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Reckoning with Racism in Nursing

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Reckoning with Racism in Nursing

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A racial reckoning brought the reality of systemic discrimination to the forefront of nursing. Now, leaders across healthcare and society are working together to drive change.
A racial reckoning brought the reality of systemic discrimination to the forefront of nursing. Now, leaders across healthcare and society are working together to drive change.
2023-09-12T15:49:31.624Z

Nursing is a profession compelled to provide care to all, but the history of the profession has not always lived up to that equitable mission. Racism in America remains pervasive, and the nursing and healthcare professions are no exception, with far-reaching consequences on patients, providers, and the nation.

Racism keeps preventive and lifesaving care out of reach for patients of color, can lead to sicker, shorter lives, and causes harm to nursing and nurses, particularly nurses of color. A diverse healthcare workforce can provide crucial perspectives needed to address racial and ethnic health disparities, and at present, people of color are under-represented in nursing and medical careers.

To explore this important issue in depth, the SEE YOU NOW podcast released a two-part series on the racial reckoning in nursing and healthcare. In the first episode, co-host Lucinda Canty, PhD, CNM, FACNMa certified nurse midwife and assistant professor of nursing, spoke with Cheryl Peterson, MSN, RN, director of Nursing Practice & Policy at American Nurses Association, about that institution’s own journey of racial reckoning and work to address and eliminate the harms of racism.

Below, explore the topics covered in the podcast, from nursing’s complicated history to the profession’s path forward, and tune into the episode below to hear the conversation firsthand.

Catalyzing the Public Health Threat of Racism

Systemic racism in nursing is not new, but the summer of 2020 became a catalyst for the American Nurses Association.

“It was the murder of George Floyd,” Peterson said. “It was horrific, and I found myself having to write a statement to decry what was going on. But what we realized after that was [that] we couldn't issue statements anymore. That was not going to bring the change that we felt needed to come.”

The ANA established the National Commission to Address Racism in Nursing in 2021, led in partnership with the National Black Nurses Association, the National Coalition of Ethnic Minority Nursing Association, and the National Association of Hispanic Nurses. ANA also released a statement of racial reckoning, seeking to acknowledge and define the realities of racism.

The commission defined racism as an “assault on the human spirit in the form of actions, biases, prejudices, and an ideology of superiority based on race that persistently cause moral suffering and physical harm of individuals and perpetuate systemic injustices and inequities,” and through the statement, ANA sought to “acknowledge its own past actions that have negatively impacted nurses of color and perpetuated systemic racism.”

Acknowledging Racism in Nursing’s History

The statement also outlined the systemic exclusion of Black nurses from ANA and throughout the profession’s history, Peterson said.

“We really worked to try and create some context and understanding of the history and context of racism in nursing,” she said. “So how we were teaching nurses; [that] we work in places that have grown out of systemic racism; how our community institutions were developed…it was systemically baked into how we provided care and what that care looked like.”

Diversity in Nursing Today

Playing the tape forward, the nursing profession today is primarily white and female.

Racism remains rampant. In a recent survey, 63 percent of nurses surveyed say that they have personally experienced an act of racism in the workplace, with transgressors including peers, patients, managers and supervisors. Nearly 60 percent of nurses said they have challenged racism in the workplace, but more than half said their efforts resulted in no change. 

The invisible implications of race in society and nursing are what Canty describes as assaults on the spirit that convince nurses of color that they don’t belong there, despite their intellectual and physical capabilities.

Starting a Dialogue to Find a Path Forward

Now, Peterson says, comes the work of mitigating existing harm and preventing future harm.

Following the statement of reckoning, Peterson said nurses of color responded with a “trust but verify” message.

“What we heard was, ‘Okay, we appreciate where you’re coming from. And we’re going to watch. We’re going to watch for action.’”

The commission began with a series of listening sessions to create a safe space for nurses to discuss the full spectrum of racism and its impact on their professional lives, from microaggressions to explicit bias and exclusion. The commission’s goal, Peterson said, is to provide nurses with the space for solace, and empower nurses of all backgrounds to advocate not only for themselves but for other nurses.

“I think what we've done thus far is shine a light,” she said. “That's all we've done. Now what we have to do is begin conversations with leaders, with other national nursing associations to say, ‘How are you dealing with this? What does it look like in your space?’”

To formalize anti-racism in nursing, ANA and its partner organizations are building a foundation of engagement and training throughout nursing, academia, industry, media, and more.

Specifically, the organization has committed to the following actions:

  • Continue to serve as a partner in and support the National Commission to Address Racism in Nursing as it strives to create antiracist practices and environments.
  • Advocate for and follow established guidance on the reporting of race and ethnicity in professional journals and publications.
  • Advocate for appropriate representation and inclusion in textbooks and other educational material.
  • Actively engage in a program of diversity, equity and inclusion within the association.
  • Provide transparency into the race and ethnic makeup of the ANA Board of Directors, leadership and staff. 
  • Deliberately work to build diversity within ANA's volunteer and governance structure. 

“We have to continue to shine a light,” Peterson said. “We have to continue to listen, and we have to continue to learn.”

Finding Systemic Solutions Across Industries

The series' second episode focused on the roles of media and industry in addressing and eliminating racially driven health disparities, inequities and changing long-standing perceptions of nursing, featuring Errin Haines, one of the founders of 19th, a nonprofit, independent newsroom and Vanessa Broadhurst, Executive Vice President, Global Corporate Affairs at Johnson & Johnson.

“Media is an institution, and we know that the racial reckoning was really about a reckoning with our institutions in this country, and media was not excluded from that reckoning,” Haines said.

Media’s role is often that of representation, she said – depiction of who gets to be a healthcare provider, what a patient looks like, and how a patient is treated.

“What is the interaction between the provider and the patient and how accurately [is it] reflecting people's experiences? That can be very important, especially in terms of setting people's expectations,” Haines said.

Industry also plays a role in supporting and improving representation of people of color in medicine, said Broadhurst, who discussed Johnson & Johnson’s health equity investments and initiatives. Through a series of programs, Johnson & Johnson is committed to addressing racial and social injustice as a public health threat, as well as funding and partnering to diversify the healthcare and broader workforces.

One example is Our Race to Health Equity, a collective effort between health systems, the industry, media, academia, government, and more to address the challenges that people of color continue to face when it comes to their care access and outcomes.

"Our Race to Health Equity is Johnson Johnson's ambition as an industry leader,” Broadhurst said. “That working with others, we can help to create a world where the color of your skin is not a determinant of your access to care, quality care, or importantly, health outcomes.”

Johnson & Johnson has committed $100 million over five years to invest in and promote health equity solutions, including over $500,000 in scholarships for diverse nursing students through the foundation of the National Student Nurses Association and partnerships, such as through the Chief Nursing Officer Institute (CNOI), which prepares diverse nurses for senior leadership positions.

The company has also partnered with the National League for Nursing on a program designed to help students of color transition from nursing school to their first clinical role, as well as with AACN to measure inclusion and belonging in the academic space. Further, Johnson & Johnson also supports an Addressing Unconscious Bias and Disparities in Healthcare program led by CME Outfitters, in which modules spanning more than 10 disease states shed light on barriers to equitable health care access, help HCPs recognize the issues, and empower them with tools to use in their clinical practice.

Nurses are critical to the healthcare system, Broadhurst said, and are uniquely positioned to transform healthcare and patient outcomes for the better, including efforts to improve health equity.

What You Can Do

There are many actions for nurses and nursing students to take to learn about and embody anti-racism in the profession.

Learn more about steps you can take as an individual from the National Commission to Address Racism in Nursing, explore Top Ten Ways to be an Antiracist in Nursing, or listen to a collection of health equity SEE YOU NOW episodes, which are also eligible for continuing education credit through the ANA.

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