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COVID-19 leadership challenges: experiences of nurses from minority ethnic backgrounds

Five nursing professionals describe how the pandemic affected their work, teams and patients

Five nursing professionals describe how the pandemic affected their work, teams and patients

  • The pandemic has disproportionately affected people from black and minority ethnic backgrounds, including many nurses
  • How nurses have dealt with fear among patients and colleagues and increased workloads, while introducing systems involving less face-to-face interaction
  • Challenging conditions have brought out best practice in leadership roles and opportunities for reflection

Although 2020 was designated International Year of the Nurse and Midwife by the World Health Organization, the global nursing profession could never have known just what lay in store.

As the first wave

Five nursing professionals describe how the pandemic affected their work, teams and patients

  • The pandemic has disproportionately affected people from black and minority ethnic backgrounds, including many nurses
  • How nurses have dealt with fear among patients and colleagues and increased workloads, while introducing systems involving less face-to-face interaction
  • Challenging conditions have brought out best practice in leadership roles and opportunities for reflection
From left: Fawn Bess-Leith, Comfort Aba Asmah, Joan Nelson, Ruth Oshikanlu and Adebola Aroboto

Although 2020 was designated International Year of the Nurse and Midwife by the World Health Organization, the global nursing profession could never have known just what lay in store.

As the first wave of COVID-19 virus surged through the UK, it became clear that not all was equal.

Disproportionate impact on staff from ethnic minority backgrounds

A disproportionate number of NHS staff from minority ethnic backgrounds died after contracting the virus, leaving many nurses to face understandable fear about going to work amid heightened risk of illness or mortality. They were also grappling with concerns from patients about their risk of infection.

More than a year since the COVID-19 pandemic was announced, five UK nurses and midwives from minority ethnic backgrounds reflect on how the pandemic changed their nursing practice and the roles they’ve played in supporting patients, communities and colleagues during this time.


Ruth Oshikanlu, Queen’s Nurse, independent health visitor and nurse entrepreneur

A safe space to talk and share experiences

Ruth Oshikanlu, Queen’s Nurse, independent health visitor, nurse entrepreneur, chief executive of Goal Mind and RCN fellow
@RuthOshikanlu

In January 2020, my professional peer support group for black nurses and midwives working in London and Kent – Unleashed Leaders – met to set our goals for the year ahead.

In what was the International Year of the Nurse and Midwife we wanted to celebrate the difference we make to the populations we serve.

The same month I also began my Churchill Fellowship in the USA to investigate trauma-informed approaches to care for young people who have experienced adverse childhood experiences in January.

However, the year soon changed course.

On my return to the UK, I took up a role as an agency health visitor in north London. But within a couple of weeks, I contracted COVID-19 and was extremely unwell for six weeks.

‘Nursing’s response to the pandemic has highlighted the crucial role we play in achieving sustainable global health’

As I was recuperating, I felt saddened about how the plans we’d made to celebrate the International Year of the Nurse and Midwife had been scuppered.

I was also terrified about returning to the front line to continue practising, as I did not feel protected while working. I had not been provided with PPE before I contracted COVID-19.

Online forums to support staff and patients

During 2020, I set up two virtual platforms to provide support for anxious clients and colleagues.

The first was an online forum, Virtual Mamahood, to support pregnant women and new mothers who were feeling isolated, worried, overwhelmed and stressed due to the pandemic.

The second was a national service to give colleagues a safe space to talk and connect with others facing the same challenges, called Carers Café. The idea arose after listening sessions for ethnic minority staff, held by the Chief Nursing Officer for England’s Ethnic Minority Strategic Advisory Group, of which I’m a member. Many nurses reported not feeling protected or supported at work.

Online platforms Virtual Mamahood, Nurses & Midwives Talk and Carers Café, set up to support nurses and patients
Online platforms Virtual Mamahood, Nurses & Midwives Talk and Carers Café, set up to support nurses and patients

In June, I was awarded a COVID-19 Action Grant and used the funds to provide front-line black and brown healthcare staff with culturally and spiritually sensitive psychological support, working with community and faith leaders.

I also set up Nurses & Midwives Talk, a video interview podcast to celebrate the diversity of nursing roles and the difference we’ve made during a challenging global pandemic.

I’ve interviewed more than 345 nurses and midwives from over 30 countries, who have demonstrated their resilience, tenacity, innovation and expertise.

Nursing’s response to the pandemic has highlighted the crucial role we play in achieving sustainable global health.

My biggest wish is that we continue to be valued, respected and rewarded as health leaders beyond the pandemic.


Comfort Aba Asmah, locality manager at a health visiting service in north London

Compassion and communication: my lessons in leadership

Comfort Aba Asmah, locality manager at a health visiting service in north London

The COVID-19 pandemic has been an eye-opener and a learning opportunity for new leaders like me.

It has undoubtedly been a challenge – emotionally, physically and mentally – in terms of how to support a workforce in uncertain times.

COVID-19 ripped through the country, affecting black and minority ethnic communities disproportionately. This created a frightening narrative for all of us in the community, especially those with health co-morbidities. One of the things I found was how many people had issues that were being hidden and not talked about.

‘Being a new leader in these times has been challenging, but this has taught me that leadership is driven by compassion, good communication, transparency and openness’

As a profession, we are good at what we do, but not always so good at sharing our problems with others. This allowed me to think about how to support people.

I completed the NHS Leadership Academy Mary Seacole Programme last year, which has given me confidence during this difficult time.

Being a leader is not about control, but about empowering the team and trusting them. Some of the skills I developed on the course – empathy, compassion and strong communication – I applied to practice, enabling me to understand the emotional stress that staff were going through.

Greater use of phone consultations with parents has been a big change for health visiting teams
Greater use of phone consultations with parents has been a big change for health visiting teams Picture: iStock

The other important element was to be responsive to their needs and signpost adequately. I had to be innovative in the changes that I brought to my workforce – it was not easy, but necessary because of the circumstances.

Embracing working from home and using the telephone more to contact parents has been a massive change.

Leading with care

Having regular catch-ups with members of the team helped bring back a sense of togetherness and provided much-needed emotional support.

Throughout this, I’ve had an excellent coach who is enabling me to be a better leader through deep thinking, reflections and innovative methods of leading.

Being a new leader in these times has been challenging, but this has taught me that leadership is driven by compassion, good communication, transparency and openness. I am looking forward to continuing to lead with care in the future.


Joan Nelson, Queen’s Nurse, health visitor and midwife who works in a London school nursing team

Overcoming safeguarding challenges amid restrictions

Joan Nelson, Queen’s Nurse, health visitor and midwife who works in a London school nursing team

One of the biggest challenges for school nurses during the pandemic has been that not all children have been physically present in school due to the COVID-19 restrictions.

Our school nursing team quickly adapted to provide services via social media, phone advice lines and video calls so that children would not experience barriers to accessing a school nurse and had a safe space to be heard. With the use of these communication platforms, we were able to support children.

Some children had COVID-19, others were experiencing the negative effects of lockdown, and then there were those who had a mental health diagnosis or symptoms, as well as children experiencing various forms of abuse and exploitation.

‘School exclusions are stigmatising and can have a profound negative impact on a child’s self-esteem, mental health and future life chances’

Safeguarding concerns were heightened because of school closures. Children in the greatest need were not always attending school in line with recommendations that they should, and this in itself became a safeguarding challenge.

Our safeguarding workload increased. However, there was the flexibility to pace our day and seek advice and support via safeguarding drop-ins and through our team leader and operational management support.

Specialist help for children with unmet needs

During lockdown, I completed a health needs assessment via video call for a boy who had been permanently excluded from school and had additional health and mental health needs.

During the 2018-19 academic year, 7,894 children were permanently excluded from school in England. School exclusions are stigmatising and can have a profound negative impact on a child’s self-esteem, mental health and future life chances.

In the 2018-19 academic year, 7,894 children were permanently excluded from school in England
In the 2018-19 academic year, 7,894 children were permanently excluded from school in England Picture: iStock

The boy shared his experience and expressed his wishes and feelings during my assessment. I identified some unmet needs and signposted him to specialist services, which helped him access an assessment of possible underlying difficulties.

Through these external agencies he was also able to access specialist advice and advocacy about his school exclusion. The support provided ultimately led to his exclusion decision being overturned.

My involvement was recognised by his parents, who contacted my line manager to express their appreciation for my support.

That is just a snapshot of one intervention that made a difference to the life of a child; many such interventions are still ongoing in the school nursing service.


Fawn Bess-Leith, specialist health visitor in perinatal and infant mental health

Sensitive, compassionate adaptations to perinatal care

Fawn Bess-Leith, specialist health visitor in perinatal and infant mental health, Florence Nightingale Foundation Windrush scholar

More than one in ten women experience mental health problems within a year of giving birth.

My specialist role is crucial in the multidisciplinary pathway in delivering effective mental healthcare to mothers, fathers and infants in their own homes during the perinatal period, from pregnancy to the child’s first birthday.

For me, 2020 began with the award of a place on the Florence Nightingale Foundation’s (FNF) Windrush Leadership Programme for black and minority ethnic nurses and midwives. The programme offers bespoke leadership development in a less conventional way – through a peer-to-peer learning environment that allows you to discover your own leadership style.

During the pandemic, I embraced new ways of working and delivered care by offering a blended approach. For some families I provided well-being visits and contact for a four-week period, alternating with face-to-face and virtual contacts, which focused on any difficulties that the mothers were experiencing.

‘The impact of COVID-19 on professionals and women in the perinatal period caused intense and overwhelming fear and anxiety’

I supported new mothers with concerns about issues ranging from low mood and emergency food to housing, school, immigration, so that they had better control of their situation and the next steps.

My input meant that expert, reliable support was offered at a time when other services were less available, reducing the need for hospital admissions.

‘Listening visit’ guidelines standardised support for new mothers with postnatal depression
‘Listening visit’ guidelines standardised support for new mothers with postnatal depression Picture: iStock

One of my clients, the mother of a five-month-old infant, had a mental health diagnosis and a high chance of relapse in the postnatal period. She had been admitted to hospital every October for the previous five years, however, in part due to the support she received during the perinatal period, she was not admitted last year.

Trauma-informed approaches to address anxiety

The impact of COVID-19 on professionals and women in the perinatal period caused intense and overwhelming fear and anxiety. In response to this, during the second half of 2020, I employed trauma-informed approaches to care to address the effect of psychological trauma in a more sensitive and compassionate way.

I developed ‘listening visit’ guidelines – non-directive counselling for mild to moderate postnatal depression – for the local health visiting service as my quality improvement project for the FNF leadership programme.

This ensured standardisation of practice across the heath visiting workforce, providing structure to the content and delivery of listening visits to support mothers with mental health problems.


Adebola Aroboto, female genital mutilation/perineal health specialist midwife, St George’s University Hospitals NHS Foundation Trust

The unseen impact on FGM risk

Adebola Aroboto, female genital mutilation/perineal health specialist midwife, St George’s University Hospitals NHS Foundation Trust, Florence Nightingale Foundation Windrush scholar

Female genital mutilation (FGM) involves the total or partial removal of the female external genitalia or the cutting of these organs for cultural or non-medical reasons.

Much like COVID-19, FGM is a global issue that requires a global response. Around 200 million women and girls alive today are affected by FGM and it is estimated that 4.1 million women and girls are at risk from the practice each year.

We need to make FGM everyone’s business, through education and community engagement.

The risk of FGM has increased due to international lockdowns. While other gender-based forms of abuse, such as domestic violence, have rightly received a significant amount of attention during the lockdown, FGM has not received the same attention, which it deserves. This is because talking about the vagina is still viewed as taboo.

‘Face-to-face consultations became virtual. This posed a major challenge, as many survivors of FGM are not familiar with the anatomy of the vagina or uncomfortable discussing it’

My role as a specialist FGM midwife drastically changed during the pandemic as face-to-face consultations became virtual.

This posed a major challenge, as many survivors of FGM are not familiar with the anatomy of the vagina or are uncomfortable with discussing it. To provide appropriate care, these women were provided with face-to-face consultations in a COVID-19 safe environment.

Individualised care for FGM and childbirth

Evidence has shown that women with FGM are significantly more likely than those without to have adverse obstetric outcomes, for example, related to perineal tear or postpartum blood loss, with long-term effects.

Appropriate birth plans can help to reduce the risks associated with FGM and childbirth.

Face-to-face consultations were necessary to provide appropriate care to those affected by FGM
Face-to-face consultations were necessary to provide appropriate care to those affected by FGM Picture: iStock

Having face-to-face appointments enabled me to identify the type of FGM women had, assess the risk FGM posed for them in labour, discuss the option of reversal and plan individualised and holistic care.

The appointments also gave women the opportunity to ask questions and enabled them to make informed choices on the treatment options offered, without pressure from their family.

Healthcare practitioners have a responsibility to unmask the harmful practice of FGM and work towards eradicating it by empowering women to be more body-aware and challenging perceptions of it as a taboo subject.


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