How I conquered my fear of 'Speaking up' - a Filipino nurse's lessons during pandemic

According to the study of HSJ, BAME (Black, Asian and Ethnic Minority) individuals make up the 64% of deaths in the nursing and staff group in the NHS. The numbers are disproportionately high especially considering BAME only represent 20% of the NHS staff population. It is hard to comprehend these numbers but more so, why a significant number of the deaths are Filipinos. The Covid-19 pandemic has taken so many lives and Filipino health workers have been hit hard with this reality. 36% of the healthcare worker deaths who were not born in the UK are from the Philippines.

Why are Filipinos severely affected by this pandemic?

There were views that our own culture of being quiet may have contributed to the significant number of Filipino health workers affected by this deadly virus. Do we, Filipinos, have a passive culture? Do some Filipino nurse experience this dilemma?

Having been here in the UK for quite a while now, I can say that I can relate to the concerns of most Filipinos, especially the new nurses. I was raised in an environment where hard work and respect are highly valued. My father has instilled in me and my siblings that we need to be respectful to our elders and those at the top of the hierarchy all the time, through the simple “mano po” gesture to not questioning their decisions. Challenging elders was frowned upon and was a form of disrespect.

Moving here to the UK changed my views about a lot of things. When I started my first job in the UK, I was given work which I struggled to manage. I was asked to do things which I was not comfortable doing. I was struggling but I chose to be quiet and suffer in silence.

Why did I choose not to speak up?

I had questions going through my head- will they understand me? Will I be able to explain my concerns well in English? Are my concerns valid? Will I lose my job if I challenge them? Will I create conflict? Is this a sign of disrespect?

Although these are all valid questions, all they have brought was fear and hindered me to express myself. As I become adept with my clinical and decision making skills and learned the dynamics of my department, I have learned to be assertive. I have learned that whilst working hard is a good trait to foster, I also need to learn how to voice out my views especially if I feel something is not right, if I feel that patient’s safety is a concern or if I feel unsafe or not protected at all.

Standing up for what we believe in and putting our foot down is hard, especially for those who are new to their respective Trusts or workplace. Being a minority can pose more difficulty in raising concerns: with the fear of losing your job, fear of rejection, and uncertainty whether your concern is valid or not. I get that. But if you don’t speak up, your voice will not be heard. And if you won’t say it, you won’t get it. Proactivity is the key.

Speaking up may freak you out but there are ways where you can harness that voice to be heard without sounding impolite. During the height of the pandemic, it was a challenge and I needed to step up and learn to voice out my concerns the right way.

First, examine the situation. Assess whether you are reacting emotionally or logically. Look at the situation in the eyes of another person. Whether it is your manager or a colleague who challenges you, you need to understand their side. If you had PPE concerns, do you feel a surgical mask is not enough when you need to provide care to a Covid positive patient? Do you really need a FFP3 mask whilst transferring a patient to another area? Evaluating the logic behind your action warrants a rationale of your concern. Ask your trusted colleague their thoughts. This expresses humility by not jumping into conclusions based on your fears and emotions but by taking the consensus of those who have had experience in a situation like yours. If you feel that your senior colleagues or your manager can’t help you with your concerns, your union representative may be able to help you deal with your plight and come up with a plan of action that will hopefully benefit you and your department. The Royal College of Nursing (RCN) has produced detailed escalation guidelines of when a concern should be raised and when to seek help as necessary.

Second, practice your lines. Delivering a concern across to someone, especially if you are not used to speaking up, can be terrifying. We hear concerns similar with mine. These are all valid concerns but can be overcome with proper planning and preparation. Practice your lines or try to even run it with your trusted colleague and ask for feedback. This will also help you boost your confidence and will help you ensure that you are able to convey the message effectively. But being confident is not enough, you need to know your facts so that your points come out objectively and professional.

Third, be flexible. The idea is to create a symbiotic relationship between you and your surroundings. As mentioned earlier, if you feel PPE is still inadequate and you feel that you need help in speaking up, your union representative may be able to create a bridge of compromise that can be beneficial for you and your department. Expect that there must be give and take situation because after all, you are facilitating a dialogue with your colleagues and not negotiating with an enemy.

Lastly, show your passion about what you believe in. Explain why your concern matters, and how it can improve your performance at work. Maybe, it will give you peace of mind and in turn preserve your mental health. Or you may ask for a proper risk assessment where your manager can put you to an area that is suitable for you. Explore excellent evidence that can back up your concerns but still be a perspective taker. Combine your will and drive with facts that can substantiate your point and this can enhance your stance on a subject matter.

Speaking up may be hard at first and takes a lot of courage to do so. Remember that you are the best advocate for yourself. And if all else fail, there are representations that you can seek to help amplify your voice and make it heard. We must protect ourselves so we can provide the best care we ought to give our patients. If you keep quiet and brush your worries aside into thin air, then how would others know your concerns and be able to help? We should not fear confrontation, but rather fear the aftermath of not speaking up for ourselves.

As they say, do not suffer in silence… We have a voice - let’s use it.

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