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Intersectional characterization of emergency department (ED) staff experiences of racism: a survey of ED healthcare workers for the Disrupting Racism in Emergency Medicine (DRiEM) Investigators

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Abstract

Introduction

The impact of racism on patient outcomes in Emergency Medicine has been examined but there have been few studies exploring the experiences of racism in health care workers. This survey aims to explore the experience of racism by interdisciplinary staff in a tertiary ED. By characterizing the staff experience of racism in the ED, we hope to inform the design of strategies to disrupt racism and ultimately improve the health and wellness of both staff and patients.

Methods

We conducted a self-administered, cross-sectional survey to explore the reported experience of racism by healthcare workers in a single urban ED in an academic trauma centre. We employed classification and regression tree analyses to evaluate predictors of racism through an intersectional lens.

Results

A majority (n = 200, 75%) of all ED staff reported experiencing interpersonal racism (including physical violence, direct verbal violence, mistreatment and/or microaggressions) in the workplace. Respondents who identified as racialized self-reported significantly more racism at work than white respondents (86% vs. 63%, p < 0.001). Occupation, race, migrant status and age were identified through intersectional machine-learning models to be significantly predictive of the experience of racism. Nearly all respondents felt that the disruption of racism in Emergency medicine is important to them (90%, n = 207) and (93%, n = 214) were willing to participate in further training in anti-racism.

Conclusions

Racism against interdisciplinary staff working in EDs is common and the burden on healthcare workers is high. Intersections of occupation, race, age and migrant status are uniquely predictive of the experience of racism for EM staff. Interventions to disrupt racism should be informed by intersectional considerations to create a safe working environment and target populations most at risk. ED healthcare workers are willing to take steps to disrupt racism in their workplace and need institutional support to do so.

Abstrait

Introduction

L’impact du racisme sur les résultats des patients en médecine d’urgence a été examiné, mais peu d’études ont exploré les expériences de racisme chez les travailleurs de la santé. Cette enquête vise à explorer l’expérience du racisme par le personnel interdisciplinaire dans un ED tertiaire. En caractérisant l’expérience de racisme du personnel à l’urgence, nous espérons éclairer la conception de stratégies visant à perturber le racisme et, ultimement, à améliorer la santé et le bien-être du personnel et des patients.

Méthodes

Nous avons mené une enquête transversale auto-administrée pour explorer l’expérience signalée de racisme par les travailleurs de la santé dans un seul service d’urgence urbain dans un centre de traumatologie universitaire. Nous avons utilisé des analyses d’arbres de classification et de régression pour évaluer les prédicteurs du racisme dans une optique intersectionnelle.

Résultats

La majorité (n = 200, 75 %) de tous les employés de l’urgence ont déclaré avoir été victimes de racisme interpersonnel (y compris de violence physique, de violence verbale directe, de mauvais traitements ou de microagressions) en milieu de travail. Les répondants qui se sont identifiés comme racialisés ont déclaré beaucoup plus de racisme au travail que les répondants blancs (86 % c. 63 %, p < 0,001). La profession, la race, le statut de migrant et l’âge ont été identifiés par des modèles d’apprentissage automatique intersectionnels pour être significativement prédictifs de l’expérience du racisme. Presque tous les répondants étaient d’avis que la perturbation du racisme en médecine d’urgence était importante pour eux (90 %, n = 207) et (93 %, n = 214) étaient disposés à suivre une formation plus poussée en matière de lutte contre le racisme.

Conclusions

Le racisme à l’égard du personnel interdisciplinaire travaillant dans les DEA est courant et le fardeau imposé aux travailleurs de la santé est élevé. Les intersections de la profession, de la race, de l’âge et du statut de migrant sont des prédictions uniques de l’expérience du racisme pour le personnel EM. Les interventions visant à perturber le racisme devraient être fondées sur des considérations intersectionnelles afin de créer un environnement de travail sécuritaire et de cibler les populations les plus à risque. Les travailleurs de la santé ED sont prêts à prendre des mesures pour perturber le racisme dans leur milieu de travail et ont besoin du soutien institutionnel pour le faire.

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Data availability

Due to the risk of re-identification the primary data is only available after discussion and appropriate ethics approvals by contacting the corresponding author.

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Funding

This work was supported by internal research funds from the Health Sciences Centre Emergency Department.

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada

    Kanisha Cruz-Kan, Carmen Hrymak, Shelly Zubert, Paul Ratana & Murdoch Leeies

  2. George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada

    Brenden Dufault

  3. Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada

    Brenden Dufault

  4. Health Sciences Centre, Shared Health Manitoba, Winnipeg, MB, Canada

    Lula Fesehaye, Jodi Kornelsen, Carmen Hrymak, Shelly Zubert & Murdoch Leeies

  5. St. Boniface Hospital, Winnipeg Regional Health Authority, Winnipeg, MB, Canada

    Paul Ratana

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  1. Kanisha Cruz-Kan
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for the Disrupting Racism in Emergency Medicine (DRiEM) Investigators

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Correspondence to Murdoch Leeies.

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Cruz-Kan, K., Dufault, B., Fesehaye, L. et al. Intersectional characterization of emergency department (ED) staff experiences of racism: a survey of ED healthcare workers for the Disrupting Racism in Emergency Medicine (DRiEM) Investigators. Can J Emerg Med 25, 617–626 (2023). https://doi.org/10.1007/s43678-023-00533-y

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  • DOI: https://doi.org/10.1007/s43678-023-00533-y

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