“You’re treating me this way because I’m black,” shouted the woman. “You’re just another racist nurse!”
The daughter of a patient to me. One of the less appealing aspects of my job as Charge Nurse is dealing with patient complaints. When I heard the commotion out at Triage, I automatically went out to the front to see if I could resolve the problem. It was, I thought at the time, a more-or-less standard concern about the wait times: the patient had come in because of fairly severe abdominal pain, and her daughter thought her mother was not receiving appropriate treatment. I reviewed the chart to assure myself we had done everything for the patient we could at this point, in particular ensuring her CTAS score was correct* and that we had begun blood and urine tests. Further, I had the triage nurse reassess the patient: vital signs were stable, and she did not now seem to be in any particular distress, even by her own admission. And the more immediate problem for me: the ED was packed and there was literally not a stretcher to be had, even if I thought the patient needed a bed immediately. It was when I discussed all of this with the daughter of the patient she accused me of racism.
I’ve been called racist before, always in the context of patient and family perceiving their care is substandard because of their race. For nurses, it’s an accusation which adds a layer of complexity to care. In the first place, for me, and many nurses, the epithet is personally distressing. It makes us wary around patients who call us racist; it changes the nature of the nurse-patient relationship. We think we provide colour-blind care because in treating patients we are subject to all sorts of constraints barely perceived by the public, and which have nothing to do with race. Practically speaking, when a patient or a family utters the r-word, a nurse has to start a long trail of documentation for his own protection, which ironically, will delay care further. And knowing all that, we tend to believe the word is used manipulatively to jump the queue or otherwise to receive preferential treatment. It’s a situation rarely, if ever resolved happily, if only because the emotions evoked. Calling someone racist is very powerful.
My standard response to patients who make the accusation of racism has always been along the lines that we provide care regardless of race or any of the protected categories, such as religion or culture. I try not to take it personally. I strongly believe that in Toronto, which is the most culturally diverse city on the planet, it’s nearly a practical impossibility to be obviously racist and work in a health care profession. In my own ED, we have nurses and physicians whose family origins are literally on every continent except Antarctica, and we treat an incredibly diverse population, with large numbers of immigrants and new Canadians. My reasoning is the reality of working in health care will cull out bigots: they will be simply unable to cope. And I can say without hesitation I never personally have seen overt racism affect patient care.
Sharp-eyed readers will notice I’m hedging a bit, because I’m starting to think about my own assumptions about racism and health care. In what context did the daughter make the accusation? What was her experience of the health care system? Some of us unfairly, unjustly and without objective evidence tend to think of such-and-such ethnic or racial group as being “stoic” or “hysterical” or “prone to crime” or “violent’ or “indigent.” This does have consequences for care. The death of Brian Sinclair, for example, about which I’ve written about elsewhere, was almost certainly in part because of stereotyped attitudes about aboriginal people. I suspect we harbour more racist attitudes than I would like to believe of my colleagues. In 2009 a professor at York University named Tania Das Gupta released the results of a survey of 573 Ontario nurses, in association with book she published on racism and nursing called Real Nurses and Others: Racism in Nursing:
In the survey, 41 per cent responded that they had been made to feel uncomfortable because of their race, colour or ethnicity. Most Black/African Canadian nurses (82 per cent) and Asian Canadian nurses (80 per cent) said they had experienced this, as well as 50 per cent of South Asian Canadian nurses and 57 per cent of Central/South American Canadian nurses. Even 25 per cent of the white/European Canadian nurses said they had been made to feel uncomfortable because of their ethnicity or religion, said Das Gupta.
So I have to ask the question: if we do this to each other, what do we do to our patients?
*Beds in all emergency departments are prioritized according to patient acuity.