Hair racism: the everyday prejudice black nursing staff face at work
Nurses of African-Caribbean heritage discuss workplace attitudes that expose employers’ and individuals’ bias against black norms of grooming and undermine cultural identities
- Black nurses describe feeling marginalised and even violated at work because of discriminatory attitudes to their hairstyles
- Cultural competence is a fundamental nursing value that needs to extend to colleagues as well as patients
- Advice on how to combat hair racism in healthcare
A nurse manager demands you alter your hairstyle even though it complies with uniform policy. A colleague pulls on your hair to ‘see if it’s real’; a patient suddenly runs a hand across your head to get a feel for your hair’s texture.
These, say the co-authors of two research papers, are the everyday experiences of many black nurses and amount to ‘hair racism’.
Expectations to conform to the white norm
Middlesex University nurse lecturers Georgina Cox and Sheila Sobrany can offer numerous examples where black nurses have been subjected what they call ‘cultural violence’ in relation to their locs, braids, cornrows and other ways they choose to wear their hair.
‘For so long, it’s been put forward that to be black and professional your hair has to be “Eurocentric”,’ says Ms Cox. ‘It’s got to be straightened, it’s got to conform to the white norm, not what is the black norm.
‘And the black norm is thick, kinky, curly. If we want our hair straight, we have to process it. There are many, many women – and probably some men too – who have gone bald from these chemical processes in a bid to appear more European and more “acceptable”.’
Attitudes that hark back to the days of slavery
The Black Lives Matter movement has highlighted systemic discrimination in many workplaces and organisations, and healthcare is no exception, says one of the two articles, an editorial in the Journal of Clinical Nursing.
‘A colleague dug her hands into my afro and her hands went on my scalp. You just feel there’s no respect for my culture and who I am. It was really, really unpleasant’
Neomi Bennett, founder of Equality 4 Black Nurses campaign group
In the article, Ms Cox and Ms Sobrany, along with their co-authors, argue that attitudes revealed in the policies and behaviours in some health services have progressed little since the days of slavery and missionary schools, ‘where natural black hair was seen as “unsightly, ungodly and untameable”’.
Discrimination manifest in attitudes to hair is rarely blatant, they say. Rather, it is cloaked in euphemisms often found in dress codes that ban hairstyles regarded as ‘extreme, unusual, fad, eccentric, unconventional, distracting or uncombed’.
‘So in other words, black hair is not acceptable,’ Ms Cox says.
Black hair as an object of curiosity – and a reason to invade individuals’ personal space
She says there are many examples of inappropriate behaviour, by patients and other nurses, in relation to afro hair, a style she often chooses to wear.
‘I was working on a ward and this particular patient just wanted to keep touching my hair,’ Ms Bennett says.
‘I was upset by it. I felt violated because your hair is something very personal. But when I spoke to the matron about it, she said it was my fault for not tying my hair up.
‘She and my colleagues didn’t see it as anything to warrant me being upset so it was almost as if I was gaslighted.’
On another occasion, it was a colleague who behaved inappropriately. ‘She dug her hands into my afro and her hands went on my scalp. You just feel there’s no respect for my culture and who I am. It was really, really unpleasant.’
Design of PPE head coverings fails to acknowledge needs of many black healthcare staff
During the height of the coronavirus pandemic, Ms Bennett was forced to wear clinical-waste bags to cover her hair because the coverings that came as part of standard personal protective equipment (PPE) did not accommodate her afro.
‘So I walked around with a yellow bag on my head,’ she says, an experience she describes as degrading.
‘In those critical times, when you’re dealing with a pandemic, you would think PPE would be selected for the whole workforce and not just certain people.’
Diversity by design – how one nurse took action over PPE head coverings
Imperial College Healthcare NHS Trust matron Noni Nyathi worked with the trust’s senior leadership and PPE and procurement groups during the COVID-19 pandemic to champion the provision of hair coverings for staff with African-Caribbean heritage or who cover their hair for religious reasons.
‘It’s important to create an open discussion because, if we don’t highlight these issues, positive change can’t happen,’ she says.
Referring to the papers published by the Middlesex University nurse lecturers, Ms Nyathi says: ‘Research like this helps to highlight systemically where policies lack insight and collaboration from staff of diverse backgrounds, and should provide an important opportunity for organisations to reflect and update guidance to better represent staff groups.
‘Awareness is the first step and discussion about staff hair had been a missing link at the start of the pandemic.
‘I had taken action to cover my hair because washing it so often meant it had become dry and difficult to manage. I discovered many colleagues facing the same problem and we had an open conversation to share our experience with senior colleagues and with the procurement and PPE groups.
‘They actively wanted to know what they could do to solve the problem and support staff more effectively. Hair caps and hijabs now form part of the trust uniform policy and are available to all staff who need them.’
‘The message is unapologetic: black nurses must fit in with norms of white organisations’
Intensive care nurse Cledwyn Musipia contributed to the editorial co-authored by Ms Cox and Ms Sobrany.
Like Neomi Bennet, he has had colleagues wanting to touch his hair, which he wears tied back in locs.
‘I don’t know whether it’s down to racism, lack of knowledge or ignorance,’ he says. Either way, he finds it annoying, especially when others have their own ideas about the significance of his hair.
‘Some people just assume you must smoke weed and are Rastafarian.’
‘It’s not what’s on the person’s head, it’s what’s in their head that’s important’
Georgina Cox, nurse lecturer, Middlesex University
In the editorial article, Ms Cox and Ms Sobrany offer examples from themselves and their black colleagues of ‘hair racism’: an instructor petting a nursing student’s hair and claiming it resembled the instructor’s puppy; another student being told to ‘tame’ their afro; a nurse with locs being asked to wash their hair before coming back on duty even though the hair was freshly washed.
‘The message being sent clearly and unapologetically is that black nurses are aberrations and it is their responsibility to discipline their black hair to assimilate and fit in with the expectations and aesthetic norms of white organisational settings,’ the editorial states.
Discrimination under the guise of infection control and professionalism
Discriminatory hair policies are defended in a variety of ways, says Ms Cox, and infection control is one of them.
But their editorial argues that any evidence indicating nurses’ hair poses a substantive infection risk is scant.
‘Some nurses fall back on white privilege to invoke “infection control” or “professionalism” to coerce and control black identity,’ they write.
Similarly, there is no evidence to support the assertion that patients ‘don’t like’ black hairstyles. Studies of patient preferences indicate only that they prefer staff to be clean and presentable.
Dress codes in nursing have changed over time as the profession has moved away from hats and starched aprons.
Current NHS guidance in England says only that where hair is long, it should be tied back off the collar.
As rationale for this, the guidance refers to a Thames Valley University literature review of how uniforms affect the image of individuals and organisations. The review found that patients prefer to be treated by staff who have ‘tidy hair and are smartly presented’.
Role of senior nurses in combatting discriminatory interpretation of uniform policies
If it is the interpretation of policy that is discriminatory, rather than the policy itself, there is a clear role for senior nurses in ending what Ms Sobrany says are microaggressions towards black nurses.
In the second of the research papers, she, Ms Cox and their fellow authors say nurse managers have a vital role to play in helping to excise racism from health services.
‘If you see behaviours and practices that discourage colleagues from being who they are just because of their appearance, be the person who speaks out’
Sheila Sobrany, nurse lecturer, Middlesex University
‘Considerable lip service is paid to the empowerment and autonomy of nurses,’ the article states.
‘Now is the time for nurse managers and leaders to make this rhetoric a reality by helping decolonize nursing through ending hair policy and dress code micromanagement.’
The only hair policy required is that hair should be clean, away from the face, off the collar and not in the way of any procedure being undertaken, the authors add.
Does appearance still matter in nursing?
When reflecting on policies and standards about hair, there is perhaps a wider issue to be addressed: does appearance continue to matter in nursing?
Where once nurses were regarded almost as a breed apart, distinct and separate from their patients, now every effort is made to ensure they reflect the communities they serve. Tattoos, piercings and bushy beards, along with hair that is brightly coloured, cropped, cornrowed or extended, are widespread in the patient population, especially in large, multicultural cities.
Staff are expected to be sensitive to diversity in all its forms. Yet this cultural awareness does not always extend to colleagues, particularly in relation to their hair, Ms Cox and Ms Sobrany argue.
‘Hair remains a rampant source of racial discrimination with serious economic and health consequences’
CROWN Act, California
‘Maintaining clinical standards is important,’ Ms Cox says. ‘We don’t want to bend the rules. But we want people to be more aware of appropriate behaviours in relation to racism, discrimination, bullying and harassment.
‘We have all of this cultural competence, cultural diversity, and we’re supposed to be understanding and caring. We talk about decolonizing the curriculum and how to care for black and Asian hair and skin, and we live in a multi-ethnic society. So why can’t nurses give colleagues the same respect?’
Ms Sobrany adds: ‘It’s not just about amending policies, it’s about changing attitudes.’
It may also be about changing the law.
In some parts of the United States, legislation known as the CROWN Act (see box) has been introduced that outlaws discrimination based on an individual’s hair preferences.
The CROWN Act
In June 2019 the US state of California passed a law the prohibits discrimination specifically on the grounds of hair.
The CROWN (Create a Respectful and Open Workplace for Natural Hair) Act bans schools and workplaces from discriminating against people with natural hairstyles. Wider equality legislation had failed to prevent such discrimination.
‘Hair remains a rampant source of racial discrimination with serious economic and health consequences, especially for Black individuals,’ the act states.
Some other states have since passed similar laws and others have filed legislation.
The CROWN Coalition is an alliance of organisations committed to the advancement of anti-discrimination legislation across the US.
Research relating to the CROWN Act found that 80% of black women responding to a survey agreed with the statement: ‘I have had to change my hair from its natural state to fit in at the office.’
The research also found black women’s hair is more likely to be perceived as unprofessional than the hair of other women.
Advice on cultural competence among nursing colleagues
What messages would Georgina Cox and Sheila Sobrany like nurses and nurse managers to take from their work?
‘One, it’s not what’s on the person’s head, it’s what’s in their head that’s important,’ says Ms Cox.
‘And two, if we’re going to have cultural competence in our nurse training and teaching, and if we’re going to display that to patients, isn’t it even more important we display it to each other?’
‘Try to be more allied in your thinking with the person you’re talking to,’ Ms Sobrany suggests.
‘If you want to be helpful and supportive, and you see behaviours and practices that discourage colleagues from being who they are just because of their appearance, I would say be the person who speaks out and says that’s not right, and not be the bystander who does nothing.’
And start having conversations, she adds.
‘You will feel very cautious because you don’t want to offend anybody. But ask the person, “Do you mind if I ask you questions about black hair because I don’t know enough, and I’d like to know more?”. Try to be open-minded and more self-aware.’
Ms Cox says: ‘Ask me a question. I don’t mind you asking. Just don’t come and stick your hand in my hair or pull on my locs – and I’ve had that happen to me.’
- Research paper: Time for nursing to eradicate hair discrimination
- Research paper: Will nurse leaders help eradicate 'hair racism' from nursing and health services?
- NHS England: Uniforms and workwear: guidance for NHS employers
- Culturally-sensitive PPE head coverings and staying cool and comfortable at work
- ‘Don’t brush aside our everyday experience of racism’