Practice Tip of the Week | Understanding Microaggressions in Nursing

Microaggressions can be defined as “the everyday verbal, nonverbal, and environmental slights, snubs, or insults, whether intentional or unintentional, which communicate hostile, derogatory, or negative messages to target persons based solely upon their marginalized group membership.” Microaggressions can be categorized into these groups: micro-assaults, micro insults, and microinvalidations. This week, Director of Practice Laura Kincheloe, Ed.D., MSN, RN, NE-BC interviewed Dr. Edtrina Moss, PhD, RN, AMB-BC, NE-BC, CLSSGB about microaggressions in nursing, how they might appear in different circumstances, and how allyship can be employed in different situations.

Dr. Moss, the term microaggression may be a term not every nurse has heard. What is the definition of microaggression?

Edtrina Moss (EM): Microaggressions can be defined as “the everyday verbal, nonverbal, and environmental slights, snubs, or insults, whether intentional or unintentional, which communicate hostile, derogatory, or negative messages to target persons based solely upon their marginalized group membership.” Microaggressions are categorized into these groups: microassualts, micro insults, and microinvalidations.

What are a few examples of how we might see this happening to nurses or patients in our practice?

EM: Examples of microaggressions towards nurses and patients may look like the following:

“You are very articulate!”

“Your name is difficult; do you have a nickname?”

“Are you really in pain? I can’t prescribe you any narcotics?”

“I’m sure what you are trying to say is…”

“You are pretty for a dark person.”

“How do you get your hair like that?” or touching a woman of color’s hair without permission.

“I am not racist. I have several Black friends.”

“When I look at you, I don’t see color.”

“You’re being too sensitive!”

“You seem angry!” and any opinions or feelings being minimized, ignored, or overlooked, which can be linked to higher rates of maternal mortality.

You mentioned hair—can you describe the history around African American and Indigenous hairstyles?

EM: Black hair is a symbolic and historical reference to survival, resistance, and celebration. Certain styles symbolize a person’s tribe, social status, and family background. Enslaved Africans used cornrows as a means of communication to transfer and create maps to escape plantations. Also, rice, gold, or seeds were hidden in the braided hairstyles in case of captured and forced across the Atlantic slave trade, they would have some small amount of food for sustenance. Slave owners shaved off the hair of slaves to erase their identities. Our hair is an expression of our strength, creativity, culture, and connection to a heritage that was stolen from every generation of African Americans through slavery.

Understanding this history is important because people of color care for their hair differently, specifically related to how, when, and what is used to clean, condition, moisturize, and protect their hair. Many of the hairstyles, such as weaves, extensions, and wigs are protective hairstyles for Black people. Specifically, these hairstyles promote growth and protect against humidity, precipitation, and extreme temperatures, all of which adversely affect natural hair health.

If someone witnesses a microaggression, what are some ways we can become an ally and speak up about this?

EM:

Know what to look for: understand and identify specific ways microaggressions manifest and impact individuals/groups.

Assess and understand: your own implicit biases.

Listen: to the lived experiences of individuals who are targets of daily microaggressions.

Learn: to advocate in the moment of injustice and hold yourself accountable.

Speak up:  when and where appropriate with intervening behaviors, e.g. interrupting the interrupter: “Actually, Edtrina wasn’t finished speaking. I would like to hear the rest of her comment.”

Reach out: validate individuals/groups experience of microaggressions and the inappropriateness of the behaviors.

How do people know when to speak up?

EM: Reflect on whether the same behavior would be demonstrated toward someone who is of the same race, ethnicity, gender, or social class. Reflect on whether the same behavior would be demonstrated toward a white male.

Should we be worried about offending someone if we speak up?

EM: As stated above, speaking up is more about when and where it is appropriate and less about if it is appropriate. Speaking up may be risky but if you are championing allyship, inclusion, and belonging, consider how the risk for speaking up outweighs the risk for not speaking up.

Is it okay for someone to ask a question about cultural, racial, ethnical differences with patients? Peers? Leaders?

EM: “Learning and inquiry” can be a powerful approach in inclusion and belonging. When one shows genuine interest in something or someone outside of themselves, it can create an environment where everyone can feel embraced, included, and accepted as their authentic selves.

President Theodore Roosevelt once said, “In any moment of decision, the best thing you can do is the right thing, the next best thing is the wrong thing, and the worst thing you can do is nothing.” Sometimes the right thing to do is the hardest.

As we reflect on our nursing practice this is appliable to many circumstances and situations, even beyond diversity, equity, inclusion, and belonging. A nurse’s duty is to always advocate for patient safety, including any nursing action necessary to comply with standards of nursing practice and to avoid unprofessional conduct. Advocacy could extend to ensuring your patient’s voice is heard. Additionally, this advocacy can be extended to your fellow nursing colleagues and aligns with the ANA Code of Ethics Provision 1.5 where we have a duty to respect all nurses and ensure an ethical environment, free from incivility. While we can’t expect perfection, we can all take these tips into consideration when working with or caring for others.