The Virus of Systemic Racism
Racial inequality in healthcare is not just a systemic issue; it's a human crisis.
For Black, Asian, and global majority nurses and carers working in both the NHS and private healthcare, the harsh reality of systemic racism isn't an abstract concept. It's lived every day.
These nurses and support workers endure discrimination that stains the very fabric of the English healthcare system, leaving them bruised by bias, exhausted from constant scrutiny, and trapped in an unjust cycle. Despite their unwavering commitment to patient care, Black, Asian and global majority nurses often find themselves marginalised, their voices silenced, and their contributions overlooked. In a system that should champion equality and professionalism, they encounter hostility and prejudice in the workplace and within regulatory bodies like the Nursing and Midwifery Council (NMC).
Stereotypes are powerful, invisible weapons that harm those who cannot escape them.
In healthcare, where trust and competence should reign supreme, Black, Asian and global majority registered nurses are disproportionately scrutinised and belittled. They are wrongly seen as less capable, more prone to error, or treated unworthy of their responsibilities.
The NMC's 2024 Independent Culture Review exposes a shocking truth: over 40% of staff have witnessed or experienced racially charged microaggressions, further fuelling these harmful stereotypes. Such biases shape how Black, Asian and global majority nurses are perceived and treated, making them easy targets for unfounded complaints and heightened scrutiny. Yet, it is not just internal. The experiences of migrant nurses show how deeply ingrained these biases are. Patients often reject care from foreign nurses, preferring white ones, as if nationality or ethnicity determines a person's capability.
One nurse's account of a patient consistently refusing help from foreign nurses but accepting it from a less experienced white nurse shines a light on the disturbing racial preferences that linger within the very people healthcare professionals strive to serve.
How does this impact morale? What does it do to a person's soul to be viewed as inferior despite years of training and experience? For Black, Asian and global majority nurses and support workers, the weight of discrimination is unrelenting. While minor mistakes by white colleagues might be brushed off, the same errors by Black, Asian and global majority nurses and support workers are often treated as major infractions, leading to investigations, performance reviews, and, too frequently, formal complaints, NMC, Safeguarding and often Police referrals. This is the grim reality in workplaces that claim to value diversity but, in practice, fail to protect those who are most vulnerable.
There has been a longstanding and troubling disparity in the number of referrals of Black nurses, to the Nursing and Midwifery Council (NMC) when compared to their white counterparts. This issue has persisted despite efforts to create a more equitable and fair healthcare system, highlighting the systemic challenges that Black nurses continue to face.
Data from the NMC in 2021 shows that Black African nurses were disproportionately referred to the NMC in comparison to white nurses. Although nurses from Black backgrounds made up around 7% of the nursing workforce in the UK, they accounted for a staggering 25% of fitness-to-practice referrals. In contrast, white nurses, who comprised approximately 70% of the workforce, were responsible for around 58% of these referrals.
This data reveals a significant and unjust imbalance.
Earlier data from the 2020 Equality and Diversity report echoed this disparity, showing that Black African nurses, despite representing a much smaller proportion of the overall nursing workforce, were referred at a far higher rate than their white counterparts.
Similarly, a Royal College of Nursing (RCN) review conducted in 2019 found that Black nurses, particularly those from African backgrounds, were four times more likely to be referred to the NMC than white nurses. These figures highlight the ongoing racial inequalities within the healthcare system and the disproportionate scrutiny faced by Black nurses in the UK.
The NMC Independent Culture Review reveals that fear dominates the working environment. Many Black, Asian and global majority staff feel powerless to raise concerns, knowing that retaliation or, worse, silence will follow. The data is damning: 21% of minority staff said they wouldn't even feel comfortable reporting instances of discrimination.
This is not just an anomaly; it reflects a broader trend across the healthcare system. Complaints often spiral into damaging referrals, where nurses face long, painful investigations that drag on for years, based more on bias than legitimate concern over patient care or public Safety.
Overseas international nurses, too, bear the scars of racial microaggressions from colleagues. They are bullied, undermined, and excluded, made to feel invisible in their own workplaces. The question we must ask is: how does this level of targeting break down a person's spirit? How long can someone endure being treated as less than before they decide to leave the profession they love?
At the heart of the issue is the NMC, the body meant to protect and uphold nursing standards. Instead of shielding nurses from injustice, its fitness-to-practice (FTP) process symbolises the system's failure.
The 2024 report lays bare the dysfunction: 53% of NMC staff admit there's no clarity around procedures for bullying and harassment, and even when policies are in place, 36% say they aren't followed. The result? Careers are left in ruins, and mental health is shattered as cases stretch on for years with no resolution in sight.
What makes this even more heartbreaking is that some nurses, subjected to these prolonged investigations, have tragically taken their own lives. The system that should have been their safeguard became their undoing.
How do we justify such a loss? How can the healthcare sector live with the knowledge that it is complicit in the destruction of careers, lives, and potential?
Even worse, the NMC's backlog of FTP cases, over 5,577, reveals a system that is overwhelmed and unfit for purpose. The burden falls disproportionately on minority nurses, who are referred for trumped-up charges and exaggerated infractions that would scarcely merit attention if they were white.
How can a system claim fairness when its very processes perpetuate racial injustice?
Systemic racism in healthcare doesn't just thrive; it spreads like a virus, infecting every level, from hospitals and clinics to regulatory bodies.
It is an illness that not only stifles the careers of Black, Asian and global majority nurses but damages the integrity of the entire healthcare system. Every microaggression, every biased referral, every career blocked by institutional racism chips away at the vital diversity that healthcare desperately needs.
The toll on overseas nurses is particularly stark. They experience exclusion, isolation, and deliberate obstacles to their career progression. Many being denied access to training and development opportunities, watching as less experienced white nurses and support workers advance while they remain stuck in place. One nurse lamented that despite his hopes of gaining new qualifications, he would likely return home no further in his career than when he arrived. This stunted professional growth directly results from a system that punishes difference rather than celebrating it.
The 2024 NMC Independent Culture Review is not just a report—it's a call to action. Systemic racism in healthcare is not an abstract concept to be debated in boardrooms or diluted by idle policies. A cancer must be rooted out with bold, decisive action. The time for complacency is over.
The NMC and healthcare employers must face the uncomfortable truth of their complicity in perpetuating racial biases. Anti-racism training cannot be optional, nor can it be superficial. It must be embedded in every healthcare system level, from management to the regulatory bodies themselves.
The NMC's fitness-to-practise process must undergo radical reform. Cases must be handled with fairness and transparency, and the disproportionate targeting of Black, Asian and global majority nurses must be addressed head-on. Special attention needs to be given to the racial bias that taints existing complaints and investigations. We must go beyond lip service and provide meaningful support for Black, Asian and global majority nurses.
We stand at a crossroads. The system is broken, but it doesn't have to stay that way. The voices of Black, Asian and global majority nurses have been ignored for too long, but their experiences are real, raw, and impossible to deny. Through biased workplace practices, unbalanced narratives, and flawed regulatory processes, these nurses are disproportionately targeted, disciplined, and ultimately forced out of the roles they've worked so hard to achieve.
The Overseas International nurses who come to the UK seeking opportunity are met instead with microaggressions, bullying, and a system rigged to hold them back.
Their dreams of professional growth are suffocated under the weight of institutional racism.
We can no longer allow these injustices to go unchecked. The time for change is not tomorrow - it is today.
The NHS, private healthcare institutions, and the NMC must confront their biases and commit to creating a fairer, more inclusive environment. The very future of healthcare depends on it.
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It is like a pandemic. They are always out to deal with any black nurse