English-Only Policies and Allegations of Racism in Nursing: Safety, Culture and Respect Prevail

Observations of Racialized Respect and Dysfunction in Healthcare Workplace Dynamics

Healthcare workplaces mirror broader societal inequities, embedding racialized power dynamics that shape professional relationships, communication, and collaboration. While systemic racism in healthcare is well-documented, little research captures how these dynamics unfold in real-time. This study employs a 2-year qualitative participant-observation approach in a medium-sized acute care hospital to examine racialized workplace interactions among nursing professionals, offering a context-rich understanding of how systemic exclusion operates daily. Unlike studies relying on self-reported experiences, this approach minimizes recall bias and uncovers the subtle mechanisms that sustain inequities-non-verbal exclusion, coded language, racialized delegation of tasks, and strategic adaptation by Black staff. Findings reveal disparities in respect distribution, inequitable workload assignments, and help-giving patterns that reinforce in-group favoritism and out-group marginalization. Black professionals faced exclusion, heightened scrutiny, and dismissive communication, leading to workplace stress and high attrition. By applying Social Identity Theory to hierarchical healthcare environments, this study illustrates how professional hierarchies intersect with race to perpetuate exclusionary dynamics. Addressing these patterns requires structural interventions that foster equity, accountability, and inclusive leadership to disrupt systemic barriers and create collaborative workplaces that support professional growth and patient care outcomes.