COVID-19’s burden on ethnic minority communities
One in five NHS nurses and midwives are from ethnic minority communities[i] where the burden of COVID-19 has fallen heaviest. Among all staff employed by the NHS, Black, Asian and minority ethnic (BAME) groups account for approximately 21 per cent, including roughly 20 per cent among nursing and support staff and 44 per cent among medical staff (i.e., doctors and dentists).
Initial analysis of health and care worker BAME COVID-19 deaths suggest they account for 63 per cent, 64 per cent and 95 per cent of overall deaths in the staff groups respectively [ii]. The fact that nurses and carers, particularly those from BAME backgrounds would be so negatively and seriously impacted by COVID-19 has been alarming to communities and organisations throughout the country.
How can we support nurses and healthcare assistants?
With funding from The Burdett Trust for Nursing, the aim of Supporting nurses’ resilience has been to acknowledge and recognise the challenges faced by many ethnic minorities nurses and healthcare assistants (HCAs) living and working in the London boroughs of Brent, Ealing, and Harrow – who are at higher-risk of serious illness and death from COVID-19 infection, and from developing chronic disease.
During Supporting nurses’ resilience C3 has:
- Engaged with nurses and carers through surveys and focus groups.
- Documented the challenges nurses and carers have faced during the COVID-19 pandemic.
- Analysed survey and focus group data to identify a set of workplace recommendations to help address these challenges; and
- Collated a set of resources – a digital library – to help promote resilience by connecting nurses and carers with appropriate mental and physical health resources.
Nurses and carers attended virtual focus groups in June 2021, which aimed to explore the impact of COVID-19 on participants’ mental and physical wellbeing, workplace factors and lessons learned. Participants were also asked to generate ideas and to co-design solutions and recommendations to be shared with managers.
Despite the challenges brought about by the pandemic, we were able to recruit and work intensively with 18 nurses and carers across the three boroughs, including nurses, students, health care assistants and paid carers. All participants had been working in the healthcare system prior to the COVID-19 pandemic, across a variety of settings including hospitals, primary care, supportive living homes, and residential care homes. Several of the participants were not born in the UK and were consequently living and working alone in England – without their families and support networks.
Capturing the challenges
Seven themes emerged from the focus group and survey data and included:
- Personal health and wellbeing
- Coping strategies
- Patient care
The word ‘scared’ was frequently cited during focus groups.
- Specifically fear associated with travelling to work as well as being at work, and at home.
- Some of the participants needed to work to satisfy their visa requirements, and these individuals expressed additional stress and pressure because of this.
- There was a common feeling of hopelessness, especially in 2020. The participants reflected on the beginning of the pandemic and described an unease of not knowing what to expect during their shifts from one day to the next.
“I need to work to keep my visa – if I get sick, I don’t know what I will do!”
Participants discussed feeling isolated at home and at work.
- Participants living alone especially expressed feeling isolated and how lonely they felt arriving home from a shift.
- A participant who worked in a care home recalled how she felt after being the first member of staff to test positive for COVID-19, and described feeling as if her colleagues blamed her. She expressed feelings of loneliness and isolation on returning to work and not feeling part of the team.
Personal health & wellbeing
“I do not totally agree with the statement that my ethnicity is at high risk of getting COVID-19. My ethnicity is at high -risk due to many of us being on the frontline of care, or other services that require frequent contact with people.”
- Some participants expressed feeling greatly concerned when it was reported that individuals from ethnic minority backgrounds were especially negatively impacted by COVID-19 infection, and that this was not acknowledged in the workplace.
- Many participants commented on a lack of breaks during a shift and not being able to access kitchen facilities and to even make even a cup of tea due to infection control measures.
- Participants expressed that there were always staff off-sick or isolating.
- Many participants felt that they couldn’t ask for time off, or if they did it was turned down to cover shifts for staff off sick or isolating.
“Keeping in contact with colleagues who were self-isolating (via group chats), and talking about my fears with my family was helpful.”
- Participants agreed that talking to family members and friends provided support, which included online conversations with family members in other countries.
- Several participants stated that other members of staff/colleagues provided support often through informal group chats.
- Most participants travelled to work via public transport, and many expressed their fear of catching COVID-19 on public transport and passing it to family or patients.
- Another participant said his employer would not allow staff to use public transport and so had to buy a bicycle and cycle 8 miles a day to visit patients.
“Patients are dying, and you go home feeling like you can’t save lives.”
- There was an overwhelming sense of compassion for patients particularly those who were dying with COVID-19. The amount of death observed by participants caring for seriously unwell patients impacted upon how well participants felt able to do their job.
“As a nurse, even though I have confidence in disease infection control, I was in a dilemma due to a lack of information at the beginning of the pandemic.”
- Most of the participants felt that managers were unsupportive and more concerned with covering shifts than the welfare of staff.
- Several participants expressed that they had felt forced to take annual leave at times when they didn’t want to.
- Many participants perceived a distinct lack of information and guidance. As the pandemic progressed new ways of working were established and the frequently changing guidance was challenging to keep up to date with, especially in care home settings.
- Some participants felt they had enough PPE and others felt that their access was limited at times.
- Nursing students that were early in training, were pulled out of placements and their plans felt unknown and insecure.
Identifying Workplace Recommendations
Both the surveys and the focus groups asked participants for recommendations for employers to help support staff resilience and consider what may have helped them to deal with the specific challenges that they identified.
Participants were asked to prioritise their top three workplace recommendations for employers, which they identified as:
- Financial bonus
- Emotional support
- Staff health checks.
1. Financial Bonus
While financial bonus was the top recommendation, all participants were resigned to thinking it would never happen.
“Clapping is great, but money is better” resounded across the focus groups. Participants wanted financial acknowledgement of the extremely challenging time in which they had worked. Many expressed that a financial bonus (in any form) would enable them to feel that their managers, their organisations, and the government understood the tremendous strain they had been working under – and appreciated their efforts.
2. Emotional support
The most popular theme to emerge from discussions around recommendations was for managers to be kinder and to offer emotional support. Participants said they wanted to be treated like human beings with families and issues and commitments outside of work, rather than just bodies being sent to the frontline.
3. Staff health checks
Time off away from work was considered extremely valuable to participants, either to escape from work or to care for sick family members.
Participants felt strongly that more should be done by the employing organisations for staff wellbeing and suggested offering staff health and wellbeing checks, with ongoing support if needed. It was felt that it would be valuable for managers and colleagues to ask how staff are and follow up with them in a group setting or individually.
The outputs from the participant surveys and focus groups have informed the creation of a digital library from which participants can access relevant mental and physical health resources and webinars to learn about preventing major risks for serious illness from COVID-19 infection.
Within the digital library, The Nursing You Platform, adapted specifically for this initiative, is freely available to all participants. This platform is designed by nurses for nurses and carers, to help themselves so they can keep doing what they do best – caring for others. Participants are encouraged to take a self-assessment after which a personal report is generated.
Delivering this work during the ongoing COVID-19 has been challenging particularly in relation to recruiting and engaging with nurses and carers (for obvious reasons), which subsequently resulted in an extension to the original timeline.
There are several key takeaway points from this work that will inform our longer-term initiative Nurses for healthier communities.
- The first is simply – be kinder. The importance of kindness in the workplace resounded across all focus groups, and perhaps was not confined to work during the COVID-19 pandemic but in fact participants identified there had been a longstanding need to promote kindness in the workplace prior to the pandemic.
- Secondly, it was recognised that employers and managers must acknowledge the challenges of working during a pandemic and show greater sensitivity towards factors that put individuals at greater risk such as ethnicity.
- Thirdly in the longer-term, it must be acknowledged that the nursing and care workforce has experienced a prolonged and ongoing period of fear, and the impact of this sustained chronic state of fear has yet to be fully realised.
- Fourthly, there is a need to improve knowledge and confidence in caring for people with preventable chronic conditions.
- And finally, there must always be space for all members of the workforce to reflect and learn from experiences, to be better equipped and more resilient to deal with future challenges.
[i] NHS (2021) An Overview of Workforce Data for Nurses, Midwives and Health Visitors in the NHS. www.england.nhs.uk/about/equality/equality-hub/equality-standard/an-overview-of-workforce-data
[ii] Razaq A, Harrison D, Karunanithi S et al (2020) BAME Covid-19 Deaths – What Do We Know? Rapid Data & Evidence Review. www.cebm.net/covid-19/bame-covid-19-deaths-what-do-we-know-rapid-data-evidence-review
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