The time has come to stand together and change the system
By Michelle Danda, Claire Pitcher, & Jessica Key
May 24, 2022
- Nurses have an important role to play in combatting systemic racism in the Canadian health-care system.
- Regular reflective practice is necessary to uncover taken-for-granted policies and practices that are rooted in racism to recognize that racism in health care extends beyond individual overt acts.
- Nurse activism can take many forms, including arts-based projects that are intended to challenge dominant discourse and create a more socially just system.
The nursing profession is built on central values that include compassion, caring, building relationships, and advocacy. Yet racism is pervasive in Canada, including the health-care system. The “nurses as heroes” popular media rhetoric depicts nurses as health-care professionals who can do no wrong, obscuring the role they may play in perpetuating social injustice, such as systemic racism (Garland & Batty, 2021; Mohammed et al., 2021). However, nurses can also be an integral part of the solution.
Nurses hold a prominent place in the health-care system, specifically in positions where there is an opportunity for them to be change agents in acknowledging existing problems with policies and practices that disadvantage and disproportionately negatively impact racialized groups. The impacts of racism are felt in the greater population but also among nurses themselves in the health-care workplace. The time has come for nurses to stand together and take action to change the system.
The Canadian Human Rights Act, passed into law in 1985, rendered discrimination based on national and ethnic origin and colour (essentially meaning race) illegal. Although this legislation has been paramount in protecting many Canadians from the most overt forms of discrimination, it has fallen far short of accomplishing the goal of eliminating racism on either individual or systemic levels. Many Canadians fail to acknowledge the reality that multiple barriers continue to exist for those who identify as Black or Indigenous or who are people of colour in both accessing and receiving optimal health care. Countless examples of racism within our health-care system continue to occur and are increasingly present in public media. Racism is also a pervasive threat to human rights that is documented in the municipal, provincial and federal institutions with which health care regularly interfaces, such as the criminal justice and education systems.
The changing tide
Some nurses may be asking, “Why does it seem as if racism in health care is a hot topic now, but no one ever talked about it before?” Asking this question is an important first step in rethinking the structures of our health-care system. The question encourages us to think about reasons why the issue of racism was not previously discussed openly and challenges us as individuals to understand the ways in which this important topic came to appear in media headlines.
Background to the situation
By many accounts, our profession’s current reckoning with racism reached a pivotal turning point with the widespread media attention following the death of African American George Floyd on May 25, 2020. Floyd, a Black man in Minnesota, was killed by a police officer, who was later convicted of murder in the death, while suspected of having used a counterfeit $20 bill. The police officer kneeled on Floyd’s neck in a move to physically restrain him, which ultimately killed him. Horrifically, this incident likely would not have garnered the attention it did had a bystander not captured it on video. The response — and reckoning — was palpable. Black Lives Matter protests occurred in unprecedented ways and were widely reported in the news. Media headlines and grassroots activists began to scrutinize other deaths of young Black Americans at the hands of police, such as Breonna Taylor, who had been shot in her apartment just two months before Floyd’s death. Although much of this initial action had a strictly American focus, it laid the groundwork for heavier scrutiny of systemic racism in Canada as well.
Overt racism is not absent in Canada, and the public soon became keenly aware of racist acts by those whom it typically trusts the most: nurses and health-care professionals. Within weeks of the police killing of George Floyd in the United States, reports emerged in British Columbia of widespread anti-Indigenous racism in health care. These reports focused on what was dubbed a “Price Is Right” game of guessing Indigenous patients’ blood alcohol levels in emergency department settings. As nurses who work in the areas of mental health and substance use, we began to ask ourselves how such deep-seated practices, behaviours and influential values can change when leaders in the health-care system are reluctant to admit that racism exists.
Shining a light on racism in Canadian health care
As thousands of people rallied on streets across the country protesting systemic racism, reports of this “game” simply could not be ignored. No longer could our leaders rely on false notions and outdated rhetoric about health-care workers’ absolution from racism because of the care and compassion that were thought to underlie the practice of clinicians in the system (Hilario et al., 2021). Staring every health-care worker in the face was the reality that racist behaviours are too often part of the accepted conversation, especially among homogeneous dominant groups, and this fact in and of itself exposed the depth of the problem. As Canadians and as nurses, we must face our own racist history, including that of anti-Indigenous policies and institutions in which nurses actively participated (Laroque et al., 2021).
As Canadians and as nurses, we must face our own racist history.
The time had come to shine a light on what many witness and experience every day — the real and undeniable racism that is pervasive in our health-care system. To address these concerns, British Columbia appointed Mary Ellen Turpel-Lafond to conduct a comprehensive independent review of these allegations (Turpel-Lafond & Johnson, 2021). Out of these findings came the In Plain Sight report, released in November 2020. Out of respect for the nuance and detail contained within the report, we opted not to summarize its findings in this article. Rather, we encourage you to read it now if you have not already. We especially encourage you to read it if you have not heard about racism in health care from racialized patient advocates; if you fall into this group, you may want to consider the reflection questions we posed in our article last week.
Yet another example of seemingly undeniable racism in Canadian health care was the death of Joyce Echaquan in a Quebec hospital in September 2020. Yet again, the toxic and deadly actions of the health-care team — insulting Echaquan and failing to act on her pleas for help — would have undoubtedly gone unacknowledged had she not filmed the incidents as they unfolded (Wylie et al., 2021). Following a public outcry, the Quebec coroner presided over an inquiry into Echaquan’s death and ultimately concluded that she would still be alive today if she were White (Browne, 2021).
Empowering nurses to change the system
It is time for our nursing institutions, such as schools, to embrace an anti-racist curriculum. Educators and leaders can greatly impact the nursing profession by integrating equity-oriented practices in nursing schools. Nursing education should embrace a curriculum that includes the history of our profession and the racist policies and practices that haunt our past, along with how they continue to influence present-day practices (Browne et al., 2021; Laroque et al., 2021). All schools of nursing must work to develop diversity, equity and inclusion committees (Zappas et al., 2021). The action that nurses take must be more than simply checking off a task on a list or adding a supplementary class, but rather an overhaul of the system to include the voices of people who have been silenced (Wylie et al., 2021). Strong action that includes people with lived experience is needed. Their stories need to be told.
A call to action
With these harrowing stories in mind, it is impossible not to ask, “What can we do now to acknowledge, address and eradicate racism in health care?” First and foremost, a strong argument can be made that acknowledging the problem is the first step to addressing and eradicating racism in health care and is ultimately necessary to collectively heal from its impacts. This means knowing the names and stories of people such as George Floyd, Breonna Taylor, Joyce Echaquan, Brian Sinclair, whose deaths made headline news after their interactions with racist institutions. There are many others that have gone unreported. We must also pay attention to the stories of people such as Mona Wang, a UBC Okanagan nursing student whose health crisis was, under British Columbia’s Mental Health Act, responded to by a police officer who put her foot on Wang’s head in a public lobby after a wellness check.
Nurses cannot ignore glaring problems in health-care services that are exacerbated by the social determinants of health, especially services that are deeply entwined with police institutions, which disproportionately negatively impact people who identify as Black or Indigenous or people of colour.
Fighting against systemic racism is not easy, especially in a health-care context deeply impacted by concurrent issues such as the COVID-19 and opiate overdose crises. After the first step of acknowledging systemic racism, the daunting next question is “What now?” As part of the Hearing Our Voices film project, we compiled a non-exhaustive list of actions you may consider adapting to your context to start (or continue!) on your journey to being an anti-racist nurse*:
- Share the short film Hearing Our Voices: De-centering Whiteness in Health Care with your colleagues and invite them to discuss the film as it relates to your work environment.
- Familiarize yourself with anti-racism resources, terminology and history. A list of resources to begin this journey is available on the Hearing Our Voices website.
- Join or start a working group with colleagues focused on addressing racism in health care (these are sometimes called diversity, equity and inclusion groups).
- Commit to listening and acting if you witness racism in your work environment and/or if someone reports a racist incident to you.
- If you are White, commit to learning about racism in ways that amplify and compensate the voices of people who are Black or Indigenous or people of colour. It requires significant mental and emotional labour to teach others about these topics, especially for racialized people, who are forced to exist within and bear the burden of these racist systems in their daily lives. Taking initiative for our own learning by accessing and, where appropriate, paying for the plethora of existing resources about anti-racism helps ensure that we are not perpetuating racist and exploiting structures within our workplaces.
- Familiarize yourself with any statements your employer, union, regulating college, alma mater or other guiding nursing bodies have released on the topic of racism. Where statements have not been released, contact your leadership to advocate for a statement to be made. Examples of existing statements include:
*For information on the term “anti-racist,” please read this discussion from the Alberta Civil Liberties Research Centre.
Browne, A. J. (2021). Written submission May 28, 2021: Quebec coroner’s public inquiry. Vancouver, BC. Retrieved from https://www.faq-qnw.org/wp-content/uploads/2021/05/Dr.-Annette-J.-Browne-Expert-Witness-Written-Submission-May-28-2021.pdf
Browne, A. J., Varcoe, C., & Ward, C. (2021). San’yas Indigenous cultural safety training as an educational intervention: Promoting anti-racism and equity in health systems, policies, and practices. International Indigenous Policy Journal, 12(3), 1-26.
Garland, R., & Batty, M. L. (2021). Moving beyond the rhetoric of social justice in nursing education: Practical guidance for nurse educators committed to anti-racist pedagogical practice. Witness: The Canadian Journal of Critical Nursing Discourse, 3(1), 17-30.
Hilario, C. T., Browne, A. J., & McFadden, A. (2018). The influence of democratic racism in nursing inquiry. Nursing inquiry, 25(1), e12213.
Larocque, C., Foth, T., & Gifford, W. (2021). No more settler tears, no more humanitarian consternation: Recognizing our racist history and present NOW! Witness: The Canadian Journal of Critical Nursing Discourse, 3(1), 7-10.
Mohammed, S., Peter, E., Killackey, T., & Maciver, J. (2021). The “nurse as hero” discourse in the COVID-19 pandemic: A poststructural discourse analysis. International Journal of Nursing Studies, 117, 103887.
Turpel-Lafond, M. E., & Johnson, H. (2021). In plain sight: Addressing Indigenous-specific racism and discrimination in BC health care. BC Studies: The British Columbian Quarterly, (209), 7-17.
Wylie, L., McConkey, S., & Corrado, A. M. (2021). It’s a journey not a check box: Indigenous cultural safety from training to transformation. International Journal of Indigenous Health, 16(1).
Zappas, M., Walton-Moss, B., Sanchez, C., Hildebrand, J. A., & Kirkland, T. (2021). The decolonization of nursing education. The Journal for Nurse Practitioners, 17(2), 225-229.
Michelle Danda, RN, PhD(c), CPMHN(C), graduated from the bachelor of nursing accelerated track program at the University of Calgary in 2008. She currently lives in New Westminster, B.C. She is an informatics nurse in Vancouver, B.C., and practises mental health nursing at Lion’s Gate Hospital in North Vancouver, B.C. She has four beautiful children with her partner, who is also an informatics and mental health nurse. She is a PhD candidate in the doctoral nursing program at the University of Alberta, studying the history of psychiatric nurse education in British Columbia.
Jessica Key, BN, RN, is a citizen of the Musgamakw Dzawada’enuxw Nations as well as a settler of British and Irish origin. She is a registered nurse who currently works as an Indigenous patient care clinician, where her work is focused on increasing adoption of Indigenous cultural safety in acute care settings, anti-racism and decolonization in health care, and supporting and advocating for Indigenous clients and families. She is currently completing a master of science in nursing at the University of British Columbia, and is also a founder and director of Akala Society.
Claire Pitcher, MSN, RN, is a registered nurse with a bachelor of science in nutrition and food science from the University of Alberta (2009), a bachelor of science in nursing (2011) and a master of science in nursing (2017) from the University of British Columbia (UBC). She is also a UBC School of Nursing adjunct faculty member. Claire is a descendant of English and Irish settlers and currently lives on Musqueam, Skwxwú7mesh (Squamish), and Tsleil-Waututh territory. Claire is committed to applying an anti-racist and anti-oppression lens to every aspect of her personal and professional life.