Racism is intensifying for nurses of colour in the decreasingly universal Canadian health care system, subjected as it has been to creeping privatization and corporatization since the late 1970s. Even with official recognition by the Ontario Human Rights Commission that systemic racism comes in complex and subtle forms, along with a few grievances being won, and anti-racist policies and practices being put in place in some institutions; a majority of nurses of colour continue to labour in toxic, debilitating work conditions for multi-layered reasons. 

Das Gupta’s book is an important study of how multiple forms of racism play out, in an often mutually exacerbating way, in the working lives of nurses in Ontario. She summarizes these as ‘everyday racism based in individual behaviour, systemic racism, common-sensical beliefs and racist/colonialist discourses’ (114). These forms of racism and whiteness are often complexly deployed through heteronormative gender, class and ability relations in the deeply hierarchical world of health care professions and their accompanying institutions. The inhumanity of racism in nursing comes in often-disguised forms. Insidious processes of micromanagement are implicitly institutionally sanctioned and carried out by largely white managers and co-workers as a profoundly harassing form of systemic racism. The material effects on people of colour are equally profound, including a range of mental health problems, chronic disease, as well as lost jobs and other opportunities. 

The study’s purpose was to both expose the ‘common experiences, patterns, features and surface manifestations of systemic racism in Ontario’ and ‘to develop a theoretical framework for understanding systemic racism’ (11). What racism looks like, how it is experienced and how it evolves over time, varying with class situation and how other social relations, is often institutionally specific. Yet, Das Gupta presents a sickening historical continuity in anti-Black racism from slavery to the contemporary health care context. One Black nurse reported racism deployed by patients and their families who would tell her not to touch them, ‘with [her] Black hands’ often asking instead for the ‘nurse in charge’ (72). The meaning of ‘common-sense’ comes through in such vile experiences as 

Blackness in a person is associated… with roles that are servile, ‘lower than’ and inferior compared to whiteness. Thus, a Black nurse in charge is confusing for a person who is steeped in racial ways of thinking. Moreover, her Blackness also marks her as ‘dirty’, ‘polluted’ and thus unfit or dangerous to touch (72). 

The research is presented following both a theoretical chapter on the historical relationship of race, gender and class relations, and an applied analysis of the political economy of healthcare in contemporary Ontario. In her review of various conceptual orientations, Das Gupta starts by looking at the historical specificity of the process of racialization. As the chapter develops, she explores racism under topic headings of racist ideology, attitudinal, everyday and behavioural racism, and everyday racism as racist behaviour, amongst others. The conceptual overlap amongst the sections is somewhat confusing even for a reader familiar with the subject. We never get a clear sense of either the distinction or overlap between everyday and systemic racism nor what the exact difference is between a category called ‘attitudes’ and one called ‘ideologies.’ It is unclear how the relational processes of consciousness and activity would make these apparently distinct. Perhaps the source of the separation points to the complex nature of individual/institutional relationships. It may also be that the presentation of the theory is a manifestation of the cyclical mode in which she says racist praxis operates. More clarity on all this would certainly have been helpful. 

Das Gupta offers an enlightening discussion of nurses as paid workers in the healthcare system, grounding contemporary profit-driven, cost-cutting attacks in an already gendered and classed organization of the work, a system that has become yet another social environment where the customer is always right (73). That women do such paid work is buttressed by an ideology of naturalness, as such work is seen merely an extension of women’s unpaid domestic private and community duties. In the neoliberal era such an essentialist grounding has been further used against women seen as having ‘been abusing the system by taking state-funded universal healthcare for granted and not being responsible for it’ (42). 

By exploring the reality of the increasingly stratified and hierarchical organization of the nursing profession, Das Gupta complicates the common notion of nurses as middle-class professionals. This opens the door to her unpacking of the ongoing relationship between Victorian ideas of (white) womanliness, associated layered ideas of women of colour as multiply threatening (to nation and whiteness), the various forms of racist dehumanization levelled against, for example, Filipina or Black nurses, and a fundamentally racialized organization of this gender and class stratification. The result in day-to-day workplace life is a pattern of racist treatment that includes: targeting, scapegoating, excessive monitoring, marginalization, dispersion, infantilization, blaming the victim, bias in work allocation, underemployment and denial of promotions, lack of accommodation, segregation, co-optation and selective alliance, and tokenism (53-4). Relations that are generally written off as ‘regular manager-staff interactions’ (52) focusing on ‘individual incompetence or individual pathology’ (68), or ‘personality’ differences among co-workers, are exposed by Das Gupta as having a very different and selective character. 

Das Gupta carries well her orientation to intersecting social relations into the study and data analysis, vividly conveying race, gender, disability and class not as abstract concepts but as complexly lived social relations by real people. Research participants of colour reported a range of racist treatment from doctors, managers, and patients. Often the perpetrator was white but not always, as male doctors are so powerful in relation to nurses, regardless of race. However, the most frequent perpetrators of ‘put downs’ were white co-workers, often in collusion with managers. In one case, Shirley was fired for supposed ‘unprofessional behaviour’ after a number of white patients, colleagues and her supervisor complained, the latter saying she ‘felt physically and verbally threatened’ by Shirley, who herself reported feeling under racially-based attack in a poisoned environment. She was given more night shifts, had no choice in holiday time, docked pay for lateness and was subjected to racist slurs. Such toxic ‘differential management practices’ are hallmarks of racial discrimination, not uncommonly experienced ‘particularly by strong, outspoken Black nurses who are assertive in their resistance to racism’ (76). The study points to a need for similar research to be carried out in other types of workplaces. Of even greater concern is for unions to make serious political and financial commitments to anti-racist organizational change, including actively holding white workers accountable for their racism. 

—Reviewed by Sheila Wilmot, OISE/University of Toronto

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 Das Gupta (York Univ.) describes an exploratory study undertaken in 2000 that examined the common experiences, patterns, and features of systemic racism within professional nursing in Ontario, Canada. From this qualitative study, the author developed a theoretical framework for analyzing and understanding systemic racism. The book identifies complex and multiple definitions of racism; contextualizes racism in nursing; and presents research findings and a discourse analysis. Das Gupta suggests that within nursing, racism in paid workplaces is disguised; this creates difficulties in identifying, understanding, and combating it. However, her finding did identify four forms of racial harassment that are common in Ontario. She observes that these arise from unconscious policies, procedures, and practices. Moreover, the largest proportion of what she terms “put-downers” are colleagues, followed by patients, physicians, managers, and others. Das Gupta notes that many nurses are forced to quit their jobs or leave the profession because health care institutions are not proactive in dispelling employment inequities, but rather take an adversarial approach. This is a well-written volume that describes the serious problem of systemic racism and suggests that it be addressed through an alternative justice model. Summing Up: Recommended. Upper-level undergraduates through professionals/practitioners. 

—D.B. Hamilton, Western Michigan University

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The quote from the author Tania Gupta that adorns the back cover of Real Nurses and Others: Racism in Nursing pulls no punches about what readers will find inside. “Most nurses of color experience everyday forms of racism, including being infantilized and marginalized,” she writes. “Most [nurses interviewed for the book] reported being ‘put down,’ insulted or degraded because of [their] race/ ethnicity/ color.”

Das Gupta is a Canadian sociologist and activist whose previous book, Racism and Paid Work, included a chapter on racial discrimination in Canada’s nursing wokforce. Real Nurses and Others, which began as a study commissioned by the Ontario Nurses’ Association (ANO)’s Racially Diverse Caucus, expands on this earlier research to present a full-length examination of systemic racism in nursing, based in part on surverys and interviews with nearly 600 ONA members, both minority and majority.

Although the book focuses ezclusively on Canada, American readers -including nursing staff, managers, administrators and hospital diversity directors- can also learn much from Das Gupta’ analysis of the many subtle and not-so-subtle ways racial/ethnic disrimination manifests itself in today’s nursing workplace. For example the title Real Nurses and Others refers to a black interviewee’s comment that white patients and family membres routinely treated her as is she was a nursing assistant or aide rather than a “real” (i.e white) nurse–a situation that all too many American nurses of color relate to.

Das Gupta presents what she calls an “intersectional analytical framework” for understanding how a why workplace racism can occure in heath care institutions. but Real Nurses and Others really comes alive when it focuses on the case studies and personal testimonials of the many nurses who reported experiencing discrimination from colleagues, managers, patients, doctors and others because of their race/ethnicity. the book documents many examples of “everyday racism” -e.g., targeting, scapegoating, excessive monitoring and blaming the victim–as well as “how fear, lack of support, management collaboration, coworker harassment and ineffective institutional responses make it difficult for victims of racism to fight back”

The slim (128-page) book does have a few shortcomings. There is no research data on Aboriginal (First Nations) nurses, an admittedly small but still important part of Canada’s minority nursing workforce. And while Real Nurses and Others does an excellent job of discussing the problem of racism in nursing, I would have liked to see Das Gupta go one step further by proposing some recommendations and solutions. But all in all, this brave and provacative book makes fascinating reading-especially for those in the nursing profession who are not afraid to engage in honest dialogue about a serious issue that is all too often swept under the rug. 

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 Professor Tania Das Gupta didn’t intend to study racism in nursing, but since she was often called as an expert witness in racial discrimination cases involving nurses, she thought she’d take a closer look. The culmination of her research is her recent book, Real Nurses and Others: Racism in Nursing, because what she found surprised her.

 Das Gupta, chair of York’s School of Social Sciences in the Faculty of Liberal Arts & Professional Studies, thought most of the racism toward nurses would come from their patients or maybe their managers, but in fact the majority came from other nurses (27.3 per cent). “It raises the whole issue of co-worker racism in a union environment,” she says. The patients were the next most likely group to express racism (23.8 per cent), followed by doctors (14.3 per cent) and nursing managers (12.8 per cent).

 “It’s very systemic. It’s very difficult to put your finger on it,” says Das Gupta. “I would call it a new racism. It didn’t have the mark of the kind of racism we’re used to. It doesn’t use the language of racism. This new racism is very subtle.”

 And, she adds, “It’s difficult to prove in the court system.” Still, a group of nurses alleging racial harassment for having been fired did win their case in 1994. It was the first case in which Das Gupta was called to be an expert witness. “This was a landmark case in Ontario and Canada. It was the first time the Human Rights Commission took up these complaints as a systemic case,” she says.

 After that, Das Gupta continued to be called. Eventually, she decided to study racism in nursing. She used a multi-level approach to the study. A survey was sent out to all nurses from the Ontario Nurses’ Association (ONA); 593 responded out of some 40,000, what Das Gupta calls the largest single sample of Ontario nurses that she is aware of. She conducted 18 in-depth interviews and looked through other arbitration cases. The study uses a developed theoretical framework that can be applied to other situations or occupations and takes a race, gender and class approach to looking at how racism takes place in an occupation where it is mostly women.

 In Real Nurses and Others: Racism in Nursing (Fernwood Publishing, 2009), Das Gupta looks at the importance of studying racism in nursing, gender and class concepts, the political economy of health care, what the nurses say, race and racism at work and the way ahead, along with the findings of the study.

 “There were some striking findings that you go ‘Oh my God is that right?’” says Das Gupta, acting chair of the new Department of Equity Studies at York. The nurses were asked if they had ever been made to feel uncomfortable because of their race, colour or ethnicity and 82 per cent of black/African Canadian nurses, 80 per cent of Asian nurses, 50 per cent of South Asian nurses and 57 per cent of Central/South American nurses said yes. So too did 25 per cent of white/European nurses.

 “When the racism is coming from a patient, it raises the interesting question of how does one fight back in that situation,” says Das Gupta. “If a person is ill, does that make it all right for a perpetrator to be racist? I think not.”

 Das Gupta was also surprised to learn that most nurses who experience racism don’t take the issue to their union. Most tend to try and handle it on their own.

 Real Nurses looks at how fear, lack of support, management collaboration, co-worker harassment and ineffective institutional responses make it difficult for victims of racism to fight back.

 Over 14 per cent of nurses reported that any action they took had no effect on the harassment. Yet 58.1 per cent of black/African nurses and 48.3 per cent of Asian nurses perceived that their race, ethnicity or colour affected their relationship with their colleagues, while 54.8 per cent of black/African nurses, 44.4 per cent of Asian and 44.4 per cent of South Asian nurses said it affected their relationship with their manager.

 Both those relationships can affect job promotion. “There’s a pattern of differential of treatment,” says Das Gupta. Over 40 per cent of black/African nurses and over 30 per cent of South Asian nurses reported their race, ethnicity or colour affected their access to training opportunities in the workplace. Somewhat fewer, indicated their performance reviews were also affected. Das Gupta wonders why the ONA hasn’t done more.

 “There’s no one institution that’s not affected by systemic racism. I think there’s a role for government, unions, employers and even community groups to play.”

 But one of the first places it should start, says Das Gupta, is in the schools of nursing, where racism can be dealt with head on. In fact, she says, it may be a good idea for them to read Real Nurses, the title of which came from the experience of one black nurse who was always asked if she was a “real” nurse. Her response was always the same, to say yes she was a “real” nurse; that RN (registered nurse) stood for “real” nurse.–By Sandra McLean, YFile writer

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