Resources and Publications CRRF Reports Implementing Accountability for Equity and Ending Racial Backlash in Nursing | Implementing Accountability for Equity and Ending Racial Backlash in Nursing |
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Accountability for Systemic Racism Must Be Guaranteed to Uphold Equal Rights in Society and Promote Equity in Health.
Centre for Equity in Health and Society The Centre for Equity in Health and Society (CEHS) is a virtual centre that coordinates a research network of interdisciplinary researchers and advocates for equal access and participation in organizations responsible for health. We recognize that membership in a marginalized group or category poses an additional risk for persons with respect to social and healthy outcomes. Additionally, research suggests that risks increase for persons with compounded risk factors such as race and gender, poverty and disability. We recognize as well that the broad determinants of health (e.g., housing, employment, good access to health services) have a significant impact on members of marginalized groups or individuals of difference. Equity is a determinant of health. Moreover, the nature of marginalization is that barriers exist so that voice, participation, and choice are restricted, which impedes efforts to correct the effects of marginalization and the trauma it produces. CEHS acknowledges the experience of reprisal for trying to counteract marginalization. In collaboration with researchers at George Brown College, Ryerson University, the University of Toronto, and York University, the CEHS research focus is on transformative justice practices, ethnoracial competencies and critical structural analysis for organizational change, and inter-sectoral collaboration. CEHS annually awards leaders who have facilitated accountability for equal access and participation in nursing. The Centre for Equity in Health and Society is an affiliate of the Urban Alliance on Race Relations and consults with health services students, professionals and unions on education, and career development. Executive Summary
“Nursing, like a cappuccino – white on top, brown on the bottom – requires stirring up.”
Resistance to Accountability for Equity in the Health Care SystemIn the context of global migration, the ethnoracial diversity of the nursing profession in Canada is greater today than ever before. The profession's resistance to ensuring equal access and participation for all nurses has been compounded by sporadic under-funding of nursing care. An emerging body of research shows that systemic racism is a serious problem in health care delivery organizations. An anti-racism policy issued by the Joint Provincial Planning Committee of the Ontario Hospital Association and the Ministry of Health (1996) was shelved following the defeat of the New Democratic Party government in Ontario and the rescinding of the Employment Equity Act by the Conservatives. A curriculum plan that Yoshida introduced in 1994 at a prestigious nursing school to include anti-racism content in Canadian nursing education has been steadfastly resisted (Hagey and MacKay, 2000). We present evidence in this report that when accountability is demanded by nurses experiencing systemic racism, the issue of racism is resisted systematically. This participatory action research documents witnesses' accounts of resistance by decision-makers in privileged positions within the health care system. For example, minutes show that in the Northwestern General Hospital case, white nurses were asked what specialty they preferred when they applied, whereas nurses of colour were told there were openings only in long-term care. The result of this unwritten systemic racism policy was racial segregation. Most specialties were staffed by nonracialized nurses, whereas long-term care was almost completely staffed by racialized nurses (Calliste, 1996, 2000b; Ontario Human Rights Commission [OHRC], 1994). Months after the OHRC awarded $320,000 to the complainants of harassment in this case, some executives of that hospital were reported as excusing the events as a problem of "reverse discrimination" instigated by the complainants themselves. This denial of the systemic racism that was publicly exposed reveals persistent resistance to equal access and participation and resistance to the accountability measures that the commission administered. Evidence of the Need for Accountability to Dismantle Systemic Racism The accounts reported in our participatory action research are voluminous and continuing. Even if space permitted exhaustive testimony, we would be bound by concerns for confidentiality and the very real threat of backlash for accountability efforts. Our presentation of evidence is limited to four pieces where we have been able to respect confidentiality and provide some detailed perspectives for readers to understand that systemic racism persists because accountability for it is systematically thwarted. Acknowledging that accountability can occur at individual and organizational levels and be public or private (Henry, Tator, Mattis, and Rees, 1995), we conceptualize accountability as both a privilege and a responsibility that is fundamental in relationships at all levels. We understand systemic racism as the privileges associated with not having to be accountable for racial dominance. That is, racial oppression activates privileges. Through commission and omission in race relations, privileges accrue to members of the dominant groups, and immunity from accountability is upheld by group power. Instances of systemic racism in organizations can be identified and rectified by self-monitoring, peer monitoring, stakeholder monitoring, executive monitoring, and editorial monitoring. Evidence of Nurses Experiencing Racial Profiling Evidence suggests that some nurses experience racial oppression. In other words, race, ethnicity, and colour are felt to have an effect on relations in the workplace. We present previously unpublished findings from a pilot survey that Tania Das Gupta conducted among some participants in our larger study. Of the sixty-two persons who completed the questionnaire, thirty-eight were Black/African Canadian, thirteen identified as Asian or South Asian Canadian, five as White/European Canadian, four as Other, one as Central/South American Canadian and one no response. There were fifty-seven females in the convenience sample, three males, and two who did not specify gender. Participants felt that race, ethnicity, and colour had an effect on relations with patients (39/62); on the hiring of nurses (39/62); on relations with colleagues (38/62); on relations with managers (37/62); on where they were assigned to work (33/62); on access to training (30/62); on performance reviews (21/62); on the experience of being disciplined (15/62); on sick leaves (12/62); and on access to accommodation for disability (3/62). Of the sixty-two nurses who participated, fifty-six said they had been put down, insulted, or degraded as a nurse because of their race, colour, or ethnicity. Of these, thirty-eight said that a patient put them down, thirtytwo said that another nurse had put them down, twenty-four said that a manager had put them down, and nineteen said that a doctor had put them down. Some respondents mentioned more than one offender. Of the fifty-six who had been harassed, forty-seven said they were affected emotionally, twenty-eight mentally, and eighteen physically. Several nurses noted more than one effect. Of those who had been harassed, thirty-three said that they took some action. Of the thirty-three who took action, sixteen had no results or negative results and thirteen had positive results, whereas four had ongoing proceedings. Although these findings were preliminary and their purpose was to assist Dr. Das Gupta in developing her questionnaire for a larger study, we believe they provide evidence that nurses are experiencing racial profiling that calls for accountability. We refer readers to the larger study commissioned by the Ontario Nurses Association (Das Gupta, 2002) that shows that white nurses of European ancestry experience far fewer negative effects of race, colour, or ethnicity than nurses from groups subject to racial profiling. Marshall's (1996) analysis of the 1991 Census data for the health care professions showed that blacks are underrepresented in management positions. Nestel (2000) reported that the 1991 Census indicated that visible minority nurses in Ontario have half the chance of their white counterparts to move into the managerial level. Hagey and MacKay (2000), who studied racialist discourse in a nursing school, found that students were fearful of discussing racism. For example, one student said, "that person may perceive this as a threat and it will come back on you in different ways…" (p. 53). [...] |
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