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.