Professor Laura Serrant OBE, Leadership, Development and Inclusive Practice Specialist, keynote: Optimising equity, inclusion and belonging to safeguard our professions and ourselves
The NHS faces a significant challenge in the coming years to ensure it has a workforce that can meet the needs of our population. As outlined in the NHS Long Term Workforce Plan ensuring we can provide safe and efficient care to those who need it will rely on not only attracting people into nursing but also retaining those already in the profession. During her keynote presentation at Northumbria University’s first Working Well in Healthcare event, Professor Laura Serrant discussed an aspect of staff retention that is often overlooked. She highlighted that making sure individuals feel represented within the workforce by optimising equity, inclusion and belonging is fundamental when it comes to growing, developing and retaining a healthy workforce.
A sense of belonging
When it comes to retention of skilled workers, particularly in the NHS, we talk a lot about what will make people stay in the profession, how we can support them with their development, will it help if we increase their salary, can we offer them more opportunities and so on. These things are all important but today, I want to talk about another area of retention that’s often overlooked and that is whether our staff feel they are represented within the workforce and whether they feel they belong.
Whether they feel they belong in our profession is absolutely key to whether they stay because people don’t stay where they don’t feel wanted. That sense of belonging is a key challenge for us across the whole life cycle of our professionals’ careers.
Taking a global approach
“Public health is the science and the art of preventing disease, prolonging life and promoting health through organised efforts and informed choice of society, organisations, public and private, communities and individuals.”
Wanless, 20041
The key point I want to take from the Wanless quote above is the recognition that tackling our workforce challenges isn’t just down to one group of people, it can only be achieved through the organised efforts of multiple groups of people working across policy, in education, on the front line and within our communities. It is vital that we recognise what our own contribution can be as well as what our peers can contribute and work together to bring that to life.
When we think about the healthcare landscape it’s important to understand we are talking about a global profession. Diseases and illnesses travel the world – something which we received a stark reminder of during the COVID-19 pandemic – and our professionals work across the world. We need to work together to overcome these challenges because they do not only exist within the NHS they exist in every healthcare system across the world.
We know that the global landscape of healthcare is changing, and we need to understand what that looks like so that we are not only reacting, but proactively thinking what we can do. How can we think forward, instead of always responding backwards? The work Northumbria University is doing in terms of its Centre for Health and Social Equity and its health and social care workforce development efforts within that is a great example of how we can recognise our contribution and proactively plan to meet these challenges head on.
An equitable workforce
We have a huge workforce that can help us to get through these challenges and we need a diversity of people working in a diversity of places to deliver on any solutions. If we are all at the bedside – which is an important place to be – who is writing the policy to enable us to practice, who is training the next generation so we don’t have to work forever, who is doing the research which will help us to recognise the impact of what we’re doing?
Now, naturally with a diversity of professions comes a diversity of people and it’s essential that we optimise equity, inclusion and a sense of belonging across our workforce, because as I’ve mentioned above, whether our staff feel they belong, is key to whether they stay.
When we talk about equity, diversity and inclusion people can sometimes feel a bit uncomfortable and that’s understandable. I know I’ve sat through a lot of equality and diversity training which has, in my experience, done very little except make people feel bad about themselves. The training we deliver rarely helps individuals to identify how they can support their colleagues even if they’re morally committed to doing so.
It's an uncomfortable space because we’ve had the training, we should know what we’re doing, which words to use right? And that’s really what it’s always been about. However, the space we’re actually trying to create in an equitable world is one in which people feel that they are confident and competent to ask questions, to adapt their practice, to think about their intentions and to help and support themselves and other people to give the best that they can. We need to overcome the hesitancy to get involved because we’re scared to get it wrong.
Equally, this fear of getting it wrong extends into our practice, which is changing all the time. How do we deliver better care? How do we improve service quality? And, at the same time, how can we be resilient in our professions and the way we deliver them?
2020: the year resilience gained a new meaning
2020 is the last time we were all scared of getting it wrong. It was the year resilience became merely surviving, not thriving. Half the time you were not coping, or you were juggling 10 things at once and honestly, we were all just trying to make it through. Since then, there has been a lot of pressure on us to improve, to do things better and it’s felt like we’re in the eye of a storm. And, in the eye of the storm, you’re not sure and you don’t step forward, sideways or backwards for the fear of losing your footing.
I’m here to tell you that that we can step forward, together. If we recognise the links between ourselves and the others in our profession and work towards a workforce where everyone feels they belong and can contribute in their own way.
Equal chances, equal outcomes
Being able to understand how we create this space and bring this concept to life is about developing a shared language around this. One of the problems we have in policy, in strategy, in procedures is the language we use. If you look at documents, research papers, policy documents, procedures and strategies, gold standard pathways, wherever you are, whether you’re in practice, research, education we all use words interchangeably as if they mean the same thing.
What does it mean to give people an equal chance of a good outcome? Is that equality? Or is that equity?
Equality is essentially about doing everything the same for everybody. When it comes to what we’re talking about today it’s not that it’s not relevant but, it is usually focused on systems, processes and ensuring that we standardise things. However, even if everyone has the same given to them, that still doesn’t mean the same outcomes.
If we shift to equity and we think about what the outcome is that we want, we think about the people instead of the processes, and we accept we need to have some insight into what those individual needs are, then we can start to design a space where everyone in our workforce has access to the same opportunities, training and development. They feel like they belong.
Striving for social justice
In order to truly overcome the challenges we’re talking about we need to think about the area we operate in, how we deliver care and to who. What is it that we’re aiming for as a profession and as a system? I would say, what we ultimately want is social justice. When we talk about social justice we’re talking about not just at people, or processes, that for whatever reason need additional support at specific points, we’re looking at the causes of the problems in the first place.
We’re not just dealing with the immediacy of needs. We’re looking at the fundamental causes of the inequities in our profession. Then we’re bringing together policy, strategies, systems and people to address those problems.
For me, it’s been 42 years since I started my training, I was the first in my family to go to university. My parents left school at 10 and 13 because at that point in the Caribbean they had to pay for secondary education, and they couldn’t afford it. So, equity and chance has always been a big part of my life.
As a black woman, a black nurse, a black nursing professor, most of my training from day one has been walking this tightrope around being inside or outside, part of what is going on but not quite fitting in.
That’s the journey that many people take in our workforce, so to use another example how do I as a 30 year old, fit into a space where everyone else is 18? Or how as an 18-year-old on placement do I fit into a space with qualified professionals, probably older than me? There’s so many different reasons people will question whether they fit and to revisit my initial statement – whether they feel they fit is key to whether they stay.
In many ways I fit, I was a student nurse, but in other ways I didn’t. I was on one of the first nursing degrees whereby everyone in practice was asking what kind of nurse needs a degree? Back then trans-cultural nursing – what we’d now refer to as culturally-safe care – was really quite problematic.
As part of a global profession, the training we deliver needs to reflect the world we live in. If I was to collapse in front of you today, I would want to be confident in your competence to be able to look at my skin colour and notice where I have poor effusion or poor circulation but that has not always been the case.
When my son was younger, the health visitor came to see him and he had a bluish tinge down his back, the result of a common condition which back then was known as Mongolian Blue Spot. Only, I was questioned about non-accidental injury because the health visitor hadn’t been told about the condition and had never seen it before. Now, it was fine, I was a qualified nurse, and I knew what it was but imagine if I was someone else, someone with a different background?
The equity, equality and social justice we’re seeking as a profession still isn’t reflected in our practice today. Even now, with the latest revisions to the NMC competences, equity and inclusion is a recommended golden thread. It’s not compulsory. How can it be in the 21st century we are training healthcare practitioners in a space where equality and equity is not compulsory, and then we say they are fit to practice in a global profession? These are not just issues of morality, they are matters of life, death and safety and they are absolutely fundamental to building a workforce that can meet the demands of the world we live in now.
Nurturing wellness in our workforce
So, what is it we’re actually trying to do with our workforce and our profession moving forward? If the outcome is equity, then are we putting in what we need to to make people feel they have an equal chance of success? An equal chance of doing and giving their best as well as an equal chance of giving and receiving good care?
Here are some of the silent issues in health equity we seldom talk about. The belief that health is free at the point of delivery and is given according to need – not always. The belief we have an equal risk of everything – we don’t. The belief that if we are equal in the way we do things, if we use equality as a basis, we will have similar outcomes - yet we know that there is unwarranted variation between our chances, our life chances and our experiences in healthcare and education. And the belief that if we are good at our professional work, we have equal chance of promotion, we have equal chance of progressing, - yet the data tells us something different. It is these issues that we need to recognise and that we need to overcome.
A good friend of mine, Muna Abdi, who is an educational consultant said: “It’s not inclusion if you invite people into a space that you’re unwilling to change”2 – there’s a difference.
How do we nurture wellness in our workforce in this space that we’re in? How do we continue to have a workforce which is equitable, continue to have a diverse workforce and continue to be able to deliver high quality care and give an equal chance of doing a good job for all of us, no matter who we are and where we go? How do we build a space where our workforce, where our professionals feel they belong?
Ultimately, we have to think about moving away from only thinking about diversity in relation to protecting characteristics. They’re important, but they’re not the whole story. Audery Lorde once said that we don’t live single issue lives.3 When I walk into a room, I don’t walk into the room as one part of myself. I come as my whole self, we have to start thinking about equity, diversity, inclusion and belonging in what we do across a multitude of intersecting elements of ourselves. We are all individuals with different attributes and experiences, and we need to ensure our care, our support, our education and our research reflects that.
Key takeaways
Now if we think about everything, we’ve talked about in relation to our professional practice what do we need to remember? Equality, diversity and inclusion is more than just colour or status, it is a complex picture of who each of us are and how we feel accepted and part of the environment we’re in. Without this, we cannot safeguard the future of our profession because people won’t want to join us, and they certainly won’t want to stay.
What I have learned is that if we really want to inspire the next generation of practitioners, and the current generation so we can retain them, it’s important that we have roots and wings. It’s important that we know where we’ve come from, we know what worked well and what didn’t and we recognise there’s an opportunity here for the future workforce to be different, not just like us, but a generation that has learned and progressed from what we did. This is how we grow our profession. What we did in the past will not sustain us in the future and we need to do things differently.
So, remember; When you look at statistics, remember every data point is part of a story and that should be a story of outcomes, not just intentions. Remember you only fail forwards4. The fear of getting something wrong can’t stop us. Every failure is a learning opportunity. And remember that the way to the top is up and down and we have to be able to ride that roller-coaster and allow ourselves to be human, we’re going to make mistakes so make your peace with it.
References
Securing Good Health for the Whole Population (2004) available at here.
Muna Abdi, Educational Consultant
Sister Outsider, Audrey Lorde (2007) available here.
Embracing the Lessons in Failure, Lisa Nichols (2023) available here.
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