Chapter 4: Anti-Racism and Nursing Communication
Anti-Racist Communication in the Healthcare Environment
As healthcare providers, we have made a collective commitment to promote health and well-being and to do no harm. However, Black and other racialized individuals can have exceptionally distressing experiences of racism as they access and/or work in the healthcare system (Czyzewski, 2011; McGibbon, 2009).
As healthcare providers and users, we all have preconceived ideas and perspectives about the world based on our own lived experiences, thoughts, and beliefs, which can negatively affect our interactions with others (Trepagnier, 2001, p. 145). We all need to take practical steps to become anti-racist and to foster an anti-racist environment (Ivey-Colson & Turner, 2020).
The process of becoming anti-racist requires constant awareness about how you communicate –verbally and non-verbally, including written communication. Think about the words you use and the actions you take. Earlier, we discussed the power of words – silence is equally important. Your silence or inaction says something to others, whether they are your patients, families, or interprofessional team members (Obasi, 2020).
During communications with others, you should also be aware of power differentials. Consider the power relations between you and patients, families, and community, as well as between you and colleagues, educators, and managers. Power differences emerge across ages, cultures, geographical locations, gender, and sexual and racial identities, and these can intersect with the experiences of individuals (see Chapter 1 on intersectionality). People in leadership positions have power: because their actions can have deep and lasting effects, they must be aware of their own biases and racism.
Racism may not always be overt. It is often covert, and you may struggle when finding ways to address it, especially in professional spaces. Fears of being targeted as a problem at work might make you want to remain silent and unobtrusive, but our nursing practice standards require us to protect the health and safety of those for whom you care and interact with (Boakye et al., 2024; College of Nurses of Ontario, 2019).
Let’s explore some examples of explicit racism, microaggressions, actions, and inactions that reinforce racism in the clinical setting. How might you navigate communication with others when addressing this kind of racism in a clinical setting?
Scenarios
Think about the following three scenarios. What would you do? It would be easy to remain silent, but if you don’t speak up, the racist and toxic environment will remain unchanged. How could you advocate for these patients? It is your duty as a health professional to dismantle racism and foster an anti-racist environment.
- A 16-year-old Black boy, wearing baggy pants and a hoodie, comes to the hospital in severe pain with his mother, a single parent. He is admitted to the adult unit where you are working. You overhear some colleagues making comments like, “I’ve seen his kind before. He is asking for morphine. I bet he’s on drugs. That’s why he is asking for morphine. Let’s assess him after we finish seeing our other patients.”
- A woman who is a Muslim attends her obstetrical appointment with her husband. She is wearing a hijab (head covering). Your nurse colleague asks you to distract the woman’s husband so she can ask her about her home situation and if there is any domestic violence. Your colleague is convinced that the patient must be hiding bruises behind her hijab.
- You are in a team meeting. The manager addresses a complaint by a patient’s family claiming that their Jamaican mother is being ignored because she speaks , while the other patient in the bed next to their mother has an interpreter. Suddenly, the assigned nurse complains, “Why doesn’t she just speak proper English? I don’t understand a word she is saying!” Others agree and another says, “She’s living in Canada now. Why can’t these people learn to speak English? When in Canada, do what Canadians do!” Everyone agrees.
As a nurse, you are responsible for speaking up and finding ways to address racism. Have the difficult conversations. A few ways to engage in critical allyship include petitioning for informative anti-racism workshops, educational resources, and courses. Many organizations, including the Canadian Nurses Association (CNA), College of Nurses of Ontario (CNO), Registered Nurses’ Association of Ontario (RNAO), and the Canadian Public Health Association (CPHA), are already working to address anti-racism and specifically anti-Black racism. Racism is a safety concern, and your involvement can support their work in dismantling racism within our healthcare system.
References
Boakye, P., Prendergast, N. (2024) .“There is nothing to protect us from dying”: Black Women’s Perceived Sense of Safety Accessing Pregnancy and Intrapartum Care. Nursing Inquiry. https://doi.org/10.1111/nin.12638.
Campbell, J. (2007). Parallel space but disparate usage: Negotiating language use in a bilingual society. Caribbean Quarterly, 53(1-2), 95–103. https://doi.org/10.1080/00086495.2007.11672309
College of Nurses of Ontario (2019). Practice standard: Code of conduct. https://www.cno.org/globalassets/docs/prac/49040_code-of-conduct.pdf
Czyzewski, K. (2011). Colonialism as a broader social determinant of health. International Indigenous Policy Journal, 2(1), 5. https://doi.org/10.18584/iipj.2011.2.1.5
Hassen, N., Lofters, A., Sinit, M., Mall, A., Pinto, A. D., & Rackal, J. (2021). Implementing anti-racism interventions in healthcare settings: A scoping review. International Journal of Environmental Research and Public Health, 18(6), 2993. https://doi.org/10.3390/ijerph18062993
Ivey-Colson, K., & Turner, L. (2020, September 8). 10 keys to everyday anti-racism: The founders of a new organization, the AntiRacist Table, suggest tools you can use to work against prejudice and inequality. Greater Good Magazine. https://greatergood.berkeley.edu/article/item/ten_keys_to_everyday_anti_racism.
McGibbon, E. A. (2009). Anti-racist health care practice. Canadian Scholars’ Press.
Obasi, C. (2020, June 5). Silent racism: Why not speaking up becomes lethal for the collective. Harper’s Bazaar. https://www.harpersbazaar.com/uk/culture/culture-news/a32769018/silent-racism-george-floyd/.
Trepagnier, B. (2001). Deconstructing categories: The exposure of silent racism. Symbolic Interaction, 24(2), 141–163. https://doi.org/10.1525/si.2001.24.2.141
Jamaican Patois is an English-based dialect that is influenced by the Ghanaian language. It is often referred to as broken English, and considered as lower class by white society, but the slaves used Jamaican patois to preserve their African identity (Campbell, 2007)
