gowns, as compared to 19% of white British nurses.
53% of BAME respondents had been asked to reuse single‐use PPE, as compared to 42% of white British respondents.
40% of BAME staff received training in what PPE to wear, as compared to 31% of white British respondents.
Source: Based on Royal College of Nursing (2020).
How are intelligent kindness and resilience relevant here? An individual cannot be resilient in a system which fails them. Many forms of discrimination including those based on race, gender, sexual orientation and belief exist in healthcare. As individuals and organisations, we need to recognise discrimination and make changes to create a level playing field for all. An individual’s resilience is challenged if their workplace is permeated by discrimination. We should be mindful that our colleagues experience many repeated ways of discrimination:
‘Modern racism is far more subtle. It’s indirect, it’s oblique and it is far more difficult for others who are not on the receiving end of it to detect’.
– Professor Binna Kandola OBE
Our own growth as resilient practitioners includes being able to empathise and understand the lived experiences of those who work alongside us. The concept of whistleblowing as a component of patient safety is now well established. Alongside this, we need to embed within our professional values the need to be ‘active bystanders’ for our colleagues whose resilience and well‐being is undermined by discrimination (Box 1.5)
Box 1.4 Story of Consultant Urologist, Mr Abdul Chowdhury.
Abdul Mabud Chowdhury was a consultant urologist at Homerton University Hospital in East London. After training in Bangladesh and working in Zimbabwe, he moved to the United Kingdom to work in the NHS.
At an early stage of the Covid‐19 pandemic, Mr Chowdhury appealed to the UK prime minister for ‘appropriate PPE and remedies’ to ‘protect ourselves and our families’.
Five days later, he was admitted to hospital and subsequently died of Covid‐19.
Dr Chaand Nagpaul, chairman of the British Medical Association (BMA), said it was ‘so tragic’ that the 53‐year‐old had died after issuing a warning about a lack of PPE.
Source: Based on BBC News (10 April 2020).
Box 1.5 The role of the active bystander.
Active bystanders show that certain types of behaviours are not widely accepted by others and break the silence that has previously allowed them to thrive. Active bystanding to address behaviour targeted at minority or marginalised groups such as BAME students is also very important in demonstrating support and inclusion.
The BMA Charter advocates an ABC approach:
Assess for safety: if you see someone in trouble, ask yourself if you can help safely in any way.
Be in a group: it is safer to call out behaviour or intervene in a group, and where this is not possible, report the behaviour to others who can act.
Care for the person who may need help and ask them if they are okay.
Source: BMA (2020).
‘What hurts the victim the most is not the cruelty of the oppressor but the silence of the bystander’.
– Elie Wiesel, Holocaust survivor
Conclusion
The global pandemic has reminded us of the need to protect healthcare workers in order to enable them to optimally care for patients. A UK Institute for Public Policy Research report in April 2020 (Thomas and Quilter‐Pinner, 2020) reported that half of health workers felt their mental health had deteriorated in the first eight weeks of the pandemic, and 20% reported that Covid‐19 and the resulting difficulties had made them more likely to leave their profession. They suggested five core guarantees that need to be given to the health and care workforce.
Safety: Staff shouldn’t be under pressure to work without adequate protective equipment.
Accommodation: For staff facing long journeys to work or with concerns about family safety, there should be alternative accommodation provided.
Mental health: Workers’ mental health should be ensured by extending priority access to health and care professionals.
Remuneration: Staff should receive their full salary if they fall ill; and, beyond the pandemic, no health and care professional should be paid less than the real living wage.
Care guarantee: Government should support professionals to remain in work by ensuring that they are able to meet unpaid care commitments – such as childcare or caring for other dependent family members.
Organisations need to embed these guarantees, as part of resilience training and support for practitioners to facilitate safe and effective delivery of patient care. Possible approaches to training are considered in Chapter 10.
Healthcare practitioners are motivated, almost without exception, by a desire to safely and effectively restore their patients to health and well‐being. During the pandemic, this has been universally recognised by the public in a myriad of forms – from a weekly round of communal applause to feats of extraordinary fundraising to support local staff. They deserve the thanks and respect of us all:
‘It is not the critic who counts; nor the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming…’
– Theodore Roosevelt
Further reading/resources
1 BBC News (2020) Coronavirus: NHS doctor who pleaded for PPE dies, 10 April 2020. bbc.co.uk (accessed 8.11.2020).
2 Bourne, T., Vanderhaegen, J., Vranken, R., et al. (2016) Doctors' experiences and their perception of the most stressful aspects of complaints processes in the UK: an analysis of qualitative survey data. BMJ Open, 6 (7), e011711. DOI: 10.1136/bmjopen‐2016‐011711. PMID: 27377638; PMCID: PMC4947769.
3 British Medical Association (BMA) (2020). A Charter for Medical Schools to Prevent and Address Racial Harassment. British Medical Association, UK.
4 Casey, D. and Choong, K. A. (2016) Suicide whilst under GMC's fitness to practise investigation: were those deaths preventable? Journal of Forensic and Legal Medicine, 37, 22–27. DOI: 10.1016/j.jflm.2015.10.002. Epub 2015 Oct 22. PMID: 26519926.
5 General Medical Council (GMC). (2019) Caring for Doctors; Caring for Patients.
