Tackling discrimination and systemic racism in academic and workplace settings

An integrative review of racism in nursing to inform anti-racist nursing praxis in Aotearoa New Zealand

AIM

To synthesise international literature to identify mechanisms that maintain racism in nursing and understand the factors that contribute to designing and implementing anti-racist praxis to inform nursing in Aotearoa New Zealand.

DESIGN

An integrative literature review was undertaken, integrating Indigenous Kaupapa Māori methodologies to ensure a cultural and philosophical lens.

METHODS

Peer-reviewed literature published, between January 2011 and July 2023 were sourced. Of 1296 articles, 16 met the inclusion criteria and 4 were identified via citation chaining. In total, 20 articles were included. The Johns Hopkins Research Evidence Tool was applied, findings extracted, and thematic analysis completed utilising Indigenous Kaupapa Māori principles.

DATA SOURCES

Databases, including CINAHL, Scopus, PubMed and Aus/NZ Reference Centre, were searched in July 2023.

RESULTS

Two key themes were identified: (1) colonial active resistance to change; and (2) transformational, visionary, and proactive nursing.

CONCLUSION

Nurses are well-positioned to confront the structures that maintain racism in health and education systems but are often actors in maintaining status quo. Anti-racist praxis can be a mechanism for nurses to reimagine, redefine and transform nursing care, leadership, and nursing education to begin to eradicate racism.

REPORTING METHOD

This integrative review adhered to the 2020 Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) method.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

IMPLICATIONS FOR THE PROFESSION

Racism remains prevalent in nursing and the healthcare system. It is necessary to implement anti-racist praxis and policies that resist, deconstruct, and dismantle power and racism while validating Indigenous values, beliefs and practices. This is vital to deliver equitable health care.

IMPACT

This integrative review presents lived realities and knowledge of Indigenous and racially minoritised nurses and scholars, alongside nursing allies to inform anti-racist praxis. This evidence signifies that it is time to walk the walk to challenge the colonising systems and processes that hold racism in place.

Affirmative action and employment equity in the professions: Backlash fueled by individualism and meritocracy

In the 40 years since federal employment equity initiatives were launched in Canada, they have faced persistent backlash. This backlash is grounded in and fueled by conceptualizations of justice and equality that are rooted in ideologies of individualism and meritocracy. Here we draw on 140 qualitative interviews with members of six professions from across Canada, who self-identify as Indigenous, Black or racialized, ethnic minority, disabled, 2SLGBTQ+, and/or from working-class origins, to explore tensions between concepts of justice grounded in group-based oppressions and those grounded in individual egalitarianism. Though affirmative action and employment equity opened up opportunities, people were still left to fight for individual rights. This push to individualism was intensified by persistent hostile misperceptions that people are less qualified and in receipt of 'unfair advantages.' Through discursive misdirection, potential for transformative institutional change is undermined by liberal discourses of individualism and meritocracy.

Factors influencing job satisfaction and professional competencies in clinical practice among internationally educated nurses during the migration journey: A mixed-methods systematic review

BACKGROUND

The increasing migration of internationally educated nurses (IENs) from developing to developed countries highlights the importance of implementing integration strategies that facilitate their workplace transition, leading to improved job satisfaction and professional competence.

AIM

The mixed-methods systematic review aimed to synthesise the current literature on factors influencing job satisfaction and professional competencies among IENs throughout their transition process, including the pre-migration, migration, and post-migration periods.

METHODS

This study conducted a mixed-methods systematic review from 2013 to 2023, using the CINAHL, Scopus, and PubMed databases and employing a Population, Interventions, Comparisons, Outcomes (PICO) framework. Quality assessment employed the Mixed Methods Appraisal Tool (MMAT), and data analysis followed a convergent parallel design. Data synthesis was presented narratively, and the literature review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

Out of 565 articles, eleven studies (eight qualitative, two quantitative, and one mixed-method) met the inclusion criteria. Three key themes that influenced job satisfaction and professional competencies among IENs were identified: pre-migration and pre-deployment demands, challenges in workplace integration, and post-migration career challenges and retention strategies.

LIMITATIONS

The study primarily focused on IENs recruited from developing countries, potentially limiting the generalisability of the findings to IENs from other regions or countries. Furthermore, the inclusion of nurses from developed countries who also migrated was limited in the available studies, which further restricts the applicability of the research findings.

CONCLUSIONS

It is essential to reconsider the pre-migration language requirements and evaluate the feasibility of completing them during the integration period to enhance the job satisfaction and professional competencies of IENs. Additionally, key factors for improving job satisfaction among IENs include providing personalised support, addressing managerial barriers, facilitating career advancement, efficiently managing workloads, and promoting effective communication within the healthcare team.

Applying intersectionality to address inequalities in nursing education

AIM

The aim of this paper is to discuss the significance of the intersectionality framework for addressing prejudices, racism and inequalities in nursing education and clinical learning environments.

BACKGROUND

Discrimination and racism against nursing students and educators based on their gender, ethnicity, race and social identities is well-documented in the nursing literature. Despite documented discrimination and incivility based on intersectional factors, it is reported that often nurse educators show limited interest in the culture, diverse experiences and values of nursing students with culturally and linguistically diverse backgrounds.

DESIGN

Discussion paper METHODS: The discussion was based on contemporary literature about intersectionality, discrimination and racism in nursing. We completed a cursory search of literature in nursing education journal and selected nursing and health science databases. This was not a formal literature review. Using a fictional example, the application of intersectionality to address inequalities in educational settings is illustrated.

RESULTS

Intersectionality is an invaluable tool for examining interwoven power relations and power struggles arising from racial, gender, ethnic, religious and sexuality and disability-related differences. Nurse educators, students and leaders should be more cognizant of their preconceived views, sociocultural stereotypes and varied forms of sociocultural oppression affecting their interactions with each other in clinical learning environments.

CONCLUSIONS

Incorporating intersectionality can address prejudices, racism and inequalities arising due to sociocultural, ethnic, power-related and intergenerational issues among educators, students and other personnel involved in creating clinical learning environments.

Anti-Black racism: Gaining insight into the experiences of Black nurses in Canada

The call to address anti-Black racism in workplaces resonates across several organizations and institutions in Canada. But specifically, the coronavirus disease 2019 pandemic shed further light on how health inequities negatively impact the Black community. After conducting a literature review of the experiences of Black nurses in Canada, a deeper understanding of their plight was gained. In healthcare, the findings from the Black Nurses' Task Force report conclude that anti-Black racist practices are pervasive in nursing, and there remains a paucity of research in this area. This study builds off the report by exploring how Black nurses experience anti-Black racism while working in Canada's healthcare system. Inspired by critical race theory and Black feminist thought, an exploratory qualitative research study was conducted, using semistructured interviews to gather data. The study concludes that Black nurses experience anti-Black racism within the workplace, and it manifests itself through some of the attitudes of colleagues, patients, and nurses in leadership roles. Despite policies and statements that were in place to protect them, anti-Black racism continues to occur systematically. The findings point to the need for change in the overall workplace culture, which includes a fair representation of Black nurses in leadership roles, further research to identify best practices for tackling anti-Black racism within Canada's healthcare system, and mandatory training on anti-Black racism for healthcare leaders, educators, and service providers.

"Let's Call a Spade a Spade. My Barrier is Being a Black Student": Challenges for Black Undergraduate Nursing Students in a Western Canadian Province

BACKGROUND

We need more understanding of experiences that hinder or promote equity, diversity, and inclusion of Black students in undergraduate nursing programs to better inform their retention and success.

PURPOSE

To explore documented experiences of Black undergraduate nursing students, review barriers affecting their retention and success, and suggest evidence-based strategies to mitigate barriers that influence their well-being.

METHODS

We used a focused qualitative ethnography for recruiting Black former and current students (N = 18) in a Western Canadian province's undergraduate nursing programs via purposive and snowball sampling. Most participants were female, 34 years or younger, with over 50% currently in a nursing program. Five participants later attended a focus group to further validate the findings from the individual interviews. Descriptive statistics were used to describe participant characteristics; we applied a collaborative constant comparison and thematic analysis approach to their narratives.

RESULTS

Challenges influencing Black students' retention and success fell into four main interrelated subthemes: disengaging and hostile learning environments, systemic institutional and program barriers, navigation of personal struggles in disempowering learning environments, and recommendations to improve the delivery of nursing programs. Participants also recommended ways to improve diversity and mitigate these barriers, such as nursing programs offering anti-oppression courses, platforms for safe/healthy dialogue, and more culturally sensitive learning-centered programs and responsive supports.

CONCLUSIONS

The study findings underscore the need for research to better define nursing program conditions that nurture safe, learning-centred environments for Black students. A rethink of non-discriminatory, healthy learning-teaching engagements of Black students and the mitigation of anti-Black racism can best position institutions to promote equity, diversity, and inclusion of Black students.

Linguistic racism towards internationally educated nurses in Finland: Critical reflective analysis

BACKGROUND

The shortage of nurses in Finland has prompted the recruitment of Internationally Educated Nurses (IENs) from developing countries mostly with fragile health systems. However, linguistic racism has emerged as a growing threat to the safety and well-being of IENs in the country.

AIM

To discuss the consequences of linguistic racism directed towards IENs and to propose solutions to address this issue.

METHOD

This discussion employed self-reflection as a means of engaging in critically reflective analysis.

DISCUSSION

The discussion highlighted the factors contributing to linguistic racism, including poor language proficiency, misrepresentation of the nursing profession due to skin color, and political tensions. The phenomenon of linguistic racism affects IENs' communication with patients and colleagues and has a detrimental impact on the mental health and overall health of IENs.

CONCLUSION

To address the issue of linguistic racism, this discussion proposed a comprehensive strategy that includes anti-racism training for healthcare personnel, the establishment of a conducive workplace culture that fosters diversity and inclusivity, and the provision of adequate assistance and support for IENs.

COVID-19 pandemic in long-term care: An international perspective for policy considerations

This paper identifies key factors rooted in the systemic failings of the long-term care sector amongst four high income countries during the COVID-19 pandemic. The goal is to offer practice and policy solutions to prevent future tragedies. Based on data from Australia, Canada, Spain and the United States, the findings support evidence-based recommendations at macro, meso and micro levels of practice and policy intervention. Key macro recommendations include improving funding, transparency, accountability and health system integration; and promoting not-for-profit and government-run long-term care facilities. The meso recommendation involves moving from warehouses to “green houses.” The micro recommendations emphasize mandating recommended staffing levels and skill mix; providing infection prevention and control training; establishing well-being and mental health supports for residents and staff; building evidence-based practice cultures; ensuring ongoing education for staff and nursing students; and fully integrating care partners, such as families or friends, into the healthcare team. Enacting these recommendations will improve residents' safety and quality of life; families’ peace of mind; and staff retention and work satisfaction.

American Academy of Nursing consensus recommendations to advance system level change for nurse well-being

The COVID-19 pandemic has required close examination of workforce-related stressors that over decades have contributed to widespread burnout, negative health outcomes, including mental health outcomes, and the loss of the well-educated professionals who are the future of the nursing profession. In the United States and globally, evidence points to factors known to diminish well-being, including inequities, issues of minority status, persistent discrimination, and demanding work environments. The American Academy of Nursing (AAN), dedicated to organizational excellence, nursing leadership and evidence-based policy, develops statements reflecting its mission and those of its nursing affiliates and corporate member, The American Nurses Association. Within nursing, despite the efforts of its members toward advancement, professional fulfillment is often constrained by the systems in which nurses practice and workplace factors over which they have little control. Action by key organizations to initiate changes at systems levels in workplace safety, to increase professional mobility, and propel policies that increase access to health care resources could improve nurse well-being. This paper proposes recommendations from the AAN Expert Panels on Building Health Care System Excellence, Psychiatric Mental Health and Substance Use, and Global Health Expert Panels for the American Academy of Nursing to leverage related policy in the arenas of government and professional/healthcare organizations. Transforming health care work environments and advancing nurse well-being and equity can be accomplished through key, innovative policy changes. These will be achieved through collaboration among associations, organizations, nonprofit groups, and with the public and the media.

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

AIM

The aim is to illustrate and analyse reflections from graduate nursing students over their experience of discussing racism in healthcare in an educational intervention.

DESIGN

A qualitative, descriptive design was adopted.

METHODS

Data were collected through written reflections and analysed through content analysis. In total, 81 students participated in the intervention; 39 paediatric and 42 public health care nursing students. Of those, 27 participants gave consent to have their written reflections included in the study.

RESULTS

Three main categories were developed in the content analysis of student reflections: (a) the implicit embeddedness of racism in healthcare organization; (b) the effect of racism on interactions with patients; and (c) a growing awareness of one's own understanding of racism. This study indicates that student nurses discussed racism as relevant to understanding good clinical practice for the benefit of patients and work-based wellbeing of staff. This recognition of the organizational nature of racism warrants nursing leaders and managers to include racism as a social determinant of health in the undergraduate and graduate curricula to educate the next generation of nursing about racism.

"You have to strive very hard to prove yourself": experiences of Black nursing students in a Western Canadian province

OBJECTIVES

This study explored the experiences of Black students in two western Canadian undergraduate nursing programs.

METHODS

Using a qualitative focused ethnography design grounded in critical race theory and intersectionality, participants were recruited using purposive and snowball sampling. Data were collected through individual interviews, and a follow-up focus group. Data were analyzed using collaborative-thematic analysis team approaches.

RESULTS

n=18 current and former students participated. Five themes emerged: systemic racism in nursing, precarious immigrant context, mental health/well-being concerns, coping mechanisms, and suggestions for improvement.

CONCLUSIONS

An improved understanding of Black student experiences can inform their recruitment and retention. Supporting Black students' success can potentially improve equity, diversity, and inclusivity in nursing education programs and/or their representation in the Canadian nursing workforce.

IMPLICATIONS FOR AN INTERNATIONAL AUDIENCE

The presence of a diverse nursing profession is imperative to meet the needs to provide more quality and culturally competent services to diverse population.

Investing in Canada’s nursing workforce post-pandemic: A call to action

Nurses represent the highest proportion of healthcare workers globally and have played a vital role during the COVID-19 pandemic. The pandemic has shed light on multiple vulnerabilities that have impacted the nursing workforce including critical levels of staffing shortages in Canada. A review sponsored by the Royal Society of Canada investigated the impact of the pandemic on the nursing workforce in Canada to inform planning and implementation of sustainable nursing workforce strategies. The review methods included a trend analysis of peer-reviewed articles, a jurisdictional scan of policies and strategies, analyses of published surveys and interviews of nurses in Canada, and a targeted case study from Nova Scotia and Saskatchewan. Findings from the review have identified longstanding and COVID-specific impacts, gaps, and opportunities to strengthen the nursing workforce. These findings were integrated with expert perspectives from national nursing leaders involved in guiding the review to arrive at recommendations and actions that are presented in this policy brief. The findings and recommendations from this policy brief are meant to inform a national and sustained focus on retention and recruitment efforts in Canada.