Healthy Work Environments Best Practice Guidelines

Document Sample
Healthy Work Environments Best Practice Guidelines Powered By Docstoc
					Healthy Workers
 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)

• Ontario Primary Health Care Nurse Practitioner, York University, 2002
• Lieutenant Governor appointed Council member, College of Midwives of Ontario
• 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
• 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
• 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
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: or
Key Recommendations from
 different sectors of the CEHS

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
• stake account of discrimination,
  harassment and procedures for redressing
  grievances and complaints.
• Leadership Training and Anti-racism
• university research units will evaluate
• 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.
• to integrate anti-racism, anti-
  discrimination, anti-
  harassment, employment equity
• 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
• of recruitment and strategies for
  retention of Aboriginal, racialized and
  non-visible minority faculty and
• 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
Committees and panels

be required to be diverse and
 inclusive so that they reflect
 the diverse population of
Ethnoracial competencies

be made a requirement for
• nurse registration and
• an expectation for ongoing,
  self-reflective practice for
  registration in self-reflecting
Regular in-service   education

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
• 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!