Research toward equity in the professional life of immigrants: A study of nursing in the metropolis. Phase I: Making racism see-able: The Grievances/complaints tiled by women immigrant nurses who are members of designated minority groups.

Research team:

Principal Investigator: Professor Enid Collins, Ryerson Polytechnic University, School of Nursing Coinvestigators:

Dr. Agnes Calliste, St Francis Xavier University, Department of Sociology & Anthropology

Dr. Ushi Choudhry, Seneca College, School of Nursing

Professor Judy Fudge, York University, Osgoode Hall Law School

Dr. Rebecca Hagey, University of Toronto, Faculty of Nursing

Ruth Lee, Women's College Hospital

Project Co-ordinator: Dr. Jane Turrittin

Research Assistant: Sepali Guruge, M.A Student, Faculty of Nursing, University of Toronto

Legal Research Assistant: Shirley Henry , R.N., Student, University of Windsor School of Law SYNOPSIS

SYNOPSIS

In an effort to raise awareness of issues related to workplace racism in nursing, this qualitative study investigated the way immigrant women nurses of several visible minority groups spoke about their experiences with racism and interrogated their formal redress and grievance proceedings. Theory and methods developed by Essed (1991), van Dijk (1993), and D.E. Smith (1990) were used to guide data collection and analysis. A network sample of 9 immigrant nurses, representative of the diversity characteristic of women of colour in the nursing in Metropolitan Toronto, who had filed formal grievances charging their employer with discrimination were interviewed; the documents generated in conjunction with their litigation were subjected to legal analysis. A goal of the project is to target policy changes so that incidences of grievances related to workplace racism can be decreased. The following themes, based on participants' verbal accounts, are among those that are emphasized in disseminating the findings: description of racism; identification of formal and informal policies pertaining to access, participation, promotion, inclusion, and conflicts; reactions and responses to discrimination; financial and other costs; implications for the immigrant nurses and for their caring profession and for how the health care system is structured and regulated. .

OVERVIEW OF RESEARCH UNDERTAKEN

The study utilized qualitative research methodology and documentary analysis. Participants were interviewed after being recruited through personal networks, publicity in the College of Nurses Communique, and Ontario Nurses Association (ONA) Newsletter, as well as in association with various nursing groups. In addition to transcripts of the taped interviews, data were collected in two focus group sessions. Focus group participants were asked to validate themes that were discovered during data analysis as well to add any new information that they felt was relevant.

Legal documents submitted by the participants were the compilation of all their correspondence and particulars of discrimination and the grievance process. These documents were used to generate a catalogue of different legal procedures and remedies available to nurses. A "map" that depict the interaction of various procedures was constructed. This can be applied in future to analyzed legal documents.

RESEARCH RESULTS:

The research sample included registered nurses from 7 countries who immigrated to Canada between 1960 and 1980. All but one had received their nursing diploma abroad, though several had achieved education beyond diploma level in Canada. Work history placed them in institutional setting, with their job responsibilities at the staff purse and managerial level with some movement between these positions within the time periods they reported.

Among filed complaints or grievances alleging racism, some were successful, some not and some still awaiting the outcome. Most participants indicated that they would fIle a grievance again if they had to do it, but our sample is not large enough to say whether there is a relation between successful outcome and this tendency. In obtaining our sample, we found more willingness to share the pain and humiliation of the experience when there was a successful conclusion to the struggle. That is, we talked to quite a number of individuals who expressed strong motivation to meet with us, but also indicated ambivalence about opening up their wounds again by telling their story and in the end they chose not to.

Participants' narratives provided rich data to support the perceived existence of individual and systemic discriminatory practices. Participants gave accounts of positive experiences when they initially started work --they were enthusiastic individuals, committed to the ideals of nursing, with high levels of knowledge and skills eager to move forward. In the current climate of restructuring of the health care system, however, discriminatory practices were exacerbated and predicated along in-group out-group lines. In their experiences, conflict escalated over time from petty harassment by colleagues and superiors to outright hostility. Dealing with these conflicts resulted in innumerable physical , emotional. professional and financial stressors for these nurses, who made the decision to file grievances only after enduring long periods of escalating conflict. In all cases reported escalation took the following forms:

a) perceived differential treatment i.e. denial of privileges granted to white nurses

b) problematizing the immigrant nurse of colour and documenting the effects of the escalating conflict c) labeling the nurse as aggressive, rebellious, unmanageable, etc., thus deterring support, polarizing the setting and isolating the nurse

d) full reprisal and punishment for a state of conflict perceived to be fueled by management .

With the current of restructuring of the health care system, the climate of working relations for nurses of colour nurses is a chilly one. Participants acknowledged the overall impact of restructuring but also relate accounts of differential treatment in the reality of their experiences at the staff nurse and managerial levels. The data provide rich accounts of participants' experience including behavoiur toward them which was highly controlling. For example, a participant who had worked in a managerial position and had experienced rewards and success in her position, requested time off from a new executive director to pursue education toward a higher degree. She reported this new superior's response: "...she would only support me to do a degree if it was a degree of her choice at a university of her choice ", Under the new executive director she experienced a series of petty harassments which led to on going conflict culminating in instant dismissal from her position.

Nurses seek support in the refuge of family, church, close friends and relationships. In two instances family physicians were cited as sources of support. There was limited evidence of support from official nursing organizations and nursing colleagues. One nurse however shared a positive experience in gaining assistance from the Registered Nurses Association of Ontario (RNAO) in securing legal counsel. Some participants identified individual friends, or groups outside the mainstream of nursing as their source of support. In one situation, the support person spoke of the extreme loneliness and isolation which her colleague experienced in going through the grievance process. She also described the inept performance of the lawyer appointed by the union, a perception shared by a number of the participants. Despite having some support, the nurses having to deal with on going discrimination as well as navigate the grievance process experienced innumerable physical, emotional, professional and fmancial stressors.

This study makes contribution to the literature on race relations, because the types of conflicts reported are unique in identifying pathological labour relations and the resulting heart rendering situations of these nurses.

Legal documentary analysis demonstrated that the two most important means of seeking legal redress to complaints in of race discrimination in employment are under the Ontario Human Rights Code or through the grievance process in collective agreements. There are a number of different remedies for addressing racial discrimination. These include grievance arbitration and Human rights arbitration, but the interaction of these processes is complex and the nurses in our sample found that they had to become legal experts themselves, and in so doing became very critical of the processes and available remedies.

OUTPUTS

1. Theoretical perspective: Toward a critical phenomenology of the institutional integration of immigrants

Everyday racism has been made see-able in the experiences reported by black women in Philomena Essed's ground breaking work, (1991) Understanding everyday racism: An interdisciplinary theory, published by Sage. Our findings are from a sample of women who took the decision to name and grieve or complain about the problem in attempting to assert themselves in their work setting. These participants offer new understandings about the workings of racism in the institutional context. By also drawing on the work of Dorothy Smith on institutional ethnography and Himmani Bannerji on returning the gaze, our study will stand as a critique of the special problems some immigrants encounter in attempting to integrate into the institutional life of our health care system in Canada.

2. Monograph: Indignities and indignation: Immigrant nurses try legal strategies

The indignities these nurses suffered were not tolerated. They perceived that they were risking their livelihood, career, financial and family stability, they were willing to endure possible damage to their physical health, the roller coaster of crises and emotional trauma, and the lingering and recurring pain and hardship. The negativity in their accounts of racialized treatment range from petty harassment to outright, hostile behaviours. While some of their cases contain unique issues such as illness from an occupational health hazard or whistle blowing on the part of the nurse, we find many commonalities in the grievance/complaint experiences. Within a year, we plan to produce a monograph which will develop particular themes drawing upon the expertise of team members. The outline for the monograph is shaping up as follows with each member of our team working on more than one chapter:

a) description of sample, players and settings emerging from the data including the context of under funding of health care and downsizing

b) description of racialist discourse documenting i) the process and racialist effects of the disadvantaging, ii) the formal and informal policies pertaining to access, participation, promotion, inclusiveness, perpetuation of conflict

c) immediate reactions by the immigrant nurse (typology)

d) active coping responses ( decisional processing)

e) mapping of selected grievance and complaints pathways taken by the nurses

t) later reflections on domains of hardship/ remedies/ prevention

g) implications for immigrant nurses who are members of visible minorities

including the looming threat of challenge to their credibility and capacities, the

need for personal support in a chilly climate and the potential for organizational

development and policy dialogues

h) theoretical implications for race relations research

i) the personal and professional costs of these phenomena to nurses and the

challenges to nursing as a caring, accountable discipline

j) summary of policy issues with a view to strategic changes

COLLABORATION AND PLANS FOR DISSEMINATION

The principle underlying our dissemination strategy is to make racism seeable so that ultimately policies to prevent and redress inequities based on racial discrimination can be developed. Because we feel that it is critical that the results of the study be made available to the larger nursing community we are targeting that community for education. In addition to CERIS workshops, the results will be shared through educational seminars in several nursing venues, including the Culture Care Nursing Interest Group (CCNIG), as well as organizations such as the Barbados Nurses' Association, which endorsed the research project. Invitations will be extended to members of official nurses' organizations including the College of Nurses, The Ontario Nurses Association, and the Registered Nurses Association of Ontario (RNAO) at a joint conference sponsored by the CCNIG and the International Nurses Interest Group ( a member group of the RNAO). Articles on different aspects of the research will be published in nursing and related publications, including the Canadian Journal of Nursing Research, RN Magazine, Western Journal of Nursing Research, and the Canadian Journal of Women and the Law. The research is timely given the trend in nursing to evidence-based practice and the potential utilization of our evidence.

TRAINING OPPORTUNITIES

The project provided training opportunities to two students. An MA student in Nursing gained experience in interviewing techniques, data collection and analysis. A law student benefited from skilled supervision as she undertook analysis of legal documents and wrote an analytic review of the pertinent legal proceedings to date. Team members presented a pre-conference workshop of the International Nursing Research Conference held at University of Toronto in April, 1998 on racism in nursing offered to the nursing community. The workshop gave an opportunity for the nursing research assistant to discuss preliminary research findings and participate in small group sessions and face to face informal networking to enhance race relations and promote anti-racism