Practice Expectation Spotlight

Recent events across North America remind us that systemic racism still exists. Practice Expectations call us to work in a manner that combats racism by supporting social justice and cultural safety. Read the scenario and definitions below and reflect on your practice.

Davis Whyte RN and Clair Broan RN(NP) decided to look at their own practices with their clients, to determine where they may be taking part in practices that either are not culturally safe or do not support social justice.

They both work in a busy environment where clients come from a variety of cultural backgrounds with a wide range of family and socio-economic supports.  The health needs of their clients are high and resources are limited, but when they prioritize, they meet many of their clients’ health care needs. In prioritizing their workloads, they wondered if they inadvertently put the needs of clients who may appear more socially advantaged or with easier needs to meet, over people whose needs are more difficult or those who experience greater social disadvantage?

Clair and Davis are aware from previous experience that critically looking at their own practice in this manner can bring up some tough discussions and feelings. So, they agreed to the following reminders adapted from Robin DiAngelo to aid their discussions:

  • Systemic racism goes beyond individual intent to collective group patterns.
  • We may or may not be aware of racism for it to continue.
  • Strong opinions may not be based in evidence-informed knowledge.
  • People have a deep interest in denying oppression that benefit them, often whether or not they realize it.
  • One’s racial position affects their ability to see racism.
  • Putting effort into protecting rather than expanding their current worldview prevents intellectual and emotional growth.

They began with a review of the Entry-level Competencies for the Practice of Registered Nurses knowing these apply to RNs.  In their review, the following competencies stood out:

  • As advocates, RNs support healthy public policy and principles of social justice.
  • As scholars, RNs engage in self-reflection to interact from a place of cultural humility and create culturally safe environments where clients perceive respect for their unique health care practices, preferences, and decisions.
  • As leaders, RNs take action to support culturally safe practice environments.

Upon their review of the Entry-level competencies for RN(NP)s, they were then reminded that in addition to the RN competencies, entry-level RN(NP)s use appropriate communication strategies to create a safe and therapeutic environment for client care including taking action to support culturally safe practice environments.

Clair and Davis discussed a recent practice situation where the client expressed a lot of frustration towards his health care team.  He would say he felt disrespected and disengaged from the care he received, to the point where his health status plummeted requiring an emergency room visit.  On discharge, he returned to their service then continued disengaging despite their best efforts.  They wondered what they were missing and considered why this client did not feel they were demonstrating respect for him despite all of their efforts to remain polite and caring.  They asked themselves if they took enough time to ask and receive his input on his goals, values and care planning.  Were there missed opportunities to learn about him? Perhaps there were elements of his identity, culture and community they were not paying attention to?  In prioritizing meeting their workloads on a daily basis, did they miss prioritizing his views of his health care needs?   With their reflection, they put together a plan not only to reach out to this client in a new manner; but also brought their thoughts back to their team so they could review their service as a whole.

We would like to invite you to reflect on your practice with an eye to the entry-level competencies, particularly the ones relating to social justice and cultural safely.  As you do this, consider these definitions from the entry-level competencies:

Cultural Humility: a process of self-reflection to understand personal and systemic biases and to develop and maintain respectful processes and relationships based on mutual trust. It involves humbly acknowledging oneself as a learner when it comes to understanding another’s experience.

Culturally Safe: an outcome based on respectful engagement that recognizes and strives to address power imbalances inherent in the healthcare system. It results in an environment free of racism and discrimination, where people feel safe when receiving health care.

Social Justice: the fair distribution of society’s benefits, responsibilities and their consequences. It focuses on the relative position of one social grouping in relation to others in society as well as in root causes of disparities and what can be done to eliminate them. 

References and Resources

Entry-level competencies for the Practice of Registered Nurses (2019)

Entry-level competencies for RN(NP)s

Cultural Safety Respect and Dignity in Relationships

Reading Guide for White Fragility

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