Nurse managers and their staff often face racism in the work place; Minority Nurse reported that almost half of minority nurses said they have experienced barriers in their career because of their race and educational background. In addition to institutional barriers, there is also the problem of patient racism, where patients refuse care based on the race or ethnicity of the provider. As a nurse, you might be put in the unenviable position of deciding how to handle one of these situations. Do you refuse care to the patient? Do you acquiesce to the patient’s unreasonable demand?
The New England Journal of Medicine published an article last week that provides some useful information about how to handle patient racism. The authors point out that there are a number of concerns to take into account, both legally and ethically. The situation pits a number of rights and laws against each other, including the patient’s right to refuse medical care, laws that require hospitals to provide medical care in emergency situations, and employment rights that dictate that hospitals cannot make staff decisions based on race. Nurses that have been reassigned based on a patient’s racial demands have successfully sued their employers, but if a patient doesn’t receive proper medical attention in a timely manner, facilities are equally liable.
The journal lays out five factors to consider when faced with this difficult situation:
- The patient’s medical condition: If the patient is unstable, treat the patient right away, regardless of the patient’s preference. It is possible that their current condition is impairing their mental faculties.
- The patient’s decision-making capacity: Try to assess if the patient is capable of making decisions for themselves; psychosis or dementia are important factors to consider. If the patient lacks decision-making capacity, try to persuade the patient to reconsider their request.
- Reasons for the request: If there are clinical or ethnically appropriate reasons for reassigning staff, that should be taken into consideration. For example, if there are language barriers or religious concerns, it might be reasonable to accommodate the patient.
- Effect on the provider: Always take into account the effect a decision might have on the employee. "For many minority health care workers, expressions of patients' racial preferences are painful and degrading indignities, which cumulatively contribute to moral distress and burnout," according to the article. Always try to support staff when possible, and discuss their preferences when deciding how to respond.
- Options for responding: In some situations, staffing might dictate your decision. If the department is understaffed and you cannot provide proper coverage by reassigning, try to persuade the patient.
If faced with a non-emergency situation and a patient is deemed capable of making decisions, the article suggests that it may be best to suggest that the patient seek care elsewhere; though that also has its risks depending on the availability of other treatment.
For more information on this difficult issue, including a useful decision-making tool, read the New England Journal of Medicine’s full article.