Microaggressions, the subtle (and sometimes not-so-subtle), offensive comments or actions directed at a member of a marginalized group that reinforce stereotypes, come in many forms. Registered nurses Annalise George and Tina Santos and emergency room technician Jenny Sloan share their experiences dealing with and responding to microaggressions as well as the impact they can have on individuals and workplaces.
Microaggressions, the subtle (and sometimes not-so-subtle), offensive comments or actions directed at a member of a marginalized group that reinforce stereotypes, come in many forms. Registered nurses Annalise George and Tina Santos and emergency room technician Jenny Sloan share their experiences dealing with and responding to microaggressions as well as the impact they can have on individuals and workplaces.
Hosts: Kari Haley, MD, and Steven Jackson, MD
Guests: Annalise George, Tina Santos and Jenny Sloan
HealthPartners website: Off the Charts podcast
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Kari Haley:
He's a rehab doctor from Chicago.
Steven Jackson:
She's an emergency medicine doctor from the Twin Cities.
Kari Haley:
Together we're examining the health equity emergency.
Steven Jackson:
Inviting voices for change without the cue cards.
Kari Haley:
I'm Dr. Kari Haley.
Steven Jackson:
I'm Dr. Steven Jackson.
Both, together:
And this is Off the Charts.
Steven Jackson:
Welcome to the show. We're very excited today to be having great conversation about a very interesting but very pertinent and a very applicable topic, particularly in today's world, microaggressions and also called death by a thousand paper cuts. (Dr.) Benji Matthews referred to one of our older episodes, if you will. Dr. Haley?
Kari Haley:
Yes, I am really excited today because one, Steve is outnumbered in terms of health care professionals-
Steven Jackson:
I'm scared.
Kari Haley:
... from the emergency room to PM&R today – it's physical medicine and rehabilitation, which is his specialty, so I'm really excited because we have a great group that I work with in the emergency department. And so I'm just going to have everyone kind of go around and introduce themselves so we can all get to know you a little bit more.
Tina Santos:
I'm Tina Santos, and I've been a nurse at Regions (Hospital) ER for several years, since 2011.
Annalise George:
Annalise George. I'm a nurse in the ER, probably for the past eight years.
Jenny Sloan:
I'm Jenny Sloan, and I've been down in the emergency room department since 2011. I've been with Regions since 2003.
Steven Jackson:
I know you guys are deeply involved in our diversity, equity, inclusion endeavors and trying to shift the culture and make sizable impact. What does that look like?
Tina Santos:
It started out as an individual change that I wanted to make and what that looks like on a daily basis, especially when coming into work, is making sure that I'm coming in with a clean slate, if you will, a clear mind. The way that I do that is I process anything that had happened previously from work and I let whatever stress that was run its course through my body. And after that processing, I'm not holding any stress, any irritability, any previous experience, any previous patient experience or memory to the next patient that comes.
Kari Haley:
What is your group, and what have you guys been doing, and what is the vision for your group?
Annalise George:
We started as just kind of a opportunity to come together and talk about things that we've experienced in our department and things that we wanted to change. And I think it's been the same group of us for two years, and then this year we got the opportunity to take our discussions outside of our department to our Safety Day education days. And I'm just really excited from that point to see what happens when the conversation goes out beyond our smaller group to see how it plays out in our day-to-day care of our patients.
Jenny Sloan:
My experience within the group, I think I came in, I don't know, I want to say probably it's been about a year now. I can tell you my experiences and the reasons why I even joined the group, just the unfairness of and my experiences working down in the ER far as being a minority and the things that I experienced and that I have seen my fellow coworkers experience, and then also the experience that I seen far as the patients. And that's what made me really wanting to join the group.
When I first came to the group, I was very disencouraged. How are we going to put this out here, and how are we going to get to a point where we can have those uncomfortable conversations? And the way that the group was going, we all was all new to it, and it seems like the meeting was going pretty much to a dead end in my eyes because of what I have seen over the years and concerning diversity and concerning changing the culture, giving people the tools to not necessarily change them, but for them to question and to question themselves. How are we going to do this? This been going on for, I mean, my whole working career and I'm sure it's been going on before then. And it's just like, you know, we have had meetings in the past. We had a meeting that was called bias meeting. And that meeting itself was... I just thought that it was less, like, why don't you call a spade a spade and call it racism? And then even when it comes to not only Black people, but just Black and brown people, but just even with the transgender and gay and people that's just different from, can I say it, different from white, outside of that. And it's just like, let's talk about the elephant that's in the room.
And the meetings that they had in the past, I just totally disagreed with it. And that's one of the reasons why I was so frustrated with the DEI meeting. But as things came along and we starting to get more information and have an outside person to come in and just give us a little bit more structure of how we should at least start to go by it and to get our footing and get that foundation of how we should proceed, my mind started changing because I started to see we making some grounds. It's baby steps, I guess, and that's what allowed me to hold onto it, because I can actually see some changes and see that we are getting it out there and that individuals are doing what we hoping that they will do, not necessarily, not trying to call anyone out and saying "you this" or "you that" or "you doing this wrong" or "you doing that wrong," but just to get that information out there so they can just question themselves.
Steven Jackson:
So what kind of shifted? Was there a personal aha moment or a group of aha moments?
Annalise George:
I think this all really started post-George Floyd and we're having greater conversations as health care institutions recognizing our own bias in our care that we provide. That was the background that started the relaunch of our diversity equity committee. And I think it was kind of, before, going through a checklist of, yep, we had a talk about racism and microaggressions, so therefore-
Steven Jackson:
Yep, check the boxes.
Annalise George:
... we're great. We're all set. But really, it takes a long time and it's really intentional work, and I think it's no wonder that it took our group two years of working and having conversations with a small, intimate gathering to be able to have the ability to talk to our larger department, because we are a very large department. And it's not without its challenges, but it's kind of everyday intentional work that everyone in the department has to be on board with for it to make progress and to make change.
Tina Santos:
Yeah, I think there's a couple of high-profile things that just happened within the nation. I feel like the death of Trayvon Martin was something that I feel like had made waves within our department with a few of our employees. There was just so many. There were some anti-immigrant things... The wall being built. I mean, those are other things that I feel like really did kind of lead up to this, and it just felt like there were so many reverberations of those. I feel like as a department, how we had trouble addressing these formally and in a unified place.
Kari Haley:
Those were really huge events, too. And in the work that we do, in the department that we do, we're seeing patients on their worst day or at their worst, and we're often intimately involved in some of... It may not be the large-scale, big headliner murder, but we see gun violence every day. We see intimate partner violence every day. We see the effects of racism and what society has, where people are in society. We see the effects of that every single day. So I think that kind of bringing it back to those microaggressions and stuff and seeing and hearing them every single day, eventually it accumulates. And I feel like the group really made a huge conscious effort to, OK, enough's enough. And I think it's great that your small group is now really expanding.
I'd like to hear some of the thoughts about what does it mean when you're expanding, and how is the plan to roll it out to maybe someone who's not quite there yet or some of our colleagues who don't experience it or don't experience it in the same way.
Tina Santos:
I know there was a push from amongst the core members to get leadership there.
Steven Jackson:
That's strategy.
Tina Santos:
Right? But that's where we started, because I think previous attempts, like Jenny was saying, some things were missing, and what are those? And I do feel like leadership, starting there, it really sets the tone. So I think what we had commented about in those early meetings is like, we need more leadership here. And it's great that they responded, and we see them now and we notice them now, and... Or you know what I mean? Their presence is, I guess, just very noticeable and the stance that they have taken in this education rollout amongst the department is like, this is our norm. So yeah, I'm glad that they took a firm stance on that.
Jenny Sloan:
Yeah, and then going back to the aha moment, allowing us to say what we want to say, going back to having those uncomfortable conversations and the aha moments is when I had it not only in my head but in my heart as well that leadership was... I have never experienced leadership like we have now, and I definitely give them kudos and they definitely support us, and we was able to express ourself freely. I'm sure all of us only know what we seen growing up. And you take that in school and that's what's learned in the school. This is what you are taught, because the people that's teaching you, that's what they know. So it's just like, let's get them the residents, the new employees, the new nurses, the new medics, the new ERTs. Let's get that out there now when they coming into the job so they know that this is the culture that we want to have in our department, in our hospital. That was the aha moment for me when I seen that leadership had our backs and supported us into putting it out there on what we feel and what we think should take place.
Steven Jackson:
Leadership being involved, and not just being involved but leadership leading the efforts, it's essential. And I think going back to I think what we've all alluded to and even said explicitly is that we want to change culture. We don't just want different pockets of people on board and in alignment with what we're trying to do as an organization, but there needs to be an expectation of how we are to be and who we are to be, living our values. And everyone that works here and everyone that visits here and receives care from us, they need to feel welcomed and included and valued, that that's not an option. That's not a, "Well, I hope you felt welcome." No, you need to feel welcome or else we're not doing our job. And I think setting that culture of expectation, it had to happen.
It's unfortunate there were tragedies. We've talked about George Floyd many, many times on our podcast, and Trayvon Martin and the many others and the many others, many other incidents that have happened. But I think there was a shift, and I think more than ever we're having uncomfortable conversations. It's not a fad. It's not just something you put on your website to say you stand with plug in the group, but there's real, sizable change that has to happen now, because now the numbers are talking. Now we're looking at data and we're looking at the disparities, and this is a health equity podcast. We can look at our health equity numbers and we got a lot of work to do.
Annalise George:
I think in the emergency department as well, we're uniquely suited as being that first point of contact for patients and the importance of building that trust from the beginning and how one comment, one microaggression, can break all the trust and work that you've done. So everyone needs to be collectively engaged in the work that we're doing.
Tina Santos:
Mm-hmm. And that's, yeah, that's even to assume that we come in with trust, they come... You know what I mean? That the patients come in with trust when they are in our care.
Steven Jackson:
They may not.
Tina Santos:
Right? And so-
Steven Jackson:
They come in in the red.
Tina Santos:
And I think we're not used to that. I think all I've heard for several years in a row, it's just like, nursing is the most trusted profession in this country, and... So when are we not?
Annalise George:
I think more often than not, we're trying to rebuild the trust with patients that have historically had their trust broken in their experiences in health care.
Tina Santos:
And yeah, I think we need to approach every community, every patient as, like, we actually don't have your trust, but I can earn it and we can do that as an organization, as a department.
Jenny Sloan:
Right. Yeah, and it's just, for me-
Steven Jackson:
I love it.
Jenny Sloan:
... action speaks louder than words. Being that example and speaking up, that's another thing that far as you see something, say something. "That's not right." Lead by example. I feel that I have that freedom to say something.
Steven Jackson:
Yeah.
Kari Haley:
Yep. I feel like there's been, even in the years that I've been there, a shift of being afraid that you might get in trouble for saying something, or you might be looked down upon because you called something out to being encouraged to do it and supported if you do see something, because it's more like we want to know. And I feel also, just even to your comments, Jenny, about the culture in the emergency department, too, I remember when I first came here, there was a lot of almost grumblings about needing to use the iPad interpreter or something. And now, honestly, I really feel like everyone is really, "Oh, help me find the iPad interpreter," or, "Leave the interpreter on." There's not near... The culture is slowly, but it is, I think, shifting.
Tina Santos:
Yeah, and it is slowly changing, and I think we also have to think about why it is so slow to change. I mean, to Jenny's point, having the freedom to say something, what was the barrier there?
Jenny Sloan:
Mm-hmm.
Tina Santos:
And one of the barriers was a very real fear of retaliation. So when you did have a very negative experience from saying something that is maybe related to your identity or how you treat someone, but if it just very, very much affects your core, that's the history that we're working with, to not only have the freedom, but now we have to as individuals have to work through the uncomfortableness of that and facing that and being brave again to do so.
Jenny Sloan:
Yeah, and it's just like, for me, I look at it like this just to keep myself encouraged, because we didn't get here overnight and what's going on here has been going on since basically day one. For me, in my mind, it's going to be slow. It's going to be a slow process, but I can see that process. I have seen a change that I never would have thought that would happen, even the diversity in staff and diversity far as staff in leadership. I see that change and that makes a huge difference. I can even see a shift in the respect far as from doctor to tech or from nurse to housekeeping or whatever have you. It's just some of that big I's and little you's is kind of getting broke down.
And I can literally see that. It's very, very slow, but it's happening. And I look at the work that we are doing, and as we get better and as we find more information, that things around us will as well get better for everybody because it's the cultures. It's not just for staff, but patients. But it's from staff to staff that I have seen change.
Steven Jackson:
You know, we're talking about microaggressions here and we've defined these terms in previous episodes. Micro-assaults are, for example, telling a racist joke and saying, "Oh, just kidding." A micro-insult is being, I guess, unintentionally discriminatory. And a micro-invalidation is saying that there is no racism or "what you're feeling is in your mind" or "it's all in your head, it didn't happen," or "it's not there." And I'm just curious as to, are there any personal stories that stand out to you guys as care providers where someone has micro-assaulted you or said something off-putting that you knew didn't come from a good place? I'll just put it there.
Jenny Sloan:
Yeah. I have felt many of that over the years, and I have seen my fellow coworkers also experience that over the years where it's just like... I'm going to use a patient example, but it's many. But I will go into a patient's room, doing my job as I do, and I will get questions about, "OK, did you go to school for this? How many years you had to go to school to learn this?" And they'd start asking me questions like that. But that same patient, same staff level, another ERT, I have experienced going to that same room and none of those questions are being asked. And I want to repay it back and it's like, "Why are you asking the questions?" But I don't, just because I have experienced it over the years that I have learned to maintain my peace, because that would go into a argument.
But another microaggression is when I doing my job and I will have a staff member that's I guess you would say above me, another nurse or another provider, to question what I've done. And then when they seen that I knew what I was doing, they would say something else that's... They would question me at first, and I had another staff member to say, "Oh, Jenny's been here for a long time, and Jenny, you know, she's really good," blah, blah, blah. And to explain them to me and then the whole thing would change. "Oh, I was just... This just didn't look right to me, so I was just asking." And I was just like... For instance, I would do a EKG. And the EKG is off.
Kari Haley:
EKG's a heart tracing, for those who aren't medical.
Jenny Sloan:
Oh, yes, yes. The EKG is off and I would have someone... He questioned me three times. He was like, "Was the tapes right, or was this right?" And I was just like, "I did it three times." "Oh, I was just asking because this just doesn't look right." But I'm like, "OK." So different microaggressions like that, but it's many. It's many. I don't think our podcast is long enough, but it's many.
Tina Santos:
Since you can't see me, I identify as a Mexican-American woman. I had an incident where a coworker joked about, and I'll paraphrase here, building a wall around my car.
Steven Jackson:
Oh, my gosh.
Tina Santos:
And it's wild to me because I feel like... So it was on a unit. It was in the middle of one of our pods. And two of my, I'll call them upstanders, responded by saying, "No. No, you can't." I had my own words and I left. I mean, it takes a while to... And I see your facial reactions here. I mean, there's a lot of raised eyebrows, and maybe some would not call that a microaggression, but it was absolutely played off as a joke.
Steven Jackson:
That's a macroaggression.
Tina Santos:
And as I process this, and it's taken a really long time to do so, it's crazy to me to think about that I feel very fortunate that this aggression was made in front of people that spoke up.
Steven Jackson:
Mm-hmm.
Tina Santos:
And I also can't believe that those words just came out of my mouth. I'm very fortunate that this aggression happened. I can't imagine had that pod not responded the way they did, how much longer that would've taken to address and process.
Jenny Sloan:
I have, with my hair.
Tina Santos:
Mm-hmm.
Jenny Sloan:
Yes. Yeah, and yeah, I have had those over the years as well. My hair went from braided to an afro. Just if you guys don't know, I'm Black American. And I had someone to actually put their hands in my hair and say, "Oh, I just wanted to see how that feel." And that particular day, I kept my composure in a way where I didn't lose my job, because that's how much... It's just something rolls up in me. And I have got different things like that over the years, over our heads. And, you know, you call it a scarf. You can call it a wrap. You can call it whatever you want. I was told that, why am I wearing that? And other things were said, which things like that over the years you kind of block it out of your head. But as Tina was telling her story, it kind of comes back.
I can't remember my response, but I remember that same person send it to another girl, which was Black on her head, and she pulled me to the side and she was actually crying. I mean, I didn't know what to do because it's like going back to that culture. You thinking that because everything gets turned on you, and you know it's like, OK, you reported this and this and this and that, and it's just like you make it out like it's no big deal. But it's not a big deal to you, but it's a big deal to us.
Steven Jackson:
Mm-hmm.
Kari Haley:
Mm-hmm.
Jenny Sloan:
Yeah, so I didn't know how to even respond to her. And yeah, I didn't even know how to, "Well, you should do this," or "you should say this." I didn't know what to say, so I didn't say anything and I kind of regret that. But yeah, and going back to the microaggression, it's so many. So, so many.
Kari Haley:
Yeah. It's a neverending, but hopefully improving battle, I guess.
Jenny Sloan:
Yeah.
Kari Haley:
I mean, I think we all in this room probably have had multiple microaggressions, macroaggressions, just blatant-
Jenny Sloan:
Yeah.
Kari Haley:
... blatant aggression directed our way. But I think as we feel safe in having the space and leadership that is supportive of us reporting or letting others know our feelings and that it's not OK to say things or to perform certain ways that we act with or interpersonal reactions and interactions, I think hopefully that means that people will start identifying the words that they use and the way that they say them and whom they're saying them to, and that that will hopefully help us continue to move in the right direction about it. And I think just talking about it is huge. And we used to not talk about it, and I think just talking about it, people can recognize it and that is at least one step in the right direction.
Steven Jackson:
Annalise, I want to give you the final word.
Annalise George:
Oh, really?
Steven Jackson:
Any take-home points or anything you'd like our listeners to walk away with as we conclude this, again, very important but pretty impactful discussion about microaggressions and how to cope with it?
Annalise George:
I think it's about, like we were saying, creating a culture where we can safely call out microaggressions so they don't have that continued building effect, as Jenny was saying, that she had throughout her career and never had a voice to speak up. And it is the responsibility of everyone in a department, if you recognize it and you see it, to call it out. Call it out in a way to learn and to grow from there, I think is really important to get people on board with making the change. We were talking to Tina and myself the other day about, especially the battles in our department, it's so fast-moving and we're so... We hold a lot in and we don't ever really process it. And we need to do a better job of creating a space where we can say, "Hey, I noticed that interaction. It bothered me. Can I talk to you about why it bothered me?" And creating a way to have a dialogue so we don't continue to build up on our microaggressions. So we stop the behavior, we call it out, we recognize it, we try to correct it in real time, but then we also build from there and try not to repeat it.
Steven Jackson:
Well, thank you guys for your time and for what you do. Thank you for, in spite of the challenges and the challenging environment, I can only imagine being a non-ER clinician, the emergency-ness of what you do. But thank you for still delivering great care in spite of everything that happens, and thank you guys for contributing to this culture that we're shifting into so that all are welcomed, included, and valued and thriving.
Kari Haley:
Thank you for being here and sharing your stories and being vulnerable. And I think it'll be really impactful.
Annalise George:
Thank you.
Steven Jackson:
Off the Charts is a production of HealthPartners and Park Nicollet.
Kari Haley:
It is recorded by Jimmy Bellamy, with Creative by Peggy Arnson, Tina Long, Tim Myers and Jeff Jondahl.
Steven Jackson:
Production service is provided by Matriarch Digital Media.
Kari Haley:
Our theme music is by Ryan Ike.