Article Figures & Tables
Tables
Level Description 1 — Discourse structures Identify and examine talk and text: language and words used by participants. 2 — Social structures Identify and examine social, institutional and systemic processes, policies or practices identified by participants. 3 — Cognitive structures Regarded as the interface between the discourse and social structures. Identify and examine the perception and meaning ascribed to the experience or phenomena by participants. Component Description of component Strategy performed by researcher Credibility The degree of confidence in the truthfulness of findings. Peer-debriefing: weekly supervisory meetings, monthly expert committee meetings, consultation with African Nova Scotian health advisory group.
Reflective journaling.Confirmability The degree of neutrality of the study’s findings. Findings are based on participant data and not the bias or motivation of the researcher. Provision of an audit trail detailing the process of analysis. Reflective journaling. Dependability The extent to which the study can be repeated by other researchers to achieve similar findings. Inquiry audit: involves an external review and examination of the research process, specifically the analysis. Transferability The ability of the research findings to be applied to similar groups or populations in other contexts. Thick, detailed and rich description of methods, which permits readers to determine whether findings are transferrable to their problem. Area Theme and subthemes African Nova Scotians as a distinct people Situating African Nova Scotian identity The power of socialization: setting the foundation
“We are not homogeneous”: a place that feels like home
Navigating social constructs
The leaky pipeline in education Early education: from colourblind to invisibility
Transitioning to postsecondary: patching the leaky pipe
Fitting a mould: a nontraditional student in a traditional institution
An ethic of care “Caring is in my blood”: an intergenerational tradition of care
“My duty to educate”: leaning in and taking the lead
Caring for the self: on mental, emotional and spiritual well-being
Institutions of care “Black tax” in nursing Nursing as a service: the blending of art and science
Nursing politics: navigating intraprofessional tensions
Nursing education: primed for praxis
Invite only!: gatekeepers, policies and structural design
Nova Scotia health care as an archaic institution Who is at the table?: inclusion beyond tokenism
Competency gaps: mistrust, discrimination and patient harm
Community-oriented care within a medical-based model: providing the best care
Leadership philosophy and practice Leadership reimagined: lifting as we climb “It’s part of your job”: leadership as integral to nursing
Along the pathway to success: climbing the professional ladder
Black feminist leadership: a practice and philosophy rooted in community-oriented care
Theme Subtheme Illustrative quote Situating ANS identity The power of socialization: setting the foundation Well… I grew up in a rural community… in a town as the only biracial family at the time. There’s a lot of challenges, let me tell you. I went to an all-white school. You know, you get the name calling. I was the kid that wore the braids … that stuff. (R#12)
I grew up in Nova Scotia. And we know the battles that we faced … in a rural town. And nobody understands the struggle like we understand the struggle. Actually, when you try to express your struggle to … someone that’s not lived the Black experience, they’re totally oblivious, and [that] actually is quite invalidating. They actually discount how you feel and tell you how you shouldn’t feel that way because, “Oh, we just don’t see colour and we accept everybody for who they are.” It’s like, oh, I’m glad that’s your experience but that has not been my lived experience. (R#3)“We are not homogeneous”: a place that feels like home We’re not at all homogeneous. And Nova Scotia’s Black community is changing very quickly because in the 80s and the early 90s, we had such a huge migration of our Black community to Ontario. All of my ancestors, from like 300 years back, have all been from here. … You definitely see that difference of experience when you have blending of other parts of our diaspora that are coming into Nova Scotia. And you have this wonderful diversity that’s growing. But you also have a lot of people who don’t understand the experience of Black Nova Scotians. (R#13)
I remember saying to my mom when I had finished nursing, … “You know, I wonder if I should come home. I wouldn’t mind trying to live in Halifax and nurse there.” And she said, “Don’t come home, child, they don’t make the same money there as they make everywhere else. So just stay behind where you are.” I still remember that. (R#4)Navigating social constructs Lately I’ve seen these little comments on Instagram, on Haligonia.ca, “Oh, all that stuff that’s happening in the States, it doesn’t affect us here.” Like if you’re Black, it’s going to affect you … . Saturday was a sad day for me. … every time I was on Facebook or Instagram, just seeing all this stuff, and I’m like I need to take a break because I can’t take this. And I don’t even think I’d go to a march because I’d start crying because it’s like this is what I have to do because I’m Black, just to be Black? (R#16)
When I speak up, there’s the stereotype of a Black woman who’s angry. So I have to kind of tone-police myself sometimes because I know how I will sound. You have to think about your career. And you don’t want to sound like the angry Black woman. Not that you should have to police that, because anybody else could say the same thing you did in the exact same tone, and it will be interpreted as, wow, what an assertive person. (R#13)
I think I’ve just become … I don’t want to say harder, but I have just learned to kind of not take it personal. Because I know that there are a lot of people out there who are ignorant to different cultures. They don’t see the minority as being people who can do this kind of stuff. … Like be nurses and doctors … Because they come from a different time. I make a joke out of it sometimes. Other times I won’t even really acknowledge it. I guess it just really depends on my mood for the day. (R#7)The leaky pipeline in education Early education: from colour-blind to invisible I went to a local high school. And over there they weren’t really focused on certain people’s career paths. I don’t want to say they weren’t looking at the Black folks, but they weren’t. (R#15)
No one in my family had gone to university. I’ve never had a university experience to draw upon. And that’s something that I think is huge. Because I didn’t have that background to know what university would be like to even know that it might be a possibility. So that really targeted me toward going to college because that just … seemed like an easier flow or way to get into a program. I had no idea about university at all. And I didn’t have the support there. And even through school, I didn’t have the guidance counsellors or anybody saying, “Why aren’t you going to university?” Which in hindsight is crazy because I was on student council, I had good grades, I was involved in different extracurricular activities. There was no way that I wouldn’t be able to manage university. But it was just never a conversation that was ever had. (R#9)Transitioning to postsecondary: patching the leaky pipe When I was younger, I went to a nursing camp for Black students. So that also helped me to say, okay, this is what I really want to do. We did things that nurses do. Like doing needles and like putting on little finger casts and stuff like that. So now, they have a camp in the summer which was similar to the camp that I attended when I was younger. Strictly for Black students in junior high school, just trying to get them introduced to health care. So whether it be nursing or medicine or physio … So they start them off earlier, in junior high. So that when they get to high school, they can pick the right courses … their sciences and their math. (R#7)
So what I loved is that camp that I was a part of when I was a nursing student. And it got students … in grade 8 or grade 9. Because the goal was before they went into high school, and having an idea of what courses they would need to be able to set themselves up to be successful to get into a nursing program. Now, that was just at a local level of Halifax. Which I guess is where the biggest population of ANS students would be. But I know I would have valued an experience like that when I was in junior high. I did have the opportunity to go to science camp in a rural community. And again, I was the only ANS student. So I just think having specific opportunities for ANS students, whether it’s nursing or health professions, I think experiences for learning in youth are huge. (R#11)
That’s when I heard about TYP. I filled out the application forms, applied. And I’ll never forget the day I saw the letter. And the letter said “you’re accepted.” And that day I was like my life is just going to be changed. (R#16)Fitting a mould: a nontraditional student in a traditional institution We talked to the young people, young women who were pregnant. Your life is not over. It’s harder. Because I went back to school. I did all my education except my high school education as a married woman, with children. And if you really want to do it, it takes a lot out of you, but you can do it. If you’re a mother and you’re a wife, and you’ve got responsibilities, it’s harder to do it. But it’s still attainable … you can do it if you want to do it. (R#2)
Me and my sibling were the first in the family to go to university … I didn’t really have anyone to look to in the health care profession. I didn’t really know many nurses or doctors because there ain’t none of that down here. (R#15)
I was self-motivated because I thought about what an opportunity for me … And my dad always was like education is so important. Because my dad’s parents, who are both ANS, they were denied those opportunities. So, for me, it was always about valuing this as an opportunity that I’ve been given and not to waste it. Not everyone is going to think like that. That’s just my experience of what kept me moving forward. My grandfather couldn’t read. He was illiterate. I’ve been very, very blessed to have a plethora of education opportunities that have set me up so that I can have the job that I want and live a comfortable life. And that’s not lost on me, that that’s from the sacrifice of others in my family history. (R#11)An ethic of care “Caring is in my blood”: an inter-generational tradition of care I didn’t have big encouragement, other than from my grandmother. Going to my grandmother’s house, I’d always seen her in white uniform coming home at 3:00. I can remember her saying, “Come over and visit me.” And I always remember hanging out the line of clothes, the uniforms and looking at them. And seeing her taking safety pins out of her pockets and nail clippers. … And then my mom always had me ironing her white uniforms growing up. … It started off with going, as a child, in and out of nursing homes. That’s where it started. I’d visit my grandmother and go to my mother’s work. (R#12)
When I was young, my grandmother had Alzheimer’s. So me and my cousins would take care of her a lot. And they always knew that I wanted to do something in health care. So whether it be nursing or medicine or something along those lines, I always knew I want to do something that way. (R#7)“My duty to educate”: leaning in and taking the lead You have your patients that are prejudiced or racist. But I always go back to thinking, okay, well, that’s the area where they’re coming from. However, it’s my duty to educate them. (R#8)
Personally, it gets exhausting because it shouldn’t be my job to have to explain these things to people. But if I don’t then nobody else is. And I see other colleagues, other Black colleagues who struggle with it because they’re either Black and new to Nova Scotia and dealing with sort of that silent racism that we see far too often, or they’re from the Black community here but haven’t taken on that responsibility within a leadership role and feel like they don’t have a place to say it. (R#13)Caring for the self: on mental, emotional and spiritual well-being I have better coping than I did back then. And the type of work that I do is extremely helpful for that. So I don’t get stuck. I don’t get stuck with it like I used to get stuck. Yeah, it still happens. And then when you confront people, they’re less likely to come back at you. And that’s why I find my courage, it’s like if I deal with this now then they’re not going to come at me that way as much. … If I show them my comfort with my Blackness then they can’t use my Blackness as a weapon against me. (R#3)
I say my little prayer on my way to work every day. Lord, let my hand do your work and your work only. (R#18) Don’t do what I did and play yourself down. Be proud of who you are and let that emanate from who you are. (R#4)Note: ANS = African Nova Scotian, TYP = transition year program.
Theme Subtheme Illustrative quote “Black tax” in nursing Nursing as a service: the blending of art and science I think sometimes people have to remember that we’re there to care for the patient. So any of our own personal feelings need to be left at home. (R#18)
I mean it’s a good profession. It pays well. But you’ve got to be in it because you love it. And sometimes you can even say to staff members — “Well, why are you even in nursing if you hate it so much?” (R#12)
Then it would come to, “Is [participant] on today? I don’t want you. I want [participant] to come in.” It is because I would take the time, right. Then you would have family members say, “Oh, my gosh, [participant], you stand out above everybody else. It doesn’t matter if they need to use the bathroom. You’re only supposed to be doing medication. But you have no issue taking them to the bathroom or changing them.” And I would tell them, well, I’m here to care for them so it really doesn’t matter what they need, that’s what I’m here for … I’m treating them like humans. (R#8)Nursing politics: navigating intraprofessional tensions I felt like I was never going to fit in. I felt like I would get common ground in a conversation where like I had children, and a lot of these nurses had children. So, I would say, “Oh, how are your kids? Where do your kids go to school?” But I very much felt left out in those conversations … I thought maybe it was me, maybe I was aggressive, maybe I came off too harshly. But I don’t think so because I always knew what I wanted to be taught. So I can’t really say that there’s a nurse that sticks out in my mind as someone who took me under their wing and mentored me. And I think that’s what led me to always strive to make sure that that never happened to somebody else. And that’s why I have such a strong sense of mentorship today with the nurses. (R#4)
They should be helping me out. But these were older people that have been doing this for 5 million years. They’re jaded. They’re on their way out the door. They’re ready to retire. They’re sick of the place. They’re sick of the politics. They’re like in their 70s. Which not all of them are like that. It just so happens that people that unfortunately I was around, that’s how they were acting. (R#16)
I mean it’s sad to say that because there aren’t enough of us … I feel I always have a different experience than somebody else. I always feel like I have to do things 100% right because if I don’t then the next nurse will come on, and the patient will be like, “Well, it was the Black one,” and everybody knows who it is. So I found that it kind of made me work harder and want to be better for myself and for my patients. Always keeping my head high and owning up to everything that I do as a nurse, making sure that my assessments are good, and just being a great leader for the patient and for the interdisciplinary team. (R#7)Nursing education: primer for praxis In my nursing class, it was me and another Black girl in our whole like class of like 180 or 160 students. So as a student, when I would go in our clinical group, I always felt like I stood out. (R#7)
We’re like taught from a white perspective, a European perspective. I found that in classes they would teach things that weren’t true. We did the Tina simulation where you talked to Tina on the computer. You had to like interact with her and try to give her. … You had to be good at asking questions so you could get the actual answer. So they were saying that there were all these things wrong with Tina. And some of them were true. But there was 1 thing that they commented on, which was the darkness around her neck and how that was a health issue. And it can be, but lots of people who are darker complexion just naturally have that discolouration around their neck. But they were putting it in all my classmates’ head that that’s just automatically wrong. So I’m like, you’re going to go into the workplace and you’re going to offend someone who’s Black. And guess what, you’ve just ruined that relationship. So I felt like they were just giving false information. Also when they would cover a topic of anyone who wasn’t white, they would just be like, “Oh, you’ll see something different.” But they never told you what you would see that was different. They’d be like, “Oh, you’re looking at oral mucosa. And for someone who is white, it will be pink. And for someone who is like black, it’ll be a different colour.” But then the next topic just starts. And you’re like, well, what colour is it going to be? Like how am I going to save lives if I don’t even know what’s going on? (R#14)
There were some heated topics. I remember it was just me and 1 other ANS student in this class because we always tried to stay in the same classes together just for support. … And I remember there were some heated topics about employment equity and affirmative action. And, of course being a predominantly white class, there were some people who would say “I don’t believe in affirmative action.” And I was like, wait a minute, like, no, no, no … I hate to bring up history, and the social determinants of health, and how we have systemically been oppressed. And I hate to bring up the Black card, as people say. But … we are in the condition we are based on systemic issues, historical issues. Like there’s nothing we can do change that. But I feel that white people just don’t understand that. And I felt like at that point, from a leadership perspective, I was advocating for my population and my community. That was big in a nursing school from a nursing student perspective. (R#10)Invite only!: Gatekeepers, standards and structural design It’s at the School of Nursing. When you go there and you fill out your application forms. She was showing me the papers. And I’m looking at the courses. I was like oh, I can’t wait to take this course, I can’t wait to take this class. And she’s like, “Well, you’ve got to make sure you get in first.” And I was like, oh, I’m pretty sure I’m going to get it … I’m like no, I know I’m going to get in. And she’s like, “Well, don’t start picking things now. You better get in first.” (R#16)
If I had walked away upset and not spoke with anybody, that would have changed my whole life. It was potentially life changing… because I wasn’t accepted into any other program. I didn’t apply for any other programs. So that was my first experience with the School of Nursing. (R#3)
I feel very much that if I was Caucasian, I would have been further ahead than what I am now … it feels like the old boys club or the old girls club. And, it sparked me into almost writing a book called “If only they could see me” or “If they could see me.” I’d write the story about my life and what it’s like. But I really do think that my race has a lot to play with the fact that I haven’t been in leadership positions. … And, I guess one has to sort of resign themselves to the fact that it is what it is. But I really do feel that if I was born a different colour, I would be a lot further ahead with the experience that I have. (R#4)Nova Scotia health care as an archaic institution Who is at the table?: Inclusion beyond tokenism I’m a big advocate for Black people in the health care field because I feel it’s needed and it’s important, especially in Nova Scotia, because we have such big Black communities. And like I said, for them to feel represented in the health care field. When they see you, it’s amazing. It’s a good feeling … I am a big advocate for nursing and trying to get more Black nurses in the hospitals because I know the way the Black community feels when they see a Black person. It’s like I’m the best thing in the world. It doesn’t matter who I am, any of that stuff. (R#7)
Patients have stated how good it is when they come into this place and they see that there are Black nurses here that understand what they’re going through, who may have been in the same shoes that they’ve been, who have dealt with racism at the workplace, who have dealt with racism and classism, in Nova Scotia. They feel great about having someone that understands and that knows. They don’t have to explain everything because we understand. So that’s one reason why I think we need Black nurses — because we need to mirror our community … why shouldn’t we have Black nurses? Why shouldn’t we have Asian nurses? Why shouldn’t we have people that represent this community? But Black nurses are crucial, right. In this space where I’m working, we need to have Black nurses. (R#6)
We should have a voice at the table. And any programs that they’re setting up should involve us. We should be involved. For example, I’m feeling really proud that yes, we have a person who is the ANS health consultant. However, for 10 or 15 years, we’ve had the gay, lesbians; we’ve had the Acadians. So why are we always just an add-on? … I think that it should be automatic when you’re setting up a program of any sort … you should cover everybody, not just be an add-on, and not be told that your numbers are small. (R#5)Competency gaps: mistrust, discrimination and patient harm We’ve been a marginalized population in Canada, let alone Nova Scotia. You have some patient advocates, like Aboriginal patient navigators. Do you have any Black patient navigators? You know, there’s nothing like that. So one of the things I see is we’ve certainly not done ourselves any favours with bringing up anything to do with Black people. (R#4)
I had a patient from our community. And they were brushing her hair. And I said, ‘whoa, she needs oils in her hair, she needs grease.’ And they’re looking at me like I’m crazy. And I’m saying she needs lotion on her skin. Put some cream on her. … Our skin needs that daily. (R#8)
Even as far as when Black newborn babies are born, they have Mongolian spots. Well, I think everybody knows what they are now, hopefully. But, I recall a woman who came to the Black health program, she said that they called community services on her when she brought her baby in for a check-up. Community services was called. She was put in one room, her baby was put in another room because her baby had bruises on his back. And it was Mongolian spots … I guess the other reason is so we can add to the knowledge about our race, about Black people, you know. … There just needs to be more information. Not only just understand things that are physical, like sickle cell anemia, like Mongolian spots, but also to understand the history. What has that person encountered in their life? What have they dealt with before they come into a clinic or before they can go into a hospital, and they’re upset and they’re angry because you said something? Can we just bring another perspective? Can you have somebody who understands, who can shed a little light on that situation? (R#6)Community-oriented care within a medical-based system: providing the best care I think working in acute care and seeing the lack of representation from the ANS community accessing services. Not having that representation and not having that reflected within the workforce. Because I was the only Black nurse. There were some other allied health workers. But not having that representation … I think how important it is to have professionals that are representative of the patients you want to see in these programs … I know there are youth out there that could benefit from these programs and services. … The structure of how some services are set up create barriers to access. It’s how the programs are structured, the staff, and some of the expectations around the programs that don’t take into consideration aspects of how to best engage with people. (R#9)
More Black people are staying home and being looked after at home. I find it’s rare to have an Indigenous or a Black person on our unit. They’re staying home longer, and being looked after at home. And it’s not usually the diagnosis of caregiver burnout either. A lot of times when it’s caregiver burnout, it’s like they’re just dropped off. “I had enough. It’s like I’ve had enough. I can’t do it anymore.” But you don’t see that so much with the Black population or the Indigenous population. (R#12)
Which is why we’ve got to take care of ourselves, mentally and physically before you try to go through a system that isn’t designed for you to be taken care of. You can’t rely on that. You have to be the one that you rely on. Then when the time comes, let’s hope we have some diversity in the field. That’s the last boat you want to have. You want to take care of yourself is what I was trying to say. (R#15)Note: ANS = African Nova Scotian.
Theme Subtheme Illustrative quote Leadership reimagined: lifting as we climb “It’s part of your job”: leadership as integral to nursing Well, that’s part of your job. No, but it’s part of your job. When you apply for your nursing license, part of it is how much professional development did you do? … I didn’t even think of that as leadership. What I thought was what’s good for the community, what’s good for my people. (R#2) I was just doing my job. Personally, I felt like I was just doing what I do. I just encourage people. I just want to see people excel and do well in their lives, and to feel that they have some control, and not feel that they don’t have skills. (R#6)
I like to think of nursing leadership as roles in which nurses are able to advance their profession. And I’m being a bit vague about what type of person that could be because I think any nurse can be a part of nurse leadership. And I think every nurse has a responsibility to be a part of leadership. I try to harp on that with nurses that I work with. Some certainly don’t have the same value as I do on the input into leadership. But I think that all nurses have that responsibility in some way. We’re a regulated profession with a certain amount of ethics and accountability to the public. And I think that part of that is taking on leadership in whatever way you can. (R#13)Along the pathway to success: climbing the professional ladder I always wanted to pursue my master’s and be a nurse practitioner. So I’m trying to keep my goals in mind. I don’t want to get too comfortable. I always had that goal in mind. I’m like master’s, master’s, master’s. (R#10)
I have noticed there’s a disproportionate amount of males in leadership roles versus the amount of males in nursing overall. … Which makes me wonder the reasons behind that. Like are women not ambitious for those roles or are men more ambitious. I think there’s probably something to be said about they’re more favoured, they’re chosen more often. And from what I’ve seen in nursing school, professors like them. It’s more effortless. Their journey throughout nursing school and through their practice. Patients, coworkers, doctors give them a benefit without having to prove themselves. (R#1)
I would love to see more involvement like tying education and health care professions together. My local tutoring group asked me to come in and talk to kids. Because … if they’re not seeing health care professionals who look like them, it’s not going to be something they think they can do. If all they’re seeing when they go into the hospital, from the Black community, are aides and housekeepers. … And not that those jobs aren’t valuable and meaningful. But if that’s what they’re seeing, that’s all they will pursue. (R#13)Black feminist leadership: a practice and philosophy rooted in community-oriented care When I think about nursing and leadership, I think about being in the community, assisting people, whether it be in school, whether it be … people in their own residence, assisting people to educate them, but also assisting them to take care of and be advocates for themselves. When I think of leadership, I think of advocacy. And I think of sharing what your community is saying, sharing what the residents in your community consider important health concerns for them, and working diligently to try to meet those needs. I’m very community-minded. … Not just nursing and being a manager or being in an administrative position in your workplace but being a leader in the community and being a champion to the community for people to be whole and to be healthy. (R#6)
But the people in the community, when someone was sick, the women of the community got together, whether it was cleaning the house, cooking food, or making pads. I remember my grandmother making quilting pads for incontinence pads. So that tradition was there too for community. And when I went into nursing, I never thought of leadership. What I thought was, oh my God, people in the community don’t know about this. What can I do? I’m here. (R#2)
I think that the concepts of nursing leadership is part of our scope and a part of our ethics. And I think that scope and ethics need to be incorporated into every single class. Because if you’re going to say that we want to foster a culture of diversity then you need to include diversity everywhere. You need to do the same thing with encouraging nursing leadership. So you have to kind of foster that along every step of the way, through every sort of course. And then among the Black community, with Black nurses. I think when you have an opportunity to have groups together, whether it’s associations … when you can have groups get together, then within that you can say we want to foster leadership among ourselves. How are we going to do that? And have something that is grown from within the community rather than pushed upon the community. I look at a lot of good models within the US [United States] because they have such a large Black population compared with us. (R#13)