As well-intentioned as healthcare professionals are, discrimination still occurs in the workplace. While some examples of discrimination and oppression are overt, many take the form of microaggressions.
A microaggression refers to a comment or remark, sometimes subtle or unintended, that is discriminatory towards another person based on being a member of a marginalized group.
Especially in healthcare, where employee conflicts can impact patient outcomes, engaging in productive practices for managing microaggressions is beneficial for everyone.
There are a few types of microaggressions you may encounter as a professional in a healthcare setting. It’s important to understand the differences between them before putting the 6 steps to use.
A microassault is the most overt of microaggressions, a somewhat tempered derogation like “It’s a shame that you got pregnant, you wasted a spot in this competitive program.” This implies that a woman “took” a spot from a male applicant and that her intent is to not return to her field because she’s starting a family.
A microinsult conveys rudeness and insensitivity about someone’s heritage. For example, “You’re getting the mild sauce? I thought Mexican people like spicy food.” This creates the notion that Mexican people are a monolith and have the same individual taste preferences.
A microinvalidation is a comment that excludes or negates the feelings or experiences of a person from a marginalized group. For example, “We’re using a new edition of this textbook that you’ll have to buy, but I don’t want to hear any moaning and groaning about the cost cutting into your party budget.” This assumes students would be inconvenienced by purchasing a book as a superficial additional expense, not considering the genuine budget constraints of students from a variety of financial backgrounds.
The 6 Steps in Action
For our purposes, let’s consider an example. A Black nurse presents a medically complicated patient to several medical students that are on the unit for a six-week rotation. After he finishes, a White female medical student approaches him and says, “Wow, you are so well-spoken.” You are the charge nurse on the unit, and your nurse, the target, comes to you and recounts this incident. How do you proceed?
Identify the roles and forces at play in the incident
First, identify your role in the microaggression, a target, a bystander, or a superior, and also within the organization. In healthcare, strong and enduring hierarchies exist within various disciplines as well as between them, which only compound the societal forces at play that enabled the microaggression.
As a person in a leadership role, if a subordinate comes to you to share an incident of bias, it is crucial to listen thoughtfully and believe them, as well as work through next steps to identify an action plan. Saying something like “I’m sure she didn’t mean it like that,” or “I think you’re reading too much into it” will only lead to staff disengagement, distrust, and eventual turnover.
Identify the communicator
The communicator is the person tasked with addressing the microaggression with the offending party. An individual in a leadership role may be in a better position to address the matter with the offending party, and your willingness to act as the communicator may vary based on your role in the incident.
As a charge nurse in this example, consider whether you would address this incident with the student, or go to the resident or attending supervising the medical student. What are the consequences for each, for you, your staff nurse, and the student? The student is receiving a grade for the rotation, and you want to make sure your staff is aware that you will stand up for them and this type of microaggression is unacceptable.
Build the message
Check your own biases and beliefs. Does the message align with your own interests? Do you have a shared identity, racial or professional, with the person you’re confronting? If not, can you create a common, non-stigmatized identity? In a healthcare setting, this could be promoting camaraderie between staff on the same unit, discipline, or institution.
If you are the designated communicator, this is an opportunity to implement The Sandwich Strategy, which is to give a compliment, the difficult feedback, and then another compliment. For example, you could say to the medical student, “I’m glad to see that you are excited about working with our patients and connecting with our staff. While you may have intended to compliment our nurse for his strong presentation, the way you communicated it implied that the default for a nurse, a male, or a Black person is that they would not be well spoken. As members of the university hospital family, I know it’s important to all of us that we communicate effectively with one another and foster good relationships. We’re looking forward to having you on the unit for this rotation and helping support your personal and professional growth.”
Review the message
Tone and content are both extremely important when delivering a message about an incident of bias. Consider whether your message includes constructive feedback that you can state clearly. If you are acting as the communicator but were also the target of the incident, are you too activated to communicate effectively? Consider these factors as you review your intended message prior to its delivery.
Whenever addressing an incident of microaggression or bias, it is important to focus on a specific behavior, not an inherent quality about the person. For example, say “The comment you made was insensitive and inappropriate,” instead of “You are insensitive and racist.” Also, differentiate between intent and impact. While someone’s intent may have been a compliment or benign statement, the impact on the target was different, and by addressing that discrepancy, hopefully the offending party will consider possible impact moving forward.
Many individuals perceive discussion of systemic sexism, racism, and other forms of bias as a personal accusation, leading to defensiveness. Defensiveness is counterproductive if it hinders someone from engaging in conversation or encouraging corrective action.
Some strategies you can use to dismantle defensiveness include a discrepancy strategy, where you make an individual aware of how their behavior differs from values they hold personally or organizationally, or a perspective-taking strategy, when you direct an individual to imagine the experience of the target and how they experienced microaggression. Both of these strategies tap into the empathy that is essential in health care to nurture patients and care about their outcomes.
Ongoing training and education are essential in promoting and implementing diversity and inclusion practices. If you’re in a leadership role, advocate for regular, mandatory, ongoing training on race and gender for all levels of staff. Too often, clinical staff are included in these trainings, when administrative and support staff are the first point-of-contact for patients and require these skills.
Most essentially, at any level of an organization, model the art of making a mistake gracefully. We are all going to make mistakes, despite our promoting inclusion in healthcare workplaces. You can demonstrate to your colleagues or staff that making a mistake is acceptable by implementing these steps yourself when you misstep, as well as taking opportunities to confront bias proactively, and encouraging active and ongoing education. With these skills in place, you will be moving towards building a more productive, communicative workplace.