Finland's economic performance over the last 8 years has been somewhat subpar vis-à-vis that of its Northern neighbors. Yet the country boasts a relatively strong start-up network, a potential source of much-needed growth.
Two factors help explain the current momentum of Finland's start-ups, while a third (more recent) development is likely to benefit the country's start-up ecosystem in the long-run.
First, a slump in traditional Finnish exports has been an impetus for innovation. While Nokia's implosion is widely recognized as having contributed to the country's current economic malaise, it has also ultimately been conducive to the growth of smaller, more agile enterprise. Nokia's epic demise has left behind a pool of tech-savvy entrepreneurs, many of which have helped expand Finland's now diverse start-up scene.
Supercell, a mobile game developer headed by a Nokia veteran, now has offices in Europe, the United States and Asia and boasts revenue of over 2 billion dollars. In general, Finnish start-ups have pivoted strongly towards profitable gaming technology, which is easy to disseminate online.
Other pillars of Finnish growth are also increasingly under strain, making it necessary to identify innovative, growth-spurring alternatives. With a tenth of Finnish exports going to Russia alone, EU-Kremlin sanctions have damaged Helsinki's economy. Russian-Finnish trade nose-dived in 2015, falling by almost 35%, due to Ukraine-related sanctions and a feeble Russian currency. The Finnish forest industry, which accounts for roughly a fifth of all Finnish exports, is generally becoming increasingly less competitive.
Second, start-ups in Finland benefit from a robust support system. The Finnish government has relatively liberal funding policies, even for still embryonic ventures. Tekes, the Finnish Funding Agency for Innovation, is largely responsible for the financial support of nascent companies.
Moreover, platforms like 'Startup Sauna' have been designed to fast-track start-ups. Startup Sauna sponsors a five-week 'accelerator program' for entrepreneurs and contributes to the organization of Helsinki's annual start-up 'Slush conference'. It is, in this context, telling that Finland has been classified as the second-best country for innovation by the World Economic Forum.
There are further grounds for relative optimism. The Finnish economy has hitherto suffered from the fact that Finland's comparatively low labor productivity has been awkwardly coupled with high labor costs. Yet a deal – the 'Competitiveness Pact'– aimed at loosening up the country's excessively rigid labor market was struck last month by the Keskusta government and trade union representatives.
The accord is a big deal: it involves a temporary brake on wage increases, more hours for workers per annum, and a cutback in a host of other employee privileges, all in return for income tax reductions. The agreement will probably increase the output of Finnish firms, start-ups included, by depressing labor costs. For the latter, the labor market reform deal is likely to become most important when they attempt to significantly expand business operations after having attracted significant investment.
Start-ups always involve risk for entrepreneurs and investors alike. Yet the three above factors – an abundance of tech-specific human capital, a robust support network and the introduction of more market-friendly labor reform – are likely to ensure the continued dynamism of the start-up scene in Finland.


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rise up, Comus, sing your song….
A brief history of Comus
Album line-ups
Comus on Prog Archives
Roger Wootton
Bobbie Watson
Glenn Goring
Colin Pearson
Andy Hellaby
Jon Seagroatt
Drip Drip
Song To Comus
The Bite
Songs recorded
Down Like A Movie Star (from To Keep From Crying, 1974)
Drip Drip (from First Utterance, 1971)
In The Lost Queen's Eyes (from 7″ Dawn maxi-single,1971)
Out Of The Coma (from Out Of The Coma, 2012)
Song To Comus (from First Utterance, 1971)
The Return (from Out Of The Coma, 2012)
Touch Down (from To Keep From Crying, 1974)
Songs live
'Drip Drip', Korjaamo, Helsinki, 2012
'Out Of The Coma', Korjaamo, Helsinki, 2012
'Song To Comus', the Borderline, London, 2012
'The Herald', Melloboat Festival, Sweden, 2008
Glenn Goring: six and twelve string guitar, bongos
I was born in Kings College Hospital in Camberwell, south London. After being thrown out of school at 16, I went to Ravensbourne Art College where I met Roger Wootton. I soon discovered that Roger and I shared a passion not only for art but also for music. We began playing Velvet Underground songs in traditional folk clubs, which, surprisingly, never went down at all well. Our folk duo turned into a band that would eventually become Comus. After making "First Utterance" and somewhat disillusioned with the music business I left the band in 1972, returned to Art College to finish my studies, and gained a BA in Fine Art. I then moved to Norfolk in 1978 where I began a career as a freelance picture restorer and copyist of old masters as well as making my own paintings and sculptures. In 1990, I became an official copyist for the National Portrait gallery.
During the early eighties, I also started writing for stage and radio. Andrew Hellaby, with whom I had never lost contact since leaving the original Comus, composed the music and FX score for my play "Captain Jack Goes Down" which I also directed.
In 1989, I gained an MA in creative writing at the University of East Anglia. Here I was lucky enough to be tutored by Malcolm Bradbury and Angela Carter. I concentrated mainly on writing narrative fiction and wrote several short stories and a novel. However, throughout my life, I have never given up music. With a group of friends, I formed a band called The Hollow Men. I wrote songs, played the guitar, and sang.
In the nineties, my guitar playing went through a period of change. I love flamenco so a guitarist friend of mine taught me some basic techniques. We formed a duo and played a kind of hybrid flamenco-jazz-folk in clubs and bars in and around East Anglia.
More recently, in the 2000s, I won an award to develop an original film script based on a play I'd written. I was also commissioned to write a half-hour TV drama that was broadcast on Anglia television.
I'm still here in the wilds of Norfolk, painting, writing, making stuff and playing more music than ever. I also have a passion for growing garlic and very hot organic chillies. Roger and I are the chilli heads in the band.
Visit Glenn's art website.

redpajama_set_name: RedPajamaCommonCrawl


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IMGA → And the IMGA MENA Excellence in Art award goes to… Mafioso! (Pesarkhande)
And the IMGA MENA Excellence in Art award goes to… Mafioso! (Pesarkhande)
Mafioso (Pesarkhande) is a multiplayer turn-based strategy game, narrating a course of events when Mafia groups seized the control of different city districts. Innovative, engaging gameplay and iconic characters with unique art style make Mafioso an appealing experience.
This is an interview with Mohamad Zehtabi from Paeezan Game Studio.
Mafioso won the 2nd IMGA MENA Excellence in Art award.
Can you introduce yourself?
Paeezan Game Studio is an independent game studio based in Iran. Our goal is to create high-quality multiplayer games for players all over the world.
For those who don't know Mafioso (Pesarkhande), can you give us one sentence to describe your game?
Mafioso is a PVP turned-based strategy game which players need to collect heroes, upgrade their abilities and use them wisely in battles in different arenas.
What makes your game unique?
Mafioso focuses on innovative and engaging gameplay and iconic characters with a unique art style. Mafioso benefits from elements of turn-based strategy, online battle arena, and card games, so a wide selection of game characters and precise and timely use of their abilities and efficient utilization of mana points are essential to winning battles. The characters are inspired by Tehran's lifestyle in the 60s and Italian mafia mobs. Each and every one of them has their own unique sense of style and clothing according to their personalities. Mafioso has a kind of dark comic vibe which we tried to reflect that humor through the characters in the best way we could.
Now about you and your team: what's the story behind your studio's creation?
We are an independent game development studio who has been working on different PC and mobile title games for more than 6 years now. Our first project "E.T. Armies" which has been produced by our development team was voted as the most anticipated indie game of 2013 by indedb.com community. Our second project is called "Magnis" which is a mobile title with a unique and challenging gameplay. Currently, we're working on our new title "Mafioso" and we have many exciting plans for developing it.
The comic-style design is amazing, the game is challenging and fun in the meantime. What inspired you?
At First, we had 3 different prototypes and after making those prototypes we come to realize that which kind of gameplay could be more fun and challenging for the players. We set our goal to make a strategy game that is different from other strategy games a game that has a new art-style and gameplay and also easy to learn but in the meantime hard to master so Mafioso is based on our 3 other games and it is the mixture of our ideas. And if I want to say what inspired our art, designing our characters and storylines I must say Tehran's lifestyle in the 60s and Italian mafia mobs and some movies such as GodFather, Good Fellas, and some other crime thrilling movies were a huge inspiration to us.
How do you feel about winning an IMGA award? Tell us about your victory.
It was so overwhelming for us we were so excited for Winning the title "Excellence in Art". Since we have not published our game globally yet and it was in our plan to do so now winning this title surely could helps us to get to that point that we wanted to achieve and also Getting selected by different judges from around the world with the various and different point of views and cultures means we did our job on that field in the best way and we are trying to making our game better and better for the IMGA global contest.
Any new game or project coming out in the next months? Anything else you would like to say to the world
We have some ideas for starting a new project but Right now like I mentioned earlier we are on the verge of publishing our game worldwide so we are working a hard as we can on the game to make it ready for all the players out there.
Lastly, we want to thank IMGA for choosing us as the best game in Art in MENA region that made us so honored and happy and we will try our best for the IMGA Global contest.
Discover all winners at http://mena.imgawards.com/winners-nominees/2nd-imga-mena/
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A lot of yokai have recurring themes to them: prostitutes, priests, young boys… these are not coincidences. These different classes of yokai are all there for reasons. In some of the cases, they are commentaries on societal problems that Toriyama Sekien and other yokai-ologists saw in Edo period Japan.
Another commonly recurring theme is having one eye. A number of yokai have this trait, ao bozu, hitotsume nyudo, hitotsume kozo, yamajijii, dorotabo, ippondatara of course… the list goes on and on. So where does this trait come from. Why are there so many one-eyed gods?
The most common theory is pretty interesting, and it is related to yesterday's topic: just what makes a yokai a yokai and not something else? Scholars believe that many one-eyed yokai may actually be former mountain gods who were forgotten over time and corrupted into yokai.
You may have heard that Japan is the land of 8 million kami. That's not really an exaggeration either. There are kami everywhere. Every river, every tree, and yes, even every mountain has its own local kami. Of course beliefs change, populations move, and oral traditions evolve, so those kami may change over time, or be forgotten, or be replaced by other kami brought in by migrants. And what happens to the old kami that get demoted? Maybe they turn into yokai.
Ippondatara's story is particularly interesting because not only is he attached to a very specific place (a mountain range located between Nara and Wakayama) but he is also attached to a very specific time (December 20th). Why this day? Well, it is very close to the winter solstice, when fall ends and winter begins. Perhaps that was a holy day related to some long-forgotten god of those mountains between Nara and Wakayama… In that area, children are warned to stay out of the mountains on that day, and it is considered unlucky. Why? Maybe the change from bountiful fall into cold, dead winter was associated with death or misfortune in some old local superstition? Changes in the season are also strongly associated with yokai and evil spirits. In some area, kappa are said to transform from water spirits into mountain spirits (maybe even gods?) during the change from fall to winter. Perhaps that day was associated with kappa migrations? Perhaps ippondatara picked up parts of that legend over time?
All of this is purely speculation. Nobody knows for sure, and that is part of the appeal of folklore. There is this hint, just a faint whiff of a truth buried in there somewhere. We can look at the oral traditions and remnants of ancient legends passed down, with all of the changes, additions, and subtractions applied over the centuries, and try to figure out what, if anything, it means. But looking at all of these points; the date, the one eye, and the similarities between other yokai, it seems impossible that there isn't some connection doesn't it? Ippondatara must fit in there somewhere. Of course, we probably will never know… but then, that's the fun of it! If we knew for sure, he wouldn't be a yokai would he?


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Musicivic incubates sustainable, locally-based, professional chamber music organizations supporting social, cultural, educational, and compassionate vitality in towns and communities everywhere. Check out exciting adult and youth programming for our first collaboration. The Makery and Musicivic!
Musicivic @ The Makery
Open rehearsal/wine reception - 8pm
Join us at The Makery and get to know our classical ensemble in residence, Musicivic Baroque! They will be performing several concerts in a 3-day residency including a children's concert, Music & Making for adults, and a formal evening concert. The open rehearsal and wine reception on June 17 is open to the public and provides a chance to observe and engage with the process of musicians rehearsing and putting together a program of music during which the audience can ask questions. Repertoire will include early 17th and 18th Century including the elegant Telemann "Paris" Quartet No. 3. Musicivic Baroque includes Natalie Kress, baroque violin; Elena Smith, viola da gamba; and Robert Warner, harpsichord. They will be joined by guests Lynn Hallarman, traverso; and Chloe Prendergast, baroque violin. Limited Space, Tickets required
- Donation suggested but not required - $15/pp
Kids Craft+Concert - 4-6pm
Come enjoy a kid-friendly concert at The Makery! Sit up close, ask questions, and learn about the special musical instruments from the 17th and 18th centuries such as the harpsichord, traverso, viola da gamba, and violin. Have the option to take part in a craft while enjoying the music! Limited Space, Tickets Required
-Donation suggested but not required -$10pp
-Craft included with donation
Music & Making - 8pm
Enjoy making a craft at The Makery while listening to an inspiring concert by Musicivic Baroque and enjoying a refreshing glass of wine. Let the music inspire you to create as Musicivic Baroque performs baroque gems from 17th and 18th Century Europe on period instruments including harpsichord, traverso, viola da gamba, and baroque violin!
Limited Space, Tickets Required
- Craft included with donation
Wednesday, June 19, 8pm
Musicivic Baroque - 8pm
Enjoy a beautiful concert of 17th and 18th Century music performed on period instruments while enjoying a glass of wine. Musicivic Baroque consists of Natalie Kress, baroque violin; Elena Smith, viola da gamba; and Robert Warner, harpsichord; and will be joined by guests Lynn Hallarman, traverso; and Chloe Prendergast, baroque violin. Explore baroque Europe in pieces both fiery and elegant such as Castello duo decima a3 and Telemann "Paris" Quartet No. 3 and please stay afterwards to meet the artists and explore The Makery! Limited Space, Tickets Required
- Donation Suggested but not required -$15pp
Musicivic Baroque
Natalie Kress, Baroque Violin
Praised by the New York Times for her "splendid playing", 29 year old Natalie Kress has already begun a successful career as both a modern and baroque violinist; highlights of which include performing at the Kennedy Center Honors with Yo Yo Ma in 2015; winning the 2012 Jules C. Reiner Violin Prize from the Tanglewood Music Center; as well as performances at Carnegie Hall in 2010 and 2016. Natalie received her Bachelor's of Arts in Music and Psychology and Master's in Music from Stony Brook University (where she studied with Soovin Kim) and is founder of the Three Village Chamber Players which performs free chamber music and outreach concerts throughout Long Island and New York State (3vcp.org). Natalie is a co-founder and an Executive Advisor of Musicivic Inc. (musicivic.net), which is a national non-profit arts incubator, accelerator, and managed services network supporting local professional chamber music organizations in towns and communities everywhere. As a baroque violinist Natalie is the Director of Musicivic Baroque and has performed with Boston's Handel and Haydn Society, Grand Harmonie, Stony Brook Baroque, Shanghai Camerata, and La Grande Bande. She will begin studies at The Juilliard School this fall as a graduate student in Historical Performance.
Elena Smith, Viola da Gamba and Baroque Cello:
A Philadelphia native, Elena Smith maintains an active career performing on modern cello, baroque cello, and viola da gamba. She received her B.Mus in Cello Performance from Temple University, where she studied with Jeffrey Solow. Ms. Smith has studied with Kathryn Picht-Read, Phoebe Carrai, Sarah Cunningham, and has performed in masterclass for Marcy Rosen, Peter Stumpf, Jean-Guihen Queyras, Jörg-Michael Schwarz, Thomas Fritzsch, Paolo Pandolfo, Todd Phillips, Daniel Phillips, and The Lysander Trio.
Ms. Smith is a core member and newly-appointed manager of Blue Line String Quartet, and she is a founding member of Muse Camerata, an all-female ensemble that specializes in performing music from the sixteenth through eighteenth centuries. She has appeared with Venice Baroque Orchestra, New York City Opera, Gamut Bach Ensemble, Crescendo Period Instrument Orchestra, Elysium String Quartet, Fairmount Chamber Ensemble, Wayne Oratorio Society, Chiaroscuro Consort of Viols, Ex Umbris, Elm City Consort, and many other ensembles on the East Coast, including as a soloist with the Olney Symphony Orchestra.
Ms. Smith has participated in Juilliard at the Piccola Accademia, American Bach Soloists Academy, International Masterclasses in Gaming, Austria, Accademia Viol Intensive at Early Music Week at Pinewoods, the annual conclave of the Viola da Gamba Society of America, International Baroque Institute at Longy, and Amherst Baroque Academy.
Ms. Smith resides in Philadelphia, PA, and teaches cello privately throughout the Philadelphia area.
Robert Warner, Harpsichord:
A native of Pennsylvania, Robert Warner began his musical studies at an early age in piano and violin with faculty of Bucknell University. He holds bachelors degrees in both math and music from the University of Rochester, and became interested in the world of early music while exploring the harpsichord and baroque violin at the Eastman School of Music. As a graduate student at Stony Brook University, Robert studied harpsichord extensively with Arthur Haas while earning master's degrees in both music history and performance, followed by a DMA in harpsichord performance also at Stony Brook. During this time he gave frequent recitals, acted as assistant director of Stony Brook's Baroque ensemble, and collaborated often with other musicians as a harpsichordist and baroque violinist in chamber music, opera and orchestral performances.
Upon graduating from Stony Brook, Robert was accepted into the Juilliard School's Historical Performance program, continuing his harpsichord studies with Peter Sykes. During this time he participated in projects led by William Christie, Jordi Savall, and other leading figures in the field of early music with frequent performances in New York City's Alice Tully Hall and international tours to the Netherlands and New Zealand.
Robert has participated in most of the country's top early music summer festivals, including the American Bach Soloists Academy in San Francisco and the Oregon Bach Festival's Berwick Academy. Robert now resides in New York City where he continues to be an active performer. He is currently the artistic director and harpsichordist of the New Amsterdam Consort, the harpsichordist for Voyage Sonique, and a founding member and harpsichordist of Musicivic Baroque.
Lynn Hallarman, Traverso:
Dr. Lynn Hallarman was the Director of Palliative Care Services at Stony Brook Hospital in Stony Brook, NY, from 2007-2018, during which it received national recognition and numerous awards. She is a graduate of Yale University School of Medicine and completed her residency training at Strong Memorial Hospital in Rochester, NY. Dr. Hallarman is the recipient of the 2010 Stony Brook Medicine Education Innovation Award for her curriculum work and is currently grant funded to develop a medical student curriculum on health equity and the seriously ill patient. She has worked on the national level as a primary author on palliative care pain and communication curriculum for the Center to Advance Palliative Care.
As a professional traverso player, Dr. Hallarman studied at the Manhattan School of Music and is currently a graduate student at Stony Brook University under the mentorship of harpsichordist Arthur Haas. Dr Hallarman studies traverso privately with Sang Joon Park and Sandra Miller of the Juilliard School, and has played for international artist, Na'ama Lion, at the International Baroque Institute at Longy and Amherst Early Music Festival.
Chloe Prendergast, Baroque Violin
Chloe Prendergast is a violinist originally from Denver, Colorado. As a historical performance specialist and devoted chamber musician, she is co-artistic director of the Beethoven Festival of the Hague and MusicBox, a concert series dedicated to dismantling barriers surrounding classical music performance. Chloe is a member of Holland Baroque, founding member of the Butter Quartet and Duo 't Viooltje, and has performed both in the Netherlands and the United States with groups including the Handel and Haydn Society, Seattle's Pacific Musicworks, the Henry Purcell Society of Boston, the Baroque Chamber Orchestra of Colorado, Luthers Bach Ensemble, Collegium Ad Mosam, Le Concert d'Apollon, the Arcadia Players, and Dutch Baroque. She has also appeared at music festivals internationally, including the Connecticut Early Music Festival, the Utrecht Early Music Fringe Festival, and Aigues-Vives en Musique. Chloe completed her master's degree at the Royal Conservatory of the Hague with Kati Debretzeni and Walter Reiter and her bachelor's degree at Willamette University, where she was a Phil Hanni scholar and studied principally with Anthea Kreston and Daniel Rouslin.


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Diversity & Equality in Health and Care
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Managers? perspectives on promotion and professional development for black African nurses in the UK
Gloria Likupe BSc (Hons) MSc PhD DipN RN1*,Carol Baxter CBE PhD FRSA MFPHM2, Mohamed Jogi MSc MA LLB (Hons)3and Uduak Archibong BSc PhD FWACN FRCN4
Lecturer, Faculty of Health and Social Care, University of Hull, Hull, UK
Head of Equality, Diversity and Human Rights, NHS Employers, Leeds, UK
National Programme Manager, NHS Employers, Leeds, UK
Professor of Diversity, University of Bradford, Bradford, UK
*Corresponding Author:
Gloria Likupe, Faculty of Health and Social Care, University of Hull, Hull HU6 7RX, UK. Tel: +44 (0)1482 4600; fax: +44 (0)1482 464695; email: [email protected]
Received: 4 September 2013 Accepted: 9 February 2014
Visit for more related articles at Diversity & Equality in Health and Care
An exploratory qualitative study design was adopted for this study and underpinned by Rex's migrant workers framework (Rex, 1999). Semi-structured interviews were conducted with ten ward managers from four NHS trusts in the north-east of England to gain an insight into their experiences of working with black African nurses with regard to equal opportunities in accessing professional development and promotion. Managers reported that black African nurses experienced racism from patients, racism from colleagues, discrimination and lack of equal opportunities. A unique finding of the study was that managers stereotyped black African nurses as lacking motivation for professional development and promotion.The authors recommend that NHS ward managers receive training in implementing anti discrimination policies and valuing equalityand diversity.
black African nurses, discrimination, nurse migration, professional development, promotion.
The 1990s and early 2000s saw unprecedented recruitment of nurses fromoverseas to the UK, to work both in the NHS and in the private sector. Data from the Nursing and Midwifery Council (2004, 2005) showed that during 2002–2003 more than half of all newly registered nurses were from outside the UK. A substantial number of these nurses came from sub- Saharan Africa. Buchan et al (2004) found an increase in the number of African nurses being recruited to London hospitals. The highest proportion were from South Africa (17%), followed by Nigeria (6%) and Ghana (3%). Allan and Larsen (2003) reported that nurses from South Africa, Zimbabwe and Nigeria contributed a large number of nurses to their focus group interviews on the experience of internationally recruited nurses. Data from the World Health Organization (2006) indicate that nurses and midwives trained in sub-Saharan Africa and working in Organisation for Economic Co-operation and Development (OECD) countries represented 5% of the workforce. Nurse migration is a global phenomenon as more and more countries become reliant on international recruitment to address nurse shortages (Kingma, 2001, 2006).
Nurse academics have focused their research on motivational factors for overseas nurses relocating to the UK, and experiences of overseas nurses working in the UK (Shields and Wheatley Price, 2002; Buchan, 2002; Allan and Larsen, 2003; Withers and Snowball, 2003; Gerrish and Griffith, 2004; Taylor, 2005; Smith et al, 2006; McGregor, 2006; Alexis et al, 2006; Larsen, 2007; Henry, 2007; Alexis, 2009; Okougha and Tilki, 2010; Likupe, 2013). These authors reported that overseas nurses were motivated to relocate to the UK for personal reasons such as material gain and professional development. Likupe (2013) also pointed out that recruitment of overseas nurses and policies have contributed to nurse migration. The nurses in most of these studies reported negative experiences, including racism, discrimination, and lack of equal opportunities in the workplace. In particular, Shields andWheatley Price (2002) reported that black African nurses experienced discrimination and faced racism more often than other groups of ethnic minority nurses. This paper focuses on the perspectives of nurse managers of wards in which black African nurses were employed.
Previous studies have investigated the experiences of overseas nurses from their managers' perspectives (Gerrish and Griffith, 2004; Smith et al, 2006; O'Brien, 2007; Allan, 2010). Most of their findings were also negative. Gerrish and Griffith's measurement of success was biased towards the advantages of employing overseas nurses in the NHS, with little focus on the experiences of the nurses themselves during the adaptation period, or their social experiences in the UK (Gerrish and Griffith, 2004). Smith et al (2006) reported that promotion to management posts in the NHS appeared to involve a system of patronage and sponsorship. Furthermore, they observed that stakeholders recognised that differences in culture contributed to some overseas nurses experiencing feelings of isolation, and that this in turn affected their career progress. Overseas nurses perceived the system of promotion that was dependent on patronage and sponsorships as institutional racism and discrimination, as the process was not transparent. Allan (2010) reported that managers were concerned that skills learned overseas might not be up to UK standards, and as a result overseas nurses were placed at the bottom of ward hierarchies and discriminated against.
Ashraf (2013) has stated that BME staff are still experiencing discrimination, especially in leadership and management posts in the NHS, despite various positive action initiatives, such as Getting on Against the Odds (Department of Health, 2002) and the 'breakthrough' programme (NHS Executive, 2003). Kline (2013) echoes the same sentiment by stating that BME staff are discriminated against in the recruitment and promotion processes. Kline (2013, p. 6) adds that 'BME staff are grossly under-represented among senior management but disproportionately involved in disciplinary grievances, bullying and harassment cases and capability reviews.' In addition, black African nurses are over-represented in referrals more than any other ethnic group, and most of them are dismissed with no case to answer (Royal College of Nursing, 2013).
The reasons for discrimination are complex. One explanation is provided by the implicit association test (IAT), which was developed by Greenwald et al (1998) to establish why people discriminate. Implicit attitudes are associated with unconscious bias and can help to predict certain behaviours and judgements directed at members of certain groups or inform decisions about who should be employed or promoted (Dasgupta, 2004). Implicit attitudes may explain why black African nurses face the most discrimination in the NHS.
Promotion of equality of opportunity has a business as well as a moral case. A systematic review of the literature conducted on behalf of the UK Government's Equalities Office in 2013 (Department of Business, Innovation and Skills, 2013) stated that the implementation of equality policies is good for recruitment and retention of staff, productivity of staff in the organisation, a good reputation and mitigation of the risk of litigation. The UK Equality Act (2010) aims to eliminate all forms of discrimination in order to foster these factors.
It is acknowledged that different groups of overseas nurses may have different experiences in the NHS depending on cultural, nurse education and development factors of their home countries (Royal College of Nursing, 2008). It is therefore important to gain managers' perspectives on their experience of working with overseas nurses. This study aimed to explore, from their managers' perspectives, black African nurses' experiences of discrimination and equal opportunities in the NHS, in relation to access to professional development and promotion opportunities.
Rex's migrant workers' framework was used to underpin the study. Rex (1999) links race relations to other sets of social relationships, such as class. In Rex's model, race relations are encouraged by the existence of structural conditions such as conflict over scarce resources. He identifies the existence of a number of unwanted and low-status industrial jobs that are associated with immigrants, and shunned by locals, as a source of greater relative deprivation for immigrants. The situation with regard to nursing is of course different, as nursing is classed as a skilled profession (Iredale, 2001), and qualified nurses have an entry level to the profession regardless of immigration status. However, it is progression in the profession that may relate to Rex's framework, since immigrant nurses are most likely to be found in the lower grades, as these are the grades that are least appealing to UK nurses. In the present study all of the nurses were employed at entry grade regardless of their qualifications and experience. Managers reported that this was NHS policy because the nurses required an adaptation period in which to familiarise themselves with UK nursing practices. However it was not uncommon for nurses to be on this grade for two years or longer.
Rex (1999) argues that stratification and other structural factors characterise race relations situations. Some race relations are based on a class system in which there is an exploitative relationship between the upper and lower classes. However, Rex concedes that a system of this kind is less perfect in modern times, and that it breaks down into a status system: 'Everyone is therefore allocated a certain standing in society along a quantitative scale. This position accorded to a man may be high or low according to the lightness or darkness of his skin' (Rex, 1999, p. 339). A race relation situation arises when:
1 one group of people behaves towards another group of people in a way that denies them equal access to social services
2 the groups involved are recognised by signs that are regarded as unalterable
3 the unequal relationship between the groups is justified by various deterministic beliefs (Rex, 1970).
The first of these conditions emphasises the significance of inequality, the second emphasises the importance of physical differences, and the third emphasises the subordinate group's possession of the negative characteristics that justify racial inequality (Pilkington, 2003; Department of Health, 2005). These ideas, which originated in the nineteenth century, have their foundation in the belief that black people are biologically inferior to white people.
The above-mentioned three conditions which give rise to race relations are distinguished by Pilkington (2003) as racialism and racism. Racialism consists of practices that disadvantage people on the basis of their supposed membership of a particular race, whereas racism consists of beliefs that the disadvantaged group invariably has those characteristics attributed to it. Racism is directly related to discrimination, as it creates and justifies unequal relationships between groups (Pilkington, 2003).The best example of a race situation is imperialism, which involved the domination of white western European countries over countries in which most people were of different skin colour (Rex, 1999; Pilkington, 2003). In the case of Britain, this was manifested by colonisation of most of sub-Saharan Africa. It can therefore be argued that nurse recruitment from sub-Saharan Africa is a colonial legacy brought about by a common language and education. This colonial legacy manifested itself as the perception of 'the other' directed towards black African nurses expressed as overt or covert racism and discrimination. This is supported by the findings of Larsen (2007), Smith et al (2006) and Allan (2010), among others, who reported that overseas nurses felt they were isolated by managers when it came to professional development and promotion.
Aim of the study
This study is part of a larger qualitative study, aimed at exploring the experiences of black African nurses in the UK, which took place between 2006 and 2009. This part of the study focused on exploring the experiences of the nurses from their managers' perspectives in the various settings in which they were employed.
Study sample
Four large NHS trusts where the proportion of ethnic minority nurseswas known were chosen for this study. Managers were selected on the basis that they supervised and worked with black African nurses and therefore had had the experience that the researchers wanted to study. There was no need for nurses to share their experience with their managers, as it was the managers' perspective of their experience with black African nurses that was required. Eight managers were interviewed individually and two managers were interviewed together (see Table 1).
Before the study commenced, a protocol describing its aims and objectives as well as the methods of investigation and dissemination of the results was sent to the Central Office of Research Ethics Committee (COREC) and the Multi-Centre Research Ethics Committee (MREC), and was granted approval. The protocol was then sent to the research and development committees of the four selected hospitals (Department of Health, 2005), and was granted approval in all four cases. Managers were assured that they would not be identified in any report or publication emanating from the study. They were also informed that they could terminate the interview at any time if they had any concerns about it. Information relating to the research was provided and managers were informed that they could withdraw at any time without giving any reason. All of the managers agreed to participate in the study. Informed consent was obtained from each of the managers prior to the interviews.
Data for this part of the study were collected in December 2009. Semi-structured interviews were used to collect data from managers who were supervising black African nurses, in order to obtain their perspectives on the experiences of nurses from this section of the population. This method allowed the participants to talk about their experiences in order to obtain 'thick' descriptions (Brinkman, 2012). Flexibility allowed for responses to be fully probed and explored (Kvale and Brinkman, 2009). This involved interpreting both what was said and how it was said. For this reason the interviews were tape recorded so that they could be transcribed verbatim and also listened to again during data analysis.
The interviews lasted for 90–130 minutes. Each interview started with the question 'Please tell me your experiences of working with black African nurses.' Subsequent questions depended on the answer to this question. Other broad questions and probes included the following:
• 'How do you value the skills of the Black African nurse?'
• 'Tell me about any difference in practice that you notice.'
• 'What support do you give to black African nurses?'
• 'What is your understanding of equal opportunities?'
• 'Tell me how you make sure that opportunities are accessed equally on your ward.'
The audio-recorded data were transcribed verbatim soon after the interviews. The analytic framework described by Spencer et al (2003) was used as a platform for initial ordering of the data. This involves four recursive phases:
1 construction of a coding table based on issues and questions derived from the literature review, the aims and objectives of the study, and recurring views and experiences of the participants
2 coding or indexing of the data, whereby the framework is applied to the data in a systematic way
Table 1: Managers, manager profiles and number of nurses supervised
3 charting, whereby a chart is created and the data are sorted by summarising the participant's views and experiences
4 mapping and interpretation, whereby the summarised data are used to find relationships between themes and to provide explanations for the findings.
In order to do this the first researcher familiarised herself with the data by listening to the tapes again and comparing them with the transcriptions. This process continued until the researcher felt that she had understood the characteristics of the data. While reviewing the data the researcher simultaneously identified recurring themes and ideas. These themes were then sorted and grouped under main themes and subthemes.
Managers' experiences with black African nurses centred on two main themes and their related subthemes:
1 racism and stereotyping:
• racism from patients
• racism from colleagues
• stereotyping from managers
2 discrimination and equal opportunities:
• availability of information on development opportunities
• lack of support.
Racism and stereotyping
The majority of the managers indicated that black African nurses suffered racism from patients as well as from colleagues. Some managers also displayed stereotyping between different groups of overseas nurses. The language used by managers in the interviews was carefully worded, yet stereotyping could be discerned. Racism can be very subtle; one can practise it without even realising it (Potter and Wetherell, 1987).
Racism from patients
Racism from patients was manifested in various ways, but mainly through racist comments and attitudes:
When we are working we hear them say things [about the African nurses] but we just carry on because we know that's what old people can be like.
(Charge nurse, medical elderly ward)
From a cultural point of view I think the issues are when nurses come towards the patients who are prejudiced but I haven't really come across a lot of that, they tend to be more isolated incidents.
(Charge nurse, medical ward)
Some managers attributed patients' racist attitudes to age. Others attributed them to personality or a patient's condition:
There is one patient who has got psychological problems and he would say like I don't want a black nurse but you do make allowances for that but generally they are alright.
(Charge nurse, colorectal ward)
Comments about racism towards African nurses came mostly from charge nurses on medical wards. It may be that older adults have had the least contact with black people and have had the longest exposure to stereotyped images of black Africans, and are therefore more likely to display racist attitudes. Marks (1994) described cases in South Africa where white patients refused to be nursed by black nurses, and attributed this attitude to racist socialisation. However, lack of appreciation of cultural differences on the part of black African nurses could account for interpreting older patients' behaviour (in some cases) as racism. Larkey (1996) also highlighted categorisation of different races and specifications of various cultures as two processes that inform theway people stereotype each other and anticipate certain types of behaviours.
It was not clear from managers what was done to manage the situation so that stress could be minimised.
Racism from colleagues
Managers described cases where black African nurses were bullied and some of them were subjected to name calling:
I think she felt bullied as well because people's expectations were a lot higher, all the time she was aware that people were looking at her practice.
don't like saying these things either because I feel disloyal to them [white nurses] by saying that. But some of the staff are harsh, they have got this harsh side to them but I really feel sorry saying that.
(Charge nurse, surgical ward)
Managers appeared to contribute to racism through inappropriate scrutiny of black African nurses and instructing others to practise such scrutiny as well:
I still observe because they could fib to me. They might say yes I can do this but I still got to be aware that they could be telling me a few mistruths. It's not only my eyes but somebody else's eyes as well, and they are monitoring as well.
This charge nurse mistrusted black African nurses to the point of arranging special observations.
Stereotyping from managers
Although the managers recognised that black African nurses were facing racism, they failed to recognise that they themselves were contributing to this. Racism from managers came in the form of stereotyping, as they indicated that other overseas nurses were better at their job than black African nurses. For example, a ward manager made the following statements about a Filipino nurse and black African nurses on her medical ward:
She is Filipino and she is an excellent staff nurse and I think she would be excellent as a junior sister but she is not interested, she doesn't want the aggravation, doesn't want the responsibility. So what I have done is we have two kits for our Band 6, I have dug them out and I have started to work through them with her to develop her further, but at the end of the day if they don't want to develop you can't make them, can you? ... I would probably say that [name of black African nurse]'s knowledge of hospital policies it is probably very limited, because again they focus on patients.
(Charge nurse, renal ward)
African nurses are not bothered about developing themselves; they just want to go back to Africa. They are just concerned with their work but they are not bothered.
These statements seem to favour the Filipino nurse. This manager thought that the Filipino nurse was excellent and that the African nurse had no comprehension of hospital policies. The fact that the manager seemed to be providing information to the Filipino nurse and not to the black African nurse is noteworthy; this information would apparently be wasted on the African nurse as she would be unable to articulate and use the information. Here it seems that stereotyping led to discrimination as the African nurse was denied information on the premise that African nurses do not want to develop themselves. A charge nurse from a different area also said:
There was one Filipino nurse who was here for three years and was extremely good and I had jobs on ward 19A and she was really good, an E grade post came up and I said why you don't go for it. But it took a good two years of bullying in a nice way. But like I said for [the black African nurse] there hasn't been an opportunity on this ward, but there have been on other wards. I know she likes it here, she likes the people, she likes the work, and it works out well within her home life.
The charge nurse went out of his way to encourage the Filipino nurse to apply for promotion because she was 'extremely good', but preferred the black African nurse to stay on the ward as she supposedly liked it there. The charge nurse had apparently not informed the black African nurse of promotion opportunities elsewhere, but assumed that she was happy with her grade on the ward. Different managers made similar remarks about overseas nurses from different areas that seemed to indicate that black African nurses had low motivation and were less capable than other overseas nurses, so it was not worth encouraging them to develop professionally.
Discrimination and equal opportunities
Availability of information on development opportunities
Some managers saw it as their responsibility to inform nurses of development opportunities on the ward through various means, and blamed nurses for not being motivated enough to take up opportunities when they were offered. These opportunities were mainly in the form of courses and study days:
It's my duty to make sure that I disseminate all the information that I get to my staff. So I will put out all the information, but it's up to them to read it. I will pop out information for them to read. And it's not just for [name of black African nurses], but you will find junior staff, because they are junior, they can't see past the ward. I find that they do not push themselves to do courses. Again it's all about patients.
Some managers admitted that they did not discuss any professional development plans with black African nurses:
I don't know what they think because I have not had any discussion with them about their career path.
Others said that it was difficult to send African nurses for professional development because of funding problems:
I know colleagues who have African nurses in their wards and when they are doing their personal development plans on lots of courses and they ask for help with funding but at the moment the trust is quite stringent with how many study days one can do because they have to pay for them. So a lot of people don't get an awful lot but as far as I am aware it is fair between all the nurses on the ward and the ward manager would ensure that everybody would have equal access to study leave.
However, some managers admitted that it was difficult if not impossible to apply equal opportunities, as applicants could be identified from their application forms:
Someone on the panel that shortlist does not have access to the geographic background of the individuals. Having said that, we know that on the application form you have to write down where you had your education or professional qualifications, so you can identify individuals who were not educated in this country according to that. I am not suggesting that people don't work within equal opportunities, but I am saying if somebody knows that person whether they can be truly objective I don't know.
The only ethnic minority (black) manager who was interviewed in the study recounted how it had been difficult for her to develop and advance in her career:
To get the sister's post I have applied about three times before I got the sister's position, and I was convinced am going to leave the unit because I had to go off and do a Master's degree, I had to do a lot of courses, did everything and then when I applied for the job I realised that I amjust banging myself against a brick wall, then I thought I am going to leave and see if I can work with the consultants to do some sort of research.
(Charge nurse, critical care)
This charge nurse explained that black nurses had to prove themselves if they wanted to move up the career ladder. They had to get extra qualifications, and even then they did not gain the recognition they deserved:
I think that is where the problem lies. They do the courses and then afterwards they don't always get the responsibility.
Henry (2007) described the same phenomena in a study of perceptions of career progression in the NHS of a group of nurses and midwives who had been trained in Ghana. Henry (2007) noted that lack of opportunities in career progression can lead to a demoralised, resentful and divided workforce. One then wonders how such a workforce is supposed to provide good-quality care for patients.
A related theme on equal opportunities was the lack of support for black African nurses. Managers explained that often there was no support on wards for nurses, due to staff shortages. Newly qualified nurses were able to cope better because they were educated in UK institutions but were also required to have a preceptor and a period of supervised practice. Black African nurses were allocated mentors, but working with a designated mentor was not always possible:
She didn't get as much support as what she should have done really, and she kind of came in and just got on with things and we tried to do it as best as we can, so it just took that bit longer, and slowly as months went by she just got more and more confident.
The charge nurses agreed that although the black African nurses were well qualified and practitioners in their own right, they still needed support to adapt to the UK system of nursing. Documentation and policies were special areas that were singled out as needing supervision.
This paper has presented managers' perspectives of the experiences of black African nurses in the UK. According to these managers, black African nurses experienced racism both from patients and from white colleagues. They also had less access to professional development and promotion opportunities. This is consistent with the findings of previous studies of overseas nurses (Shields and Wheatley Price, 2002; Buchan, 2002; Allan and Larsen, 2003; Withers and Snowball, 2003). More recently, in a survey of 30 NHS trusts in England, Kline (2013) found that the probability of BME staff being shortlisted for a job was less in 29 of the trusts; the probability of a white candidate being shortlisted was on average 3.48 times higher than for a BME applicant, and a white candidate was 1.78 times more likely to be appointed than a BME applicant. In addition, a report by the NHS Institute for Innovation and Improvement (2009), cited by Kline (2013, p. 8), observed that the shortage of BME senior managers in the NHS is partly due to 'racially biased recruitment' practices, and added that overseas qualifications are undervalued.
The Royal College of Nursing (2013) has launched a 3-year project entitled 'Is That Discrimination?' The first phase focuses on raising awareness of what discrimination is, and reminding RCN members of their employment rights as well as their right to work in environments that are free from unlawful discrimination. The second phase will focus on providing enhanced learning and developmental support for RCN's accredited representatives and caseworkers in identifying and effectively challenging workplace discrimination. It will be interesting to see how the different ethnic groups are treated in this project, and how effective developmental support will prove to be.
Kline (2013) explains that there is a clear correlation between how BME staff are treated in the NHS and the experience of patient care. This study has looked at the experiences of black African nurses from their managers' perspective, and confirms the experience reported by nurses in previous studies, suggesting that despite changes in equality legislation and equal opportunity policies, the situation has not changed much. The implication might be that patients are being denied the best care because selection and recruitment are biased by race, ethnicity and nationality.
The experience of racism from patients and colleagues observed by managers has been included in this discussion as this phenomenon has not been well explored in the literature. It may be that managers are influenced by the behaviour of patients and other nurses in their application of equal opportunities in the workplace, or it could be that implicit racial attitudes are in operation. If this is the case, there is an even stronger case for implementation of antiracist policies in the workplace, and for continual monitoring of this to ensure that these attitudes are eliminated among both staff and patients.
Managers often displayed prejudice and stereotyping attitudes toward black African nurses. They often described these nurses as abrupt and less motivated than other overseas nurses. Black African nurses were not trusted with regard to their skills, and were closely watched by both managers and white nurses. Managers often favoured other overseas nurses over African nurses. Although all BME staff are discriminated against with regard to professional development and promotion, this study has shown that black African nurses are at a particular disadvantage. This could be because their qualifications are perceived to be inadequate, or because managers are influenced by the state of healthcare in Africa, which is generally portrayed negatively both by the media and by the nurses themselves. It may be that managers need to be made aware that although black African nurses work in often under-resourced and poor conditions, it is these same conditions that provide opportunities for them to develop nursing skills which are often lacking among UK nurses (Likupe, 2011). The existence of racist attitudes as described by Rex (1999) earlier concerning skin colour should not be dismissed.
In addition to black Africans, nurse migration into the UK included a wide range of ethnic groups, including Afro Caribbean, European, Filipino and Indian nurses. Therefore the tendency to categorise all immigrant nurses as a homogeneous group perhaps needs to be revised. This may be a mistake, as different overseas nurses are viewed differently by both managers and white nurses in the UK, which may influence their chances of professional development and promotion. It may also influence their experiences of racism from both patients and colleagues, and thus how they are affected by these experiences.
The findings also suggest that managers are aware that black African nurses are discriminated against on the basis of race and nationality with regard to professional development and promotion. These findings are similar to those of Lemos and Crane (2001). Furthermore, Shields and Wheatley Price (2002), Allan and Larsen (2003), Alexis et al (2006) and Taylor (2005) reported that overseas nurses are denied training and career development. However, the majority of the managers did not seem to realise that they contributed to discrimination, nor did they take any action following allegations of discrimination from patients and colleagues. Likupe (2011) and Likupe and Archibong (2013) found that black African nurses are particularly disadvantaged. This is consistent with the findings of Sears and Henry (2003), who posited that symbolic racism and negative feelings about black people are based on early learned fears and stereotypes.
The results of this study are similar to those of O'Brien (2007), who reported that managers discriminated against overseas nurses not only with regard to use of technological skills but also in terms of selfdevelopment and promotion. However, the findings that managers did not trust black African nurses to tell the truth and that they thought black African nurses lacked motivation for self-development are unique to this study. This lack of trust in and stereotyping of black African nurses by managers could have implications for them in accessing professional development opportunities and promotion, and may contribute to what Kline (2013) calls 'discrimination by appointment.'
Equality and diversity have moral, business and legal implications. An inclusive work environment encourages participation by all staff members who share common values. According to the Equalities Review (2007), staff are more likely to be motivated and perform well in an organisation where everyone is valued and respected. They are also less likely to leave their jobs if they are working in such an environment. The costs associated with bad practice related to equality far outweigh the costs of implementing good practice (Employment Tribunal and EAT Statistics (GB), 2006–2007).
The managers stereotyped black African nurses as unmotivated, and therefore may have discriminated against them when allocating professional development opportunities and promotion. According to Rex (1999), this practice keeps a certain population on the bottom rung of the ladder, which is what seems to have happened to some of the black African nurses. The management approach adopted in this study appears to be embedded in institutional racism and consistent with treatment of migrant labour in the way described by Rex (1999). In this study, prejudice as practised by managers may have served as a divisive factor both among overseas nurses and among the nursing staff as a whole, with the potential to create a stressful environment for all concerned. It may also have resulted in discrimination with regard to pro fessional development and promotion, which would directly affect the quality of care given to patients.
The managers in this study did not mention competency and education as issues that were of concern in allocating resources for professional development or promotion. Racism appeared to be the primary motivation for denying the nurses opportunities. Kyriakides and Virdee (2003) reported that a climate exists in the NHS in which low standards are synonymous with overseas doctors from the new commonwealth, the term 'overseas doctor' being a euphemism for 'black doctor', whose medical standards are deemed inferior.Nursing studies of overseas nurses have not investigated this phenomenon to date. The results of this study indicate that perceptions of black African nurses in the UK may not be different from those of overseas doctors.
The study also highlights the importance of managers being aware of the experiences of overseas nurses. It is through this awareness that anti-discriminatory policies and practices which are locally relevant and locally owned can be implemented. There is a need to provide training in awareness of unconscious bias, as this study has shown that this influences decision making with regard to professional development and promotion. This training needs to be implemented at the time of recruitment of student nurses, and continue throughout their nursing training.
This study has demonstrated that black African nurses working in the NHS in the UK experience stereotyping, racism, discrimination and lack of opportunities. The practice among some managers of discriminating against black African nurses because of stereotypical attitudes could be detrimental to patient care and have a negative impact on the ability of NHS trusts to meet their responsibilities under the Equalities Act 2010. The NHS cares for a diverse population with different cultural needs. It iscommitted to providing care that is effective and sensitive to the needs of everyone. It is important that every nurse is valued, so that patients' healthcare needs are met in an inclusive and culturally sensitive manner.
Unfortunately, most of the managers in this study had stereotyped attitudes towards black African nurses. Some managers were positive and were operating equal opportunities policies in their practice. This is encouraging, and it should be promoted as good practice. However, managers need training in issues of inclusion and diversity in order to foster a positive team spirit in the workplace and ensure that nurses' skills from various backgrounds are utilised effectively in the care of patients. Robertson (2012, p. 5) supports this view, stating that 'diversity and inclusion training for managers should include bias testing and strategies for mitigating the impact of bias so that they have the opportunity to be consciously proactive.'
The Francis Report (Francis, 2013, p. 67) makes clear the importance of frontline staff in the provision of good-quality care, and states that 'patients must be the first priority in all that theNHS does ensuring that, within available resources, they receive effective care from caring, compassionate and committed staff, working within a common culture.' This culture can be created through a strong and fair leadership that values diversity and creates a common set of values among staff.
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