Racism in Nursing - Not Just an American Problem

 by Kaz Weida and Gerard Soucy, RN CHPN

America isn’t the only country that has a problem with racism in nursing. In the UK, 25.7% of the National Health Service (NHS) staff is from minority ethnic groups. A recent survey found that a clear majority of the black and minority ethnic NHS staff, about 70%, reported experiencing racial discrimination. 

In fact, a report leaked to the press by a whistleblower at the Nursing and Midwifery Council (NMC), the country’s nursing regulator, indicates widespread allegations of racism and a work environment persistently hostile for minority staff both within the NMC and the NHS.

“The documents reveal how Black and ethnic minority staff fear they will be exposed if they speak up about racism. Concerns were also raised that Black and Asian people are not being promoted equally, driving a lack of equality in pay between staff.”

How a UK nurse won a landmark discrimination case against NHS England

Michelle Cox is a registered nurse with more than 30 years experience with the NHS who knows the scope of this structural racial discrimination firsthand. As a Continuing Healthcare Manager for the NHSE&I based in Manchester, she was the only black nurse in the region in 2018 and was appointed to the Chief Nursing Officer’s Black Minority Strategic Advisory Group.

While in this position, Cox endured what a judge later ruled was an “intimidating and hostile and humiliating environment” where her line manager, Gill Paxton, specifically excluded her from team events. The same manager also encouraged a colleague to report Cox for mental health issues.

With support from the Royal College of Nursing (RCN), Cox took her case to an employment tribunal in 2022. The tribunal unanimously decided that after Cox’s whistleblowing claim, her employer failed to adequately address the reported grievances associated with the discrimination and harassment.

Of particular note was an incident that arose while the line manager was providing evidence during the tribunal.

“At a hearing, in September, Ms Paxton 'extraordinarily' made reference to Miss Cox 'eating bananas' when trying to make a point about meeting notes – which was 'shockingly poor' and evidence of possible 'subconscious discrimination,' the judge said.”

Learn more about lateral violence experienced by nurses of color in the workplace in our episode, Nursing Foundation Violence.

Implications of Michelle Cox’s case for healthcare organizations around the globe

Michelle Cox prevailing at the tribunal sends a clear warning to healthcare organizations that the lip service and PR campaigns they are using to address racism in nursing are simply not enough.  And that to continue to ignore or undermine whistleblowers who come forward with claims will come at a significant cost to them.

Mushtag Kahin is a mental health practitioner in the UK. She says that while the situation is improving for nurses of color, much more needs to be done to address racism in nursing. “The NHS needs to take practical steps in tackling nepotism, discrimination, and racism in recruitment - such as mandatory diversity panels. In the senior positions in the executive board, there should be at least 50% mandatory make-up from people from the global majority.”

Kahin also advocates for an independent body that would review racism complaints and assess fines against NHS Trusts to hold them accountable. She also believes students and staff at NHS should have anti-racism training every two years led by external experts.

“People are uncivil in the workplace when they are empowered to get away with it,” Kahin observed. “People should be reported and follow disciplinary action if they are not improving, even after attending anti-racism training. We must encourage nurses of color to share their stories and validate their feelings.”

“We need to celebrate nurses of color and not take them for granted. To retain nurses from the global majority, we need to promote them and have diversity from the top down so they can be inspired to get the top jobs in the NHS.”

Our next blog post will takes a deeper look into the response by the Royal College of Nursing to Cox’s complaint, and compares it to the American Nursing Association’s (ANA) attempts to address racism in nursing.

Kaz Weida is an editor and journalist covering topics in health, education, science, technology, social issues and advocacy.

Gerard Soucy, RN CHPN is a nurse and blogger practicing in serious illness, end of life, death care, final disposition, bereavement and legacy.