Interpersonal, institutional, and structural racism in Canadian nursing: A culture of silence

Abstract

Background Alongside declarations against racism, the nursing profession in Canada needs examination of experiences of racism within its ranks. Racism at multiple levels can create a context wherein racialized nurses experience barriers and ongoing marginalization. Purpose This critical interpretive qualitative study asks how interpersonal, institutional, and structural racisms intersect in the professional experiences of racialized nurses in Canada, and how nurses respond. Methods Self-identified racialized nurses (n = 13) from across Canada were recruited primarily through snowball sampling, and each was interviewed by phone or in person. Once transcribed, interviews were analyzed inductively, which led to the levels of racism as a guiding framework. Results From entry to nursing education throughout their careers participants experienced racism from instructors, patients, colleagues and managers. Interpersonal racism included comments and actions from patients, but more significantly lack of support from colleagues and managers, and sometimes overt exclusion. Institutional racism included extra scrutiny, heavier workloads, and absence in leadership roles. Structural racism included prevalent assumptions of incompetence, which were countered through extra work, invisibility and hyper-visibility, and expectations of assimilation. Racialized nurses were left to choose among silence, resisting (often at personal cost), assimilation and/or bolstering their credibility through education or extra work. Building community was a key survival strategy. Conclusions Everyone in nursing needs to challenge the culture of silence regarding racism. White nurses in particular need to welcome discomfort, listen and learn about racism, then speak out to help disrupt its normative status.

“We'd really love to but we're really busy”: Silence, precarity and resistance as structural barriers to anti‐racism in nursing education

“…is perhaps more constructive towards replacing white silence that is complicit with racism with responsibility, accountability, voice, and action. Beagan et al (2022) in their recent work focus on silence as a lived cultural expression of white supremacy and Iheduru‐Anderson and Wahl (2022) on silence as absent discourse resulting from a‐racial or post‐racial nursing discourses. Beagan et al (2022) note that silence can be protective, differently, but for both ROB and RWB people.…”

“…Beagan et al (2022) in their recent work focus on silence as a lived cultural expression of white supremacy and Iheduru‐Anderson and Wahl (2022) on silence as absent discourse resulting from a‐racial or post‐racial nursing discourses. Beagan et al (2022) note that silence can be protective, differently, but for both ROB and RWB people. I lean on Ahmed's (2018) brilliance here in deconstructing the mechanisms of institutional violence that create a culture of silence in her work on complaint.…”

“…However, as Beagan et al (2022) found, it remains necessary to report this demographic data with much less specificity than I hoped, as the protection of my participant's anonymity outweighs all other research interest. A more robust analysis of identity is taken up in a separate manuscript focused on discourse, and not here.…”

“…When the thing that is not supposed to happen is actually a norm, as racism is, "a use is sustained by a fantasy that a use can be suspended" (Ahmed, 2018, p. 21). We can consider the proclaimed 'zero-tolerance' environment, that Beagan et al (2022) also critique. Here, the institution must symbolically produce that absence of use, that they have tolerated nothing, and so it no longer exists.…”

“…My journey towards racial literacy (as an ongoing, non‐linear process) began with explicit and longitudinal anti‐racist education that I sought and received outside of the nursing discipline, exposure to lived experience outside of my own and a personal investment of time. These processes are not embedded in the structure of higher education for educators, and the evidence of racial ignorance in nursing spaces (Beagan et al, 2022; Browne, 2005; Eaker, 2021; Hantke et al, 2022), tensions between the theoretical and lived values of nursing (Bell, 2021a; Collier‐Sewell et al, 2023; Rabelais, 2022; Valderama‐Wallace & Apesoa‐Varano, 2019) and institutional racism in higher education (Henry & Tator, 2009; Rodriguez & Kokka, 2021) foretells of difficulties in applying anti‐racism to nursing education.…”