When we talk about sensitive issues, we use the phrase: the elephant in the room. Racism in nursing is a sensitive issue. Actually, it’s a must-not talk about topic. As nurses, you must care for patients in a holistic way, you must treat them with the ultimate respect and dignity. However, nurses from visible minorities do not seem to receive respect from any instance. Racism and discrimination in nursing are very subtle topics and no one wants to address them. Racism can come from different sources such as: the institution (institutional racism), the peers (nurses to nurses) and from patients.

Racism, discrimination, docile, domination, sensitive topics, power, resistance, racial discrimination, racialism, racial prejudice, xenophobia, chauvinism, bigotry, casteism, nursing.

Introduction

“Race,” often refers to conferred identities based on an imagined hierarchy of human value related to phenotypes, skin color, and other supposed biological expressions of group inferiority. The term “race” also carries with it histories of stereotyping, exclusion, and other forms of social injustice (Karlsen & Nazroo, 2006). Racism can be classed as a sensitive topic/research as defined by Renzetti and Lee (1993), the “disruptive” nature of sensitive topic, which challenges the status quo, can create discomfort; this must be provided by the researcher, whose research (Racism as a topic) may be considered a potential threat to the participants or organizations involved. If a perceived threat exists between the victim and the perpetrator of racism, there is always the possibility that defensive mechanisms will develop (eg: mistrust, resistance concealment) by the participants in order to resist the intrusion of the discomfort. According to Renzetti and Lee (1993), three major areas of concern have been identified as possible threats to sensitive research, namely the intrusive threat, the threat of punishment and the political threat.  The healthcare settings are a favorite place for racism and discrimination to take place.

Institutional racism

Healthcare professionals must adjust their practices to address the risks of violence to the extent that these risks are considered an integral part of their reality in healthcare settings. Staff must be alert to the perceived risks of violence and put in place protective mechanisms in their workplace. But, what mechanisms can be put in place to prevent micro aggression like racism and discrimination in the workplace? Healthcare professionals from visible minorities are vulnerable to violence as everyone else and face racism and discrimination.  Institutional racism can be hard to unmask. Healthcare professionals from visible minorities, have difficulty to access management positions, even if they have the knowledge, the skills and the experience to fulfill the position. Some black nurses expressed that they will not be in charge if there are Caucasian nurses who work on that shift, even if Caucasian nurses are the most novice. Another black Registered nurse stated that she will get the most unpleasant patient and the most unwanted shift (night & weekend shift). But, the worst is if she commits the same mistake as a Caucasian nurse, she will get punished more severely than the Caucasian nurse.

A healthcare professional states:

Unfortunately yes. I would say that I have mostly been a victim of micro-aggression, but on occasion, direct racist comments are shared (for example, derogatory comments to Haitian people, while I am Haitian). Among the micro-attacks, I can nominate me to be denied job opportunities in special project positions, while it is possible that I was the most qualified candidate. It’s hard to prove that the job should have been mine, for example, and difficult to be sure that I’m targeted because of my different ethnic backgrounds, but it’s hard not to question. Other examples that come to mind for micro-aggression are exclusionary behaviors, such as not receiving invitations, or being excluded from conversations by colleagues who are part of the dominant culture. Again, these people are likely to explain these behaviors through reasons, such as lack of personal affinity or otherwise, but it is hard not to wonder why it would seem that I have to work so hard to be included or be treated equally.

Some staff states that they are the witness of racist and discriminatory behavior in the their workplace:

Unfortunately, yes again. I have observed that physicians of different ethnic origins are less included, and feel more excluded. Their authority is questioned and their skills questioned much more than their counterparts in the dominant culture. I also find that caregivers have judgments about patients and their families who are from different ethnic backgrounds and have different beliefs about health and their role in family involvement. There is not much tolerance I find to derogate from the “mold” or only those who meet exactly the requirements of the dominant culture can return.

Racism and discrimination from patients

Another black nurse states that she experiences religious bias from her co-workers and patients:

Coworkers assumed because I am a practicing Muslim that I have met and married my husband through an arranged marriage. I could recall speaking to a coworker about marriage. She had asked me how I came to meet my husband and I explained that we met in high school. She then told me not to take offense, but that she assumed I was forced into an arrange marriage. I am a practicing Muslim and she assumed that arranged marriages are still a common practice within my religion. I did take to offense, due to the fact that I do not think it is fair to stereotype individuals and that stereotypes are based on ignorance. Patients have assumed because I am an immigrant that I speak English with an accent/struggle with the English language.  I can recall being asked by a patient where I am from. I’m asked this question very often, as I am a black women and also because I wear a head covering. I replied Somalia and he proceeded to say that I speak “good English” and “you have picked up our language very well.” I didn’t know how to reply because I couldn’t understand what he really meant by this comment. But I later understood that I once again am facing ignorance from individuals who neglect to understand that English is also my language and that Canada is my country.

Another black registered nurse recants her experience in these terms:

A patient was screaming for help and I ran to assist and the patient scream at n—-r is not allowed here, I don’t want black nurse. The other coworkers who were there, did not say anything. The hospital did not say anything, but ignoring the racism from patient.

By ignoring racism from patients, the institution is enabling racism and siding with them. This is because no one wants to address the “R” word.

Racism from peers

Racism and discrimination from peers are masking under jokes, or healthcare professionals are told, you are always using the race card. Even when the victims of racism and discrimination brought it forward, the healthcare settings downplayed it by saying it is a communication problem. Some staff members mention that they develop some mechanisms to deal and cope with racism and racial discrimination in their workplace:

Peer support helps me a lot. I have trusted friends to whom I can share my thoughts, and when there are cool events, it helps to be able to trust and feel understood. I find that as a woman, I also experience a double discrimination, because there are also challenges to sexism. I think I also use detachment (I try not to constantly think about situations of racism, and detach myself a little from these heavy and negative thoughts) and give the benefit of the doubt in the sense that the members of the dominant culture is not always aware of their exclusion and micro-aggression behaviors, they too are victims just like us of a social system that is not their creation. I also sometimes try to think of ways we can all work towards a better future.

Conclusion

Racism and discrimination are very difficult to unmask as no one wants to acknowledge that racism and discrimination are concepts that are still alive and people from visible minorities face them on a daily basis. The victims of racism are scared to speak about it, as they are afraid of the repercussions from their peers or that they will get punished by having a heavier load of work. And, they are tired of the psychology of victim-blaming. They know that the institution will not do anything about it. The institution has the power to fight racism, so everyone must take a stand to fight racism and discrimination.

Recommendations to fight racism and discrimination in the workplace

• Speak up
• Promote excellence and no white privileges
• Give equal opportunities to all
• Have a zero tolerance for racism and discrimination no matter the source

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