African Nova Scotian nurses’ perceptions and experiences of leadership: a qualitative study informed by Black feminist theory

Abstract

People of African Nova Scotian (ANS) ancestry constitute a culturally distinct group within the larger Black population in Nova Scotia, Canada. This ancestry dates back to the 1600s, when Black people arrived in Nova Scotia as enslaved, fleeing or "freed." 1-3 People of ANS ancestry are historically one of the largest congregations of Black people in Canada (currently 22 000 people, constituting an estimated 2.4% of the Nova Scotian population, 1 72% of whom identify as third generation or greater), which has resulted in a particular socialization and social context. [1][2][3][4] People of ANS ancestry represent one of the largest racially visible groups in Nova Scotia. 1 More than 50 ANS communities are located across the province, including in historic settlement sites. [1][2][3] High rates of chronic disease, such as high blood pressure, diabetes and mental illness, have contributed to substantially worse health for ANS people than for the general population of Nova Scotia. 4,5 Social and structural determinants of health have been implicated in the disproportionate rates of chronic illness experienced by ANS people. 5,6 In 2017, the United Nations concluded that racism in Canada, particularly in Nova Scotia, exacerbated disparities and in equities across sectors including education, health and employment. 4 Anti-Black racism -which permeates policy, practice, decisions and systemic processes -results in discriminatory treatment that compromises health. 7 Addressing anti-Black racism in health care requires practitioners who are competent, invested in change and in positions to instigate reform. 8 Leadership, which is a standard of practice and basic entry-level competency in nursing, encompasses formal and informal roles that contribute to enhanced health. [9][10][11] Nurse leaders challenge health inequities and disparities through their knowledge and skills, by influencing health policy, shifting practices and contributing to the transformation of the larger health care system. [8][9][10] Archival data reveal a legacy of segregation and exclusion of Black people in nursing, which contributes to issues of recruitment, retention and representation of ANS people in the nursing profession and in positions of leadership. [12][13][14][15]

Learning to fake it: limited responses and fabricated references provided by ChatGPT for medical questions

“…The medical questions were identified by selecting five research articles published at the end of 2022 in four high-impact factor medical journals (BMJ (13)(14)(15)(16)(17), CMAJ (18)(19)(20)(21)(22), the Lancet (23)(24)(25)(26)(27)(28)(29)(30)(31)(32) and NEJM). These 20 articles spanned different topics and fields.…”

“…For example, the primary objective "to critically examine the leadership experiences of African Nova Scotian nurses in health care systems?" (18), was changed to: What are the leadership experiences of African nurses in the United States health care systems?…”

“…In a few instances where the objective was deemed too narrow to ensure a minimal breadth of references, we formulated the question in a broader context. For example, the primary objective “ to critically examine the leadership experiences of African Nova Scotian nurses in health care systems ?”(18), was changed to: What are the leadership experiences of African nurses in the United States health care systems ?…”

Contradictory Mobilities and Cultural Projects of Afropolitanism African Immigrant Nurses in Vancouver, Canada

“…Moreover, scholarship on anti-Black racism in nursing has tended to focus on experiences among Black Caribbean nurses, particularly in Ontario and Quebec, where a relatively larger number of Black Canadian immigrants predominantly settle (see Calliste 1996;Cooper Brathwaite et al 2022;Das Gupta 2009;Hagey et al 2001), and in Nova Scotia with its distinctive role in Black Canadian history (see Etowa et al 2009;Flynn 2011;Jefferies et al 2022). In British Columbia, De Sousa et al (2023) highlight the historical contributions of Black nurses predominantly from the United States and the Caribbean between 1845 and 1910, while Kihika (forthcoming) examines how systemic barriers located within the historical context of a racialized Canadian state policy continue to characterize the realities of African immigrant nurses in Vancouver in contemporary times.…”

Racial humility over competence: Addressing anti-Black racism and healthcare leadership responsibility

“…The absence of racebased data collection to measure and monitor health disparities for Black community members in terms of access, disease prevalence, and treatment within the healthcare system has been an ongoing struggle. [8][9][10] Healthcare governance has also been called into question with the revelation that only 1.9% of hospital board members nationally identified as Black, providing solid evidence of the lack of Black input in decision-making at the highest levels. 3 During this racial awakening, health leaders with limited guidance or expertise were called upon to lead and address how the Canadian healthcare system is complicit in systemic anti-Black racism.…”