Silencing of Nursing Voices

Bloomberg Nursing PhD student Andrea Baumann wants to examine factors contributing to the systemic marginalization of nursing voices.

To understand this issue in the context of the COVID19 pandemic, Baumann with the support of a $105,000 grant from the Social Sciences and Humanities Council (SSHRC) Doctoral Fellowship, will interview individual nurses in the GTA about their experiences during the pandemic, and examine the impact of structural power inequities on their ability to provide care and work in a safe environment.

The pandemic has shone a spotlight on the many preexisting challenges in health care. One such issue pertains to the barriers that restrict nurses from speaking out,” says Baumann. “The ways in which nurses are silenced, can be perceived as a form of structural violence, and it affects not only nurses but the safety and quality of care of their patients as well.

Pre-pandemic, research showed that nurses reported “feeling punished,” for speaking out. During the emergency phase of the pandemic it became common knowledge that nurses were dealing with unsafe working situations whether that was an inadequate supply of PPE, or other concerns about patient safety.

This persistent constraint on nursing voices reflects deeper issues within the organizational structure of health systems. Baumann describes the “normalization of the abnormal,” as a characteristic of the devaluation of nurses, and a precedent for the treatment of nurses from both a gender and race-based perspective.

“In Canada over 90 per cent of the nursing work force is female. Historically, this gendered aspect of the role means that the work of nurses has been imbued with the traditional female characteristics of caring, and has not been valued as highly as the contributions of historically male dominated professions such as medicine. I am curious about how this gendering of nursing work may have contributed not only to the subordination of the position, but also to the constraints against nurses’ ability to speak out,” says Baumann.

As part of her doctoral research, Baumann will draw upon historical examples of how the silencing of nursing voices puts patient safety at risk.

One such instance will reflect on the landmark case in Winnipeg in the early 1990’s where twelve children died due to complications from cardiac surgery. Though nurses had repeatedly voiced their concerns about the surgeon’s incompetence and the possibility of malpractice, they were consistently overlooked.

“This case was significant because findings of the inquiry recommended a review of hierarchy within that work environment and also that the perspectives of nurses be valued,” says Baumann.

“Of the many issues contributing to nurses’ inability to speak up and speak out, I feel that race is likely to be a strong indicator of whose voice gets heard,” says Baumann, “I want to bring this issue into focus by hearing directly from those who feel they are voiceless.”

The pandemic Baumann believes, has generated a form of currency for nurses that can be leveraged. Capitalizing on this increase in public interest and support that has not been seen since the 1918 flu pandemic provides an opportunity for nursing leaders and policy makers to create lasting change.

“I do hope that my study will be one contribution to building on this understanding of structural power inequities that either enable or constrain the ability of nurses to voice their concerns,” says Baumann.

“People are listening now, we need to raise our voices.”