‘Racism is a subtle, sly, slippery thing’: A need for anti-racism praxis in nursing education

By Madeleine Kruth and Candice Waddell-Henowitch
April 2021
Print Version

What you need to know

Racism in health care is an ongoing issue. Nursing and psychiatric nursing students hold a unique role in the health care field and are poised as new practitioners to change the system in favor of equitable service delivery.

The experiences and insights shared by nursing students from Brandon University indicated that:

  1. Racism continues to exist in healthcare and nursing education, in both blatant and subtle forms, despite the implementation of cultural competency training.
  2. Students felt underequipped to deal with racism they experienced or witnessed.
  3. There is currently a lack of anti-racism praxis in nursing education.
  4. More needs to be done to incorporate anti-racism praxis into nursing education.

Why this research is important

Systemic racism is a real and present problem at all strata of our society, and racialized minorities bear a disproportionate burden of morbidity and mortality. As we continue to grapple with it, the COVID-19 pandemic has highlighted health inequalities extant in Canadian society and how devastating their impacts can be on BIPoC populations.

Addressing these inequalities requires an honest look at behavioural and structural changes that can be made in healthcare education, informed by students currently engaged with the system.

How this research was conducted

This two-phase qualitative study included an anonymous survey of 24 participants and a structured interview of 11 participants. Nursing and psychiatric nursing students were asked to explore experienced or witnessed racism in health care and educational settings. Responses were transcribed and coded by the researchers, both individually and as a team.

What the researchers found

Participants shared instances of racism, both experienced and witnessed, during their time as students in class and their practicums. One of the most salient problems expressed was a lack of preparedness for dealing with racism in concrete and practical ways, both when experiencing and witnessing. Students expressed how current training, such as cultural competency modules, is insufficient in implementing true anti-racism praxis. They expressed a desire for a better approach to anti-racist nursing education, including behavioural and structural changes. The students that participated in this research shared that anti-racism is a necessary part of their education, going so far as to say that it would make them better health care providers.

How this research can be used

Nursing educators must re-evaluate how cultural competency training is delivered in order to support genuine anti-racism practice. Listening to the experiences of students currently engaging with the healthcare system can inform anti-racism action plans in educational institutions, contributing to a cultural change and addressing the systemic inequalities experienced by racialized individuals here in Canada. The themes that emerged were used to structure both an academic research article and support developing a student-led anti-racism action plan for the Faculty of Health Studies (ongoing).


The authors would like to thank all of the students that took part in this research project and bravely shared their personal stories. Additionally, the authors would like to thank Dina Tabatataie and Heather Stephen for their involvement as research assistants. This research was funded through a Brandon University Research Committee New Faculty Research Grant.

About the Researchers

Madeleine Kruth

Madeleine Kruth, MSc


Madeleine Kruth holds an MSc in Global Health from McMaster University and is currently pursuing a BSc in Applied Disaster and Emergency Studies at Brandon University.

Candice Waddell-Henowitch

Candice Waddell-Henowitch, PhD(c)


Candice Waddell-Henowitch is an associate professor in the Faculty of Health Studies, Department of Psychiatric Nursing.


  • anti-racism
  • Canada
  • Manitoba
  • nursing education
  • psychiatric nursing education
  • qualitative survey

Editor: Christiane Ramsey

Research at Brandon University follows comprehensive policies designed to safeguard ethics, to ensure academic integrity, to protect human and animal welfare and to prevent conflicts of interest.