Is There Racial Tension Among Your Staff?
By Gary Evans, Medical Writer
As the pandemic unfolded, it became clear people of color were suffering healthcare inequities, the inhumanities of the past like the Tuskegee Experiment were revisited, and some hospitals began to address unequal treatment for the same conditions among white and Black patients.
There was only one problem: The call was coming from inside the house. A sweeping survey on racism by the Robert Wood Johnson Foundation (RWJF) yielded some damning findings about nurse-to-nurse racism.1
A staggering 72% of Black nurses reported experiencing racial discrimination from their own nurse colleagues. The patient level was higher at 88%, but racial incidents involving so many colleagues is disturbing, considering nurses are perennially voted the “most trusted” profession. Still, this is a profession with a reputation so notorious for bullying colleagues that the phrase “nurses eat their young” remains in the lexicon.
Overall, 65% of Asian nurses experienced racism from colleagues, with a frequent trope in another study revealing humor or blame in the rise of SARS-CoV-2 in China.
“Long before the pandemic, the Asian population in the United States had been viewed and treated as the physical embodiment of foreignness and disease, and this stigma does not disappear because you are a medical worker wearing a white coat,” the author reported. “Asian healthcare workers have experienced racism during the COVID-19 pandemic, including from the medical community, with potentially long-term consequences for those affected. These [incidents] may be an anonymous comment in an online physician forum, a careless statement recorded in an academic interview, an ignorant joke told by some hospital workers passing by, or even an unconscious act of a colleague.”2
These sometimes-offhand remarks can inflict lasting damage and affect mental health. The authors of another study who interviewed nurses said they reported wide-ranging experiences, from insensitive joking to overt exclusion.
“Participants reported a variety of responses, including emotional reactions such as shock, fear of retaliation, and frustration at being expected to represent one’s identity group,” the authors wrote. “Although the encounters themselves were fleeting, their impact was enduring. Early-career encounters were most challenging, and participants grappled internally with lasting effects for years.”3
In the RWJ survey, 57% of Latino/Hispanic nurses reported racism from colleagues. In a somewhat surprising finding, 48% of white nurses said they were subjected to racial discrimination by co-workers. The RWJF report authors did investigate the latter finding, but a separate study found this in taking a closer look:
“Non-Hispanic white healthcare workers suggested that they faced discrimination due to the recent racial justice movement,” the authors found. A female, white nurse said, “In general, the current racial awareness movement has portrayed white people as racists and have been also held responsible for racial injustices that have happened in the very distant past.”4
Overall, in the RWJF survey, 59% of nurses of all races reported experiencing racial discrimination from colleagues. Black nurses reported the most troubling findings, including:
- 15% called slurs or insulted by a supervisor or boss;
- 27% called slurs or insulted by a co-worker;
- 35% experienced humiliation in front of others at work;
- 34% were threatened or harassed at work.
Nine out of 10 nurses who witness or experienced racism or discrimination in the workplace said it has affected their mental health and well-being.
Asked about the findings, RWJF spokeswoman Beth Toner, RN, said, “[As nurses], we must hold ourselves accountable for our own behavior.” Based on the survey findings, there is a lot of accountability — or lack thereof — to go around, some of it going back to nursing school.
“Nurses say there was a culture of racism/discrimination in their nursing school and that more training/education is needed,” the RWJF report authors noted. “More than half of nurses say that their nursing school taught about racially/ethnically sensitive bedside manner, [but] less than one-third were taught about racial bias/stereotypes or systemic racism in healthcare.”
The American Association of Colleges of Nursing conceded this point, saying, “A lack of minority nurse educators may send a signal to potential students that nursing does not value diversity or offer career ladder opportunities to advance through the profession. Students looking for academic role models to encourage and enrich their learning may be frustrated in their attempts to find mentors and a community of support.”5
To cite a common example, microaggressions often come in the form of a “left-handed compliment” that seems to praise the recipient but carry an embedded insult. For example, telling someone of color “You are so articulate” carries the implicit message the people like them are not usually so well-spoken.
In the RWJF survey, Asian, Black, and Latino/Hispanic nurses were significantly more likely than Caucasian nurses to have seen or experienced microaggressions. Nearly half (47%) of nurses said the microaggressions were committed by colleagues.
Overall, 65% of Black nurses, 53% of Asian nurses, and 44% of Latino/Hispanic nurses said they experienced or saw microaggressions. Yet, much as we have seen with reporting of violence, only 23% of nurses report racial incidents of any variety.
The authors of another report talked to a male nurse who was Black and Hispanic. He often was mistaken for an environmental services worker. As to reporting such incidents, he said bluntly, “Forget about it. They will just fire you.”6
The RWJF surveyed 980 nurses nationwide from March 23, 2022, to April 7, 2022.
“A majority of nurses (85%) say hiring ethnically and racially diverse nurses is an organizational priority, and most agree hiring practices would improve the ability to recruit and retain racially and ethnically diverse nurses,” the authors concluded. “Eight in 10 nurses say zero-tolerance workplace discrimination policies, clear consequences, and reporting anonymity would improve nurses’ workplaces’ ability to retain racially and ethnically diverse nurses.”
REFERENCES
- Robert Wood Johnson Foundation. Insights into nurses’ experiences and perceptions of discrimination. May 2023.
- Wu JH. Asian healthcare workers in the COVID-19 pandemic: A long road to recovery. Nat Med 2021;27:1135.
- Saadi A, Taleghani S, Dillard A, et al. Original research: Nurses’ experiences with racial, ethnic, cultural, and religious discrimination in the workplace: A qualitative study. Am J Nurs 2023;123:24-34.
- Hennein R, Tineo P, Bonumwezi J, et al. “They wanted to talk to a ‘real doctor’”: Predictors, perpetrators, and experiences of racial and ethnic discrimination among healthcare workers. J Gen Intern Med 2022;37:1475-1483.
- American Association of Colleges of Nursing. Fact sheet: Enhancing diversity in the nursing workforce. Last updated April 23, 2023.
- McFarling UL. ‘A target on my back’: New survey shows racism is a huge problem in nursing. Stat. May 31, 2023.
A sweeping survey on racism by the Robert Wood Johnson Foundation yielded some damning findings about nurse-to-nurse racism. A staggering 72% of Black nurses reported experiencing racial discrimination from their own nurse colleagues. The patient level was higher at 88%, but racial incidents involving so many colleagues is disturbing, considering nurses are perennially voted the “most trusted” profession.
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