Visions Journal

A feminist and antiracist lens

Jue Luo, RN

Reprinted from the Is It Safe to Be Me? Creating inclusive and accessible workspaces issue of Visions Journal, 2024, 20 (1), pp. 28-30

As nurses, we often face abuse and violence at work. Personally, I've had my fair share of being yelled at and even physically assaulted. I recall an incident where a patient, furious at the facility's policies, punched me in the head. This attack left me shocked and humiliated. Sadly, my experience is far from unique. Many of my colleagues have endured similar violence, leading some to sustain serious injuries and even leave the profession.

The rest of us keep showing up. But we're only human, and wearing that professional façade too long takes a toll. Unresolved trauma from witnessing or experiencing workplace violence affects our performance and mental health. A province-wide survey in 2019 underscored high rates of mental health symptoms among BC nurses, with about half reporting symptoms of PTSD—that’s 1.5–3 times higher than the national average.¹ And statistics show violence toward nurses has increased in BC over the last two decades.² Personally, I see a link between these two realities.

As frontline workers, we interact with individuals who tend to be distressed due to health concerns. In BC, local issues like forest fires and the overdose epidemic have also contributed to collective trauma and stress. Frustration with our strained healthcare system has led many to direct their anger at nurses. Since the COVID pandemic, I've noticed a rise in violent incidents experienced by myself and my colleagues alongside those reported in the news. This trend is backed up by a national poll showing satisfaction with healthcare among BC residents dropped by 36% from 2020 to 2023—the largest decline among all provinces.³

Digging into research, I found gendered and racialized perceptions of our profession that have deep historical roots. These troubling perceptions intersect with challenges faced by the BC healthcare system and perpetuate violence toward nurses. We need to address structural sources of violence that compromise nurses' well-being. As an Asian female nurse and recent immigrant to Canada, I'm willing to share my insights and contribute to this important discussion.

Gender bias and devaluation of emotional care

Even though more men and people of different genders are becoming nurses these days, nursing is still mostly viewed as a career for women. As of 2021, more than 90% of BC nurses were female.⁴ When violence happens for us at work, it's often brushed off as part of the job, mimicking how society normalizes violence against women.

Feminist literature points out that women in caring roles, like nursing, are expected to show endless empathy.⁵ This perception makes patients and visitors more likely to get aggressive towards female nurses and intrude into our personal space. Some of my colleagues have been subjected to offensive comments about their bodies and unwanted touching. Alarmingly, work-related sexual violence experienced by BC nurses has increased drastically over the last two decades.²

Nurses often don't receive the respect we deserve compared to doctors, who are viewed as the ones making critical clinical decisions. However, I know firsthand that the emotional and relational care nurses offer plays a significant role in healing. We invite patients to ask questions, listen to their fears and provide comfort.

Unfortunately, recent healthcare reforms focused on cost savings have burdened us with excessive paperwork and tasks, leaving us with less time to connect with patients.^5,6 This, combined with the ongoing nursing shortage, contributes to long wait times. For years, BC has recorded the longest wait times in ERs and walk-in clinics in the country.^2,7 As a result, some patients become frustrated and lash out.

Racial stereotypes and underreported racialized violence

Another source of structural violence affecting nurses is institutional racism. While BC prides itself on multiculturalism, clashes can arise due to different languages, cultures and traditions. In a high-pressure healthcare setting, patients or health professionals might misinterpret the actions of a racialized nurse. For example, an Asian nurse who avoids eye contact—a sign of respect in their culture—may be perceived as uninterested or unprofessional.

Personally, I've faced racial slurs from a patient who insisted on having a Caucasian nurse. In another instance, a patient doubted my competence because my English isn't perfect. In those moments, I felt hurt, demoralized and vulnerable. Repeated exposure to microaggressions can lead to emotional and physical exhaustion. It's troubling that many workplace anti-violence programs only address physical attacks and overlook racist attitudes and actions that nurses of colour encounter regularly.

A study in the US found that Asian and Black nurses were less likely to speak up about workplace violence compared to white nurses.⁸ In my opinion, this can be partly explained by the pressure on nurses of colour to fit into certain stereotypes, such as being the "grateful immigrant" (a myth that immigrants should always be thankful for their new country, even when treated unfairly).

I've found myself staying quiet when I sense harassment at work sometimes, worried I might be labelled as oversensitive. For Asian nurses, stereotypes also depict us as submissive or only capable of menial tasks, like feeding or cleaning. We can be seen as unworthy of respect, making us more prone to workplace violence.

As BC welcomes nurses from around the world to care for a diverse population, it's crucial for organizations to provide better support to newly arrived nurses of colour. Simply asking individuals to enhance their communication skills and adjust to the Canadian work culture is missing the point.

From my research and observations, the higher rates of violence experienced by nurses in BC are tied to systemic issues and stereotypes, including those related to gender and race. I believe organizations can do a better job by involving frontline nurses in developing effective strategies based on our lived experiences. Additionally, improving staffing levels is essential for nurses’ safety, as research shows heavy workloads are a primary reason for patients' dissatisfaction and aggression.²

Helping ourselves

To my fellow nurses, I want to offer a word of encouragement. It's OK to feel overwhelmed, but you don't have to face unsafe work situations alone. We can take small steps to strengthen our resilience:

• Lean on trusted co-workers. Nursing thrives on the camaraderie we build facing challenges together.

• Set boundaries firmly and be OK with saying "No." Avoid taking on more tasks when you are already spread thin.

   

• Speak up and report incidents of violence to your manager and union. Refuse to work in situations where you feel threatened.

• Get involved in workplace safety initiatives, like diversity and inclusion training, community outreach and healthcare workers’ rights committees.

• Engage in activities outside work that help you relax and recharge.

• Celebrate your cultural heritage, language skills and who you are. Never believe anyone who uses your differences to justify mistreatment.