Crucial Conversations QA

Responding to Racism While On the Job

Dear David,

I work in a community hospital with culturally diverse patients and staff. Recently, a nurse told me about an upsetting experience. The nurse is African-American and was caring for a patient in a double room. He overheard a conversation between his patient’s roommate and a visitor. In a loud, strident voice, the visitor expressed his views about a situation concerning race that has been widely reported in the media. The visitor criticized the African-Americans involved and made several borderline and blatant racist comments. The nurse heard the comments and left the room without comment, but was angry. He later asked me, “What could I have said?” Several people thought that as a “professional” he acted correctly by not saying anything. I am troubled by the notion that silence is the professional approach to racism. What do you advise?

Dear Troubled,

Usually, I would say that silence is not the professional approach to racism. There is a reason we teach people to have crucial conversations—you can help put an end to evils like racism by sharing your opinion candidly and respectfully. And yet, given the setting and his role, I think your colleague handled himself in the most professional way possible.

I’ll begin with the problems that come from not speaking up. First, when you don’t speak up, you allow the bad behavior to continue. Others see your silence as acquiescence, permission, or even encouragement. We saw this when we studied parents who failed to talk to their children about alcohol and drugs. Their children assumed they had permission to drink and use.

Second, in Crucial Conversations we say, “If you don’t talk it out, you will act it out.” What we mean is that your concerns will be expressed in your behavior—often as bad behavior toward the offending person.

A few years ago, I collaborated on a research study with Dr. Joan Reede, the Dean for Diversity & Community Outreach at Harvard Medical School. We were interested in what happens when people experience an ethnic or sexist slight, but say nothing.

We identified seven categories of common slights, small offenses that most women and minority members experience at least monthly. We called these slights undiscussables because few of the women or minority members spoke up when they experienced them.

We discovered that these undiscussables destroy relationships. Even though the slight was never discussed, 96 percent of our subjects left the interaction believing the other person was a bigot. We called this study Silent Judgment to highlight this dynamic.

So, why do I think your colleague was right to keep his mouth shut despite the obvious injustice he was subjected to? Because he isn’t just a passer-by on the street. In this specific circumstance, as a nurse, he is operating in the patient-caregiver dynamic and that relationship is both unique and sacred.

First, the relationship is lopsidedly unequal. Patients feel powerless, both because they are ill and because they’ve ceded personal control to the hospital and its caregivers. As a caregiver, you awaken them in the middle of the night, you invade their personal space, and you cause them pain. Your patients are at your mercy and only hope to receive it. How bad is it? It’s so bad that most patients and family members won’t even remind a nurse to wash up, for fear of making a bad impression and exposing themselves to retaliation.

Second, because of their illnesses, patients aren’t at their best. I know that when I’m sick, I become grouchy, self-centered, and short-tempered. I hope others will give me a break!

Third, patients are involuntary visitors. They would rather be home, on a cruise ship, at a beach resort, in a ski lodge, or even back at work. They are only in the hospital because their health requires it. They may even feel like prisoners.

Fourth, patients don’t have the privacy they are used to. Instead, they share their rooms and caregivers walk in whenever they want. As a result, comments they intend and expect to be private, aren’t. And it’s not as if they can move to a private location for more sensitive conversations. They’re stuck in their beds.

For these many reasons, I think your colleague was right to stay silent when he overheard the hateful comments. By speaking up, he would likely violate the patient-caregiver boundaries—for both his patient and his patient’s roommate. And though silence may be perceived as tolerance for racism, he should place his patient above his own frustrations while on the job. Should he overhear those comments in a restaurant later that day, I would encourage him and everyone to speak up and put an end to bigotry—but unfortunately, that is not the case in the situation you describe.

And not speaking up also means he will have to deal with his frustration and anger. Remember, “If you don’t talk it out, you’ll act it out.” Acting it out would be unprofessional. It would be what patients fear most.

We’ve all found ourselves in situations where we’ve decided against speaking up and had to master our frustrations. The key in these situations is to step back, take a longer more inclusive view, and get your heart right.

We recommend asking yourself, “What do I really want long term for myself, for others, and for the relationship?” When your friend asks himself this question, it will help him put this incident into a broader perspective. And it will help him act on his values, rather than responding to others’ slights while serving his patients.

I hope this helps,


David Maxfield

David Maxfield is a New York Times bestselling author, keynote speaker, and leading social scientist for organizational change. For thirty years, David has delivered engaging keynotes at prestigious venues including Stanford and Georgetown Universities. David’s work has been translated into twenty-eight languages, is available in thirty-six countries, and has generated results for three hundred of the Fortune 500.
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44 thoughts on “Responding to Racism While On the Job”

  1. Hello – I have to say I respectfully disagree with your response. In the spirit of disclosure, I am African American. The LW stated that the visitor and not the patient made the remarks – so, the nurse could have simply said, “remember, you in a shared space and must be mindful that you can be overheard and that some of things you said may cause discomfort to those around you”.

    What if the patient he was caring for did not like what the visitor was saying either – that could have impeded their recovery. Who knows, the visitor may have purposely acted obnoxious just to make the Black nurse uncomfortable. We must always speak up, if for no other reason than making the person accountable at the moment.

    1. Monica, I couldn’t agree with you more and came to say the same. Thank you so much for sharing.

      David, I understand all the reasons that saying something is difficult in this situation and appreciate that you wanted to get into the mind and emotion of the patient. However, I do not think that these become excuses for the behavior, and the comments still need to be addressed.
      There are a plethora of reasons that speaking up in healthcare settings is difficult. From interactions with patients to interactions with physicians — there are power dynamics, emotions, and considerations aplenty. However, we must hold ourselves to a higher standard and find ways to have respectful conversations and dialogue within these structures. The Silence Kills research from Vital Smarts shows the danger of not addressing incompetence, poor teamwork, and disrespect in healthcare. I think the behavior should have been addressed. Monica provides a great way to do this while maintaining respect.

      Thank you,

    2. Couldn’t agree more. I have been reading and following crucial skills for over 3 years now, and this article misses the mark by a mile.

      Full disclosure, I am also of African Descent.

    3. I am caucasian. David’s response didn’t sit well with me either. I like Monica’s suggestion. If there was concern that the patients might be stressed by the nurse’s intervention, she could wait ’til the offending visitor left the room. (But I understand nurses don’t usually have that kind of time.)

      This won’t prevent me from continuing to follow and learn from Crucial Skills, but in the interest of sharing ‘candidly and respectfully’ I wanted to weigh in on this one.

    4. I agree that engagement would be a constructive step. Perhaps the nurse checking in and directing his attention to the patient– “do you need more water?” or some other of the thousands of things nurses do for their patients in the course of a shift. Once the care issue has been addressed, the nurse has demonstrated respectful interaction as the opener. Monica’s suggested remark afterwards seemed spot-on, and might follow nicely. I might even add, “this is a two-way effort: please make sure to call us on things that might make you uncomfortable–like if one of us forgets to wash our hands. Better communication results in better care.” Or something more eloquent than that…

  2. If there is a clearly defined boundary about what patient language/requests will be silently borne for the reasons you describe and which will not, it may help create a situation of respect for everyone. In 2013 an African-american nurse was barred from caring for the child of a white supremacist and it’s not an isolated (see Would that behavior be allowable, for the same reasons you describe? I feel it shouldn’t be.

  3. I don’t think that saying nothing is the correct response. While saying nothing to the patient may be correct. He should have said some thing to the African American Nurse. He is leaving his co worker out there by herself and thinking that he does not have her back.

  4. Thank you Monica. I like your response. It does a good job of maintaining safety, while holding up a mirror so people have to think about how they are being seen. What do others think?

    1. I disagree with Monica. What happened to freedom of speech? If a football player can sit through the National Anthem, and that is freedom of speech as people claimed, then the visitor had every right to speak his opinion on a situation. It’s not always about race.

      1. Freedom of speech is first amendment right that guarantees you freedom from restriction by the government. Speech has consequences – especially in the workplace, where the employer needs to protect its employees even as it provides care.

    2. David, sorry, but I respectfully disagree with your article. To simplify, the governing criteria in my opinion is the benefit of all people involved. and I believe that saying something that is racist deepens one’s racisim, and for their own sake should be respectfully called out, and this could be expressed in a way that will be of benefit to all involved, and strengthen the sacred bond you mentioned.

      1. But the criticism was of the BEHAVIOR of a particular group of people who happened to share the characteristics of inability to wait for actual facts to be known before reacting violently against random victims, because they identified solely with the color of the skin of the individuals involved in the individual incident.

        Was it badly expressed? Probably. Should the visitor have been reminded that it was a shared room? Definitely.

  5. So true that if we don’t talk it out, we’ll eventually act it out…this situation reminds me of ‘charged’ conversations I’ve been part of over the years, but as our pastor says, “they can’t force you to stop loving them”. We need to pre-think our responses to things we might hear so we have a ready response that will stop the negativity rather than escalate the conversation…which takes no effort these days.

  6. I completely disagree with the advice to stay silent because that is the “professional” thing to do. Essentially that tells professional people of color that they need to endure blatant racism and the microaggressions that they deal with on a daily basis without speaking up.

    This is another example of being told to stay quiet for the good of others. Whether or not you’re a helper and whether or not the other person is in a place of their choosing we always have the right and choice to speak when racist and offensive words are said to us and about us — without repercussion of being called unprofessional.

    There are ways to speak up AND be professional. For example, I heard your conversation/when you said X and found it offensive. Please do not use that language in my presence.

  7. Obviously all advice is not good advice, however everyone has their own opinion. I respectfully, disagree with this approach.

    I would have reminded the individual that they are in a public environment and the comments are offensive and to please change the conversation.

    If the individual refuse to stop I would then inform my superior.

    NEVER be afraid to address racism / hatred!!!!

  8. Monica offers a good alternative and insight into other dynamics of the situation.

    Another variation of the situation might be that the statements were not overheard but made directly in the presence of the nurse. I’ve spent ample time in hospitals both as a patient and caring for others, and I think all of David’s observations about patients are accurate. Even so, when confronted directly with bigotry, even in the role of healthcare provider, it’s appropriate to speak up. What would be an appropriate way to address that situation?

  9. I agree with Monica, especially since it was the visitor who made the comment. And I like Monica’s comment since it holds the visitor accountable in a way that is difficult to argue, no matter the person’s opinion. I do agree that if the setting was different, there may have been a different response to address the offensive of the comment, or to ask questions about what makes this person make the statements they made.

  10. I was disappointed in your response. You go to great lengths to empathize with the patient who did not make the comments. But you don’t really go into much detail as to how the employee can “talk it out” so he won’t “act it out”.

  11. David,

    I propose that as many negative remarks are made regarding LGBT individuals as overt racism comments today. I noticed that your study with the Dean of Diversity and Community Outreach didn’t include this population. Diversity concerns are more than skin color, and I am not saying that racist comments don’t happen, they do.

    I am saying that society as a whole is not as attentive to the LGBT community regarding negative comments. As you said, you must speak up rather than remain silent.

  12. As a minimum the nurse should have commented “I am sorry, I apologize and let me return when the conversation is more inclusive. Please, notify the hospital’s administration as soon as possible, due having a patient within the room.”

  13. I had a similar incident at work yesterday. An employee walked in the office and spoke to each employee (5) while making her way to my office – at the end of the short hallway. When she greeted me, she asked whether I had attended a recent Martin Luther King Jr. event. I am black and she is white. I responded, but I wondered why didn’t she ask any of the five white employees…I too didn’t say anything:-(

    1. Sheila, as an African-American woman, I also experience situations like this. I always think the best of everyone, until given a reason to feel otherwise. In this case I would have told myself that the employee actually thought she was being sensitive and inclusive by asking me about something that might be more relevant to me than to other employees. I’m not sure if that’s the right way or not to think of it, but I honestly think some people don’t know when they are being inappropriate. And how do you tell someone who is trying to be nice, that they are actually being inappropriate?

      1. I agree Anita – I know she did not mean any harm by only asking me about the event. On flip side have we become too sensitive – “we” meaning everyone? Yes, it seems it doesn’t take much to offend someone these days.

        1. Yes, I agree. We are way too sensitive these days. I’m amazed at how easily people are offended or how quick we are to believe the worst. This case in the hospital isn’t an example of that, but it seems that, thanks to Facebook and Twitter, people can be crucified within seconds of expressing a thought!

  14. I believe that a professional reminder that this is a shared space and all comments can be overheard should be made, especially if it is a conversation that continues for some time. There are other patients and families in the area that are stuck there using that healing space as well and the nurse is an advocate all of his patients.

  15. If there is a clearly defined boundary about what patient language/requests will be silently borne for the reasons you describe and which will not, it may help create a situation of respect for everyone. In 2013 an African-american nurse was barred from caring for the child of a white supremacist, took that to court. It’s not an isolated incident. Would that behavior be allowable, for the same reasons you describe? I feel it shouldn’t be.

  16. I love this conversation. I opened the comments in order to leave one saying how much I love David’s response. And then I read Monica’s. And what’s great is, you’re both right!
    David for recommending keeping the situation “patient centered”. As a Jewish practitioner who is observant and wears a yarmulke (and has a high percentage LGBT practice and an Af-Amer, Muslim front desk person), I’ve had patients slip and say little things as well bigger things such as this “joke”, “Careful doc, or one day they’re going to turn you into a lampshade”. And this person really did think that was a joke. And I said nothing. Painfully, nothing which, unfortunately is how I usually handle these things. Don’t hurt the feeling of others no matter what. Oy, such an upbringing! On the other hand, as their doctor, I have the struggle to stay patient centered.
    And Monica’s gentle, respectful reminder to be sensitive was not an accusation of the person as bad, wrong or a bigot. Whether or not that person was a bigot (and perhaps actually did deserve some more pointed words) the situation called for the patient-centeredness of David’s response combined with the sensitivity and non-accusing nature of Monica’s. I think that way it could more likely come out just right for all.
    Thank you everyone for this conversation.

    1. You have to remember that not everyone has the same context of their remarks as you do.Unless I KNOW differently, I choose to believe that the person who made a remark that I fund hurtful did not intend to hurt me personally.

      If circumstances permit it, I will kindly educate them. “I don’r know if you realize it but the Holocaust is not just textbook education for everyone. There are many people, and not all just Jewish, who are keenly aware of the many missing faces that should be around the holiday table but can’t be.”

      Otherwise, life is just too short to go around looking for ways to be offended.

    2. Yes, I agree. I always like it when there are a lot of comments. It’s how I learn. When it comes to interpersonal skills, there is no repository of “right answers.” My father used to say these were skills you, “learn at your mother’s knee or some other low joint.” You all are a very valuable source of learning for me.

  17. Yes, David, you missed the boat on the fact that it was the visitor and not the patient. Also, any time a person who takes the opportunity to make sensitive comments in a public environment don’t care whether they are heard or not. It was intentional. Clearly the visitor feels superior.

    The response could have been along the lines of “Excuse me sir, this is a hospital where our #1 priority is to care for the ill. Your comments were overheard and upsetting. Please either lower your voice, refrain from such comments, or leave. If you continue to make such comments, we will call Security and have you removed.”

    I’ve done this will foul mouthed kids before in a theater. Once their behavior was confronted and threatened with removal by people with authority, a funny thing happened…. they immediately stopped. They even apologized.

    By the way, for a person of color, these kinds of comments stay with a person all day long. I guarantee you that nurse either thought about it or fumed all day long. It could have possibly affected her ability to do a quality job. No one will ever know.

  18. While this response is very well written and wonderfully thought provoking, the decision not to speak up feels a little bit like the “sucker’s choice”. Given my past work experience in Healthcare, I am wondering if there is another option?

    It feels as though the nurse could EITHER speak up and negatively impact the patient or say nothing and deal with his feelings. Perhaps, there is an “AND” option here. Could the nurse respect the sacred patient/nurse relationship AND be honest about what he was experiencing? Isn’t that why we are given Crucial Conversations tools? Is this a place for a contrasting statement, for example: “I don’t want to debate your opinions, I know you have probably had a lifetime of experiences that inform your perspective on this situation. I do want to share that the statements being here make me feel a little uncomfortable.”

    Finding a way to say something AND respect the sacred relationship is the reason why I LOVE the work of Crucial Conversations. Let’s keep challenging ourselves to believe we CAN discuss the un-discussables.

  19. Could the nurse have made a comment such as: “This sounds like you need privacy for your conversation. I’ll leave you two for now and return when you have finished this conversation.”?

    Then leave.

  20. I just think it’s great that we can openly and respectfully discuss this here. So different from what I often see in social media 🙂

  21. Our hospital is constantly working on issues like this. We understand we need to provide excellent care to all, but we ask for and expect respectful, civil behavior from each. Our employees do not have to endure violence at work without responding.

    In addition to providing extra training to our leaders and our security folks about working through behavior issues with patients and family members, we have provided our staff with skills – depending on the situation – from the Anti Defamation League:

    6 Strategies to Respond to Acts of Bias and Prejudice
    1. Assume good intent and explain the impact: I know you may mean well, but that hurts.
    2. Ask a question: What do you mean?
    3. Interrupt and redirect: Let’s not go there.
    4. Broaden to a universal behavior: I think that applies to everyone.
    5. Make it individual: Are you speaking of someone in particular?
    6. Say, “Ouch!”: (‘ouch’ and educate, time permitting).

    I will say an additional thing. Those who are in the groups that society’s actions deem as the superior place usually have very little understanding of the continuous, life-long, and often unspoken grinding that bias, bigotry, and intolerance places on those subjected to it. If you are not the target, it is invisible to you. If you are subjected to it, it either colors or blanches nearly every interaction you have.

  22. Hi David — as others have said, I respectfully, but strongly, disagree with your analysis, and recommendation. Silence in the face of racism, no matter what setting, is abhorrent. I am a physician, and in at least two settings, I challenged two dying patients, after they made racist statements about, and to, my medical students and/or residents. Using crucial, tactful, but very clear, language I addressed the patients’ racist expressions. Silence would have been disrespectful to my students and my residents, and I wanted to model for them how to have really difficult conversations — just like conversations in which I have to tell a patient that they are dying. Neither illness nor pending death, “protect” a patient from an appropriate crucial conversation.

  23. I agree with Monica, and think her response is well though out. When I read David’s response I was intending to post a reply similar to Monica’s. No need to do that now, as so many others agree with her as well, good job.

  24. Yes, I agree with many of you who have answered this post in terms of an alternate solution like the one Monica expressed. When we have the appropriate tools, we certainly have better ways to manage highly charged topics which is reflected in the dialogue the responses. Applying Crucial Conversation type tools allows us to more effectively address these type issues.

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