This week’s Blog is written by Dame Donna Kinnair, Chief Executive and General Secretary of the Royal College of Nursing.

As Chief Executive and General Secretary of the Royal College of Nursing, I represent 450,000 registered nurses, midwives, students and nursing support workers. The work we do has a direct impact on nursing staff working in every health and care setting – and our professional and employment support and guidance has never been more needed than during this past twelve months.

Nursing staff represent the largest health care workforce – and in England, one in five nursing staff are from Black, Asian and minority ethnic (BAME) backgrounds. Our health and care system is staffed by a diverse workforce in every profession and pay grade with one in five NHS staff in England reporting a non-British nationality.

As a black nurse myself, I have experienced challenges during my career – and my experience is not unique. Many nursing staff find themselves facing everyday racism and hostility in the form of outright discrimination as well as subtle microaggressions and uncivil workplace behaviours in their day-to-day experience.

And it isn’t just racism that staff in our health care system struggle with. They personally experience discrimination based on sex, disability or other protected characteristics and as a nursing leader, I am keen that the RCN support nursing staff to challenge discrimination and show leadership in achieving equality for all.

You can see discrimination evident in the lack of representation of BAME people in senior nursing positions. Nursing skill, talent and ability are equally distributed across the population but what remains unequally distributed is full equality of opportunity. This is something that must change – it remains a sore point of injustice in healthcare.

Large systems like health and social care must recognise the role that all forms of racism play in denying opportunities to BAME nursing staff, as well as nurses and nursing support workers with other protected characteristics. Student nurses also report difficulties in getting universities to properly understand the complexities of these issues too.

To challenge this, all organisations must clearly commit to achieve equality and inclusion – making sure there is full accountability for action and progress. How organisations establish the importance of this agenda at every stage and level of operation is key to driving a clear narrative that makes this agenda everyone’s business.

It is vital that leaders, and by extension role models for others, are fully representative. Diversity must be seen as a source of strength for nursing as we bring our knowledge of different lived experience to bear to provide personalised and culturally competent care to patients.

The power of role models is felt when they behave in ways that are authentic and real to that individual which then encourages others to develop their own leadership style. This gives the next generation of nursing staff and nursing leaders the confidence to bring their insight and authentic self into the workplace.  It is only through this, will we see real change in the structure of our nursing and health and care leadership roles.

2020, and extended into 2021, is the WHO Year of the Nurse and Midwife – and the spotlight has been on nursing like never before. The COVID-19 pandemic is immensely challenging for nursing staff – professionally and personally – and nursing has been at the forefront of the COVID-19 response, including the current vaccination rollout.

The COVID-19 pandemic has revealed a lot about health inequalities and wider structural disadvantage in our society. And those from some black and minority ethnic backgrounds are among the groups that face an elevated risk of catching and dying from COVID-19.  The full impact COVID-19 on different groups of health care workers is not yet fully understood and further research and study is needed to explain the gaps in our knowledge and understanding.

But in a survey of RCN members during the first wave of the COVID-19 pandemic in 2020, our BAME members reported they felt unsafe in the workplace because of a lack of PPE and felt unsupported by their employers who tolerate bullying and discrimination. We are unclear as to why these issues around safety at work, especially for BAME staff, have been slow to be answered by employers and the government.

Nursing on the front-line of the COVID-19 pandemic requires a huge range of skills and BAME nursing staff do not deliver care in a bubble. They will face the same pressures and concerns as any other group. It is absolutely crucial for this group to be listened to and for organisations to be guided by the lived experience of staff. All too often, organisations forget that part of their mission must be to create workplaces for human beings to work and achieve their full potential. Inclusion remains a powerful and compelling solution to delivering this.

The RCN continue to support nursing staff through the COVID-19 pandemic – we are advocating on behalf of all our members regularly with system leaders and those in government on the key issues impacting our members. And we continue to develop the evidence and guidance nursing staff need to deliver care during COVID-19 – which is updated regularly and available on our website.

As we continue to live and work through the COVID-19 pandemic, nursing staff from all backgrounds should think of themselves as leaders in how we shape and structure change across the wider health and social care sector. All nursing staff can use their position and knowledge to challenge discrimination. We must all see it as our role to support individuals who experience marginalisation to be able to voice their concerns and for their insights to be taken seriously and acted upon.

Tackling discrimination requires all of us to build our inclusion literacy and knowledge about tackling inequality in the workplace and beyond. And through this, we will model the way to improve care and outcomes for our patients. Only when equality is delivered for our health and care staff and there is an increase in diversity and representation in all roles, will we improve things not just for our patients, but for ourselves and our colleagues.

During this pandemic and the extended Year of the nurse and midwife, I think it has become more essential that ever to do all we can to move the nursing profession forward. And I will continue to advocate for and represent all our members – whoever they are, whatever they do and wherever they work.