The narrator tells us:
“I was working in the surgical ward, and this started one afternoon, when I was in the afternoon shift. We have a procedure in which the day shift would debrief the afternoon shift and transmit new information, observations and specific awareness points about each patient in the ward. We only have very short time for this exchange. Then afterwards, each of us in the afternoon shift would look more deeply into the files of the patients whom we have a special responsibility for that very day or evening. So, after the reporting meeting, I made a round to “my” patients.
One of the patients – an elderly woman – should apparently still have been in the recovery- and awakening ward after her surgery. Thus, she was supposed to be absent from our ward. She was supposed to be “on leave”, as we call it in our professional language. With this clear expectation, I open the door to her room, and there she is lying in the bed. Very surprised, I exclaim: “My God, are you here?”. For some unknown reason, my colleagues from the day shift failed to communicate that the woman was already back in our ward.
The woman is frightened, apparently also because of my surprise, and maybe also because of her condition after her surgery and anesthesia etc. She cries out that we have forgotten her. She seems to be very frustrated, and she insists on calling her daughter immediately.
With a very short notice, the daughter arrives to the hospital – being also extremely angry and frustrated. She claims that I have behaved and spoken very badly to her mother. Even though I actually had tried to calm down her mother, the daughter attacks me verbally in the most discriminatory manner, referring to my ethnic background.
The senior nurse is involved, while the daughter insists on filing a complaint to the top management level in the hospital hierarchy. The daughter actually files the complaint, writing the following words:
“A nurse named M. of foreign origins and, by the way, VERY difficult to understand came into the room and claimed: Goood, are You here. We thought You were in the awakening ward – while this was written in their files. It said “on leave”, and thus they didn’t know she was back in their ward….and then I think that one can, at least, ask of a nurse in Denmark that she speaks Danish in an understandable way. This is not the case for M….”
Confronted with this complaint, the senior nurse asks me to give the daughter an apology and in this way bring the matter and the complaint out of the world. I refuse to do so, since:
Firstly, I have done nothing wrong.
Secondly, I have actually been treated in a most discriminatory manner, illegal from the statutory perspective.
In the wake of the complaint, the senior nurse convenes me for a personal interview, and I insist that my shop steward has to attend this meeting. During this meeting, my shop steward and I maintain the standpoint that I shall not apologise in this case. It is, in fact, unfair to bring me into such a defensive position, especially in the light of the discriminatory perspective in the complaint and in the daughter’s behaviour.
A little later, I moved from the ward to work in another hospital ward. Thus, I don’t know what has further happened in the case. As far as I know, the daughter has threatened to bring the case to the Patients´ Complaints Board. I realized that I was not the only nurse in the total case and complaint. The daughter also had a number of other complaints about the ward, the professional services etc.
It turned out that the daughter kept a meticulous, minute-to-minute diary of all kinds of complaints from the hospitalisation of her mother. Thus, I was only a small piece in the total picture. But even so, this was a very shocking experience…”
1. Identities of the actors in the situation
The narrator is a nurse in one of the large hospitals in the Capital area of Copenhagen. At the time of the incident, she is working on a surgical ward. This incident happened about half a year ago. The narrator is 47 years old. The narrator was not born in Denmark, but migrated to DK many years ago from Uganda. She was educated as a nurse in the Danish healthcare educational system.
Before the incident, the narrator knew about the elderly patient, but the narrator had no previous contact with the patient’s daughter. The narrator was very familiar with the senior nurse and the shop steward.
The incident involves 4 other people apart from the narrator:
- An elderly woman being hospitalised to undergo surgery, probably in her seventies.
- The daughter of the hospitalised woman, probably in her fifties.
- A senior nurse, head of the ward for the nurses.
- A shop steward for the nurses.
The elderly female patient has an ethnic Danish background. Due to this, she probably has a formal – and more or less active – affiliation with the Danish Christian church. This may also include a hierarchical, ethnocentric and partially condescending view on and relationship to other ethno-cultural and religious traditions and norms.
The middle aged daughter could probably be described in the same way, when referring to cultural background: ethnic Danish background with a more or less active affiliation with the Danish Christian church. In the case of the daughter, this would most certainly include a hierarchical, ethnocentric and partially condescending view on and relationship to other ethno-cultural and religious traditions and norms. Furthermore, her hierarchical outlook also has a class-related and social dimension. This is expressed when she perceives and deals with hospital staff as a kind of servant required to service. Thus, she positions herself and her mother above the staff member regardless of ethnicity.
Likewise, the senior/chief nurse has an ethnic Danish background. As the leader of a multicultural staff, she is accustomed to relate to people of different ethnic and cultural origins. She will to some extent know the “codes” in intercultural communication. However, in this case, her actions indirectly reflect that she does not have much insight into being abused and discriminated against.
The shop steward nurse has African origins, but lived in Denmark for many years. She is active in many cultural-political environments. In the incident, she actually supports the narrator efficiently and maintains the narrator´s right to feel abused, both legally and personally.
2. Context of the situation
The incident takes place in the surgery ward in one of the large hospitals in the Capital area of Copenhagen. The incident includes several consecutive and closely linked episodes, all of them located in the ward:
Firstly, the triggering episode between an elderly patient and the narrator.
Secondly, the following confrontation with the patient’s daughter, which causes the first shock.
Thirdly, the complaint from the daughter, arising partly out of the confrontation between the daughter and the narrator.
Fourthly, the reaction to the complaint from the ward management/the senior nurse and the lack of support from the management, which causes the second shock for the narrator.
3. Emotional reaction
The narrator was emotionally affected and felt mistreated in several respects:
From a personal point of view:
She felt discriminated due to her ethnicity, her skin colour and African origins.
She felt patronised as if she was a second-class citizen compared to the mother and daughter in the case.
From a professional point of view:
She felt devalued and demoted as an experienced and professional nurse.
Her professional self-esteem and pride were particularly affected in relation to her linguistic competence. Although she fully masters the Danish language, she did feel that in the daughter’s complaint her accent was equated with lack of talent – and thus also lack of health competence.
From an employment and organisational point of view:
She felt very disappointed and let down – and even abused by the ward manager/the senior nurse – while this person was prepared to let the narrator take the blame for something she didn’t do.
She also felt anger, disappointment and even contempt for the professional weakness of the senior nurse, who in a critical situation showed a total lack of personal and professional strength and courage to support and protect an employee, being victim of an unfair and discriminatory treatment. On the contrary, the senior nurse would support the complaint in order to prevent a situation where the complaint was taken to a higher level of the management hierarchy.
Representations, values, norms, ideas, prejudice: The frame of references of the person who experienced the shock.
In accordance with her values, the narrator felt mistreated on more than one level:
The discriminatory level and values of equal treatment and human rights.
On the discriminatory level, the narrator experienced that her values of equal treatment and respect for diversity was exceeded and violated. In particular, she felt discriminated against due to her ethnicity, her skin colour and African origins.
In summary, in this specific case, the narrator was aware of the discriminatory aspects of the complaint, and she was rightly pointing to the law, as according to Danish law as well as European directives and international conventions, it would be illegal to refer to her ethnic background as an argument against her professional skills.
The ethnocentric level and values of respect for diversity.
On the ethnocentric level, the narrator also felt violated and offended academically, professionally and personally, by the condescending – and inaccurate statements – about her language in the complaint. She masters the Danish language, and her accent gives no reason to point to difficulties of understanding. However, although this part of the complaint could be easily refuted, the violation has deeper layers, because lack of linguistic skills in some cases is confused with a lack of professional competence and even with lack of talent. This layer in the complaint did actually hit the narrator very hard, because it is completely out of touch with her own norms and values about equality and respect of diversity, be it ethnic, cultural, social diversity.
Again, the insinuations in the complaint may be difficult to prove. But even so, it would be relevant in this case to make a complaint to the Danish Authorities for equal treatment.
The organisational level and values of diversity management.
On the organisational level, the narrator felt anger and disappointment, because she was let down by the management and so obviously failed to gain any support and backing from the senior nurse, even though the complaint and its personal and professional attacks were clearly unfair. On the contrary, the senior nurse was first and foremost concerned to save herself in relation to the top management in hospital. This behaviour was in every way contrary to the narrator’s own norms and values of mutual respect, integrity and fairness – but also values of intercultural understanding and diversity management in a large public organisation characterised by diversity among employees as well as patients and relatives.
From this perspective, the behaviour of the senior nurse was also a serious breach of the value to be firm about the obvious injustice and to show managerial responsibility and firmness – and actual leadership.
5. What image emerges from the analysis of point 4 for the other group (neutral slightly negative, very negative, "stigmatised", positive, very positive, real, unreal) etc?
The narrator´s images would both address the daughter and the boss – the senior nurse in this incident:
In the eyes of the narrator, the daughter is acting out of prejudices against people with different ethnic backgrounds. From the narrator’s perspective, the daughter also acts from the prejudice that people with different ethnic backgrounds – especially with African backgrounds – are not able to work on the same professional level as white people. Furthermore, she acts from an automatic prejudice that people with different ethnic backgrounds are not able to speak and express themselves properly in Danish. This is expressed and “proven” by the inconsistency in her complaint: when she understands that the narrator was not informed of the presence of the mother, she changes the complaint to be about the narrator´s lack of understanding of the Danish language, etc.
In the eyes of the narrator, the senior nurse is acting both defensively and cowardly in the situation. From the narrator’s perspective, the senior nurse is placing greater emphasis on avoiding that a complaint against the ward’s service reaches the top management of the hospital. By asking the narrator to apologise, the senior nurse exposes that to her it is more important to avoid a complaint than to support an employee against unfair and discriminatory treatment. From the narrator’s perspective, this is a clear sign of poor managerial competence and lack of personal backbone. By doing so, the senior nurse is indirectly defending a discriminatory and probably illegal behaviour, thereby also giving – deliberately or unconsciously – a management sign that it is okay to talk disparagingly to professional staff members with reference to their ethnic background.
6. Representations, values, norms, prejudice: The frame of references of the person or group that is causing the shock / that caused the shock in the narrator.
The background of the elderly female patient is unknown to us. But due to her reactions in the situation, she would apparently be quite dependent on her daughter. Furthermore, she seems to show prejudiced reactions, presumably influenced by “the fear of the unknown and foreign”.
However, at the same time her reaction could also be attributed to her current state. Probably, she has recently woken from anesthesia, she may feel pain and anxiety associated with surgery. Maybe she also experienced that the staff are not always accessible, when she needs some help etc.
The background of the middle aged daughter is also unknown. But due to her reactions to the situation, she quite openly holds prejudices against people of other ethnic origins. She seems to approach them as second-class people, not being equally skilled and professional whether they are educated and experienced. Furthermore, she seems to place herself on a higher social level, acting from a hierarchical approach, where hospital staff should be servants. Her general day-to-day logbook suggests that she generally has expectations of special service and servility, which in many ways belongs to a past with clear hierarchies and clear class differences.
But even though the wording of her complaint really suggest this interpretation, her reactions – overreaction – may also reflect her own fear and concern for the mother’s condition.
The senior/chief nurse in this particular incident refers especially to the managerial and organisational perspective where she, in fact, is responsible for the protection of her staff as well as responsibility for the service towards patients and relatives. On an organisational level, her reaction may reflect the need to maintain a good reputation for the hospital service. On a personal level her behaviour may reflect her own ambitions to emerge as an effective ward manager – and perhaps a personal fear of not being able to cope properly with the management task, thereby receiving criticism from management authorities on a higher level in the hospital hierarchy.
7. Does the situation highlight any problem concerning the professional practice, or in general about the respect of cultural differences in intercultural situations?
This incident is an example, how a hospital neither from an organisational and structural perspective nor from an integrational and egalitarian perspective maintains the basic principles and values of equality and diversity management in practice.
Even though many healthcare professionals would certainly confirm that they are nowadays trained in intercultural communication and competences – the incident reveals that in practice intercultural issues may collide with completely different interests of management and even economic issues. The hospital cannot afford to receive too many complaints from patients and relatives. This may pave the way for a bad reputation. In this incident, the ward manager/senior nurse considers the interests and rights of the narrator as subordinate to the hospital´s organisational and structural positioning. The senior nurse herself may also lose personal power and prestige, if there would be too much bad publicity within her domain. In total, this confirms that intercultural training should also put a special focus on the intersectionality between intercultural understanding and organisational structures – an intersection that goes far beyond the purely communicative level.