Black Nurses on the Frontline

In 2018 the NHS turned 70. Two short years later it was bracing itself for the biggest public health crisis it had ever faced.

Just as the human impact of Covid has been devastating, the toll on the health service has been incalculable. Through it all the NHS and its workforce stretched itself far above and beyond everyday service. They were heroes. We stood outside in the rain and clapped for them.

And yet Black health workers were near-invisible in the media—and then they began to die, in far greater numbers than their white colleagues. While only 21% of NHS staff are black, Asian or from minority ethnic background, 63% of all NHS staff deaths were from these groups in the early weeks of the pandemic.

The same year the NHS was founded, the HMS Windrush arrived in Britain. Among the passengers were the first cohort of Black nurses, travelling en masse with other skilled and unskilled workers to the UK.

Britain simply did not have the workforce it needed to recover from World War II, let alone create a health system that would become the envy of the world without the labour, skills and commitment of Black nurses. Sadly, most of the nurses, midwives and other health workers experienced more betrayal than belonging in the UK.

The NHS is struggling to train and retain nursing staff and one in ten nursing positions is empty. It seems like a good time to think back on the experiences of Black nurses in the UK and in Sheffield, especially in the wake of a conference, report and film launch of Nursing Narratives: Racism and the Pandemic, which happened at Hallam University’s City Campus earlier this month.

In shock

While Sheffield’s universities and hospitals have a long history of nursing education and research, in the early 1990’s Black trainee nurses were rare in the city and all-white courses struggled to train culturally competent nurses. I was called in on a temporary contract to help one cohort prepare for engagement in the real world. This was their final class of their final year. I was using applied theatre methods at the time and was keen to help the trainees think about their voice, body and ethics around caring for themselves and others in such a demanding profession.

I arrived in class to find that the most urgent question coming from a young trainee’s sorrowful face was how she could tell when a Black patient was in shock. My face in that moment gave her and her classmates a clue.

I was not there in a clinical capacity, but I absorbed and tried to address the pent-up anxiety and curiosity of the students during my half-day with them. I thought about the failure of their course to answer this question and many others and fed this back to a sheepish course leader. I grieved for the Caribbean workforce, who as elders would be treated by young nurses who would not know how to recognise a state of shock beneath dark skin.

‘Mixed reactions’

The irony runs deep, because the Motherland called, and we came.

The first hurdle we met was the mixed reactions of white colleagues. Some were happy and welcoming, but others were difficult to work with and offended by our arrival. We learned quite quickly that no one in management nor government was going to smooth the way for us in these daily interactions.

We encountered massive structural hurdles which were even more worrying. Unless we undertook more training, or in some cases totally re-trained, we were stuck at the lowest levels of the nursing ladder because our qualifications and credentials were not recognised.

Even now there continues to be a dual labour market, where our skills and education—for most of us now all obtained in the UK—are still not valued equally. Decades of NHS re-structuring has also impacted on the experiences of Black nurses, leading to staff shortages, and decrease morale, pay and protections.

I think of the nurse and activist Dorothy Dixon-Barrow, who arrived in the UK from Jamaica in 1957. Women like Dixon-Barrow combined their skills as a nurse, later midwife, health visitor and health educator to great service within the NHS in Sheffield. And when she left the NHS she took her skills as a persuasive speaker, community organiser and canny politician to the Sheffield Racial Equity Council, where she became Chair, before retiring in 1994.

In the face of all of this, Black nurses have continued to staff the NHS, organising and creating alliances which highlight research around the Black experience of healthcare professional. Laura Serrant, Professor of Nursing in the Faculty of Health and Wellbeing at Sheffield Hallam University and Chair of the Chief Nursing Officer (CNO) BME Strategic Advisory Group, represents a new phase in the development of leadership in this area which is much needed.

Meanwhile, international recruitment of nurses continues. Managers telling Black nurses to be ‘more resilient’ in the face of racist comments and actions isn’t good enough, is it? Policies around racism must reach beyond the idea that it is a minority issue. They need to be rigorous and implemented as though the entire NHS was at stake—because in so many ways, it is.

Black African nurses’ experiences especially suggest that they are seeing the same race discrimination as previous generations of Black nurses. New research from the NHS Race and Health Observatory indicates that racism remains overt as much as covert among staff and patients, with some of that racism emboldened by Brexit.

Black nurses feel undervalued, personally and professionally. They feel the burden of dashed expectations and struggle with weighing up the pros and cons of staying in the UK. They feel betrayed by their profession and by the former colonial power that had once shaped their own countries.

A ‘warm and successful physician’

Before the NHS there were Black nurses in the UK, the most famous being Mary Seacole. Born in Jamaica in 1805, her reputation as a nurse on the battlefield of the Crimean War (1853-6) rivalled that of the famous Florence Nightingale, whose group rebuffed Seacole’s services.

Seacole’s contribution was acknowledged by many influential people including W.H. Russell, considered to be the first modern war correspondent. Russell’s dispatch for The Times dated 14th September 1855 said Seacole was a “warm and successful physician, who doctors and cures all manner of men with extraordinary success” and “has earned many a poor fellow’s blessing.”

At war’s end Seacole’s labour was forgotten, until military leaders arranged a four-day musical festival in her honour at the Royal Surrey Gardens in Kennington. She went on to publish her autobiography in 1857, The Wonderful Adventures of Mrs Seacole in Many Lands. She is buried in Kensal Green cemetery and a statue of her likeness stands in front of St Thomas’s Hospital in London.

In 1994 the Mary Seacole Award was established to support the work of nurses, midwives and other health professionals working to research issues related to improving health care among black communities. Internationally renowned researcher, Sheffield-born and raised, Emeritus Professor Gina Higginbottom of Nottingham University won this award in 1998. Higginbottom said in an interview that being given this award gave her “an exceptional launch pad” for her career.

As of now, the Mary Seacole Award is being phased out and integrated with another award dedicated to the memory of Florence Nightingale.

Yes, really.