Analysis

Racism and nursing students: how to call it out and where to seek support

Students often feel they lack support to report incidents, whether on campus or placement

Call for universities and placement providers to do more to end discrimination and support BAME students

  • Nursing students lack confidence that authorities will believe their complaints of racism
  • NHS and university leaders have a responsibility to understand the adverse experiences of BAME nursing students and take action
  • Practical guidance on what to do if you experience racism or have witnessed it

Senior nurses say nursing students need more support to raise concerns about racism while at university.

The call comes after a Nursing Standard investigation found two thirds of universities had recorded no official complaints from nursing students about racial harassment in five years.

Call for universities and placement providers to do more to end discrimination and support BAME students

  • Nursing students lack confidence that authorities will believe their complaints of racism
  • NHS and university leaders have a responsibility to understand the adverse experiences of BAME nursing students and take action
  • Practical guidance on what to do if you experience racism – or have witnessed it
Students sitting in a university lecture hall
Picture:iStock

Senior nurses say nursing students need more support to raise concerns about racism while at university.

The call comes after a Nursing Standard investigation found two thirds of universities had recorded no official complaints from nursing students about racial harassment in five years.

Legal definition of racial harassment

On average, 27,000 nursing students began UK degree programmes every year during this period.

I in 5

nurses in the UK are from black, Asian or minority ethnic backgrounds

Source: NHS.uk

Racial harassment is defined by the Equality Act 2010 as behaviour related to a person’s race that violates their dignity and creates an intimidating, hostile, degrading, humiliating or offensive environment.

This behaviour might include:

  • Physical attacks, racist name-calling, insults and jokes.
  • Exclusion from conversations or group activities or exposure to racist material.
  • Microaggressions – comments or actions that indirectly, subtly or unintentionally discriminate against the individual.

Out of the 90 universities that offer undergraduate nursing degrees, 73 responded to Nursing Standard’s request for information.

All these institutions confirmed they had procedures that enable students to raise complaints of racism while at university and on placement.

However, 49 universities said they had received zero official complaints and the remaining 24 universities recorded a total of just 43 official complaints between them in the academic years 2015-19.

Twenty of these complaints were made by nursing students about university-based incidents. A further 23 complaints were raised by nursing students about incidents on placement.

I was singled out in a way white students were not

Nursing student Elisheba Gardner
Elisheba Gardner

After experiencing racism on campus and placement, Middlesex University third-year adult nursing student Elisheba Gardner received support from her institution’s race equality group.

Ms Gardner recalls a security guard – on more than one occasion – singling her out for snacking while working late in the library, but not white students doing the same.

A placement assessor was consistently rude to her and to other members of staff who were not white British, she says.

She says the Student Healthcare Academics Race Equality, Diversity and Inclusivity Network (SHAREDIN) made the difference between her ‘carrying on and not carrying on.’

‘You get to talk about how you feel before you stamp it as being racist’, she says.

Scale of racial harassment in universities may be hidden

1 in 20

university students from England, Wales and Scotland who responded to a call for evidence said they had left their studies due to racial harassment

Source: Equality and Human Rights Commission

Recent research from the Equality and Human Rights Commission (EHRC) suggests the scale of racial harassment among all higher education students in England, Wales and Scotland is higher than reported cases might indicate.

An EHRC survey of 1,009 students found 24% of those from an ethnic minority background had experienced racial harassment since joining their courses, compared with 9% of their white peers.

Two thirds said they had not reported it, giving reasons including lack of confidence that the university would address the problem, or not knowing how to complain.

Respondents told the EHRC survey they could not judge whether an incident was serious enough to report, or lacked proof it had occurred.

What to do if you experience racial harassment

A black woman sitting talking to another woman
Picture: iStock

Earlier this year, an investigation by the BMJ and doctors’ union the British Medical Association found that fewer than half of medical schools in the UK collect data on students’ complaints about racism and racial harassment.

The study requested information from 40 schools, 32 of which replied. Half of the respondents reported that they collect these data.

In the decade since 2010, these schools have recorded 11 complaints between them, the data show.

BMA guidance suggests students should:

  • Seek support Speak to someone they trust and feel comfortable with, who will actively listen and not rush to judgement. This person could be a bullying or harassment adviser, student counsellor or representative
  • Keep a record of incidents and stick to the facts This will help if they report or complain formally
  • Challenge behaviour, or escalate it A calm and non-confrontational approach offers the person a chance to apologise, reflect and learn. Focus on the behaviour rather than the person, framing discussion as ‘When you said… I felt…’ rather than ‘You’re a racist’ or ‘You’re a bully’, which can lead to defensiveness and conflict
  • Report behaviour and complain Familiarise themselves with their institution’s policies and procedures for reporting and dealing with harassment. Expect to be kept updated and supported throughout and for the complaint to be responded to in a timely way

What students can do if they believe their complaint is not resolved

Students in England and Wales can contact the Office of the Independent Adjudicator.

Those in Scotland can seek redress through contact the Scottish Public Services Ombudsman and in Northern Ireland, students can go to the Northern Ireland Public Services Ombudsman.

Adapted from BMA guidance

Others feared the personal consequences that reporting might have on their education, career and well-being, or worried they would be seen as troublemakers.

Students worry they will not be believed if they complain

Stacy Johnson, associate professor at the University of Nottingham
Stacy Johnson

University of Nottingham’s school of health sciences associate professor Stacy Johnson agrees students may be reluctant to report racial harassment through fear of the consequences, and wants universities to offer better support.

She says: ‘Students tell me they don’t think they will be believed because they have not been believed in the past, perhaps when they’ve raised concerns.’

She says students from black, Asian and minority ethnic (BAME) backgrounds are often worried their academic record will be affected if they speak out.

‘When nursing students are on placement, often the concern that they want to raise is linked to the person who is going to be assessing them.

‘They have a lot of concerns about what that means for them and their progress on their course.’

I have witnessed racial harassment – what do I do now?

The British Medical Association (BMA) suggests witnesses of racial harassment should consider becoming ‘active bystanders’.

Universities may offer training in active bystanding, defined by some institutions as being aware when behaviour is inappropriate or threatening, and choosing to challenge it. Those that do not offer it should be asked to do so, the BMA states.

Active bystanding may mean giving a disapproving look when racist jokes or comments are made, or being confident enough to express disapproval verbally.

Try the ABC approach:

A Assess for safety and ask the individual subject to the harassment if you can help safely in any way

B Be in a group as it’s safer to call out behaviour or intervene in a group, or report to others who can act

C Care for the person and ask them how they are

Adapted from BMA guidance

Responsibility of placement providers to support nursing students in the face of racial harassment

18%

of all institutions (fewer than 1 in 5) said they received no complaints of racial harassment from either staff or students

Source: Equality and Human Rights Commission

Health Education England chief nurse Mark Radford points out there are clear expectations of placement providers within its quality framework for education and training, in terms of supporting students experiencing racial harassment.

‘As part of the framework we expect providers to demonstrate a culture that responds to feedback from learners and that concerns raised are addressed.’

The time and emotional cost of reporting racial harassment can be an additional barrier, says Professor Johnson.

She wants to see UK universities adopt some simple rules to support students who are raising concerns about racist behaviour.

‘I would like to see an NHS that actually understands the importance of racial equality’

Yvonne Coghill, former director of the NHS Workforce Race Equality Standard

Investigations should be confidential, says Professor Johnson, and people under investigation should be unable to make counter claims until the initial investigation is complete and the investigator should not know the complainant or person under investigation.

How a student network is raising awareness and offering support

Academic staff at Middlesex University in London set up a support network 18 months ago, after nursing students approached lecturers about their experience of racism and discrimination.

The Student Healthcare Academics Race Equality, Diversity and Inclusivity Network (SHAREDIN) now has 100 members.

Co-founder adult nursing lecturer Sheila Sobrany says SHAREDIN holds regular online meetings to discuss concerns relating to all aspects of nursing courses.

The network supports nursing students with advice, introduces them to senior nurse leaders from black, Asian and minority ethnic (BAME) backgrounds, and is fostering relationships with placement providers.

Seeing things from other perspectives

Network member Zoe Carciente, who recently completed her children’s nursing degree at Middlesex, says being part of the group helped her see things from other perspectives.

Nursing student Jezelle Miller
Jezelle Miller

‘[It] made me realise that being a white person you probably do get it easier in some ways,’ she says.

‘You don’t see all of these undercurrents because you are bit oblivious, because they are not directed at you.

‘It is about opening up your eyes and listening, really listening, on the ward or out in the community.’

Lead officer and third-year adult nursing student Jezelle Miller was supported after opting out of work during the pandemic over concerns about personal protective equipment and heightened risk of COVID-19 for BAME staff.

She also says she witnessed racism towards a member of staff while on placement before the pandemic.

Of the network, she says: ‘There is no judgement and it’s a place where you can feel safe to voice any concerns.’

What universities are doing to understand the experience of BAME students

The Council of Deans of Health (CoDoH), which represents university nursing, midwifery and allied health faculties, says it is working with universities and BAME students through its student leadership programme to understand the issues students face.

The programme, which has been running for four years, has a cohort of 50 students raising and discussing key issues, including those affecting diversity and equality.

CoDoH chief executive, Katerina Kolvya says: ‘This gives a platform for students to effect change at a policy level and have an impact on universities' procedures.’

Leaders need to want to see change for change to happen

Yvonne Coghill, former director of the NHS Workforce Race Equality Standard
Yvonne Coghill

But effective change needs to start at leadership level, according to Yvonne Coghill, recently retired director of the NHS Workforce Race Equality Standard (WRES).

Ms Coghill says racism constitutes a wider social issue that only leaders can tackle.

‘Until senior leaders really want it to change, it is not going to,’ she says. ‘It has to come from the very top.’

WRES data collected over the past five years have helped to highlight racial inequalities in the NHS, and Ms Coghill says organisations have been negligent in addressing these.

‘The question isn’t what should be done,’ she says. ‘The question is why aren’t they doing it?’

Ms Coghill believes more training is needed to help white people understand their ‘privilege, potential prejudice, and position of power’.

‘I would like to see an NHS that actually understands the importance of racial equality and begins to work towards making sure all members of staff, regardless of their background, have a good experience in working in it,’ she says.

NS Student: study skills, clinical skills, well-being and more

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