Work-based learning in the National Health Service

Peggy Warren’s (2019) book, Black women’s narratives of NHS work-based learning: An ethnodrama, centers the voices of Black British and Black Caribbean women who engaged in educational and professional development in the National Health Service (NHS) in Britain. The sub-title, “The difference between rhetoric and lived experience” provides the key to understanding the book’s message concerning the opportunities that the women who participated in Warren’s study thought they were partaking of, and what actually eventuated.

Warren worked with a group of women who were completing the foundation degree program that was designed to lead to a new ancillary role in the Health Service, that of Assistant Practitioner (p. xv). Using a Black feminist approach to research, Warren’s anti-racist and anti-colonialist study is influenced by her reading of bell hooks, Audre Lorde, W. E. B. Dubois, Paulo Freire, Booker T. Washington among others (p. 1). The study aimed to explore why it was that over half of the Black British and Black Caribbean women who started the part-time foundation degree in Health and Social Care did not finish. Warren aimed not only to honor the oral storytelling of the participants, but to “encourage Black women to critically engage and scrutinize [their] situations using [their] histories” (p. 5). 

The approach to representation of the findings of the study draws on autoethnography and the arts-based approach of ethnodrama. African Adinkra symbols drawn from West Africa are used to represent each of the characters in the ethnodrama. For example, a main character (that I took to be the author and researcher) is represented by the symbol of “Sankofa”, meaning, “go back, learn from the past, then move forward” (p. 115). The first four scenes of the ethnodrama take readers through the participants’ migration experiences from Jamaica, and introduce the women’s educational legacies, their personal journeys into health care and their ambitions to become nurses, and the critical empowerment approach to education taken in the study. For example, in this chapter, the women discuss their understandings of readings from the work of W. E. B. Dubois and Paulo Freire. The fifth scene represents data from an interview with a member of a commissioning team through the medium of a NHS conference. In this pivotal chapter, readers learn more about the development of the Assistant Practitioner role as a way to fill the perceived gap in the supply of nurses within the healthcare system, and at the same time reduce costs of care by paying lower wages to nursing staff (pp. 44-45).

Scene 6 represents the women’s distressed responses to information conveyed in the commissioner’s interview. For example, one of the characters, Mama B.: comments:

Okay, in lay man’s terms, we hoped that our education would be converted into a more fulfilling role with better pay… got it! Instead, we’ve come to understand that because the ‘strategy’ was a ‘knee-jerk reaction’ that we, an already subordinated group were only to reap exploitation and professional relegation for our sacrifice. (p. 53).

This scene also portrays the women’s reflections on their sources of support that contributed to their resilience in the face of ongoing challenges, including song texts. Scene 7 represents the final formal meeting of the group, also with songs delivered in chorus. This scene includes images of posters created by the women that represented the collective challenges and personal experiences faced during the continuing education program. The women’s exclamations provide a sense of both what they gained from participating in the research project, and their thwarted expectations of the foundation degree program. For example:

GyeNyame: ‘We wanted WP equality not the poisoned chalice of opportunity!’

Dame-Dame: ‘We longed for transformative pedagogy, not a colonized approach to study!'(p. 105).

The final scene represents Sankofa’s reflection on the study and what she had learned as she dialogues with an ancestral spirit, Akoko Nan (signifying the parental role of protection and correction, p. 8).

As a reader, I found the women’s accounts of their experiences in higher education representative of the very troubling impacts of neoliberalism in education and healthcare. Given the global COVID-19 pandemic that has afflicted people everywhere, implementing an educational program designed to save money seemed to be a short-term solution destined to fail both health care workers and the health care system. In fact, readers learn in an epilogue that the Assistant Practitioner’s position no longer exists. Clearly as Warren indicates, there are more stories to tell, and this book depicts points in time.

Overall, this book has much to offer those interested in applying critical lenses to further education, and will be of interest to scholars using Black feminist standpoint theory. Since I do not have expertise in nursing, nor do I have an understanding of the National Health Service in the UK, I found some of the nuances of the different levels of nursing staff somewhat challenging to follow. I also would have liked larger images of the posters represented in Scene 7. (Admittedly, I might also need a new prescription for my glasses!) Nevertheless, this book will be of interest to those in the nursing profession – especially Black women who have found themselves marginalized within higher education. Finally, Warren employs both autoethnographic accounts and ethnodrama to represent her narrative. Readers interested in applying those approaches in their own work will find another example to inform their work.

Kathy Roulston


Warren, P. P. (2019). Black women’s narratives of NHS work-based learning: An ethnodrama. Peter Lang.

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