An overseas nurse manager tells her story.
Sixteen years ago, I arrived in the UK, an overseas nurse with dreams and aspirations. I was told you could be whatever you want from an inspirational leader and I held that very close to my heart. I was naïve when I came to the UK, it was the early part of nursing immigration. There were a lot of cultural and language differences. I remember when a patient said she wanted to ‘spend a penny’ and I was looking around for a penny!
I couldn’t recognise racism at that point but now when I reflect back, I remember when I was on day surgery, we would get an influx of patients at eight in the morning. I remember clocking most of the patients with another Indian nurse. I was doing this even when we had other nurses, English nurses and their healthcare assistants, who could do the job. It took a toll on my back because I now suffer from back pain from pulling the trolleys. I would get 25 patients, while the normal load was seven. I didn’t get any tea break. I was continuously working till one o’clock. And then at one o’clock, I would have my lunch break. I didn’t know how long my lunch break was. So, I just went, ate quickly and came back. Nobody told me your lunch break is half an hour.
It was always difficult to raise any concerns. Once I raised an issue with a band six nurse and she just turned it back on me and said she had heard a lot of complaints about me. But she never approached me independently about anything. It was only because I had raised an issue. And when I asked to speak with the individuals who had raised concerns, she didn’t want to do that. I never raised any concerns with the band 7 because she acted as though I didn’t exist. She never spoke with any of the overseas nurses to ask how we were settling in. I was invisible for the years that I worked in that hospital.
I think the first time I recognised racism was when I applied for a Master’s programme. I was successful and went to a nurse consultant to ask if she would act as a supervisor. She went back to the panel to ask why I had been given the position, saying I wasn’t qualified. I was told by the organisers that I had won the place through careful consideration and could continue, but it meant that I had no mentor and just did the course by myself.
Where I was working in critical care, the work was very heavy, and I realised that I would not be able to progress beyond those heavy roles in that hospital. I could see that I might get a band 6 job on the wards, but not in a specialist unit because the jobs were mainly filled by white peers who were given more progression opportunities. I was single, with no dependents so when I got my indefinite leave to remain, I decided to move. Its noteworthy that none of the 33-member cohort who came with me from India were able to progress before they got their indefinite leave to remain. Many remain Band 5 nurses after nearly 20 years.
I flourished in my new place of work and progressed well. I became a matron and worked in two different trusts. In one trust there were a lot of patient safety issues. I started highlighting one issue after another, to the chief nurse and others. But when I escalated it, they started bullying and harassing me.
They tried to suggest that I was bullying and harassing nurses and that I was behaving in an unprofessional way. It is funny, because they suggested that I was rallying nurses to get rid of white colleagues. The manager tried to suggest that I wanted her position, but there was no evidence. It was just made up. I can very clearly mention everything about the bullying because bullying leaves a long-lasting impact on you. But the managers could not even remember the events properly when it came to the hearing.
I was depressed. I had bald patches all over my head as a result of the medication I was prescribed. I was very, very clinically depressed, almost suicidal. I had built my career with so much effort. I had hidden the obstructions every part of the way. It’s not easy to do that. And then suddenly it has all been snatched away from you. There was no case to answer. I was innocent but it took 15 months to get back to my clinical role.
When COVID hit I was involved with a lot of international nurses in a post pastoral capacity. They were really frightened. There were practically no white nurses in the organisation who were on the floor. And these are poor nurses who have just literally come from India or Philippines. They were on the floor with no masks, nothing. And they were told, just get on with it, because that’s PHE guidance. And I remember answering some of their calls saying, ‘Ma’am, we are really frightened for our lives. This is not right, I worked in Saudi and we had a lot more PPE than what we have here. We are all going to die.’ And I sat with my manager at that point in corporate and she just said, well, ‘we’re just following PHE guidance’. But were they comfortable working in these conditions? We didn’t see any of these managers on the floor. So when it came to pandemic, because I worked in a very ethnic minority heavy area, I felt very angry because I felt like they are letting them die. It didn’t seem to matter because obviously they’re all ethnic minorities and as a result we had 5 deaths in our organisation.
None of the managers were redeployed and all these people in comfy jobs, they never got redeployed to our areas. Nothing. So sometimes there would be one nurse on the ward for 28 patients. And that’s it. That’s all we had. And at that point, I was not in my clinical role. I was pushing to come back. They were saying we don’t want you to come back to your clinical role. I said, isn’t it better for me to come now in the middle of a pandemic? I was just treated like dirt but I had to go back to assert my innocence. When I came back. I was literally invisible again, nobody talked to me.
I felt very vulnerable for my patients who didn’t get the care they needed. There were not enough nurses and after some time, I think some of the nurses developed some sort of apathy because no one showed care towards them. It was terrifying for people; they knew they were working with a management that didn’t seem to care about them. So, they reciprocated in the same way. They were terrified. Some of them just went to their GPs, got shielding letters, they just covered themselves. I felt, this is what happens in an unequal, unfair society. People who will know how to manipulate the system will do and others will continue to be victims. It ends up as a survival game.
My patients did not get the care they needed. There were patients that were not getting oxygen and they needed oxygen; patients not getting observations done when they needed those observations being done. And you as one person can’t do it. That’s really the difference in having a mass power. You can’t change things alone. That is why distributed leadership, collective leadership is so important in organisations. You can’t do this on your own. If I had my chief nurse coming and rolling up her sleeves and helping, that would have been role modelling. If I had my director of nursing doing the same, it would have been role modelling. But no, we didn’t see that. So staff thought, you are tucked away in your offices protecting yourself. But they had no office, they didn’t even have a place to sit and eat their food properly.
If I had the chance to make the workplace safer, I would have deployed all those non-clinical nurses who were not working on the wards back to the wards. I would have started the upskilling of the non-clinical nurses and put them all back on the wards for some months. Because you must know a pandemic lasts two to five years, it does not go away in six months’ time.
The NHS management structure still follows a military structure. It’s all hierarchy. Its outdated. We need a distributed leadership system which would empower people on the floor. They would feel more part of an organisation and more part of decision making. They wouldn’t feel things were done to them. They would feel, we were engaged, we knew. And that would have had a better impact on their mental well-being, as a group of people working in the middle of a calamity – the pandemic. And that would impact on how they treated their patients.
And Racism is a crime isn’t it? For me, there should be clear consequences for people. The organisation needs to say, we are not taking this lightly. People, including nursing directors should be referred to NMC and struck off for racism. They shouldn’t be allowed to be a nurse.
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