Breaking barriers: A Blueprint for Inclusive Recruitment of Trainee Advanced Practitioners
Introduction
Inclusive recruitment practices are pivotal in cultivating diverse and thriving healthcare environments. By prioritising inclusivity, healthcare institutions can unlock the full potential of their workforce, leading to improved outcomes for both staff and patients alike.
Although the National Health Service (NHS) boasts one of the most ethnically diverse workforces in the public sector, evidence indicates that systemic and organisational discrimination persists within the healthcare sector (The King’s Fund, 2020). Effectively addressing this issue requires a paradigm shift that goes beyond individual change and involves a cultural transformation led by inclusive leadership (Kline, 2019). Advanced Practitioners, with their unique expertise and diverse skill sets, are ideally positioned as role models to champion this cultural shift. To achieve this, it is essential for advanced practitioners to comprehend the significance of equality and diversity and to exemplify diversity within the workforce. However, a recent review of NHS Workforce Race Equality Standards (WRES, 2022) by the North East and Yorkshire (NEY) Regional Faculty for Advancing Practice highlighted the significant underrepresentation of minority ethnic groups in advanced practice roles across the region.
The inclusion of a diverse advanced practice team offers numerous substantial benefits, such as improved patient care and outcomes, a more efficient healthcare delivery system, and the promotion of equitable opportunities for staff. By bolstering diversity in our workforce, we cultivate leaders with a wealth of experience, enabling them to better connect with employees, the public, and patients (Elliot et al, 2016). This, in turn, enriches capacity for understanding and relating to a broader range of perspectives. The NEY Regional Faculty is committed to enhancing representation and opportunities for all individuals. Consequently, this toolkit is designed to provide comprehensive resources, guidelines, and strategies aimed at promoting inclusivity in the selection of trainee Advanced Practitioners. It offers practical support to individuals, organisations, or institutions seeking to create environments that are welcoming, accessible, and equitable for all individuals, regardless of their background, identity, or characteristics.
Background
There is a widely acknowledged belief that a workforce mirroring the broader community it serves yields numerous advantages (NHS England, 2023). Having a representative workforce at every level enhances an organisation’s ability to address the needs of patients and provide high-quality, culturally sensitive, and appropriate healthcare. There are many equality strategies and standards to measure and improve performance, including:
- The Workplace Race Equality Standard (WRES)
- Workforce Disability Equality Standard (WDES)
- NHS equality, diversity and inclusion (EDI) improvement plan – NHS England » NHS equality, diversity, and inclusion improvement plan
- Gender Pay Audit
- Equality Delivery System (EDS)
- Care Quality Commission (CQC)
To actualise these benefits, a recruitment toolkit designed with a focus on equality and diversity will systematically embed these principles into the hiring process by providing structured guidelines and resources. It ensures that job descriptions are inclusive, job advertisements reach a diverse audience, and selection criteria are unbiased. Tools such as standardised interview questions, diversity training for hiring managers, and mechanisms to monitor and report on diversity metrics help to eliminate biases and promote a fair evaluation of candidates. By offering clear, actionable strategies, this toolkit aims to support organisations in building a diverse and equitable advanced practice workforce, fostering a more inclusive organisational culture.
Equality Act 2010
The aim of the Equality Act is to promote equality and prohibit discrimination in various aspects of life, including employment (The Equal Opportunity Act, 2010). The Act aims to ensure that everyone has the same opportunities and is treated with fairness and dignity, regardless of their background or characteristics. It also provides a legal framework for individuals to challenge discrimination and seek redress if they believe they have been treated unfairly. Overall, the Equality Act is designed to foster a more inclusive and equal society by preventing discrimination and promoting equal opportunities for all. Under the Act it is unlawful to discriminate against people because of nine protected characteristics:
- Age
- Disability
- Gender reassignment
- Race
- Religion and belief
- Sex
- Sexual orientation
- Marriage and civil partnership
- Pregnancy and maternity
The toolkit will incorporate these legal requirements, offering practical guidance on compliance as well as actively promoting fairness and inclusivity throughout recruitment practices, fostering a diverse and competent advanced practice workforce, ultimately enhancing patient care through a rich variety of perspectives and expertise.
Recruitment and selection training
All those involved in the recruitment of staff must complete mandatory training to understand their legal obligations at every stage of the process. This training should also tackle conscious and unconscious biases that could impact the applicant and the organisation and should cover topics such as reasonable adjustments, targeted adverts, and fair evaluation methods. Such training significantly improves inclusive practices in the following ways:
Legal Compliance
By receiving training on employment law, recruiters gain a clear understanding of their legal obligations and responsibilities. This ensures that recruitment processes are conducted in accordance with legal requirements, thereby reducing the risk of discriminatory practices and potential legal repercussions.
Promotion of Fairness
Training on biases, both conscious and unconscious, enables recruiters to recognise and mitigate their own biases throughout the recruitment process. This promotes fairness and impartiality, ensuring that all candidates are assessed based on their qualifications, skills, and suitability for the role, rather than irrelevant factors such as race, gender, or disability.
Awareness of Reasonable Adjustments
Training should cover topics such as reasonable adjustments to accommodate candidates with disabilities or specific needs. This ensures that recruiters are aware of the accommodations that may be necessary to provide equal opportunities for all applicants, thus fostering an inclusive recruitment environment.
Targeted and Promotional Job Advertisements
Training should educate recruiters on the importance of creating job advertisements that are inclusive and avoid discriminatory language or requirements. By understanding how to create targeted and promotional job advertisements that appeal to a diverse range of candidates, recruiters can attract a more diverse pool of applicants.
Questioning and Scoring Process
Training should also address the questioning and scoring process during interviews and assessments. Recruiters should be trained to ask relevant, non-discriminatory questions and to evaluate candidates based on predetermined, job-related criteria. This helps to ensure consistency and fairness in candidate evaluations, minimising the impact of biases on decision-making.
Unconscious Bias
Unconscious bias, also known as implicit bias, happens when our brains make quick judgments and assessments of people and situations without us realising (Oxtoby, 2020). Our biases are influenced by our background, cultural environment, and personal experiences, and can result in discriminatory treatment and unfair evaluations.
Although unconscious biases are a common aspect of human cognition, they pose a considerable risk to inclusive recruitment efforts by perpetuating unfair treatment and systemic inequalities in the workforce, which may lead to the exclusion of qualified candidates from underrepresented groups (Royal College of Nursing, 2023). These biases can influence decision-making, including hiring decisions, in subtle and unintentional ways, which can undermine efforts to create an inclusive and diverse workforce. It can creep in at any stage, from the language used in job descriptions; where a job is advertised; during candidate shortlisting; through to appointment. It is important to learn to recognise where it occurs; when it is occurring and to ensure there is a pause to take stock before making a judgement. Being aware that we all have biases and understanding the impact bias can have on judgements and decision making is a first step to influence and change behaviours. The following may help to counter unconscious biases:
| Principle | Action | Expected Outcome |
|---|---|---|
| Be honest with yourself. Understand the types of bias you have. | Engage in self-reflection to identify personal biases and preconceptions. | Increased self-awareness leading to more conscious decision-making and reduced influence of unconscious biases. |
| Change your outlook to prevent attribution bias. | Challenge assumptions and consider alternative explanations for behaviours or traits. | Reduction in the tendency to attribute traits to certain groups, leading to more objective evaluations and decisions. |
| Take your time. | Engage in thoughtful consideration and avoid rushing through assessments. | Improved quality of decisions, with greater accuracy and fairness in evaluations. |
| Include a variety of people in recruitment processes. | Ensure diversity in the shortlisting process by involving individuals from diverse backgrounds in candidate selection. | Enriched shortlist with candidates from various backgrounds, enhancing the potential for finding the best fit for the role. |
| Think about each person as an individual. | Challenge stereotypes and focus on evaluating candidates based on their unique qualities. | Enhanced appreciation for individual merits, resulting in fairer assessments and increased diversity in selections. |
| Consider your opinions and impressions of candidates. | Document your assessments to identify and address any biases or patterns in your evaluations. | Transparency in decision-making processes, enabling the detection and mitigation of biases, leading to fairer outcomes. |
| Have a diverse interview panel. | Form an interview panel that represents diverse backgrounds and perspectives. | Reduce bias, promote inclusive hiring practices and support diversity recruitment goals. |
| Improve everyone’s awareness of equality and diversity and inclusion. | Promote awareness through training sessions and discussions on inclusivity and bias. | Cultivation of a more inclusive organisational culture, where diversity is celebrated, and biases are actively addressed. |
Cultural awareness, competency and sensitivity
The foundation of cultural awareness lies in acknowledging the presence of both differences and similarities without attaching a positive or negative judgment to them (Kaihlanen et al, 2019). Cultures are moulded by various factors, including individuals’ experiences, upbringing, ethnic background, religious beliefs, social affiliations, and more. Enhancing intercultural understanding begins with the recognition that diverse cultures may approach situations in distinct ways (Kennedy et al, 2017). Cultural awareness, competency, and sensitivity regarding recruitment can be enhanced in the following ways:
| Strategy | Approach |
|---|---|
| Cultural competency training. | Develop deeper understanding of various cultures, traditions, and communication styles. |
| Cultural sensitivity in communication. | Use inclusive and culturally sensitive language in job descriptions, correspondence, and interviews. |
| Understanding Cultural Nuances. | Be familiar with cultural nuances affecting candidate communication for more accurate interpretation. |
| Adapted Assessment Methods. | Modify assessment methods to be culturally sensitive, ensuring relevance to diverse cultural contexts. |
| Inclusive Outreach. | Implement strategies to reach diverse candidate pools, such as targeted recruitment events. |
| Asking for Feedback. | Solicit candidate feedback on recruitment experiences to improve cultural sensitivity in the process. |
| Continuous learning, staying informed about equality, diversity, and inclusion issues. | Supports a more informed approach to recruitment and cultivates an ongoing curious mindset about different cultures to enhance cultural competence. |
Recruitment Preparation
Identify the current diversity of the Advanced Practice workforce prior to recruitment. Understanding the profile or demographics of the workforce is essential for developing effective employment policies that promote diversity, equity, and inclusion.
Understanding people’s views through data and staff surveys is an important step towards increasing diversity in the workplace. Equality monitoring requires a two-stage process – data collection and analysis.
Sharing personal information is entirely voluntary; however, the quality and fairness of the recruitment process depends on the date collected. To ensure recruitment of a diverse and inclusive workforce, it is essential to gather comprehensive data that reflects the applicant pool. Employees should be encouraged to provide this information, with the understanding that all data will be handled confidentially and securely. By doing this, organisations can identify and address potential biases or gaps in their recruitment practices, ensuring that opportunities are accessible to everyone.
Equality and diversity information enables a comparison of the demographic representation within teams against local community, regional, and national statistics. Based on this analysis, targeted actions can be implemented to address the underrepresentation of specific groups. If there is a significant level of disparity it may be useful to probe deeper to understand if there are barriers to recruitment for some sections of professionals.
For instance, if the data reveals a significant level of disparity in the representation of certain ethnic groups among advanced practitioners, it may be beneficial to conduct further investigation to understand if there are any barriers to recruitment for these particular sections of professionals. This could involve conducting focus groups, surveys, or interviews with affected individuals to gather insights into their experiences and identify any systemic issues that may be hindering their recruitment or advancement within the organisation.
Undertake a job analysis using an Equality Impact Analysis (EIA)
Also known as an Equality Impact Assessment (See Appendix for example) or Equality Analysis, it is a systematic process used to evaluate the potential impact of policies, practices, or decisions on equality and diversity. The aim of an EIA is to identify any potential positive or negative effects that a proposed action may have on different groups within society, particularly those with protected characteristics (UK Research and Innovation, 2021). It serves as a valuable tool in ensuring that job analyses are conducted in a fair, inclusive, and unbiased manner and helps to proactively address disparities, enhance diversity, and create an environment that promotes equal opportunities for all. It is important to consider equality, diversity, and inclusion at every stage of the recruitment process to ensure it is fair and transparent.
Preparing for recruitment: Inclusive job descriptions
Ensuring job descriptions use inclusive and have gender-neutral language can help eliminate unconscious bias associated with traditional gendered terms and ensures that the job description does not inadvertently discourage individuals of any background from applying. It also expands the candidate pool and increases the likelihood of finding the most qualified candidates for the position. Equally, consider if the criteria can directly or indirectly discriminate against potential applicants. When creating job descriptions, consider the abilities of an advanced practitioner as specified by the multi-professional framework, along with the knowledge, skills, and behaviour’s necessary for an individual to develop these competencies.
Example: “Must be a registered nurse with extensive experience in providing direct patient care, including leading on complex assessments and clinical decision-making.
This wording excludes other healthcare professionals, such as those from an AHP background, who can also qualify for advanced practice roles. It reinforces a narrow view of the role, rather than being professionally inclusive and open to applicants from different healthcare backgrounds with equivalent skills and qualifications.
The focus should be on attracting healthcare professionals with the relevant skills and qualifications. Candidates should be able to demonstrate the broader competencies associated with advanced practice, as outlined in the multi-professional framework.
It may also be tempting to prioritise those with extensive time in a role, but it’s important to consider how this could unintentionally disadvantage individuals who have taken parental leave, work part-time, or have caring responsibilities. Although proficiency is often developed over time, it’s essential not to overlook candidates who demonstrate the necessary skills and competencies, regardless of their time in the workforce.
Alternative example: Must be a registered healthcare professional, with experience in providing direct patient care, and demonstrates relevant clinical competence and proficiency.
By focusing on skills and competencies rather than individual professional backgrounds or arbitrary experience thresholds, the job description becomes more inclusive and ensures that candidates are assessed based on their abilities rather than their age or socio-economic background.
In a rapidly changing profession, adaptability and a willingness to learn are essential traits. Candidates who showcase these qualities, along with the necessary skills and competencies, will bring fresh perspectives and innovative ideas (NHS Providers, 2023).
Job advertisements can also exhibit gender bias through the use of gendered language, which can unconsciously influence the perceptions and applications of potential candidates. This bias manifests in several ways:
Gendered Adjectives and Descriptors
- Masculine-coded words: Terms such as “assertive,” “competitive,” “dominant,” and “confident” are often associated with male stereotypes.
- Feminine-coded words: Words like “nurturing,” “supportive,” “understanding,” and “interpersonal” are linked to female stereotypes.
Pronouns and Titles
Using gender-specific pronouns (“he” or “she”) instead of gender-neutral pronouns (“they” or “you”) can subtly suggest a preference for a particular gender.
Cultural and Environmental Descriptions
- Describing the workplace culture in gendered terms can also lead to bias. A workplace described as a “high-energy, fast-paced environment” might be perceived as more male-oriented, while one described as “supportive and nurturing” might be seen as more female-oriented.
This uses more words that are subtly coded as masculine. It risks putting women off applying but will probably encourage men to apply.
Example: The Advanced Practitioner will use expertise to provide comprehensive care to patients. The candidate will be confident and assertive in approach and demonstrate strong leadership skills.
Instead, gender-neutral terminology is used to illustrate the desired qualities without implying a specific gender, promoting inclusivity in the job description and preventing unintentional exclusion of candidates.
Example: The Advanced Practitioner will display a collaborative and proactive approach and be able to guide and inspire others.
Inclusivity Statement
Include an inclusive statement – this helps to demonstrate that the team cares about equality and diversity and encourages applications from marginalised and underrepresented groups.
Example: We are committed to fostering an inclusive and diverse workplace that reflects the communities we serve. We believe that diversity enriches our perspectives, enhances creativity, and drives innovation. We value and celebrate individual differences. We are dedicated to providing equal employment opportunities for individuals, and we actively encourage candidates from all backgrounds to apply. Our hiring decisions are based on skills, qualifications, and relevant experience. We strive to create a work environment that promotes fairness, respect, and collaboration among our team. We are committed to providing reasonable adjustments for individuals during the recruitment process and throughout their employment journey. If you require adjustments, please let us know, and we will make every effort to accommodate your needs.
Positive action – Diverse candidate sourcing
Positive action refers to a range of lawful measures that can be taken to address or prevent disadvantages experienced by individuals from certain groups with protected characteristics (NHS Employers, 2021). In the recruitment setting it encompasses measures that can be implemented to inspire individuals from groups with distinct needs or a history of disadvantage or limited participation to seek employment opportunities. Equality legislation permits positive action both prior to and during the application process (NHS Employers, 2021). It allows employers to actively encourage specific groups to apply or provide assistance to individuals with protected characteristics to overcome disadvantages, participate fully, or meet particular needs. However, it is only permissible under certain conditions. It must:
- Be related to the level of disadvantage that exists
- Not be simply for the purposes of favouring one group of people over another where there is no disadvantage or under-representation in the workforce.
Example: Hospital A is unable to employ positive action to specifically attract applications from women, given that their data indicates 82 percent of trainee Advanced Practitioners are women. The data has however shown that less than 20 percent are from a minority ethnic background and meant that diverse candidate sourcing could be focused on encouraging applications from this group of people.
Diverse candidate sourcing helps attract a wider pool of talent.
Examples include:
- Utilising specific groups e.g., Black Asian and Minority Ethnic (BME) staff network groups.
- Job shops and drop-in sessions for application support.
- Targeted communications and social media activity.
- Using more images of underrepresented people in advertising.
- Think carefully about where job adverts are placed to reach as many people as possible from all backgrounds
Example:
Hospital A advertised for trainee Advanced Practitioners across multiple departments. They organised recruitment events within the hospital tailored for healthcare professionals from minority ethnic backgrounds. Details about the positions and recruitment events were disseminated through various channels, including the BME staff network group, computer screensavers across the trust, and social media campaigns emphasising the commitment to enhancing diversity.
The recruitment events provided insights into the role’s responsibilities and the desired attributes, along with guidance on effectively communicating these aspects on application forms. Facilitators included Trainee Advanced Practitioners from ethnic minority backgrounds, who shared their successful experiences and offered one-on-one support to individuals, aiding them in navigating the application process and preparing for interviews.
Additional recruitment events were organised, open to individuals from all backgrounds. However, these separate events tailored specifically for staff from a minority ethnic background offered the choice to attend a session designed to meet their specific needs, providing a supportive atmosphere conducive to asking questions.
Shortlisting
The purpose of shortlisting is to identify applicants whose skills, knowledge, experience, and qualifications match those that have been identified as being necessary for the job.
It is preferable if everyone on the interview panel is involved in the shortlisting exercise, but at least two panel members should be involved – This enhances the diversity of viewpoints and offers a more comprehensive understanding of an applicant. By incorporating a varied shortlisting panel or involving someone with an alternative perspective, you may uncover unique qualities in candidates and gain insights that could help identify potential that might otherwise be overlooked (The Chartered Institute of Personnel and Development, 2022). This practice enhances the authenticity of the selection process.
Eliminate any information that could influence judgment based on protected characteristics. For example, disregard details like education dates, which can reveal a person’s age, or the location of their education, which can indicate if they are an international applicant. The evaluation of candidates should be solely based on their ability to perform the job according to clear and transparent selection criteria’s.
At this stage, bias may enter decision making. You may unconsciously select someone similar to yourself or someone who will “fit in” with the existing team. Ensure precise documentation of the reasons behind an applicant’s inclusion or exclusion from the shortlist.
Pre interview – Consider providing an information pack
One of the barriers interview panels can generate is that people from diverse backgrounds can be more or less likely to have good interview skills based on existing environmental and social inequalities (NHS Employers, 2021). This leads us to make a judgement on how good someone is at interview rather than the skills they have for the specific role.
A pre-interview information pack is a valuable tool for both employers and candidates. It helps set expectations, reduces anxiety, provides relevant details, and ensures a smooth interview process. A list of elements may include:
- Welcome letter – Including a brief introduction to the organisation and them team along with a warm welcome
- Job description and key responsibilities and expectations
- Team and organisation overview, including values and vision
- Interview schedule – Date, time, location and the names and roles of the interviewers
- Interview process – Overview and types of assessments for example, scenario, presentation types of questions
- Prepared questions – Allows candidates to prepare thoughtful and well-structured responses that showcases their abilities and experience more effectively. It provides the interviewer with more in depth understanding of a candidate’s skills
- Post interview process – Including expected timescale for outcome
- Contact information before the interview and on the day
- Useful resources
The Interview
Accessibility
- Inquire about disabilities and reasonable adjustments when scheduling interviews.
- Schedule interview dates to avoid conflicts with cultural or religious events or try to be flexible and have a range of dates/times around these periods.
- Ensure venue is fully accessible for both candidates and panel members.
- Be ready to adjust timings for candidates needing extra time for assessments, presentations, etc. For instance, those with disabilities, including neurodiversity*, or individuals requiring additional time due to English being their second language.
* Neurodiversity refers to variations in how an individual’s brain processes, learns, or behaves compared to what is commonly perceived as “typical.” Being neurodivergent will often amount to a disability under the Equality Act 2010, even if the person does not consider themselves to be disabled (ACAS, 2024)
Assessments and Questions
- Align questions and assessments with required skills and qualities, agreed upon by all panel members.
- Tailor questions to essential competencies, incorporating behavioural, situational, and competency-based inquiries.
- Ensure consistency by asking every candidate the same questions.
- Establish a structured scoring system to evaluate candidate responses.
- Define criteria for strong, adequate, or weak responses for each question or competency.
- Take relevant notes during interviews to facilitate evaluation and selection.
Evaluation
- Review interview notes and grade candidates objectively.
- Compare evaluations with other panel members.
- Discuss strengths and weaknesses to reach a consensus
Selection
- Prioritise the best candidate based on evidence and criteria.
- Avoid favouring candidates with similar characteristics to the panel.
- Ensure selection based on merit, regardless of protected characteristics.
- Be mindful of unconscious bias in decision-making.
Post Interview
Support unsuccessful candidates
Offer feedback to candidates who were not successful. Refrain from stating that others were more qualified; instead, provide impartial feedback that is constructive and meaningful solely based on the job requirements. Highlight positive aspects of their performance as well as areas for improvement. Remember that feedback should be specific, actionable, and focused on helping the candidate grow (McDonald and Company, 2023). It is an opportunity to guide them toward improvement rather than simply pointing out shortcomings. Additionally, be mindful of the tone and language used.
Equality data and information.
Monitor and review the equality data, such as gender, ethnicity, and age, etc at each stage of the selection process to check for adverse impact. By systematically gathering and reviewing data at each stage, you can discern whether individuals face varying degrees of success and pinpoint specific groups that may require additional assistance. This proactive approach enables you to offer enhanced support in subsequent stages, ultimately contributing to improved assistance in future recruitment.