Combatting racism in nursing: despite many years of cultural safety education, racism in nursing still exists. It is the responsibility of all nurses to confront both individual and organisational racism.

Last year I read two books that caused me to think again about racism in nursing. the first was Jane Robinson's biography of Jamaican nurse Mary Seacole, who went to the Crimean War and became a heroine. (1) Last year she was named the greatest Black Briton in British history. The second book was a correction of stories about black Australian nurses, called In Our Own Right. (2)

Some stories were very similar to others I had read in nursing literature. These included those by American nurse anthropologist Evelyn Barbee who has studied health disparities among African Americans; a study of nursing in a multi-ethnic context in Britain; (3) an article by Aboriginal nurse Salty Goold; (4) and accounts by the late Irahapeti Ramsden, pioneer of cultural safety in this country. (5) At international nursing conferences I have also heard first-hand stories of racial discrimination from nurses around the world.

In 1997 I contacted colleagues in the United Kingdom (UK) who had punished articles about how racism affects nursing in Britain. Encouraged by their response, I visited these colleagues that same year. Some, like professor at the Research Centre for Transcultural Studies in Health in Middlesex, Rena Papadopoulos, and nursing research fellow at the University of Central England, Birmingham, Paula McGee, are well known; others less so. All were fervent about the effects of racism on them personally, their nursing colleagues, their patients and the nursing profession.

For six weeks I visited nurses and midwives involved in clinical practice, teaching and research. We talked about the tack of black nurses in senior positions in all fields of nursing, the tack of knowledge of pain control for sickle cell anaemia, the plight of immigrants, the effects of blatant racist remarks, biased health services and so on.

My first visit was to a Pakistani pre-school teacher who had published an article in the Nursing Times about the racist attitudes of some health visitors. She had set up an organisation to combat the negative effects of such attitudes on young children and to promote positive responses to children of different races. This was sparked by a personal experience she had had of a hearth visitor visiting her own child and imparting some negative attitudes. I spent time with author and social worker Lorraine Culley at the Mary Seacole Research Centre in De Montfort University, Leicester. Cully's research had contributed to the examination of racism within the National Health Service. Talking with her sparked my interest in Seacole's life and the racial slurs she experienced under none other than nursing pioneer Florence Nightingale and her colleagues. When Seacole applied to go to the Crimea to nurse wounded soldiers, the war office refused to interview her because of her ethnicity. Nightingale also rejected her as a nurse and called her "a brothel-keeping quack". Seacole funded herself and went anyway. (1)

I also visited prominent nursing authors involved in novel transcultural nursing concepts, which have some similarities to cultural safety. They were keenly interested in the cultural safety literature I took with me and were very welcoming. Other reading nursing authors' thinking on reflective practice brought up concepts that also linked to cultural safety. Reflecting on that experience, reading Irihapeti's thesis on cultural safety (5) and remembering stories told to me over the years, it is clear racism is still rife within nursing in this country, as it is in others. Sometimes groups outside the so-called "mainstream" are accused of being over-sensitive in their response to remarks made about them or to them. So often, those who make such remarks fail to realise the racist attitudes or other prejudice implicit in such remarks. The British pre-school teacher who criticised the attitudes of some hearth visitors knew how important it was for children of different racial backgrounds to have their identities valued. Challenging hurtful comments and helping people think about the effect their words may have on others are vital if we want our hearth systems to be culturally safe.

I will always remember a Pacific nursing friend once telling me, "My biggest hurt was when someone flicked my nursing badge with her finger and asked me why I was wearing that. I answered that I had earned it and it had been hard work!" Flicking my friend's precious nursing badge had been insult enough, but the insinuation that my friend was not capable of gaining a nursing qualification was very humiliating to her.

Nurses from different ethnic backgrounds have to contend with humiliating comments like this every day. No matter how trivial the slight may appear, the recipient will register it. When such disrespect continues, there is a residual effect, as the teacher in Britain was all too aware. Coupled with individual disrespect is organisational discrimination where racism is used to keep different groups apart. During my visit to the UK, a Jamaican nurse with a PhD and considerable expertise in sickle cell anaemia told me she could not progress beyond her junior lecturer position nor could she get a clinical post in her specialty. Her experiences are borne out by the literature. (3)

Stories of Aboriginal and Torres Strait Island nurses told in In Our Own Right show how hard it is for them to be accepted as nurses in Australia. (2) It is not surprising that Aboriginal and Torres Strait Island nurses and Maori nurses have an affinity due to the impact of racism, a product of our colonial histories.

Fighting racism can bond all nurses. Keeping certain groups of nurses excluded from promotion or recognition of expertise causes nursing ranks to sprit and weaken. Reducing such institutionalised racism is the responsibility of all nurses. To prevent racist insults, all nurses need to be aware of what we say and how we say it. Being constantly aware and looking out for organised racism will strengthen our profession and prevent repercussions for our patients.

Diana Grant-Mackie, RN, BA, MN, is a retired community nurse from Auckland.

References

(1) Robinson, J. (200) Mary Seacole: The charismatic black nurse who became a heroine of the Crimea. London: Constable.

(2) Goold, S. & Liddle, K. (2005) In our own right: Black Australian nurses' stories. Queensland: Maleny, eContent Management Pty Ltd. Order at http://inourownright.e-contentmonagement.com/.

(3) Beishon, S., Virdee, S. & Hagell, A. (1995) Nursing in a multi-ethnic NHS. Oxford: Carfax.

(4) Goold, S. (1995) Why are there so few Aboriginal registered nurses? Issues in Australian Nursing: 4. Melbourne: Churchill Livingstone.

(5) Ramsden, I.M. (2002) Cultural safety and nursing education in Aotearoa and Te Waipounamu. Victoria University of Wellington PhD thesis.