Black, Caribbean and African-descent nurses in British Columbia face frequent “entrenched and pervasive” racism and discrimination at work that is causing trauma and fuelling health inequities for Black and racialized patients, according to a new survey.
In the survey as well as group meetings conducted by the Coalition of African, Caribbean and Black Nurses in BC, nurses described frequent workplace bullying and harassment from colleagues, patients and their families. They described some co-workers refusing, before the pandemic, to touch objects previously handled by Black colleagues.
One nurse described being physically assaulted by a colleague after the nurse informed the colleague that they’d taken the nurse’s chair.
“Everyone who came to our group meetings had different experiences of racism and discrimination,” said Ismalia de Sousa, a nurse and PhD student at the University of British Columbia school of nursing who helped found the coalition in 2020.
But many shared experiences, like being dismissed by superiors, having few opportunities for promotion or being scapegoated for mistakes made by non-Black colleagues, came up again and again, de Sousa said.
Ninety-three per cent of survey respondents were women, and three-quarters were born outside Canada, meaning intersecting sexism, racism and xenophobia further worsen the harm they experience.
“Those experiences have significant impacts for respondents’ personal and professional lives, and have long-lasting traumas too,” de Sousa added.
Now the coalition is calling for transformative action to support Black nurses and end anti-Black racism in health care that is affecting both staff well-being and patient care and outcomes.
“As nurses, student nurses, academics and researchers, we have an ethical duty to safeguard human rights, justice, equity and fairness,” reads a Wednesday open letter from the coalition addressed to the provincial government, health authorities and regulatory colleges for nursing.
“This is why we call on you to heed the B.C. Human Rights Code and work collaboratively with us to find solutions that put an end to racism and racial discrimination and its associated emotional and physical impact on our members, non-members and the public.”
The coalition was founded by a group of concerned nurses in the wake of the pandemic’s first wave and the public reckoning with racism in health care, and anti-Black racism following the murder of George Floyd in Minneapolis.
Racism and discrimination are not new for Black nurses who’ve been living with them for years and decades, stressed de Sousa, but the events of 2020 shone a light to make them unignorable.
In B.C., the extent of anti-Black racism in health care and its effects is obscured by the lack of race-based data collection and missing research on the specific experiences of Black nurses in the provincial context.
There is a lot of data from elsewhere in the world on anti-Black racism experienced by health-care workers, de Sousa said, but it can’t be considered an exact indication of what is happening in B.C.
Meanwhile, there are very few Black people, let alone nurses, in senior leadership positions in health authorities in B.C. Respondents said this is a direct result of managers being unwilling to invest or train Black nurses for higher positions or to progress in their careers.
“Some of these ideologies and beliefs are deeply rooted in history, for instance the idea that Black people are uneducated,” de Sousa said, noting for many years Black women were barred from attending nursing schools in Canada. “And these beliefs are still manifested, sometimes unconsciously, in the ways people treat and perceive Black nurses.”
For the nearly half of surveyed nurses who were trained outside Canada, like de Sousa, barriers to registration in Canada also contributed to poor mental health or feeling helpless to report discrimination during practicum settings.
It’s also difficult always being the first Black person to do something or the only one in the room, said de Sousa. “That’s the importance of mentorship and seeing someone in a leadership position who looks like you and thinking you could be that person.”
This lack of support or promotion for Black nurses impacts patient care as well, particularly for Black patients who may not feel respected or heard by care teams they can’t see themselves in.
“In certain positions of power, if those people are not representing the people for which we care, then we won’t have health-care practice that represents everyone and that caters for everyone and that is taking into consideration every individual,” said de Sousa, “but we will have inequitable health-care policies and certain groups will remain invisible.”
The coalition hopes, like the In Plain Sight report on anti-Indigenous racism in health care, that the survey’s establishment of the extent and impacts of racism can spur action from government and health-care authorities.
In 21 recommendations, the coalition calls for senior officials dedicated to anti-racism work in every health authority, mandatory anti-racism training for all employees and enhanced policies against racism and discrimination in the workplace.
They also want a commitment to hire more Black nurses into leadership positions by 2024, a review of treatment plans and criteria that differ by race, and the establishment of a centre led by Black experts and community-builders to study causes and solutions to health-care inequities for Black people in B.C.
Barriers for internationally trained nurses to practice in B.C. should be removed, and more resources should be made available for immigrant and newcomer physical and mental health care.
“We urge everyone to recognize that while our skin colour is rooted in genetics, our experiences in society are not,” reads the letter. “Our experiences are manifestations of the deeply racist divisive societies we live in .125that.375 we must all work together to dismantle.”