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Ethnicity and Labor Stratification in the UK National Health Service

Discrimination and bias in the workplace have been associated with adverse outcomes such as low job satisfaction and employee retention problems (Moceri, 2012), hostility and poor quality of patient care (Wheeler, Foster, & Hepburn, 2014), as well as exploitation and isolation (Batnitzky & McDowell, 2011). To guard against these outcomes, nurse leaders and hospital administrators need to develop and implement policies that prevent incidences of discrimination from happening in work settings (Moceri, 2012). This paper uses a case study to not only exemplify the ethical implications of discrimination and violations against federal and state laws, but also to demonstrate how discriminatory practices can be addressed in workplace settings.

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Discrimination Case

In the 1990s, a health care organization known as Woodbine entered into a binding agreement with the Immigration and Naturalization Service (INS) of the United States to be allowed to recruit foreign registered nurses in its nursing home so that it could address the prevailing shortage of skilled nursing professionals in some of its operational areas in the country. Although the health care organization agreed to pay the foreign nurses the same wages it paid nursing professionals in the country, it soon reneged on its promise by not only paying them about $6 an hour less than their U.S. colleagues but also posting them to work as nurse assistants and technicians despite the fact that they had been trained as registered nurses. A private discrimination case was filed against the health center by one of the Filipino nurses, after which the organization agreed to pay compensatory damages of $1.2 million, back pay (average rate of pay that U.S. nurses earned while working for Woodbine), and accrued interest to the foreign nurses and their attorneys (Gatewood, Field, & Barrick, 2011).

Ethical Principles

The ethical principle of justice was violated in the case since the agency (Woodbine Healthcare Center) failed in its duty to make fair decisions on how to compensate its workforce. This led to a situation where the Filipino nurses were compensated unfairly despite the commitment that was made by the organization to harmonize their pay with that of U.S. registered nurses (Gatewood et al., 2011). The second ethical principle that was violated is that of dignity, as underscored by the fact that Filipino nurses were not accorded the same respect and dignity in the allocation of duties and responsibilities. As demonstrated in the case, the foreign nurses ended up becoming nurse assistants and technicians despite their qualifications as competent registered nurses (Gatewood et al., 2011).

Title VII Protected Class

The Title VII protected class that is involved in this case is national origin as demonstrated by the fact that the nurses were discriminated against by virtue of being Filipinos. Similarly, it can be argued that the nurses were discriminated against because they were foreign nationals, meaning that their low pay and prejudiced job postings were as a result of their nationality rather than their professional qualifications (White & Fulton, 2015).

State and Federal Laws

The federal laws that were violated in the described case include the Civil Rights Act of 1961(allows employees to receive punitive damages as well as compensatory damages for financial or psychological harm from the employer), Lilly Ledbetter Fair Pay Act of 2009 (provides protection for unlawful employment practices associated with compensation discrimination), and Title VII (prohibits discrimination of employees based on race, sex, color, religion, and national origin) (Niles, 2013). Owing to the fact that the Filipino nurses were practicing in Kansas, the state law that was violated is the Kansas Act against Discrimination (KAAD). This law “criminalizes employment discrimination on the basis of race, color, religion, national origin, ancestry, sex, disability, and genetic information” (Steck, 2012, p. 102).

Evidence-Based Methods

Research is consistent that discriminating nursing professionals based on their national origin and race not only affects their self-confidence and attainment of professional goals, but also lowers their general quality of life and affects their learning and promotion opportunities (Moceri, 2012). As such, it is important for nurse leaders to develop and implement evidence-based practices aimed at preventing employment discrimination and other harmful practices. One of the evidence-based methods that could be used to prevent the discriminatory practices illuminated in the case is to ensure that all employees are compensated based on merit and professional competence, rather than using considerations of nationality or racial background (Wheeler et al., 2014). Another evidence-based method is to ensure that roles and responsibilities in work settings are assigned based on the qualifications and competence of nurses to perform these tasks to the satisfaction of the management and patients. Such a method is fair and just, particularly in terms of ensuring that jobs and tasks are allocated based on the expertise and professionalism of employees to accomplish the tasks (Gatewood et al., 2011; Nielsen, Stuart, & Gorman, 2014). Lastly, it is also important for the nurse leader and other relevant stakeholders to create “work environments that are perceived by nurses to be non-biased and supportive” (Moceri, 2012, p. 99). The creation of a non-biased and supportive work environment demands for the harmonization of compensation structures and work distribution schedules based on merit, rather than national origin or racial considerations (Batnitzky & McDowell, 2011; Tsang, 2013).

Short Policy

The agency is an equal opportunity employer that is committed to providing a safe, fair, flexible, and respectful work environment for all employees regardless of national origin or racial considerations. The agency will not discriminate against any of its employees based on national origin, and will take affirmative action to ensure that employees from other nationalities (minorities) are provided with a fair and equitable work environment that is conducive to the attainment of their personal and professional career objectives. Work responsibilities shall be assigned to employees based on their educational background and ability to complete them in a satisfactory and professional manner.

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Changes to the Human Resources Policies

It is important to create a unit within the human resource department that deals specifically with foreign nurses to ensure that their needs and complaints are adequately met. Additionally, it is important to introduce a compensation strategy that rewards employees based on merit, competence, and professional knowledge. Furthermore, it is important to revise job allocation plans and schedules to ensure that tasks and responsibilities are assigned based on individual competency and educational background. Lastly, an education program should be rolled out to create awareness among all employees on how compensation and job allocation issues should be handled within the organization. Such an education program is important as it will enable employees to not only report any perceptions of discrimination or unfair work practices, but also to communicate effectively to the relevant human resources unit when faced with actual or perceived discriminatory practices in work-related settings (Gatewood et al., 2011).

Conclusion

This paper has used the Woodbine case to discuss several issues related to discrimination and how it could be effectively addressed through workplace policies and making changes to the human resource policies. The case violates the Title VII class of national origin in addition to other federal and state laws. Overall, the paper has been successful in demonstrating how the discriminatory practices identified in the case could be addressed to prevent the adverse outcomes associated with workplace discrimination.

References

Batnitzky, A., & McDowell, L. (2011). Migration, nursing, institutional discrimination and emotional/affective labor: Ethnicity and labor stratification in the UK National Health Service. Social & Cultural Geography, 12(2), 181-201.

Steck, M.B. (2012). Concept analysis: Awareness of discrimination based on genetic information. Nursing Forum, 47(2), 100-105.

Gatewood, R., Field, H.S., & Barrick, M. (2011). Human resource selection (7th ed.). Mason, OH: South-Western Cengage Learning.

Moceri, J.T. (2012). Bias in the nursing workforce: Implications for Latino(a) nurses. Journal of Cultural Diversity, 19(3), 94-101.

Nielsen, A.M., Stuart, L.A., & Gorman, D. (2014). Confronting the cultural challenge of the whiteness of nursing: Aboriginal registered nurses’ perspectives. Contemporary Nurse: A Journal for the Australian Nursing Profession, 48(2), 190-196.

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Niles, N.J. (2013). Basic concepts of health care human resource management. Burlington, MA: Jones & Bartlett Learning.

Tsang, C. (2013). Uncovering systematic discrimination: Allowing individual challenges to a “pattern or practice.” Law & Policy Review, 32(1), 319-333.

Wheeler, R.M., Foster, J.W., & Hepburn, K.W. (2014). The experience of discrimination by US and internationally educated nurses in hospital practice in the USA: A qualitative study. Journal of Advanced Nursing, 70(2), 350-359.

White, B.J., & Fulton, J.S. (2015). Common experiences of African American nursing students: An integrative review. Nursing Education Perspective, 36(3), 167-175.

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StudyCorgi. (2022) 'Ethnicity and Labor Stratification in the UK National Health Service'. 1 May.

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