In February this year, the authors of a rapid review of evidence into inequalities in health care considered not just the health inequalities of several patient groups, but also the ethnic inequalities in the NHS workforce (Kapadia et al, 2022).
The authors considered studies of several areas of the NHS, including workplace inequality for British staff from ethnic minorities and racism in the workplace. They also found that internationally educated nurses experienced feeling distressed, confused and humiliated due to the covert and overt discrimination experienced while working in the UK. Incidents of discrimination reported by participants included: ‘patients who exhibited racist behaviours’, ‘refusing care from international or Black nurses’, ‘staff who would undermine the work of their international colleagues, or draw unfair conclusions about work ethic, motivation or character’ and ‘managers were also seen to apply more scrutiny to Black international nurses working in their team’.
I feel that there has been a lack of action to improve NHS workplace culture in this area. I was therefore pleased this month to see that NHS England (2022) has launched a resource entitled Combatting Racial Discrimination against Minority Ethnic Nurses, Midwives and Nursing Associates.
The resource states that it is firmly rooted in our Nursing and Midwifery Council's (NMC) professional Code (2018) and is designed to support all registrants, with specific support for leaders, by providing advice on the action that can be taken if racism is witnessed or experienced. It provides practical examples of how racial discrimination, harassment and abuse can be recognised and challenged. It also highlights other useful resources and training materials to support our learning.
The resource cites the Tackling Inequalities and Discrimination Experiences in Health Services (TIDES) team at King's College London, which was commissioned by the NHS Confederation to undertake a rapid synthesis review of research, policy recommendations and examples from healthcare practice to support the development of effective anti-racism practice designed to help improve the experiences and outcomes of minority ethnic nurses and midwives in the NHS.
Four key areas
The resource highlights four key areas that make up the nursing and midwifery anti-racism resource framework, with actions for consideration as an individual, and as a leader. The resource also signposts to a large number of very useful additional resources.
Challenging racism
There is advice relating to challenging racism, irrespective of seniority, and to speaking up when witnessing racism. The report states that racism must be challenged even if the witness feels uncomfortable, is unsure what terminology to use, or inadvertently uses terminology that may offend individuals. However, it is stated that these risks need to be overcome as it is worse not to challenge racism, and the resource is aimed at developing knowledge and confidence in our intent to be anti-racist.
Caring and belonging
The resource states that ‘true workplace inclusion is evident when people feel a sense of belonging and being valued: this requires people to feel psychologically and physically safe to be themselves at work and share views, opinions, and experiences in a respectful and thoughtful fashion.’ The environment that we need is one of openness and listening. Importantly, the resource encourages us to look at our teams to check to what extent diversity exists and what can be done to promote equality. Advice is also given on hosting staff networks for minority ethnic staff.
Challenging leadership
The resource encourages all leaders to consider the impact that racism has on health and occupational outcomes seriously, stating that effective leaders will work to dismantle discriminatory practices in the healthcare system that affect staff and people in our care. It also encourages us all to advise our employer what we need them to do to better fulfil their duty of care and statutory obligation to adhere to best professional practice.
Authentic inclusion
The NMC Code is woven throughout the resource and in this area, aligned to the Code, it asserts that everyone has the right to dignity and respect, and to feel included. If a staff group is not inclusive, this may impact on staff, outcomes and the safety of the people in our care. It goes on to say that staff must identify, challenge and report any exclusionary practices and behaviours, and support colleagues to do the same. Two key areas of focus from this element advise us to become part of a network or a community that has a better understanding of how racism impacts colleagues and use the insights from network or community members with lived experience to inform how we can ensure an inclusive workplace.
Potential
I believe that this resource, although long overdue, has the potential to be extremely powerful to open conversations, to signpost and to lead to wider individual and team development to improve workplace cultures, equality and, ultimately, patient care.