An independent review into the culture of the Nursing and Midwifery Council (NMC) has uncovered a ‘toxic’ combination of poor behaviours including racism, bullying and discrimination that have affected its mission to protect the public.
The nursing regulator commissioned an independent review earlier this year following allegations of sexism, racism and a lack of freedom to speak up about issues.
The NMC said it took the findings of the review very seriously and would deliver a culture-change programme rooted in the review’s recommendations.
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Investigators Nazir Afzal and Rise Associates found that 40% of 1,040 NMC staff polled had experienced or witnessed microaggressions in the past year.
There were multiple accounts of ignorant remarks being made, including a Muslim staff member being asked “Why don’t you have a Guinness?” and an employee with an Indian name being told their name was “very difficult” and asked if they could shorten it.
Twelve per cent had experienced bullying or harassment in the past year and 17% said they had witnessed it. Almost a third (31%) said that procedures for bullying and harassment were not clearly outlined, and a further 36% said procedures for bullying and harassment were not acted upon.
The report says: “The NMC is a complex organisation, consisting of six directorates, and while there are many staff content in their roles, we found far too many that were struggling.
“They were angry, frustrated and exhausted. We saw staff break down in tears as they recounted their frustrations over safeguarding decisions that put the public at risk. We heard staff talk about taking antidepressants, managing their hair falling out and not being able to sleep because of bullying and bad management. And we heard staff angrily recount experiences of racism in the workplace.”
It identified a huge backlog of fitness-to-practise cases, with around 6,000 awaiting a decision. Some nursing professionals have spent four or five years waiting for a decision, which has had a severe impact on their mental health. Six people have died by suicide in the past year while awaiting a decision.
The phrase I would use to describe some of the challenges is ’toxic positivity’. It’s hard to bring concerns or challenges up as you are often labelled as a negative person” – NMC staff member
NMC staff reported high levels of stress over their workloads and feeling under immense pressure to clear the backlog in fitness-to-practise cases. This pressure had an impact on the decisions being made, with one staff member stating that the screening team had failed to close down cases where nurses posed a clear danger, including one who had been accused of sexually assaulting patients and raping a colleague.
One staff member said: “The phrase I would use to describe some of the challenges is ’toxic positivity’. It’s hard to bring concerns or challenges up as you are often labelled as a negative person and there is no recognition that you can still want the best for teams and the business and still recognise and describe things that don’t work or are challenges.”
The review also found that:
- training and development had been seen as “nice to have” rather than an essential part of a culture of continuous improvement
- career progression did not appear to be structured, with some accusing the NMC of “cronyism”
- performance management had not been undertaken in a meaningful way
- managers and HR have little understanding of disabled workers’ conditions or failing to make reasonable adjustments
- over 50% of respondents said that it was either very unlikely or unlikely that they would be able to fulfil their career
aspirations at the NMC.
The report makes 36 recommendations, including the need for the NMC to transform itself into a people-focused organisation, strengthen policies and learning around bullying and harassment, develop an anti-racist action plan, and increase the proportion of black and ethnic minority managers.
The NMC said that racism, bullying and discrimination should never have had a place at the organisation and it would work towards achieving racial equality. It said it had already strengthened its guidance on concerns about sexual misconduct and abuse outside professional practice.
NMC’s response
Sir David Warren, chair of the NMC council, said: “This is a profoundly distressing report to read. First and foremost, I express my condolences to the family and friends of anybody who has died by suicide while under fitness-to-practise investigation. Our safeguarding lead is urgently revisiting those cases and examining the impact of our processes on all those who are involved in them.
“I am extremely sorry to hear the testimony of NMC colleagues who have shared their distressing experiences of racism, discrimination or bullying. On behalf of the council, I give my absolute assurance that addressing this will be front and centre of change at the NMC.
“I also apologise to those nurses, midwives, nursing associates, employers and members of the public for whom we have taken far too long to reach fitness-to-practise decisions. Nazir Afzal’s recommendations, together with our existing improvement plan, will make the step-change in experience they expect and deserve.
“We now have clear recommendations to take the organisation forward. I’m grateful to all our colleagues who have spoken up about these issues. I know that what matters to them now is action, not words.”
Angela Sutcliffe, who stepped down as NMC chief executive last week due to ill health, said: “Having received the draft of this important report three weeks after my decision to step down, I know there is powerful testimony from colleagues sharing their stories about racism, discrimination and bullying and their views of the NMC.
“It’s extremely important for the organisation to truly listen and respond. Clearly, some colleagues have had experiences at the NMC that are not acceptable and should not be tolerated. I’m devastated this has happened on my watch and I apologise to everyone affected, our colleagues, professionals on our register and the public.”
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