Brokering Inclusion:the case
of Nurse Education
Dr. Kathy Martyn
Brokering
Classic Grounded Theory study that set out to understand how nurse
educators worked with students who have disabilities
Brokering emerged as the central organising theme
As a strategic social process it comprised of three stages
Professional Reckoning
Negotiating a temporary pass
UnEmployability
Culture and Climate of Health Care
1 Influenced by competing legislation
2 Beliefs that somethings are fixed and
unchanging
3 No clear path or direction to go
4 Filled with uncertainty and risk
Climate and culture of the healthcare work
place
• Remains influenced by biomedical model of disability
• Workers in health care are expected to be 'fit and able'
• The work place reflects the 'real world of nursing' - characterised as being
difficult, unsupportive, pressurised and short of time, staff and resources.
• Student clinical experiences – these are not the real world of nursing
• Health care professionals believe themselves to be non discriminatory,
supportive and enabling in their professional practice
• BUT believe that it is difficult to be supportive and enabling of workers who
have disabilities.
Boundary spanning at the interface between
education and the workplace
• Adopt a ‘third party’ working relationship – HEI, workplace and
student.
• Recognise the limitations of their role
• Set out to secure a 'deal' that was right for the moment, but did not
fundamentally change their beliefs about the difficulties in having
professional workers who have disabilities
Hierarchy of disability and of practice
• All fields of nursing believed it would be difficult to support some students
who had disabilities during the courses, or as workers once registered
• Educators used an informal hierarchy of disability to make decisions about
the suitability of a student to become a nurse.
• Able disabled students required few accommodations and could ‘pass as
normal’ in the workplace.
• Virtuous disabled students had overcome hurdles to become students and
were considered worthy of educators and practitioners making additional
effort, as long as this was not prolonged and the student would eventually
pass as normal. Students who had overcome physical difficulties ,
traumatic injuries or life threatening illnesses were likely to be placed in
this group
Hierarchy of disability
• Students who had Dis- Abled disability presented as needing more
support, were less likely to pass as normal and may present with
characteristics similar to the client group. Students with a MH
diagnosis were often placed in this group.
• They were considered inherently risky, and posed a risk to the
workplace by creating instability or a risk to patients by not
maintaining professional standards
• Practice areas were then matched against this criteria – students who
needed accommodations were considered to be ‘dis- abling’ to the
work place and were more often placed in areas of ‘low acuity,’
slower work pace, where differences less obvious.
Negotiate a temporary pass
• Minimise barriers to inclusion – time, resources, change in practices
• Present student in a positive light
• Offer trades to secure a student access to clinical environment
• Strategically identify individuals who they knew to be understanding
or ‘call in’ favours
• Strategic use of the rhetoric of inclusion ‘ Equality Act’, Occupational
Health Clearance
(Un) employability
Professional beliefs support inclusion and enablement
Occupational beliefs about the nature of health care work believe that
health care is incompatible for workers who have disabilities.
• Health care workplaces are not able to be supportive- professional
regulation and professional/workplace expectations
• Professionals who have disabilities add to the burden on health care –
risk to smooth running of the organisation, risk to patients and risk to
themselves
• Uncomfortable with supporting students on a course – believed they
were setting a student up to fail
Students who are different
• Must disclose more of themselves than any other student or worker
• Must present themselves as contrite and grateful of the opportunities
they are given
• Must set aside their needs for those of their patients or workplace
when asked
• Must not challenge traditional working practices
• Must not appear as ‘them’
• Must demonstrate exemplary behaviours at all times.
Moving forward
• Need to explore concepts that surround work and workability in the
light of Equality Legislation and the neo-liberal language that
focusses on the individual –
• Student workers needing to ‘prove’ that being supported in the
workplace will make them the ‘model worker’
• The concern of ‘fairness’ to other workers
• The inability to look at professional requirements through the lens of
‘disability’
• Lack of understanding of how difference can enhance the workplace.