Of all the training sessions delivered to health and social care staff, specifically in the South East of England:
70% of Black, Asian & Minority Ethnic staff report that they have been racially abused in the last year.
85% of all staff asked had witnessed a colleague being racially abused by a patient or relative in the last year.
A number of people had additionally been victim of racial profiling or remarks but did not constitute them as abuse.
A great team to work alongside. Left to Right (Basanta Gurung, Anthony Underwood, myself, Brian Powell, Saikou Barry)
Part of the Job
A very sad reality is that many staff feel it's just "part of their job". Due to the brilliant patient centred approach our NHS takes; there is an underlying need for the patient to be put first, often regardless of their behaviour. This also often the reason why staff do not report each occurrence, due to frequency and normalisation of that type of behaviour.
Mental Capacity
This is a huge factor when discussing challenging behaviours and in this case specifically racial abuse.
We often allow a much higher degree of abuse from individuals who lack mental capacity or have limited or intermittent cognitive function.
For example elderly patients with Dementia or Alzheimer's, may appear verbally abusive, or aggressive at times and often the behaviour is tolerated more so due to the impacts of their condition. This is also common in A & E departments where staff face a constant flow of individuals suffering from:
-alcohol or drug abuse
-mental health conditions
-drug and alcohol withdrawal
-head injuries
Some of the above presentations may cause the individuals to lack capacity thusly effectively losing control of what they say or do and at times acting completely out of character.
I give an example: On a Saturday afternoon in an A&E car park we helped an elderly lady out of her car she thanked us profusely calling us gentlemen, she appeared to be a lovely, gentle quite frail 90 year old. She was admitted and a few days later had a UTI (Urinary Tract Infection), the lovely lady had temporarily gone and been replaced with a oddly strong and aggressive individual. Repeatedly striking out at staff and using racial slurs at anyone who was not white British.
We visited that lady 2 days later and she was back to her lovely self, oblivious of the words she'd used and the attempts to assault staff.
In this state of confusion and delirium, would this behaviour be tolerated?
Yes is the realistic answer to that, is it nice? Of course not, but when the individual has no control of what they are saying, we tend to take the words less personally. Can they be incredibly personal and hurtful, absolutely, but there is a high degree of resilience in the health sector, and an understanding of impacts of treatment and condition.
We Tolerate It Too Much
Most organisations have a strict zero tolerance policy on violence and aggression towards staff. However this is sadly not the case.
We all too regularly hear that people are encouraged to accommodate patient requests to an unreasonable degree regarding a staff members colour, race or culture. This is especially common if the patient has threatened violence.
I myself have received a phone call (regarding a patient who was deemed at risk but had full capacity) saying: "the patient has said he will kick off if we don't put white security staff in his room". The staff member then requested I move my staff around to accommodate his request in order to avoid conflict.
So what is he correct course of action in such situations?
We undoubtedly do not want to escalate the situation and we do want the patient to have a good experience. Equally we don't want to put our colleagues in harms way and leave them in a difficult situation.
When someone has Mental Capacity; I would challenge that request every single time. How would my staff feel being told by their manager that of no fault of their own they're being stood down due to the colour of their skin?
Don't Avoid All Conflict- Reconvene Reassess & Readdress
Should we be accommodating such demands? If we do are we rewarding this behaviour? By giving in, by avoiding this conflict we are giving a green light to that type of behaviour. That individual will likely go from one hospital to another continuing to take that approach simply because it has remained unchallenged.
Should a lone member of staff challenge this behaviour immediately? Absolutely not, it must be challenged in a planned and safe and risk assessed manner. If you always avoid addressing a behaviour and allow it to continue, it is likely that this behaviour will reoccur. It may even worsen as the individual sees there is not consequence.
Avoiding conflict can be strategic, allowing you time to reconvene, reassess and readdress.
We should absolutely challenge abuse of all forms in all sectors, but it is frightening how frequently staff working for the NHS receive racial abuse. I have seen the look in the eyes of the people who recount their experiences, the emotional impacts are telling.
So I encourage all to challenge and address injustice in all environments, support your colleagues and stand up for one another. It's shocking that in 2020 this remains such an issue.
If you have experienced racism in your workplace or have had an experience you would like to share, feel free to comment!
We have an open course waiting to go live once life returns to normal: https://www.octraining.co.uk/personal-safety-training
Be Strong but Kind!