., Brown, M., 2003. . 2nd Ed. Racism. Routledge, London.
Mulholland, J., 1995. Nursing, humanism and transcultural theory: the ‘bracketing out’
of reality’. Journal of Advanced Nursing 22, 442–449.
Murphy, K., Macleod Clark, J., 1993. Nurses’ experiences of caring for ethnic-minority
clients. Journal of Advanced Nursing 18, 442–450.
Nursing and Midwifery Council (NMC), 2004. NMC Standards of Proficiency for Pre-
registration Nurse Education. NMC, London.
Nursing and Midwifery Council (NMC), 2006. NMC Standards to Support Learning and
Assessment in Practice. NMC, London.
Olumide, G., 2007. Sleepwalking to diversity? In: Hann, A. (Ed.), Health Policy and
Politics. Ashgate Publishing, Aldershot, pp. 139–150.
Puzan, E., 2003. The unbearable Whiteness of being (in nursing). Nursing Inquiry 10
(3), 193–200.
Quality Assurance Agency (QAA), 2004. Subject Benchmark Statements: Nursing.
Quality Assurance Agency, London.
Scammell, J., 2010. A Qualitative Study of Racialised Constructions of Difference in
Mentor and Student Encounters in a Nurse Education Department in England.
University of Wales, Swansea: Unpublished DNSci thesis.
Schroeder, C., DiAngelo, R., 2010. Addressing Whiteness in nurse education: the socio-
political climate project at the University of Washington School of Nursing.
Advances in Nursing Science 33 (3), 244–255.
Sue, D.W., Capodilupo, C., Torino, G., Bucceri, J., Holder, A., Nadal, K., Esquilin, M., 2007.
Racial microaggressions in everyday life. The American Psychologist 62 (4),
271–286.
Vydelingum, V., 2006. Nurses’ experiences of caring for South Asian minority ethnic
patients in a general hospital in England. Nursing Inquiry 13 (1), 23–32.
Yi, M., Jezewski, M., 2000. Korean nurses adjustment to hospitals in the United States of
America. Journal of Advanced Nursing 32 (3), 721–729.