When you think about it, it really doesn't make sense: how can the NHS, the fifth-largest organisation in the world, employing over 1.7 million people, 20% (340 000) of whom are from black and minority ethnic (BME) backgrounds, have so few senior leaders from those backgrounds? Nursing is no exception.
In London, we now know there are more BME nurses than nurses from a white background, 27 982 to 24 847 (Mitchell, 2018; Royal College of Nursing (RCN), 2018), we also have evidence from the 2017 Workforce Race Equality Standard (WRES) data that the BME nursing workforce increased by around 5000 while the white nursing workforce decreased by around 1500 (NHS England Quality and Diversity Council, 2017: 25–28).
Nurses are the backbone of the NHS and the evidence is that the nursing workforce is becoming increasingly more diverse. In fact, nurses in the NHS are more diverse than the population of England as a whole. People from BME backgrounds are significantly more likely to become nurses compared with their representation in the population. Black/Black British people are 2.2 times more likely to be a nurse compared with their overall representation in the population of England (NHS Digital, 2018)
One in five nurses, midwives and health visitors in the NHS is from a BME background and in London that figure is much higher, yet there are only eight executive directors of nursing in the NHS and two of those are in interim posts. In London there are only three.
I can think of only two reasons why this situation exists. First, that the vast numbers of talented and educated BME nurses, midwives and health visitors working in the NHS simply are not good enough, or second, the system has inbuilt discriminatory processes and people that are skewed towards appointing people from non-BME backgrounds and discriminates in favour of appointing them, particularly to the most senior posts. I believe the first reason can be dismissed.
In 2009, reading the executive summary to NHS Staff Management and Health Service Quality, I came across the following, which has stayed with me and inspired me ever since.
‘There is a spiral of positivity in the best performing NHS trusts. The extent to which staff are committed to their organizations and to which they recommend their trust as a place to receive treatment and to work is strongly related to patient outcomes and patient satisfaction. Climates of trust and respect characterise these top performing trusts. This is best evidenced by the link between ethnic discrimination against staff and patient satisfaction. The greater the proportion of staff from a black or minority ethnic (BME) background who report experiencing discrimination at work in the previous 12 months, the lower the levels of patient satisfaction.’
Since the WRES was introduced into the NHS in 2015 we have data that shows BME staff have a poorer experience of working in the NHS than their white counterparts, they are less likely to be appointed from shortlisting, more likely to enter formal disciplinary proceedings and less likely to have the opportunities to go on non-mandatory training. This obviously leads to dissatisfaction and disillusionment among the BME workforce that ultimately leads to organisations not having that spiral of positivity and, of course, poorer patient satisfaction.
We also have evidence that shows that people who are cared for are more likely to care—compassionate leadership, leadership that is inclusive and fair, increases staff motivation and ultimately leads to higher quality care and patient safety.
‘More than ever nursing needs to have talented and committed individuals leading it’
The nursing profession is currently going through one of the most challenging times in its history, there are currently 42 000 nursing vacancies in the country (Triggle, 2018), the bursary for nursing students has been removed, nurses from the EEA are going home and not applying to come here and there has been a pay freeze for the last 6 years. In addition the RCN, our professional body, is in turmoil. The UK's demography is changing; there are more older people with multiple chronic disease and greater expectations of the service.
Nursing seems to be at a crossroads, although on the plus side, nurses are the most trusted profession in the UK (Ipsos Mori, 2017). Nurses are said to uphold the most ethical standards, this is incredibly positive and very powerful. More than ever nursing needs to have talented and committed individuals leading it. By selecting only a certain type of person to be in lead positions in the profession we cannot have the diversity of thought, behaviours or beliefs needed to help improve the NHS or our profession.
It is clear from the data and the statistics that nurses from BME backgrounds are still very much committed to the profession and state frequently in staff surveys that they enjoy their jobs and would recommend it to others.
The BME nursing workforce in England is as integral and necessary to the NHS now as its members were when the first immigrants came to this country 70 years ago to help in the fledgling NHS. It is a sad fact that in 2018 many still face discrimination and are denied the opportunities available to their white colleagues.
My plea to nurse leaders is to take stock, have a good look at the makeup of the nursing workforce as well as the needs of our increasingly diverse population, then start making the demonstrable and practical changes needed to make all nurses, regardless of background, race, religion, sexuality or gender feel valued, appreciated and included in the service of patients.