Full disclosure:
I am a white, middle-class, middle-aged woman.
And that is how I was when I came into nursing. I was 42 years old when I started my nurse training in 2003. After 18 years in magazine publishing, I was blown away by the diversity I found in the NHS. For the first time EVER, I was working alongside Black, Asian and Overseas colleagues, delivering care to an equally diverse patient population. I loved it.
I loved the teamwork, the variety and the humanity involved in hospital nursing. After working with the same 10 people in my magazine office for the previous seven years, I loved that shift working meant that the team I was part of was different every day: different colleagues, different team leaders, different patients, every shift. Different, yet the same: I was well mentored throughout my training and preceptorship, and quickly felt part of my various ward teams. Post-qualification I worked in the renal directorate, so I got to know our patients well, too, as their chronic condition sadly necessitated ongoing regular contact with healthcare providers.
All through my life I have been aware of and uncomfortable with the advantages that the (now ‘protected’) characteristics of my ethnicity, class and age have brought me.
Coming into nursing as and when I did, I undoubtedly benefited from them. They gave me a confidence and resilience that younger, less life-experienced, colleagues may have
lacked - though I have always been hugely impressed by the very young nurses I have worked with: they are so much more caring and kind than I was at their age, they see so much of life’s suffering every day, yet keep calm and carry on. Amazing.
Being middle class and from a medical family, with a grandfather, father, brother and sister-in-law who were doctors meant I was more like the doctors in the team than most of my nursing colleagues, and so possibly more visible to those higher in the team hierarchy.
And being white… well, I was shocked and disappointed to realise, pretty quickly, that this made me more like the majority of managers I worked for than the black nurses and HCAs I was doing the hands-on caring and cleaning-up alongside, shift in, shift out.
As a loud-mouthed, confident, older, white nurse, I was earmarked for a leadership role early on. Within six months of qualifying, I started in a training position with the Diabetes Specialist Nurse (DSN). This was my dream job, the specialty that attracted me to nursing in the first place, the role I had wished for. I was delighted to be offered the opportunity and did not say no to it.
What I hadn’t realised was that I had unwittingly leapfrogged over several other, much more experienced Black nurses to get it. One, Ngozi, had the courage to come to me and ask how I had managed it. Red-faced, I stuttered that I was sorry, I didn’t know, it wasn’t up to me. Which was true, but so lame… Years later, when I missed out on a bigger and better diabetes job to a colleague whom I considered much less experienced and worthy of the role than me, I tasted the bitterness of resentment myself, and marvelled at Ngozi's ongoing support and kindness towards me, despite her own personal disappointment at being overlooked.
There were two of us in that first training position: me and Marcia, a black nurse from Jamaica with more than 20 years’ nursing experience to her name. We supported each other through the steep learning curve we were both on. But once the training secondment was over, Marcia went back to her ward job and I was able to carry on as a part-time Band 6 DSN alongside my Band 5 ward job. And, a few years down the line, when jobs came up in a bigger Diabetes Team, I and another white nurse doing a similar role to me in another directorate were offered the contracts and Marcia wasn’t. Marcia applied many, many times for substantive diabetes nursing jobs and never got one.
As it happens, I did not take up the offer from the bigger Diabetes Team. By then, I was disenchanted by the Jobs for the Girls culture that I had witnessed within that team, and across the Trust. By which I mean: Jobs for the White Girls. Almost every DSN I have ever met has been a white, middle-aged woman. Yet diabetes disproportionately limits the lives of Black Asian and Minority Ethnic populations (Diabetes UK, 2019; Goff, 2019). How did the managers of that team, which consistently rejected Marcia's applications, fail to recognise the opportunity that they were being offered? To have a highly experienced and motivated Black nurse on their team, with the cultural insider knowledge and ability to speak to a significant patient group in their mother tongue – what a gift that could have been!
The only answer I have to that question is: institutional racism, however unconscious the individual perpetrators of it may be. Whatever it was that they included in their Job Specifications, Essential and Desirable criteria, they managed to rule out an excellent candidate who would have enriched their team culture – and improved their patient outcomes. But preserving the cultural hegemony, maintaining the status quo, staying within their comfort zone – in which everyone in their office looked the same, ate the same sort of food and watched the same sort of TV programmes – won the day.
Shifting the cultural balance within an organisation takes work and makes work: a new team member with different and possibly (if not probably) negative life experiences may not be able to ‘hit the ground running’ in a new job; He/she may need extra support at first. That takes time and energy and generosity from the existing members of the team who, in this day and age, probably feel as overstretched and undervalued as every other NHS nurse and would need adequate resources and support to achieve this.
And who would want to be the only black member of a white team? It would not be easy, especially if there is any sniff of tokenism about their appointment. But redressing the current balance needs more than tokenism. If the ethnic diversity of the whole healthcare workforce were properly reflected at senior and management levels, there would not just be one lone black person in each specialist team: in some localities, there would be up to 45% (Kline, 2014; Ross, 2019). And everyone would benefit from such a shift: general nursing culture and knowledge would be enriched; Black nurses would feel valued instead of overlooked, taken for granted and, at worst, abused; and our patients would be much, much better served.
As has been eloquently expressed elsewhere, ‘You Can’t Be It If You Can’t See It’ works both ways. If Black nurses don’t see themselves represented at senior and management levels, they are unlikely to even consider these as career goals. But if there are no Black nurses in those senior roles, there is no one who understands the barriers that prevent people of colour from progressing upwards, and what is needed to break those barriers down. Stalemate. Catch-22. The vicious circle closed.
Racism, race, class and gender inequalities are so tightly woven into all aspects of culture and society I realise I have strayed away from the issue of racial equality, so I will sign off with a personal story that highlights the unrecognised cushion that white privilege has bestowed upon me. My most recent job was in a community nursing team, after the introduction of long shifts ruined hospital nursing for me, once and for all. As a community nurse, I routinely visited patients in a local care home. When my own 92 year-old mother was admitted to that same care home, I had a slightly unprofessional chat with the home’s manager about a male resident I had met as a nurse.
‘He’s such a sweet man,’ I said. ‘Well, yes,’ she replied, ‘if you’re white, that is. He is terribly rude to all the black nurses and carers.’
I was truly shocked, but it made me realise just how different my experiences are from that of my black colleagues. As a lone-working community nurse, I would never, ever see that side of that man. I never have to gird my loins to protect myself against rudeness and possible abuse from a racist patient or family member: it just wouldn’t happen to me. This is true white privilege – something that is unconsciously enjoyed, a taken-for-granted ease in a world peopled by too many ignorant and hateful bigots who, by a fluke of my family heritage, do not automatically judge me as inferior or unworthy of everyday politeness and decency because of the colour of my skin.
I have not yet worked out what to do about this on a personal level – except, maybe, to support my black friends and colleagues as much as I can, in the knowledge that life is not so easy for them.
To tell them, and the world, in no uncertain terms that Black Lives Matter to me.
If anything in this article resonates with you please feel free to get in touch. If you are experiencing clinical racism from either your colleagues or service users we can support you with specialist race based therapist, we can help you to raise a grievance and connect with other Black and Asian nurses who understand your struggle. Please stay strong x