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Microaggressions can look like lots of different things.

They can be something that somebody says to you; they can be a way that you’ve been made to feel. They are often subtle behaviours, but their effects are far from subtle.  

As a Black nurse, I’ve experienced lots of microaggressions. I used to turn a blind eye to them, but when I became an educator, they became harder to ignore when students came to speak to me about racism in the workplace.  

I started to address racism in a more proactive way: by acknowledging what was happening to students and providing helpful strategies to manage their responses.  

What are microaggressions? 

The difference between microaggressions and overt racism can be very subtle, and difficult for the individual to define and describe.

A microaggression might be intentional, or it might be unintentional or unconsciously done. But it doesn’t matter how it was meant, the important thing about microaggressions is that intent does not supersede impact.   

A microaggression is something that has made an individual feel uncomfortable, marginalised and small. Whether it’s a comment about someone’s appearance, language skills, how they wear their hair, or their role, it’s an attempt to “other” them.

Impact of microaggressions 

When somebody is subject to a microaggression, the effect can vary. It can be momentary discomfort, or even a bit of confusion. The person might wonder if that comment was meant for them. 

Microaggressions have an accumulative effect and that can be significant on a person’s mental health and wellbeing. They can even affect someone’s ability to carry out their job, which is why they must be taken seriously. 

The term “micro” makes it sound like something small and inconsequential, but it’s not. Micro refers to the subtle delivery of the aggressive behaviour – not it’s impact.  

When people are subjected to consistent microaggressions, they can feel that they don’t belong, that they’re somewhere they shouldn’t be, and that they are not included. It can have a huge impact on professional self-esteem, which can then affect professional performance.  

It can cause people to feel like they need to be perfect, that they need to overwork and overachieve to maintain the same level as colleagues who are not subject to microaggressions. 

Sometimes it’s okay to do this for a little while, if someone is chasing a promotion, but if they’re doing that all the time, that can take a toll and lead to burnout. 

Your responsibility to speak up

  • Standard 12 of the RCN Nursing Workforce Standards states: “The nursing workforce should be treated with dignity, respect, and enabled to raise concerns without fear of detriment, and to have these concerns responded to.” 
  • In the same standard, point d) states: “Encouraging staff to report near misses and incidents and ensuring appropriate follow up by accountable managers creates psychologically safe environments and a learning culture.” 
  • The RCN Respect Charter acknowledges that personal behaviour has an impact on others and, as members, we are committed to treating everyone with courtesy and respect. 
  • The Nursing and Midwifery Council sets out in The Code that all nursing staff act with honesty and integrity at all times, treating people fairly and without discrimination, bullying or harassment.

Identifying microaggressions

Nursing staff should be aware of how microaggressions manifest in the workplace to better safeguard and stand up for their colleagues.  

Often when a verbal microaggression is made, the perpetrator could be talking in a friendly way, even smiling at them, and the microaggression is simply dropped in there.  

The person on the receiving end might have a first response to laugh, or might feel uncomfortable but carry on and ignore it. If given space, they might realise it was leaning into a stereotype, inflicting a harmful type of discrimination, or just overt racism, which could cause “race trauma”. 

It might only dawn on them afterwards that it wasn’t right. That can be difficult to deal with, because people feel like the moment’s passed and it’s not important anymore, so they don’t raise it.  

Microaggressions can accumulate quickly, because the first time it might feel awkward, and the second time it is more uncomfortable.  

A third party who witnessed the conversation might check in to see if they’re OK because they noticed the microaggression. Sometimes having another party confirm what happened can be reassuring, especially if they didn’t want to admit it to themselves. 

Calling it out 

Firstly, calling out a colleague can be hard, and it’s not always possible or appropriate – for example, if a patient is present, or if their colleague is very senior to them.  

Secondly, the person experiencing the microaggression does not have a responsibility to call it out.  

However, it’s harmful behaviour, and there is a range of ways someone can approach it.  

If someone does choose to call the perpetrator out, they should be polite and non-confrontational, but also empowered.  

Lorna Hollowood. Credit: Steve Baker
Above: nurse educator Lorna Hollowood. 

My approach is to give that microaggression back to them. That means, don’t respond or answer to the microaggression, but simply say “What do you mean by that?” or “What made you say that?” 

Here's an example. If someone says: “You’re so articulate, you speak so well for someone from where you’re from”, don’t try to justify it by saying something like: “I’ve lived here for 10 years.” Instead, say: “That’s an interesting thing to point out, what made you say that?”  

Probe the person to think about where that question came from. I’ve tried that as a technique and it felt empowering. Yes, it caused an awkward moment, but I didn’t feel like I’d confronted it in an offensive way and it put me back in the driving seat. 

If someone does choose to call the perpetrator out, they should be polite and non-confrontational, but also empowered

Effective allyship

All of us have a responsibility to tackle racism, but microaggressions can happen to women, to people of different sexual orientations, gender presentation, background, class or faith, to students, and to older members of staff. There are so many characteristics that can be at the end of micro-aggressive behaviour.

I would urge all nursing staff that if ever you see or experience such behaviour to have the confidence, and if it’s appropriate, to call it out at the time.  

If you can’t do that, then don’t ignore it. Ask the person who was the victim of the microaggression if they’re OK, explain that it made you feel uncomfortable and ask them if they felt the same. Open up the door to conversations. You may also want to consider how you can empower the victim to challenge the behaviour. 

If you’re an RCN rep, members might come to you first for direction and support. You don’t have to have all the answers, but you can demonstrate empathy and understanding.  

Don’t underestimate the power of being an ally. Being an ally can mean recognising that something was wrong – that can be all the allyship that someone needs to help them stand up for themselves.  

Learning lessons

In the clinical environment, I would urge all nursing staff to increase their literacy around microaggressions and have reflections and debriefs when incidents occur.  

This may not always be appropriate. If it’s between colleagues, that should probably be kept outside of the wider team, but patients can be abusive to members of staff. Incidents involving patients could provide a useful opportunity to have discussions in the staff room; we can’t take it for granted that everybody knows what forms racism can take. 

For example: if a student says to their supervisor that a patient has been asking them where they’re “really” from, that’s an opportunity to have a conversation with the wider staff group. During a handover, you can let the new staff know that you have a student who experienced racism in their last shift, explain exactly how that manifested, and recognise it as a microaggression.  

Ask staff to look out for them and check in and make sure they’re OK, and if you hear a patient behaving that way again, bring it to someone’s attention. Ignoring or dismissing it can be incredibly harmful. 

Over the course of my career, I’ve had to develop a language and competency to talk about these things, and it’s been empowering for me personally. I’m a committed anti-racist – I know my colleagues are too – and we have a responsibility to eradicate racism faced by nursing staff in the NHS. 

Lorna Hollowood is a lecturer in nursing and completing a PhD looking at the experiences of the Windrush generation in UK care homes. 

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