Healthy Workers for Healthy Clients Betty Wu-Lawrence, RN For Health Equity Council 28 September 2007 Lived realities on Factors such as • socio-economic status, • gender, • immigration status and • ethno-racial minority as risk factors on health My Social Location? Chinese immigrant woman: Mother tongue Cantonese Employment experience • Public Health Nurse (Toronto Public Health) • Nursing Professor (Centennial College, Toronto) • Critical Care Nurse (University Health Network, Cardiac Intensive Care Unit) Education/Qualifications • Ontario Primary Health Care Nurse Practitioner, York University, 2002 • Lieutenant Governor appointed Council member, College of Midwives of Ontario 1993-1996 • M.Ed, OISE University of Toronto, 1994 • Bsc.N., Registered Nurse since 1979 • Union Steward, CUPE 79 since 1995 • Community Experience • Chinese Canadian Nurses Association (Ontario), Founder and executive (since 1986) • Riverdale Immigrant Women's Centre, RIWC, Board Director (since 1990) • Woodgreen Community Centre, Board Director (1991 – 1993) • METRAC, Board Director (1994 -2000) • Centre for Equity in Health and Society, Board Member (since 2003) ―The experiences of professional nurses who have migrated to Canada: cosmopolitan citizenship or democratic racism?‖ • Turrittin, J., Hagey, R., Guruge, S., Collins, E., Mitchell, M. (2002). • International Journal of Nursing Studies 39, pp. 655-667 Health outcomes of nurse complainants in racial disputes • Feelings of exclusion, loss of belonging • Feeling humiliated, contained • Intimidation, paranoia, isolation • Loss of confidence and grief • Depression, loss of focus and memory loss • Distressing physical symptoms • Death images • Sensations challenging integrity and wholeness • Positive awareness • Less than optimal health basis for professional work • Long-term effects I was the charge nurse in the delivery room and there was another nurse with me, a whiter nurse, but she didn't have as much obstetrical experience. And there was a patient who I assessed could be a high risk patient and so I assigned her to myself. Although I was in charge, I figured I will take care of this patient. Half way through her labour her husband came in and he asked me to speak to the doctor…(This) was in the night and the doctor is not here; he is at home. But (her husband) went and called the doctor at home. The doctor called me and the doctor said, "You need to turn over this patient to the other nurse." I said, "What? What do you mean? Do you make the assignments here, Dr. L?" He said, "The husband does not want a black woman touching his wife (nervous laugh). I figured I have never heard such craziness in my life. I said, "I am a professional nurse and I said, "Dr. L., you need to tell this husband, if he doesn't want the nurse to take care of his wife, take the wife…to another hospital." But (Dr. L) didn't. He insisted…that I give up the patient…. Table 2: Impact of Race, Colour, or Ethnicity in Employment (Reported by Nurses) Type of Impact of Racial Domination in Employment Reported • 54 were made to feel uncomfortable as a nurse because of race, colour, or ethnicity • 56 felt put-down, insulted, or degraded because of race, colour, or ethnicity By a doctor…………..19 By a patient………….38 By manager………….24 By another nurse…...32 When I saw the baby coming out, I called the paediatrician at home and I ran in. And the wife started haemorrhaging. So, here was the nurse in there—the wife is bleeding; the baby was flat. I went in. The baby was flat…I resuscitated the baby. In the meantime, I am telling (the nurse) what to do—to massage the fundus to get the bleeding down…And when the paediatrician came the baby was crying and…fine…. The patient apologized (to) me for the way her husband had treated me. I said to her, "Because of the colour of my skin, you could have had a dead baby." And, actually, all through this I told her that, "Your husband could have had a dead wife. Just because I am a black woman, I can't touch; and I am a professional nurse and experience. You know, this is what we put up with in this country. But I was able to prove to them that, in spite of the colour (of) my skin I had the expertise to be a professional nurse. Some people would have never gone back. Never. (2002:657) Table 3: Nurses' Responses to Racial Discrimination in Employment Type of response reported Number Type of response reported Number (non –exclusive categories) (Non-exclusive categories) Took some action: 33 Emotionally affected 47 Ongoing 4 Positive result 13 18 Physically affected Negative/no result 16 Did not take action 22 Mentally affected 28 No response 7 Table 1: Demographic Overview of Survey Respondents (n = 62), Conducted with Nurses from November 2001 – May 2002 Ethnoracial Identity Number Black/African Canadian……………….. 38 Asian or South Asian Canadian …… 13 Central/South American ……………… 1 White/European ………………………….. 5 Other …………………………………………. 4 No response ………………………………… 1 Gender Identity Female …………………………………………. 57 Male ……………………………………………… 3 No response ……………………………...... 2 Das Gupta, T., (2002) • Stressful knowing that you are…on the outside; stressful knowing that they don’t want you there… • The final taking away the…job…from me was so humiliating. Humiliation…is (an) unbearable experience…It really affects my health, affects my marriage (crying)…It was the worst I ever had in my entire life. • It took me about 8 month to recover enough…I had gone through a major memory loss, my depression had caught me…I just stayed enclosed in my bedroom for months. • I went into shock...(and) started shaking…I never stopped shaking for days, days…it was like a dagger…I could feel the pain in my heart…within a month I became very sick. I went into a … state of shock. I jusst crashed. I got dizzy and (would) be vomiting at four o’clock in the morning. Low energy and extreme fatigue. It was such an effort to start a new day….I was devastated. Pains in my chest…pseudo heart attack…My blood pressure went up to 180. • I felt as if I was being invaded. I feel that my life has been tattered…that I’m not being supported by my union…things that I found very easy for me to do before…I’ve just been drained. • I took time off work; the doctor gave it to me—stress leave. I was tensed, you know. I couldn’t do my job. When I look back, my brain probably was functioning at half a level. • It is a psycho-physiological…aspect to it…when you go under stress for almost 5, 6 years, my serotonin is very depleted. Today, sometimes I’m speaking and I can’t speak. I lose my words; I forget things, which is not at all like me. Source: Implementing Accountability for Equity and Ending Racial Backlash in Nursing by Hagey, R., Jacobs, M., Turrittin, J., Lee, R., Purdy, M., cooper Brathwaite, A., Chandler, M., Das Gupta, T. Canadian Race Relations Foundation (Toronto, 2005. Centre for Equity in Health and Society, pp. 90-94. See full report at: www.BeForEQuality.com or www.CRR.ca Key Recommendations from different sectors of the CEHS network, Goal: to build accountability for systemic racism impacting on nurses through changes in legislation and policy • An investigation by the Ontario Human Rights Commission, (OHRC) • (under section 29 [g] of the Code) investigate into the systemic discrimination with respect to education and employment in the health care system. • stake account of discrimination, harassment and procedures for redressing grievances and complaints. • Leadership Training and Anti-racism Education • university research units will evaluate curricula, • develop and disseminate new knowledge on ethnoracial competencies • achieve diversity in leadership. • develop questions for registration and licensure examinations pertaining to antiracism and racial dispute proceedings. • Ontario Legislation • The Ontario Human Rights Commission be legislated to report directly to an all-party committee of the Parliament instead of to the Attorney General. • Ontario Policy The Ontario Human Rights Commission develop policy to: • monitor workplace complaints proceedings for reprisals and step up investigations to properly document reprisals and irregularities in procedure. • levy fines based on the degree of resistance to anti-racism procedures in the complaints process • The OHRC report to the legislature categories of complaints and statistics on how they are dealt with. • Private and union practitioners adjudicating racial complaints report to the legislature similar data • Confidentiality of complainants and respondents is ensured but list the sector—for example, health care—in which the complaint arose. Ministry of Health and Long Term Care to require the Nursing Secretariat • to provide the opportunity for the inclusion of Aboriginal and visible and non-visible minority member representatives in its proceedings in collaboration with the Joint Provincial Nursing Committee. • • The MOHLC • to integrate anti-racism, anti- discrimination, anti- harassment, employment equity assurance, • language and culture-care agendas in the nursing and other relevant secretariats to carry forward the requirement of ethnoracial competencies in a mission of diversity and equity in health care. • The College of Nurses of Ontario to introduce • transformative justice proceedings to handle allegations where a racial dispute is evident between a client and a nurse • On National Accreditation • The accreditation proceedings of hospitals and health agencies in cooperation with all regulatory colleges implement equity assurance to augment their quality assurance programs. • the Canadian Association of Schools of Nursing (accredition arm) require evidences: • of recruitment and strategies for retention of Aboriginal, racialized and non-visible minority faculty and students • of anti-racism curriculum • of ethnoracial competencies among faculty, staff and students. Voluntary Policy in Key Organizations: • Provincial, regional, federal and national bodies supporting and directing health services research develop programs to obtain and publish data on health care workers in terms of Aboriginal status, ethnicity, mother tongue, and visible minority identity. The Ontario Hospital Association to • develop and promote best practice models of anti-racism policy. • Guiding policies should include Principles for Good Governance in the 21st Century • and the United Nations Declaration of Human Rights—Legitimacy and Voice, Equity, and the Rule of Law. • All regulatory and professional bodies introduce upgrade in: • Registration forms • Committees and panels • Ethnoracial competencies • Regular in-service • Electronic monitoring • employment systems review Registration forms be changed to allow for self-identification of Aboriginal, racialized and non-visible minority status Committees and panels be required to be diverse and inclusive so that they reflect the diverse population of Canadians. Ethnoracial competencies be made a requirement for • nurse registration and • an expectation for ongoing, self-reflective practice for registration in self-reflecting professions. Regular in-service education programs and human rights orientation to new staff at all levels. Electronic monitoring using human rights software to track equity indicators. Tools for employment systems review be adapted to identify set-up and backlash experienced by racialized employees ―Tools for decision making in turbulent time: • First we think • Then we get together to find an objective solution • At the end of the day, we need to look at our hands and examine whose blood have we got on (for future needs to avoid doing any harm unintentionally).‖ Figga Haug (1995 at OISE) I have a dream: What is good for you is good for me, What is good for me is good for you!