How one B.C. nursing leader hopes to address anti-Indigenous bias in 'intrinsically racist' system
Nursing college registrar Cynthia Johansen says she is 'asking people to change their hearts and minds'
This story is part of a series examining systemic discrimination against Indigenous patients within the nursing profession in B.C. Read Part 1, Part 2 and Part 3 in the series.
In Cynthia Johansen's mind, reconciliation begins with the painful realization that she's spent most of her life ignorant of the full history of Canada and the true impact of more than 150 years of oppressive anti-Indigenous policies.
"Holy God, I've missed like 90 per cent of the core information and learning of what it means to live here, and I'd better figure that out," she explained. "Reconciliation for me is about bridging that gap, and what role I can play as an individual Canadian to fix it."
As registrar for the B.C. College of Nurses and Midwives (BCCNM), which sets the standards and expectations for more than 67,000 health professionals, Johansen has the power to play a much larger role than most Canadians.
"It's so clear the harms that have been created by a [health-care] system that is intrinsically racist, and individuals acting within that system are driven to act in that way because of the fact that the system around them supports that behaviour," she said.
The body she oversees is B.C.'s largest regulator of health professionals, and has the power to discipline nurses who fall short of their legal responsibilities, including the ability to revoke their licences, as well as influence over the curriculum taught in nursing and midwifery schools.
In a wide-ranging interview with CBC News, Johansen spoke about how she and her staff at the college are trying to tackle this crucial work, an undertaking so enormous it will have to continue long after she's retired.
"To me, our commitment isn't just a short-term initiative — tick a box, we did that action plan, put it on our website, and on to the next thing — this is an undercurrent of everything we do until it's no longer harmful for Indigenous people in the system."
Shifting beliefs before they cause harm
A series of reports on the B.C. health-care system have laid bare the scale of the problem. The 2020 In Plain Sight report details disturbingly prevalent stories of bias and discrimination experienced by thousands of Indigenous people, and says it's clear there is "widespread systemic racism" that many people in positions of power have long known about but failed to address.
The 2022 Remembering Keegan report on the death of Keegan Combes exposed how that racism played out for a Skwah First Nation man whose care was neglected after he accidentally drank windshield wiper fluid.
And just this summer, results of a survey conducted among more than 3,300 B.C. health-care workers belonging to 10 professional colleges — not including BCCNM — revealed the troubling prevalence of certain racist attitudes.
For example, 20 per cent agreed that "Indigenous people have problems with drugs and alcohol" and 10 per cent said that "as a society, we're being too accommodating to Indigenous Peoples."
Although her college did not participate in the survey, Johansen said it's her responsibility to stamp out similar attitudes.
"My issue is making sure that we have taken action to shift that belief before it causes harm," she said.
To that end, the college introduced a new "Indigenous Cultural Safety, Cultural Humility, and Anti-Racism" practice standard in February 2022, in partnership with the College of Physicians and Surgeons, that details the duties of every nurse and doctor to reflect on their own biases, educate themselves, put that education into action and then call out racist behaviour by their colleagues.
That standard is already under review to determine how well it's working, but in the meantime, it's been adopted by several other B.C. colleges.
Late last year, BCCNM underwent an external review of its complaints process to determine how it could be more welcoming for Indigenous people.
The biggest finding in the review from Novatone Consulting was that Indigenous patients very rarely file complaints, despite the widespread discrimination documented in the In Plain Sight report. That might be because they don't expect any action to be taken or believe they'll be treated poorly during the complaint process and in the future, the review says.
"Why aren't people reporting concerns? Well, again, we are part of the system that has been causing that harm," Johansen said.
Without formal complaints, which are necessary to investigate discrimination by individual nurses, it's difficult to understand the extent of anti-Indigenous racism, or to take action against those responsible.
The college is now working on how to make the complaint system more accessible and welcoming to Indigenous people. It's hiring an Indigenous staff member to be the point person for these complaints, and considering changes like allowing community representatives to make complaints on behalf of patients and accepting complaints through other means than writing.
But none of that will make a difference without building trust.
"The relationship with community is so important. They need to know who we are. They need to know what we can do. They need to know that we're open to hearing from them, that we're going to make it as easy as possible for them," Johansen said.
'Changing culture' will take time
The college is restrained by the legislation that governs it, which both defines and limits its powers, Johansen said. However, she said promising changes are on the way when the new Health Professions and Occupations Act is implemented.
One of the most important additions to the new act is that it specifically defines anti-Indigenous racism as a serious harm that could lead to discipline.
"Consequences come when the harm has been named, identified and reported to us," Johansen said.
She acknowledges it may be a long while before significant improvements are obvious on the ground.
"Putting in place a standard or looking at our complaints process, those are all really important things for us to do. But it's also about changing culture, and that takes time," Johansen said.
"We're asking people to change their hearts and minds."
Of course, Johansen's power only extends to one thread in the complicated web that makes the health-care system, but B.C. Health Minister Adrian Dix said there is a commitment from public bodies across the province, including all the health professional colleges, to enact change.
But, he acknowledged, "It's taking way, way too long. … That doesn't reflect well on B.C. or Canadian society."
Tania Dick, a Dzawada̱ʼenux̱w nurse who is director for cultural safety and humility and clinical practice for health ministry, said she's yet to see a significant change in how Indigenous patients are treated by nurses, and is still hearing plenty of horror stories from community members.
"I personally feel like the change isn't happening fast enough," she said.
Still, Dick has seen a notable shift of a different kind across the health-care system.
Now, she said the Indigenous patients she's spoken to understand how to raise concerns about racism, and they have fresh hope that serious problems might actually be addressed.
"They're feeling heard. They're feeling like they're understanding the assessment, they're understanding the next steps," she said.
"I haven't heard that clearly before amongst my people."
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