"Hearing Our Voices - Nurse Advocacy In Action"

Michelle Danda PhD(c) RN CPMHN(C), Claire Pitcher MSN RN (C), Jessica Key BSN RN

September 2021

Recently, there has been an increased focus within North American media and society at large on racism in health care. As trusted and ethically-guided professional practitioners, nurses play an essential role in these conversations and thus it is imperative we understand the historical, social, economic and political roots of racism. It is equally important that we engage in anti-racism work, an example of which we will share below.
 

Background to the Issue of Racism in Canada

The concept of race is rooted in 18th and 19th century imperialism where colonizers constructed an understanding of the people who originally inhabited a geographical area as 'other' and 'less than' to justify exploitative colonizing practices such as resource extraction. This was despite the fact that, as stated by Claxton and colleagues¹, "[h]umans are intrinsically similar genetically and thus race is considered to be socially constructed, often by socially dominant groups, to reflect discriminatory or cultural attitudes of superiority". Over the past 4 centuries, this foundation of the process of 'othering' has led to countless iterations of race-based violence, discrimintation and oppression².
 

Canada itself is a settler-colonial state founded on the racist belief of Europeans being superior to Indigenous people and people of colour. Nurses' knowledge of this history is crucial for understanding the current Canadian context, where the Canadian Human Rights Act has offered its citizens legal protection against discrimination including racism since the mid-1980s³. In many ways, this legislation laid the groundwork for Canada’s international reputation as a "multicultural and egalitarian country...free from racism and other forms of discrimination"⁴.
 

Understanding the Connection Between Whiteness and Power

This perception of a "Welcoming Canada", however, exists in stark contrast to the growing body of evidence stating racism both exists within the Canadian health care system and it negatively impacts the health and wellbeing of racialized people ⁵. Race is a social construction, meaning it is a subjective phenomena, interpreted and influenced by the values and beliefs of people. These beliefs, however, translate into very real and objective differences in the health and wellbeing of racialized people living in Canada. Within a culture of white supremacy, perceptions of who is 'white,' and in turn accepted into the dominant group, inherently impacts who has access to cornerstones of our survival such as housing, health care and social support networks. Meanwhile, understandings of whiteness have changed over time because this concept is not defined by any objective measure; rather, the concept of 'whiteness' has subjectively morphed to meet the needs of the dominant group over the past several decades to include and exclude various groups of people⁶. Over the same period of time, authors, scholars and academics have begun to deconstruct ideas of whiteness and its ties to power, social status, and white supremacy⁷. In Canada we pride ourselves on not having the race segregation of the United States, but this in itself is problematic because it silences the covert nature of othering by race.
 

In Canada, the pervasive yet false belief that "racism does not exist here" warrants close attention because this widely embraced narrative of a "welcoming Canada", obscures and silences the reality that racialized people experience poorer health outcomes than non-racialized people across our country. Too often, nurses who experience and witness intersecting forms of oppression, including but not limited to racism, sexism, homophobia, transphobia and classism, are expected to survive within, and whistleblow against, a broken system. It is time for us, as a nursing profession, to actively resist the insulting and dehumanizing questions of whether racism exists in health care, and rectify the ethics of placing the burden of changing the system on those negatively impacted by it.
 

According to Zancheta et al's 2021 article, "the large majority of racist practices result from social relations that go beyond the individual [...to] impregnate daily life until they become banal, invisible and inaudible [...thus] faciliat[ing] tolerance towards racist individuals [while] victims who protest against racism are labelled as paranoid and meddling killjoys" (3). This reality of racism as seemingly invisible to those in power underlies the narrative within health care of the 'always altruistic' nurse who is impervious to experiencing or enacting discrimination and bias. This narrative is front and centre each time a story appears in the media where blatant racism is at play, yet we are subjected to news headlines suggesting otherwise or giving the perpetrators of the racist actions the benefit of the doubt. Too often the only recourse in such stories comes via lengthy and arduous "official processes," such as public inquiries and/or pursuing criminal charges. One of the many harms of this reality lies in having racialized people be repeatedly forced to witness and experience racism within our political, social, economic and government systems while predominantly white leaders have the audacity to question whether racism exists.
 

Taking Action - Using Film In Advocacy

It was within this historical and current socio-political context that the co-authors of this article began to brainstorm how we could disrupt the above described trends. We also reflected on a short-film we had created together in 2019 which focused on the importance of compassion in mental health nursing. In retrospect, we realized that our shared commitment to practicing from a place of compassion as nurses could not be untangled from our commitment to acknowledging intersecting forms of oppression within the healthcare system. With our follow-up film, however, we wanted to situate conversations about compassionate nursing practice within a broader and more systemic context acknowledging that not all people are treated equally in health care.
 

To align with anti-racist practices, it was important for us to secure funding for the film so we could compensate our team and contributors for the time and emotional work of participating in the film. We secured a creative team, a small funding grant and began to work on bringing our idea from concept to reality. We wanted our creative process and film itself to push back against the culture and norms of white supremacy including forces such as urgency, perfectionism, valuing the written word over all else and valuing quantity over quality⁸. Our goals were simple: to show up, work together and do our best to actively decenter whiteness.
 

What Can You Do?

We believe that disrupting the pervasive racism that exists within health care requires action at all levels from the grassroots frontline - through initiatives such as our creation of this film - up to and including formal action at the highest levels of government. As nurses, treading lightly to minimize the discomfort of acknowledging racism in healthcare is no longer an option for us and so, we created this short film. We share it alongside dialogue and a collection of follow-up resources to disrupt the racism we have witnessed and/or experienced. We invite you to watch this film, to engage in dialogue with us about this film via our website, to share it with your colleagues and to help us unite frontline grassroots action with sustained, systems-wide anti-racist action in health care and more specifically within nursing. We invite you to start and continue talking about and working to uproot racism as it shows up in your area of practice.
 

Click here to watch our film.
 

References

• Baldwin, J. (1984). On being white... and other lies. Essence, 14(12), 90-92.
• Browne. "Moving Beyond Description: Closing the Health Equity Gap by Redressing Racism Impacting Indigenous Populations." Social science & medicine 184 23–26.
• Canadian Human Rights Commission. (1985). Canadian Human Rights Act. Ottawa, Ontario: C. Theroux.
• Claxton, N. X., Fong, D., Morrison, F., O'Bonsawin, C., Omatsu, M., Price, J., & Sandhra, S. K. (2021). Challenging Racist" British Columbia": 150 Years and Counting. University of Victoria and the Canadian Centre for Policy Alternatives (BC Office).
• Okun, T. (2021). White supremacy culture - still here. Retrieved from https://www.whitesupremacyculture.info/
• Shiells, G. (2010). Immigration history and whiteness studies: American and Australian approaches compared. History Compass, 8(8), 790-804.
• Zanchetta, M. S., Cognet, M., Rahman, R., Byam, A., Carlier, P., Foubert, C., ... & Espindola, R. F. (2021). Blindness, deafness, silence and invisibility that shields racism in nursing education-practice in multicultural hubs of immigration. Journal of Professional Nursing, 37(2), 467-476.