Missing data obscures the hazard of racism in nursing & midwifery

Anyone working as a nurse or midwife will tell you they have been doing it tough. Working flat-out through a global pandemic with chronic understaffing and stagnant wage growth, it’s no wonder they are leaving the professions in droves. Imagine how it feels then, to face the additional challenge of racism every time you go to work? That’s what the NSW Nurses and Midwives’ Association members reported in a 2018 survey — and here’s what we did about it.

It’s little surprise to anyone who has been in a hospital or nursing home lately there is a breadth of cultural, racial, and linguistic diversity in the nursing and midwifery workforce. But although we see it, we don’t know for sure the exact composition of the workforce, what their experiences are, or how culturally, racially, and linguistically diverse nurses and midwives are represented across various pay bands and roles. That’s because there’s no comprehensive data being collected by employers — anywhere.

Perhaps employers don’t think they need to know. After all, on the surface nurses and midwives appear to be getting on with the job. However, we will not know the true extent of the experiences of inequality and discrimination workers may be facing if we do not seek information through intentional engagement with workers, including data collection. Lack of information-seeking can lead to unchallenged systemic racism in workplaces and adverse outcomes for all workers.

Alternatively, in a worst-case scenario, maybe it’s that employers don’t want to know. Not knowing means that inaction can be justified and questions about the effectiveness of existing strategies to educate and value the workforce are left unchallenged. A ‘nothing to see here’ approach that serves employers so well, but leave workers unsupported.

Perhaps employers don’t think they need to know. After all, on the surface nurses and midwives appear to be getting on with the job. However, we will not know the true extent of the experiences of inequality and discrimination workers may be facing if we do not seek information through intentional engagement with workers, including data collection. Lack of information-seeking can lead to unchallenged systemic racism in workplaces and adverse outcomes for all workers.

Alternatively, in a worst-case scenario, maybe it’s that employers don’t want to know. Not knowing means that inaction can be justified and questions about the effectiveness of existing strategies to educate and value the workforce are left unchallenged. A ‘nothing to see here’ approach that serves employers so well, but leave workers unsupported.

The impact of racism on nurses and midwives can be career-damaging and — if addressed poorly or not at all — life limiting. Epidemiological research shows that depression, anxiety, low self-esteem, and cardiovascular disease are just some of the harmful consequences of exposure to racism. It is important that employers acknowledge racism as a workplace hazard that causes physical and psychological harm.

The absence of data about the diversity of the workforce and issues impacting culturally, racially, and linguistically diverse nurses and midwives, led the NSW Nurses and Midwives’ Association (NSWNMA) to survey their members in 2018 and find out what was really going on.

The findings in the Cultural Safety Gap report painted an alarming picture. Of the 1200 nurses and midwives who responded, half felt they had, or were unsure if they had, been discriminated against in the workplace. The main source of discrimination was co-workers and managers, closely followed by patients and residents.

Common forms of discrimination ranged from verbal attacks to isolation and unfair scheduling of workload. 5% had experienced physical abuse. Most respondents experienced discrimination at least monthly, but around 10% experienced it every time they turned up for work. The frequency and sustained nature of these incidents are a serious health and safety concern. The hazard is largely unseen or mismanaged by employers who lack the systems, insight, education or sometimes will to manage these risks appropriately.

Discrimination and inequity were also demonstrated through lack of career opportunities:

• 40% said they had been passed over for promotion
• 20% reported that they lacked confidence to apply for a management position.

Although we don’t have the data to prove it, anyone looking at the composition of upper management in big health and aged care providers can see there is currently no room at the top for diversity.

Standing alone against racism in a workplace can be a lonely and dangerous experience that is aggravated when the people you report to are unlikely to be culturally, racially, and linguistically diverse themselves and are therefore less likely to innately understand what you are experiencing. In some cases, the people you report to can be the perpetrators of racism themselves. Otherwise, their mismanagement of the issue can contribute to the harm despite their best intentions.

Additionally, colleagues who want to take bystander action may fear being targeted themselves, lack the necessary skills to act or feel disempowered. That can lead them to experience vicarious trauma and additional harm.

Participate in professional networks

The NSWNMA recognised the vital role unions have in protecting the rights of nurses and midwives, supporting them to shift the imbalance of power whilst providing a layer of safety that collectivism brings. To achieve this, an ongoing partnership with members was established through a culturally and linguistically diverse nurses and midwives’ professional reference group.

The group now meet bi-monthly online, so anyone living and working as a nurse or midwife in NSW can participate. The group also encourages non-culturally, racially, and linguistically diverse members to participate as allies, recognising that everyone has a role to play in stamping out racism.

Campaign for improvement and share resources

As part of their commitment to addressing racism, the NSWNMA signed up to the Australian Human Rights Commission Racism – it stops with me campaign. Through this campaign, members of the reference group have used their insights, personal experiences and expertise to develop guidance for health and aged care workers on what to do if they experience racism, how to take bystander action and also how to navigate those unacceptable workplace behaviours experienced by many. Check out the resources:

• Webinar: Promoting diversity and inclusion for CALD nurses and midwives
• Posters, flyers and brochures

Address the systemic issues in the workplace, industry and Australian culture

However, the group recognises that providing information, whilst helpful, is addressing the impact and not the cause. The group are committed to broadening their collective advocacy through ongoing projects, which tackle the systemic issues that allow racism to flourish.

There needs to be a cultural and racial safety lens scanning all health and aged care organisations that focuses on the lived experiences of nurses and midwives working in them. There needs to be a seat at the table in decision-making for culturally, racially, and linguistically diverse nurses and midwives and empowerment through proportionate representation in upper tier management structures. A doing with, rather than doing for approach that is more likely to succeed in creating safer workplaces.

If Australia is to really value, support and retain its health and aged care workforce, it’s essential the conversation and action starts now. Let’s get the data, let’s monitor the career pathways, let’s put our culturally, racially, and linguistically diverse nurses and midwives at the heart of organisations, embedding accountable recruitment, support, and value systems within workplaces. Let’s stop talking about racism and get on with the job of tackling it head on.

If you are a nurse or midwife working in NSW and wish to join the NSW Nurses and Midwives’ Association, visit our website.

If you are already a member and wish to get active in tackling workplace racism you can join the culturally and linguistically diverse nurses and midwives’ professional reference group by emailing [email protected] and putting ‘Join CaLD professional reference group’ in the subject line.

If you’re struggling with issues related to racism and other forms of discrimination in your workplace and would like to talk it out with someone, Nurse & Midwife Support is here for you — free, confidential, 24/7. Give us a call on1800 667 877 or by email.

Catherine Ivanfy, RN

Catherine is a Professional Officer with the NSW Nurses and Midwives' Association. Catherine is responsible for coordinating education and ensuring that nurses and midwives have the right knowledge to work safely in their contexts of practice. Catherine is a registered nurse and has worked and educated in a wide variety of clinical settings such as intensive care, neurology, gastroenterology and whole of hospital. Catherine is passionate about the nursing and midwifery professions and has a keen interest in education. Catherine’s goal is to bring education on topics of interest and allow easily accessible education for all nurses and midwives.

Helen Macukewicz, RN, Msc SCPHN

Professional Officer, New South Wales Nurses and Midwives Association

Helen qualified as a registered nurse in 1989 and has worked in a variety of nursing roles including hospital and aged care management, regulation of health, aged care and children’s services and as a Health Visitor in the UK. She has been a Professional Officer at the NSW Nurses and Midwives’ Association since 2015, having moved to Australia in 2014. Helen is passionate about social justice and working to ensure all nurses and midwives receive a fair go.