Work experiences of ethnic minority nurses: a qualitative study
Arab nurses in Israel
The Arab minority is the largest ethnic minority in Israel, comprising about 20 % of the population [10]. Arabs differ from the Jewish majority in Israel in religion, culture and language. Although they enjoy full citizenship, the Arab population’s socioeconomic status is lower, unemployment rates are higher, education levels are lower and income is lower [11, 12]. Moreover, the ongoing national conflict in the region and the inferior political status of Arabs in Israel place tremendous pressures on this population [13]. Health disparities between Arabs and Jews persist. Mortality and morbidity rates among the Arab population are higher than among the Jewish population and life expectancy is lower [14].
Health disparities persist despite the fact that, since 1995, equality in the provision and quality of healthcare for all citizens, including the Arab citizens, is mandated by Israel’s National Health Law. In addition, Israel’s Ministry of Health requires health organizations to invest in the accessibility of health care services to populations of different cultural origin and recommends, whenever possible, to recruit medical, paramedical, and administrative personnel from various linguistic and cultural groups [15].
The Israeli healthcare system therefore provides relatively equal employment opportunities to Arab citizens [16, 17]. This stands in contrast to certain other fields of employment, such as the military industry and other security-related fields, which are practically barred to Arabs [18, 19]. Besides the conflictual political situation, another obstacle to Arabs’ successful integration into the Israeli labor market is their lower level of education. Despite a sharp rise in the level of education among the Arab population (particularly among Christian-Arabs) [20], the rate of academics among the Arab minority is lower than that of academics among the Jewish majority [17].
In light of the obstacles Arabs face in the Israeli labor market, the nursing profession constitutes an outstanding career path for educated Arabs. Birenbaum-Carmeli [21] pointed to the increasing numbers of Arab nursing students in Israeli institutions of higher education. As a result, the Arab population is well represented in the profession of nursing, and its nursing employment rates are similar to the proportion of Arabs in the general population. Data gathered during the years 2011–2013 reveals that while the relevant Arab population (aged 15 and over) constitutes 18.3 % of the total population, the proportion of Arabs among all Israeli employees is only about 12.8 %. Yet Arabs account for 18.4 % of all nurses [22]. Nursing is a common employment path not only for Arab women [23] but also for Arab men [24, 25]. Even though nursing is a traditionally female occupation, nursing constitutes a major employment path for Arab men in Israel, who choose this profession far more frequently than do Jewish men. A total of 38.6 % of all Arab nurses were men, compared to only 7.5 % of Jews [25].
Scholars who examined what motivated Arab students to take up nursing found that they mentioned altruism, a desire to help others, followed by professional interest [26]; as well as the therapeutic aspect of the profession, professional practices (such as authority and responsibility) and employment conditions (such as working hours and wages) [27]. In their qualitative study, Arieli and Hirschfeld [28] found that while among Jewish nursing students pragmatic considerations constituted a relatively minor motivation for choosing nursing, almost all the Arab students they studied reported that their choice of nursing was basically rooted in pragmatic and instrumental considerations, since the profession would assure them relatively secure and gainful employment. Popper-Giveon and Keshet [25] likewise showed that Arab male nurses chose to practice nursing primarily because of the economic benefits of the profession, which enable them to perform the social role expected of young Arab men in Israel, namely to acquire property, build a home, marry and start a family.
Most of these studies focused on the Arab students’ motivations to choose the nursing profession. Their findings are important because they may help to recruit Arab nurses to the Israeli healthcare system. One particular research project [28] examined the ways Arab and Jewish nursing students, who study side by side in an academic school of nursing located in northern Israel, perceive each other, as well as the nature of the relationships among them. This study, which was based on semi-structured interviews, revealed that the students perceive themselves as constituting two separate groups according to nationality. While cooperation between the groups, which focuses mainly on study-related tasks, is described as generally satisfactory, social distance across these two groups is clearly felt. Another qualitative study of Arab nurses in Israel [29] addresses the experiences of registered nurses during their studies toward their Bachelor’s degree. Focusing on minority-majority relations in mixed work Jewish-Arab teams in healthcare organizations, these studies found that nurses cope quite effectively in their daily practice. However, working in a mixed team does tend to arouse anger, animosity, disrespect, tension and alienation, which, nurses reported, impede their functioning at work.
The findings indicated the presence of implicit discrimination and tensions associated with the salience of social categorization. These tensions exacerbated in crisis situations. In calm periods nurses manage to draw on similarities and embrace shared identities. Their major coping pattern was to deflect their disagreements to a “hidden sphere”. These nurses are largely left to their own devices in coping with these deep social and national schisms. These studies focused on working relations in mixed teams and cooperation among their members.
In line with these previous findings, the purpose of our research was to explore work experiences of Arab nurses in Israel, with a view to using our findings to plan further research on the subject of ethnic minority nurses in a multicultural society. We focused on the benefits gained and difficulties experienced by Arab nurses in their ongoing work in Israeli public hospitals, which serve both Jewish and Arab patients and employ both Jewish and Arab professionals. We emphasize mainly the experiences that are specific to them as members of an ethnic minority population; experiences that may contribute to our understanding of ethnic minority nurses in other multicultural contexts as well, and may have implications on job satisfaction, recruitment and retention of ethnic minority nurses in healthcare organizations.