A health care assistant on internal medicine unit D60, was getting ready to take a patient on a requested smoke break when he made several offensive comments and called her the N-word.
“I just kind of froze. I wasn't expecting it,” she said. “I’ve had patients call me every name in the book besides that. I remember feeling so frustrated because I was trying so hard to help him, even though he was being rude to me, so I kind of cried, out of frustration.”
She turned to her unit’s leaders for support. “They were very kind and had no tolerance for what was going on,” she said. One of those leaders was the unit's educator who listened to her experience and immediately went to the patient to address his behavior with him. During that conversation, the patient continued to use racially offensive terms about the HCA. The leader was firm in letting the patient know that his behavior was unacceptable, and the issue was escalated to their nurse manager and eventually Customer Service.
For the leader, who also had experienced discrimination in her career, there was no question that she had a responsibility to respond to this situation. “I let her know, ‘You are not alone… you have us,’ and I thanked her for reporting (the incident).”
his experience is not a rare occurrence in health care. Some patients behave in discriminatory ways toward the staff and especially use slurs to disparage, degrade and humiliate their target. Being a patient does not exempt an individual from acting respectfully. University of Utah Health’s Patient Rights and Responsibilities include refraining from using any discriminatory remarks or engaging in other discriminatory behaviors (such as requesting not to have caregivers based on protected class status) with all hospital employees.
How Do I Address Discrimination from a Patient?
Addressing discrimination often feels uncomfortable, especially when the behavior comes from a patient who will continue to receive care.
Here are some strategies for addressing these problem behaviors:
Report the patient’s behavior. Seek support from your unit leaders so that they can confront the patient, inform the medical team and assemble resources.
Do not ignore the patient’s behavior. The behavior likely won’t go away and may even get worse. Ignoring the behavior also sends a message that discriminatory behavior is acceptable—it’s not. Permitting discriminatory behavior to continue or not acknowledging the harm sends a message to the targeted staff that they are not equal and do not deserve the same respectful treatment as their peers.
Speak up for your coworkers. Coworkers can speak up and stand up for their colleagues when they witness discriminatory or bigoted behavior by patients by using phrases such as:
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“Everyone in this hospital is competent to take care of you.”
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“We don’t discriminate in this clinic.”
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“I respect that person.”
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“I find your comment offensive. We are committed to showing respect to all our patients and we expect the same from them.”
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“I am disturbed and shocked by the discriminatory words being used right now, so I am leaving the room to report this behavior. Our hospital does not allow discriminatory behavior.”
It’s important to remember that while these are difficult moments with patients and making these statements may feel awkward and uncomfortable, allowing patients to engage in discriminatory behavior is harmful.
Do not minimize the employee’s experience with discrimination.
Bystanders may want to avoid confrontation because addressing discrimination can bring up feelings of discomfort, fear and even shame. Some may want to avoid further conflict until the patient is discharged. Rather than addressing the situation, it’s not uncommon to rationalize or even justify the behavior by minimalizing it using statements such as:
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“He didn’t mean anything by it.”
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“He’s harmless.”
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“Patients come first. Cut them some slack, they’re not feeling well. Be the bigger person.”
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“He’s from a generation where that is acceptable.”
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“You’re overreacting, Just ignore it.”
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“We’ll reassign you and that will take care of it.”
Minimalizing statements such as these only add to the initial injury.
Give the employee a choice to be reassigned if they are uncomfortable to continue providing care. Talk to the employee and offer the option to be reassigned. Don’t “protect” staff by reassigning without their permission. This may seem like the right thing to do but this, in itself, is considered discrimination.
Check-in with your coworker
It can be difficult to know how to check in with a victim of discrimination. As the intro case study reflects, feeling the support of colleagues can go a long way in repairing the emotional damage of experiencing discrimination. Here's a simple strategy for checking in with a colleague:
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Acknowledge that they experienced something harmful “I’m so sorry this happened to you. What happened was not okay.”
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Offer connection,“You’re not alone. I care about you. You belong.”
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Offer support, “What do you need right now? Do you mind if I check back in with you to see how you’re doing?”
Acts of discrimination can have a profound affect. University resources including the Employee Assistance Program and the Office of Equal Opportunity should be offered for additional support.
What happened in our opening story?
The D60 leader and staff responded ideally to a bigoted situation by reporting it to department leadership, addressing the behavior with the patient and attending to victim. The HCA shared “They all comforted me and let me know that it was going to be okay. They let me know they were going to do something about it.”
Just as patients are entitled to discrimination-free care, so, too, are employees entitled to a discrimination-free workplace. Promptly and firmly addressing discriminatory behaviors by patients is a demonstration of core University of Utah Health values of diversity, responsivity, compassion, and trust.
Acting isn’t always easy, but it’s always the right thing to do.
If a patient’s behavior escalates and staff feel unsafe, any staff member can call the Behavioral Emergency Response Team (B.E.R.T.) for support. Please refer to the University of Utah Health policy Violence and Behavior Contract for additional information.
University Discrimination Policy: The University of Utah does not discriminate on the basis of race, ethnicity, color, religion, national origin, sex, pregnancy, pregnancy-related conditions, age, disability, sexual orientation, gender identity, gender expression, genetic information or protected veteran’s status, in employment, treatment, admission, access to educational programs and activities, or other University benefits or services. If you or someone you know has experienced discrimination, sexual misconduct including sexual harassment, or disability discrimination, we encourage you to report it to the University's designated and authorized Title IX/ADA/Section 504 Coordinator in the Office of Equal Opportunity and Affirmative Action:
Sherrie Hayashi, Director
Title IX/ADA/Section 504 Coordinator
Office of Equal Opportunity and Affirmative Action (OEO/AA)
201 South Presidents Circle, Rm.135
Salt Lake City, UT, 84112
801-581-8365
801-585-5746 (fax)
oeo@utah.edu
www.oeo.utah.edu
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