Words Matter! Skilled Communication Through an EDI Lens

By Mary Pat Aust, MS, RN Apr 12, 2022

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I’d like to share a story with you about why words matter through the lens of equity, diversity and inclusion (EDI).

I’d like to share a story with you about why words matter through the lens of equity, diversity and inclusion (EDI). About one year ago, then AACN President Liz Bridges forwarded me an email from Tracey Loudon, MN, RN, CNS, CCNS, CCRN-K. Tracey is a CNS at Kaiser Sunnyside Medical Center in Clackamas, Oregon. In her email, Tracey shared the following:

“I was reading an article recently, and the author referred to the cable that links one device to another as the ‘slave cable.’ My shoulders sank into my body and I cringed. I asked myself, ‘How does this language end up in a professional journal, and why is the term still being used for so many years?’”

She goes on to share: “Recently, I was speaking to a colleague of mine about this topic. At first he said, ‘What is the big deal?’ The cable has been called a slave for years, and it makes sense as it is connected to the master. We both paused and realized how deeply this label is buried or ‘unconscious’ and how much it needs to change immediately. The term is probably only unconscious to some, but not to all staff. To many of our colleagues, this term is an injury every time they hear it spoken aloud.”

You may wonder how these often-used terms and phrases could be harmful to others when the intention wasn’t to hurt someone. As Tracey shared above, when we use terms that have racist or stereotypical origins, they perpetuate those beliefs and can cause injury and harm to others.

As I thought more about this, I saw the connection between the words and phrases I’ve used and the AACN Healthy Work Environment Standards. I dug out my copy of the standards and looked up Skilled Communication and reconnected with the following critical elements:

  • Skilled communicators seek to protect and advance collaborative relationships among colleagues.
  • Skilled communicators invite and hear all relevant perspectives.
  • Skilled communicators demonstrate congruence between their words and actions, holding others accountable for doing the same.
  • Skilled communicators seek input on their communication styles and strive to continually improve.

I immediately felt remorse for the times I, as a bedside critical care nurse and educator, had referred to a slaving cable. I wondered if this means that I have racist tendencies. Could these words be perceived as microaggressions toward some of my colleagues? Does it mean that I should pause and consider the impact of my words on my family, friends, colleagues, patients, etc.? Even when I mean no harm, harm can happen. I’m reminded of my favorite quote by Maya Angelou, “I did then what I knew how to do. Now that I know better, I do better.”

I am curious by nature, and this “aha” moment motivated me to explore how I can make my language more inclusive. I want to learn what terms I’ve used before that are likely to be harmful to some of my colleagues or to individuals I meet. The American Psychological Association has released Inclusive Language Guidelines, and the American Medical Association offers Advancing Health Equity: A Guide to Language, Narrative and Concepts to help us learn to be more inclusive and equitable in our communications. I’ve learned a few things that you may find helpful.

Offensive words and phrases come in a variety of shapes and sizes. Many offensive phrases or terms do not contain a racist term or racial epithet. Many, such as slaving cables, serve as a reminder of America’s slave owner past. Here are a few examples:

  1. “Sold down the river” – in today’s context we use this term to refer to a betrayal of some sort. However, the origins of the term refer to a betrayal of Black people by selling them into perpetual bondage. Masters in the Northern states would send defiant slaves down the Mississippi River where the Southern masters treated slaves in a much harsher manner.
  2. “Cakewalk” or “that takes the cake” are terms used today to signify that something is simple or easy. The origin of this term refers to a dance performed by Black slaves on plantations. White slave owners forced Black couples to dance and compete for cake. Eventually, the dancers added their own style and used it as an opportunity to mock the slave owners who missed the point.
  3. “No comments from the peanut gallery” is a term used to describe a group of people who criticize someone usually by focusing on insignificant details. Historically, it was used as a synonym for the back seats or upper balcony, mostly reserved for Blacks in the segregated South.
  4. “Gyp” or “gip” is commonly used slang to describe if someone is being cheated or swindled. This term evolved from the word “gypsy,” which is a term imposed upon the ethnic group known as the Romani. The Romani traveled and made money by selling goods. The inevitable business disputes led to the Romani people being considered swindlers.

Using inclusive language acknowledges diversity, conveys respect for all people, is sensitive to differences and promotes equal opportunities. Words can either drive us apart or bring us together. In Health Equity Guiding Principles for Inclusive Communication, the Centers for Disease Control and Prevention provides these five principles:

  1. Avoid the use of adjectives such as vulnerable, marginalized and high-risk. For example, instead of vulnerable populations, marginalized groups or high-risk groups, try groups that have been economically or socially marginalized, under-resourced communities and groups with a higher risk.
  2. Avoid dehumanizing language. Use person-first language instead. For example, instead of homeless, the morbidly obese or the handicapped; try people who are experiencing homelessness, people with morbid obesity or a person with a mobility disability.
  3. Remember there are many types of subpopulations. For example, instead of minorities, ethnic groups or racial groups, try a person from racial and ethnic minority groups or people living with mobility disabilities.
  4. Avoid saying target, tackle, combat or other terms with violent connotation when referring to people, groups or communities. For example, instead of target population, combat [disease], war against [disease], try the intended audience, consider the needs of [population of focus] or eliminate [disease].
  5. Avoid unintentional blaming. For example, instead of people who refuse vaccination or people who do not seek healthcare, try people who have yet to receive vaccination or people with limited access to healthcare.

Even when no harm is intended, harm can occur. I encourage us all to pause to consider the terms and phrases we use when referring to patients, colleagues and others, stop using terms and phrases that divide us, and start using terms and phrases that unite us. As Tracey says, “It’s time to speak up and make a change.”

As Tracey shared in her communication, “We need to have a conversation about changing the terms, reeducating our critical care teams, reeducating industry, holding each other accountable and speaking up when these terms are spoken.

“We should notify editors when we notice racially insensitive language that needs to be removed and corrected. Speaking up is hard, it takes courage. We have much to gain and little to lose. Time to speak up and change.”

How do the words you choose protect and advance collaborative relationships among colleagues? How skilled is your communication? Now that we know better, can we do better?