Racial Refusals In Nursing

'Racial refusal' is a phrase that refers to the practice of patients and / or family members who refuse care from particular nurses, physicians, nursing assistants, techs and other types of healthcare workers due to the caregiver's racial-ethnic background. Nurses Relations Article

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For starters, 'racial refusal' is a term I constructed several years ago to denote the practice of patients and / or family members who refuse care from certain nurses, physicians, aides, techs and other healthcare workers solely because of the caregiver's racial-ethnic background.

Racial refusals can be inflicted upon staff members of any race, creed, ethnicity or national origin. Also, patients belonging to any racial-ethnic background are capable of refusing particular staff members for reasons that are purely race-based. Most importantly, these refusals tend to throb like a virtual slap in the face whenever they do happen to a person.

I currently live in a part of the country where racial refusals take place with regularity. In fact, the specialty hospital where I am employed is presently attempting to accommodate the racially biased preferences of a patient who has requested that no black members of staff provide any care for her.

Anyhow, these types of requests are normally accommodated at my workplace because nursing management and hospital administration wants to ensure that the facility's Press Ganey patient satisfaction scores remain above a certain threshold. In exchange for favorable patient satisfaction scores and repeat stays, management will attempt to 'WOW!!' the patient by making staff assignments based on racial-ethnic background.

On the other hand, the hospital where I work cannot always reasonably accommodate patients' race-based requests for staff members, especially on the night shift, due to the fact that every single one of the night shift nurses and techs in the entire building might be from the same racial-ethnic background on some evenings.

My views on this issue might be controversial, but here they are. I feel that patients who are not actually paying for their care (read: charity care) have no business refusing caregivers due to race.

I also feel that patients who receive help from the federal government to fund their care (read: Medicare or Medicaid) have no business refusing caregivers of a certain race.

After all, people of all races and nationalities pay taxes that help fund these programs. Finally, I feel that patients who are receiving care at any hospital or other healthcare facility because they lack the education and expertise to provide their own medical treatment and nursing care have no business refusing caregivers due to racial reasons.

One more thought before I depart for the evening.

As a black female, I would prefer that these racially prejudiced patients have their requests accommodated, as contradictory as this may seem.

Here is my reasoning.

A patient who does not want me to serve as his nurse can make boldfaced claims regarding poor nursing care and fabricate allegations of abuse that could make my professional life tremendously miserable. These patients are generally set in their ways, resistant to change, frequently spiteful, and sometimes elderly.

Their racial prejudice is their personal problem of which I want absolutely no part. I would prefer to live and let live.

No matter what you do, always hold your head high in the face of a racial refusal. Even though the patient is essentially rejecting you based on your race, you are still worthy of respect, dignity and a basic right to exist in the society in which we live. It is unfortunate that some people have not changed with the times.

Specializes in ICU.
Preeps said:
Yes I agree with you. I was specifically addressing it to the OP who coined her term, "racial refusing." I agree there are racist (of all colors) out there. But just because someone declines a nurse and they are of a different race does not mean they are racist.

I suppose the difference is a racist would say I don't want a "[insert race]" looking after me. A non-racist would say "can I have a different nurse" and would accept any nurse of any race as a replacement.

We have accommodated "race requests" in the past, but normally, I just end up jealous because these type of people are usually all-around jerks, not just racists, and I get stuck looking after them. ;) Not to take away from the harm that racism does to people however.

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Specializes in Family Nurse Practitioner.

I have naturally tan skin and am from an ethnic minority, not hispanic or asian, but my accent is mainstream American. I find that both black and white patients are very comfortable around me. I've had white patients speak about "incompetent" nurses or techs from other races or ethnic groups or speak about how they are so hard to understand. I've had black patients speak openly to their family members while I'm in the room to their family members about their white nurses, mentioning them as white. Rarely do I hear of a black patient refusing a white nurse or tech. This has happened one time that I can think of.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
ausrnurse said:
I suppose the difference is a racist would say I don't want a "[insert race]" looking after me. A non-racist would say "can I have a different nurse" and would accept any nurse of any race as a replacement.

Exactly! You worded it more succinctly than I ever could.

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Ruby Vee said:
Personally, I don't think racial rejections ought to be accomodated unless the patient suffers from dementia and is having flashbacks to their time in a Vietnamese prison camp, as a prisoner of the KKK or whatever. No, it's not fun to be racially rejected and have to care for the patient anyway.....

I agree with tolerating dementia patients, as they often get fixated on small things (such as being convinced that one CNA "steals" the eggs off her plate....she doesn't GET eggs due to an allergy!)

About twenty years ago, I was the DON of a 120 bed SNF in the south, and had a perfectly alert and oriented white patient AND his family insist that he absolutely, positively could not share a room with one of "those" people (melanin enhanced gentleman, who was post CVA and quiet as a churchmouse.) I agreed to move Mr. Bigot, but made it clear that I only had ONE male bed [which was mostly but not exactly true....] sooooo

INSTEAD of his quiet former roomate, he got to share a room with a demented patient who screamed most of the day...and had even louder screaming night-terrors when it was dark. But hey, he was WHITE!! (evil grin).

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Specializes in Emergency and Critical Care.

This is such an important issue to talk about, because only we have control over our own behavior. Male nurses have been allowed to be refused by female patients for years, I have been berated for being overweight, because if you are fat you must be lazy, religion is being abused in the public, racial bigotry seems to have re-immerged instead of lessening. I'm not sure what country I live in anymore.

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Specializes in Med-Surg, NICU.

Great post Commuter!

I am a black woman as well. To be honest, I usually am more forgiving if the patient is very old and/or demented but I get very unnerved when I encounter younger racists.

I agree that if a patient can't pay for his or her own care out of pocket AND care for themselves without the help of public institutions, that patient shouldn't be allowed to refuse care based on race, etc. That being said, I have no desire to care for such people and would gladly be reassigned to a patient who DOES appreciate the care I give.

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Specializes in ICU-my whole life!!.

OP,

great topic and this one for sure opens more than a can of worms! I am extremely curious as to how patients feel about AA doctors or from other ethnicities as they lay in a hospital bed... Do the patients refuse these doctors because of their race, color...etc....? Or do these ignorant, lo IQ patients readily render themselves at the doctor's mercy to save their sorry immature derriere?

There should be equal reception regardless if a nurse or a doctor are from totally different backgrounds.

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It is sad that people don't judge someone on the content of their character. It is also very, very sad...and ignorant, when people say things like "klan country" and former Confederate states, to speak disparagingly of Southerners or Southern states. I have lived in 17 states, served 21 years in the Marines, am multi-ethnic, and spent 18 years in public school education. Interestingly, the least prejudice place I ever lived was Mississippi (2008-2012), as a rule the most prejudice people I ran across, black and white were from the Northeast. I try not to generalize, there are always exceptions. As a Principal,I handled cases from both ends, of black parents not wanting white teachers and vice versa, I never allowed their requests, I took the time to explain why and I never had to eat crow. I hope I never run into this in nursing, but if I do I'll try educating first.

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ThePrincessBride said:
I agree that if a patient can't pay for his or her own care out of pocket AND care for themselves without the help of public institutions, that patient shouldn't be allowed to refuse care based on race, etc..

YES! .......and TOTALLY off topic, patients getting their care from other people's tax dollars ought NOT get P-G surveys, either!

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I went last year for a colonoscopy work up with the NP who scheduled the doc's appts. She asked which doctor I preferred. I told her the name of the doc a friend highly recommended as we've only lived in Arkansas for a few years. She said, "Okay... um... he's black you know...does that matter?" I had to say, "I beg your pardon??" because I couldn't believe I'd heard her correctly! She just said, "You ARE in the South, you know." I wish I'd had had the presence of mind to say what my daughter said she'd have said... "Um... no ... does it matter to him if I'm white??"

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This makes me sick. I am a white RN (feeling stupid even saying that) and have been witness to several requests from patients to not have "non white" nurses or techs and it makes me so mad when management tries to accommodate. That is just saying in this day and age that racism is still alive and that it is ok. I agree with the OP's feelings on who shouldn't be able to request any caregiver....that being said, I have talked to nurses who have been requested to not be the nurse for a patient due to their race and they said the same as OP, that they would rather not have that patient for the same concerns. It is absolutely appalling that being afraid for their license is even a possibility. It makes it difficult for me to have that patient and I wonder what would happen if all of us nurses stuck together and refused to have that particular patient. I would love to see the faces of these patients when management told them that they were unable to get any nurse to care for them because they were racist! I pray I see the day when this is no longer an issue....

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My apologies if my need to post an answer to your inquiry is inapproriate. I fully realize you were addressing the author of the peice. Though I read your response, and feel compelled to offer my opinion. My hope is that it helps to address your questions...

Preeps said:
OK let me ask you this, first you "profile" the patient that you say qualifies as one most likely to refuse on the bases of race. However, you in saying most likely elderly are in a sense continuing the very same profiling and prejudice you supposedly despise against a segment of the population.

Another question, would you consider every patient who is not black who complains about a black nurse as a racist? Or could you actually consider that this patient is not prejudice and this nurse is lacking in some way to meet the needs of her patent?

To your first question - profiling is an inherently negative term. Unfortunately for all of us it's graduated from investigative jargon to a household term denoting negative intent in our assessments of those unfamiliar to us. The context you appear to use it in here seems to meet the aforementioned bar. I'd like to say to you that I don't believe this is profiling. This is because of the easily discernible bits present when one refuses care from a professional based solely upon observance/acknowledgement of the race of said professional. Sadly, there are hundreds of negative descriptors used in situations like these. I've had it happen to me personally many times in my career thus far. I don't expect it to stop anytime soon.

Yet even so, I don't believe there is an accurate profile to catalog in relation to this topic. I've been the nurse being asked to switch assignments because my co worker was refused by a patient and/or family that happened to be ethnically classified as White, Latino, African American, or of Mixed Heritage. Suffice to say, the workings of the mind and preferences of patients are not something one can discern easily from simply viewing them. This is information the patients and/or their families make known to us. And by doing so become an issue that must be addressed in whatever fashion.

To your second question - I would not immediately qualify any patient as racist. They would have the burden of proving this to me by their statements. Perhaps by their actions as well to whatever extent. And even if they are, I've only felt pity for them. There have been situations I've found myself a part of where it simply wasn't appropriate for me to care for someone. But they require more insight and consideration in my opinion. For example, the male patient I had recently that was an assault victim. He was beaten very badly by men who share my skin tone. Or, the man covered with racially inflammatory tattoos. He was unconscious, however his family and friends were quite loud and very vocal regarding refusing any care from me. I ended up caring for him anyway for a time with another staff member tied to my hip to protect me. I will go as far out of my way as is reasonable to accommodate concerns of this nature. Yet it isn't always practical to do so.

In addition, I'd like to say that in my time so far, making the assumption that a staff member with equal or greater training/certification is lacking somehow in caring for the needs of a patient is unstable ground to stand upon. I'm not certain in what you mean there, but it does raise questions for me.

Finally, it's been my experience as well that people engage in racial refusals in nursing - as it's coined, have generally struck me as having concerns regarding their medical care so far on the backburner one questions it's relevance. Having been in an ER, then ICU/etc as a critically injured patient... the respective Race/Creed/Gender/Appearance/Sexual Orientation of those attempting to save my life didn't even make it into my mind. For those that do, I question what it is that they actually need?

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