Date published: 3 November, 2022
Date last updated: 6 December, 2022
Nursing, midwifery and care

Combatting racial discrimination against minority ethnic nurses, midwives and nursing associates

Resource for nursing and midwifery professionals registered with the Nursing and Midwifery Council.

Foreword

Racism is unacceptable and it has no place in health and care. But we know that it exists and that the impact on our colleagues can be devastating.

As registered professionals, we all have responsibility under the Nursing and Midwifery Council (NMC) Code to challenge discriminatory behaviour, creating an environment where people are treated as individuals and with dignity and respect.

This resource is firmly rooted in our professional Code and it is designed to support nurses, midwives and nursing associates, providing advice on the action you can take if you witness or experience racism. It also supports those in leadership roles to be inclusive leaders.

This document provides practical examples of how, as nursing and midwifery professionals, you can recognise, and challenge racial discrimination, harassment, and abuse. It also highlights other useful resources and training materials that will support you to care with confidence.

We want you as professionals to feel empowered so that together we take action to identify and address racism. We also recognise that there is more to do to ensure robust leadership accountability is underpinned by the right processes. This document is a resource for individuals at all levels.

This resource does not replace existing NHS England policies and procedures for speaking up and managing racism. It is a resource to support best practice in line with organisational policies and procedures.

We hope you will share this among your colleagues and that it will help us work together to make a real difference.

Dame Ruth May DBE, Chief Nursing Officer for England, NHS England.

Andrea Sutcliffe CBE, Chief Executive and Registrar, Nursing and Midwifery Council.

Joan Saddler OBE, Director of Partnerships and Equality, NHS Confederation.

Introduction

“Racism is a serious public health threat and directly affects the wellbeing of millions.” Centers for Disease Control and Prevention.

This resource supports each nurse, midwife and nursing associate working in the NHS to combat racism and secure your and your colleagues’ wellbeing and psychological safety. It shows you how you can discharge your professional duty in opposing racism and gives practical examples of how to recognise and challenge racial discrimination, harassment and abuse. Within and across our professions we all need to work together to build a safe environment and an inclusive culture that promotes a healthy work experience, both for our benefit and people in our care.

This resource has been developed in partnership by the Chief Nursing Officer (CNO) and Chief Midwifery Officer (CMidO) Ethnic Minority Action Plan Steering Group, NHS Confederation and the Nursing and Midwifery Council.

Who is it for?

It is for all nursing and midwifery professionals registered with the Nursing and Midwifery Council working in the NHS. This resource is designed to help every one of us recognise and challenge racial discrimination and in doing so promote everyone’s wellbeing, physical and psychological safety. While the resource has been developed with a focus on NHS organisations, the principles apply and the resources highlighted will be helpful for all nurses, midwives and nursing associates working in every health and care setting.

How is it of use?

The resource can help you act according to best professional practice, when:

  • witnessing racism
    • you better understand and feel confident about what you can do during and after witnessing an incident that is directed at someone else
  • experiencing racism
    • you feel better equipped to manage incidents as they are happening to you and afterwards
  • leading anti-racism
    • you feel you have the insights and skills to provide anti-racism leadership that creates safe working environments, and tackles and responds effectively to racial discrimination, harassment or abuse.

The practical examples and tools will help you discuss, explore and challenge racism safely and effectively, including at the time a challenging situation occurs.

This resource and the nursing and midwifery framework below are informed by the insights of experienced nurses and midwives, and a rapid qualitative evidence review (Jieman, AT., Onwumere, J., Woodhead, C., Stanley, N., Hatch, SL. Developing anti-racist practice to support black and other racially minoritised nurses and midwives within the NHS: A rapid qualitative evidence synthesis. Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London; July 2022) This resource uses the framework and reflects the four domains of the Code for professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC Code): prioritise people; practise effectively; preserve safety and promote professionalism and trust.

Nursing and midwifery anti-racism resource framework

Image text: This diagram highlights the four key areas that make up the nursing and midwifery anti-racism resource framework and are explored in this resource; 1. Challenging racism, 2. Caring and belonging, 3. Challenging leadership and 4. Authentic inclusion.

The Tackling Inequalities and Discrimination Experiences in Health Services (TIDES) team at Kings College London were commissioned by NHS Confederation to complete a rapid synthesis review of research, policy recommendations and examples from healthcare practice to support the development of effective anti-racism practice that can help improve the experiences and outcomes of minority ethnic nurses and midwives in the NHS. The adaptation of the above framework diagram stems from their review findings.

Publications:

1. Challenging racism (NMC Code – practise effectively)

Racism is a public health crisis (American Public Health Association). All NHS organisations must have due regard to the need to eliminate unlawful discrimination’, advance equality of opportunity and foster good relations between all its people. Challenging racism requires sustained proactive action by our organisations, but each of us also has a duty and responsibility to proactively identify, challenge and oppose racism; and to look at ourselves and be willing to change any behaviours and unfounded beliefs that could damage our colleagues and people in our care. It is an expectation of the NMC Code, and a pre-requisite for effective practise.

“I would like to see zero racism in the NHS.” Taking an active role in leading anti-racism (Angela Knight Jackson; Studio Giggle) watch time: 3:28 minutes.

Actions you can take

If you observe racism as a colleague or leader,  you can:

  • Challenge racism from people in our care or staff regardless of their seniority. In line with the NMC Code, you should feel able to immediately engage with the individual who is displaying discriminatory behaviours. Keep your language and tone clear, calm and objective. If you find it difficult to challenge ‘in the moment’, seek support; see ‘Resources to help you’ below. You should feel able to not ignore the incident.
  • Speak up when witnessing racism. Be an ‘active bystander’ by telling individuals that their discriminatory behaviour is unacceptable. You should feel able to intervene by directly stepping in, distracting away from the situation, escalating to someone with more authority or delaying action until after the immediate event. If you escalate or delay taking action, you need to check in with the victim of racism after the incident. Ask if they are ok and explain what steps you plan to take. Check with the manager you escalated to that they have taken appropriate action.
  • Speak out when you witness a racist incident, even if it feels uncomfortable or you do not know the ‘correct’ terminology. Using incorrect terms can be experienced as stigmatising, depersonalising and ‘othering’ (othering is a process whereby individuals and groups are treated and marked as different and inferior from the dominant social group, and as a consequence may suffer discrimination) but it is worse not to challenge racism. The resource can be used to help you feel more confident in offering an apology if someone is hurt by your words. People are likely to accept an apology when they see you are trying to do the right thing by standing up against racism.

Support from your organisation, leaders and colleagues

  • You should expect your NHS employer to provide training to help you to put its zero tolerance policies into practice. This means that everyone in your team knows how to respond to an abusive or threatening person or incident and protect colleagues and people in our care, including how to contact security and the police, and take appropriate legal action.
  • You should expect your colleagues to stand up against unacceptable behaviour and violence. Senior leaders act as proactive allies by assisting you to take appropriate action to protect yourself, others and hold perpetrators to account in line with the NMC Code.
  • Your training should help you to develop confidence to act and effectively respond to discriminatory behaviours, report discrimination incidents and care for an affected person.

“…step up and be the friend, co-worker, peer who says something about it…” Bystander Intervention (University of Maine’s Rising Tide Center, 5-Minute Professional Development Series) watch time 5:45 minutes.

Resources

2. Caring and belonging (NMC Code – preserve safety)

True workplace inclusion is evident when people feel a sense of belonging and being valued; where they are psychologically and physically safe to be themselves at work and share views, opinions and experiences in a respectful and thoughtful fashion.

Everyone has the right to dignity and respect, and to feel included. But what if the behaviour of others means you or a colleague feel excluded?

“…I think racism kills people…” Racism in the NHS – Documentary watch time 18:58 minutes.

Actions you can take

Use the tools and advice in this resource to help you manage racist exclusion at the time it happens.

  • Feel able to talk to your colleagues, managers or HR colleagues about your concerns; how exclusion is impacting on your wellbeing and performance or that of your colleague.
  • Keep a diary of incidents so that you have a record of what is happening and how it is impacting on you and colleagues.
  • Feel able to expose barriers and lead change without negative repercussions. Racism can be embedded in organisational structures; it can inhibit access to professional development opportunities and hinders career progression. Feel able to work with colleagues to promote anti-racism, for example, look at your team; how diverse is it? Ask your manager about what they’re doing to promote equality; support and speak up for a colleague if they have been having a negative experience at work.

Support from your organisation, leaders and colleagues

All NHS organisations have policies that deal with discrimination. Below are some examples of good practice within these policies.

  • NHS organisations host events where safe and useful conversations can be held about implementing anti-racist policies and practices that deliver transparent solution-focused outcomes.
  • NHS organisations host robust staff networks so staff and allies from racially minoritised communities (a replacement of the acronym BAME (Black, Asian, and Minority Ethnic) to better explain that people are actively minoritised by others rather than naturally existing as a minority. The term racially minoritised confirms that so-called minoritisation is a social process shaped by power. The lancet; Vol5 August 2020) can share their experiences, develop strategies and implement actions for improving anti-racist practice.

NHS organisations work with staff to educate to reform practice. For example, demonstrating respect for cultures in practice.

“…have a really good support system around you, (..) people that can push and motivate you…” How I overcame racist abuse in the NHS (Hafsa Mahumad, UEA paramedic science graduate, Norfolk; House of Medics) watch time 9:31 minutes.

Resources

3. Challenging leadership (NMC Code – promote professionalism and trust)

All leaders have a duty to take racism and its effects on our health, occupational outcomes and people in our care seriously. Effective leaders will stand with us to dismantle discriminatory practices in the healthcare system that affect us and people in our care. It is aligned with the NMC Code and promoting professionalism and trust.

Our professional revalidation process supports us in delivering professional standards of practice and behaviour and is an opportunity to reflect on and develop anti-racist behaviours, and practices.

“… many are too afraid to speak, unless the workforce is properly supported…” Ethnic minority leaders in NHS on what needs to change to keep BAME health workers safe (ITV News) watch time 3:55 minutes.

Actions you can take

  • Talk to colleagues who you feel safe with.
    • Decide what steps you need your employer to take to address the racism you witness or experience.
  • Come together with your colleagues to agree what support to seek from your employer.
    • Advise your employer what you need them to do to better fulfil their duty of care and statutory obligation to adhere to best professional practice.
  • Seek advice (from organisations listed at the end of this resource) because you may need to challenge if leaders take no action.

Support from your organisation, leaders and colleagues

All NHS organisations should promote anti-racist policy, practice and procedures, and know how to respond to racist practices, behaviours and incidents.

  • Encourage conversations about racism and anti-racism with all staff, valuing the voices and experiences of staff from racially minoritised communities.
    • Best practice is where teams are offered protected time for open conversations about racism.
  • Best practice is where everyone receives training in effective anti-racist responses and encourage cultural change.
    • For example, cultural awareness training reflects the nature of British culture, as well as respect for the cultures of nurses and midwives’ countries of origin.
  • Best practice is where transparent anti-racism practise is championed.
    • This includes implementing robust anti-racist policies, practices and procedures in line with their statutory duties that ensures a safe working environment for and the health and wellbeing of staff. Staff feel supported after distressing racist incidents.

Data such as the Workforce Race Equality Standard (WRES) and your employer’s WRES action plan should be published to show an organisation’s progress in creating a non-discriminatory working environment where all staff feel reassured that they can achieve their full potential and all people in our care feel reassured they will receive the best quality care.

WRES addresses representation and lack of opportunity for career progression.

“… what was worst, my White colleague was just standing there, not saying anything (…) ” Experience of racism in the NHS (Consultant Devesh Sinha; Barking, Havering and Redbridge University Hospitals NHS Trust) watch time 2:17 minutes.

Resources

4. Authentic inclusion (NMC Code – prioritise people)

The NMC Code 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 safety of people in our care. Staff must identify, challenge and report any exclusionary practices and behaviours, and support colleagues to do the same.

“We will be a workforce that is cohesive, cares for each other regardless of background…” Inclusion and race equality in the NHS (Yvonne Coghill; NHS South East Health and Wellbeing Community) watch time 2:35 minutes.

Actions you can take

  • Become part of a network or a community that has a better understanding of how racism impacts colleagues.
    • Use the insights from network or community members with lived experience to inform how you can ensure an inclusive workplace.
  • Share experiences or observations of exclusionary practices
    • eg ask if a restaurant would make a nice change from the pub for a team event and be more inclusive?

Support from your organisation, leaders and colleagues

  • Good practice allows you to attend networks.
  • Supporting suitable networks for staff to join is embedded in the thinking of board members, the Chief Nursing Officer and Integrated Care Board chief nurses and chief midwives.
  • Good practice is co-development of anti-racist action plans and practices with professional staff networks of nurses, midwives and nursing associates, and networks of staff from racially minoritised communities and their community organisations as ‘critical friends’.

Resources

Further resources to help you

Listed below are links to resources and support to help you if you think you have been unfairly discriminated against.

1. Know your rights

Your employer must follow the law on preventing discrimination.

  • Health and Safety Act – Section 2 ensures the health, safety and welfare, including mental health
  • Equality Act 2010 – protects employees from unlawful discrimination, harassment and victimisation on the grounds of race
  • Equality Act guidance – understand your rights to be treated equally in employment
  • Nursing and Midwifery Council – The Code sets out relevant aspects of the Code in accessible terms

2. Get help from your organisation

Importantly, you can talk to your employer first to try and sort out the problem informally. If things cannot be sorted out informally ask for external professional support.

3. Ask for external professional support

If things cannot be sorted out informally, you can reach out for professional support.

Publication reference number: PR1897

Date published: 3 November, 2022
Date last updated: 6 December, 2022