Anti-racism in nursing practice – our professional duty to act

I joined the NHS back in 1984 as an undergraduate nursing student at the University of Hull. I was the only black student in my year. Growing up in the suburbs of Liverpool I was the only black child in my primary school and one of two black students in secondary school. I was used to being seen as ‘different’ and from a young age I had already developed behaviours and strategies to cope with that.  

Fast forward almost 39 years to 2023. I am lucky to have had an amazing and fulfilling nursing career, working in hospitals, the community and in policy. Despite the odds I have been able to become a senior nurse leader and QNI Fellow. Owing to hard work, plus sponsorship, support, and encouragement from other senior leaders, I have been able to succeed. That doesn’t mean it has always been easy for me. I have experienced racism first-hand both professionally and personally. The uncomfortable truth is that racial discrimination is a daily reality for many people.  

I returned to the NHS from retirement in August 2022 and have since been working as a Senior Nurse Advisor at NHS England, supporting the national nursing team with the Anti-racism in Professional Practice programme. As you can imagine, it really means something to me to take on this role. 

The work is driven by long-standing race inequalities shown in our NHS workforce data and in health outcomes within the populations we serve. This was starkly highlighted during the pandemic when COVID-19 disproportionately impacted on our Global Majority* workforce and communities.   

The Anti-racism in Professional Practice programme began in January 2022 when NHS England partnered with the Nursing and Midwifery Council (NMC) and NHS Confederation. The aim was to build a consensus around the steps needed to promote anti-racism in professional practice.  It focused on personal responsibility to adopt anti-racism and to increase understanding of how institutional racism contributes to individual practice.  

In November 2022, we jointly published the resource: Combatting racial discrimination against minority ethnic nurses, midwives and nursing associates. This resource is for all nursing and midwifery professionals registered with the NMC working in the NHS. It supports all nurses, midwives and nursing associates across health and social care to combat racism and secure their own and their colleagues’ wellbeing and psychological safety.   

As registrants we have a professional responsibility (NMC Code) to: 

• Challenge discriminatory behaviour. 
• Create an environment where people are treated as individuals.  
• Treat people with dignity and respect. 

The resource can help registrants act according to best professional practice, when: 

Witnessing racism 

• you better understand and feel confident about what you can do during and after witnessing an incident that is directed at someone else. 

Experiencing racism 

• you feel better equipped to manage incidents as they are happening to you and afterwards. 

Leading anti-racism 

• you feel you have the insights and skills to provide anti-racism leadership that creates safe working environments, and tackles and responds effectively to racial discrimination, harassment or abuse. 

The resource also outlines the expected behaviours from NHS organisations and leaders, which includes the provision of training to support zero tolerance policies; senior leaders acting as proactive allies by taking the appropriate action; the provision of safe spaces for conversations such as robust staff networks and events; and organisations working with staff to educate and reform practice. 

Everyone has a role to play in combatting racism and I would encourage all community nurses to: 

• Familiarise themselves with the resource and the subject (even if this means feeling uncomfortable or unsure at the start).  
• Find out more about what your organisation/employer is doing to support this agenda. 
• Create safe spaces to discuss the resource at team meetings. 
• Build it into your revalidation. 
• Reflect it in a personal objective as part of the appraisal process. 
• Support Global Majority colleagues. Take time to listen to their experiences without judgement. Consider sponsorship.  
• Think about how the resource could be used to support quality improvement in your practice. 
• Help us to continue to develop and improve this resource by completing NHS Confederation’s survey. The survey closes on 1 September 2023. 

The most important thing is to act. In the words of Martin Luther King Jr, ‘’The ultimate tragedy is not the oppression and cruelty by the bad people but the silence over that by the good people.’’  

Michelle Mello, RN, BSc (Hons), MSc, PGCE is Senior Nurse Advisor, Team Chief Nursing Officer, NHS England

* Global Majority refers to people who are Black, Asian, Brown, dual-heritage, indigenous to the global south, and or have been racialised as ‘ethnic minorities’. It is a collective term that first and foremost speaks to and encourages those so-called to think of themselves as belonging to the global majority. 

About Michelle Mello

Michelle is a nurse with over 38 years’ experience of working in the NHS in a variety of roles. This has included clinical, management, commissioning, strategic and executive level posts. Clinical roles included working in hospitals and in the community as a health visitor and diabetes specialist nurse. Michelle also worked in a senior academic post at Warwick Diabetes Care, University of Warwick.

Since 2012 Michelle has held national roles in NHS England working with the Chief Nursing Officer, Right Care Team and latterly the Personalised Care Group. From November 2020 to March 2021 Michelle was seconded to the London regional team as Clinical Quality Director. In 2022 Michelle retired and returned part-time to NHS England.

She is a Fellow of The Queen’s Nursing Institute and a Florence Nightingale Foundation Scholar.

Follow Michelle on Twitter: @MSHMello