Black sub-Saharan African nurses experienced incidents of discrimination and disadvantage based on their race and skin colour from their colleagues and patients after migrating to live and work in rural Australia, a new study has revealed.

The overseas qualified nurses felt unwelcome, not trusted and undervalued. As a result, they adopted various coping strategies, such as blocking their minds of the negative behaviours to adjust to being viewed differently.

Published in the Mar-May 2021 issue of the Australian Journal of Advanced Nursing (AJAN), the study, “It’s only the skin colour, otherwise we are all people”: The changing face of the Australian nurse, examined the experience of racial discrimination by black sub-Saharan overseas-qualified nurses working in rural Australia.

The study states the arrival of black African people as skilled professional migrants is relatively new in rural Australia, with the presence of black sub-Saharan African nurses in Australian healthcare facilities “changing the face of the Australian nurse”.

Led by Sophia Dywili, from the School of Nursing, Midwifery and Indigenous Health and Charles Sturt University, the study interviewed 18 sub-Saharan African overseas qualified nurses working in rural New South Wales who had migrated to Australia after being granted a 457 visa.

All participants had resigned from their full-time employment as RNs when they left their countries for Australian jobs. Some gave up senior positions, such as clinical nurse educator and district nursing officer.

At the time of the face-to-face interviews and focus group discussion, which took place in 2014, all participants worked full-time as RNs at either a public hospital or an aged care facility.

While participants described receiving positive support from their managers and some colleagues upon arriving in Australia, they quickly encountered unexpected challenges as they entered their workplaces, which they felt were because of racial differences.

Specifically, African nurses reported feeling unwelcome, and undervalued and not trusted in their workplace.

One study participant said, “There were racists among the staff”, with some not even wanting her to touch their cup. Others said patients showed discomfort in being nursed by black nurses, while in some instances, concerned relatives of patients did not want their loved ones to be looked after by a black nurse.

“She [relative] said to the nurse I was working with, “Excuse me nurse, I don’t want my mother to be nursed by a black person…in our family, we don’t do that; we don’t associate with them”.

Many of the incidents were not reported to management as most African nurses involved felt they had to deal with the issues alone.

The study found participants also felt they were not trusted, nor were their nursing skills recognised or valued by their colleagues and patients, resulting in loneliness and stress. For example, in some instances, participants needed to convince patients they were receiving the appropriate care.

“When we were new here and doing the medication round…they didn’t take the medication…and then when an Australian girl passed through, they would ask her if they should take that medication and then they took it…Obviously, you knew that they didn’t take the medication because they didn’t trust you”, one participant said.

Nurses attributed such encounters to them being of African origin. They also felt their colleagues did not trust them either and put the mistrust down to racism.

Generally, nurses felt they needed to deal with the issues by themselves.

They reported using various strategies to respond to the discrimination from their colleagues and patients to cope with being seen differently.

Some nurses suggested alternative carers for their patients, while others tried to stay out of the spotlight and attempted to block their minds of the negative behaviours and instead focus on their migration goals.

Some nurses, however, reciprocated the negative behaviours, which affected patient care.

“It seems the issue here was not just being an overseas qualified nurse; it was about being black and being an undesirable,” authors write.

“Regardless of participants possessing the required qualities and skills, some people had problems with this dark skin. The subtle discriminatory behaviours of patients and their relatives avoiding care from black nurses, nurses not providing help to their black colleagues with heavier workloads or managers limiting opportunities for black nurses to advance their careers, is not acceptable.”

According to researchers, the study’s findings illustrate the power of welcoming people to their new country, the existence of discrimination by race at their healthcare facilities, and the importance of trust and teamwork at the workplace. The study also highlights the resilience of black sub-Saharan African overseas qualified nurses in times of adversity.

Ultimately, the study found there are pockets of racial discrimination that need to be addressed within the Australian healthcare system, as they undermine the confidence of overseas qualified nurses in their professional practice.

Even though health services did not tolerate racism, more proactive processes could have been put in place to identify and prevent such racist intolerance, authors argue.

They suggest Black African nurses need more support from nurse managers to feel safe in their workplace and facilitate their integration. Nurse managers also need to be more vigilant in monitoring staff interactions in their units and intervene when racism is uncovered.

“Findings indicated that there were nurses who did not engage in such behaviour [racial discrimination], nurses who saw and heard these racist incidents but did not act to prevent them.

“A little more support would move those nurses a little higher above being just nonracist and being responsive to such incidents.”

To read the complete study click here