Let’s talk… inclusion: Being the change

This resource is designed as a starting point for ensuring none of us remain neutral where there is bullying, discrimination and incivility. 

It is intended to support staff in every care setting with practical tools and techniques to build on and complement organisational work around equality and inclusion.

It aims to help open up conversations and encourage everyone in the workplace to get involved in tackling workplace incivility.

Workplace incivility is characterised by rude or discourteous behaviour that is intended to harm the target. It can have a damaging impact on workplace relationships, trust and communication and ultimately can harm patient care.

What is discrimination?

The Equality Act 2010 lists four types of discrimination:

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Language constantly evolves and changes and it is important to note that there may be different uses of terms or phrases that are acceptable in different groups or settings.

Top tips for making your language inclusive:

• Educate yourself on current terminology.
• Engage with different groups to understand the history and impact of misused terms.
• Be prepared to be challenged.
• Practice what you learn.
• Practice how to respond when you get it wrong.
• Apologise if necessary and keep learning.

Members of marginalised or oppressed groups cannot tackle inequalities on their own. These groups need people from majority groups to challenge the status quo at a systemic, structural and institutional level as well as individually.

This is because those in the majority are most likely to hold the power to bring about change.

Allyship is about action not empty words.

Examples of allyship

• Speaking up when you notice bias or discrimination.
• Reflecting where you might be complicit in bias or discrimination and actively working to change that.

Workplace incivility is defined as low-intensity poor behaviour. This could be subtle rudeness or discourtesy without intention to cause harm.

This kind of behaviour tends not to fit formal definitions of bullying or discrimination.

Examples could include ‘dirty looks’, patronising tones or emotional put-downs.

Rising demand and fewer resources across health and care settings can erode morale and create the conditions for workplace incivility.

This is an issue for nurses, health care support workers and ultimately for patient care.

Creating and sustaining better behaviour in workplaces means more inclusive workplaces, happier staff and better patient experiences.

In order to address incivilities and be an active ally you need to be in a position where you feel psychologically safe.

Psychological safety is important. It helps create environments where everyone feels safe to contribute and challenge when needed, addressing issues as they arise without fear of reprisals or victimisation.

Scenarios

Whatever your age, you are never too young or too old to experience bias or discrimination. You may be perceived as ‘too young’ to lead a team or be treated as though you have no new ideas because you are older.

Scenario

You are taking part in handover after a long and challenging night shift. The nurse in charge from the night shift makes some comments about how an older member of staff had made the shift more difficult due to them being slower carrying out tasks. Nobody challenges this during the conversation.

The student nurse that has come onto the day shift then asks some clarification questions regarding 2 of the patients on the ward and the nurse in charge rolls their eyes and tuts, and reluctantly answers the questions whilst making it clear they just want to get home after a challenging shift

Tips for dealing with this scenario

• Show compassion and empathy to the nurse in charge for the difficult shift.
• Don’t start from a position of blame.
• Decide whether to say something in the wider group or speak with the nurse in charge after handover to offer feedback on how their comments could be perceived and how they made you feel.
• Share with the nurse in charge how you want to raise awareness around how those comments could be perceived and their potential impact.

Under UK legislation disability is defined as having “a physical or mental impairment that has substantial and long-term adverse effects on your ability to carry out normal day to day activities.”

The RCN is committed to working within the social model of disability. This model subscribes to a lack of inclusive cultures, environments and attitudes that have a disabling impact on individuals and groups rather than a medical condition being the cause of the disabling impact.

Scenario

You are on an interview panel for a new person to join your team. All of the panel have scored one particular candidate the highest and they were clearly the strongest candidate.

However, your manager who is leading the panel, shares that they do not wish to appoint them given the disclosure of a disability. The manager feels they are likely to require a lot of time off sick and that the team cannot afford to take that risk given how stretched they are. They suggest appointing one of the other candidates.

Tips for dealing with this scenario

• Ask your manager what makes them think this and what evidence they have.
• Reflect back how it seems unfair to make that assumption.
• Point out that occupational health will make it clear if there is likely to be any impact and it is not for the panel to make that judgement.
• Ask other panel members for their thoughts.
• If you don’t feel safe to speak directly to your manager, explore speaking with someone else within your organisation such as HR, staff side, freedom to speak up representative etc.

‘Gender’ and ‘sex’ have been used here with ‘sex’ being the legal term within the Equality Act 2010and referring to men and women only under sex protections. ‘Gender’ is the more inclusive term.

All genders and sexes can experience discrimination and disadvantage because of their gender in and out of the workplace.

Scenario

You are in the staff only area getting changed and you overhear a large group of colleagues, both male and female, talking about the new member of staff that has joined the team.

You hear them making references to this woman’s body parts and making sexualised jokes based on the outfit she is currently wearing. All colleagues involved are laughing along. A female colleague then starts to refer to how much time she is likely to need off work due to having a young family and suggests she will probably be given favours by the male manager due to how she is dressed.

Tips for dealing with this scenario

• Decide how safe you feel to intervene in the conversation and feedback on how the comments being made and references you feel are inappropriate.
• If you do not feel safe to do so, think about how you can raise this with your manager separately.
• Think about how you are going to handle any conversations that you are directly part of where these views may be displayed so that you can appropriately challenge them.

The Equality Act 2010 provides protection from discrimination on the grounds of gender reassignment. Gender reassignment has been used as the legal term, but gender identity is the more inclusive term. In both cases, they refer to a person’s intrinsic sense of being male (boy or man), female (girl or woman) or another gender identity. You can be at any stage in the transition process, and it is not necessary for you to have completed treatment or undergone surgery for the protections to apply.

Scenario

A member of the team is currently transitioning to change their gender. The team have all been informed with the manager working with the member of staff on how they are supported at work. One member of the team is consistently using the wrong pronouns for this member of staff. This happens both with the person present and when they are not.

Tips for dealing with this scenario

• If you feel able, speak to the person who is being misgendered and offer support, and try to find out if and how they would like to resolve this.
• Find a time to have a conversation with the other person.
• Offer them feedback that you have noticed they are using the wrong pronouns.
• Ask them if they are aware they are doing it.
• Seek to provide a supportive space – what do they need to try and change this.
• Have some resources ready to help support the person in why pronouns are important.

Just because you are pregnant, have recently given birth, or are on maternity leave, it doesn’t mean that it is acceptable for employers to treat you unfairly.

Scenario

Your manager pulls everyone in for a chat to discuss a promotion opportunity that is due to come up. All eligible colleagues have been invited apart from a member of staff who is pregnant.

The pregnant member of staff overhears you and your other colleagues discussing the promotional opportunity and gets upset that they have not been spoken to about this.

Tips for dealing with this scenario

• Offer support to your pregnant colleague with compassion and empathy.
• Encourage them to raise the issue with the manager.

The Equality Act also provides protection against discrimination in the workplace on the grounds of marriage and civil partnership.

Scenario

There is an international work event coming up that requires representation from within the team you work in. The lead for the event only approaches single people in the team to offer them a place on the trip, based on thinking that any staff married or in a civil partnership would not be in a position to travel internationally due to their ties and commitments.

You are one of the married members of staff and only when a single colleague tells you about it do you know the event is even happening and who’s been asked if they would like to attend.

Tips for dealing with this scenario

• Decide if you feel able and safe to have a conversation with the lead who is organising the event.
• Reach out to them and seek their views on how they have decided who to ask whether they would like to be part of the trip.
• Explain how it has made you feel being excluded based on that fact.

Everyone has a race, ethnicity and nationality and the Equality Act 2010 says that it is unlawful to subject people to unfair treatment and discrimination on that basis.

Scenario

It’s the start of your shift and when discussing with the team leader all the task allocations for the day, you notice that for the third shift in a row that week the tasks that are the less desirable ones of the job are once again allocated to the internationally educated nurse on shift who is from the global majority.

These are all duties within the role, but you have noticed a pattern of when any internationally educated nurses are on shift, they seem to always get allocated those tasks over the other tasks that need to be achieved during the shift.

Tips for dealing with this scenario

• Reach out to the member of staff and have a conversation about what they may have noticed about the difference in task allocations. If they agree, work together to decide how they may wish to tackle this.
• Consider what is your relationship with the team leader? Consider whether you feel able to offer them this reflection and feedback.
• Consider joining any groups where you can learn more about the experiences of staff from different backgrounds (join a race equality staff network if your organisation has one), widen your social media following to see and hear different views and experiences.
• Consider offering to swap tasks as a way to challenge the practice.

In the Equality Act (2010), religion or belief can mean any religion, for example an organised religion such as Christianity, Judaism, Islam or Buddhism, or a smaller religion like Rastafarianism or Paganism, as long as it has a clear structure and belief system. The Equality Act also covers non-belief or a lack of religion or belief.

Scenario

You work with a colleague who is observing Ramadan as part of the Muslim faith. This requires them to fast between sunrise and sunset.

Once Ramadan has begun, about 5 days in, you notice that the member of staff is making significantly more errors than they usually do, they also seem quite withdrawn, and you are worried that observing Ramadan is impacting on their functioning at work.

Tips for dealing with this scenario

• Seek out any organisational guidance for staff during Ramadan and learn more about how to support your colleagues during that time.
• In the first instance, try and have a conversation with your colleague from a supportive perspective to be able to offer them your feedback and work to explore what is going on for them. Have they noticed the same? Do they need to consider if they require any adjustments during this time?
• Consider whether you need to speak to your manager about it, if the other options are not possible or you feel the impact is so significant.

Whether you identify as straight, bi, gay, lesbian or any other identity, you are protected from discrimination and unfair treatment on those grounds. “Workplace bullying is prevalent among health and social care staff, with a quarter of lesbian, gay and bisexual staff experiencing homophobic and biphobic abuse from colleagues in the last five years.” Stonewall, Unhealthy Attitudes: 2015.

Scenario

You are in a Multi-Disciplinary Team (MDT) meeting about a patient. Concerns have been raised about the patient’s mental health and substance misuse.

It is mentioned that they identify as gay and what keeps them well is their regular visits to an LGBTQ+ inclusive group. One of the other members of staff in the MDT makes a comment about how they think being gay is wrong and should not be allowed.

No one else in the meeting challenges this statement. As someone who identifies as gay, you felt too uncomfortable to challenge in the moment.

Tips for dealing with this scenario

Consider your options as to how you would like to raise this. Do you feel safe to have a direct conversation with the person who made the comment? If so, have the conversation with the person and explain the impact the comment had on you.

Don’t put yourself in a vulnerable position unless you feel safe to do so.

Raise with your line manager.

Seek out any help and support available around you.

It is against the law for an employer to discriminate against you because of your religious or similar philosophical beliefs or political opinions.

Scenario

You are an experienced senior nursing lecturer with several published research studies. You apply for the role of Reader in Nursing Studies and find that you are not shortlisted.

After making enquiries you learn that your views as a nationalist did not sit well with the Professor of Nursing who was responsible for the recruitment.

You are outraged and demand that action is taken immediately.

Tips for dealing with this scenario

• Take a moment to care for yourself.
• Document the conversations.
• Contact the RCN for support.
• Consider documenting the conversations.
• Request a copy of the universities equality of opportunity of employment policy and make a decision whether to submit a complaint.
• Consider looking at the recruitment statistics for the university and its workforce statistics on political opinion.

In Northern Ireland, carers are protected from workplace discrimination by the Human Rights Act, and Section 75 of the Northern Ireland Act.

Scenario

You are a health care assistant working in a care home whose surviving elderly parent has been diagnosed with dementia and requires a lot of care. As you have no other siblings, you decide to become their main carer.

You are finding it difficult to cope with these new responsibilities and want to ask for reduced hours. Your employer has a blanket ban on flexible working requests.

Tips for dealing with this scenario

• Remember: if you are looking after someone who is elderly or disabled, the law will protect you against direct discrimination or harassment because of your caring responsibilities.
• Associative discrimination is the legal term that applies when someone is treated unfairly because either someone they know or someone they are associated with has a certain protected characteristic under the Equality Act 2010.
• Contact the RCN for advice and support.
• Ask to see copies of any relevant policies.