Systemic and organizational barriers and facilitators to the advancement of ethnic minority women nurses in healthcare leadership: A meta-synthesis

Objective: This meta-synthesis explored system and organizational-level barriers and facilitators for women in nursing from ethnically minoritized backgrounds that impact their advancement in healthcare leadership. This topic is important because nursing accounts for a significant proportion of the global health workforce, and women represent the majority of the nursing profession, yet, women nurses are underrepresented in healthcare leadership. This disparity is further compounded for women nurses from ethnically minoritized backgrounds, including migrants. Design: Systematic review methods incorporating meta-synthesis. Data sources: Six databases (MEDLINE, EMCARE, EMBASE, PsycINFO, PubMed, and CINAHL) were searched from January 2000 to November 2024 for terms including: "women", "nurses OR midwives", and "leadership". The search was limited to the English language. Review methods: Template analysis was performed to identify system and organizational-level barriers and facilitators that impact on ethnically minoritized women nurses' career progression. Methodological quality of included studies was assessed using the Joanna Briggs Institute Cross-sectional and Prevalence Studies criteria and Critical Appraisal Skills Programme-Qualitative Studies Checklist. Results: Twenty-one papers were included in this review. Under four main categories, seventeen sub-themes were identified: 1. Systemic/outer setting barriers (skills, education and qualification recognition for migrants; societal racial bias), 2. Systemic/outer setting facilitators (policies; supportive nursing organizations specific to ethnically minoritized women; research, evidence and awareness on racism; representation across all stakeholders in nursing), 3. Organizational/inner setting barriers (lack of support for organizational processes and policies; institutional racism; discriminatory organizational culture; limited access to effective mentoring and networking; ineffective support tools; impact of persistent barriers), and 4. Organizational/inner setting facilitators (organizational processes and policies; organizational culture; mentoring and networking; support tools; training and development). Conclusion: Women nurses from ethnically minoritized backgrounds encounter systemic and organizational-level barriers to healthcare leadership, contributing to their underrepresentation in leadership. Recruitment, promotion, and retention processes for leadership positions are adversely affected, primarily due to bias, inadequate support mechanisms, and discrimination. Addressing these issues and removing structural barriers for women nurses from ethnically minoritized backgrounds requires a systemic and organizational-level approach. By identifying these disparities, healthcare systems can work towards creating equal opportunities for all nurses to advance, resulting in more comprehensive and equitable care delivery.