https://www.infirmiere-canadienne.com/blogs/ic-contenu/2024/04/22/est-ce-laccueil-recrues-attendaient
Study sheds light on need to address incivility experienced by students and new nurses
By Kathryn Chachula & Nadine Smith
April 22, 2024
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It is essential that new nurses engage in self-care and healthy coping mechanisms as they continue to learn and grow in their first year of practice. However, without adequate supports, new graduates will change units or consider leaving the profession altogether if racism, microaggressions, and sexism in the health-care system continue.
According to the transition shock theory (Boychuk-Duchscher, 2012), newly graduated nurses experience a tumultuous first year of practice. During the COVID-19 pandemic, the Canadian Association of Schools of Nursing (2020) warned that “nursing graduates are entering a health care system that is volatile and overwhelmed” (p. 2). This situation has contributed to unwarranted racism, microaggressions, and sexism that continue to be problematic in Canadian health care (Chachula, Dusome, & Smith, 2023), resulting in immeasurable hidden ethical, economic, and workforce costs (Elias & Paradies, 2021).
In a recent study completed by Chachula and colleagues (2023), new Manitoba graduates that included baccalaureate-prepared registered nurses (RNs) and registered psychiatric nurses (RPNs) have encountered racism and violence through witnessing or directly experiencing these events, perpetrated by other health-care professionals. These acts of incivility were exhibited toward themselves as new nurses, toward patients, or from patients toward them as new nurses in their first year of practice.
The participant narratives in the study, discussed below, showcase how these events impacted new graduates’ first year of practice.
How does racism and violence impact newly graduated RNs and RPNs?
The researchers found that these forms of violence are subtly destructive and can impair the ability of new nurses in forming their professional identity. These events negatively influenced teamwork and patient care on the units in which they were occurring. As one participant in the study stated, it left them “not knowing what to do” and “feeling like I don’t belong and feeling excluded from the team due to race … [and] having to guess why I’m being treated differently than others [or] hearing overtly racist and microaggressive comments” by colleagues. These acts influence the health and well-being of new graduates trying to adapt and grow their professional identity in nursing.
Racist remarks were experienced not only from members of the health-care team, but also from patients. As one new RPN from a visible minority stated, “Patients will call me names, although it’s not tolerated when they do that. … There was this one time when a patient was really verbally aggressive and threatened to climb over the desk and, you know, attack me.” In this instance, the new graduate’s co-workers stepped in and told the patient that such behaviour would not be tolerated.
These events underscore the need for additional protections and co-worker support in the workplace setting from patients while nurses try to provide the best care possible in environments that may be under-resourced. There is a need for educational institutions, employers, unions, and nursing associations to advocate, campaign, and teach nurses how to intervene when such violence and threats occur in the nursing workplace.
One participant in the study reflected on a situation in which nurses were in a code white (emergency with an aggressive or violent patient) and were not included in the critical incident stressdebriefing that occurred afterward. The individual was excluded from the followup meeting despite being the team member who was most affected by the occurrence, requiring treatment in the emergency department for a laceration inflicted by the patient.
As this participant progressed through the year-long research study, she came to inform us that she would be leaving the work environment related to a lack of support. Inclusion in the debriefing and a more supportive setting might have prevented the new graduate from leaving her job, together with the resulting disruption in developing her professional identity as a nurse.
New female graduates also spoke of sexism and sexual harassment perpetrated by male counterparts in the health-care team. One recalled experiencing unwanted physical touching that left her feeling shaken: “It’s just a little hand graze to the kidney. Sometimes they might palpate it a little bit, and then they slide [their hand] right off. It gives you this whole-body rush of absolute disgust.”
New graduates discussed their fear of whistleblowing when sexually harassing behaviours occurred. One stated, “I think that there have been people who have stood up for themselves in those situations, and they are the ones who have lost their jobs instead of that individual [perpetrator]. So, I would be scared in that situation.”
While self-care is important when these behaviours are encountered, standing up without fear of losing their job or needing to change workplaces is paramount for new graduates and all nurses, regardless of gender, who have entered what is supposed to be a health-care workforce that cares for others.
The need for greater advocacy and supports for new graduates
These encounters highlight the need for workplace reform that supports justice, equity, diversity, and inclusion protections and practices where violence, racism, and microaggressions are not tolerated in the workplace. Any such instance requires redress in a timely manner.
It is essential that new nurses engage in self-care and healthy coping mechanisms as they continue to learn and grow in their first year of practice. However, without adequate supports, new graduates will change units or consider leaving the profession altogether if racism, microaggressions, and sexism in the health-care system continue.
Nursing organizations, including the Canadian Nurses Association, play a key role in advocating and supporting the work of nurses in safe and healthy workplace environments. As a collective, nurses have the ability to call out violence to repair and address these harms occurring within the Canadian health-care system.
The role of educational institutions and workplaces
Educational institutions and workplaces need policies and strategies that focus on the well-being and safety of students and nurses. Policies are important in order to prevent and mitigate the impact of incivility as students and new nurses are socialized into the nursing profession.
Transparency and accessibility in policies are essential to ensure that students and new graduates feel empowered to report any incidents of workplace incivility without fear that the incivility will be repeated or escalate. Racialized students and new graduates should be included in the development of policies that incorporate an anti-racist and decolonial lens.
Educational institutions and workplaces can include strategies such as role playing and simulation exercises that provide learners of all experience levels the opportunity to practise professional and effective communication skills when dealing with discrimination and incivility, whether from patients or from other health-care professionals. This type of educational opportunity could also provide learners with experience on how to report and address such incidents, including de-escalation strategies.
Acknowledgments
This work was supported by a Brandon University research committee grant. The authors would like to thank Debra Dusome, RN, BA, Ex.AT, MA, as a co-investigator on the project and the new graduates who participated in the study.
References
Boychuk-Duchscher, J. (2012). From surviving to thriving: Navigating the first year of professional nursing practice. Saskatoon, SK: Nursing the Future. https://nursingthefuture.ca/
Canadian Association of Schools of Nursing. (2020). Nursing education during the COVID-19 pandemic. https://www.casn.ca/wp-content/uploads/2020/03/COVID-19-POSITION-STATEMENT.pdf
Chachula, K., Dusome, D., & Smith, N. (2023). New registered nurse and registered psychiatric nurse graduates’ transition-to-practice amid the pandemic: An art-based grounded theory study. Nurse Education Today, 130, 1–7. https://doi.org/10.1016/j.nedt.2023.105946
Elias, A., & Paradies, Y. (2021). The costs of institutional racism and its ethical implications for healthcare. Journal of Bioethical Inquiry, 18(1), 45–58. doi: 10.1007/s11673-020-10073-0
Kathryn Chachula is an associate professor in the Department of Nursing at Brandon University. Her research centres on teaching and learning in nursing education.
Nadine Smith is an assistant professor in the Department of Psychiatric Nursing at Brandon University. Her research interests include mental health and psychiatric nursing education.
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