Applied Science, Faculty of
Medicine, Faculty of
Nursing, School of
Population and Public Health (SPPH), School of
DSpace
UBCV
Hamzavi, Neda
Master of Public Health / Master of Science in Nursing - MPH/MSN
University of British Columbia
Canadian Schools of Nursing are underpinned by white, colonial legacies that have shaped and defined what is valued as nursing knowledge and pedagogy. Despite historical attempts within academic institutions to address diversity and multiculturalism, efforts to address racism and to promote Black, Indigenous, and People of Colour (BIPOC) scholarship have been slow to influence nursing education. Furthermore, faculty members and leadership at Schools of Nursing do not represent the diversity that exists in clinical nursing and the growing diversity in the graduate student population. Importantly, BIPOC nurse leaders, historically and presently, are repeatedly left unacknowledged as knowers and keepers of nursing knowledge. This lack of diversity today constitutes knowledge generation, research, and healthcare practices that do not reflect the increasingly diverse Canadian population. This study examined the experiences of BIPOC graduate nursing students as they navigated white academic spaces. BIPOC graduate nursing students are situated uniquely as they traverse leadership spaces that do not reflect their lived experiences or identities. In this study, eight BIPOC nurses who were either current graduate students or had graduated from a graduate program in the past five years from a Canadian nursing school were interviewed. Using narrative inquiry, epistemologically guided by critical constructivism, and theoretically underpinned by Critical Race Theory, participants were interviewed for the purpose of understanding their experiences in the nursing academy. The voices of these participants resulted in the construction of the following three themes: Entrenched in Whiteness, Erasure of Identity, and Navigating Belonging. Participants demonstrated both how they experience whiteness at the institution as well as how they create belonging for BIPOC. Participants demonstrated a desire to diversify nursing leadership in the academy and clinical spaces to better represent and respond to the healthcare needs of BIPOC. These study findings re-enforce the importance of the following recommendations: the need for Schools of Nursing to acknowledge their colonial and racist underpinnings; the need to diversify nursing faculty and the graduate nursing student population; and the need to conduct audits of nursing curricula and syllabi to ensure they reflect the multitude of ways of knowing beyond Eurocentric and Western knowledge.
EXPLORING THE EXPERIENCES OF BLACK, INDIGENOUS, AND PEOPLE OF COLOUR GRADUATE NURSING STUDENTS IN WHITE ACADEMIC SPACES by Neda Hamzavi BScN, Ryerson University, 2013 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF PUBLIC HEALTH AND MASTER OF SCIENCE IN NURSING in The Faculty of Graduate and Postdoctoral Studies THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver) July 2021 © Neda Hamzavi, 2021 ii The following individuals certify that they have read, and recommend to the Faculty of Graduate and Postdoctoral Studies for acceptance, the thesis entitled: Exploring the Experiences of Black, Indigenous, and People of Colour Graduate Nursing Students in White Academic Spaces submitted by Neda Hamzavi in partial fulfillment of the requirements for the degree of Master of Public Health and Master of Science in Nursing in Population & Public Health and Nursing Examining Committee: Dr. Helen Brown, Nursing, UBC Supervisor Dr. Joan Anderson, Nursing, UBC Supervisory Committee Member Dr. Maryam Nabavi, Equity & Inclusion Office, UBC Supervisory Committee Member iii Abstract Canadian Schools of Nursing are underpinned by white, colonial legacies that have shaped and defined what is valued as nursing knowledge and pedagogy. Despite historical attempts within academic institutions to address diversity and multiculturalism, efforts to address racism and to promote Black, Indigenous, and People of Colour (BIPOC) scholarship have been slow to influence nursing education. Furthermore, faculty members and leadership at Schools of Nursing do not represent the diversity that exists in clinical nursing and the growing diversity in the graduate student population. Importantly, BIPOC nurse leaders, historically and presently, are repeatedly left unacknowledged as knowers and keepers of nursing knowledge. This lack of diversity today constitutes knowledge generation, research, and healthcare practices that do not reflect the increasingly diverse Canadian population. This study examined the experiences of BIPOC graduate nursing students as they navigated white academic spaces. BIPOC graduate nursing students are situated uniquely as they traverse leadership spaces that do not reflect their lived experiences or identities. In this study, eight BIPOC nurses who were either current graduate students or had graduated from a graduate program in the past five years from a Canadian nursing school were interviewed. Using narrative inquiry, epistemologically guided by critical constructivism, and theoretically underpinned by Critical Race Theory, participants were interviewed for the purpose of understanding their experiences in the nursing academy. The voices of these participants resulted in the construction of the following three themes: Entrenched in Whiteness, Erasure of Identity, and Navigating Belonging. Participants demonstrated both how they experience whiteness at the institution as well as how they create belonging for BIPOC. Participants demonstrated a desire to diversify nursing leadership in the academy and clinical spaces to better represent and respond to the healthcare needs of BIPOC. iv These study findings re-enforce the importance of the following recommendations: the need for Schools of Nursing to acknowledge their colonial and racist underpinnings; the need to diversify nursing faculty and the graduate nursing student population; and the need to conduct audits of nursing curricula and syllabi to ensure they reflect the multitude of ways of knowing beyond Eurocentric and Western knowledge. v Lay Summary Canadian Schools of Nursing perpetuate whiteness and exclude diverse identities, as evidenced by the people who are depicted, historically and presently, as nursing pioneers and leaders. This study aimed to better understand how Black, Indigenous, and People of Colour graduate nursing students navigate academic spaces that are mostly occupied by whiteness. Eight participants who were either current graduate students or who had graduated within the past five years from a graduate program at a Canadian School of Nursing were interviewed. The study findings show that participants had difficulty in belonging as their diverse identities were not represented in the academy. Participants spoke to the lack of diversity in the faculty and in nursing research and practices that have shaped the nursing profession. Canadian Schools of Nursing must work to create more diverse and inclusive environments that are representative of the diversity of students as well as the Canadian population. vi Preface This thesis is the original work of Neda Hamzavi, a student in the Master of Public Health and Master of Science in Nursing dual degree program at the University of British Columbia. Dr. Helen Brown was the supervisor who provided guidance and support throughout the process. Dr. Joan Anderson and Dr. Maryam Nabavi were members of the thesis supervisory committee who also read drafts and provided critical insights. This study received ethics approval from the University of British Columbia’s Behavioural Research Ethics Board (UBC BREB Number: H20-02752). vii Table of Contents Abstract................................................................................................................................... iii Lay Summary.......................................................................................................................... v Preface..................................................................................................................................... vi Table of Contents.................................................................................................................... vii Acknowledgements................................................................................................................. x Dedication............................................................................................................................... xi Chapter One: Introduction...................................................................................................... 1 1.1 Situating the Problem.............................................................................................. 2 1.1.1 The Self as the Other.................................................................................. 2 1.1.2 A Walk Through a School of Nursing in Canada...................................... 4 1.1.3 The Lack of Diversity in Canadian Academic Institutions........................ 5 1.1.4 The Underpinning Whiteness of Nursing and Erasure of the Other.......... 6 1.1.5 Decolonizing Nursing and Canadian Healthcare....................................... 11 1.1.6 Situating the Study in Present-Day Context.............................................. 13 1.2 Study Purpose......................................................................................................... 15 1.3 Research Question................................................................................................... 15 Chapter Two: Literature Review............................................................................................. 16 2.1 Eurocentric Underpinning of Canadian Past and Present....................................... 16 2.2 The Importance of Epistemic Diversity.................................................................. 20 2.3 Eurocentrism in Nursing......................................................................................... 27 2.4 Research Significance............................................................................................. 31 Chapter Three: Methodology.................................................................................................. 34 viii 3.1 Epistemological and Theoretical Perspectives........................................................ 35 3.1.1 The Use of the Term BIPOC and CRT...................................................... 37 3.2 Narrative Inquiry.................................................................................................... 39 3.3 Research Design...................................................................................................... 40 3.3.1 Sampling Approach.................................................................................... 40 3.3.2 Recruitment ............................................................................................... 41 3.3.3 Data Collection.......................................................................................... 42 3.3.4 Data Analysis............................................................................................. 43 3.4 Ethical Considerations............................................................................................ 44 3.4.1 Ethics Approval and Informed Consent..................................................... 44 3.4.2 Protection of and Support for Participants................................................. 45 3.4.3 Researcher Reflexivity............................................................................... 47 3.5 Rigor........................................................................................................................ 49 3.6 Knowledge Translation and Dissemination............................................................ 51 3.7 Study Team............................................................................................................. 52 Chapter Four: Findings........................................................................................................... 53 4.1 Theme 1: Entrenched in Whiteness........................................................................ 54 4.1.1 Subtheme 1.1: Whiteness in the Physical Space........................................ 55 4.1.2 Subtheme 1.2: Whiteness in the Intellectual Space................................... 59 4.1.3 Subtheme 1.3: Whiteness as a Gatekeeper................................................. 62 4.1.4 Subtheme 1.4: Unacknowledged Whiteness............................................. . 67 4.2 Theme 2: Erasure of Identity.................................................................................. 69 4.2.1 Subtheme 2.1: Selective Acknowledgement of Oppression...................... 70 ix 4.2.2 Subtheme 2.2: Lack of Research and Expertise with BIPOC.................... Communities 71 4.2.3 Subtheme 2.3: Lack of Critical and Intersectional Perspectives................ 73 4.3 Theme 3: Navigating Belonging............................................................................. 77 4.3.1 Subtheme 3.1: Feelings of (Not) Belonging.............................................. 77 4.3.2 Subtheme 3.2: Existence as Resistance – Creating Belonging.................. 83 Chapter Five: Discussion and Recommendations................................................................... 88 5.1 Discussion............................................................................................................... 89 5.2 Recommendations................................................................................................... 101 5.2.1 Acknowledging the Colonial and Racist Underpinnings of Nursing......... Institutions 102 5.2.2 Diversifying Nursing Faculty..................................................................... 103 5.2.3 Diversifying Nursing Students at the Graduate Level............................... 105 5.2.4 Conducting an Audit of Nursing Curricula and Syllabi............................. 106 5.3 Limitations and Future Research Recommendations.............................................. 108 References............................................................................................................................... 110 Appendix A: PICO Table and Systematic Literature Search Results..................................... 123 Appendix B: Recruitment Announcement.............................................................................. 125 Appendix C: Recruitment Poster............................................................................................ 126 Appendix D: Interview Guide................................................................................................. 127 x Acknowledgements First and foremost, I would like to express my gratitude to the participants of this study who courageously shared their experiences with me. You are pushing the boundaries and paving the way for nursing to be more representative and diverse. I sincerely thank you for your strength, for your vision, and for your bravery. You are an inspiration. I would like to express my gratitude to Dr. Helen Brown who held space for my experience and encouraged me to follow my truth. Thank you for believing in me. Most importantly, thank you for using your privilege to reach for justice and equity. With the utmost respect, I would like to thank Dr. Joan Anderson for being a trailblazer in nursing and for truly paving the way. Your work and leadership in nursing and social justice have allowed scholars like me to follow in your footsteps. I am humbled to have had your wisdom to guide this journey. My gratitude goes to Dr. Maryam Nabavi, who has been a voice of reason and a place of solace for me throughout my graduate journey. Thank you for your mentorship and support as I learned to stand as a woman of colour in graduate school. Lastly, thank you to the University of British Columbia School of Nursing for providing me with a grant to support my work. xi To my parents, Fereidoon Hamzavi and Narges Jalilian, who crossed oceans to be here. To my life partner, Mark Joseph Sinclair. This accomplishment is yours as much as it is mine. To my brother, Kaveh Hamzavi, who held down the fort so I could attend graduate school. xii you broke the ocean in half to be here. only to meet nothing that wants you. −immigrant Nayyirah Waheed 1 Chapter One: Introduction The purpose of this work was to actively surface the colonial history of Western1 nursing academia and provide empirical evidence for the importance of decolonizing these spaces. The intent was for this work to be an act of resistance against the colonial legacies that have and continue to shape the way we construct and interpret epistemic knowledge within nursing. This work brought to the forefront how Western academia actively erases diverse2 voices by failing to acknowledge the absence of diverse identities in its physical and intellectual spaces, thereby perpetuating gatekeeping behaviour which prevents the production of epistemic diversity. Epistemic diversity is imperative to represent the diverse Canadian society that currently exists. The inspiration for this research question emerged when I3 was a keen first year graduate student after practicing bedside nursing for six years in various settings across Canada. My observations and visceral experiences as a visible minority woman in white4 academic nursing was the foundation for this work. Therefore, I delved into this discomfort to interrogate the lack of 1 When the term “West” or “Western” is used in this thesis, it refers to the global west, not Western Canada. 2 Diversity exists among many realms and intersects within identities along the lines of race, ethnicity, gender identity, and sexual orientation among other things. This study focuses specifically on racial diversity. 3 Throughout this proposal, “I” refers to Neda Hamzavi, the primary contact and master’s student writing and conducting this thesis research study. 4 It is beyond the scope of this thesis to unpack the social construct of White identity and privilege. I encourage the reader to read on this topic and explore their own identity in relation to it. For the purposes of this thesis, the term White is used to refer to identities of European descent. Additionally, whiteness, is a social construct representing “...a set of assumptions, beliefs, and practices that place the interests and perspectives of White people at the centre of what is considered normal and every day” (Gillborn, 2015, p. 278). Thus, when referring to academic spaces as white, there is an implied centrality of whiteness, that the space is created based on the normality of White identity and experience. Anyone who does not identify as White is thus existing in the periphery of this space as the other. Furthermore, when referring to identities that are White or Black, the terms will be capitalized as they refer to a noun. When referring to spaces and places that embody whiteness, this will not be capitalized as they are defining adjectives. When the term is used in a quote, the spelling of the original author is not changed. 2 diversity in nursing academic spaces and ask the following questions: where is everybody else and why are they not at the table? 1.1 Situating the Problem 1.1.1 The Self as the Other5 I believe research is inherently personal and stems from our lived experiences. Therefore, it is imperative to explain and lay out the experiential foundation that inspired my thesis work and research question. In 1997, I migrated from Iran to Canada with my parents and my brother. I vividly remember the ways in which our existence in spaces as the Other took shape, slowly, over time. The feeling of Otherness never completely left, though it did diminish with time through the process of integration and assimilation. However, this feeling resurfaced upon entry to graduate school. The moment that molded my experience in these white6 academic spaces as a visible minority/BIPOC7 was at an event to celebrate one School of Nursing in Canada. This event was 5 As per Anderson et al. (2003), colonialism resulted in the construction of race as categories whereby non-European people and physical features were identified as inferior and therefore as the uncivilized or subordinate Other. 6 I acknowledge, appreciate, and respect the hard work European-settler nurses in Canada have contributed to establishing a solid foundation for the growth of professionalism and academia in nursing. However, there is a lack of acknowledgement of the ways in which colonialism and white privilege have positioned these identities in a place to excel compared to their non-White colleagues. 7 Visible minority is defined as “...persons other than Aboriginal peoples, who are non-Caucasian in race or non-white in colour” (Statistics Canada, 2019a). This mainly includes the following groups: South Asians, Chinese, Black, Filipino, Latin American, Arab, Southeast Asian, West Asian, Korean, and Japanese (Statistics Canada, 2019a). As a visible minority writer, I am cognisant of the ways in which being classified as a visible minority, in and of itself, is problematic as one is identified as a visible minority only in relation to those deemed as White. As argued by Blackford (2003), such terminology can work to further perpetuate notions of the colonizer versus the colonized in modern times. Furthermore, the term visible minority works to sum up the individual experiences of different non-White identities as equivalent; it ignores the ways in which racism affects people differently. It is imperative for those who do decolonial work to understand that not all Indigenous peoples nor visible minorities have the same experiences. The purpose of this work is to start this dialogue but by no means does it wish to assume that all Indigenous peoples or all visible minorities have the same experience. While these terms are legally recognized in Canadian terminology, I acknowledge the ways in which they are problematic and have limitations. Therefore, moving forward, the term BIPOC (Black, Indigenous, and People of Colour) will be used as it is more contemporarily used in dialogue addressing race-related discourse and more reflective of current social vocabulary used to describe identities that do not define themselves as White. This is further discussed in section 3.1.1. 3 held to honour the history of nursing and commemorate those who had and continue to contribute to the profession of nursing. In a sea of White faces, I did not see myself. I spent a few hours at this event feeling awkward and uncomfortable. I tried to look for the nursing that I knew and had grown to love over the past six years: diverse, internationally educated, multilingual, BIPOC nurses who were serving a diverse population. However, there in that room, I did not see it. At the same event, I purchased the book titled Cross-Cultural Caring (Waxler-Morrison et al., 2005). While reading this book, I had an “Aha!” moment: there I was! In this textbook, there was a chapter for people of my ethnic background, accompanied with an explanation of how to provide culturally safe care for people of my ethnicity. The editors explained: A “cultural minority” is a distinctive and identifiable subgroup in the Canadian population that sees itself as having origins, beliefs, and values that contrast with the culture of the homogenous, most-dominant, sub-group of the Canadian population, the white, largely European, culture. Underlying this contrast is an imbalance in economic and political power that favours the dominant group. (Waxler-Morrison et al., 2005, p. 7) While I thoroughly appreciated the text, informed by the lived experiences of immigrants and identities of non-European descent, I also realized something profound. The healthcare system was not built for me, the Other. The academic institution was not built for me, the Other. Thus, I continue to exist in these spaces as the Other. All the emotions of my migration to Canada resurfaced. Do I belong here? Should I even be in graduate school? Is nursing leadership an option for people like me, the Other? As the semesters passed, these questions swelled in my mind. I could no longer un-see the reality that our healthcare and academic institutions were built on a colonial foundation that upheld the normality of whiteness and this was the same foundation underlying nursing. I began to wonder, do Others feel the same? How are they learning to survive, exist, and thrive in these spaces? Most importantly, how is the lack of diversity in nursing leadership impacting health research and practice in the profession of nursing? 4 1.1.2 A Walk Through a School of Nursing in Canada Walking through the halls of Schools of Nursing in Canada can elicit different meanings and emotions for students depending on who they are and whether they see a reflection of themselves. Upon exiting the elevator in one school, for example, displayed on the wall are pictures of all the past directors of the School of Nursing. An immediately noticeable feature to those paying attention is that there were no obvious BIPOC who had occupied these roles. Around the corner, there is a doll display depicting the history of nursing in this region of Canada. In this display of 18 dolls representing nurses, only three of the dolls are BIPOC. These three dolls are labeled as follows: “Ancient Civilizations”, “First Nations of Nursing” and “Hospital Nursing”. All the other dolls are visibly White. It is interesting to note that the dolls depicting early nursing in Canada and the establishment of nursing in Canada are both seemingly White. Ironically, they are placed with the First Nations nursing doll in between them, with no explicit recognition given to the impact of colonization and Western medicine on Indigenous peoples primarily through Indian hospitals8. Of course, Florence Nightingale is larger than the other dolls and gets her own section. There are no dolls to depict nurses such as Mary Seacole or Edith Anderson Monture9. There are underlying messages and contexts not detectible unless you are actively the one excluded. If these previously described images reflect your identity, there is an implied sense of 8 Indian hospitals were initially established by Christian missionaries in the 1800s-1900s, and many were associated with residential schools. These hospitals worked to assimilate Indigenous peoples to practice Western medicine and forcefully stop them from engaging in their traditional practices. As well, these hospitals segregated Indigenous peoples from European-settler communities. Indian hospitals were underfunded, crowded, and provided sub-par care to Indigenous peoples. Indigenous peoples with tuberculosis were removed from their homes and placed in these hospitals, often for years at a time, and subject to invasive surgeries and medical experimentation (The Canadian Encyclopedia, 2018). 9 Mary Seacole was a Creole nurse who was rejected from serving in the Crimean War. Edith Anderson Monture was the first First Nations nurse in Canada. Their achievements as nurses are described in detail in section 1.1.4. 5 belonging. On the contrary, if they do not, feelings of Otherness and of lack of belonging are elicited. The problem lies in the fact that those who are not made to feel Othered are predominantly those in positions of power, as evidenced by the fact that historically, no obvious BIPOC person has held a director role at the school. Thus, this implies a sense of exclusivity as BIPOC are not depicted as those who are leaders in the school, further eliciting a lack of belonging in white academic spaces where evidence of diversity dialogue and action is already lacking. 1.1.3 The Lack of Diversity in Canadian Academic Institutions In February 2019, Universities Canada commenced a national survey in order to collect data on equity, diversity and inclusion (EDI) in universities across the country; this effort was the first of its kind (Universities Canada, 2019). This survey identified that universities across the country struggle to recruit and retain diverse staff and faculty. While 40% of graduate student enrolments and 40% of undergraduate student enrolments identified as visible minorities or racialized10 groups, only 21% of full-time faculty identified as such (Universities Canada, 2019). Therefore, as almost 80% of faculty remain White, such demographics are not reflective of the student population. While there is a lack of diversity present, it is also imperative to understand that the experiences of the existing racialized faculty are not necessarily positive. In The Equity Myth, Henry et al. (2017) “...examine the university as a site for studying racism in Canadian society…because it represents a bastion of liberal democracy that enjoys a popular image of an institution free in the pursuit of knowledge, avant-garde in thinking, and fair in practice” (p. 3). The authors found that racialized and Indigenous scholars in Canadian academic institutions 10 “Racialized” is another term used in race-related discourse to refer to non-White people or BIPOC. 6 underpinned by white hegemony struggle to gain acceptance into the academy and repeatedly have their experiences of racism denied (Henry et al., 2017). Although some diversity is present in the academy, it exists in silos where the few racialized and Indigenous faculty do not experience support from their institution or colleagues. As well, Henry et al. (2017) found pervasive themes of tokenization, lack of support or rewards, feelings of being undervalued, and an inefficacy of current equity policies. They argue that “The system tends to replicate itself because the relationship between the whiteness of the academy and the whiteness of research is not well recognized; it is even denied” (Henry et al., 2017, p. 304). Thus, it is evident that the existence of whiteness as a social construct underpins these institutions and works to reinforce racial hierarchies. Furthermore, it perpetuates feelings of discomfort for those who do not fit the dominant racial category. Racialized and Indigenous faculty struggle to earn recognition for their work which often challenges current status-quo scholarship accepted as credible in the academy (Henry et al., 2016). Meanwhile, they are spread thin by constantly being asked to mentor an increasingly diverse student population (Henry et al., 2016). The present-day lack of diversity in academic institutions is rooted in historical discrimination against racialized bodies as the Other. In nursing, this racist underpinning goes back to its foundation. 1.1.4 The Underpinning Whiteness of Nursing and Erasure of the Other Florence Nightingale, born in 1820 in Italy to wealthy English parents, is a name that is widely known (Mcdonald, 2009). She is revered as the pioneer and founder of the nursing profession (McDonald, 2009). Her life and contributions are thoroughly documented and easily accessible. Anyone studying nursing in Western academic institutions will know her name and influence on the profession. In contrast, names such as Mary Seacole are rarely, if ever, mentioned. In fact, I had never heard of her name in nursing school or thereafter until I purposely 7 looked for her. Mary Seacole, born in 1805 in Jamaica to a Scottish father and Jamaican mother, also worked as a nurse (Mahlungulu, 2003). She did not come from wealth and therefore did not have any formal nursing training; she learned her nursing skills through working in her family’s boarding house, providing care for sick soldiers (Mahlungulu, 2003). When the European war began in 1854, she sailed to England and applied to be a nurse in the Crimean war at the British War office but was rejected due to the colour of her skin (Mahlungulu, 2003). Nevertheless, she found her own way to provide services, for example by offering herbal and traditional remedies to soldiers (Mahlungulu, 2003; Staring-Derks et al., 2015). Staring-Derks et al. (2015) state that “...her career as a nurse and doctress may well be considered as African-Jamaican-European inspired, in some sense a global model of treating the sick and wounded” (p. 516). She is regarded by some as an entrepreneur, doctress, and global nurse extraordinaire (Staring-Derks et al., 2015). Despite this, she is actively dismissed as a pioneer in nursing, often in the shadow of Florence Nightingale. According to McKay Harmer (2010), the xenophobia and racial discrimination that existed in British society at that time was likely a contributing factor that shaped the legacy of Mary Seacole. Mary Seacole was Creole, which, although a sign of privilege in Jamaica, was a cause for racial discrimination in England; Florence Nightingale, on the other hand, was related to British nobility (McKay Harmer, 2010). In addition, while Florence Nightingale has over 200 published documents, Mary Seacole’s life is not well-documented aside from her autobiography (McKay Harmer, 2010). Based on the above summary it can be argued that the colonial history resulting in racial discrimination impacts our present day understanding of nursing and its pioneers. Nursing academia continues to perpetuate this colonial ideology by giving credit to some (i.e., Florence Nightingale) while failing to acknowledge others (i.e., Mary Seacole and Edith Anderson 8 Monture), thereby resulting in a complete erasure of the contributions of the Other to the nursing profession. Aside from her contributions to nursing, the privilege that Florence Nightingale carried as an elite Brit undoubtedly propelled her emergence as a nurse leader; her privileged positioning in society allowed her to flourish and, thus, be recognized as a leader today. Racism and erasure of the contributions of the Other within the nursing profession continue to be documented in more recent decades as well. Flynn (2009) surfaces the experiences of Black nurses in the mid 1900s, trained in England, Canada, and various Caribbean islands but who ultimately found work in North America. This study, roughly one hundred years after Mary Seacole, documents the ways in which Black female nurses were systematically refused entry into predominantly white healthcare institutions (Flynn, 2009). Flynn argues that “...Black female bodies on the wards working alongside White doctors and nurses simultaneously threatened the homogeneity of the occupation, White privilege, and whiteness” (Flynn, 2009, p. 133). Similarly, African American nurses in the late 1800s and early 1900s were denied or restricted access to studying in white nursing schools (Threat, 2015). The discrimination was so blatant that the National Association of Colored Graduate Nurses (NACGN) was established as an organization with intent to support African American nurses against racial discrimination that prevented them from accessing nursing training or working in hospitals (Threat, 2015). Threat (2015) states that “For many black activists, the barriers black nurses faced in civilian nursing and in their quest for military service became symbolic of professional and personal struggles of African Americans in general” (p. 28). It is evident that racism heavily impacted nursing in Western society in the early 1900s and remains undeniable for its influence on nursing leadership today. In current Canadian academic institutions, the narrative of Indigeneity and Indigenous 9 studies has proliferated. While many non-Indigenous scholars engage in decolonial research using primarily participatory led approaches to benefit Indigenous communities (see Brown et al., 2017; Browne et al., 2016), there is also evidence of non-Indigenous researchers who engage in exploitative and extractive research11. However, the acknowledgment of the ways in which Indigenous peoples have been excluded and historically systematically barred from engaging in similar work is grossly insufficient. Edith Anderson Monture is another name rarely mentioned as a pioneer in Canadian nursing history. Edith Anderson Monture was the first First Nations registered nurse in Canada (Conn, 2019; Deer, 2019). She was born in the year 1890 in Six Nations, Ontario. Despite applying, she was prohibited from attending nursing schools in Ontario because she was Indigenous; the Indian Act prevented Indigenous peoples from attending post-secondary institutions in Canada (Conn, 2019). Interestingly, she was accepted into nursing school in New York and, in 1914, became the first Indigenous registered nurse in Canada (Conn, 2019; Deer, 2019). Edith Anderson Monture is also known for her service in the United States Army Nurse Corps as well as for being the first Indigenous woman in Canada to gain the right to vote in federal elections (Conn, 2019). Although she achieved these incredible accomplishments while resisting institutional racism, she does not get the same praise or recognition as Florence Nightingale, who did not have to overcome such barriers. Repeatedly, history is written in a way where already privileged identities are leveraged and revered as pioneers. Unfortunately, those who accomplish great feats against the grain are rarely mentioned or given the same acclaim. Thus, we must ask the questions: who is writing the history and whose history is being erased? History demonstrates the systemic barriers that Other identities experienced in their attempts to 11 In fact, the trademark of OCAP® (Ownership, Control, Access, Possession), as governed by the First Nations Information Governance Centre, functions to recognize the rights and ownership of Indigenous peoples over their own information (FNIGC, 2020). 10 enter and succeed in the nursing profession, indicating that perhaps it is not coincidental that nursing leadership is predominantly White. Indigenous nurses continue to experience racism in Canadian academic and healthcare institutions. As of 2016, only 3% of nurses in Canada identified as Aboriginal (University of Saskatchewan, 2018). Vukic et al. (2012) illustrate the racism and cultural insensitivity experienced by Indigenous nurses both while studying and practicing nursing. In this study, Indigenous nurses expressed feeling the need to prove their competence to their patients and nursing instructors; as well, they expressed concern of the potential repercussions of revealing their Indigenous identity (Vukic et al., 2012). They voiced the importance of increasing the number of Indigenous nurses at the bedside to provide culturally safe care for Indigenous patients; as well, they emphasized the need for more Indigenous nurses in leadership positions, such as in hospital management and in graduate programs (Vukic et al., 2012). In 2018, only 1.4% of professors at Canadian universities identified as Indigenous (Academic Women’s Association, 2018). We must acknowledge, understand, and unpack the ideologies that have formed the foundation of Western nursing. As per Georges (2003), “The events and multiple discourses that have brought us to this present moment in nursing recede endlessly backward into a Eurocentric cultural context with sexism, racism, and classism at its heart, and we carry this context within us” (p. 45). Nursing continues to ignore the ways in which its progression as a profession is rooted in colonialism, racism, and white privilege (McGibbon et al., 2014). McGibbon et al. (2014) argue that decolonizing the nursing profession is essential to its on-going progression both in academia and in practice. Georges (2003) argues for “epistemic diversity” (p. 50) whereby no single lived experience or truth is marked as the centre of knowledge. Rather, a 11 diversity in thought is not just endured but truly valued in a profession that serves a multiplicity of identities (Georges, 2003). By decolonizing12 the nursing profession, we decentre whiteness and strive towards epistemic diversity. We can concur that decolonization of the nursing profession will, over time, translate to the decolonization of our healthcare systems. 1.1.5 Decolonizing Nursing and Canadian Healthcare In 2018, there were roughly 431 769 nurses in Canada (Canadian Institute for Health Information, 2019). While there are no nationally reported statistics of the racial or ethnic demographics of the Canadian nursing population, it is reported that approximately 8.5% of Canada’s regulated nurses were internationally trained (Canadian Institute for Health Information, 2019). The presence of a diverse nursing profession is imperative to meet the needs of an equally diverse Canadian population. Having a diverse nursing profession contributes to culturally competent and safe systems, structures and care, as well as increases accessibility to care for historically marginalized populations (Jefferies et al., 2019). According to the 2016 census, roughly 21.9% of the Canadian population are immigrants (Statistics Canada, 2019b). It is estimated that by 2031, one in four Canadians could be an immigrant (Statistics Canada, 2016). Today’s Canadian population is increasing in diversity, requiring a thorough understanding of the various ways in which individuals, families, and communities live and experience culture as it relates to health and healthcare. As per Jefferies et al. (2019), the Canadian “...nursing workforce continues to be disproportionately Caucasian and 12 Decolonization is a term with weight, power, and intention. Indigenous scholar Smith (2008) explains that decolonizing “...involves the unmasking and deconstruction of imperialism, and its aspects of colonialism, in its old and new formations alongside a search for sovereignty; for reclamation of knowledge, language and culture; and for the social transformation of the colonial relations between the native and settler” (p.117). Furthermore, Smith (2008) goes on to explain that decolonizing research is a way of challenging the “institution of research” and the many “...underlying and taken-for-granted ways of organizing, conducting, and disseminating research and knowledge” (p. 117). In my view, decolonizing our academic institutions means de-centring White identity and whiteness, and instead making space for, and giving value and credit to, different ways of knowing and seeing the world around us. 12 heteronormative, which perpetuates dominant ways of practice that exclude diverse values and ideas” (p. 3). Premji and Etowa (2014) attempted to determine the distribution of visible and linguistic minorities in the Canadian nursing profession using publicly available population-level data from Statistics Canada13. In this study, they found that visible minorities comprised 15% of the nursing work force. They were underrepresented in leadership positions such as management (9%) and head nurse positions (8%) (Premji & Etowa, 2014). They found that visible minorities and women were disproportionately in lower-level positions (Premji & Etowa, 2014). Anderson et al. (2003) encourage examination of “...the unequal relations of power that are the legacy of colonial past and neocolonial present, and the ways in which the cultures of dominant groups have redefined local meanings, and dictated social structures, including healthcare delivery systems” (p. 197). The colonial and egalitarian underpinnings of the nursing profession impact nursing at all levels, including at the institutional level where nursing is practiced in healthcare institutions (McGibbon et al., 2014). As well, the knowledge that informs nursing practice continues to be rooted in a biomedical Western model (McGibbon et al., 2014). The presence of a diverse nursing profession both at the bedside and in leadership positions can contribute to the elimination of health inequities (Phillips & Malone, 2014) while providing “...ethnically, culturally, and linguistically appropriate and sensitive health care” (Gardner, 2005, p. 155). Therefore, it is essential to understand and address the barriers faced by BIPOC nurses, not only when they attempt to enter the nursing profession, but also as they look to become leaders in the profession, specifically as they navigate graduate studies. Addressing barriers is especially important when these nurses attempt to progress their career into leadership positions to ensure that our nursing profession, at all levels, is representative of the diversity in Canada. 13 The authors used Statistics Canada data from a 2006 census. This study was the most recently available one that attempted to analyze the diversity of Canadian nurses. 13 1.1.6 Situating the Study in Present-Day Context While the inspiration for this research study emerged from my own experiences as I began graduate school in 2018, it is imperative to acknowledge two major events that occurred simultaneously as this study took place. These two major events include the murder of George Floyd by police and the global pandemic caused by the novel coronavirus, COVID-19. On May 25, 2020, George Floyd, a Black unarmed man, was murdered14 by police in Minneapolis, Minnesota (Hill et al., 2021). This act of blatant police violence and representation of systemic racism resulted in global-wide discussions focused on anti-Black racism. As well, it highlighted the impacts of racism in general and shed light on the experiences of BIPOC living in a white-centered world. It is important to note, however, that the murder of George Floyd by police triggered such a global response as it was representative of a repeated pattern of systemic racism experienced by Black men in the United States. Edwards et al. (2019) demonstrate that Black men experience “...the highest levels of inequality in mortality risk” compared to other racial identities in the United States and are “...2.5 times more likely to be killed by police over the life course than are white men” (p. 16794). Around the world, individuals, countries, and organizations began to release statements of solidarity for George Floyd and for the Black Lives Matter15 movement. In my neighbourhood, people had posted Black Lives Matter stickers and posters in their windows, on t-shirts, and other places to demonstrate solidarity with the movement. Even the major corporation, TNA, had written “BLACK LIVES MATTER” in large 14 This incident was extremely traumatic for the loved ones of George Floyd as well as Black people and, out of respect, I will not re-iterate this trauma. I encourage the reader, if they are not yet aware of the circumstances, to read the countless newspaper articles and discussions on this unfortunate demonstration of police violence and systemic racism. 15 The Black Lives Matter movement fights for the rights of Black people and works to dismantle anti-Black racism. I encourage the reader to look up the Black Lives Matter movement for further context, to educate themselves on anti-Black racism, and engage in acts of intentional solidarity where possible. 14 black letters on their billboard outside of their store. The dialogue around solidarity, tokenism, and the optics of allyship expanded. Most importantly however, conversations on race and racism deepened and proliferated, especially in spaces such as universities and healthcare institutions. While diversity and multicultural discourse has been evident in academic institutions for some time, dialogue on racism and BIPOC scholarship have been marginalized until the recent events of the last year. The murder of George Floyd, a painful demonstration of systemic anti-Black racism, rippled all over the world and awakened and influenced conversations regarding race, creating spaces where dialogue about diversity, racism, and BIPOC scholarship had previously been relegated to the margins. Thus, the findings of this study contribute to opening the space for critical dialogue about systemic racism and whiteness within nursing academic institutions and their impact on nursing knowledge, clinical practice, research, and professional leadership. Simultaneously, the world was experiencing the unravelling of a global-wide pandemic. Around the end of December 2019 to the beginning of January 2020, the world was hearing of the first cases of a novel coronavirus first identified in Wuhan, China (Schumaker, 2020). By January 30th, 2020 the World Health Organization had declared the novel coronavirus, named COVID-19, a global health emergency (World Health Organization, 2020). The first case of the novel coronavirus was documented in Canada on January 25, 2020 (Bronca, 2020). By March 2020, Canada was essentially in a nation-wide lockdown with provinces and territories dictating their own pandemic safety restrictions. Stores began to shut down, travel nationally and internationally was very limited, and people were living in fear of COVID-19, on which the information of its transmission, symptoms, and extent of illness were unknown. In-person contact was discouraged with people outside of one’s household. For this reason, all the 15 interviews for this study were conducted digitally to abide by public health restrictions to prevent transmission of the virus. These two major world events provide some context to demonstrate what participants were dealing with simultaneously while this research study was taking place. 1.2 Study Purpose The aim of this qualitative research study was to leverage the voices and experiences of BIPOC graduate students in nursing by exploring the experiences of these students and the ways in which they navigate white academic spaces. Through exploring and analyzing BIPOC nursing students’ experiences, I constructed insights and findings about how diversity in those who are held up as knowers and keepers of nursing knowledge, namely nursing faculty and leadership, impacted clinical practice, mentorship, and health research. My overall aim was to contribute to anti-racism dialogue and action within nursing as well as to draw attention to the need for faculty diversity and the expansion of spaces for BIPOC scholarship in nursing education. Chapter Two will discuss Eurocentrism within Canadian history and the nursing profession; as well, the importance of epistemic diversity will be discussed. Chapter Three will provide an overview of the study methodology. Chapter Four will provide the findings of the study. Finally, Chapter Five will situate the findings of the study in current literature as well as provide recommendations for improving diversity in Canadian Schools of Nursing. Chapter Five will also briefly discuss the limitations of the study and suggest recommendations for future research. 1.3 Research Question The following research question guided this study: What are the experiences of Black, Indigenous, and People of Colour (BIPOC) graduate nursing students in white academic spaces in distinct contexts (e.g., graduate education, clinical practice, health research)? 16 Chapter Two: Literature Review Diversity in the nursing profession is imperative for the provision of healthcare to be representative of the values and ideals of the Canadian population. Furthermore, nursing academia must diversify to be more inclusive and reflective of its student population. In this chapter, a literature review is presented to summarize existing knowledge about diversity in nursing and identify what needs to be known. I start by critically analyzing the historical foundations of Canadian society and the ways in which this foundation has resulted in a Eurocentric nation which works to further marginalize the Other. I narrow down to look at how Eurocentrism presents itself in Western academic institutions and, more specifically, in nursing. I present arguments for the importance of epistemic diversity and conclude the chapter by demonstrating the significance of qualitative research exploring the experiences of BIPOC in academic nursing. 2.1 Eurocentric Underpinning of Canadian Past and Present Canada is a colonial country, built on notions of whiteness as the baseline. The birth of this country is founded on the colonization of Indigenous peoples’ land and exploitation of their resources. This, alongside racist early immigration policies, were “...central to the production of the state” (Thobani, 2000, p. 36). Until the mid-1900s, the nation-state worked to balance this normality of White identity while ensuring adequate immigration to enable availability of labour (Thobani, 2000). Access to citizenship was reserved for those who were of the White race, namely British and French people as well as those of other European countries (Thobani, 2000). Alternatively, those from Asia, Africa, and the Caribbean were excluded, particularly women, while men from these countries were allowed in as cheap labour (Thobani, 2000). Policies such 17 as the Head Tax16, the Exclusion Act17, and the Continuous Passage Act18 worked to systematically prohibit immigration from non-white countries. These Acts, underpinned by racist ideologies against non-European immigrants allowed for the centralization of British and French ancestry in Canada (Thobani, 2000). This resulted in a country built on a “...racial hierarchy…in which the land was dispossessed from its original inhabitants, given to white settlers, [and] largely withheld from Asians and Black settlers” (Das Gupta, 2009, p. 25). White settlers acted as gatekeepers, and Indigenous peoples were systematically prevented from partaking in nation-building meanwhile visible minorities experienced racism via the labour they were hired for and their disentitlement to Canadian identity as full and equal citizens (Das Gupta, 2009). Similarly, Harris (1993) explains how whiteness worked to negate the possession of Indigenous land by Indigenous peoples, re-asserting that whiteness inherently affords one the right to claim and possess land. At the early years of the formation of Canada as a nation-state, despite the presence of Indigenous peoples on these lands for thousands of years prior to immigrant arrivals, English and French were deemed as the identity accepted as Canadian (James, 1996). James (1996) argues this was due to Canadian government and society being built on European social structures while simultaneously erasing the preceding Indigenous identities and structures. Thus, 16 Many Chinese immigrants arrived in Canada between 1881-1885 to assist with building the Canadian Pacific Railway. Once the railway was complete, then Prime Minister John A. Macdonald created the Royal Commission on Chinese Immigration to determine the future of Chinese migration to Canada. The Head Tax, under the Chinese Immigration Act, required Chinese people to pay $50 (gradually increasing in amount) to immigrate to Canada. The Head Tax was in effect between 1885-1923, longer in some provinces. In 1923, the Head Tax was nullified, however the Chinese Immigration Act prohibited Chinese migration until 1947 (Chan, 2016). 17 The Exclusion Act was also known as the Chinese Immigration Act. This Act banned Chinese Immigration from 1923-1947, allowing only students, government officials, some merchants, and Canadian-born Chinese people into the country (Chan, 2017). 18 The Continuous Passage Act prohibited entry into Canada by those who were not directly coming from the country in which they were citizens. This mostly affected immigrants from India and Japan as these countries had no direct route to Canada. This Act allowed Canada to restrict immigration without specifically isolating race as the causal factor (Canadian Museum of Immigration at Pier 21, 2020). 18 Canadian society and its institutions, such as academia and healthcare, at their core are a reflection of British and French societies. Non-European immigrants had to “...change elements of their behaviour (based on their subculture) in order to gain access to institutions and take advantage of the opportunities in society” (James, 1996, p. 19). Immigrants were forced through an acculturation and assimilation process to adopt the norms of dominant society as well as shed parts of their identity and culture to belong (James, 1996). In its early making, White males were the prevailing decision makers in the colonial borders of Canada, with some privileges given to White women; visible minorities and Indigenous peoples, specifically women, were placed at the margins of society (Das Gupta, 2009). The demographic of Canadian society has grown more diverse over the last few decades. As per the 2016 Statistics Canada census, 21.9% of the Canadian population identified as having been a landed immigrant or permanent resident (Statistics Canada, 2017b). Most immigrants to Canada in 2016 were coming from Asia; as well, for the first time, Africa is ahead of Europe “...as a source continent of recent immigrants to Canada” (Statistics Canada, 2017b, p. 1). In 2016, over 250 ethnic origins, including Indigeneity, were accounted for in the census, exemplifying the vast diversity that has become fundamental to Canadian identity (Statistics Canada, 2017b). Furthermore, while English and French remain Canada’s primary languages, 200 different languages were reflected in the 2016 census (Statistics Canada, 2017b). This evidence confirms how the demographics of Canada have changed tremendously post-contact and colonization. Additionally, it demonstrates the dire need for our institutions across the country to be more representative of the population and, more importantly, to decentre European identity as the dominant norm. 19 Indigenous19 rights and histories have been slowly gaining their rightful spot at the forefront of societal institutions through global initiatives, such as the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) and local initiatives, such as the Truth and Reconciliation Commission of Canada (TRCC) propelled by Indigenous frontline resistance, resurgence, and activism. While argued to be centuries too late, colonial countries around the world are beginning to acknowledge and amend the historical wrongs committed against Indigenous peoples. For example, in 2008, then Prime Minister of Canada, Stephen Harper, made a formal statement of apology to those who were formerly forced into Indian Residential Schools by the federal government as a means of assimilation (Government of Canada, 2008). Indigenous populations living in present-day borders and unceded territories of Canada are diverse, speaking many languages and practicing different cultures and traditions. According to the 2016 Statistics Canada census, Indigenous peoples make up roughly 4.9% of the Canadian population (Statistics Canada, 2017a). Indigenous peoples are growing in numbers; the population has grown by 42.5% since 2006 and it is estimated that in the next few decades, the population will near 2.5 million people (Statistics Canada, 2017a). The census also reported at least 70 diverse languages spoken amongst this population20. The census demonstrates that Indigenous populations are flourishing, reclaiming their languages, cultures, and traditions. The Indigenous population is also reported to be roughly 10 years younger than the general Canadian 19 For the purposes of this paper, the term Indigenous is used to refer to First Nations, Inuit, and Métis people in the present colonial borders of Canada. I acknowledge that there is diversity amongst this population and this term cannot and does not represent Indigenous peoples in their entirety. Furthermore, I acknowledge that Indigeneity as a concept was forced into existence as it works to identify those who were Indigenous to the land prior to the arrival of European colonizers, settlers, and immigrants. In essence, the identity requires naming as Indigenous peoples now are labelled so as to differentiate them from settlers on their unceded territory. Prior to the arrival of European colonizers, Indigenous peoples simply existed with no need for labelling their identity. 20 The Statistics Canada 2016 census may not accurately represent the demographics and languages of Indigenous peoples in Canada due to the potential limitations or barriers in its accessibility for remote or rural communities. 20 population, with an average age of 32.1 years (Statistics Canada, 2018), indicating that the next generations will continue to grow and demand their presence and recognition of their rights and entitlements in settings across the country, rightfully so. It can be inferred from the literature that the colonizing identities of Canada have inevitably impacted and shaped the foundation of this country, resulting in Eurocentric social, political, and economic institutions. Others are forced to exist at the margins; the more one can assimilate, the closer one can move in proximity to the white norm. The contemporary demographics in Canada, however, demonstrate national diversity and that Eurocentrism is not, and never truly was, an accurate representation of Canadian society. This requires greater accountability for epistemic diversity within all institutions, structures, policies, and systems, such as academia and healthcare. 2.2 The Importance of Epistemic Diversity Research and academic scholarship in Canadian institutions are founded on Eurocentric epistemologies. As per Smith (2008), “Research is not just a highly moral and civilized search for knowledge; it is a set of very human activities that reproduce particular social relations of power” (p. 117). Research and academia reflect and work to perpetuate the same social structures of dominance that exist in Canadian society. The lack of BIPOC scholars in academic institutions strategically re-enforces the same dominant discourse on what is accepted as knowledge and critical thinking. Robertson (2013) argues that “...diversity is an epistemic virtue, as well as a moral one” (p. 300), indicating that the lack of diversity in our epistemologies is immoral. Epistemic diversity is described as the incorporation of the lived experiences and positionality of those who were and continue to be marginalized in society as well as in academic institutions and the production of knowledge (Robertson, 2013). Epistemic diversity requires 21 more than the inclusion of marginalized knowledge; it demands validation and centring of the voices and experiences of those deemed as the Other. It allows for the decentring of European identity as the norm, and a broadening of our societal understanding of those who have historically been silenced and pushed to the margins. The positionality of researchers, knowledge producers, and knowledge disseminators locates them in such a way that they become the gatekeepers of knowledge exchange and validation. Currently, only 21% of full-time faculty members in Canadian universities identify as racialized and only 1.3% identify as Indigenous (Universities Canada, 2019). This means that more than 75% of current full-time faculty are of European descent, or White. Furthermore, as intersectionality theory emphasizes, race intersects with other identities that are marginalized such as, but not limited to, gender identity and sexual orientation, which further sustains oppression within academia (Delgado & Stefancic, 2007). Because power and privilege are inherent within White identity, White knowledge producers are positioned as both decision makers and gatekeepers of the identities, thoughts, and ideas that are allowed into the university and simultaneously the epistemologies produced and disseminated by the university. As stated by Robertson (2013): ...one’s social location may affect one’s access to knowledge, the questions that are deemed important to investigate, the weight given to various criteria of justification such as which testimonial sources are trustworthy, and the broader background beliefs against which new information is judged, among other consequences. (p. 301) This academic colonialism and Western cognitive imperialism permeate into our social systems, such as healthcare provision and policy making. Consequently, Eurocentrism flows outward from Canadian academic institutions, via knowledge production and dissemination, into social structures and policies that further oppress those situated in the margins in insidious ways. For example, evidence of racism and unconscious bias have been shown to be built into the production of artificial intelligence algorithms due to lack of diversity in the developers, 22 reflective of the same biases that exist in society (Howard & Borenstein, 2018). This can have detrimental effects on the lives of marginalized identities, specifically women, gender nonconforming folks, and BIPOC, as these algorithms reflect the sexism and racism that permeate present-day society. BIPOC scholars continue to resist and simultaneously create spaces in the academy for their identities. Indigenous scholar Grande (2008) argues that “...the colonial tax of Native scholars not only requires a renegotiation of personal identity but also an analysis of how whole nations get trans- or (dis)figured when articulated through Western frames of knowing” (p. 234), thereby creating the conditions within which Indigenous peoples, amongst others, engage in colonial research methodologies and discourses while simultaneously actively resisting colonial structures. Research historically has been and continues to be connected to power and a method of identifying Indigeneity under the “Western gaze” (p. 116) resulting in Indigenous peoples working to both “...escape the penetration of the gaze” (p. 116) while concurrently establishing the self and Indigenous identity through sovereignty (Smith, 2008). As well, outsider utilization of research as a means of gaining access and surveillance to Indigenous communities has worked to perpetuate “damage-centred research” (p. 416), a type of research that focuses on the ways in which Indigenous identity has been ruined by its history to generate findings used to leverage support for the communities it documents (Tuck, 2009). This type of research results in a “...pathologizing approach in which the oppression singularly defines a community” (Tuck, 2009, p. 413). Tuck (2009), in its place, calls for the use of “desire-based research frameworks” (p. 416) that focus on the resilience and wisdom housed in marginalized identities. The birth of 23 critical pedagogies such as Critical Race Theory21 and Red Pedagogy22 are forms of epistemic resistance by BIPOC scholars who are working to create transformative and anti-oppressive intellectual spaces and dialogue that are reflective of and account for their living and lived experiences (Kress & Lake, 2018). Smith (2008) outlines the many ways in which Eurocentric methodological concepts such as respect and informed consent are centred around the Western understanding of their implications within research. For example, individual consent is not as valued in some Indigenous communities as is communal consent. Thus, the Western concept of informed consent by the individual can result in the “...bleeding of knowledge away from collective protection through individual participation in research, with knowledge moving to scientists and organizations in the world at large” (Smith, 2008, p. 131). This results in the loss of collective Indigenous knowledge as knowledge is leaked from communities to scientists and treated as a commodity (Smith, 2008). Similarly, those who sit on ethics boards and outline what is considered ethical in research inevitably are reflective of those privileged in society, practicing and policing the realm of research ethics as it pertains to dominant social discourses (Smith, 2008). This signals the ways in which our institutions are reflective of very specific interpretations of society and how they work to preserve colonial ideology through research, perhaps without an awareness of the act. Movement away from and rejection of Western research methodologies and epistemologies by BIPOC researchers is increasing as more and more of these identities find their way into positions of privilege and power in academic institutions (see Barnardt & 21 Critical Race Theory originated in the 1970s amongst civil rights activists, lawyers, and scholars with a goal to dismantle society along racial lines and to improve society for the better (Delgado & Stefancic, 2012). This will be discussed further in Chapter Three and Five. 22 Red Pedagogy is an Indigenous pedagogy based on “...traditional Indigenous knowledge and praxis” (Grande, 2008, p. 239). It is focused on critically analyzing the force of colonization and actively working to decolonize. It also emphasizes Indigenous sovereignty (Grande, 2008). 24 Kawagley, 2005; Chatterjee, 2019; Cole, 2002; Maitra & Guo, 2019; Marker, 2003; Smith, 2008; Tuck, 2009). Finally, BIPOC can tell their own stories, represent their own lived experiences, and reject the Western or white gaze through which they have continuously been depicted. An uprising of historically marginalized thought is now pervasive. Wildcat (2005) discusses the importance of “Indigenizing the future” (p. 418), a term coined by seminal Indigenous scholar and intellectual, Vine Deloria Jr. (Wildcat, 2005). Indigenizing the future is about colonial societies embracing the teachings of those Indigenous to the lands they currently live on (Wildcat, 2005). Indigenous knowledge and thinking changes the way we frame the past, the present, and the future; Indigenous understanding of spatiality is less linear and more wholesome (Wildcat, 2005). For example, some Indigenous cultures value oral history over the Western notion of written history (Fixico, 2003). Western academics portray history and time as linear, thereby asserting written history as factual remnants of the past (Fixico, 2003). The history that is known, nevertheless, is written from a Eurocentric lens. Fixico (2003) argues that these written accounts of history are “...subjective observations of biased minds filled with many influences” (p. 22). Our grasp of time and history is based on colonial definitions of such, irrespective of our awareness to it. European history is told as the default history; everything else is the alternative. Understanding the perspectives of Others works to show us the many ways in which Western epistemologies have, more than anything, limited our ability to see beyond their boundaries. Eurocentric thinking has caged our thought processes, our idea of life and lived experiences, and stunted our epistemic growth under the guise that we are engaging in forward, progressive thinking. This is partially done by the way Eurocentrism displays those categorized as the Other as inferior. As per Anderson et al. (2003): Central to the postcolonial project is the unmasking of colonizing practices to show how race and culture have been constructed as “rational” categories to locate non-European 25 peoples as the essentialized, inferior, subordinate Other. This analytic process reveals the construction of the Other not as a neutral category, but as the process by which Other comes to be seen as inferior against the backdrop of European civilization and physical appearances. (p. 200) BIPOC scholars working against this foundational notion of Western academia are then placed in a position where they must construct epistemology within an oppressive system that dynamically denies their experiences as valid. In such a way, the very existence of these scholars in these spaces is an active resistance against colonial structures. Fricker (2007) explains that hermeneutical23 marginalization occurs when “...there is unequal hermeneutical participation with respect to some significant area(s) of social experience” (p. 153). Those who are hermeneutically marginalized exist in a society where their lived experience is recluse of mainstream social understandings and interpretations of lived experiences; their participation in interpreting society is limited and therefore their experiences kept indistinct (Fricker, 2007). In other words, there is no socially understood interpretation for the experiences of those who are marginalized in society. This results in hermeneutical injustice, defined as “...the injustice of having some significant area of one’s social experience obscured from collective understanding owing to persistent and wide-ranging hermeneutical marginalization” (Fricker, 2007, p. 154). Present day society has minimal understanding and limited public dialogue about - and is just beginning to acknowledge and learn from - the lived experiences of marginalized identities, especially as these identities climb the social ladder and find themselves in positions of privilege and power, often as the token Other. BIPOC in academia are hermeneutically marginalized and forced to navigate spaces that were created on the very colonial constructs that denied their physical and social entry and integration into this colonial country. This hermeneutical injustice is “...a form of epistemic injustice that leaves its 23 Hermeneutics is essentially concerned with theories around interpretation and understanding (Schmidt, 2006). 26 victims without a conceptual framework for articulating their experiences either to themselves or to others” (Robertson, 2013, p. 302). To mitigate this damage, we must not only increase the presence of BIPOC in our socio-political and academic spaces, but also invest in understanding their experiences as they navigate these ostracizing spaces. Research in understanding these lived experiences is imperative to decreasing their hermeneutical marginalization and increasing social awareness of the unique colonial repression faced by these identities. Knowledge producers and disseminators in positions of power must reflect the diversity of Canadian society. Academic institutions across the country must be held accountable for their Eurocentric knowledge production and their perpetuation of colonial discourses. The inclusion of diverse lived experiences in academia and research will result in the fostering of epistemic diversity, ultimately validating the lived experiences of those historically depicted as the Other. Universities can ultimately reap benefits from both research and practice through representational diversity of BIPOC scholarship, faculty, and students that reflect the racial demographics of the Canadian population. The inclusion of these identities in leadership positions in the academy will work to decentre White identity and contribute to epistemic diversity, resulting in knowledge production that is more representative of the modern-day Canadian society we live in. This knowledge, founded on epistemic diversity, can then be enlisted to create more inclusive policies and practices in many realms, such as healthcare and education, ultimately working to foster a more socially just society. As well, epistemic diversity in nursing will contribute to the knowledge base necessary for competent and ethical nursing practice. To further understand the importance of epistemic diversity within the nursing context, a deeper look into the Eurocentric foundation of Western nursing and the experiences of BIPOC in the Eurocentric nursing culture is required. 27 2.3 Eurocentrism in Nursing Nurses provide care for the entire Canadian population, from urban to rural to remote communities. Nurses work in a plethora of settings, including clinics and hospitals to research and policy positions. Nursing is an essential healthcare profession and, without question, the largest, yet in my eight years in the profession, I have come to see the racial hierarchy that exists in nursing. I have worked in three different urban emergency departments and two reproductive health clinics in Canada; of these five settings, I can recall one BIPOC person in a nursing leadership role. This was an interesting observation for me as I worked at the bedside alongside a variety of racially, ethnically, religiously, and linguistically diverse nurses who were both nationally and internationally trained. Upon entry to graduate school, I saw the same pattern – few of the nursing faculty members identified as BIPOC. I saw this as problematic for a profession that serves the diverse Canadian population, particularly as the lack of diversity was apparent in nursing leadership positions, both clinically and in academia. Seeing this racial segregation reminded me of the first wave of feminism which saw White women obtain rights in society, but which left non-White women excluded. Nursing leadership has continued this pattern. Why is it that White women are able to obtain positions of power in the nursing profession meanwhile non-White women are not? More importantly, why in nursing is there a struggle to recruit and retain BIPOC in leadership roles when our patient population as well as our bedside nursing population are growingly diverse? As stated by Das Gupta (2009): Just as in Victorian English upper-middle-class homes, where white women maintained a cult of domesticity with the help of female servants, so also nursing managers and administrators, predominantly white, maintain a cult of domesticity in hospital wards with the help of registered nurses, registered practical nurses, nursing assistants and aides, who have significant concentrations of women of colour among them. (p. 44) In nursing, the bedside nurse role is a point of entry for many identities, including immigrants 28 and BIPOC. However, systemic racism is embedded within biased institutional policies such that these identities are unable to secure leadership positions in the profession. As per Das Gupta (2009), “Nurses of different statuses become divided along racial lines” (p. 86), resulting in institutions where White identities are filtered into management positions. Canadian Eurocentric ideologies have resulted in institutions that, perhaps subconsciously, perpetuate the same notions. Das Gupta (2009) argues that the factors contributing to this racial segregation within the nursing profession include: biased recruitment strategies such as word-of-mouth hiring; interviewers lacking anti-racist and cultural sensitivity training; biased promotional, mentoring, and leadership training opportunities; and subjective promotional criteria that are left to individual interpretation based on socio-cultural (read Eurocentric) interpretations of such criteria. Nurses cannot provide appropriate care to an increasingly diverse population without first holding a mirror to the nursing profession, reflecting on what is seen, and engaging in dialogue to address racism and the invisibility of BIPOC scholarship in nursing education. As per Allen (2006): Whiteness signifies an ethnic location against which most non-white positions must struggle to define themselves and this struggle is both omnipresent and suppressed when schooling is viewed as a way to ‘produce’ nurses – or when the whiteness of healthcare providers is ignored under the flag of ‘culturally competent’ care. (p. 67)24 24 A pillar of nursing theory is the concept of Transcultural Nursing or Theory of Cultural Care Diversity, coined by Madeleine Leininger in the mid 1900s. The purpose of these theories was to understand, and teach to nursing students, the importance of culture in shaping how we provide care for diverse populations (McFarland & Wehbe-Alamah, 2015). While these theories contributed greatly to the early Western/Eurocentric conceptual understanding of culturally competent care, a critical analysis requires looking at the viewpoint from which these theories were coined in nursing education. As well, analysis of whose culture is the default for which nursing students learn to provide care and whose culture we must seek to become “competent” in providing care is required. Western nursing education is built on Eurocentric conceptualizations of health and Western medical models of providing care whereas students must gain the competence to provide care for those of other cultures. Furthermore, Hassouneh (2006) argues that nursing curriculum focuses more narrowly on culture as opposed to broadly on anti-racist pedagogy. Hassouneh (2006) demonstrates that, while it is important to learn about cultural values that are common among groups, nursing students must be able to understand that these cultural values cannot be blindly applied without understanding that there are also differences within culturally similar groups; this is where anti-racist teaching is imperative. 29 A deep dive into the culture of Western nursing is required to critically analyze the socially constructed theoretical underpinnings of what nursing is and how our profession works to shape the healthcare system. Allen (2006) asserts that nursing educational institutions have worked to create spaces that produce students who are namely White, heterosexual, and Christian, into clinicians who will provide care for the same population, their educators being of similar identity. However, “When goals or objectives are articulated by people who do not represent politically the cultural diversity of the community, in all probability some forms of cultural violence will occur” (Allen, 2006, p. 71). Thus, we must look at the experiences of the Other in clinical and academic spaces to better understand how nursing as an institution perpetuates cultural violence. As Allen (2006) concedes, the educational and clinical spaces within which we learn and practice nursing are not void of culture, or culturally neutral, but rather “...firmly penetrated by the values and commitments of authoritarian, white perspectives” (p. 72). Consequently, we are inviting BIPOC nursing students and faculty into a setting that contributes to cultural violence against their identities. In Das Gupta’s (2009) research, it was found that 41% of the Canadian nurses in her sample (n=593) answered yes to whether they had been made to feel uncomfortable because of their race/ethnicity, with the majority of those who answered “yes” being visible minorities. Similarly, in her research of the experiences of non-White nurses in the United States and New Zealand, Giddings (2005) found that nursing was hegemonically constructed as White, able-bodied, and heterosexual. Nurses who were non-White expressed experiences of “...structural, ideological, and personal manifestations of racism in nursing” (Giddings, 2005, p. 310). In a study of nurses in two cities in Ontario, Boateng and Adams (2016) found similar themes; visible minority nurses, particularly those who identified as Black, compared to their White colleagues, expressed feelings of discrimination, being overly 30 monitored, having their knowledge discredited, and feeling socially excluded. This provides evidence that the experiences of non-White nurses are markedly different than that of their White colleagues. The privilege and influence of Eurocentrism is not only prevalent in the practice of nursing but also in nursing education (Puzan, 2003). However, this white privilege remains mainly unnoticed by both White students and faculty in the nursing academy (Hassouneh, 2006). Mainstream nursing culture is namely unaware of its internalized racism (Giddings, 2005). As per Ackerman-Barger and Hummel (2015), research around the experiences of nursing students of colour and the interaction between these students and faculty is poorly addressed. In their study, it was found that nursing students of colour experienced racism and exclusion from their instructors and classmates (Ackerman-Barger & Hummel, 2015). Aboriginal students in two Canadian nursing schools expressed encounters with racism from other students, the institution, and their clinical placements (Martin & Kipling, 2006). Similarly, Sedgwick et al. (2014) found that institutional bias and discrimination were contributing factors to the experiences of minority nursing students during clinical placements. Ackerman-Barger and Hummel (2015) argue that further researcher is “...needed to inform the nursing academy about best practices to achieve inclusive and equitable nursing learning environments to enable students of colour to achieve their full potential as students and future healthcare providers” (p. 45). Research which investigates the experiences of BIPOC faculty in white nursing academic spaces is limited. Hassouneh (2006) demonstrates the difficulty faced by nursing faculty of colour as they attempted to engage in anti-racist pedagogical teaching with White nursing students. Hassouneh (2006) furthermore argues that faculty of colour teaching predominantly White students are faced with an element of risk as the power relations in the classroom are 31 reflective of the power relations of society. Overall, it was found that resistance to discussions and pedagogy rooted in anti-racism was prevalent in the nursing academy among students and faculty, making it difficult for non-White faculty members to speak to their experiences of racism and teach the importance of anti-racist pedagogy in nursing (Hassouneh, 2006). Correspondingly, Robinson's (2014) mixed-methods study looking at the experiences of Black nursing faculty in the United States found that racism continues to persist in professional nursing, having implications for physical and mental health. We know that, historically, nurses of African and Caribbean descent have struggled gaining access into the profession in Canada (Flynn, 2008, 2009). Das Gupta’s (2009) research also highlighted the discrimination faced particularly by Black nurses in the profession in Canada. Thus, it is evident that anti-Black racism is particularly prevalent within Western nursing both in the academy and at the bedside. The current nursing literature demonstrates the experiences of discrimination, racism, and systemic “Othering” of BIPOC in the profession. These identities struggle to gain recognition of their knowledge, to gain promotional opportunities, and to access appropriate mentorship. Furthermore, they struggle to express their experiences and to gain acknowledgement for their racist and discriminatory encounters within the profession. To adequately recruit, retain, and create safe spaces for BIPOC in the nursing profession at all levels, we must first dismantle the Eurocentric underpinnings of the profession. 2.4 Research Significance Currently, the literature on the experiences of BIPOC in nursing is limited. While some literature exists within the American and Australian contexts, literature referring to the Canadian experience is scant. Existing literature focuses predominantly on the experiences of BIPOC in undergraduate nursing programs. I conducted a systematic literature search on May 8th, 2020 to 32 synthesize available literature relevant to my specific research question (indicated in section 1.3) which resulted in minimal findings (see Appendix A). A total of 23 articles were found in two databases using the PICO question in Table 1 (see Appendix A); only two studies were found relevant to the research question guiding this study. The lack of research focused on the experiences of BIPOC nursing graduate students in nursing education underscored the importance of this research study. By learning from the experiences of BIPOC graduate nursing students, my aim was to construct insights into how race and white privilege within the nursing profession operate and impact their experiences of obtaining positions of power in nursing, such as academic and managerial roles. It is important to note that, as mentioned in section 1.1.6, dialogue around race and equity globally has gained significant momentum. This highlights the ways in which major - and often unfortunate and traumatic events in society - influence peoples’ understanding of the spaces around them and propel society in new directions. This research study contributes to this dialogue necessary for increasing diversity in nursing academia and anti-racist pedagogy in nursing education. The literature review in Chapter Two provided the foundation for this study and supported the discussion in Chapter Five. Since conducting the literature review for this study, discussions of race and racism globally and within the nursing context have expanded considerably. Ultimately, nursing was and continues to be forced to address racism as racism/anti-racism became buzz words and “hot topics” despite having been a part of the experiences of BIPOC since time immemorial. Thus, since my initial literature review, articles on race and racism have proliferated in nursing academia although time will tell if this results in systemic and effective change within the profession. Still, there were no new studies that looked specifically at the experiences of BIPOC graduate nursing students. 33 Researching the experiences of BIPOC graduate nursing students provides insight into how these identities navigate Eurocentric academic spaces. As per Diefenbeck et al. (2016), further research on the experiences of under-represented identities in predominantly white nursing academic institutions can contribute to the recruitment, support and retention of these students in nursing programs. Moreover, given that graduate students have often spent some time working in the nursing profession, they also have a better understanding of the dynamics of nursing at the bedside, nursing leadership, and the transition from bedside to academia. Furthermore, this research study provides information for nurse educators who try to meet the learning needs of diverse students (Ackerman-Barger & Hummel, 2015). As stated by Anderson (2002): Recognizing these voices and treating them as legitimate is not a neutral academic exercise: it compels us to question what is taken for granted and to scrutinize the social and historical location from which dominant discourses have been produced. This challenges the foundations of dominant intellectual discourses, even those coming from a critical-interpretive stance that run counter to positivist science. (p. 9) Thus, this study aimed to surface the Eurocentrism that underlies the nursing profession and our Canadian healthcare system by learning from the experiences of BIPOC graduate nursing students. The goal of this research was to critically analyze how nursing perpetuates the same forces of oppression that it openly claims to resist, namely racism and inequity. 34 Chapter Three: Methodology With increasing diversity in academic institutions, there is also an active challenging and resisting of the intellectual foundations upon which educational institutions are built. BIPOC students have noticed the whiteness that permeates, not only the physical spaces, but also the psychological spaces of intellectual exchange. These students therefore are made to feel Othered, existing at the margins of the institution both physically and intellectually. As per Hall and Tandon (2017), “University knowledge systems in nearly every part of the world are derivations of the Western canon, the knowledge system created some 500 to 550 years ago in Europe by white male scientists” (p. 7). In my experience, academic nursing privileges the teaching and learning of Eurocentrically-derived methodologies such as phenomenology, grounded theory, and ethnography. These dominant academic methodologies mostly originate from Eurocentric and heteropatriarchal perspectives that perpetuate colonial power dynamics within academic institutions. Decolonizing academia from the inside-out requires active resistance to the Eurocentric axis upon which research and our entire academic institutions rest. Critical analysis of the Eurocentric theoretical lens informing research methodologies can disrupt the assumed knowers and keepers of knowledge and intelligence. To decolonize a colonial institution, we must put at the forefront the thoughts, theoretical frameworks, and perspectives of those who have historically and systematically been marginalized. We must not only use their work but also shift the paradigm of knowledge so that decolonial ways of knowing and doing research are accepted in the academy, not just as “alternative” ways of knowing, but as ways of knowing that are seen as equal to Western ways of knowing. Qualitative research designs are emergent and inductive, placing value on the researcher and participants shared subjective experience, whereas the primary design features for 35 quantitative studies are control, deductive reasoning, and objectivity. In qualitative research, both the analysis and interpretation are iterative processes (Polit & Beck, 2017). Hole (2014) refers to this lack of “control” as naturalistic; qualitative research is fundamentally inquiry into contexts, situated and constituted in natural environments. Essentially, “...qualitative research is a practice of empirical inquiry focused on naturally occurring phenomenon” (Hole, 2014, p. 166). In this study, I aimed to centre the voices and experiences of the Other throughout the entire research process. To do so effectively, I intentionally turned to epistemological and theoretical perspectives and research methodologies that have either been written by non-White people or have historically been used to highlight the experiences of BIPOC. As Audre Lorde famously stated, “For the master’s tools will never dismantle the master’s house” (Lorde, 1984, p. 2). This study was grounded in critical constructivist epistemology, oriented by Critical Race Theory (CRT), and employed narrative analysis as the research methodology. 3.1 Epistemological and Theoretical Perspectives Broadly speaking, qualitative researchers work to comprehensively understand a phenomenon as explained by those who have experienced it (Hole, 2014). The critical constructivist epistemological ground for this study considered the connection between power and knowledge, maintaining that in society, only certain groups and institutions can gain prominence and become sanctioned as proprietors of knowledge; powerful groups maintain their knowledge construction through legitimacy by continuously undermining alternative knowledge (Kincheloe, 2005), such as those generated by BIPOC scholars and researchers. In this study, critical constructivism provided the ground on which to create alternative discourses and new ways of thinking made possible by the findings, while also exposing subjugated knowledge and questioning dominant forms of knowledge production and proposing how space be made in 36 nursing academia for non-White epistemologies (Kincheloe et al., 2011). In this research study, CRT guided the narrative analysis. CRT originated in 1970 and was borne out of the movement of activists inspired to challenge and change the relationship between “...race, racism, and power” in our societies (Delgado & Stefancic, 2012, p. 3). CRT has been influenced by activists, scholars, and lawyers, who were looking to further the conversation around human rights after the civil rights era of the 1960s (Delgado & Stefancic, 2012). More specifically, CRT expanded on critical legal studies as well as radical feminism’s challenging of prescribed social roles and forms of domination (Delgado & Stefancic, 2012). Most importantly, CRT has a proponent of activism embedded in its framework; “...it sets out not only to ascertain how society organizes itself along racial lines and hierarchies but to transform it for the better” (Delgado & Stefancic, 2012, p. 7). Critical social theory and critical constructivist views of knowledge development advocate for “...a better approach to social existence, one that is free(er) of domination, power, inequities, and oppression” (Browne, 2000, p. 41). Thus, the goal was to engage in a process of understanding participants’ stories through a critical lens which allowed for the development of recommendations that achieve a more equitable nursing academic institution, free of racial power imbalances and oppression. CRT became the lens through which I read, coded, and analyzed the narrative data to construct the findings and distill and highlight their importance while situating the study results within current literature. In the above ways, critical constructivism and Critical Race Theory were able to guide the development of this study, the construction of the study findings, and the recommendations that emerged from said findings. 37 3.1.1 The Use of the Term BIPOC and CRT One key principle of CRT is that race is considered to be socially constructed; “...race and races are products of social thought” (Delgado & Stefancic, 2007, p. 137). Furthermore, CRT identifies and describes “differential racialization” as a term that refers to the shift in the racialization of minority identities by dominant society dependent on the changing needs of said society, suggesting that stereotypes and perspectives of different racialized groups are ever-changing (Delgado & Stefancic, 2007, p. 137). Building on the notion of differential racialization are concepts such as intersectionality which argue that “...no person has a single, easily stated unitary identity” (Delgado & Stefancic, 2007, p. 137). Thus, one could conclude that the term BIPOC works to perhaps erase the individual identities both within and between these racialized groups and, in some ways, equates – and thereby obscures – their experiences of existence and oppression in society. I note the inherent tensions and limitations when naming racialized peoples by using an all-encompassing term; herein lies the limits of language and the challenge of using terms to speak to diverse identities and experiences. While using the term BIPOC in the study was helpful for recruiting participants and protecting anonymity, I use the term acknowledging the risk of obscuring important differences within BIPOC that matter. As a scholar, I acknowledge the ways in which the term BIPOC, while bringing together different identities in their shared experiences of oppression, also is a term that fails to focus on the ways in which different identities’ experiences vary. Despite this, I chose to use the term for this study for several reasons. Firstly, in Chapter Two, I demonstrated how nursing academia has failed in acknowledging and addressing race and racism. Similarly, Hilario, Browne, and McFadden (2018) argue that “Although the nursing literature reflects increasing attention to race and racialization, contemporary analysis of the role and responsibility of the discipline in 38 addressing race-based health and social inequities through nursing inquiry remains underdeveloped” (p. 1). In the context of nursing academia where critical discussions on the concept of race are not yet nuanced nor developed, the use of the term BIPOC allows for entry into that territory and to open a space for dialogue and knowledge development in nursing. Secondly, the School of Nursing in Canada where this study was conducted does not collect race-based admission data; it was evident upon observation and through hearing the experiences of participants that there may not have been enough BIPOC graduate nursing students to allow for a more in-depth analysis of the experiences of specific racial identities at the institution. Lastly, as a master’s level project, there were limitations with regards to scope, time, and funding to recruit and interview a larger sample. While a larger sample size could have captured a wider array of experiences of racialized students in nursing graduate education, this study does offer rich narratives and in-depth description of the experiences of individual BIPOC graduate students who deeply engaged with the semi-structured interview questions in a meaningful way to answer the research question. Sample size in qualitative research focuses on generating in-depth and thick description; this was achieved with a small sample size in this study. Because the focus was on generating knowledge from peoples’ lived realities and their multiple and subjective experiences, the aim was not to develop decontextualized knowledge for the purpose of generalizability. Rather the aim was generating findings with potential transferability to other contexts. Essentially, I acknowledge the limitations in using the term BIPOC; however, for the reasoning presented, I proceeded to use this term within the study to open the space for knowledge development in nursing about how the culture of whiteness effects minority and racialized graduate nursing students in graduate nursing education. 39 3.2 Narrative Inquiry Narration is a form of storytelling. Storytelling is a custom that is common across many cultures around the world. Historically, storytelling has taken numerous forms from scenes carved into caves to oral exchanges by travelers to written forms of storytelling (Daiute, 2014). In the many forms that storytelling takes resides meaning (Daiute, 2014). Researchers who use narratives as the variable under study accept that stories ultimately account for human experience; the story told is a representation of the lived experience as told by the individual who experienced it (Pinnegar & Daynes, 2007). As per Daiute (2014): Narrative inquiry typically focuses on experience and the meaning of experience from the perspective of people living it in reality or in imagination rather than to identify objective truths. Differences in how scholars define narrative determine their beliefs about the location and operation of personal experience - such as whether it is primarily in the individual or distributed across symbolic and physical spaces where individuals interact to create and transform meaning. (p. 7) For this study, I focused on learning about and understanding the way BIPOC graduate nursing students interpreted and navigated the physical and intellectual spaces within which their academic journey took place, namely the physical and intellectual spaces within the School of Nursing in Canada where this study took place. Narrative analyses have a defining principle: narrating stories is a way for people to engage in a process of constructing and reconstructing stories to make sense of the world in which they exist (Polit & Beck, 2017). Furthermore, narrative analysis allows for a connection and linking between our internal world and the external world (Polit & Beck, 2017). In this narrative analysis, I focused on how participants narrated their own stories about navigating the nursing academic space as well as the way they interpreted their experiences of belonging. 40 3.3 Research Design 3.3.1 Sampling Approach As per Pope et al. (2000), sample size in qualitative studies should be determined in a way that contributes to answering the research question, and to guide analysis through data saturation. Thus, unlike quantitative research which provides equations to determine sample size based on desired power of the study, decisions around sample size in qualitative research are made to obtain the desired saturation and depth of information. This study had a sample size of eight participants, a decision guided by myself and my thesis supervisor as being adequate for the scope of a master’s thesis study as well as allowing for rich descriptive data. The inclusion criteria for participants were as follows: (a) self-identify as Black, Indigenous, or a Person of Colour (BIPOC); and (b) either currently be a graduate student at the School of Nursing in Canada where this study was conducted or have graduated within the last five years from a graduate program at the School of Nursing in Canada where this study was conducted. The purpose for such criteria was to allow for a larger population from which to sample as well as allow for breadth and depth in the data collected. The purpose of the five-year graduation limit was to minimize the impact of attributable factors beyond academic institutions; recruiting graduates from more than five years ago may have reflected experiences less attributable to education and leadership and influenced by other longitudinal factors. Still, I accounted for the difference in time between those who were current students and those who had graduated in the last five years and how time may have played a role in how participants described and reflected on their experiences. Therefore, time was considered as a potentially influential factor on participant responses during analysis. While the initial goal was to use snowball and then purposive sampling, I was able to 41 recruit all participants via the recruitment announcement and poster (see Appendix B and C). Due to the circumstances of the pandemic and students having been attending classes virtually since September 2020, it was deemed that interested participants who were current students should have started their program prior to the pandemic resulting in classes being conducted virtually. This was due to the nature of the interview guide which asked specifically about participants’ experiences in the physical space of the school (see Appendix D). 3.3.2 Recruitment Due to the COVID-19 pandemic, this School of Nursing in Canada was closed during the recruitment stage of this study therefore all recruitment was done electronically. To recruit participants, an email with the recruitment announcement and poster was disseminated to all those on the current School of Nursing newsletter listserv (see Appendix B and C). I was unable to access the listserv of those who had graduated already as a representative from this School of Nursing indicated that they were not permitted to contact previous graduates for participation in research. Thus, only those who still received the School of Nursing newsletter were able to respond to the recruitment request. As per this School of Nursing, the newsletter was still received by those who had graduated and remained subscribed. It is important to note that this School of Nursing in Canada does not keep race or ethnicity-based data on its student population, therefore the recruitment announcement and poster were sent to all students on the newsletter listserv. I also shard the recruitment announcement and poster with those in my network to assist with recruitment. Anyone interested in participating was asked to email myself as the primary contact. I then screened each respondent using the two inclusion criteria indicated above. If those interested confirmed that they self-identify as BIPOC and were either a current graduate student or graduated within the last 5 years from this Canadian School of Nursing, they were sent the 42 consent form for review and encouraged to ask any questions or express any concerns. Participants who remained interested to participate and had an opportunity to ask any questions were asked to sign the consent form and return it electronically to indicate their consent to participate. I received funding for this study and was able to give each participant a $50 gift card to show appreciation for their time and emotional labour. 3.3.3 Data Collection Setting Due to the COVID-19 pandemic, for the safety of the participants and data collector, all data collection was done digitally via the virtual meeting platform, Zoom. Participants were asked to disclose any issues in accessing WIFI in which case I would have conducted the interview in a more accessible manner, such as via telephone. However, no participants expressed such concern. The goal was to find a neutral setting that offered comfort, privacy, minimal disruptions, and a quiet space that allowed for audio-recording (Polit & Beck, 2017). Participants were asked to find a location that was well-lit, private, with stable WIFI and be free of interruptions for the virtual interview. Data Collection Method The interviews were conducted using a semi-structured interview guide (see Appendix D) which was prepared to answer the research question. A semi-structured interview guide “...ensures that researchers will obtain all the information required and gives people the freedom to provide as many illustrations and explanations as they wish” (Polit & Beck, 2017, p. 51). The semi-structured interview guide is a logically sequenced set of exploratory interview questions which are primarily open-ended; I also used probing questions to elicit further information from participants (Polit & Beck, 2017). The interviews were advertised to be between 45 to 60 43 minutes. However, some participants shared more, and those interviews lasted closer to 90 minutes. The interviews were audio-recorded which I then later manually transcribed. Qualitative researchers often take reflective notes, which support the research process by encouraging reflection during the data collection process, analysis, and construction of findings (Polit & Beck, 2017). These reflective notes can take the form of methodological insights to improve subsequent interviews, analytical notes to help make sense of the data obtained, and personal notes that allow the researcher to process their own emotions and thoughts related to the data collection and analysis (Polit & Beck, 2017). During the interviews I had a journal available to take notes; however, note-taking was limited to prevent the breaking of trust or the flow of the conversation while the interview was happening. Post-interview reflective notes were taken if needed and used for retrospective insights relevant to data analysis and construction of findings. 3.3.4 Data Analysis Reissman’s five-step method of data analysis was used to analyze the obtained information (as cited in Polit & Beck, 2017). This method was preferred because it allows the researcher to look at each story individually, and then find themes common among participant stories (Polit & Beck, 2017). The five steps of data analysis are as follows: (1) attending: the study participant reflects and makes sense of their experience in relation to the research question and as guided by the interview questions; (2) telling: the participant engages in a process of telling their experience from their own point of view while the researcher listens; (3) transcribing: the interview is recorded and transcribed; (4) analyzing: individual transcripts are analyzed and compared to find themes between the individual stories; as well, the researcher determines how they will order and present the data; (5) reading: the study results are read and shared among colleagues involved in the study to obtain feedback and develop a final report 44 (Reissman, 1993 as cited in Polit & Beck, 2017). This approach was fitting to the research study because it allowed for both an individual understanding of each story and a shared understanding via the creation of common themes. The data was manually analyzed to find themes. The thematic analysis process occurred simultaneously while data collection continued. The analysis continued as I began to transcribe the data and was an iterative process. As a BIPOC student, the construction of themes was also influenced by my own lived experiences of navigating the whiteness of nursing academia. While this study formally began the research, my inquiries into this topic began as soon as I started my journey as a BIPOC graduate nursing student. Drawing on the skills of critical reflexivity, I paid close attention in the analysis of how participants’ narratives both resonated with and expanded upon my experiences, while also remaining open to having some of my own experiences challenged to construct and refine the themes described in Chapter Four. 3.4 Ethical Considerations 3.4.1 Ethics Approval and Informed Consent Ethics approval was obtained from the University of British Columbia Behavioural Research Ethics Board (BREB) on September 15, 2020. Measures were taken to ensure the safety, privacy, and confidentiality of the participants in the study. It was imperative that participants were able to view a written consent form but also have an opportunity to ask for verbal explanations of the research process (Polit & Beck, 2017). Informed consent requires that participants are briefed on the purpose and goals of the study, especially with regards to knowledge dissemination. Participants were given multiple opportunities prior to, up until the commencement of the interview, and even after the interview to ask any questions and express any concerns. 45 3.4.2 Protection of and Support for Participants It was anticipated that those who were current students at this School of Nursing in Canada may feel concern about disclosing their experiences in the academy. For this reason, participants were reminded of the confidentiality of the study and that their identity would never be disclosed to any members of the University of British Columbia supervisory committee and any identifying factors that could be traced back to them would be removed. Furthermore, conducting the interviews virtually also maintained the privacy and confidentiality of the participants as participants could be interviewed in the privacy of a location of their choosing. As well, because the primary investigator as supervisor (Dr. Helen Brown) teaches and works with many Schools of Nursing across Canada, I ensured participants that any data viewed by my supervisor contained no identifying or demographic information. While it is difficult to fully obtain anonymity in a qualitative study where one’s identity is the main variable under study related to their experience, every effort was made to remove identifying factors related to the participant while also respecting their identities and personal experiences. For example, each participant was assigned an alphanumeric code. The code information sheet was kept separately, on a password-protected computer, from the de-identified data to maintain the confidentiality of the participants. No one from the study team, other than myself, has access to the audio-recordings or transcripts that identify the participants. Participants were also told about the nature of the study in relation to anonymity as it was explicitly explained in the consent form. Anonymity was maintained through the removal of identifying factors (for example, names, references to specific classes or experiences at the school, or references to the participants’ racial identity). Where participants mentioned racial indicators pertaining to their identity, this was replaced with “[BIPOC]” to maintain their anonymity. However, when participants referred to 46 racial indicators not pertaining to their identity but rather to nursing in general, no changes were made to the words of the participants. Additionally, it was decided by the supervisory committee and me that the alphanumeric codes would not be included in Chapter Four to add another layer of anonymity by preventing the reader from piecing together participants’ narratives through the quotes in ways that could threaten anonymity25. Dissemination of study results will be undertaken using themes (aggregated data) which decreases the chances of the information being traced back to study participants and helps promote the privacy and confidentiality of study participants. What this means is that the results of the study are not disaggregated by race or any other identifying factors. Rather, they are described in general as the experiences of BIPOC graduate nursing students. Furthermore, I did not ask demographic questions of the participants regarding variables such as their age, gender identity, or their racial/ethnic identity. Participants were simply asked to self-identity as BIPOC to participate in the study. Any demographic data indicated in Chapter Four are what was self-reported by participants in the interview. By not collecting demographics on the participants, my aim was to add another layer of anonymity. Debriefing after collecting data provided the participants the opportunity to ask questions or offer complaints or criticism related to the interview process; it can also be helpful after a particularly stressful interview (Polit & Beck, 2017). The participants were offered an opportunity to debrief off the record after the interview. Some wanted to debrief while others did not. All participants were thanked for their time and courage for sharing their experiences. An ethics-approved version of Zoom was used that does not store the interviews on 25 The study team discussed the potential use and value of member checking as a way to confirm and validate findings. However, member checking was not integrated in the research proposal as a means to validate findings. As the study progressed, we also discussed member checking as a way to return to participants to ensure they felt their identity was protected in the reporting of findings. With the acute attention paid to anonymity via the removal of alphanumeric codes and racial (among other) identity signifiers from the findings, the research team came to the conclusion that member checking as an additional layer of anonymity would not be needed as many steps were already taken to ensure the anonymity and confidentiality of participants. 47 Zoom’s cloud server. As well, participants were asked not to log onto Zoom using their name but instead to use a nickname or substitute name. They were informed that they can turn off their camera if they choose to do so, which a few participants did. All soft-copies of the data related to the study will be kept on an encrypted and password-protected computer by me. Access to the data will not be transferred to any members of the study team due to the potential power imbalances between members of an academic institution (faculty) and participants (current or former students). Study team members only reviewed the summary of the de-identified findings as presented in Chapter Four and do not have access to the transcripts or consent forms. Hard copies of the transcripts are kept in a locked binder by me; they will be destroyed once no longer needed. All digital copies of the study transcripts and audio-recordings will be deleted after 5 years. The telling of narrative stories related to one’s identity and experiences may elicit feelings such as, but not limited to, anger, lack of belonging, and grief. I have been a registered nurse who has provided care for diverse identities for over seven years and have extensive understanding of navigating difficult conversations and providing emotional support. This experience allowed me to guide participants in dialogue in a supportive and collegial manner throughout the interviews. Furthermore, each participant was provided with a list of resources prior to the commencement of the study that they could use should they need a safe space to talk, such as counselling services amongst others. 3.4.3 Researcher Reflexivity Reflexivity refers to “...critical self-reflection about one’s own biases, preferences, and preconceptions”, particularly in qualitative studies (Polit & Beck, 2017, p. 742). In the critical constructivist paradigm, knowledge is constructed in the minds of human beings – minds that are 48 also constructed by the society around them. This epistemological orientation was also the reflexive ground upon which I analyzed my own positioning within the study. In this research study, the research question was inspired by my own experiences as a BIPOC graduate nursing student in a white academic setting. I sought to understand if others have had similar experiences as myself. As the researcher, I understood that the data collected via the narrative inquiry methodology would unveil multiple truths, some different and some similar to my own, in relation to the experiences of navigating Eurocentric academic spaces. While my own experiences were the inspiration for this research project, I left space for and accepted that multiple truths and outcomes would co-exist and be revealed. Prior to conducting the interviews, I practiced self-awareness and mindfulness to ground myself in an openness to learning from participants, and to remain critically reflexive of any of my own preconceived notions about the topic under study. For example, conducting this study was emotionally laborious for myself as a BIPOC graduate nursing student. Hearing of the experiences and knowledge of other students elicited memories and emotions of my own experiences related to belonging in the nursing academy. Some experiences were both similar to my own but also simultaneously very different. In my journey as the interviewer, I had to practice both using my experiences as a bridge to connect to other participants while also accepting that some perspectives shared would be beyond my lived experience and understanding. Constructing the themes during analysis was an iterative and inductive process. The reflective notes, as indicated in section 3.3.3, played a role in helping me navigate and interrogate my own thoughts. However, as a BIPOC graduate nursing student who was both living this reality but also acting as the interviewer, my reflexivity and understanding of this topic were informed by my lived experience of the phenomena, knowing and sharing stories with 49 other BIPOC graduate nursing students, as well as my own anti-racist work. This self-reflexivity began the moment I became a graduate student and realized that, as a BIPOC student, I existed as the Other in this white space26. Furthermore, the expertise of the study team assisted me to remain critically reflexive of my analysis of the data. 3.5 Rigor The oft-cited framework by Lincoln and Guba (1985) was used to assess the rigor of this research study; this framework provides four criteria to assess quality: credibility, dependability, confirmability, and transferability (as cited in Polit & Beck, 2017). Credibility is explained as the confidence in how true and reliable the interpretation of the data is by the researcher, given the context and the participants’ stories (Polit & Beck, 2017). In qualitative research studies, truth “...resides in the discovery of human phenomena or experiences as they are lived and perceived by subjects, rather than in the verification of a priori conceptions of those experiences (Sandelowski, 1986, p. 30). As per Sandelowski (1986), the closeness of the relationship between the researcher and participants in qualitative research studies can both enhance and threaten the credibility of the study. Sandelowski (1986) argues that one way to prevent this relationship from presenting as a threat is for the researcher to be intentional in their role in influencing the participants and the study. I was deeply aware and reflexive of the preconceived notions I held about the expected research outcomes based on my own experiences. Thus, I brought this awareness into the research study to continually reflect on how any pre-existing assumptions I held may be influencing analysis of the data. Simultaneously, researchers who have personal experience or extensive understanding of the phenomenon they are researching are better able to “...share the language of the participants” and use their own experiences to connect 26 Refer to section 1.1.1 titled The Self as the Other. 50 with the participants (Holloway & Biley, 2011, p. 971). Thus, I was aware that my lived experience of this phenomenon provided a rich ground upon which I could reflect on the lived realities of the participants and connect with them during data collection, while also knowing my ideas could be challenged. Simultaneously, my reflexive commitment provided a lens through which to distill the significance of the core themes constructed from the data. Dependability, also known as reliability, in qualitative research refers to the ability of the data to transcend time and study conditions (Polit & Beck, 2017). A study is considered reliable if another researcher is able to follow the decision process of the researcher given the data at hand and ultimately arrive at the same conclusion (Sandelowski, 1986). One step to enhancing reliability is to train data collectors to use the same interview and probing questions (Guest et al., 2012). For this research study, I collected all data. Thus, I was able to ensure consistency with my interview techniques. Furthermore, I kept an audit trail, documenting my thought processes and reasons for arriving at decisions, conclusions, and themes from the data (Hole, 2014). I also engaged in debriefing with my thesis supervisory committee to ensure the dependability of my interpretations of the data (Hole, 2014). For the coding process and development of themes, I drew on the expertise of the study team to capture the complexity of the narrative data while also being held accountable to the theoretical orientation of CRT and my critical reflexive stance as a BIPOC graduate student. Confirmability refers to the objectivity in interpretation of the data collected; it ensures that the interpretations are indeed the words of the participants and not merely the biased interpretation of the data based on the perspectives of the researcher (Polit & Beck, 2017). Steps taken to increase dependability, as outlined above, also worked to increase confirmability of the data analysis. Lastly, transferability refers to the ability of the study findings to be applied to 51 another context or setting (Polit & Beck, 2017). While generalizability is not typically of concern in qualitative research, transferability is different and has been considered a relevant goal. While my research focused only on one School of Nursing in Canada, it is important to note that the lack of diversity in academic institutions, particularly in Schools of Nursing, is prevalent in institutions across the country. While there is no disaggregated data that looks specifically at the racial and ethnic demographic of professors in Schools of Nursing in Canada, we know based on aggregated statistics on the demographic of faculty in Canadian academic institutions as discussed in Chapter One that the lack of diversity is a common phenomenon. Therefore, it can be concluded that the study findings may be potentially transferable and relevant to the experiences of BIPOC graduate students in other Canadian Schools of Nursing. 3.6 Knowledge Translation and Dissemination Browne (2000) argues that “By turning the critical lens inward, we make possible a revisioning of emancipatory goals for nursing science” (p. 51). The goal for this study was to take a critical gaze inward to nursing. Based on the analysis informed by critical constructivism and CRT, the findings have provided the context to propose recommendations for creating more equitable and inclusive academic nursing institutions that prioritize the recruitment and retention of BIPOC students and faculty members into a welcoming and safe environment. CRT incorporates a tradition of activism in its theoretical underpinning; the goal is to change the racial hierarchy (Delgado & Stefancic, 2012). Thus, I intend to implement three outcomes upon completion of the study to contribute to the overall goal to disrupt the racial hierarchy within nursing: (1) Publish the study findings in a manuscript in an academic journal. 52 (2) Present the study findings more broadly to the Canadian Association of Schools of Nursing. (3) Present the study findings at conferences related to health education and research or inclusivity and diversity. 3.7 Study Team I was the primary contact and co-investigator for this study as a graduate student in the Master of Public Health and Master of Science in Nursing dual degree program. This project was completed as a requirement for the degree in the form of a thesis. The thesis supervisor and primary investigator was Dr. Helen Brown, a PhD prepared faculty member in the School of Nursing. Dr Joan Anderson, a professor emerita, was a committee member and consultant scholar. Dr. Maryam Nabavi, a strategist in the Equity & Inclusion Office, was also a member of the committee. All committee members had extensive experience with issues related to equity, diversity, and the experiences of students in the academy. There was no conflict of interest among the members of the study team to be declared. 53 Chapter Four: Findings The research question guiding this study was as follows: What are the experiences of Black, Indigenous, and People of Colour (BIPOC) graduate nursing students in white academic spaces in distinct contexts (e.g., graduate education, clinical practice, health research)? This qualitative research study employed a critical narrative inquiry approach. As per Daiute (2014), the focus of narrative inquiry is not to identify an objective truth, but rather to understand the experiences of individuals as told by them. Thus, the aim of this study was to better understand the experiences of BIPOC graduate nursing students as they navigated white academic physical and intellectual spaces and how they expressed their experiences of belonging in such spaces. This chapter outlines the findings of this critical narrative study inquiring into these experiences. A critical constructivist epistemological lens guided theoretically by Critical Race Theory (CRT) was employed during the thematic analysis and construction of findings and will further guide the discussion in Chapter Five. As indicated in section 3.3.2, this School of Nursing in Canada does not maintain race or ethnicity-based data on its student population; participants who responded to the call for this study self-identified as BIPOC27. However, discussions with participants regarding diversity amongst their peers indicated that there were minimal BIPOC students at the institution during 27 As stated in Chapter Three, participant demographic data was not collected. Participants, however, shared information about themselves and their identity throughout the interview. Any relevant demographic information shared was either anonymized to protect confidentiality or was analyzed within the context of their interview while maintaining confidentiality. Furthermore, it must be noted that the concept of “race” is contested and layered. For example, Atkin (2017) demonstrates the difficulty of defining the concept of race and the controversy of its use in the biological sciences. Thus, Zack (2017) argues, “The absence of real biological races and the location of racism in the effects of institutions and politics imply that race and racism are practical and ideological, matters of what people do and of values that benefit some groups in society, rather than how people intrinsically are” (p. 1), continuing on to suggest that race is “socially constructed” as a result of historical power dynamics. Additionally, Kendi (2019) argues that race is a “mirage”, powerfully stating that “We are what we see ourselves as, whether what we see exists or not. We are what people see us as, whether what they see exists or not. What people see in themselves and others has meaning and manifests itself in ideas and actions and policies, even if what they are seeing is an illusion” (p. 37). Therefore, one’s race is socially constructed based on how we see ourselves and how the world sees us. 54 the time which participants were students. Eight interviews were conducted using a semi-structured interview guide (see Appendix D). To set the context for the interview and dialogue, each participant was first asked about the specific influences that impacted their decision to enter the nursing profession. The aim was to better understand participants’ viewpoints about nursing and where and how their journey began. Participants reported factors such as financial stability; familial encouragement; the influence of their culture; inspiration to give back to their community; a desire to spend time with and care for people; and passion for teaching about and promoting health. Overall, the participants reported a range of three to 14 years of being a registered nurse in positions that included providing care at the bedside as well as other positions that continued during graduate education and beyond. The three overarching themes that were constructed were: Entrenched in Whiteness, Erasure of Identity, and Navigating Belonging. I constructed subthemes to provide a more nuanced analysis and thick description of the overarching themes (Polit & Beck, 2017). It is imperative to understand that these themes occur simultaneously and are interconnected as opposed to mutually exclusive. While they are discussed separately, I will speak to the ways they are connected in this chapter and the next. Collectively, these three themes reflect the participants’ experiences of this School of Nursing’s underlying context and culture of whiteness that affects BIPOC graduate nursing students in specific ways. 4.1 Theme 1: Entrenched in Whiteness The first theme that was constructed from the data reflects how BIPOC graduate students expressed being entrenched in whiteness both within the nursing profession and the institution. Participants were invited to reflect on their experiences as BIPOC in the nursing profession and if they had encountered BIPOC in nursing leadership roles prior to undertaking graduate 55 education. All participants spoke about experiencing the dominance of whiteness in the profession prior to entering graduate school; they specifically referenced the lack of racial diversity in nursing leadership positions in clinical spaces. All eight participants indicated that they had either never encountered or had limited experiences of having BIPOC in a nursing leadership role in their areas of practice prior to entering graduate school. From these initial context-setting interview questions, it became evident that participants primarily encountered White or White-passing28 people in clinical nursing leadership roles. Whiteness in the academic institution demonstrated itself in a multitude of ways. The subthemes included: whiteness in the physical space, whiteness in the intellectual space, whiteness as a gatekeeper, and unacknowledged whiteness. 4.1.1 Subtheme 1.1: Whiteness in the Physical Space Some participants identified how the physical space of this School of Nursing embodied whiteness. For example, one participant explained their29 experience of walking along the halls of the school at the beginning of their graduate journey. In the following quote, this participant30 described their experience of looking at the pictures of previous graduates on the walls of the school hallways: And then suddenly I reach the [School of Nursing] and, like, okay where is, where 28 Harris (1993) discusses how proximity to whiteness via features that are interpreted as white afford one the ability to “pass” as White and thereby gain entry into spaces which have historically excluded non-White people. Harris (1993) argues that “Passing is well known among Black people in the United States and is a feature of race subordination in all societies structured on white supremacy” (p. 1712). 29 Gender neutral pronouns are used to maintain the anonymity of all participants. 30 Participants will not be numbered using their alphanumeric codes to add another layer of anonymity by preventing the reader from piecing narratives together and possibly identifying the participant. 56 is everyone? Where are the [BIPOC]31 nurses? Where are the BIPOC nurses? I remember very well walking in the corridors, you know, as soon as you come out of the [elevator] and looking at the walls and at the photos on the walls, and so many times, probably every single time I walked in those corridors, I always try to see if I spotted any [BIPOC] nurse in those pictures. Another participant expressed similar sentiments seeing the graduate photos in the hallways: ...one of the things in the hallways is all of the photos, like the grad photos of like, the various.... cohorts, and it’s just like, again, it’s a little irksome because, it’s like, you, you know, you can see when, you know, people of colour started appearing in the grad classes. And then if you look at the [Masters] grads, I don’t know off the top of my head, I don’t recall the PhD grads, but, um, yeah, you can see, it’s like a visual reminder of, um, you know, like everyone’s White. This participant also added how seeing these photos was not a surprise given their view that such elite spaces are often dominated by White people. Another participant described their shock and disbelief when seeing the doll display depicting the history of nursing in this region of Canada. This participant expressed their surprise of seeing few BIPOC dolls represented32: Because it’s just like, it’s just so, it brings up this racist history of nursing...It’s very scary when you see these historical images of nurses. It’s the same way when I see nun, the nurses who were nuns, when I look at them, I’m freaked out.... You know, like, it’s the same kind of scary feeling of like...This is our history and it’s not wrong, this is our history. I mean, we’re just being, we’re just scared of what’s the truth, that is the truth. I mean, like, that is representative of...our history and our lineage. When I look at them...that’s not what I envisioned the future to look like. These participants were looking for themselves in the physical spaces they navigated; however, they were not reflected in what they saw. One participant stated that “The space was not very inviting or welcoming, or it didn’t feel like it was inclusive of peoples’ different experiences”. 31 Where participants referred to race and their own identity, these words were replaced with [BIPOC] to further maintain the anonymity of the participants. 32 This doll display was referred to in Chapter One. This participant brought up the doll display unprompted by the interviewer. 57 Another participant indicated, “...I can see how that space, like the physical space can be construed as very...impersonal or triggering or uncomfortable for different folks coming from different...experiences and backgrounds”. Overall, from the perspective of some participants, the space did not particularly exude a welcoming of diverse identities or a sense of inclusivity. Similarly, whiteness in the physical space presented itself in the form of physical bodies who existed in the space. Participants expressed the lack of racial diversity at the institution as an obvious issue to them. Several participants expressed their shock at how there was such a contrast between the diversity that exists at the bedside and the lack of diversity in nursing faculty. One participant stated: Like, starting my [graduate education], I was just like, ‘where is everybody?’. It’s not right...given the make-up, it just doesn’t make sense to me, the make-up of the nurse workforce and then the make-up of the leadership... This participant also stated that “...in terms of the demographics, the practicing clinicians look nothing like academic make-up or leadership make-up in this country...” in reference to the ways in which the diversity that exists in the nursing clinical spaces is not reflected in nursing leadership spaces, such as nursing faculty. This participant highlighted that there are many nurses in clinical practice who have immigrated from other countries, using the specific example of nurses from the Philippines (or who are Filipino), yet noted in their interview that Filipino nurses are not represented in Canadian nursing faculty. Similarly, another participant stated that “Because when you, when I look at my colleagues in nursing, there’s such diversity, and then I looked at the faculty and everyone was White. And I just didn’t think that it was reflective”. This participant echoed similar sentiments as the previous participant, stating that the clinical nursing demographic includes many diverse entities which are not reflective in faculty, “...when you look at nurses...there’s a lot of Filipinos, there’s a lot of, um, Indian people, but when you looked at 58 faculty at the School of Nursing, it was...not reflective”. A third participant also stated, having worked with many nurses from the Philippines in clinical settings, they were surprised that this demographic was not reflected in graduate nursing program enrolment. These three participants surfaced – and even questioned – how their experiences of racial diversity in the clinical setting were not reflected in academic nursing. One participant stated “...a lot of the speakers and all of my profs right now are, like, older White women”. Another participant expressed similar frustrations in their experiences in nursing in this institution and others in Canada, and challenged the lack of dialogue around this issue: We should be talking about the fact that the majority of nurses and the majority of, like, registered nurses, and instructors and clinicians and all the people in leadership, they’re White women...So we’re looking at a very White, very women, very heterosexual ...institution. A third participant expressed the following: I think also what striked me was the fact that not only amongst students but also faculty, faculty is predominantly White, and White older33 women, and I don’t think there are a lot of other voices, um, that should be there. The whiteness of the physical space was evident to some participants when navigating the school’s website during their admission process, a place where pictures and names of all faculty exist. Other participants came to see this as they took more courses and were exposed more to the school’s faculty. The quote above by one of the participants regarding whiteness in students and faculty indicated how whiteness extended beyond faculty to the student population, which contributes to an overall environment of whiteness. Another participant also made this point: ...I stand out more. Like, I’m more identifiable. You know, like, I remember, I mean I’m lucky if I have someone, another person of colour in the classroom, you know, like an Asian person or like a Middle Eastern person, like, I remember this one classroom – I 33 Here, “older” age is brought up, alongside White, by a participant as a noticeable descriptor of faculty. Age is discussed further in this chapter and Chapter Five. 59 literally was the ONLY, it was like White, White, White, White, White, White, it was a circle, White, White, White, and then the one [BIPOC] student. And I just remember thinking, like, what the hell? This quote expresses the visceral awareness that this participant had as the only BIPOC student in a room filled with White students. When asked if they felt uncomfortable, this participant went on to express that this is something they are used to, especially in places of power and privilege, despite being alone in it. Another participant also recalled being one of few BIPOC students in the classroom; they felt hyper-aware of their existence in a predominantly White space. Similarly, two other participants also discussed the lack of diversity in their graduate level nursing cohorts, explaining that while there was some diversity in the graduate cohorts, it was not reflective of the diversity of nurses providing clinical care. In this study, some participants described feeling hyper-visible in graduate spaces as they navigated both the whiteness of the physical space as well as the whiteness in the physical bodies of faculty and other students. 4.1.2 Subtheme 1.2: Whiteness in the Intellectual Space Participants were invited to share their perspectives on the curriculum, textbooks, and research articles that were used to teach graduate nursing students. They were asked to reflect on who was often cited as a knower and keeper of nursing knowledge. All participants indicated a lack of reference to BIPOC researchers as knowers and keepers of nursing knowledge. Mostly, references used in classrooms to teach the student population were predominantly of White or Western scholars. One participant expressed: ...everything is very representative of the [pause] established academic, west-, like kind of that like western conceptualization of what is knowledge and what is academia, and like that interpretation of things is like the way to go. And I think everything seems to reflect, reflect that viewpoint. 60 This participant also added “...maybe it could be valuable if there was more, kind of, validation and understand that there are different ways of knowing and doing and gaining knowledge”. Another participant expressed similar sentiments when talking about the content used to teach certain nursing courses, stating “...its history told by who?...certainly I know there were a lot of voices that were not being included in the history that was being taught”. This participant described how they try and challenge these narratives in their classrooms, stating the following regarding content taught to students in a nursing course: ...you know, again, we’re talking about Florence Nightingale. I mean we continue to raise the voices of some while completely ignoring and eliminating the voices of other nurses who have also made [contributions] that are BIPOC nurses and I think that if we don’t continue to be critical about the papers, even any paper that we read, then we just continue to give the same message....There have been other really important BIPOC nurses that have been as important as Florence Nightingale that we continue to exclude from the readings. This participant then took it upon themselves, in the classroom, to remind their peers to notice that the paper they were reading failed to include any history related to BIPOC nurses. Similarly, another participant reported the following as their experience with the nursing curriculum content: So yeah, I mean everyone’s White, they’re all White. It’s like the post-positivist paradigm, like, there’s no, like, we’re doing the [name of course] and I think there was, like, one article written by a [BIPOC scholar], um, out of like the entire curriculum. And I like, I get like maybe there isn’t, you know, a lot out there, but I mean maybe making a note of that and like saying that, or you know, really sourcing some articles that are not just written by White people. Another participant explained that many of the faculty tend to use their own research or the research of other faculty members from within this School of Nursing in Canada as content for the curriculum. Given that a majority of the faculty are White, this contributes further to the reinforcement of White people as knowers and keepers of nursing knowledge. Another 61 participant, when asked if the content is reflective of BIPOC in Canada, stated “That’s an easy answer. No. It’s like people writing about it. It’s like White people writing about it. But not direct voices, I would not say so”. This participant further stated that those who do write about it write from a “high level theorizing” perspective. Another participant, similarly, expressed that most of the resources listed in course syllabi are predominantly by Canadian authors but that they lack references from writers who are from other parts of the world. One participant explained that “...what we get presented with as kind of the foundation of nursing knowledge are in and of themselves deeply...contextual, political...”. They continued to say the following: ...it took me a while to realize that I could even interrogate it and I don’t, I think as a graduate student, for example, um, something didn’t sit well but, again, right, it took me a long time to be able, as a student, because I, I’m so steeped in course work, like other students, so steeped in just like trying to learn the material, drowning in the material and realizing, only years later, that, you know, maybe, maybe, you know...some of it didn’t sit well or the whole, kind of process, didn’t sit well with me because it wasn’t relevant to my experiences or my interests, and also that it was very, very, very [pause] very focused, very Eurocentric, very focused on a particular idea of nursing and nursing knowledge and what counts, as you know...who gets cited, who we learn...why these are the foundations, yeah. The above participant expressed that, while they didn’t feel comfortable challenging what they were taught as a student, they specifically noted that there was also no dialogue from the faculty for positioning the theorists, whose philosophies were taught in graduate level nursing courses, as European, White, male philosophers. This same participant stated, “...we didn’t have those frank conversations”. The above subtheme demonstrates how participants felt whiteness has occupied and presented itself in the intellectual academic spaces, as evidenced by the researchers, philosophers, and theorists who were cited as representative of the nursing knowledge creators. All participants expressed that the content taught in the graduate curricula were not representative of BIPOC experiences in Canada. 62 4.1.3 Subtheme 1.3: Whiteness as a Gatekeeper Participants highlighted how whiteness acted as a method of gatekeeping, and in very particular ways. Specifically, they spoke about their experiences of graduate student admission and the nuances of what research is deemed worth pursuing as both being filtered through a white gaze. One participant discussed their experience of looking for a supervisor, stating they “...felt that [their supervisor] in some way would be more willing to accept a [BIPOC] nurse”, indicating that they had considered how their identity may impact their supervisor’s perception of them. This participant stated the following: ...I realized there were no [BIPOC] faculty at the school but, to be honest, in the past...I was not used to [having], I mean there’s definitely no one in [research area of interest] that is a BIPOC nurse that has mentored me so, for me, it was about who in these spaces would accept me or would help me achieve what I want without perhaps holding me back as others have. This participant expressed feeling very happy with their supervisors and the support received. However, it was evident that an awareness of their identity as a BIPOC nurse and gaining acceptance in the academy meant first finding a research supervisor who they knew would likely not be BIPOC and would accept their invitation to supervise and support them as a BIPOC nurse. This participant, referring to what they looked for when searching for support from those in leadership roles, stated they considered “...people that will create opportunities for you...that would not hold you from achieving your best, for being great at what you can possibly be, for believing in yourself, and what you can achieve, regardless of what you look like”. In this way, whiteness was sustained and reproduced through the dominance of White faculty at the school. Whiteness, in this way, determines – and limits – who can and cannot be accepted into the academy via graduate programs. 63 Furthermore, a participant also highlighted how assumptions by faculty about students can result in students being invited or excluded from demonstrating their knowledge on nursing related topics. One participant suggested that perhaps certain students were overlooked as experts of nursing content and were subsequently less likely to be invited as speakers to events compared to White students. This participant also stated that, when it comes to events held at this School of Nursing in Canada, it seems that some BIPOC students may be overlooked: In terms of conferences, events, you know, specific workshops that may be put together... I think sometimes we tend to give the voice of those that speak the loudest and we forget that there are others that may be quiet but that doesn’t mean that they don’t have the experience and that they don’t have the knowledge, you know. Just because someone is not the loudest person in the room, we cannot discredit them, right. And I have...been in workshops where I think that those that have been invited to speak, um, I think there are other students at the School of Nursing that have much more experience than those that have been invited to speak. And I know that those that have been invited to speak is because they are the loudest person in the room but also, is it also because they are White? What this subtheme reveals are the ways in which whiteness performs gatekeeping by determining who is allowed entry into the institution for research and graduate education. Whiteness also then performs gatekeeping once students are admitted into the space by determining which students are provided opportunities to demonstrate and share their knowledge via occasions such as conferences and events. Another way that whiteness as gatekeeping was evident in the data was through how one participant referenced the institution’s attempt to diversify the student body to meet what they believed to be race quotas. A participant explained that they had thoughts that perhaps their race was a reason for them being admitted into the program. This participant stated “I said it as a joke but maybe that’s why I got into nursing. Um, so, because...I’m a person of colour...going into nursing...so part of me was thinking maybe they wanted to diversify the group...”. They also stated the following: 64 ...it was strange because it was kind of like the first thing that I thought about, um, when I got accepted. I was like oh maybe it was because of this. Um, cause the space was very White, putting it bluntly. Um and so anytime I think of that, I was like oh they want to diversify their, and at the time I was reading about [name of university] and they were trying to diversify their, um, their medical program. Um, and so I thought this was, this was the School of Nursing trying to diversify their graduate programs. This participant was critical of the basis upon which they were admitted into the program, questioning if their admission was a tokenistic attempt at diversification or based on a well-earned merit for graduate education. When entering graduate school and being in the academic spaces, this participant noticed they were one of only a few BIPOC, which led them to question how just existing in a white space meant also questioning their belonging to that very space, a theme discussed later in this chapter. Another participant shared their belief that faculty may view BIPOC students as less productive and less likely to publish than White students, particularly if they are international students or learned English as a second language. This participant shared their impressions of how faculty may be more inclined to work with White students based on assumptions that White students are more likely to generate scholarly outputs, such as publications: ...sometimes I feel like working with - this is my perception - sometimes working with students of colour, is a little more, I don’t want to say threatening, but it doesn’t seem.... there’s this like feeling that I get that like if you invest your time in a person of colour, you’re not going to get the outputs that you want. A professor wants a student who’s going to be able to publish at the end of the day. This participant indicated that these exclusionary impressions are not explicit; rather, they are insidiously felt by BIPOC students: ...this is something that we feel, this is not, like, it’s not something that, and – which is why racism is hard to identify in academia, it’s because it’s not explicitly going to be like ‘you’re an, an [racist term] and why are you here’. It’s not going be like that, it’s going to be more like this implicit thing of like ‘Oh my god! Here’s another White student who, like, was able to, you know, they had their life together and was able to publish a paper in undergrad. Let me take them under my wing’. 65 This quote highlights how racism and bias may not be outwardly vocalized as identifiable comments but rather experienced or felt by BIPOC students as a subtext in the space they are navigating. Whiteness as gatekeeping was expressed by a participant as extending beyond the nursing academic institution to organizations that provide scholarships and further educational opportunities. One participant identified a case where they were being interviewed by a panel of White-presenting interviewers for a particular academic opportunity. As a BIPOC student, they expressed discomfort, specifically when they were asked about their personal identity and biography and how it related to their research interests around working with a specific marginalized population. This participant expressed the following: ...maybe I just didn’t feel safe. It felt so threatening to be asked that question in that context...in another context I would, like right now, I can share about my experiences that have...been foundational to the kind of work I do...in that moment, it felt like I would be selling my story to them or giving them a story that they wanted to hear...I don’t know...it just didn’t feel right to me. This participant further expressed their hurt and frustration at this feeling of having to justify the connection between their own identity and their study population: ...they kind of kept probing and it was that feeling like they wanted a particular story ....and so, and for me, I think, when I reflect back on that, I think my emotions were coming from a place of indignation and anger and wondering why do White people get to study anybody they want and not have to rationalize or justify their standpoint and, just because I want to work with a particular group, I want to work with, um, [study population] or diverse groups, I have to justify that. Why does a White woman get to interview Indigenous people, um, you know, immigrants, anybody they want, AND White people, and that’s okay. And they don’t have to justify themselves. So, I think it was coming from that place. For the above participant, this was a difficult and powerful experience that elicited significant emotion when shared. It highlights how whiteness acts as gatekeeping, even if it is not directly tied to this School of Nursing in Canada but by extension as a granting power that provides 66 opportunities for furthering research and educational prospects. Another participant shared similar sentiments regarding decisions they made about the research they want to conduct; they spoke of being mindful that studying race may be more difficult than studying something like gender, stating “...I want to be deliberate in picking something that I know that if I go for [further graduate studies], if I go for other things, it’s not going to pigeonhole me...”, stating that studying race may be deemed not fruitful or profitable, even if that’s where their interests lie. They further expressed that, as a BIPOC student, it’s easier to assimilate with what White researchers are doing due to the lack of mentorship and what is deemed worthy research. This demonstrates how whiteness works to also gatekeep the topics that are deemed important to research in the nursing academy, evidenced by what is and is not currently studied by the mostly White nursing faculty. Another participant shed light on the ways in which White faculty have a real opportunity, as people in positions of power, to challenge the institution and prompt change. This participant explained: I would love if there was this, kind of, reality check or face-to-face interrogation of, you know, like, are we valuing certain authors or certain ways of thinking because that is the most important or is it because that’s what we know and that’s what’s legitimized in other places? This participant also explained that specific faculty who are well known and hold power in the profession can raise questions of why certain researchers perceived as knowledge holders are always used as the reference point while others are excluded; this in turn can shift the dialogue towards including more BIPOC both in the institution and in the curricula. This participant elaborated by stating “...I feel like when BIPOC folks do it, it feels, I don’t know. I feel like the perception of people that are reading are just like ‘oh you’re just complaining again’, kind of thing”. This participant shared that when BIPOC attempt to challenge the system and ask for more representation in the institution, they are portrayed as “just complaining again”. Thus, the 67 words of this participant point to the fact that White faculty who are aware and understand this dynamic can use their privilege to open the gates to more intentional, as opposed to superficial and tokenistic, diversity in the institution and profession of nursing, both physically and intellectually. 4.1.4 Subtheme 1.4: Unacknowledged Whiteness A few participants brought forward that White faculty lack awareness of their role in perpetuating whiteness in the institution, leaving it unacknowledged. For example, one participant discussed the ways in which some faculty at the institution worked to create a diverse climate, whereas others at the institution were unaware of race-related issues until a major event took place that triggered global awareness regarding racism, and more specifically, anti-Black racism34: ...I think some faculty do create that space, um and I think, that’s because they’ve, I think that’s because they’ve really reflected on their own positionality. Um, so I do think that some faculty do create that space. I do think that some other faculty...have not taken those suggestions forward or have not, or did not come back and acknowledge what they were doing until Black Lives Matter movement. So, for me, I think there is a period before the summer, you know, before George Floyd, and there is a period after George Floyd...what I don’t want it to fall into, [inaudible], and I’ve observed this already, is the performative allyship. This participant also said: ...I don’t know how many faculty at the School of Nursing have reflected on their own positionality and where they stand and the assumptions they make of any of the students that come through their door. This participant, as explained in subtheme 1.3, demonstrated how assumptions made of students can impact how they are treated in the academic space, what opportunities they are given, and how their knowledge is acknowledged and respected. This lack of awareness of others and the self by faculty can impact the assumptions they make of BIPOC students. This lack of awareness 34 This was discussed in section 1.1.6. 68 can also impact the way faculty perceive the importance and relevance of global issues. For example, another participant discussed how, during September 2020, a movement called the Scholars’ Strike took place to raise awareness of police brutality and systemic racism, specifically against Black and Indigenous people. For two days, scholars across North America were asked to strike and use classroom time to teach about these issues in a show of solidarity with the movement that had rippled across the world. This participant expressed the discomfort that was felt when their White faculty member mentioned the strike but decided to continue with the class due to the timeline in the syllabus. This participant later in the interview also explained, when discussing the importance of diversity and inclusivity, that: I think it’s hard for an older, White professor to really understand. Like, they might just not get it. Like, they might feel like they care and maybe think that they care...but I don’t think they could really get, get what it’s about. This participant had experienced a racist incident in which, while working on a specific unit that was predominantly White, they were repeatedly assumed to be the care aide, despite having been a registered nurse for several years and with graduate education; this participant felt that this was because of the way they looked and the colour of their skin. This same participant continued to say: ...it’s this awkward thing and I don’t think that until you experience something similar that you can, like, really care enough about it to...understand how that, like, plays out in a classroom environment or, like, within nursing practice. Like, I just don’t think you can get it. Here, the participant shares their view that when whiteness and “older” age intersect, there is a reduced capacity for White faculty to “get” racism in classrooms or clinical spaces. This participant demonstrates an assumption that being White and of older age results in an inability to understand or care about racism. While the scope of my analysis was limited to race and racism within the data, this quote highlights how ageism may be furthered when assumptions are 69 made about the interaction of race and age. While not the focus of my analysis, it is important to consider how whiteness and relations of power are interpreted vis a vis other “isms”, such as ageism35. Another participant drew attention to the importance of White faculty positioning themselves in relation to their work, stating “...a lot of the professors, a lot of the faculty were White. And faculty members doing research with racialized populations and yet not positioning themselves. I thought that was very problematic”. This participant explained that White faculty working with racialized populations perhaps lacked this awareness and were “...unwilling to look at their own privilege and their own positionality”, and the ways in which working with these populations has actually contributed to “...the stature they’ve gained”. Overall, we can see that whiteness presents itself by dominating the physical space via nursing iconography and photos as well as faculty and students; and intellectually via scholarly references predominantly by White researchers used to educate graduate nursing students. As well, whiteness works to open or close the gates to the academy via determining the student body that is or is not admitted, the research that is determined priority, and by broader opportunities which act as an extension of the academy as filters determining which students and research should be supported in their work. 4.2 Theme 2: Erasure of Identity Along with being entrenched in whiteness in the multitude of ways described in theme 1, there was simultaneously an active erasure of BIPOC in the nursing academic space. Participants described the ways in which they felt they did not see themselves represented in the profession in academia. Subthemes within theme 2 include selective acknowledgement of oppression, lack of 35 This is discussed in more detail in Chapter Five. 70 research and expertise with BIPOC communities, and lack of critical and intersectional perspectives. 4.2.1 Subtheme 2.1: Selective Acknowledgement of Oppression The first subtheme reflects how participants shared how oppression operated within the institution; specifically, how not all oppression is acknowledged and, as a result, how some identities are erased. For example, one participant, reflecting on their experience, stated: ...the School of Nursing is doing a bit, is doing some good work around, like, Indigenous perspectives in some ways and some people, some researchers are, that’s their area, and things like that. I’m going to hazard that representation of Black and People of Colour voices is less well represented or, maybe no one’s trying to represent those voices as much. Similarly, another participant reflected on their own research around racism while at the institution and how the topic of racism was not often raised and, when it was, it was only in reference to anti-Indigenous racism: ...it was brought up in certain contexts in terms of, you know, colonization and people working with Indigenous women and First Nations health, but it was often, at that point anyways, it was, um, like cultural competency, cultural safety was often framed around Indigenous health and not so much, not as explicitly in relation to racism at large. As well, a third participant expressed how there was no explicit acknowledgement of the myriad of ways racism affects others when the focus is on one identity, Indigeneity: ... [name of university] nursing only recognizes specific forms of racism, like, they’re very quick to acknowledge anti-Indigenous racism which is, as they should, they 100% should. But I think that a lot of these conversations just don’t become nuanced because they completely disregard everybody else. Right. Like, yes, I think it’s important to talk about these things, but, as a [BIPOC] person, my experience is completely erased. What these quotes exhibit is that, by way of white gatekeeping, the nursing academic institution demonstrates a lack of understanding and awareness of the ways in which colonialism, racism, and oppression have intersected to impact many identities – as reported above by one participant, “...these conversations just don’t become nuanced”. These participant voices signal a significant 71 failure by the nursing academy to create space for intentional and all-encompassing discussions around racism with students as well as research on the impact of racism on the health of populations. 4.2.2 Subtheme 2.2: Lack of Research and Expertise with BIPOC Communities Many participants discussed the lack of presence of research with BIPOC communities in the nursing graduate curricula and amongst faculty as salient and hard to dismiss. Participants discussed facing barriers when trying to find faculty that could support their work with BIPOC communities. For example, one participant explained that they were having trouble finding faculty that could support their research because no faculty had experience or expertise with the population or intervention that they want to study within a specific racialized community. This participant expressed that they will likely have to look outside of the faculty of nursing for support: ...from the research I did do, there’s no one who is looking at the population I want to look at. No one is looking at the kind of intervention I want to do. No one, like, I think what I’m going to end up having to do is having multiple supervisors from various faculty. This participant expressed that a lot of the research currently done at the institution focuses on illness, not on wellness. They stated “I am not a subject that could be researched by any of these people researching...I want my experience, or experience like mine to be captured somewhere. Because I think that there is something there”. Another participant had previously, in theme 1.3, expressed the pressure of not studying something that would pigeonhole them into a specific topic, namely race. This perspective also sheds light on the fact that, despite their interest in wanting to engage in research related to BIPOC, they did not feel there was a space or the available mentorship for them in the nursing academy to pursue such research; therefore, there was a feeling of having to align their research perspectives with what was already being done by 72 the existing faculty. This participant went on to explain that it’s not specifically that the faculty are not interested in studying race as a determinant of health, but rather “...it’s just not on their radar because it’s not a part of their lived experience. They’re just not, they’re not thinking about these things, you know?”. Comparably, when asked their thoughts on why there was a gap in literature, specifically around the health of BIPOC, another participant shared: I think the reason that there are gaps is because, or the reason research is done in a particular way, a very deficit-based way, is, is yeah, it’s really around peoples’ agendas and so that has to do with the framing. Um, but also, sometimes it’s absent because, um the people who are doing research are interested in phenomena that they, um, that’s rooted in their own lived experiences and when people who are doing research don’t have the lived experiences that represent the full spectrum or range of experiences and conditions that shape health, then that’s not represented in what gets constructed as nursing knowledge. Another participant, whose research focused on the experiences of a specific subset of racialized nurses, found it difficult to find mentorship with lived experience. They resorted to literature from other scholars who did have the lived experience to help guide their work. While they felt supported by their supervisor and committee members, they stated “I think there is that limitation that, like, unless you have that lived experience or kind of understand the context firsthand, um, you don’t quite get it”. Yet another participant expressed their perspectives as well, shedding light on the importance of having faculty who have expertise in teaching BIPOC thought and methodologies. This participant reported it would be helpful if there was more of a [BIPOC] presence at the school to support this work: ...I wish there were more [BIPOC] voices that I could turn to within the School of Nursing, for kind of, for expertise and guidance on how are we, how can I do my research in a way that’s not so firmly rooted in, kind of, Western nursing knowledge, um, so that’s something that I’m trying to figure out... 73 This subtheme demonstrated that, while faculty may have some content knowledge or methodological expertise related to the topic of BIPOC health and wellness, it was not prevalent or widely supported by all faculty. Rather, students found it difficult to find mentorship and support in their interests in researching the lived experiences of BIPOC in Canada; they felt most of the faculty did not engage in such research or have the lived experience to understand it in its depth. 4.2.3 Subtheme 2.3: Lack of Critical and Intersectional Perspectives Participants expressed that the nursing courses taught at the graduate level lacked critical and intersectional perspectives. Some felt that the nursing faculty did not have the lived experience or expertise to discuss these topics. For example, one participant expressed their frustration with the lack of discussion in graduate level research courses around critical data analysis: ...a small example would be, we’re taught ‘define your population’, oh women...we’re using women and female simultaneously, we’re not having any critical thinking about how to make it trans inclusive, how to do racial analysis, how to capture that information, like nothing. Those things can be incorporated in a master’s level research course and they should be. Like, there is a difference between racial and ethnic data...and we’re not talking about that. It’s just like how to do research. We’re not even talking about how research fundamentally is a White, colonial, male institution and we’re not having any, like, critical analysis about research. Another participant also expressed that they were interested to learn more about the intersection of BIPOC identity and transgender care and a better understanding of the barriers these populations may face as they access healthcare; they explained that “I didn’t really get that taught at [name of university]. It’s only through my, my own sort of learning, self-learning...it would’ve been nice to get some of that teaching at [name of university]”. One participant expressed their desire to learn about theories such as Critical Race Theory to inform their own personal research, yet they noted a real absence of literature and 74 dialogue from faculty teaching about such critical topics. This participant went on to state “...it would make sense if someone is not that well-versed in Critical Race Theory to not, to not teach it” but emphasized that “They need to hire someone that can teach these things”. This participant also emphasized that the lack of such teachings and critical perspectives in the graduate nursing curricula increases the workload of students who are interested in such topics, stating that, if left up to the curricula provided, “...I’m not being educated the way I want to be”. Similarly, another participant expressed that the theories and philosophies they were interested in that discussed critical perspectives were not prevalent at the graduate level: ...we learned all about the continental philosophers, all the Western philosophers, but I wanted to, um, well, yeah, several of my courses I wanted to focus on Black Feminist Thought and intersectionality and in my other, in my [name of other courses], I wanted to focus on race, the construction of race, and I wanted to look at, um, how racism plays out in nursing inquiry and research, and schools of thought... When asked their thoughts on the graduate curriculum and its inclusion of different ways of thinking, one participant expressed the following: ...some inclusion in, like, throughout the different courses, the curricula, like embedded within those, just space to kind of explore and understand, again, different kind of, traditions and world views, um, as also valid and not something that, and have that kind of like built in and integrated throughout the different courses would be quite powerful and not something that’s reliant on a specific instructor to have experience in that area or relying on the one student in that class or in the program that has that experience and, um, taking the onus off the individuals and putting it kind of like as a responsibility for everybody... This participant also expressed that bringing in guest speakers to facilitate such dialogue is also an option. Another participant felt that the graduate programs were not created with the intention of teaching students how to challenge thought-processes and to propel change but rather as a checkbox so nurses can obtain leadership positions in institutions. This participant explained: I think a lot of master’s programs are not trying to create researchers who are going to 75 do meaningful research. They’re just trying to create master’s prepared nurses so they can go to the next stage of leadership so they can say ‘yup, check mark, done my master’s’, but it’s not actually creating a strong discipline in terms of inquiry and challenging status quo and making professional change or thinking things through in a contemporary setting. The above quotes from participants demonstrate the importance of having critical perspectives that go beyond Western and Eurocentric philosophies to be more woven into the graduate nursing curricula. Having more in-depth and diverse thought processes taught to students helps to foster critical thinking in students that encourages them to think deeply about the factors that impact health. One participant, very well-articulated, stated “...that’s what I want to see more of in the school, is being able to challenge our way of thinking and applying different lenses at different points beyond just what we’re comfortable [with]”. A participant mentioned that in one specific course when the opportunity was there to choose a topic to discuss, such as racism and its relevance to nursing, it was not brought up in the course, even though it was a topic that was socially prominent at the time. Two participants brought up that faculty are not prepared to engage in dialogue around how racism impacts nurses themselves in practice or how to prepare BIPOC nurses for experiencing racism in their own lives or at the workplace. While racism may be discussed and taught as a social determinant of health for patients, one participant explained the ways in which nursing programs do not prepare BIPOC nurses for practicing in potentially racist healthcare environments: None of my instructors thought to mention how racism might affect me on the job, right, they’re training me to do nursing but they’re not thinking through, like, maybe it’s diff-, maybe when I try to make a therapeutic alliance with someone, I’m automatically at a disadvantage because they think I’m incompetent because if the colour of my skin... This participant also stated: There’s, there might be some interest or documentation about what is it like to be a Black person getting healthcare or being a, um, coloured person, you know, receiving 76 healthcare, Indigenous, Black, White, Asian, whatever. But I think that there’s not that much research or interest in thinking about what is it, what is it like, because I embody that. I leave work and I live with that on my skin. I’ve already told you and mentioned that racism is considered a social determinant of health. They’ve done studies and proven that racism shortens your life. It literally can manifest itself in cancer and chronic disease, and...I don’t want to die young, or, like early, or like have some sort of horrible health consequence because I felt like I had to accept racism at my job, or I had to, like, tip-toe around someone being very problematic and not being believed. It’s exhausting to do that too, and there’s a lot of that, too, right. Another participant similarly explained that a predominantly White faculty is not prepared to have discussions with BIPOC students about the ways in which these students may experience racism themselves: And so, in my practice, especially in my undergraduate program, after my undergraduate program, I don’t think that I was taught to critically think about social determinants of health in relation to me. I think they talk about social determinants of health...but I don’t think that the faculty is equipped or willing to engage with students and their own lived experiences. This participant, referring to the current faculty who are mostly White, went on to explain that “I think that they’re comfortable talking about it at a theoretical level but they are not comfortable engaging with the very people they are teaching, as people who are coming with these histories and whose lives are underpinned by those structural conditions” as well as “I think that there is great value in even just acknowledging the possibility that their very students could be living with these lived realities”. What’s evident from the words of these two participants is that nursing academic institutions teach race and culture from a theoretical and perhaps white perspective, not recognizing the many BIPOC students who are learning in these spaces also come with their own lived experiences of racism. While it is imperative for all students to learn cultural competency and how to provide care for diverse populations, experiences of racism are also a very real lived experience for BIPOC nursing students who either experience it as they navigate their lives or while working in different healthcare settings and providing care for 77 patients as nurses. Ultimately, when asked how the centering of whiteness and the lack of diversity in the resources used to teach students in the nursing academy affects the practice of graduate nurses, one participant stated: As someone who does identify as BIPOC, I think that it sends a repeated message, it used to send a repeated message to me, that, um, that I’m inferior. That I’m inadequate. That my lived experiences don’t reflect the foundations of nursing knowledge. I mean, I know there’s been a lot of recent discussion about this too but, you know, just even in the same way that, um, you know, in discourse analysis, they look at who are seen as heroes, who are seen as figures in the discipline... What the above quote demonstrates is that excluding diverse, inclusive, and intersecting narratives and failing to have these critical dialogues with students creates a space of not belonging. 4.3 Theme 3: Navigating Belonging The final theme that arose from the data was that of exploring and understanding ways in which participants felt they do or do not belong. Participants talked about the ways in which the physical and intellectual space of nursing academia works to welcome some identities while simultaneously excluding others, perhaps unintentionally but without true awareness of it. Participants also discussed ways they worked to create an atmosphere of belonging and how they challenged the nursing academic institution in their own ways, as a method of resistance, to create a sense of belonging for themselves and others who are also made to feel that they don’t belong. The two subthemes that emerged were feelings of (not) belonging and existence as resistance – creating belonging. 4.3.1 Subtheme 3.1: Feelings of (Not) Belonging Several participants discussed their thoughts and emotions related to the lack of presence of BIPOC at the institution, whether historically as students or presently as students and/or people in leadership positions, namely faculty. One participant, referring to the lack of BIPOC 78 students in photographs of previous graduates hung in the hallways of the school, reported the following: ...it’s quite visible when you’re walking in the corridor. But for me, was, uh, who has been here that looks like me, um, that have looked like me in the past. And I think, I know that the reason why I was looking at that and thinking about that, it’s because I’m thinking what are the chances of me succeeding here? This, in tandem with subtheme 1.1, demonstrates how the lack of diversity in physical bodies and photos of previous graduates in the space has the potential to make BIPOC question their chances of success. This participant explained how not seeing someone who looks like them in this space created feelings of having to put in more effort and work to achieve success: ...will I be given the opportunities, right? So, I think seeing someone that looks like me would make me feel, okay, this person can do it so I can do it too, right. I think that’s the importance of having a role model or seeing those that look like you in senior positions or in the positions that you wish to be one day...throughout my professional life, I have never had that. I’ve never had someone that looked like me in a position that I want to be. So, for me, I think it was about how much work do I have to put in, right? Almost like, preparing myself to brave the unknown and to know, okay then I have to work twice as hard, because people that look like me have not been in this space yet. So I know those are the reasons why I was looking into those pictures. Similarly, another participant stated that an inspiring factor for them to pursue graduate studies was the fact that they, themselves, had seen few people who look like them or who identify as BIPOC in nursing faculty positions. They stated “...a lot of the RNs maybe are not, you know, they maybe think that they can’t, um, go to school and get those leadership positions because they just don’t see a lot of people that look like them with the degrees”. This participant also stated their surprise that there were no faculty of Filipino or Indian descent with doctorates considering their experiences of seeing many nurses who are Filipino or Indian working in clinical settings. The lack of diversity in nursing faculty was a driving factor for this participant to pursue their graduate studies in hopes of showing other BIPOC that they too can occupy leadership spaces in nursing. 79 Some participants expressed that, prior to coming to graduate school, they did not even have the expectation to find someone who looks like them in positions of power at the nursing institution – they simply did not expect it and knew there would be few BIPOC faculty members. For example, one participant stated: It didn’t even, like, occur to me to find...it just kind of shows how the world works. Like it didn’t actually even occur to me to find a mentor that was, um, [pause], like a person of colour or like someone that would, you know, be able to support me in that way. This participant explained that they did not expect that having a BIPOC mentor or someone who understands the specific struggles of a BIPOC graduate nursing student as an option. When asked if they felt their experience was different from White students navigating the same space, this participant expressed: ...it’s completely different, [pause] yeah, it’s completely different. Like, I guess a student that was, that was White, like it wouldn’t...I mean they would be paired with a White supervisor for sure, because, just, with the numbers at the School of Nursing...it’s a good chance that it would be a White supervisor. Another participant expressed similar perspectives, sharing that prior to arriving to the school, they had noticed the lack of diversity in faculty based on the school’s website and knew that they could not expect a specific type of mentorship from someone who reflects their identity because there was not anyone who reflected their identity. As mentioned earlier by a participant, seeing people who look like you in positions of privilege and power in the nursing academic institution simultaneously reaffirms one’s sense of belonging in the institution. Another participant shed light on the fact that White students’ identities are re-affirmed as belonging in the academy by way of the existence of White faculty who dominate positions of power. Alternatively, and in absolute contrast, BIPOC students have 80 few people or no people who look like them in such positions, thereby resulting in feelings of not belonging. Yet another participant also emphasized this point, claiming: I know specifically I was looking for academics from like a [racial identity of participant] background...there wasn’t anybody...which is a bit depressing in terms of just having role models, right. I’m just like, I don’t know, why aren’t people in this space? Another participant described their dismay at the lack of BIPOC in nursing leadership – they reported that, although it was not something they particularly noticed in their undergraduate journey, it was much more noticeable as they found themselves in nursing leadership positions. This participant stated: ...it’s troublesome just because obviously, younger, younger people who identify with being BIPOC, um, they have no body to sort of like aspire to. Cause when we’re young, there’s no body that looks like us, or that would identify with us in leadership positions and so therefore, um, this is something that I can’t be, a leader, because obviously there’s no body that looks like me that’s a leader. Another participant expressed that the lack of BIPOC faculty at the institution resulted in feelings of not belonging, stating “...if everyone around you including the teacher doesn’t look like you, then, yeah, you would think that you don’t fit in or that you maybe have something to prove to be there”. They also expressed that when faculty are predominantly White and of older age, “...if you don’t see someone that looks like you, if you can’t talk to someone who is like you, then it’s just, um, it’s like exclusive. It’s like an exclusive community that you don’t belong to”. Here, age is invoked again by a participant as a potential factor contributing to making the academic environment feel exclusive. This same participant continued on to explain that this feeling of needing to prove that they belong resulted in being extremely “...meticulous about...making sure that [my assignments] are as perfect as I can get them, and... I strive to get super high marks because I feel like I have to maybe prove that I’m, I’m supposed to be there, 81 I’m not sure”. Another participant also reported similar sentiments regarding feelings of not belonging that are elicited by the lack of diversity in the nursing institution: ...in terms of belonging, yeah it didn’t exist really. It would be nice to see some more BIPOC individuals in sort of like academic, academia. But again, I think it’s just this cycle, that, um, I don’t see anybody in those positions so therefore I can’t get into those positions, and then it just keeps on going. I kind of think of it as like an intergenerational trauma. Um, where it kind of just, that cycle just keeps going and going and going. Um, and, the only way to break it is to allow people to get into those positions. People then acknowledge that ‘oh there is [a BIPOC] person that’s teaching these nursing courses who also has a PhD, this is something that [a BIPOC nurse] can get to’...I didn’t have anything like that growing up. And so, I think it’s only been in the last 5 or 6 years that I’ve started to think about this. Um, just because it wasn’t apparent when I was growing up either. This participant, in the above quote, reaffirms quotes by two previous participants, demonstrating the importance of the presence of diverse identities in nursing academia as a way of emphasizing belonging and inclusivity in the space. Additionally, yet another participant emphasized how the presence of BIPOC mentors for students has the capacity to change one’s perception of what they can accomplish: I think representation matters. Um, it was not possible for me to find role models and people from my background in academic spaces in nursing. And that was, that would’ve been really nice to have and really helpful to have. Just to see that it can be done. One participant explained that, while feelings of not belonging can be elicited for anybody navigating graduate school, they may be more intensified for BIPOC students, explaining that: I think an overarching, kind of...underpinning a lot of these experiences was, was, acutely, um, reflecting on who I was and not, not feeling like I belonged, not feeling like I could challenge people. So, and I think a lot of people have that experience of, you know, being an imposter, but I do wonder if it’s more acutely felt by BIPOC students. And only because there, there isn’t, there aren’t BIPOC faculty reflected in the same way. Another participant, however, explained that many BIPOC get used to navigating spaces where they are made to feel they don’t belong. This participant, having previously described barriers 82 faced by BIPOC students finding mentors who reflect their identity, described the following when asked if they felt they experienced barriers in finding supervisors for their graduate work: ...I guess when you’re a person of colour, you just kind of get used to there being barriers embedded in your life and you just forget to think about how it’s kind of unfair and how it affects you. You just get so used to just, I don’t know...So...to answer your question, there’s probably been, like, a lot of...barriers but...because I can’t imagine anything else, I don’t really notice them. Similarly, another participant stated, “...as a person of colour, you know that you’re going to have your battles when you go into academia”. With their words, these participants demonstrate the juxtaposition between BIPOC in academic nursing being potentially made to feel that they don’t belong for a plethora of reasons, as demonstrated in this subtheme, while simultaneously being accustomed to, and even perhaps expecting, to not belong in academia. Another participant echoed similar sentiments; this participant expressed the following: I’m expecting there to be some stuff that will be a little bit non-sense that I will have to advocate for myself strongly to be heard or to be seen and I’m also expecting there to be some battles that I’m not going to engage in because I need to invest time and energy doing other things. The above participant expressed that “I think most people who are not White or who are not fitting this status quo carry that weight”, referring to the fact that BIPOC carry this extra weight of having to navigate spaces where they may have to fight for their rights and other situations where they accept that the battle may not be worth it. As some participants suggested, when one is accustomed to not belonging, the circumstances which create barriers to belonging may not be perceived as barriers but, rather, as the norm. Thus, it becomes imperative to discuss the ways in which participants worked to create their own sense of belonging. 83 4.3.2 Subtheme 3.2: Existence as Resistance – Creating Belonging All participants demonstrated their own way of resisting the spaces that they navigated and, in one way or another, carving out spaces of belonging for themselves. For some, this manifested in bringing up critical topics in the classrooms to shed light on factors that impact BIPOC communities’ health. For others, it was taking the time, outside of the school’s expected course load, to educate themselves on the topics that were important to them that the curriculum failed to teach. Participants also demonstrated the many ways in which their mere existence as BIPOC students in graduate nursing spaces was, in and of itself, a form of resistance as well as building a path for future BIPOC nursing students. One participant demonstrated resistance by pointing out critical perspectives to other students. For example, this participant noticed that the articles used to teach a particular nursing topic failed to demonstrate the perspectives of diverse identities and pointed this out to the students in the class. This participant stated “...because I can’t control those readings so the only way that I can, um, create some change is by challenging those readings”. Similarly, another participant demonstrated this same sense of resisting the status quo narratives, stating the following when referring to the content used to teach nursing students: And so I find myself always having to say that to students. You know like this is what it says in the book but like these are just people who wrote this book, right. Just like put it into perspective in terms of what limited perspectives are represented in these resources. Um, I’ve had challenges as well in terms of raising this, you know, I kept raising, I really worry about us essentializing cultures and aspects of culture. The above two participants demonstrated their way of pointing out to other students the ways in which the current curriculum may limit their way of thinking about diversity and culture as it pertains to nursing. They took the opportunity to highlight to other students the nuances in the 84 nursing curricula that may further perpetuate biased ideologies around nursing and raise awareness of these nuances amongst nursing students. Furthermore, it demonstrates the ways BIPOC take on an additional burden of highlighting the lack of diverse perspectives in the nursing curricula, primarily due to the lack of structural change within the academy to reduce barriers and promote greater diversity. Many participants reported the ways in which they felt graduate curricula lacked critical and diverse perspectives, therefore they took it upon themselves to put in extra work to educate themselves on such topics. One participant felt that literature about the health of BIPOC was not well incorporated into the graduate curricula and faculty struggled to facilitate dialogue around such topics that acknowledge the history of colonialism and its impact on Indigenous health specifically: It’s not kind of incorporated into, like even when we did the [name of course], we didn’t really talk about Indigenous peoples...it didn’t really specifically target any Indigenous peoples at all. So, I, um, it wasn’t embedded into the practice, yeah. And the only learning that I did was outside of school. Similarly, another participant reported that, although there was some focus on Indigenous health and research at the school, they still needed to spend time educating themselves on certain methodologies that are not taught in the core curriculum courses, either by using their electives to take courses of interest related to this topic or by doing readings in their own time: ...because of my area of interest, I’m doing readings and, kind of trying to expand my scope of knowledge around Indigenous research methodologies which are separate from qualitative, quantitative research methodologies... As well, a third participant expressed that they were particularly interested in the “...construction of race” and that they “...wanted to look at...how racism plays out in nursing inquiry and research and schools of thought”. However, these topics were not taught in the core nursing graduate 85 courses, so it was something that this participant had to engage with using their own assignments to learn. Similarly, yet another participant expressed that they also had to spend their own time supplementing information that was lacking in the nursing graduate curricula; they stated that “We shouldn’t be putting in double or triple the amount of work to compensate for curriculum failure, basically, and a lack of mentorship”, referring to the lack of information related to decolonial theories in the curricula. Some participants demonstrated resistance by coming to graduate school and using their research opportunities to address gaps in the literature around BIPOC health. One participant, for example, wanted to focus on the health of BIPOC, as well as other identities who are typically ignored in certain areas of research, such as women and transgender people. This participant stated that “...I think for me, it’s also about bringing those areas to the forefront and understanding what are the needs of those patients”. As well, another participant also expressed that a gap in the literature related to the experiences of BIPOC inspired them to continue their graduate education and to engage in research around discrimination and racism. They stated: And so, um, I think what the graduate program did, was...introduced me to different types of languages, um, or describing phenomena that I was already interested in because of my own lived experiences and because of my work as a nurse and maybe because of my, my perspective, my worldview. And so it just gave me different ways of making sense of those experiences and those values and commitments and specifically I’m talking here about looking at, um, looking at discrimination, looking at racism, looking at the experiences of those who are rendered racialized. Um, and looking at the extent to which...they are not addressed in, in the work that is done within nursing and nursing research. What we see, based on the experiences of the above two participants, is that BIPOC graduate nursing students pursue research topics that the nursing academy has ignored. In this way, they create belonging for BIPOC whose lived experiences, as it pertains to health, are not at the foreground of the nursing curriculum. 86 One participant had indicated that an influential factor for them coming to graduate school was to demonstrate to other BIPOC that they too can achieve higher education. As mentioned earlier, this participant had recalled a time when, while in graduate school, they were working in a specific setting that was predominantly White and they were mistaken for a care aide despite being in a leadership role. This participant stated “...it’s important for, I guess, the White community to see, you know, um, a person of colour that does have [graduate education] so that the idea is not so foreign for them as well”. Another participant also felt that it was important to demonstrate the visibility of BIPOC nursing leaders, indicating that, when they were younger, they did not see many nurse leaders who looked like them. Interestingly, one participant indicated how, even within their own community, they felt they had to prove that nurses with graduate education are still professionals. They reported that even their own community members were not used to seeing people who look like themselves with graduate education. One participant described the responses when they told their family members and colleagues of the same race that they were pursuing opportunities in graduate education: I get a lot of questioning from my own family about, like, ‘what do you do again? Do you get paid?’ Like, ‘what are you, what do you mean you’re a nurse but like you’re doing other stuff?’. Um, so I think shifting those as well, the expectations. I remember in my [graduate studies], applying for a scholarship for something and one of my colleagues who is [BIPOC] was like ‘why are you bothering? Only like the directors get those kind of things’. So, this, um, just like that ingrained colonized mind, right, that is just like, this is as good as it gets, you should be happy to be here. Thus, for this participant, being in graduate nursing spaces to ultimately obtain leadership roles in nursing was also a matter of demonstrating to their own community that they too can occupy leadership positions within the nursing profession and that there is a space for people who look like them in nursing beyond the clinical space. This participant also reported that, although they did not have many or any mentors in nursing leadership that looked like them, they were always 87 happy when other junior nurses sought them out particularly because they were happy to “see somebody...from our background” in a leadership role. Finally, one participant reported that they felt inclined to push the boundaries of the white academic institution themselves to create physical and intellectual spaces where diverse identities belonged. This participant claimed, "I’m not going to sit still and [wait] for those to create a space where I have the opportunities, or those that look like me can have the opportunities...I’m going to do it myself”. They explained that, in their personal and professional experiences, they have had to previously create such spaces of belonging and so they felt that they were used to doing it. This participant also stated that the reason why they felt the need to carve out such spaces for themselves is because “...I felt that I did not belong or that I did not have the opportunity, so I wanted to create not only the opportunity for me but for those that come up after me”. In this way, this participant is actively carving out space for people who look like them so that future students can navigate these spaces more easily, with a more entitled sense of belonging that previous generations may not have experienced. Thus, the existence of this participant and many other BIPOC students is, indeed, actively resisting the erasure of their identity and paving the way for future BIPOC to pursue graduate nursing education. 88 Chapter Five: Discussion and Recommendations The following research question guided this study: What are the experiences of Black, Indigenous, and People of Colour (BIPOC) graduate nursing students in white academic spaces in distinct contexts (e.g., graduate education, clinical practice, health research)? The findings of this study, which focused on graduate students, contributes to knowledge of how nursing research and knowledge production could be expanded to include more diverse identities who are representative of modern Canadian demographics. The goal was to develop “transformative knowledge36” in order to promote change in the nursing profession, specifically nursing leadership and research, to ultimately promote health equity (Anderson, 2002, p.19). This study was successful in shedding light on the dominance of whiteness within nursing academia and the profession, and highlighted fundamental ways in which nursing schools can, and should, implement change to meet the needs of a diverse student population. The words of the eight participants interviewed demonstrate the complexity in experiences of BIPOC graduate nursing students navigating academic whiteness. As demonstrated in previous chapters, few articles exist in current literature focused on the experiences of BIPOC nurses in leadership positions such as graduate education, specifically within the Canadian context. The existing literature focuses mainly on the experiences of undergraduate nursing students or nurses working in clinical practice (see, for example, Gardner, 2005; Jefferies et al., 2019; Mapedzahama et al., 2012; Monteiro, 2007; Premji & Etowa, 2014; Vukic et al., 2012). Few studies focus on the nursing population in Canada. The study findings discussed in Chapter Four contribute knowledge to the current literature by looking at a subset of 36 Transformative knowledge is defined as knowledge that is “...undergirded by critical consciousness…and that unmasks unequal relations of power and issues of domination and subordination, based on assumptions about ‘race’, ‘gender’, and class relations” (Anderson, 1998, p. 205). 89 the Canadian nursing population that represents future nurse leaders: BIPOC graduate nursing students. Drawing on the theoretical perspectives of Critical Race Theory (CRT), in this chapter I will discuss the significance of the study findings by situating the results within the context of current literature. Because of the interconnectedness of the findings, I have constructed this discussion to speak to the themes collectively. I will discuss the recommendations derived from the study findings followed by some considerations of study limitations and recommendations for future research. 5.1 Discussion Harper (2012) defines racism as the following: ...individual actions (both intentional and unconscious) that engender marginalization and inflict varying degrees of harm on minoritized persons; structures that determine and cyclically remanufacture racial inequity; and institutional norms that sustain White privilege and permit the ongoing subordination of minoritized persons. (p. 10) CRT asserts that this racism is not the exception, but rather that it is the norm and represents the typical experiences of BIPOC in the West (Delgado & Stefancic, 2007). As well, Sleeter (2017) states that “CRT offers conceptual tools for interrogating how race and racism have been institutionalized and maintained” (p. 157). The participants in this study spoke to and highlighted the variety of ways racism, as defined by Harper (2012), was “institutionalized and maintained” (Sleeter, 2017, p. 157) at this School of Nursing in Canada as common experiences among them, despite their individual racial identities. Furthermore, participants’ experiences demonstrated the ways in which racism may not present itself as blatant aggression towards BIPOC, but rather as “...deeply rooted and embedded in our ways and systems of knowing and experiencing life” (Milner, 2007, p. 390). The results of this study illustrate how BIPOC graduate nursing students described being entrenched in whiteness. Whiteness was described by the participants as being experienced 90 through the physical bodies that existed in the space via faculty and the students at the School of Nursing in Canada which this study was conducted. As explained in Chapter Two, in 2019, approximately 21% of full-time faculty in Canadian universities identified as racialized and only 1.3% identified as Indigenous (Universities Canada, 2019). While there is no race-based data collected of Canadian nursing faculty, it is reasonable to assume based on data collected by Universities Canada (2019) that nursing faculty also are limited in their diversity and likely reflect the national statistics demonstrating lack of diversity in post-secondary institutions. Visual scans37 of faculty in nursing school websites of universities across Canada support this claim, and some participants in this study also identified that their visual scans of the website of this School of Nursing in Canada demonstrated the whiteness that was pervasive in the school via faculty. While there is no race-based data collected on the Canadian nursing population, Premji and Etowa (2014), using data from the Statistics Canada 2006 database, were able to conclude that nurses who identified as visible minorities made up 15% of the nursing workforce in Canada, thereby reflecting the trend within post-secondary nursing education. Visible minority nurses largely made up the frontline nursing roles but were underrepresented in leadership positions such as manager or head nurse (Premji & Etowa, 2014). Several participants in my study questioned why there were more BIPOC nurses in clinical spaces, but they also expressed that this did not translate to the identities that exist in the faculty that teach graduate nurses. Premji and Etowa (2014) found that nurses who identified as Black or Filipino “...were disproportionally found among frontline personnel” (p. 82). However, the study by Premji and Etowa (2014) was not focused on nursing academia, but primarily on the frontline workforce. 37 While not all those who “look” White may identify as White, discourse in race-related dialogue demonstrates how White-passing privilege or proximity to whiteness also affords one access to places of power and privilege. For example, see “Whiteness as Property” by Harris (1993). 91 Overall, Premji and Etowa (2014) stated there exists “...a pyramidal structure with minorities and women over-represented in lower-level positions” in the Canadian nursing workforce (p. 86). The participants in this study also anecdotally indicated they had rarely seen BIPOC in a nursing leadership role in the clinical setting prior to entering graduate school. They also identified that the racial diversity at the bedside was not well-represented in nursing academia. As expressed by Delgado and Stefancic (2007), CRT asserts that racism is difficult to identify given its ordinariness in the everyday experiences of BIPOC which reflects my analysis of the experiences shared in participant narratives. The lack of diverse representation in nursing leadership, and particularly in the academy, is a subtle representation of racism within nursing which can perhaps easily be overlooked and thereby rendered invisible. My study illustrated how whiteness was perceived by participants as presented intellectually; namely, those who were cited as knowers and keepers of nursing knowledge were predominately perceived as White and/or Western. Puzan (2003) argues that one way in which white privilege asserts itself is via its ability to “...determine what counts as knowledge, membership, and language” (p. 195). Puzan (2003) also explains that whiteness dominates nursing due to the way nursing identifies with scientific hegemony, while simultaneously failing to acknowledge alternative ways of knowing. Puzan (2003) states that “...devotion to science with all its trappings helps to keep nursing white and this devotion is rewarded to the extent that the largest, most prestigious nursing schools are those that capture the most funding for scientific research” (p. 196). McGibbon et al. (2014) also argue that “Nursing knowledge is steeped in an ethos of treating everyone equally, a universalist assumption that dominant culture, experience, and ways of knowing are true for all cultures” (p. 183). McGibbon et al. (2014) stated: As the nursing profession evolved within and alongside colonialist domination, these 92 same beliefs and assumptions are embedded in nursing history and in present-day nursing knowledge and practices, professional codes of ethics, policy and position papers, and institutional nursing policies and procedures. As such, these beliefs and assumptions form a foundation for the colonization of nursing at point-of-care and in educational and professional policy-making and in nursing scholarship. (p. 183) The findings of my study also re-affirm the words of Puzan (2003) and McGibbon et al. (2014). Participants reported that there was minimal effort made by the nursing institution to teach other ways of knowing, such as Indigenous methodologies, critical theories, or Black Feminist Thought. Some participants also expressed their dismay that Florence Nightingale was still being represented as the pioneer of nursing while other nursing pioneers, namely those who were BIPOC, were consistently unacknowledged. In the above stated ways, this study demonstrated how participants experienced this School of Nursing in Canada as perpetuating whiteness physically, by way of photos, bodies that navigate the space, and iconography (such as the doll display) used to represent nursing. As well, whiteness was perceived by participants as preserved intellectually via the perpetuation of colonial ways of knowing that exclude what might be deemed as Other38 ways of knowing, thereby lacking epistemic diversity. Furthermore, the findings of this study point to the ways participants expressed that nursing fails to acknowledge how it lacks diverse representation, both presently and historically. Notably, CRT argues that, because institutional racism works to benefit and advance the interests of whiteness, there is “...little incentive to eradicate it” (Delgado & Stefancic, 2007, p. 136). Thus, an intentional effort must be made by those in appropriate positions to address such issues within the nursing academy. The dismantling of whiteness takes intentional effort and work given that, by doing so, the structures of the nursing academy would fundamentally shift. 38 The “Other” was discussed in section 1.1.1. 93 As a critical scholar, I recognize that our knowledge and its expression is rooted in our own lived experiences of navigating the world around us. Therefore, I acknowledge how participants’ experiences when combined with my own experiences as a researcher can reveal assumptions about our shared reality. Critical scholarship calls on researchers “...to question our assumptions, the status quo, and the taken-for-granted” (Anderson et al., 2010, p. 110). In this study, two participants referenced the age of faculty, indicating some were of older age. One participant indicated their belief that being of older age contributed to White faculty’s lack of understanding or empathy for the impact of racism. This participant interpreted the harms of whiteness as amplified by ageist assumptions about faculty members of older age; being older was interpreted as not being able to understand and therefore care about the experiences of racism by BIPOC graduate students. It is critical to note that these participant narratives are important as they show the intersecting potential axes of racism, namely with ageism. However, as a reflexive researcher, it is critical to surface how participants also bring their own biases and assumptions rooted in their own lived experiences and interpretations of the world that influence their perceptions, in this case specifically about the impact of race (White) as it intersects with age (older). Thus, CRT expands analysis in this context by bringing a more intersectional lens to draw on when researching the impact of whiteness, within the context of other aspects of social positionality in the nursing academy (Delgado & Stefancic, 2007). As well, Anderson (2004) calls for a more critical unpacking of terms and references that we use and how we use them, stating that: ...such analyses expose the nature of oppression in ways that allow us to address specific oppressions based on race, gender, class, age, sexual orientation, religion, and other forms of oppression, as they intersect and operate structurally and in the everyday, and, in so doing, offer the hope of eventual social justice. (p. 12) 94 Thus, when thinking about the intersection of concepts such as whiteness and age, one must be critical when making assumptions on how the intersection of these identities may or may not impact an understanding of racism. For example, does being White and of older age automatically mean that one cannot understand or empathize with racism? How would this assumption perhaps limit our ability to foster allyship and allow for dialogue around the broader impacts of white supremacy and whiteness? These questions highlight how, as individuals who navigate the world, we bring assumptions to our interpretations of our surroundings based on our lived experiences. As critical thinkers, we must be willing to confront even our own assumptions to allow for constructive dialogue rooted towards equity and social justice. This study also adds to the literature a further understanding of how whiteness acts as a gatekeeper to the academy, as demonstrated by the experiences of several participants. One participant reported they felt that they were accepted into a graduate program to help diversify the institution due to their identity as BIPOC. Similarly, another participant had expressed their frustration when they were interviewed by an all-White panel for a specific opportunity; in this interview, they were questioned as to why they were interested in working with a particular marginalized and racialized community. This participant expressed their perception that White researchers are not met with the same scrutiny when engaging in research with marginalized and racialized populations. Other participants expressed their frustrations in not being able to find faculty who can support them in their research related to the health of BIPOC communities, mostly due to the lack of faculty with lived experience and/or expertise. One participant specifically felt they could not, or should not, focus on race as a variable of health as it may limit their future opportunities in academia; they expressed a feeling of having to assimilate to what White faculty were researching to be successful in the nursing academy. CRT points to the lack 95 of benefit of dismantling whiteness for White people in the academy; in nursing, the dismantling of whiteness would shift the power from White people to being more evenly shared with BIPOC researchers and leaders (Delgado & Stefancic, 2007). Furthermore, Harris (1993) argues that whiteness has “...blinded society to the systems of domination that work against so many by retaining an unvarying focus on vestiges of systemic racialized privilege that subordinates those perceived as a particularized few – the ‘others’” (p. 1791). By upholding and reproducing white supremacy, whiteness itself acts as gatekeeper by determining when diversity is important, as demonstrated in several ways. For example, whiteness in the nursing academy was perceived to perform gatekeeping by determining which students are admitted into programs. In addition, whiteness determines what is worthy of researching, as demonstrated by one participant being questioned for their research interests, and other participants’ inability to find expertise or encouragement in engaging in research with BIPOC communities. Thus, it is evident the ability for nursing research to expand beyond its current scope to including experiences of BIPOC in healthcare is limited. This is due to the, perhaps unnoticed, gatekeeping that occurs by current faculty and their lack of lived experience or expertise, or simply a lack of interest, in certain areas of research which ultimately deems certain topics less important than others. This forces BIPOC graduate nursing students who are interested in research related to BIPOC health to either assimilate to what is already being researched in the academy, thereby excluding BIPOC-related research, and possibly abandoning their research interests, or struggle to find mentorship and seek assistance from professors from other disciplines outside of nursing, as expressed by one participant in this study, to pursue their research interests. Therefore, my findings add to the current literature the ways in which whiteness performs gatekeeping by determining who can enter the academy and which research topics are worth researching. Through this gatekeeping 96 and via the above stated ways, whiteness works to set the agenda for the direction of the nursing profession. This results in institutions that boast about their inclusivity and anti-racist39 practices but really exist as a hierarchy of White professors who, through their scholarship and leadership roles, determine which identities are deemed worthy of inclusion (or exclusion) in the nursing academy as well as which research topics are worthy of exploring. As well, the policies and procedures that these institutions are founded and function on work to uphold whiteness. Extrapolating from here, we can see how the lack of diversity in nursing leaders and researchers results in the erasure of BIPOC experiences and the lack of evidence-based research to support practices and policies that provide equitable healthcare from a nursing perspective to the growingly diverse Canadian population, simply because academics with such research interests are not present or encouraged to do the work. As argued by Waite and Nardi (2017), “Decolonizing the nursing profession takes a willingness to recognize racism and its associated elements of white supremacy, white privilege, and whiteness as a personal worldview” (p. 24). In this study, participants expressed a multitude of ways in which this School of Nursing in Canada practiced the erasure of identity. Some participants expressed that, while the institution discusses and works to incorporate experiences of Indigenous peoples in Canada, they fail to discuss the experiences of Black and People of Colour identities. In this way, while students are learning about colonialism and cultural safety from the perspective of Indigeneity, the conversations are not nuanced in discussing race and racism from other perspectives. One participant emphatically expressed “...my experience is completely erased”. By way of white gatekeeping, the academy determines which forms of oppression deserve a space and which ones 39 Kendi (2019) defines anti-racist as “One who is expressing the idea that racial groups are equals and none needs developing, and is supporting policy that reduces racial inequity” (p. 24). 97 do not. Neither the participants nor I suggested that Indigeneity should not be discussed. In fact, it absolutely must be discussed in nursing to fulfill the mandate of UNDRIP and the TRCC40. Rather, the critique here is that the nursing academy, by way of white gatekeeping, determines which experiences of oppression are deemed important enough for nursing to address. Furthermore, the lack of discussion around intersectionality and critical theories worked to remove understanding and dialogue around the experiences of BIPOC. The participants expressed how the academy failed to teach beyond Eurocentric and Western philosophies, thereby further re-enforcing that BIPOC experiences and knowledge systems do not have a place in nursing. Notable through my analysis is the evidence of CRT’s emphasis on how whiteness maintains power through its refusal to acknowledge and dismantle its own existence due to the inherent privilege it represents (Delgado & Stefancic, 2007; Harris, 1993). McGibbon et al. (2014) argue that “...periods of colonial history are not thought to be influential or relevant in modern nursing and hence are largely absent in nursing discourse. Despite its lack of logic, this view remains the cornerstone of the racist legacy of colonialism in nursing” (p. 182). Furthermore, Chinn (2020) argues the following: We recognize that there are disparities, and acknowledge some of the disadvantages experienced by people of color, but fail to recognize, or acknowledge that white privilege remains as powerful a dynamic as it ever was. The languages of ‘diversity’ and ‘multiculturalism’ actually sustain this dynamic; when examined closely these perspectives in nursing treat cultures of color as ‘other’ – as interesting curiosities. Culture is seen as characteristics of any practices that are not white. Notice that there are rare, if any discussions of white dietary practices, rituals, family relationships, religious practices. ‘White’ experience is typically seen as diverse and individualized, as the ‘norm’ against which other practices are judged or compared, whereas the experience of the ‘other’, of ‘people of color’ are seen as essentialized markers of difference, with the ‘white’ norms as the point of reference. (para. 5) 40 Refer to Chapter One and Two for discussion around the history of colonialism in Canada and its impact on Indigenous peoples. 98 Lowe and Archibald (2009) argue that nursing “...as a culture transmits its survival through education that continues to use a mainstream Anglo-culture-based curriculum” (p.15). Thus, the lack of discussion in nursing of the broader ways in which colonialism and white privilege have impacted people in Canada and around the world results in the omission and erasure of BIPOC identities and experiences. Participants demonstrated how the nursing academy, while perhaps well-versed in discussing the impact of colonialism as it pertains to Indigeneity in Canada, failed to bring forth a broader understanding of colonialism and racism and the ways it has affected the many other nurses who exist in its spaces. For example, this School of Nursing in Canada where the study was conducted has been around for decades, and yet it only began to acknowledge Black History Month in recent years, after persistence and advocacy led predominantly by Black students at the school. In this way, white gatekeeping works to highlight some identities while erasing others depending on what fits its agenda, and thus continues to assert control. More specifically, one very important finding from this study is the inability of the predominantly White faculty to engage in meaningful and effective discussion with students regarding the ways in which racism may very well impact them in practice, not just their patients. Two participants discussed the failure of the nursing academy to go beyond teaching about multiculturalism to discuss the ways in which racism impacts BIPOC nurses themselves. In her article, Hassouneh (2006) demonstrates nursing’s resistance to move beyond discussions of multiculturalism to unpacking and addressing racism itself by engaging in anti-racist pedagogy. Hassouneh (2006) goes on to state that “This refusal to critically reflect on racism is often accompanied by efforts to uphold the status quo of white supremacy in the classroom through both overt and covert racist discourse” (p. 257). Nursing academia continues to function 99 through a white lens whereby BIPOC find it difficult to situate themselves to establish a sense of belonging in the profession. As well, the lack of experience and expertise with BIPOC communities in nursing research identifies a significant gap in nursing research and therefore nursing practice. Thus, we in the nursing profession must ask ourselves: how is the lack of research looking at the health of BIPOC communities impacting our nursing practice? Furthermore, how is this erasure in nursing research perpetuating whiteness and racism within nursing practice? Several participants expressed the barriers they faced in finding mentorship to support them in race-based research. The perpetuation of whiteness by the academy makes it difficult for BIPOC students to carve out spaces for themselves to succeed in ways that are meaningful and authentic to them and their identities. One participant explicitly stated “I am not a subject that could be researched by any of these people researching...I want my experience, or experience like mine to be captured somewhere. Because I think that there is something there”. Another participant expressed their desire to find mentors who reflect their identity to help guide research with their community; this participant found it difficult to find a mentor with experience beyond the use of Western research methodologies. The prevalence of predominantly White nursing faculty, and thus the absence of BIPOC nursing faculty, in nursing Canadian institutions makes it increasingly difficult for BIPOC graduate nursing students to seek mentorship and engage in research that advances research relevant to their identities and communities. For example, Jefferies et al. (2018) looked at the factors contributing to the invisibility of Canadian Black nurse leaders and concluded that the lack of such representation is as a result of generational systemic oppression experienced by Black people. Several other researchers have demonstrated the ways in which experiences of racism by BIPOC nurses have affected their career trajectory and their ability to obtain and 100 navigate formal and informal leadership positions (see Ackerman-Barger & Hummel, 2015; Das Gupta, 2009; Flynn, 2008, 2009; Hassouneh, 2006; Mapedzahama et al., 2012). Several participants in my study discussed their difficulty in finding mentorship that reflected their identity and lived experience. Phillips and Malone (2014) argue that “The limited number of minority nurse faculty to serve as role models and mentors creates an additional barrier to the successful recruitment and retention of underrepresented minority groups in nursing” (p. 47). Some participants in my study expressed that not seeing BIPOC in leadership positions was itself a motivating factor for them to obtain graduate education in hopes of becoming nurse leaders themselves; numerous participants demonstrated that they wanted to be role models for future BIPOC nurses. In this way, we can see that BIPOC graduate nursing students learn to navigate belonging by pioneering the path for themselves and future nurse leaders who will undoubtedly come after them. They learn to navigate a lack of belonging so that future BIPOC nurses will have role models and mentors to seek support from and to, hopefully, experience a sense of belonging in nursing leadership. BIPOC graduate nursing students demonstrate resilience and resistance by taking up space in the nursing academy. As one participant boldly stated, "I’m not going to sit still and [wait] for those to create a space where I have the opportunities, or those that look like me can have the opportunities...I’m going to do it myself”. Participants in my study described their experiences of navigating belonging within the academy. Participants expressed the ways in which the academy exudes exclusivity, demonstrating which identities (namely White) exist in the space as evidenced by the dominance of White faculty and White students (evidenced in theme 1) and which identities (namely BIPOC) do not belong in the academy by way of their lack of presence in the physical and intellectual spaces (evidenced in themes 1, 2 and 3). Thus, this begs the following question: 101 where does this situate BIPOC who exist in the margins of nursing academia? Emerging BIPOC scholars are striving to find their place amidst white institutions. They are actively resisting the colonial institution from the inside out, literally, and figuratively carving out space for themselves, their histories, and their identities in these spaces. Participants in my study described the importance of seeing BIPOC leaders in nursing academia; some expressed that the presence of BIPOC leaders in nursing provides representation and mentorship for future BIPOC leaders. As well, it works to re-enforce a sense of belonging for BIPOC graduate nurses. Thus, moving forward, nursing as a profession must do better to ensure that it is diverse within all its levels and roles, from clinical spaces to nursing leaders in practice to faculty in academic nursing. 5.2 Recommendations The themes and subthemes that emerged from my study are intertwined and therefore need to be viewed collectively for how they contribute to the lack of diversity and the presence of racism in nursing education. Thus, when constructing recommendations, the findings are viewed as a whole within specific target domains of action. Based on the findings of this study, the current literature addressing this topic in nursing, and the guidance of CRT, the following recommendations are made: acknowledging the colonial and racist underpinnings of nursing institutions; diversifying nursing faculty; diversifying nursing students at the graduate level; and conducting an audit of nursing curricula and syllabi. It is imperative to note that these recommendations are not effective individually but rather should be enacted collectively to prevent the existence of BIPOC in nursing academic spaces that are exclusive and ill-prepared to welcome BIPOC experiences. These recommendations are made to occur in tandem to reduce structural and systemic barriers that have historically prevented BIPOC from, not just accessing, 102 but belonging and thriving in places of power and privilege in nursing. 5.2.1 Acknowledging the Colonial and Racist Underpinnings of Nursing Institutions First and foremost, it is imperative for nursing schools to acknowledge and address the underpinning institutional whiteness and colonialism. As discussed in Chapter One and Two, nursing has been complicit in white supremacy and the perpetration of racism both presently and historically. Nursing institutions are politically oriented to equity and diversity initiatives with little action to critically reflect on the reality of their origins and the complicit nature that Western nursing has had in the enactment of colonial and racist injustice. For example, some Schools of Nursing in Canada include social justice and equity as core nursing values, mirroring the Canadian Nurses Association Code of Ethics (Canadian Nurses Association, 2017). Yet, systemic racism in nursing has only started to receive significant attention after the murder of George Floyd in the United States of America41. CRT pays critical attention to the complacency of structural whiteness in identifying and dismantling its privilege to circumvent addressing the ways it benefits from the institutional structures that re-enforce said whiteness (Delgado & Stefancic, 2007). Harris (1993) claimed that “It is long past time to put the property interest in whiteness to rest” (p.1791). While it is not effective nor does it solve anything to blame institutions for failing to act on racism and develop anti-racist structures sooner, we must hold nursing institutions accountable for their complacency. Thus, Schools of Nursing, as shaped by a Western Eurocentric paradigm, must dive into their origins, and publicly acknowledge the role that nursing has taken in producing the very racist structures that it claims to stand against. This will help demonstrate transparency and set the foundation for moving towards more inclusive and representative nursing academic spaces. We cannot work towards equity and diversity 41 See section 1.1.6 for context. 103 without first addressing the racist and colonial foundations upon which the Western nursing profession is built. We cannot only praise Florence Nightingale for her heroic work, without acknowledging that she too was indeed racist (Stake-Doucet, 2020). It is time for nursing as a profession to face the truth and publicly acknowledge this truth. It is time for nursing to develop systematic plans and structures to move away from this racist history towards an equitable and diverse future that is not tokenistic or performative but intentional and effective in dismantling systemic racism within healthcare. As stated by Stake-Doucet (2020), “We lose nothing by relegating Nightingale to her rightful place in history. We gain critical insight, growth, and a richer understanding of what nursing is” (para. 16). 5.2.2 Diversifying Nursing Faculty One major implication for the findings of my study is the importance of diversifying the nursing faculty to include more BIPOC. Several participants in my study discussed how they looked for themselves in the physical and intellectual nursing academic spaces that proved repeatedly to be predominantly occupied by whiteness. Participants found it difficult to find faculty who reflected their identities, or faculty who could support their research with lived experience or expertise in working with BIPOC communities. One participant stated, “I have to work twice as hard, because people that look like me have not been in this space yet”. It was clear that participants felt less like they belong if they did not see people in leadership who represented their identity. In this way, the whiteness of nursing faculty works to re-affirm that White graduate nursing students belong in nursing academia while simultaneously refuting the belonging of BIPOC students. Several participants suggested the importance of diversifying faculty to reflect the student population. Nursing students in the study by Monteiro (2007) also expressed the importance of “...seeing themselves represented in the diversity of faculty and staff 104 in their schools” as well as how they felt they would benefit from “...being mentored by faculty of colour (p. 101). Sleeter (2017) asserts that having predominantly White teachers has important implications for: ...how curriculum is designed and what is taught; how students are recruited and selected; how new faculty members—and who those new faculty members are—are recruited, hired, and supported; how urgently a program works to address race and ethnicity; and the extent to which faculty members who work with race are supported (p. 158). The lack of BIPOC nursing faculty presents a barrier to recruiting BIPOC nursing students (Phillips & Malone, 2014). Phillips and Malone (2014) argue that the existence of BIPOC nursing faculty and leaders works to increase the number of researchers engaged in research related to health disparities as well as to implement policies and practices aimed at addressing health disparities. Furthermore, the presence of BIPOC faculty in nursing also works to provide mentors and role models for BIPOC graduate nursing students. However, it is imperative that institutions create welcoming and inclusive cultures to enhance the recruitment and retention of BIPOC faculty42. A study of academic medicine showed that underrepresented faculty in institutions which are predominantly White are more likely to leave the institution than the majority-represented faculty (Price et al., 2009). Another study found that the underrepresentation of minority faculty in academic medicine was reported by participants to be a factor contributing to an unwelcoming environment; as well, it was reported that “...minorities lack role models or mentors with whom they can identify” (Price et al., 2005, p. 567). Thus, ensuring that institutional cultures are safe and supportive is imperative for the successful recruitment and retention of BIPOC faculty in nursing academia. This would perhaps look like spaces that both physically and intellectually demonstrate an openness and willingness to include 42 This was discussed in section 1.1.3. 105 historically marginalized identities and ways of knowing. Hassouneh (2006) stated that the existence of spaces for non-White faculty to “...openly discuss issues of racism, without fear of hostility or backlash, has been very nourishing” (p. 260). Thus, Schools of Nursing should create safe spaces for non-White faculty to share their experiences, but also have channels where said faculty can bring their concerns of racism forward to improve the climate of the school and foster belonging. 5.2.3 Diversifying Nursing Students at the Graduate Level Several participants in this study expressed that, for them, being a BIPOC graduate nursing student meant paving the path for future BIPOC nurse leaders. Some felt that they themselves had difficulty finding mentors, but they hoped to provide mentorship for future BIPOC nursing leaders via their existence in white nursing academic spaces. Some felt that by obtaining their graduate education, they were showing other BIPOC nurses that they, too, can be nurse leaders. Phillips and Malone (2014) discuss the importance of recruiting and retaining more diverse nursing students in all levels of nursing, as this will support both the diversity of the clinical nursing population as well as support the diversity of nursing researchers, both of which will ultimately help with tackling health inequity. Phillips and Malone (2014) stated the following: Given the urgent need to reduce health disparities, it seems logical that now is the time to take inventory of the roles and positions of racial/ethnic minority nurses. This type of inventory should include a current-day assessment of influential positions—within academia (e.g., deans and faculty), all levels of government (including the military), the health policy arena, societies and professional organizations, and nursing and healthcare organizations—along with descriptions of their contributions to eliminating health disparities. (p.48) Furthermore, Goeppinger et al. (2009) suggest that minority nursing students should be encouraged and mentored to engage in research as principal investigators and co-investigators to 106 increase the conduction of and enhance research related to health disparities and inequity for minority populations. They argue that such students “...often have insiders’ view of health disparities and ready access to study populations” (Goeppinger et al., 2009, p. 164). In their study, Goeppinger et al. (2009) found that minority students who had access to supportive mentorship related to research demonstrated “...enlarged...vision of their nursing careers to encompass graduate education and research” (p. 164). Participants in the study done by Vukic et al. (2012) called for an increase in Indigenous nurses in leadership positions in order to impact practices and policies that affect the health of Indigenous peoples in Canada. Increasing the recruitment and retention of BIPOC nurses in graduate spaces and supporting them as they strive for leadership positions, whether in clinical practice or in academia, increases the capacity of nursing to engage in anti-racist and culturally safe practice and to generate research that is relevant to the diverse Canadian population. Poignantly, Hassouneh (2009) argues that “...diversifying faculty and students in nursing is not just about enriching the academic environment; it is about ensuring the survival and growth of people of colour in schools of nursing” (p. 260). 5.2.4 Conducting an Audit of Nursing Curricula and Syllabi Nursing institutions must conduct internal audits of their graduate curricula to determine who is consistently being cited as a knower and keeper of nursing knowledge. Which voices dominate within the curricula and what message does this send to current and future BIPOC nurse leaders? Who is consistently portrayed as a nurse pioneer and, most importantly, who are we failing to hold up as nurse pioneers and leaders43? Furthermore, nursing institutions must do more to incorporate intersectionality and critical theories in their curricula as important 43 See, for example, section 1.1.4 for discussion of Mary Seacole and Edith Anderson Monture. 107 theoretical underpinnings to nursing research. From the data in this study, it appears there is limited to no discussion around intersectionality, Critical Race Theory, Indigenous methodologies, or Black feminist schools of thought; these perspectives are all excluded from the curricula, and one must interrogate why. Who decides which methods are seminal and foundational to nursing and who decides which ones are not? Several participants in my study expressed their interest in learning about and using other methodologies and theoretical perspectives such as Indigenous methodologies, Critical Race Theory, and Black Feminist Thought to guide their research but felt that they had to put in extra time, on top of their course work, to learn these topics on their own time and with lack of expert support. As well, nursing must move beyond discussions of cultural safety to active conversations of anti-racist nursing practice. Waite and Nardi (2017) state current nurse leaders and educators must take a more effective and intentional approach to educating future nurses on the reasons contributing to health inequities, going beyond cultural competence to deliberately discussing racism. They state, “For cultural competence to realize its potential, professional nurses must have a critical understanding about the fundamental socio-political and economic processes of power, privilege, and institutional racism that produce, support, and maintain prevailing health disparities” (Waite & Nardi, 2017, p. 20). Furthermore, Milner (2007) argues that “...the adoption and practice of color-blind and culture-blind research epistemologies and approaches can potentially lead to the dangers of exploitation and misrepresentation of individuals and communities of color” (p. 392). Thus, dialogue around race and racism as social determinants of health must become embedded within nursing curricula to expand students’ learning about intersectionalities that produce oppression and relations of power, as opposed to suggested as electives to take, left to certain faculty to teach only if it is their area of expertise, or left to students who are already interested in 108 such topics to educate themselves on. For example, nursing students need to learn about how racialization and income inequality intersect to result in health inequities that produce barriers for nurses who seek to implement social justice in everyday nursing care. Therefore, nursing curricula at undergraduate and graduate levels require intersectional theorizing to generate knowledge for safe, competent, and ethical healthcare for social justice and equity to be realized as nursing’s professional values. By making conversations on systemic racism and anti-racist nursing practice central to nursing curricula, we work to prepare both nurse clinicians and nurse researchers who are adequately prepared and trained in engaging in, not just culturally safe, but also anti-racist nursing practice and research. Furthermore, as one participant in my study had suggested, if nursing does not have the faculty with content knowledge or expertise to lecture on such topics, outside help from other faculties and experts must be solicited to ensure that all nursing students receive this education, until nursing as a profession has built the capacity to deliver such expertise. 5.3 Limitations and Future Research Recommendations One limitation of this study was how my own lived experiences of being a BIPOC graduate student may have influenced how I interpreted white academic spaces during data analysis. My experiences brought to this study have also been influenced by books, articles, and informal conversations I have had with others. These ideas may have acted as assumptions in how I read, interpreted, and analyzed the data. However, as explained in section 3.4.3, I worked actively to be critically conscious of how my experiences and assumptions about the topic influenced the research study. Another limitation of this study was the potential discomfort that participants may have felt in discussing their experiences which may have prevented them from sharing their 109 experiences in an in-depth way. As well, because the interviews were not conducted in-person due to COVID-19, this presented as a limitation as it took away from the understanding of body language that is possible with in-person interviews. Virtual interviews may have also acted as a barrier in the relationality of the experience between interviewer and participant, but more importantly, between people who share a similar experience. While this study provided findings that contribute to the sparse research on the experiences of BIPOC graduate nursing students, it is imperative to note that the aim was not to analyze the data within specific racial categories or to separate out the experiences of Black, Indigenous, and People of Colour respectively. Instead, this study focused on their experiences as a collective and how they navigate the whiteness of nursing academia. However, we know that the experiences of BIPOC both within and between the racial demographics are not all the same. For example, not all Black peoples’ nor all Indigenous peoples’ experiences are the same. 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Search # Search Terms Number of Articles S1 (Population) (MH "Nurses, Minority") 1355 S2 (Population) Visible minority nurses OR racialized nurses 7 S3 (Population) S1 OR S2 1359 S4 (Population) "indigenous nurses" 175 S5 (Population) “aboriginal nurses” 236 S6 (Population) S4 OR S5 392 S7 (Population) S3 OR S6 1710 S8 (Intervention) (MH "Students, Nursing, Graduate+") 1868 S9 (Intervention) “graduate nursing students” 1838 S10 (Intervention) S8 OR S9 2736 S11 (Outcome) (MH "Student Experiences") 5928 S12 (Outcome) (MH "Mentorship") 16 448 S13 (Outcome) “mentorship” 17 631 S14 (Outcome) S11 OR S12 OR S13 23 288 S15 (Final PICO search) S7 AND S10 AND S14 3 Note: It is evident, based on the above final PICO search in the CINAHL database, that this question has not been researched. 124 Table 3. PubMed database search (May 8th, 2020). Search # Search Terms Number of Articles S1 (Population) (visible minority nurse[MeSH Terms]) OR (visible minority nurse) 79 S2 (Population) (racialized nurse) OR (racialized nurse[MeSH Terms]) 2705 S3 (Population) S1 OR S2 2776 S4 (Population) (((indigenous nurse[MeSH Terms]) OR (aboriginal nurse[MeSH Terms])) OR (indigenous nurse)) OR (aboriginal nurse) 2570 S5 (Population) S3 OR S4 5306 S6 (Intervention) (graduate nursing education) OR (graduate nursing education[MeSH Terms]) 13 182 S7 (Outcome (mentorship[MeSH Terms]) OR (mentorship) 15 096 S8 (Outcome) Student experience 45 346 S9 (Outcome) student experiences[MeSH Terms] 0 S10 (Outcome) S7 OR S8 58 815 S11 (final PICO search) S5 AND S6 AND S10 20 Note: It is evident, based on the above final PICO search in the PubMed database, that this question has not been researched. 125 Appendix B 126 Appendix C 127 Appendix D Interview Guide: Semi-Structured Questions 1. How did you decide to participate in this study? 2. Tell me about your journey of becoming a nurse: a) What inspired you to go into nursing? b) How long have you been a nurse? c) In what areas of nursing did you practice? d) In your areas of practice, did you ever see a Black, Indigenous, or Person of Colour in a leadership position? 3. Tell me about your desire to come to graduate school: a) What program are you in and why did you choose this program? b) Why did you decide to pursue graduate education? c) What do you hope to do with the completion of this degree? d) How will this graduate degree change the trajectory of your career? 4. How has the transition from nursing practice to graduate school been for you? 5. What has your experience at the [name of institution] School of Nursing been like? a) How has your experience been the same or different from what you expected upon entering graduate school? b) What have your experiences in finding mentorship been like? c) What have your experiences in finding a research supervisor been like (if applicable)? d) What have your experiences of conducting research been like (if applicable)? 6. Tell me about your experiences in nursing academic classrooms: a) Do you feel comfortable participating? Explain. b) Do you feel that your areas of interest are taught? Explain. c) What are your thoughts around the nursing curriculum, textbooks, or research articles used to teach graduate students? d) Do you feel that the content taught at the graduate level is representative of your experiences, or the experiences of Black, Indigenous, or People of Colour (BIPOC) in Canada? Explain. e) How do you feel the content used to teach nursing graduate students impacts the way they practice in clinical spaces? Nursing research? 7. What does it feel like, for you, to walk through the physical space that is the [name of institution] School of Nursing? 8. Tell me about your experiences of ‘belonging’ (or not) at the [name of institution] School of Nursing. 128 9. If you feel the [name of institution] School of Nursing doesn’t create a sense of belonging, can you tell me what would improve this? 10. Do you feel that the [name of institution] School of Nursing creates a diverse/inclusive space? How could the [name of institution] School of Nursing create a more diverse/inclusive environment? 11. What final thoughts would you like to share about your experiences as a BIPOC graduate nursing student?
Thesis/Dissertation
eng
Public Health / Nursing
Vancouver : University of British Columbia Library
Attribution-NonCommercial-NoDerivatives 4.0 International
Graduate
Brown, Helen
Exploring the experiences of Black, Indigenous, and People of Colour graduate nursing students in white academic spaces
Text