“Just Throw It Behind You and Just Keep Going”: Emotional Labor when Ethnic Minority Healthcare Staff Encounter Racism in Healthcare

Abstract

Encountering racism is burdensome and meeting it in a healthcare setting is no exception. This paper is part of a larger study that focused on understanding and addressing racism in healthcare in Sweden. In the paper, we draw on interviews with 12 ethnic minority healthcare staff who described how they managed emotional labor in their encounters with racism at their workplace. Data were analyzed using thematic analysis. The analysis revealed that experienced emotional labor arises from two main reasons. The first is the concern and fear that ethnic minority healthcare staff have of adverse consequences for their employment should they be seen engaged in discussing racism. The second concerns the ethical dilemmas when taking care of racist patients since healthcare staff are bound by a duty of providing equal care for all patients as expressed in healthcare institutional regulations. Strategies to manage emotional labor described by the staff include working harder to prove their competence and faking, blocking or hiding their emotions when they encounter racism. The emotional labor implied by these strategies could be intense or traumatizing as indicated by some staff members, and can therefore have negative effects on health. Given that discussions around racism are silenced, it is paramount to create space where racism can be safely discussed and to develop a safe healthcare environment for the benefit of staff and patients.

‘You are Still a Guest in This Country!’: Understanding Racism through the Concepts of Hospitality and Hostility in Healthcare Encounters in Sweden

“…Racialized professionals' and trainees' experience of being deprioritized, over-looked and subject to overt racist abuse was commonplace and often interpreted as a lack of basic rights to be treated equally and to have qualifications, whether gained in Sweden or elsewhere, recognized. Some staff noted the emotional labour incurred by racism (Ahlberg et al, 2022), confirming earlier analyses (Evans and Moore, 2015), while others denied that discrimination was harmful to them, insisting that they could rise above it. The contested nature of gendered and racialized professional, ethnic and national identities is analysed here.…”

“…The lack of hospitality, in terms of welcoming strangers into clinical space, may be justified in terms of clinical priorities such as infection control and the protection of vulnerable patients. The association of medicine with the natural sciences means that clinical practice contributes to the reproduction of race as an absent presence (M’charek et al, 2014) and understanding hospitals as formerly exclusively White institutions contributes to making sense of the emotional labour (Ahlberg et al, 2022) that disproportionately burdens people of colour (Evans and Moore, 2015); emotional labour that is both gendered and racialized (Cottingham et al, 2018; Essed and Trienekens, 2008; Van Riemsdijk, 2010).…”

Discussing racism in healthcare: A qualitative study of reflections by graduate nursing students

“…Implicit racial bias is associated with inequalities in treatment choices in regard to pain management, maternal care, diabetes care, end of life care and other treatment choices (Hamed et al, 2022 ). Ethnic minority staff also experience racism from both patients and other staff (Fowler, 2020 ; Stevens et al, 2012 ) and report lack of organizational support and space to discuss racism which results in stress and emotional depletion (Ahlberg et al, 2022 ).…”

The Liberal Social Values of Swedish Healthcare Providers in Women’s Healthcare: Implications for Clinical Encounters in a Diversified Sexual and Reproductive Healthcare

“…Previous studies have shown that the dilemma of gender equality and cultural diversity in Swedish healthcare encounters involves tensions between the values of cultural and religious diversity and liberal, individualistic values on sexual and reproductive rights matters [ 6 , 7 ]. By investigating values at the intersection of the individual, professional and policy levels, this study also contributes to research on structural asymmetries in healthcare access in Sweden and other European countries [ 8 ]. For example, qualitative studies have found indications of ethnic minority healthcare staff and healthcare users experiencing racism in Swedish healthcare [ 8 ].…”

“…By investigating values at the intersection of the individual, professional and policy levels, this study also contributes to research on structural asymmetries in healthcare access in Sweden and other European countries [ 8 ]. For example, qualitative studies have found indications of ethnic minority healthcare staff and healthcare users experiencing racism in Swedish healthcare [ 8 ]. In multicultural consultations in women’s healthcare, HCPs’ awareness of their own values and patients’ values is of great importance for successful consultations by preventing misunderstandings and thus suboptimal care [ 6 , 9 , 10 ].…”