(WPO6a) Healthcare Institutions, Work, and Immigration I: Exploring the Trajectories and Mobility of Healthcare Workers in Canada
Friday Jun 21 1:30 pm to 3:00 pm (Eastern Daylight Time)
Trottier Building - ENGTR 1100
Session Code: WPO6a
Session Format: Paper Presentations
Session Language: English
Research Cluster Affiliation: Work, Professions, and Occupations
Session Categories: In-person Session
Over the past three years, the global pandemic has underscored the vital role that healthcare workers have played in upholding healthcare systems worldwide. In Canada, a significant proportion of healthcare workers comprises those who are employed on the frontlines, many of whom have recently immigrated to the country. Notably, several have been involved in multiple migrations, working in healthcare systems in other countries prior to arriving in Canada. Particularly on the frontlines of healthcare work, the pandemic has exposed the disproportionate risk and impact of structural inequality at the intersections of race and ethnicity, occupation, citizenship, and socioeconomic status. Deemed essential and amongst one of the most stressful frontline occupations, these positions are predominantly occupied by racialized women.In this session, we will explore the dynamics between healthcare institutions, work and labour, and immigration, and delve into the complexities, challenges, and opportunities arising from the convergence of these domains. Particularly, we will examine the im/mobility and stratification that workers face within healthcare institutions and organizations. Understanding their challenges is vital for developing equitable organizational and management strategies, policies that optimize service delivery, and improving their retention within healthcare institutions. Their work is pivotal for ensuring the efficient functioning of healthcare systems, provision of patient care, and effective mentorship of new workers. Tags: Health and Care, Work And Professions
Organizers: Valerie Damasco, Trent University, Eugena Kwon, Trent University; Chair: Valerie Damasco, Trent University
Presentations
Suleyman Demi, Algoma University
The COVID-19 pandemic amplified health inequity and diversity challenges experienced by ethnic minority populations in Western countries. Although these issues are known, research into equity, diversity and inclusion is uncommon in health research in Canada (Datta, Siddiqi and Lofters, 2021). Furthermore, the over-emphasis on cultural competence obfuscates structural racism embedded in the Canadian healthcare system. Statistics show that racialized are disproportionately infected with the coronavirus (Lopez, Hart and Katz, 2021; Tai et al., 2021). Among those who contracted the COVID-19 virus, Black people were more likely to be admitted to the hospital (Asch et al., 2021) and more likely to die from complications (Golestaneha et al., 2020). Consequently, this study seeks to address the following research questions: 1) what are the experiences of Black healthcare providers during the COVID-19 pandemic? What are the challenges facing Black healthcare providers in GTA? This qualitative study used purposive and snowball sampling to identify 10 healthcare professionals including 2 medical doctors and 8 nurses to form the research participants. information was gathered through in-depth interviews via ZOOM and phone calls due to COVID-19 restrictions. Data were analyzed using coding and thematizations with the help of NVivo software. The study revealed that the Black healthcare professionals interviewed experienced anxiety and neglect. They also reported a considerable burden associated with being disproportionately assigned to the care of COVID-19 patients, high COVID-19 infections and being subject to unfavourable policies. Some of the challenges facing Black healthcare providers include microaggression, barriers to leadership, and mental exhaustion among others. The study recommends tackling anti-Black racism in the Canadian healthcare system in Canada to improve the experience of Black healthcare providers.
Non-presenting authors: Liben Gebremikael, TAIBU Community Health Center; Suzzane SIcchia, University of Toronto Scarborough; Tameika Shaw, TAIBU Community Service
Krithika Subbiah, University of Waterloo
Internationally Educated Healthcare Professionals (IEHPs), encompassing physicians, pharmacists, and nurses, play a pivotal role in addressing healthcare workforce shortages in Canada. The nation actively recruits these professionals, relying on their expertise to fill positions in remote areas and fields experiencing shortages. While assumptions about universal and transferable skills underpin this recruitment, evidence suggests that the cultural and social context significantly influences IEHPs professional practices. This study delves into the vaccination perspectives of IEHPs, recognizing that their professional backgrounds, experiences, and identities may impact their beliefs about vaccinations. This study aims to investigate the influence of IEHPs intersecting identities, such as sex/gender and ethnicity/race, along with their professional contexts, in shaping their beliefs about vaccinations. The focus is on understanding how personal attributes and the environment in which they practice professionally contribute to their views on vaccination. This study utilized a qualitative approach, incorporating a case study design to explore the nuanced impact of intersecting identities, such as sex/gender and ethnicity/race, among IEHPs. Semi-structured interviews were conducted over phone or video conferencing with a diverse group of 22 IEHPs, including physicians (n=8), nurses (n=7), pharmacists (n=2), radiologists (n=2), midwives (n=2) and a dentist (n=1). The interviews, designed to elicit comprehensive insights, were recorded and transcribed verbatim to ensure accuracy. The data was analyzed inductively, allowing themes to emerge organically. Subsequently, the findings were examined through the intersectional lens developed by Crenshaw, providing a nuanced understanding of the intersectional experiences and perspectives of IEHPs within the Canadian healthcare system. The focus is on understanding how these identities, in conjunction with their professional contexts, shape IEHPs beliefs about vaccinations. The findings from the study reveal how professional identities, gender, ethnic backgrounds, and cultural influences collaboratively shape vaccine hesitancy among internationally educated healthcare professionals. The participants narrative underscored the impact of cultural nuances and generational differences among IEHPs, shedding light on the complex dynamics that influence attitudes toward vaccination. Moreover, economic considerations, historical biases, and regional challenges of IEHPs contribute additional layers to the multifaceted nature of vaccine hesitancy. The studys insights highlight the significant need for customized interventions that thoroughly consider the various factors influencing vaccine hesitancy.
Non-presenting authors: Elena Neiterman, University of Waterloo; Bridget Elizabeth Beggs, University of Waterloo; Farimah HakemZadeh, York University
Yidan Zhu, Texas State University
This research project explores how internationally educated health professionals learn professional skills, produce their own knowledge, and (re)orient their understanding of "professionalism" in Canadian health science education and higher education. In the past decade, an increasing number of internationally educated health professionals (IEHPs) have migrated to Canada to live and find work. IEHPs are internationally trained health professionals such as doctors, physicians, nurses, and midwives who received their health professional licensure outside of Canada. In Canada, close to 25.9% of physicians (approximately 18,233) were trained internationally (CIHI, 2017a). In 2016, there were 26,710 internationally educated registered nurses in Canada, representing 8.1% of the total registered nurses in Canada (CIHI, 2017b). Without a doubt, the large number of internationally educated health professionals have benefited the nation's health care system and services; however, they have also brought new challenges for both health science and higher education. One of the prominent issues is that health science education has undergone struggles in incorporating the changing contexts of the health care system into the current health professionals' education. There are tensions between the changing curriculum and educational goals, the shifting meaning of professionalization brought about by individuals with different backgrounds, and the traditional professional cultures that are deeply rooted in local higher education. Many argue that multiple conceptualizations have value that "the quest for universal definitions has failed to capture", and that health professionals should be aware of such shifted meanings and incorporate those implications into future health science education for various health professions (Kahlke and Eva, 2018). Hence, the purpose of this project is to explore the changing meaning of "professionalism" in current health science education by investigating: 1) The IEHPs' understanding of "professionalism"; 2) the professional learning experience of IEHPs in health science education/higher education; and 3) the development of professional preparation programs for IEHPs from health science educators. This study adopts a transnational theoretical framework aiming to propose a transcultural framework for promoting transformative learning in health science education. The term "internationally educated health professionals" is socially, politically, and culturally constructed. Based on that construction, immigrant professionals' knowledge and skills are unrecognized and devalued (Guo, 2009). IEHPs are usually imagined as "unprofessional" or "without any Canadian/local experience." While IEHPs try to acquire "Canadian experience" as health professionals in order to fulfil the requirements of being a qualified "Canadian health professional," there are unequal power relations between their professional knowledge and the knowledge that they need to learn in Canadian higher education. "Transnationality" has become an important framework for studying migration and mobility in the global world (Glick Schiller et al., 1992; Guo, 2013, 2016; Xiang et al., 2013). Since Glick Schiller, Basch, and Blanc-Szanton (1992) proposed "transnationalism" as a framework for studying migration, scholars have started to examine how migrants build social fields in which they link together their country of origin and their country of settlement. Debates have arisen in transnational migration studies concerning the changing meaning of "home" (Levitt, Kristen, and Barnett, 2011; Taylor, 2015), integration and assimilation across borders (Kasinitz et al., 2002; Waldinger, 2017), and the connections between return migration and transnationalism (Guo, 2016; Xiang et al., 2013). This research offers new insights that compel us to reconsider the essential debate in the study of transnational migration--the concept of transculturation. Transculturation is not a new term, it is used in cultural studies and suggests a process through which "individuals and societies chang[e] themselves by integrating diverse cultural life-ways into dynamic new ones" (Guo and Maitra, 2017). Transculturation sees cultures as fluid, and places them in constant interaction with other cultures (Guo and Maitra, 2017). This study aims to propose a transcultural framework in health science education through exploration of the changing meaning of professionalism and IEHPs' non-linear, dynamic, mixed, and fluid culture and learning experiences. Based on 10 interviews with health professionals in Canada, I argue that the transcultural framework contributes to research on health professionals learning and preparation through its three-fold impact: re-examining professionalism, fostering a just and transformative learning curriculum, and providing guidance for future research on internationally educated health professionals in adult and health professionals education.
Alison Starkey, OISE, University of Toronto
This work seeks to outline empirical differences seen in the scholarly literature between commercial and healthcare settings by exploring how occupational context, the social location of the worker, and type of interactional target/participant impacts healthcare workers’ experiences. It will address how EL and EW theories insufficiently describe the conditions of work for gendered racialized healthcare workers (HCWs), specifically retail pharmacists in southern Ontario. Doing so will elucidate the stratification gendered racialized workers experience within healthcare institutions and organizations, how this stratification challenges notions of mobility within these spaces, and how actualities of workplace violence (WPV), precarity and immobility undergirds discourses around the conceptions of healthcare work as safe, secure, and a pathway to ‘success’. As the conditions of work are the conditions of care and the conditions of care are the conditions of work (Mehra, 2020; Keith and Brophy, 2021), the quality of workplace experiences are directly correlated with worker retention, effective patient care, and functionally sustainable healthcare systems. In an era of healthcare polycrises, HCW retention is a key concern in developing and maintaining sustainable and effective patient care. The frequency of violence against HCWs has risen over the years with the understanding that it is often under-reported. Globally in 2022, more than half of HCWs (55%) experienced WPV firsthand and 16% reported witnessing it against their colleagues (Banga, et al., 2023). Of those who regularly experienced verbal, emotional, and physical violence, 55% felt less motivated and more dissatisfied with their jobs, and 25% expressed a willingness to quit (Banga, et al., 2023). Retail pharmacists are part of a worldwide trend in the increase of WPV (Bhagavathula, et al., 2022). Bhagavathula and colleagues (2022) estimate almost half of pharmacists experience WPV – violence that includes both serious assaults and threats. This is significantly higher than collective reports of WPV among HCWs (Bhagavathula et al., 2022). In the Canadian context, 37% of all working pharmacy professionals experience abuse or harassment from patients at least weekly and 19% report daily occurrences (CPhA, 2023). The Abacus Data Mental Health and Workforce Wellness Survey (2022) revealed that almost half (48%) of polled pharmacists indicated they wanted to or were thinking of leaving the profession (CPhA, 2022, 2023). Women, and increasingly racialized women, are overly represented in the ‘caring’ professions. In 2016, women comprised 75% of the paid care workforce in Canada, 21.1% of which were, in government parlance, of a visible minority (Khanam, et al., 2022). Women make up 62% of the national (Khanam, et al., 2022) and 58% of the Ontario provincial pharmacy profession (OCP Annual Report, 2022). The gendered nature of ‘caring’ jobs assumes a ‘natural’ or ‘essential’ nature to carework/labour (Erickson and Stacey, 2013). Gender bias in medicine is well-documented and is compounded when women are concomitantly racialized (Wingfield, 2019). The ‘meaning’ and consequences of emotion experiences within the increasingly racialized demographics of these workers is rarely or inadequately addressed. These ‘racial silences’ (Mirchandani, 2003) are endemic across disciplines. Seldom the explicit focus when discussing either WPV, equity work, the process of coping with sexism and racism in workplaces, or their aftermath outside of work and impact on health and well-being, emotions do, however, inform much of this research. Gendered racialized women HCWs cope with daily practical demands, work intensification, and WPV through practices and strategies that combine EL and EW and yet extend beyond these concepts on an emotional continuum. Scholarly frameworks show empirical variations between EL and EW in commercial and healthcare environments that are insufficiently addressed in the literature by these approaches (Erickson and Stacey, 2013). The occupational context of retail pharmacist is one that is simultaneously commercial and healthcare. Interrogating this occupational context, the social location of gendered racialized women pharmacists, and the interactional targets/participants of patients, who are also customers, occurring in retail pharmacies will shed light on other HCW contexts. Drawing on an analysis of the multi-disciplinary application of EL and EW theory to the experiences of various HCWs, comparisons to the literature on retail pharmacists will be made and supplemented by empirical interviews with gendered racialized women pharmacists from the southern Ontario region. Such comparisons will serve to bridge the empirical variations noted above.