BME health care workers in Scotland under Covid-19: A call for action

Guest post by Camille Fiadzo, CRER research volunteer

In 2018, CRER hosted me to complete my University of Edinburgh MSc dissertation on racial inequalities in the workplace. My research asked ‘How does the racialized somatic norm manifest in nursing?’

Through a literature review accompanied by a small number of qualitative interviews with both BME and white staff, I identified specific issues affecting nurses from racialized minority ethnic groups. These issues include increased risk of bullying and harassment, over-representation in the fitness to practice procedures (the process through which the Nursing and Midwifery Council investigates and addresses complaints about nurses’ conduct and competence) and obstacles to recruitment, promotion and retention. This research, whilst written prior to the Covid-19 outbreak, is more relevant than ever to help understand institutional racism in nursing, and create effective responses to address it.

My report suggests that successive strategies to combat these issues have failed, potentially as a result of adopting soft-touch approaches which prioritise ‘cultural’ issues rather than directly tackling racism. To clarify the social attitudes underlying these inequalities, I identified common threads in both the literature and the experiences of the nurses interviewed. A sense emerged that BME nurses face attitudes and behaviours showing that they’re not trusted, respected or even expected to be in a nursing job to the same extent as their white peers. This was linked to deeply entrenched racial stereotypes, where BME women are less likely to be seen as empathetic and professional (key qualities in the nursing profession) in comparison to their white colleagues. Perceptions that BME nurses lack these qualities lead to over-scrutiny by management, hostility from service users and exclusion, bullying and harassment by colleagues.

In the midst of the Covid-19 outbreak, racism in nursing seems exacerbated. While data for Scotland is scarce, evidence around the world shows that BME people and healthcare staff are disproportionately affected by Covid-19. Nearly three times as many BME nurses have died following contamination, compared to white nurses. In an interview with Nursing Times, Carol Cooper, head of equality, diversity and human rights at Birmingham Community Healthcare NHS Trust, said “BME staff feel that they are being put on Covid wards and exposed to patients with Covid over and above their colleagues.” She also said that BME staff “feel that there is a bias – the same bias that existed before they are feeling is now influencing their being appointed and they are terrified, everybody is terrified”.

In response, the NHS in England and the Royal College of Nursing have both published recommendations to protect BME staff. Namely, they recommend employers carry out risk assessments for their staff, especially BME staff, and have regular conversations with them to identify any physical or mental health issues that may make them more vulnerable to Covid-19. These recommendations however, are non-binding and there is no data so far on how widely and effectively they have been adopted. NHS Scotland published interim guidance for health and social care employers on staff from Black, Asian and minority ethnic backgrounds in May 2020, however this was subsequently replaced with a generic guide on occupational risk assessment.

While my dissertation was written prior to the Covid-19 outbreak, its argument is still very much relevant – it shows that the core values in nursing work to systematically exclude BME people.

In conclusion, my report suggests that bolder approaches to tackling racism and advancing the position of BME nurses are needed, along with action to tackle the poor working conditions which contribute to social divisions in the nursing profession.

Full dissertation available to download here:

How does the racialized somatic norm man

For additional information, some key documents looking at ethnicity and Covid-19:

More from the CRER blog: Covid-19 and Ethnicity in Scotland: Where's the data?

National Records of Scotland (2020) Deaths involving Covid-19 by ethnic group

Public Health Scotland (2020) Updated analysis of Covid-19 outcomes by ethnic group

Meer, Qureshi, Kasstan & Hill (2020) Covid-19 and BME Disproportionality

Khunti, Kumar Singh, Pareek and Hanif (2020) Is ethnicity linked to incidence or outcome of Covid-19?

ICNARC (2020) Report on patients critically ill with Covid-19

Royal College of Psychiatrists (2020) Impact of COVID-19 on Black, Asian and Minority Ethnic staff in mental healthcare settings assessment and management of risk