Essay on Intersectionality in Health Care

Canada is considered a multicultural and pluralistic country. It has become home for many immigrants seeking a quality of life amid social and political instability in their homeland. Every individual brings in different transition experience that gives insight into a diverse cultural and societal norm. To better comprehend these experiences, an intersectional approach is needed to accept the differences between the varied cultures. The intersectional paradigm gives heed to the social, historical, and political context, and distinguishes the unique experience of an individual based on the intersection of all applicable grounds. It considers the interaction between multiple and complex social identities such as gender, race, class, religion, language, education, immigration, or geography status by providing accurate and useful information to make a change and ensure the efforts do not cause any damage to individuals or communities. In the article, ‘Leaving the Philippines: Oral Histories of Nurses Transition to Canadian Nursing Practice’ Ronquillo (2012) examines the transition experience of Filipino immigrant nurses and studies how the cultural, societal, and historical influences play a significant role in deciding on migration. Besides, the case of Gloria Baylis as discussed by Flynn (2018) highlights various complex identity markers shaping and defining the lives of black women within societies. This paper intends to examine the struggles of immigrant nurses in Canada with the concept of intersectionality. It aims to address the importance of the intersectional approach in healthcare and demonstrate its applicability to promote shared partnerships and tactical alliances to work on issues of social injustices, isolation, inequalities, and marginalization.

With the increasing demand for nurses, the mass immigration of nurses from the global south to the north is expected to rise in Canada (Ronquillo, 2012). Nevertheless, the procedure to apply for RN licensure in Canada can be challenging and overwhelming for foreign-trained nurses. Also, at times these nurses, if not meet the required nursing competencies, have to go back to school to acquire additional educational courses despite years of working experience. Ronquillo (2012) discussed the nurse immigration history in Canada has been influenced by race, identity, and gender. Unfolding the migration of black nurses in the time of post-World War II, the Canadian government placed stringent immigration policies and ensured only those nurses with “cases of exceptional merit” (p. 100) were permitted to proceed. It is also important to note that not all members in a group share similar experiences rather these lived experiences may differ based on cultural, location, ethnic, income, health, education, age, or political differences.

According to Ronquillo (2012), 31% of Canadian nurses are from the Philippines. They graduated from an international nursing program and migrated for a better opportunity. To understand the transition of Filipino nurses, it is crucial to be aware of its roots. Nursing as a professional career for Filipinos can be traced back to the 1940s with U.S. efforts to encourage Filipino nurses’ migration as a step towards educational and professional advancement. The training for these nurses included context-based following the Westernized model of medical knowledge with the English language component (Ronquillo, 2012). Regardless of the extensive training and education to ease the transition of immigrating nurses, four primary impediments are identified: the communication challenge, marginalization, cultural differences, and variant nursing practice (Ronquillo, 2012).

Filipino nurses never defined their transition experience as discriminatory and identified themselves as being foreign due to the difference in education, origin, and race (Ronquillo, 2012). Their competencies were challenged and questioned on multiple occasions, regardless of extensive training and practice. One of the experiences of a nurse who stated that “we are hard-working Filipino nurses” (p.106) shows an effort to prove they are equally competent as their Canadian colleagues (Ronquillo, 2012). The main goal of these nurses was to establish and shape their identity by working efficiently and adapting to the nursing culture. The case of Gloria Baylis who was denied work based on race and gender is one such example. She was determined to reveal the discrimination that took place at the Queen Elizabeth Hotel. It highlights the lived realities of African women living under social exclusion and continuous denial of gendered racism. The above two examples highlight that being born in a specific race determines one’s education level, country of origin, religion, or socio-economic status together with the everyday experiences of life that can be stigmatizing. For instance, someone born into a rich family has the privilege of better opportunities and growth in life. There is a need to comprehend that all people in society at large have a shared responsibility to restructure the systemic barriers causing discrimination.

The word intersectionality was coined by Kimberle Crenshaw who defines it as the ‘interplay of multiple identities, such as race and gender about power and subordination’ (Flynn, 2018, p. 281). It can be used as a framework to explore the power dynamics of social institutions and organizational structure. The significance of intersectionality among Canadian nurses cannot be underestimated. Intersectionality incorporates various structured components, such as ethnicity, race, socioeconomic, culture, and abilities, to identify how these components shape different individuals and their numerous selves. Several studies have been done to overcome and address issues of cultural diversities within the nursing system. Such methods include retraining nurses with standard practices and acquiring the necessary skills, attitudes, knowledge, and behaviors to provide ‘culturally sensitive’ care. The integration of intersectionality signifies that every individual simultaneously occupies a different position within the socio-cultural-political framework of society. It challenges the concept of culture as static and counteracts the idea of social characteristics as operating in isolation. Intersecting within the healthcare society can influence people’s expectations, capacities, quality of life, and even their decisions.

An intersectional approach allows health organizations to assess multiple personalities and contemplate how social understandings can impact individual perceptions. In addition, it can release the healthcare provider from an expert to a learner mode. The provider in learning mode feels to acquire more knowledge about the cultural differences than the feeling of maintaining power and control. It may help to respond to the differences between men and women i.e. a difference in health and disease. The incorporation of intersectional understanding in healthcare must be focused on the analysis of an individual as a whole, with importance to power and privilege disparities in associations.

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According to the article by Ronquillo (2012) and the case of Gloria Baylis, the intersectional approach can guide to analysis of the diverse influences that affect the health of an individual. For example, according to Ronquillo (2012), the expectations and experience of practicing autonomy in nursing varied for those who migrated from other countries. The nurses who immigrated to Canada felt a need to adjust to new expectations from their environment with additional decision-making obligations (Ronquillo 2012). Some of these changes were welcomed such as freely highlighting the concerns about their patients to the physician, while others were challenging during the transition period. In one of these cases, the nurses felt a sense of isolation and depression due to feeling foreign and constantly had to prove themselves to meet the expectations (Ronquillo 2012). Similarly, Gloria Baylis had in some way undergone psychological trauma as a result of structural inequalities despite having the discrimination act. The intersectionality approach in this matter can direct the nurses to identify social injustice in everyday practice. The perspective of a person nurses hold in their practice setting can either make them contribute to socially just behaviors or create social injustice.

It is an undeniable fact that over the past few years, Canada has become more tolerant and diverse as a country on the whole. The value of multicultural societies adopted by the government of Canada revolves around immigrants. The nurses being interviewed accepted that, regardless of the discriminatory behavior, they were accepted as fellow RNs and played a significant role in shaping Canadian Nursing Practice. As highlighted in the article, racial, societal, cultural, and historical differences play a significant role in an immigrant`s decision, this concept can be generalized to all immigrating nurses, doctors, or other allied professionals. The intersectional approach can help overcome these barriers and aid overseas nurses in making sound decisions toward their progress. The integration of the intersectionality approach proposes a framework that relates to social injustice and health disparities. Healthcare organizations should focus on the interaction between race, gender, and other categories of differences in individual lives.

To understand the situation of these nurses, the intersectional approach can be utilized. One concept is about oppression and privilege. A newcomer in a given community may experience oppression based on social and historical category, for example, ethnicity, however, may experience privilege based on others, such as gender orientation. It is crucial to discriminate against an individual social category but only to identify an individual and not to assume that all members of the group will share the same perspective. Amidst the oppression and discrimination, it is important to understand how an individual newcomer's experience is impacted by multiple aspects of their personality. The intersectional approach can help overcome these barriers and aid overseas nurses in making sound decisions toward their progress. Moreover, with the growing demands in the healthcare field, much attention is needed to render culturally competent and evidence-based practice. Intersectional analysis is required to comprehend and integrate these aspects into varied differences and the framework of power and oppression. Moreover, Intersectionality gives voice to those who are directly impacted or excluded from conventional communication. Influenced communities make the most influential leaders and play a crucial role in the movement for social justice. Valuing a voice means allowing those who are affected to change and develop policies through their experiences. It endeavors to cooperate with people from diverse communities or sectors to promote any transformative variation.

The paper discusses the experiences of immigrant nurses and the incorporation of the intersectional approach to address the issues of social and health inequalities among vulnerable and marginalized populations. By utilizing the lens of intersectionality, healthcare professionals can consider varied outcomes and overcome the division between individuals and organizations when delivering quality healthcare and promoting evidence-based practice. It can offer a comprehensive solution to health inequalities through collaboration amongst the healthcare disciples.

References

1. Flynn, K. (2018). 'Hotel Refuses Negro Nurse': Gloria Clarke Baylis and the Queen Elizabeth Hotel. Canadian Bulletin of Medical History, 35(2), 278-308.
2. Ronquillo, C. (2012) Leaving the Philippines: Oral histories of nurses’ transition to Canadian nursing practice. Canadian Journal of Nursing Research, 44(4), 96-115.