Guests: Bukwa Madzinga, Julie Ngwabi, Merilyn Homes, and Marty Williams
Tags: Culturally And Linguistically Diverse (CALD), discrimination, racism, xenophobia, cultural safety
Soundcloud:Listen to Episode 37
Our Summer Newsletter is all about supporting culturally and linguistically diverse (CALD) nurses, midwives and students. We’ve partnered with the New South Wales Nurse & Midwives Association (NSWNMA) to offer you two podcasts with six passionate nurses committed to empowering CALD nurses and midwives. This is the second of two episodes, Episode 37.
In this episode we speak to four members of the NSWNMA CALD reference group. Julie, Merilyn, Bukwa and Marty share their lived experiences and the importance of addressing racism in the nursing and midwifery professions.
Our guests candidly discuss the harmful effects of racism, the benefits of being part of the CALD reference group and their motivations for putting discrimination under a spotlight.
It is a privilege to hear from passionate nurses who use their voices to highlight the issues, challenges and the pernicious impact of discrimination and racism. We thank our guests for sharing their insights and identifying opportunities to address racism in the workplace.
As Marty says on the podcast:
“Let’s use our voices so that our future (CALD members) don’t have to use theirs.”
You can also check out Episode 36: Addressing the Cultural Safety Gap with Catherine and Helen, where we discuss the findings of an NSWNMA survey on the wellbeing of CALD nurses and midwives and how the CALD reference group was formed in response. If you’re a nurse or midwife in NSW, you can contact Helen about joining the CALD reference group.
If you need to chat about any of the issues raised in this podcast, we’re here 24/7 on 1800 667 877, or you can email us.
Bukwa Budzinga RN
Bukwa is a passionate and dedicated RN with experience in a variety of surgical settings. She has held positions as a Nurse Educator in Aged Care and a Clinical Nurse Specialist in Orthopaedics. Bukwa is a committed advocate for workplace equality.
Julie Ngwabi RN
Julie is a Registered Nurse with more than twenty years experience. She moved to Australia in 2004 and holds a Master's degree in Mental Health Nursing. She believes all Nurses and Midwives thrive and deliver to the community the best health care possible when they are safe and supported.
Merilyn Holmes RN
Merilyn Holmes trained as an Endorsed Enrolled Nurse who worked in several health services in NSW. In 2010 Merilyn graduated as a Registered Nurse and currently works at Gosford Hospital in the Neurology and Stroke Ward.
Marty Williams RN
Marty is a Paediatric Registered Nurse at Westmead Children’s Hospital with over 15 years of experience in Cardiology in the United States and in Australia.
Mark Aitken [0:04] Hello, and welcome to the Nurse & Midwife Support 'Your Health Matters' podcast. Today, I'm in Canberra on Ngunnawal country, and I wish to acknowledge the traditional custodians of the land. I'm recording this podcast on the land of the Ngunnawal people. I wish to acknowledge and respect their continuing culture and the contribution they make to the life of the city and this region. I pay my respects to elders past, present and emerging.
It's great today that we've got four guests from the New South Wales Nurses and Midwives' Association Culturally and Linguistically Diverse Reference Group. I'd like to welcome our guests today. We have Julie, Merilyn, Marty and Bukwa. Hello and welcome everybody to this important discussion. Thank you.
We might start with a question for all of you. What do culturally and linguistically diverse nurses and midwives bring to the nursing and midwifery professions? I think you might all have a comment on that. Who would like to start?
Marty [1:21] Marty here, I think that CALD nurses and midwives bring a lot of lived experience. We bring a lot of international education and value to the Australian community at large. We bring a wealth of knowledge and diversity to the community at large as well, and we're also able to use our lived experience to integrate within the multicultural awareness of the Australian breadth as well.
Mark Aitken [1:57] Thanks Marty. Would anyone else like to add there?
Julie [2:01] Yes, this is Julie here, I just want to echo Marty's sentiments. I'm a mental health nurse of college background and I love my profession. I love what I do, and knowing that Australia is multicultural with people from diverse cultures accessing one health system, I think for me, being a CALD mental health nurse means that I'm able to bring who I am. My values, my beliefs, as I engaged with all people to promote their mental health and wellbeing. So in some ways for me that human-to-human interaction and connection really in positive ways, despite our differences, speaks to our humanity. So I think as CALD nurses, we do enrich the nursing and midwifery profession, as it reflects a multicultural Australia.
Mark Aitken [3:01] Thanks, Julie. I think they're excellent points and I couldn't agree more. Would anyone else like to add something there?
Bukwa [3:07] Hi, Mark. My name is Bukwa. I totally agree with the other two respondents. I'd also like to say that as CALD members, we breach the workforce shortage that the Australian healthcare system has had, an ongoing shortage of nursing staff. We are there bridging that gap.
Mark Aitken [3:27] Thanks Bukwa. Merilyn, hi!
Merilyn [3:32] I just want to add with regards to the most diverse, multicultural nation, having a CALD representative in each health facility ... I guess you do get a lot of patients that are with CALD backgrounds, too. If they see someone like them looking after them, they feel a peace and a sense of belonging. Seeing someone with their same cultural background, they will be more compliant and more engaging and participating in their care, making it easier for everyone.
Mark Aitken [4:17] Thanks, Merilyn. They're all really important points, and I appreciate your insights and for sharing them. As part of preparing for this podcast, I read an excellent article in the ANMJ October-December 2021 issue, and I assume it's in the [inaudible] as well, by Robert Fedele, and it's titled 'Let's Talk about Racism'. I would commend anybody who's listening to this podcast to read that important article. So Julie, this is a question that I believe you're going to answer. Why is racism harmful?
Julie [4:57] Thanks, Mark. Thanks, everyone. I think racism is harmful. It's very harmful in so many ways, really. I think it's a public health issue, because it affects people's health both mentally and physically as well. We know that there is well documented and empirical evidence both nationally and internationally.
For example, in 2015, there was a systematic review, which was collated by PubMed Central. It confirmed that stress resulting from racism affects our physical and mental health, for example, physical conditions such as high blood pressure. It weakens our immune systems, which opens us to other conditions as well. It puts people at risk of heart disease, and it's also been linked with risky behaviours such as smoking, alcohol and drug use, as people try to cope or self-medicate in really unhelpful ways, including unhealthy eating habits.
We know that racism is linked with poor mental health outcomes as well, and is actually twice as likely to affect mental health than physical health. Your mental health or mental wellbeing affects your functioning, including at work, which is really important for us as members of the nursing and midwifery professions, we want to be really present for our patients, and deliver the best possible care. It's associated with conditions such as depression and anxiety, high stress levels, emotional distress, PTSD, and unfortunately, suicidal thoughts. We do know of people unfortunately, who have taken their lives because of racism. So it's really harmful.
As I say, it does affect general functioning and contribution in the workplace and society more broadly. That exclusion which results from racism means that the much needed skills ... you know, my colleague Marty was talking about the international expertise and skills that we bring as well, it means those much needed skills are missing. It's a disservice to the community really, and workers facing racism may not be as productive. It puts the workers at risk of making mistakes which we cannot afford in our profession, and once you make a mistake, it actually worsens your outcome as a CALD person.
More broadly, racism impacts relationships in a negative way. It goes beyond the person actually experiencing the racism firsthand, but it affects the family as well, including the children who rely on parents for their wellbeing. It affects the children's development, their learning, which has got significant negative, long-term outcomes like their employment prospects in the future. That causes isolation, fear of experiencing racism itself causes people to confine themselves, where they feel much safer. That way, it affects one's ability to experience and contribute to life in society fully. So racism really is quite broad, the negative impacts both to the individual and to the society in general.
Mark Aitken [8:52] Thanks, Julie. That's an excellent explanation about the harm that racism causes. I thank you very much for that information.
Marty [9:05] Marty here. Can I add on to Julie's incredible breakdown of racism, how it affects nurses and midwives?
Mark Aitken [9:14] Yes, please, Marty. Go ahead.
Marty [9:16] Okay, Mark, as Julie pointed out, racism affects all of us in so many different ways, and as pointed out, to the individual nurse. Racism also affects the community and also affects the workplace in itself. Racism can increase patient harm, patient safety. If the nurse and midwife don't feel safe and secure in their own practices they may be targeted by management or other external factors, which will impact their nursing care.
Nurses and midwives also face racism coming from patients and their carers, which also can impact a nurse's physical, mental, emotional, and psychological wellbeing. Racism also affects nurses within a workplace. Unfortunately, by peers themselves, when a nurse, specifically speaking of a CALD nurse, who experienced racism in the workplace, it makes the nurse feel unsafe. And I believe no nurse or midwife anywhere should feel unsafe just doing their job.
Mark Aitken [10:36] Important information. If you're experiencing racism as a result of your work, I'm really sorry that that's happening to you, it's not acceptable. Please reach out for support sooner rather than later. Obviously, it's really important that you share that experience. If you're not sure how to go about accessing support, please know that you can access Nurse & Midwife Support, the national support service for nurses, midwives and students, anytime you need support. The service is anonymous, confidential and free, and you can contact us on 1800-667-877 or via our website, nmsupport.org.au.
This podcast is part of a newsletter that is all about supporting culturally and linguistically diverse nurses and midwives. There'll be some useful links in this podcast, the show notes and the transcript that you can use to access support. Please know that support is available, and racism is not acceptable.
What are the issues you have experienced as CALD nurses or midwives, or both, that have challenged you? I think Bukwa, you were going to answer that one?
Bukwa [11:57] Thank you, Mark. It's quite a broad question, and I'll just try and summarise because we might take the whole time if I start listing the issues that have challenged me as a CALD nurse! These issues change depending on the length of time you've been in Australia. When you first come out to Australia, you downplay most of these issues because you're concentrating on your visa status. You're not aware of the health services that you talk of. Also, there's that fear of, "Will I get my visa renewed?"
I personally came here on your 457 visa. I thought if I quit work, my stay in Australia would have ended. So most of the things I downplayed, and I look back almost 20 years on, and I ask myself, "How did I survive that?" I started off my career in Australia, in aged care in a small country town, and I was the only CALD nurse in that area, maybe even the town. I remember coming to work, and people having a tough time accepting that an African nurse is going to be in charge of this nursing home.
What my Director of Nursing then did was to appoint an assistant in nursing as the team leader. I remember coming to work, and being a registered nurse, being allocated to do showers. That was very challenging, because I know the role of a registered nurse, I know the role of an AI and being answerable to the RNs. But roles were reversed. Unfortunately, I didn't know about all the support services, I was deep in the country, in a small country town.
As the other speakers have said, these things affect you. I remember breaking down into cold sores, which is a stress reaction from me asking my Director of Nursing, "Is it a mistake?" I was told "You needed to learn." So this is just one of the things that I didn't take further and looking back at it, if I had all the services that are available now, I don't think I was even a member of the Nurses' Union at that point.
Fast forwarding later, now almost 20 years on, you think this would have changed. But you come to realise that these issues repeat themselves in different forms. What that experience made me do, I enrolled in a lot of postgraduate courses just to try and learn how the Australian healthcare system worked. To improve my professional qualification, hoping to better myself.
Here we are nowadays you find workplace opportunities, the career development opportunities that the work[place offers], they still bypass you. You find that maybe simple, like not really big career step-up roles, like even being a simple team leader, members of the CALD communities approach at the backburner. I've questioned management on all these things, and you're told that you do not have leadership skills. It is very challenging that you're an enrolled nurse, you've got more than 20 years, I mean, more than 10 years of work experience, you've got all these postgraduate qualifications, and then you're told no, we'd rather put a second/third year RN to be a CNS over you because you do not have leadership qualities.
The worry is, the documentation, the ward adverts are very correct. They are very inclusive when you read them. You've got your selection criteria, you have your desirables, it looks all good. These adverts will talk of 'inclusiveness', everybody has an equal go. But then you realise where does it jump, where you choose a third or second year student over nurses because they're CALD, with all this experience, and that's better. That is my biggest challenge today, that I still feel there is inequality in appointments to step up clinical roles. My feeling is that as CALD nurses we are more likely to fill up the workforce part, but not step upstairs and RN on the floor and don't step up. I think this is one of the reasons why the CALD group was formed because we are not seeing that representation of the CALD nurses at top-level jobs. It's generally acceptable to be left on the floor, or the bedside, but the step up roles being kept for non-CALD members.
Mark Aitken [17:06] Thanks for sharing that Bukwa, and I'm really sorry that that's been your experience, but clearly the experience of many CALD nurses and midwives. Clearly, we need to do better.
Marty [17:18] I'm sorry, Mark, can I add to my beautiful colleague Bukwa's testimony?
Mark Aitken [17:25] Please do, go ahead.
Marty [17:26] Myself and a lot of my colleagues here, a lot of the issues that we face, that we experience as CALD nurses and midwives that affects us greatly, that challenges us on a day-to-day [basis] ... I love what Bukwa just said as far as being passed over for physicians or more leadership or more managerial. That's just the tip of the iceberg. When we go down to a grassroot level, many of us are gaslighted.
If we report an issue, we're told that we're the problem, and that that system is not the problem. A lot of times, myself or other CALD nurses, if you do report an issue, you'll find that maybe your patient allocation may become even more difficult. You may find that, and I've experienced it, where my day-to-day tests become more highly scrutinised, as opposed to my non-CALD peers. I have experienced ostracism, where I can walk into a break room, and no one speaks to me at all. Unfair allocations I've experienced, where certain colleagues have had an easier workload than I've had, that have the same time in service as I. And ostracism, being gaslighted, being told that you're the problem. Also, management comes down even harder, to the point of actually emotionally breaking down the nurse.
Merilyn [19:08] Mark, would I be able to add something else to that too?
Mark Aitken [19:12] Yes, please do.
Merilyn [19:14] It's Merilyn here. I've read something about a publication that was issued by the Nursing and Midwifery Association. That was in September 2019. They conducted a voluntary survey and there were 1,234 surveys completed from CALD members. I just want to say some of that which actually reflects on what everyone had said regarding their experiences. So I'll mention a few.
This is what some of the CALD members said, regarding their experiences. Workers with strong foreign accents seem to be taken less seriously than others. Other members said, I have experienced people saying they do not understand my accent before I even start speaking. Another one is giving us more workloads because they know that we won't complain about it. Then one says, when it comes to career advancement, I become invisible. I do have the education, I have the same experience. So I think I have the wrong [inaudible].
Julie [20:38] It's Julie here. Just want to echo what my colleagues are saying. I think there's a lot of lip service, which organisations pay when it comes to issues of inclusion, equality. Yes, the policies are there, the vision statements, the mission statements, they say all the right things. But as CALD nurses will tell you, our experiences are so far removed from those written policies and expressions of inclusivity and the like, and to Merilyns point, the reality is that for some of us as CALD nurses, some people, some organisations, they really cannot see past our race or colour, and they cannot hear past our accents.
So it doesn't matter what we do. It doesn't matter, our skills, our experience, as long as we are not the acceptable colour, as long as we're not the right cultural fit really. Bukwa was saying that it's okay when we're in the flow, it's okay in some other positions. But when it comes to those stepped-up higher positions, that's when it becomes a big issue, that's when the reality sets in that no, despite the policies, the mission statements, and everything, everything which appears right on paper, the reality and our experience is quite different, which is very unfortunate.
Mark Aitken [22:17] Thanks for sharing, Julie. I agree, very unfortunate and it needs to change. What should workplaces, or what could they do to not pay lip service to this, but to really engage in real change and action that is going to stop discrimination and is going to give people opportunities to really advance their careers.
Marty [22:44] First and foremost, start with management from the top, having CALD nurses and midwives on the committees at management level to assist with writing the policies that affect us. Having non-CALD members write policies and procedures directed at CALD members does not help a CALD member. Having CALD representation from the top is where it starts.
Mark Aitken [23:14] That's a great point, Marty, and I couldn't agree more. Anybody else like to add anything there?
Bukwa [23:20] I'd like to add on, workplace appointments, I think people should stop appointing people [by] word of mouth, and the ward educator can pick a person and say, "Look, you've got leadership skills." We just go back to watch the hospital and stick to the policy. If it says to be a CNS in a ward you need five years or four years postgraduate experience, let's stick to the four years. If it says you need a grad cert, let that grad certificate be produced. Let adverts be placed on the hospital intranet, accessible to everybody.
Because what happens at work, you go on days off, you come back, somebody has been appointed to this job and it hasn't been advertised. The paperwork is there, as everybody has said and agreed to, it's there. Just follow the rules if you want a [inaudible], if people have to purchase portfolios, so be it. Let's level the playing field. Let's make it fair for everybody. The paperwork looks good. We just need to follow up. As Marty had said, that all starts with management. You need the management to say, "This is what it is."
I was fortunate to work in one of the hospitals when new management came up. There had been a lot of all these jobs where people had been appointed. Those jobs were readvertised and the people who had been doing them were given the opportunity to reapply and of course, some got them back, but that was one of the fairest things I saw, because everything was advertised, it was there on the hospital intranet for six weeks, everybody had a go and it matched up with the skills. Do you meet the selection criteria? No, you don't. Okay. You go back on the floor. If you don't meet the selection criteria, what do you do, you work with your educator. Where are my weaknesses? That's what people do. You cannot tell me people can work 10-12 years in a place and not advance. That's just not right.
Marty [25:15] Marty again, second point. Going from the other direction, what the workplace needs to do and to improve support for CALD, and support midwives: involve CALD nurses and midwives. Have us at the table when you're writing policies and procedures, have us at the table, when we're having discussions as far as fairness. Have us at the table, and actually listen to our experiences, listen to our inputs. From the bottom up, what a workplace can do is actually listen to us and give our voice actual words, not just lip service.
Merilyn [25:59] As we all know, education, [inaudible] in practice. I think it is important that healthcare facilities should integrate not just anti-racism, but also cultural awareness and diversity programs as part of orientation, or induction for new staff. Cultural awareness and diversity courses should be made compulsory for all staff as part of their yearly professional development. I think it's a good idea, too, that each health facility should have a CALD [inaudible], not only as a reference person, but also support the [inaudible], if CALD nurses or midwives need support related to their profession.
In the publication that I've mentioned before called the 'Cultural Safety Gap: Experiences in New South Wales Culturally and Linguistically Diverse Nurses and Midwives', it actually mentioned there that a development of a Diversity Inclusion Champion as an operational leader, shift role, image health, healthcare organisation, is essential. But I think this is really crucial in building that trust between CALD nurses and midwives and their management. Because I think having that leadership role would reinforce that CALD nurses and midwives are given a fair go and treated equally regardless of their colour, race, culture, or religion.
Mark Aitken [27:45] Thanks for sharing that, Merilyn. And thanks, everybody, for your insights and that really important information.
Julie [27:54] I just want to add a few things as well to what everyone is saying. When talking about support for CALD nurses and midwives, including support for racism, I think it's also important to acknowledge the reality of our experiences. As Marty was saying, it's really important to bring us to the table, and to hear our lived experience. If you want to know what exclusion looks like, if you want to know what racism looks like and feels like, you have to ask people who are actually experiencing it.
It's also important to create spaces of safety. There's so much fear around raising these issues in the workplace, despite policies and awareness campaigns egging us on to speak up, but you cannot speak up when it's not safe to do so. Otherwise, you'll find yourself in a worse off position than before. For those in positions of power to listen, and to actively act out on our experiences and to be willing to disrupt the status quo. Otherwise, nothing will change. You'll keep having the right policies, the right mission statements, but our experiences won't be budging or changing.
If reports are made, the purpose of the investigation should be to find out, to gather information of what actually happened so that you can effectively deal with it. It shouldn't be an opportunity to explore ways of denying their existence, discrediting the person because you're more worried about your public image, because this actually worsens the negative experience that the person is already going through and it further contributes to more trauma. It means that you're just kicking the can further down the road and nothing gets to change.
Mark Aitken [29:59] Thanks, Julie. Thank you everybody for those really important insights. It's very powerful to hear it from you all, and I thank you very much.
How can we support nurses and midwives who experience racism? Like I heard very clearly that we need to involve CALD nurses and midwives much earlier on when we're building services, developing services and setting up support services. So how would you say that we best support people experiencing racism?
Merilyn [30:38] I think working to help us [inaudible], one is the private sector and one is the public sector, they have support programs but it's actually set up for general staff. I think if they have more support programs specifically designed for CALD nurses and midwives, I think it would help a great deal for all the CALD nurses and midwives that [inaudible].
Mark Aitken [31:15] Thanks, Merilyn. Now, you're all part of the New South Wales Nurses and Midwives Culturally and Linguistically Diverse Reference Group, and I know that you've assisted with the development of the incredible resources that are available on the New South Wales Nurse and Midwives' Association website, and we'll certainly put the link to those resources in this podcast as part of the show notes. But could you talk about what it's been like for you, being part of this Reference Group? What does it mean to you?
Bukwa [31:51] Hi, Bukwa here, I'll speak to that Mark. I really appreciate being part of this Reference Group, because this group gives me a safe space to be who I am. It's a group where I'm not put in a box. You're an individual, you're not seen as a part of a group of people, but you're an individual. It's a place where we can acknowledge what happens to us without being judged, without having any repercussions that I've mentioned.
You've got people who identify with you, people who've lived the same experience with you. I really appreciate this and the fact that we have so much support, and you can feel that this group is really trying to change. It's not like we are only a group to come and talk of our grievances. They are trying to find solutions, we are trying to find a way forward. I really appreciate it, it's just a great space to be at. It's so refreshing when you can speak with a group of people who are living what you're experiencing.
Mark Aitken [32:55] Thanks for sharing that, Bukwa.
Marty [32:59] I would like to add to what my colleague Bukwa was saying. Being a part of the New South Wales Nurses and Midwives' Association CALD Reference Group, on a moral, ethical and professional level, it means everything to me. This space has given me safety in voice, safety in numbers, and it also enables me to not only use just my own, but my esteemed colleagues on this call and beyond, to be able to use our individualised racial trauma, to give it a voice. To affect change, to make change. I came up with a saying, I told Helen earlier, I love it: the mere fact that we're all here today using our voices, so that our future CALD members don't have to use theirs. This is what CALD brings to me.
Mark Aitken [34:09] Very powerful, and so important to get that message out there. Well, we've come to the end of this podcast conversation. It's been very powerful and important, and I'm so grateful for your input today. Bukwa, Julie, Marty and Merilyn, thank you very much.
Do you have any final words of wisdom that you would like to share with our listeners?
Marty [34:37] Again, Marty here. I'll say once again powerfully, and thank you to my lovely colleagues of today. Let's use our voices so that our future [CALD members] don't have to use theirs.
Merilyn [34:49] It's Merilyn here, I just want to add something. I know it can only get better and stronger [inaudible] our CALD group. The stronger we are, we're helping make a difference, close the gap, help nurses and midwives in the workplace.
Julie [35:08] This is Julie here, similar to what my colleagues are saying, belonging to something like the CALD Reference Group, I think it's something that we should be aiming to have nationwide because as someone said, that's where we find safety. That's where we feel like we belong, our voices can be heard and amplified, and that peer-to-peer support is really important even to our mental health and wellbeing.
Because there's a lot of gaslighting, where you're left in a situation of questioning yourself. Did I really experience that? Did I really say that? Maybe I didn't. This is a place where you know that gaslighting is dealt with. When you realise that, it actually did happen, and not trying to tell you to stop. It's important because we feel empowered, to Marty's point, it's really important that we use our voices to speak truth to power, so that the future generations don't have to deal with what we're currently dealing with.
Mark Aitken [36:13] Thanks, Julie.
Bukwa [36:14] My closing words, I'd just like to quote the Lieutenant General David Morrison, his famous words where he said, "The standard you walk past is the standard you accept." I'd like to say to my fellow colleagues in this group, let's not accept the standards we're seeing. Let's do something about it. We are doing something about it. Thank you.
Mark Aitken [36:36] Thank you very much, and what a great place to end this conversation today. But it certainly won't be the end of this really important conversation into the future. Nurse & Midwife Support is committed to raising the voices of CALD nurses and midwives, and supporting you in any way we can. So if this podcast has raised any issues for you, please know that Nurse & Midwife Support is available 24/7, no matter where you are in Australia, 1800-667-877 or via the website, nmsupport.org.au. Please look after yourselves, everybody. Your health matters. I'll speak to you next time.