It happens more often than you might think, says Rebecca M. Wheeler, MA, PhD, RN, clinical instructor at Emory University’s Nell Hodgson Woodruff School of Nursing. She interviewed 82 nurses, ages early 20s to late 60s, at two Atlanta hospitals and found all of them reported they had experienced discriminatory interactions in the hospital or seen it happen to colleagues.
- Forty nurses were educated in the U.S. Half identified as white and half as African-American — and 42 were educated overseas, most in sub-Saharan Africa, Southwest Asia or the Caribbean.
The most common discriminatory encounter involved patients and their families, including derogatory comments and questions, assumptions about the nurse’s role, and rejecting care because of the nurse’s skin color or accent. Foreign-educated nurses — who represent up to 16 percent of the U.S. nursing workforce — reported more explicit discrimination, saying they were routinely questioned by patients or their families about where they’re from, their nursing credentials and how long they had been in the United States.
“What was sad was it seemed like most nurses just took it,” says Wheeler, lead author of “The Experience of Discrimination by U.S. and Internationally Educated Nurses in Hospital Practice in the U.S.A.” Her findings were recently published in the “Journal of Advanced Nursing.”
What this means to employers
Discrimination can inflict serious psychological harm, causing anxiety, fear, insecurity, alienation, self-esteem loss and depression. Employers should be concerned about nurse retention, quality of patient care and also the potential for lawsuits and negative publicity.
Patients’ racial preferences pose a dilemma for hospitals that want to balance patient rights with maintaining professional standards and civil rights.
“When you’re a patient sitting in a bed, you have very limited control, and inflicting your prejudices is one thing you can control,” explains Mary Lou de Leon Siantz, PhD, RN, FAAN, professor at the Betty Irene Moore School of Nursing at UC Davis Health System in Sacramento and a founding member and past president of the National Association of Hispanic Nurses.
“What’s not acceptable is ignoring the situation and not accepting the reality that these prejudices still exist.”
Hospitals need to develop a blueprint for diversity, de Leon Siantz says, adding that if a patient or their family were to refuse treatment by a nurse because of racial preference, the hospital needs to initiate a discussion with them about its colorblind policy.
But only a few nurses Wheeler interviewed reported having a supervisor who confronted a patient or family member after a discriminatory encounter.
“The nurses who told me about these supervisors just loved them. You could tell talking to them that it made them so happy to have a supervisor who backed them up like that,” Wheeler says.
More than likely, supervisors did not know how to respond, suggesting most hospitals fail to provide adequate training, Wheeler adds.
Wheeler says the nurses in her study who coped most successfully with discrimination were those who confronted the situation.
How to address the situation
So what should a nurse do when a patient makes a demeaning racial remark or insult?
De Leon Siantz says: “My first thought is to say, ‘I really understand that this is a very stressful time in your life and that you are very unhappy with the fact that I’m taking care of you, but I’m the one who is here to support you in any way I can.’” Another statement might be ‘I can also ask my supervisor to come and help you think that through, but right now I need to do such and such, because this is going to help protect your life,’ suggests de Leon Siantz.
Wheeler’s study calls for conflict resolution and cultural sensitivity training for all nurses, especially those in supervisory positions to improve professional relationships and relationships with patients and their families.
Written by Janine Weisman