Of Crossroads and Pivots
To be at crossroads.
Most of us over the course of our lives have experienced some form of toxicity in a relationship be it at home, work, on a personal or professional level and have probably asked ourselves how did we get there or how can we leave or have recognised that we need to leave but are scared of what happens next! Fear of the unknown coupled with the uncomfortable comfort of the known. These concerns or thoughts become more profound when you have had a long relationship spanning years or even decades with whomever or whatever situation you are trying to leave behind. Most people when asked will tell you to just leave, but it is never that simple especially if it is all you have known as an adult and have a love/hate relationship. Over the last couple of years, I have found myself asking these same questions. How do I leave given the love/hate relationship I have, not to mention that my whole adult identity is tied to this very thing that is sucking the life and soul out of me? How do I leave the toxic profession that Nursing has become, when it is all that I have known but is no longer excited about, more so as a Black Nurse?
I have gained a lot in being a nurse and from nursing but at the same time nursing has taken a lot from me, sometimes I think more than I have gained. I recently came across a post on LinkedIn by a nurse, a proud one at that, who stated how nursing was and still is his whole identity and will forever be and I was conflicted because I understand his sentiment, as a nurse your whole life and identity revolves around nursing, how you act within and outside of work and how you are expected to live and interact with society. It's all consuming and the reason I am conflicted is because I currently have a love hate relationship with nursing. It's like that toxic partner that you are trying to leave but they keep reeling you back even though you know they are not good for you. Not good for your physical and mental health not to mention your financial health but they are comfortable, all you have known, familiar. Nursing doesn't love us Black nurses, be it our places of work, those we care for, our unions and even our governing body! That's a lot to deal with and one can't unsee the disdain and contempt and the appalling treatment we get. It's disheartening when you give 110%, when you look around and equitable healthcare, health services and work conditions are not afforded to those of us who are Black especially Black Women. Nurses be everywhere and that is a good thing given the diverse unique set of skills nurses have that are transferable to lots of industries. I can only be thankful for the opportunities, people and friends that I have had and met through my work as a nurse, the lives that have impacted mine and those that I have had the privilege of being a part of even though there have been days when I have questioned why I became a nurse. From the inequalities witnessed while training to the experience of racism and how widely it is embedded in everyday life, nursing notwithstanding.
Once again I find myself at a crossroad, needing to forge a new path ahead. I walk in grace and have faith that whatever path I choose at this season of my life, I will still advocate for nursing and nurses to be valued, especially Black nurses, as we are witnessing in real time the decline in health care services and patient outcomes due to how nursing and nurses and the brilliant work they do has been undervalued not only here in the UK but worldwide. As a service user myself having witnessed the health inequalities Black Patients experience firsthand, I will also still be a loud advocate for equity in healthcare for Black patients. Because racial weathering is a thing and racism does kill and should be a public health emergency, it's only fitting that I end with the words of Bossbabe.Inc:
“ I’m shifting from my hustle era to: My balanced era. My soft era. My ‘nervous system is calm’ era. My ‘work smarter, not harder’ era. My ‘know my worth, regardless of results’ era.”
Nothing to celebrate here!
It is getting harder and harder to celebrate being a Nurse.
I don’t know about you but life just feels Meh ( if that’s still a term) at the moment. Everything feels off and it is getting harder and harder to find the little joys in life with so much going on in the world right now. Yesterday was the culmination of Nurses’ week celebrations culminating with celebration of International Nurses’ Day which ironically ( for us Black Nurses) falls on Florence Nightingales birthday! There is a lot to unpack there but that is a rant for another day even though it could be argued that it does fit in with the sentiments i am about to express which is that it is getting harder and harder to find anything to celebrate about Nursing or being a Nurse more so a Black Nurse.
Nurses, who are the backbone of healthcare services all over the world and beyond are tired and feeling under constant assault. We are undervalued, underpaid,overworked and no one seems to want to hear our voices or opinions on how our livelihoods and those of our patients can be improved. Nursing is under assault and it is worldwide. Systems everywhere are out to get us and no one feels that pinch more acutely than us Black Nurses and i am tired and frankly do not feel like celebrating anything nursing at the moment. I know that for those of you have been brought up to believe that Nursing is give-all-no-complaint-noble-godly-self sacrificing vocation, this might seem as a ungrateful thing to say but unfortunately it is the reality.
Racism still has its foot on our necks despite report after report highlighting the far reaching consequences of the effects of racism on Black Nurses and although everyone acts surprised and expresses their displeasure the status quo is truly and firmly maintained or worse. It's like perpetrators and their over lords get more oxygen to double down and dream of more ways to heap misery. Cut pay, overwork them,remove any form of family support or any support for that matter, while making them jump all manner of hoops that they would be forgiven for thinking they were working in a circus. So no, there is nothing to celebrate here. Nursing is under attack and Black Nurses are bearing a huge chunk of this full on assault! I for one do not have the energy nor the required bandwith to celebrate. So until things change and the over lords start valuing nursing and the important part Black Nurses play in propping up healthcare systems worldwide and paying us our worth, there will be no celebrations.
Clocking Off: How I learnt not to take work home!
Black Woman working on a Laptop
As a Black Woman, I am well aware of the double edged sword( Black & Woman) of having to work twice as hard as everyone else on top of having to constantly assess and reassess your work because if anything would go wrong, you would most likely be the first to be blamed. I am also acutely aware of the racial trauma we endure and the need to be constantly hyper-vigilante in all spaces we occupy, which just adds to our racial injury.
The COVID-19 global pandemic has forever changed how we work and the workplace culture that accompanies our jobs, so to speak. In the midst of a forced shutdown, companies and employers were forced to bring in changes that many have been asking for years that most employers have mostly paid lip service to! Working from home became “THE THING” and the era of employer led as opposed to employee led flexible working came into place. Gone was the so-called rat race and all over the world employees were reflecting on what life meant to them and what changes they wanted to make. I for one was here for all of it.
Woman on Laptop and Smartphone
The world of clinical research is a fast paced one with specific timelines on collecting clinical data and reporting them. For example, more often than not, sponsors require data on SAEs to be reported to them within 24 hours of one being reported. As a clinical research nurse/study coordinator, participants had my work number and preferred to call me as opposed to the emergency number they were provided with at the start of the trials. It was great that i had such a close working relationship with our trial participants and that contributed to the smooth running of our trials but it also meant that i was almost always the first to learn about issues arising like an SAE!
That was how i found myself dealing with an SAE and the paperwork that followed, not to mention the numerous phone-calls to the sponsor on a Friday evening way after work, on my own unpaid time. Having a work phone and carrying it home with me, seemed like a great thing to do as a way of getting on top and planning my work but it also meant that it ate into my private home time and i could not really switch off. I literally carried work home with me everyday! No wonder i was constantly tired, feeling like i was being pulled from all sides, but, hey, wasn’t burnout a great marker that you were doing something right?
Black Woman reading a book.
Fast forward to a new job and I am going through all the IT set-up and but this time I have no work phone, so I would not have to carry work home with me and I could maintain that work like balance that I so craved and had etched out but I am also a work in progress, because in the middle of setting up emails and teams, I found myself synchronising my phone to my work emails and teams! Luckily I caught myself just in time to remind myself that I was already doing enough, giving my 100% at work and that work stayed at work!
But we all know that it takes years to unlearn traits that have been part of ones identity formed from societal pressures and perceptions. So I have to fight the daily urge to be on top of everything and synchronise my phone to work emails and teams and remind myself that when I leave work, I make sure I leave ‘work’ behind!
How do you maintain your work life balance? Drop us a comment.
The Wandering Nurse!
x
WHAT'S IN A NAME? When being Kenyan saved my Nursing job!
I would be lying if i said i have never really given much thought to my name(s), after all they are me, my identity even during the times i have rebelled against said names! My whole life has been defined by my names so it came as no surprise when my career was about to be defined by them, even i did not see in what way.
I have ( and I know, many other Black people/ Nurses) lived and worked in a world where my name determined whether I got a job interview, whether I got a job, whether I got promoted or paid equally as my peers! You get it! My name seemed to be a barrier, so when the opposite happened and it became my saving grace, I was very surprised to say the least.
Working for an agency or the nurse bank gives you the flexibility to choose your working hours as well as where it is you would like to work. You also get to work with different teams on different wards and develop working relationships (or not), and this knowledge is often filtered through the various agency/trust bank grapevines. Which wards/units and teams were okay and which to avoid. This meant that there were wards/units that always struggled to get their vacancies filled and the ward and duty managers got clever. They devised ways to get these vacancies filled, unbeknown to us by creating false vacancies within the popular wards/units thus taking away choice, safety nets and in some cases putting patient safety at risk.
I got caught up in these ‘work houdiniships’ on a couple of occasions and apart of causing a of angst and disorientation, they also caused pay disputes with regards to who was meant to sign the timesheets and whose budget the pay would come from! you ended up chasing payments weeks after you had completed your shift. So, i tried to avoid them as much as possible, but oneday i got caught up in one houdiniship from hell.
I had booked a shift on a ward that i knew very well as i had worked on this particular ward as a permanent staff member before and knew the staff and the layout well. I turned up for my shift, bright and early only to be told that they were fully staffed and did not need me and had not booked me! I called the trust bank to let them know what was happening and was told that yes i was indeed booked in for that ward but was meant to work elsewhere to go help with washes and be the healthcare assistant for the day. The ward i was to be sent to was one everyone avoided due to how rude the staff there were making it a very unpleasant ward to work on, hence why they struggled to fill any vacancies. I declined and stated that i would rather go back home as the whole essence of agency/bank work was the freedom and ability to be able to choose when and where you worked, a point that neither the trust bank call handler nor the duty manager took kindly to and i was threatened with referral to the Nursing and Midwifery Council (NMC) for breaking the patient safety code of conduct by leaving the hospital short staffed.
I left the ward after explaining the situation to the manager and matron and went home. On my way home, i received a call from the trust bank informing me that i had been suspended and all pending shifts cancelled pending an internal investigation, and that my return to working for the trust bank would be dependent on the outcome of the investigation. I was annoyed that they would do that and i was confident that nothing would come of the investigation as i had done nothing wrong! So i told her that while i felt it was unfair, their action, given that i was a full time bank worker, i would await the outcome of the investigation. I was then told to write a statement of events, which i did and emailed it to the head of the trust bank as requested.
Two weeks later i received an email from the head of the trust bank asking me to report to her office. Being summoned is never a pleasant experience but i was surprised this time. It was a friendly setting and a very relaxed chat. She said she wanted to meet me and talk to me face to face before she decided how the investigation was to proceed. She proceeded to ask me where i was from as my name reminded her of a brilliant Kenyan Doctor she had worked with years ago at a previous trust. We talked about all things Kenya and how while my name was similar to the Doctors, we were not related in anyway and that i had never met him, let alone met anyone with the same surname as mine professionally during my working career in the NHS.
She then asked me to narrate what happened on the day, which i did and i also told her how common these houdiniships were becoming especially when the duty manager was the same one who had been on shift on that day and how on many occasions, she had moved me to wards where i was way out of my depth, like surgical trauma and when i voiced concerns she had replied that i was a qualified nurse with a PIN. This is when, i was informed of the complaint the duty manager had written, claiming that she had requested me to go to a different ward to help cover due to a crash call and i had refused. It was the first time i was hearing of this false account of events. I told her that she could confirm with the ward manager who had taken the call and spoken to the duty manager and then relayed the message to me, that there was no crash call and that i would not have refused to go to that ward nor left if that was the case! I also got to hear of the letter of support from the ward manager and matron decrying the drastic measure that had been taken to suspend me.
She then told me she had wanted to look me in the eye when talking to me, as she could not believe that a Kenyan would behave in the way that the duty manager had described, because she had worked with Doctor Onyango and other Kenyans and they were all very good at their jobs, reliable,honest, hardworking and put patient safety above all else, so she could not believe that i had been negligent. She had also looked at my file and in the five plus years i worked for them and there had been no complaints made against me nor any caution on my file. She lifted my suspension but said she would keep a note on my file for two weeks and if no issues arose during the investigation, then my file would be wiped clean.
I later found out that the duty manager was sacked after complaints from other nurses about her attitude and false statements amongst other things. I would like to say that houdiniships are a thing of the past but that’s not the case, unfortunately and because the largest agency/bank workforce are from the Global Majority, they bear the brunt of vexatious complaints. I picked up a great assertive tip from (yes), a brilliant Kenyan Nurse for those times you find yourself in a houdiniship:
“State that your skills set do not apply on that ward that you are being moved to, however, if they are happy to guarantee a waiver in writing that they will take full responsibility for any clinical and safety shortcomings that could potentially or accidentally occur, then you are more than happy to work on the new ward!”
I still haven’t met this Doctor Onyango but if he ever reads this, i would like to say a big thank you/erokamano and also a very big thank you to all my fellow Kenyan Healthcare Workers out there.
x
Shamim aka The Wandering Nurse.
Are you Hustling backwards?!
Onwards to new adventures!
One of my favourite programmes on the BBC used to be ‘Wanted Down Under’. It followed families who wanted to relocate to Australia or New Zealand, from helping them find homes, jobs while also giving them a reality check via a comparison cost of living between the UK and their dream new life in a bid to find out if the dream was affordable. For some the better salary and cost of living afforded by moving made the dream a reality and for others it meant hustling backwards, with their dreams deferred or abandoned.
Making the decision to leave home and start a new and hopefully better life in a new place or country is something humans have been doing since time immemorial and it’s a decision that is never taken lightly. For some it is the lure of a better work life balance, affording them more family time or more time to indulge in life long hobbies or passions. For others it is the promise of a regular paycheck and the job security that comes with it, a way to support themselves and their families free from worry and stress of not knowing if they would be able to do so day after day. It is this latter reason that i would like to focus on, because more often than not, the lure of a regular paycheck and job security blinds us and we do not take into account the full picture of what the cost will be and if it is at all worth it.
How can i make sure that my take home pay will be sufficient?
In my book ‘ The Extreme Sport of Nursing While Black : A Survival Guide’ , I talk about the importance of negotiating your salary so that you get paid your worth as well as really scrutinising your contract for any issues before signing on the dotted line. While this is still sound advice, i would like to add another tip, especially for Nurses being recruited from abroad, and that is to carry out a cost of living calculation to find out if would be able to live comfortably with the money you would be paid, your take home pay.
The first step would be to find out what your take home pay would be after all deductions, do not be fooled by the salary figure quoted, as that is normally your gross and not net which is likely to be significantly lower! Remember to ask during the recruitment process and not after you have signed your employment contract! The Salary Calculator is a handy site that helps you calculate how much your take home pay would be approximately. You can customise to see your take home pay yearly, monthly, weekly or even daily. This would give you a rough idea of what you are actually being paid and from that you can then do your cost of living calculations.
Armed with this information and your calculations, you can then make an informed decision whether it is worth it to take that job and uproot yourself from all that you know, or if you can negotiate for a better pay or hold out for one or better still, if staying and diversifying your income portfolio would be best. Whatever decision you make, make it work for you and having the full picture salary wise is one step in that direction and towards a financially secure future.
Here’s to Hustling forwards, always!
The Wandering Nurse x
A Bundle of Joy and a Great Sadness
It was the last week of Block 2 exams and we were busy revising, while waiting to find out where our next placements would be. I was also waiting for news about my friend who was due to give birth any day soon. I did not have to wait long, because, the afternoon of 30th August, she sent word that she was in labour and being a Nurse/Midwife and a Primigravida, she was waiting until her contractions were frequent before coming into hospital. So i waited anxiously .
Around 7pm, i was informed that she was at the maternity ward and was asking for me. The ward was full as it was baby boom season and we quickly settled her in but my friend had other ideas. in the absence of any pain relief, she decided to go crouch by the water tank. This water tank was the bane of all Nurses/Midwives as it was outside in a dark area with no light source, not to mention filthy, but labour pains made my friend forget all this. So we sat, cursed( she doing the cursing) while i cajoled her to please consider coming inside.
After hours and lengthy negotiations and her insistence that i not leave her side at all, i managed to get her into the delivery room for one last V.E to check her dilation progress, in between reassuring her husband that all was fine. At 8 cms it was almost time. Room prepared and delivery pack at the ready, it was time. Although tired and sleep deprived, given it was around 2 am next morning, i was excited that i was finally going to meet this bundle of joy. At 10cms, we ask her to push with the next contractions.
It soon becomes clear that an episiotomy is neccesary, she just wants it over with. Crowning, screaming, swearing with lots of encouragement, out pops the head with a great deal of lovely black hair. i remark at how lovely the mop of hair is, my friend goes into full meltdown. Turns out she wanted a bald child and refuses to push any further! we are stuck, she is determined to close her legs and go to sleep. We enter panic mode, appealing to maternal instincts not to harm the child. To please push so we can deliver the child safely.
She is having none of it! but at least she stays on her back. It's now all hands on deck or we lose the child. Hand on belly with next contraction two apply fundal pressure while the rest try to get the child safely out. Finally the child is safely delivered. All is well, she is tired but thrilled and both parents are happy to meet their Son. I am tired to say the least, sleep deprived and have exams in a couple of hours. I finally excuse myself with a promise to come back later to visit before they go home.
I walk back to the nursing school, its almost sunrise. Exams start at 8am and i have not slept a wink. As i pass by the dining hall, breakfast is being prepared. i relay the good news to the cooks. The telly is on and the News about Princess Diana’s death is being announced. As i climb the stairs to my room, shocked and numb. I am reminded of the reality of life: one life begining, whilst another one was ending!
The Importance of Grieving!
I came across a post ( link at end of post) on my timeline on X ( formerly twitter), by a Kenyan Nurse in the U.K talking about her nursing experience in Kenya especially with the managers, which was mostly negative in terms of their support for anything progress related as compared to her experience at an NHS hospital on a ICU unit, where the leadership encouraged progress and supported it. According to her, this latter experience cured her fear and insecurities around sharing her nursing career goals and dreams. From the replies to her post, it seems that she is not alone in having this fear of nurse managers in Kenya. While i can understand where she is coming from and i am happy that she found healing and a positive leadership style at this NHS ICU, unfortunately this is not the case all over, especially from the point of view and experiences of alot of Black Nurses working across NHS hospitals and even beyond.
What Nurse Cate had done was significant and in those series of tweets ( or Xers), she had demonstrated that she had grieved her past job experiences and resulting traums, healed from the traumas and celebrated her victory in her journey towards her nursing career. In her podcast episode( link at end of post) titled ‘How long can you grieve a job’, Dr Monica Cox talks about how much we can lose from our jobs, in terms of how we enter our workspaces full of high hopes and great expectations to grow and thrive, only for the opposite to happen, and we end up leaving, full of disappointment and disenfranchisement. She talks about how these loses are profound for People of Colour (POC) and those from maginalised communities, and how grieving for those loses ( job satisfaction, promotions, safe working places etc) is important to both mental and physical wellbeing, and is something that should be encouraged and acknowledged.
I was reminded how as Black Nurses, we come into nursing full of hopes and expectations to grow and thrive in our workplaces. We enter the workplace in all innocence, giving our all and, more often than not twice as everyone else, shrinking ourselves to fit into places, institutions and structures that are hell bent on drowning our voices and keep us out. We are forced out of jobs and with it out of our careers, growth, seeing through our work and projects we started. We do not get to bear the fruits of our labour, for the workplace is structured to reward hardwork with progress in relation to climbing ladders, one we do not get to do. It is not by accident that we make up the largest agency workforce, because leaving our jobs and working on our own terms is the only way we can survive, provide and protect our peace. We carry with us all of this trauma of loss, loss of identity, loss of self and loss of security. We carry on best we can and rarely do we stop, take stalk and grieve, to heal.
According to Dr. Cox, we need to grieve our work losses and also celebrate the victories no matter how small. When we allow ourselves to grieve, we start on the healing path. Just remember the saying ‘ grief is not linear’ , there is no timeline. Grieve the loss of a stable workplace but also celebrate the reclamation of your peace, working on your terms and protecting your peace.
Tell me what you think. Is grieving for your job important?
The Wandering Nurse X
A Case for Clinical Nurse Specialists in Kenya?
Whilst the long awaited rainy season is upon us in Kenya, it also heralds the season of joint aches and pains for my dad, especially his knees. A trip to the doctors saw him sorted out with some pain killers, with a recommendation to come back and see a specialist should he not see any improvement in his symptoms. The said specialist could only be seen on a Wednesday, as that was the only time he held a clinic.
A couple of weeks later, with no significant improvement in his symptoms, he decided to go see the specialist. He called me once he was there and quickly handed over the phone to the doctor, who introduced himself and then to my surprise revealed that he was an orthopaedic surgeon. You see, i was at a loss as to why my Dad was seeing an orthopaedic surgeon and not a Rheumatologist? I was also questioning as to if seeing folks with joint pains was actually the best use of the surgeons time and what, if any was the waiting list like to see him? Anyway, he managed to convince my Dad that it was indeed time to start using a walking stick to help take the pressure off his knees abit.
All this got me thinking about the state of specialist care in Kenya and the under utilisation of nurses and their skills within this sector. Why are there no Clinical Nurse Specialists in Kenya? And is it time ( long overdue) to introduce this branch of Nursing?
Healthcare worker with a patient.
Nurse training in Kenya, be it via government training institutions like the Kenya Medical Training Colleges ( KMTC) or via private colleges and universities, in my opinion, is one of the most rigorous and thorough all round training programme and produces very knowledgable, highly skilled and competent Nurses, who can work in various sectors and departments. These Nurses qualify with a wide range of skills from history taking, clerking, pharmacology, management just to name a few, making them well equipped to work as part of a team within a hospital setting to autonomously within a rural health centre setting.
So it makes no sense as to why Nurses are not being used to their full potential. Why patients have to wait to see a specialist. Why there is no proper follow-up or aftercare of specialist patients who are on long-term care, because there is a shortage of specialists.
Why are Clinical Nurse Specialists Important?
The concept of a Clinical Nurse Specialist is not something that is new within the Kenyan healthcare system. We do have Nurses who are specialists in areas like Immunisations and Family Planning, Infectious Diseases just to name a few areas. The problem is that, it has not extended to other speciality areas like Rheumatology, Diabetes, Cancer, just to name a few, where long-term care and close follow-up is needed to optimise treatment and improve patients quality of life. This would also create a new career path for Nurses, which would in turn help solve the employment crisis that is plaguing the Nursing sector and seems to mainly affect degree holder Nurses but also improve continuity and consistency in patient care.
So who is a Clinical Nurse Specialist and why are they important?
“Clinical Specialist Nurses/ Clinical Nurse Specialists ( CNS) work in a variety of acute and community settings, specialising in particular areas of practice, as part of a multidisciplinary team to provide high quality, patient-centred, timely and cost-effective care. They provide tailored care depending on the patient’s level of need. They also provide education and support for patients to manage their symptoms, particularly patients with long term conditions and multiple morbidities”- Royal College of Nursing(RCN).
Like every other country in the world, Kenya has a shortage of healthcare workers, and that includes Specialist consultant Doctors. This shortage means that there is a high demand often with long waiting times for one to be seen and diagnosed, as they divide their time between their hospital(s) and private practice, and often incurs a hefty price in terms of consultation and various fees. Access to specialist care also involves travelling to the big city hospitals or Doctor’s plaza, where they have their private practices. All these are barriers towards patient care and safety, as more often than not, continuity of care is lost, with the patient sometimes ending up being worse off, as their condition deteriorates, where follow-up care involves them going through the whole process above. Having a Clinical Nurse Specialist can help bridge or even close those gaps.
A Clinical Nurse Specialist can take over the supervision and follow-up care of already diagnosed patients, freeing up the Consultant Specialist to diagnose new patients and more complex patients who require a their input. This then ensures that the patients are followed-up and continuity of care is maintained which in turn helps to keep the patients out of hospital admission. From a revenue point of view, patients save money on consultation fees, transport and hospital admission costs and the specialists increase their revenue by being able to see more new patients.
On the whole, Clinical Nurse Specialists help improve patient outcomes, decrease specialist consultants workload and deliver high quality care. So isn’t it high time the Kenyan healthcare system utilised the valuable resource that is the Clinical Nurse Specialist?
Useful Links:
"CALLING IN BLACK": Affirming my humanity as a Black Woman at work.
“If you are silent about your pain, they will kill you and say you enjoyed it” - Zora Neale Hurston.
“10”! A high or low number, depending on how you look at it or the circumstances. It was a number i was proud of, a badge of honour of sorts, a vision and reality of how “strong”, “resilient”, “efficient” and “dependable” i was. I mean i was a put -your -head -and -work- kind of person, just get on with it. What i didn’t realise was that, perfect number 10 was killing me, taking it’s toll on me and was in some ways, rooted in racism! You see, for 15 years working as a qualified nurse, i had only taken 10 sick off days! i had a near perfect sickness record, but my mind and body were falling apart!( I write about this in a previous blog post: https://www.ayiechoodembiconsultancy.com/about-healthcare/racism-in-health-a-patient-safety-issue-navigating-healthcare-while-black-part-2
“Calling - in - Black” to work was journalist and social media satirist,Evelyn Ngugi’s way of affirming her humanity to herself by staying home from work to deal with the feelings of grief and it’s emotional toll after being overwhelmed by traumatic events around violence and trauma fueled by racism faced by Black/ African American persons in the U.S.A, according to Byers et al who wrote about her work in their paper: -Giving while grieving: Racism-related stress and psychological resilience in Black/African American registered nurses. Their paper looked at race related stress in the healthcare system and how Racism-related stress can affect nurses’ engagement, performance and practice. It is a great read and worthwhile read
Byers et al are not alone in looking at how racism affects the mental health of Black Nurses, according to a study conducted by Nursing Outlook, cited by Portia Wofford in her post : - Black Nurses’ Mental Health Matters, Black nurses perceived that they had low psychological resilience in stressful situations and were affected by both lived and vicarious racism. Portia also includes this quote below in her post which resonated deeply with me about my previous and current experiences within my workplace and how i now choose to respond to them.
According to psychotherapist Megan Watson, "Microaggressions and macroaggressions in the workplace, that stem from patients, colleges, supervisors, management, and the institution itself might be rooted in racist ideology and can put a heavy burden on the work that you do and ultimately impacts your burnout."
How does all this relate to me and my sickness record? Well after years of enduring pain and illness, showing up to work regardless of how i was feeling, because taking time off sick was (and is still) frowned upon, more so for us Black Nurses in the NHS, COVID19 happened and finally there were conversations happening around workload, racism, mental health and burnout especially around and about Black healthcare workers. For the first time, it was laid bare the unfair and uneven system and bias with regards to all four and more that had been placed on Black healthcare workers and the toll it had taken. Conversations around and about change were happening. Organisations promised to do better, be better, but words without actions are just that, words!
Fast forward to 2022, and i am working at a new organisation, a global one at that, with branches worldwide and nothing has changed. The racist ‘Strong Black Woman’ myth is still firmly in place. The myth that as a Black Woman/Nurse, you can do it all, you can manage the heavy workload without help at all and you will be more than fine, since you are a Black Woman and a strong one at that! It is coated in fake accolades, that tell you how efficient you are, how capable you are, how you just ‘get on’ with it, while more work is piled on and you dig in, carry on, because, as a Black Woman, you know you have to do the work or else you and your work will be called into question. You carry the load even as it breaks your back and mind. Do not be fooled by the accolades, the false praises that are slowly sending you to your grave, eating at your soul. Do not be fooled, no one is coming to save you!
So while, nothing seems to have changed, I have. It’s business as usual on the ‘trample on Black folks/Women’ street. So i am glad that i learned from my past mistakes, my betrayal of self and body. I learnt not to be taken in by the accolades. To see the situation for what it was, exploitation, rooted in racist ideologies. I learnt to listen to my soul and body. So next time the myth of the ‘Strong Black Woman’ came calling, and tried to break my body and soul, I listened to my soul and body and I Called in Black! I mean what is a perfect score worth, if you are not around to enjoy it because your body is totally broken or you are 6 feet under? Like Zora Neale Hurston said: “ If you are silent about your pain, they will kill you and say you enjoyed it!”
Do not suffer in silence, there are steps you can take to safeguard yourself:
Talk to your manager about your work conditions and if your manger is the problem, find out who your HR person and what your workplace policy is around raising grievances and complaints and escalate the issue. Write a letter/email highlighting the issues you face and who you have raised it with and when and what was the outcome. That way there is a record and not just a word of mouth scenario. See also https://www.gov.uk/raise-grievance-at-work of how it should work and what to expect.
Ask about your organisations Occupational Health Policy. Occupational health can help establish a safe working environment for you by providing a range of services which could include recommendations around safe work loads and safe working spaces with correct equipment. You can read more at: https://www.acas.org.uk/using-occupational-health-at-work
Further reading/resources:
Harder, better, faster, stronger? Work intensity and ‘good work’ in the United Kingdom https://onlinelibrary.wiley.com/doi/full/10.1111/irj.12364
RCN Nursing Whilst Black Podcast Series: https://www.rcn.org.uk/About-us/Diversity-and-inclusion/Nursing-whilst-black
Celebrating Black Nurses’ Impact on UK Healthcare: https://www.florence.co.uk/posts/black-nurses
New anti-racism resource for NHS nursing and midwifery professionals: https://www.nmc.org.uk/news/news-and-updates/new-anti-racism-resource-for-nhs-nursing-and-midwifery-professionals/
Combatting racial discrimination against minority ethnic nurses, midwives and nursing associates: https://www.england.nhs.uk/long-read/combatting-racial-discrimination-against-minority-ethnic-nurses-midwives-and-nursing-associates/
A Point of View: Calling in Black: https://www.theinclusionsolution.me/a-point-of-view-calling-in-black/
Black Fatigue by Mary-Frances Winters: https://www.amazon.com/Black-Fatigue-Racism-Erodes-Spirit/dp/1523091304/ref=sr_1_1?dchild=1&keywords=black+fatigue&qid=1592415015&sr=8-1 https://www.wintersgroup.com/black-fatigue-is-available-now/?__hstc=201086513.b0b4ad3e2d6f8cb2ac5c1fbd0bfcdd30.1667634858234.1667634858234.1667634858234.1&__hssc=201086513.2.1667634858236&__hsfp=638492305
Calling in Black by Nicholle Ramsey: https://www.amazon.co.uk/calling-black-Nicholle-Ramsey/dp/173607461X
WHAT IS BLOCKING YOUR CAREER PROGRESSION?
“The days when NHS staff can progress at equal level is the day NHS can say they are truly inclusive and equal. If newly graduated nurses can reach to Band 8 within 3 years and non-clinical support staff to Band 6 but ethnic minority staff have to wait atleast minimum 10-20 years”. Mushtag
@mskahin1 (Twitter)
The above tweet from Mushtag was as usual a ‘pause for thought’ read and it reminded me of something a couple of Nurses from an ethnic minority background told me when i asked them why they had not applied for the Band 7 post in their department? Their answer was sad, but not shocking and was one i had heard several times, including from myself- They did not want the added stress and lack of support that came with moving up and that they were comfortable where they were, not happy or content but comfortable. A put your invisible head down and get on with the work, kind of situation. Get your pay and maintain the status quo!
As a Black Nurse, i understood this all too well. When opportunities seem like traps, not because you are not qualified, (in fact you are most likely overqualified, given that we always have to put in twice the work!). But because, you have witnessed those before you, who worked hard, climbed the ladder only to find that there is no support whatsoever at the top. That you would be expected to take on much more and often for much less. That the brick walls you will encounter will knock you so hard that you will end up being a shell of the person you once were and that finally you will pay heavily with your health, only to realise that even in sickness/illness, we are still not the same!
At one former workplace, Black Nurses were terrified of promotions. They told me that it was because they had witnessed their colleagues being sacked right after being promoted. To them a promotion to either Ward Sister or Manager = a P45. There was this one ward that seemed to have problems and no manager had ever survived once they were moved to that ward, most had to be redeployed elsewhere. So when one of the Black senior Nurses on our ward, after years of applying, got given the post of ward sister and moved to that ward, instead of celebrating her promotion, all the Black Nurses were sad, a mourning of sorts, because they were sure she was on her way out. That is how messed up this whole situation was.
This whole situation is also reflected in the Ethnicity Pay Gap as is evident in the research paper below ⬇️ . One may say, that Agenda for Change(AFC) has eliminated inequality and the pay gap or that within the NHS it is not common for there to be pay gaps amongst Nurses due to banding. But even within those banding, there are different pay-points and your moving up a pay-point is dependent on your managers assessment during your PDR, also on what progresses you have made. If you have not been given those opportunities to better yourself, to improve your practice, access to training which is not just the run of the mill mandatory training! If you have not been afforded those opportunities but instead have had your workload increased, as a warped way of rewarding your hard work, that you have proved that you can handle more responsibility, but without the correct pay, then a pay gap ensues and inequality is at play, do not be fooled.
