The implied racism in the words “You don't have any business being this good,” spoken by a white nursing instructor to Bernardine Mays Lacey in Jackson, Mississippi, in the early 1960s, resonated with this black nursing leader throughout her life. Blatant racist attitudes, supported by laws and practice, left an indelible mark that contributed to Lacey's growth as a nurse and her interest in sharing her story.
Over the course of her career, Lacey has held leadership positions, including founding dean and professor at Western Michigan University's school of nursing in Kalamazoo. She has served as special assistant to Marian Wright Edelman at the Children's Defense Fund in Washington, DC, and received numerous awards, including an endowed chair named in her honor at Western Michigan University. Lacey became a fellow of the American Academy of Nursing in 1990 and a Living Legend of that organization in 2014, and she was awarded the prestigious R. Louise McManus Medal from the Nursing Education Alumni Association of Teachers College, Columbia University, in 2015. She has also received well over $2 million in grants to develop programs such as nurse-managed centers for those living in homeless shelters and for educational support of diverse students in nursing. Lacey's career as an educator, political advocate, researcher, clinician, and leader reflects her many accomplishments in spite of the culture in which she was raised. Her story is important to know, because it offers an opportunity to learn from the not-too-distant past and explore some of the difficult truths about racism in nursing, the role of the profession in this history, and the effect of these accounts on current diversity and inclusivity efforts.
This article focuses on Lacey's early experiences growing up in the South, attending a segregated school of nursing, working in a segregated hospital and rural clinical setting, and developing strong networks of support. It is not a biography of her life but rather a candid exposure of the racism she experienced in her lifetime—a topic that is too often omitted but vital to discuss. She recalls a time when discrimination was accepted by so many, and the nursing profession enforced these norms in a very explicit way. We hope her words spark a conversation among nurses about how we may still be implicitly reinforcing these norms, even as the discipline strives for a more inclusive and diverse culture.
WHY HISTORY IS IMPORTANT
Despite an increasingly diverse U.S. population, there is a lack of nurses from ethnic and racial minority groups.1, 2 Without sufficient diversity in the profession, including among faculty and nursing students, the workforce can't provide culturally appropriate, quality care to a diverse patient population.3-5 Greater awareness of past discriminatory practices and the enduring long-term effect of racism on health care outcomes is needed to address social justice and health equity issues that affect patients today. Negative stereotypes about people of color and those from other minority groups persist in the form of implicit bias that adversely affects the care patients receive.6, 7 Historian Kylie Smith argues that without historical acknowledgment and understanding, such attitudes are difficult to change.8
Scholars have described the relevance of history in understanding contextual relationships between and among various factors, such as race, class, gender, sexual orientation, and religion.9-12 Oral history methods can magnify this understanding by detailing the life experiences of a subject, exposing us to varying personal and professional perspectives.13
TELLING HER STORY
Stories such as Lacey's permit diverse voices to be heard, studied, critiqued, and added to the narrative. Lacey is familiar with oral history as a research method, having conducted such interviews with another black nurse leader, Anna Bailey Coles, the dean of the first baccalaureate program for nursing at Howard University, a historically black university. Lacey studied the influence Coles had on the education of black nurses from 1968 to 1986 and recognized the value of her story—one that had not been told before—in reshaping the narrative about nursing education and the black experience.14
Following Lacey's participation on a panel discussion about diversity and inclusivity at the American Academy of Nursing's fall 2017 conference, she decided to tell her own story. Lacey contacted one of us, SBL, who conducted an oral history video interview at Lacey's home in Maryland in April 2018. Lacey spoke about her past for about two hours, responding to open-ended questions that permitted her to tell her story in the way she was most comfortable. (For more information about collecting oral histories, see the Oral History Association's “Principles for Oral History and Best Practices for Oral History,” www.oralhistory.org/about/principles-and-practices-revised-2009.) The audio of this interview was then transcribed and reviewed by Lacey for accuracy. (In the spring of 2019, one of us, AGP, a doctoral student interested in learning about this historical research method, participated in a review of the transcript and, subsequently, the writing of this manuscript.) Additional telephone interviews between Lacey and both of us continued in the following weeks, adding greater clarity and context to her story. The transcripts (including the audiovisual and written materials) will be donated to the Barbara Bates Center for the Study of the History of Nursing at the University of Pennsylvania School of Nursing.
GROWING UP IN THE JIM CROW SOUTH (1932-1959)
Lacey was born in 1932 in Vicksburg, Mississippi, the only child of hardworking parents. At that time, Jim Crow laws segregated people of color from the white community. Restaurants, schools, hospitals, transportation, and all aspects of daily life were divided by race. However, in early 1950s Vicksburg—unlike in Jackson, only 40 miles away—Lacey said her family could shop in some of the stores and was on a first-name basis with shop owners. Yet, although Lacey perceived Vicksburg to be more open than other cities in the South, she also knew there was a difference in the way black and white families were treated:
My mother would often take me shopping, and the [white] people in the stores treated her with great respect. They called her by her first name. . . . I do not remember feeling that I was being treated any differently, but I'm sure that I was. . . . My mother taught me that I needed to be courteous to everyone, but they had a way of letting you know that there was a difference between you and the whites.
She described how her parents taught her about knowing and valuing who she was, even in the segregated world into which she was born. Her family was well respected and part of a supportive black community. Often, her father hosted a club meeting for black men at their home—because it was his turn to do so, and because his friends looked forward to his excellent cooking, according to Lacey. She described how her father held a respected position in the community, yet even he wasn't protected from discriminatory practices. Lacey said, “My father worked as a chef in a hotel. . . . Accommodations and public facilities did not allow Negroes, except if you were working there. But growing up, I didn't feel deprived or isolated from the things that I needed to have. We weren't rich, but I don't ever remember missing a meal.”
Yet, relative privilege couldn't shield her family—or other black families—from racist laws, such as those that prohibited black people from staying in white hotels, and Lacey's mother was often approached by the local police to take in travelers overnight. She explained, “There were times when black people came to Vicksburg . . . particularly those who were ministers. . . . We had a very large house, and I remember the police bringing these black ministers to my mother's house and asking her, “Katie, do you have a room?” Lacey spoke fondly of her family home:
We were the first black family to have a home on the block. Black families bought on that side of the street, but across the street they were all white. My mother was close to a white woman who lived across the street. They had two daughters. . . . These two girls and I played together until we went to school. Then the separation came. I went to St. Mary's Catholic School, a school that accepted black students, and they went to public school. I could not attend the public school they attended.
There was a movie theater several blocks from our house. I couldn't attend the side of the movie where the whites were. They went downstairs in the movie, and blacks had to sit in the balcony in the movie. There was [also] a separate entrance.
Hearing Lacey speak about her experience of segregation as a child raises our awareness of its impact and lasting toll—not only in the South, with its embrace of laws prohibiting the mixing of races, but also in Northern states, which relied on customs and traditions to effectively do the same. Lacey's account also raises questions about how diverse nursing students can develop a sense of value after being exposed to implicit and explicit bias during their upbringing and education. Feeling marginalized, and the negative effects of marginalization on health and one's sense of worth, remains a continuing concern in nursing and health care that begs further attention.6 Smith has argued, “Modern health systems and the biomedical model are an effect and function of white supremacy, colonialism, and neoliberalism and nursing is not separate from this. To understand how this has come to be, we need more history not less.”8 The history of white nurses maintaining segregation in schools of nursing, hospitals, and home care settings is real and part of the profession's legacy. Historical accounts also illustrate how black schools of nursing offered vital opportunities for black students, who were excluded from attending most other schools.15
The National Association of Colored Graduate Nurses (NACGN) was founded in 1908 by several black nurses to address racial discrimination in nursing and health care. It was dissolved in 1951, when the profession began attempts to integrate and black nurses were allowed to join the American Nurses Association.16, 17 Yet, some state nurse registration laws continued to discriminate against black nurses, preventing them from sitting for the exam. And, even with the dissolution of the NACGN, the nursing school Lacey would attend—the Gilfoy School of Nursing at Mississippi Baptist Hospital in Jackson—maintained the segregated status of black students until 1961, when it stopped accepting black students because of “financial pressures and other considerations.”18 This was just prior to the Civil Rights Act of 1964, which required the integration of schools.
NURSING SCHOOL (1959-1962)
Lacey graduated from nursing school in 1962. She had chosen the Gilfoy School of Nursing because it was the only one in the state that accepted black students seeking to become RNs. Lacey described her school as segregated, with the few black students who were admitted separated from their white peers in both the classroom and clinical settings. Lacey said she was one of eight black students, all of whom were forced to sit in the back row while the 64 white students sat in the front rows. The very act of being separated was unsettling, but Lacey said the instructors' overt racism was even more disturbing.
The memory of one particular incident has stayed with her. Lacey recalled how, during a pediatric rotation, she had cared for an infant with Wilms tumor, a type of childhood kidney cancer. She wrote a case study that demonstrated how she had cared for the whole family, working with the infant and the parents. A white instructor graded her work, Lacey recalled, explaining that the instructor had let her know that because she was black, she could not have written such a good care plan:
My instructor called me in and said that she had other faculty read my paper. . . . [She said,] “You are going to receive an A for the paper”. . . but she had to remove five points for a typo . . . and then said, “but you don't have any business being this good.” She told me how she saw me, and I felt, the nerve of that instructor, but I had no recourse. However, it made me even more determined. I had to live with this, and after 57 years, I can still remember what was said. It has stayed with me throughout the many things I have done in my work. After receiving my doctorate from Teachers College at Columbia University, I contacted this instructor to let her know. . . . I wanted her to see what value I had.
The white instructor's notion that Lacey didn't have a right to be “this good” was a commonly held belief by the nursing staff, Lacey explained. She said that while this hurt, it was something she had grown to expect from the school, faculty, and white students in her class. Lacey attributed her strong sense of self to her family, especially her mother, and said the mentorship she received from other black nurses and the strong networks they established added to her sense of self.
Although blatant racist declarations such as “You don't have any business being this good” are not acceptable in today's nursing milieu, some may argue that the sentiment prevails. The notion may also be evident in the lack of diversity among nursing faculty and students, the persistently low enrollment and graduation rates of underrepresented and marginalized groups in nursing, and the alarmingly low percentages of executive positions held by nurse leaders of diverse backgrounds.3, 5
Citing Lacey's experience with this instructor may be useful in discussions with students of color about their feelings and experiences in school today. The microaggressions identified by some black students—such as when they feel they need to work harder for the same grades as white students—remain a constant reminder that racism still exists, implicit or otherwise.19 Connecting these marginalized feelings with Lacey's experience offers a historical context for contemporary concerns. Lacey hopes faculty today can reflect on their own bias regarding students from diverse backgrounds and consider that racism and white privilege still exist in our educational and health care institutions.
In another important experience, when Lacey was a graduating senior nursing student, she was offered a job in the operating room by the supervisor. Lacey was the first black nurse to ever be offered such a position, but the idea of working in this environment was anathema to her because she'd had a prior incident with this supervisor. Lacey had dared to use the “whites only” bathroom near the operating room, where she was working as a nursing student, rather than travel to another floor to use the “colored” bathroom. The supervisor observed this and warned Lacey not to use that bathroom again. Now, fearful of being prevented from graduating when she was called to the supervisor's office a second time, Lacey was instead surprised by the job offer:
On my last day, I was in the surgery, and someone came to the door and said the supervisor wants to see me. . . . I was like, “Oh no, what has happened?” When I went in to see her, she said, “Nurse Mays [Lacey explained that black nurses at that time weren't addressed as “Miss” but as “Nurse,” which was intended to be a pejorative term], have you enjoyed this experience up here?” I said it was very enlightening. . . . She said, “I've just come from the nursing office, and I told them that if you applied for a position in our hospital, that I wanted you to come up here in the operating room. I'm going to make you one of the best damn circulating nurses this hospital has ever seen.” I thought, you must be in a dream! I said, “I have not applied, I'm going to go to Tuskegee.”. . . Black folks in the hospital said, “We heard that she has never let a black woman be up there in the operating room as a nurse . . . she must really care about you.” I said, “I don't know, but I'm not taking the job.” That was the talk of the hospital!
Lacey's experiences were set during a time of upheaval and transition in the way women and people of color were viewed and valued in society. The civil rights movement was challenging overt racism in all aspects of life, and the second wave of feminism was questioning the role of women. Equality, value, and self-worth were common themes in both movements. Lacey's story challenges us to question nursing's history (for instance, who became a nurse, and where could they work?), as well as its present (who has access to privileges, such as gender-neutral bathrooms?).
WORKING AT TUSKEGEE (1962-1964)
After graduating from the three-year diploma program, Lacey worked at the John A. Andrew Memorial Hospital affiliated with Tuskegee University in Alabama, a historically black institution. She had worked there before, during her diploma program's psychiatric clinical rotation, when the black students were not allowed to accompany the white students on their rotation. During her employment at the hospital, Lacey learned she could pursue a baccalaureate in nursing and felt supported in this institutional environment as she began taking classes.
She recalled her work as a maternal–child health nurse and traveling to rural areas in Alabama to set up clinics for underserved populations. Aware of how racism affected students and providers of color in health care institutions, Lacey also learned how discrimination contributed to a lack of adequate care for rural black communities. Her work in the 1960s with black patients and underserved populations made evident what researchers now know—that the morbidity and mortality rates of these populations are higher than those of white populations.20 Lacey's description of the blatant racism that separated black and white communities in all settings, including health care, continues to be relevant to current discussions about health equity and the social determinants of health. As she recalled:
There were no hospitals that accepted any blacks. John A. Andrew was the only hospital in the area that would. I worked with Dr. Hank Foster [Henry W. Foster Jr.], and we would travel out to the rural areas and take a clinic out there. I had never seen maternal–child women [pregnant women] with such low hemoglobin, and they just were in very poor condition. . . . Sometimes I'd have to get in a wagon, because the car could only go so far on the roads. There was a church there that would be used, and one winter it was so cold . . . we had to make a fire on the potbelly stove to heat the place up before we could do anything.
Lacey worked at Tuskegee for two years until she returned to Vicksburg to care for her mother, who'd had a stroke. She needed employment if she was going to stay there, but no hospital would hire her. After her mother's white doctor spoke on her behalf to the board of the county hospital, it hired her as an evening supervisor. Lacey's hiring sparked protests that culminated in someone taking a shot at her while she worked:
Six of the nurses quit when they found out I was coming on because they said they would not take orders from me. . . . The hospital had an acute side, and there was this catwalk that took you to the chronic side. Every evening I had to make rounds for the units. Although the office had received threats about “that nigger you all hired up there,” I was trying to integrate. . . . When I was going across that catwalk, somebody took a shot at me, and when the police came, they had already told my mother what had happened. When I got home, my mother was packing my clothes. She said, “You got to get out of here, you can't stay . . . they will kill you and that would kill me.”
Lacey left Vicksburg that night and moved to Washington, DC. Reflecting on the change she had observed in her hometown, she said, “I think Vicksburg began to feel we were a threat now, we were getting educated, we were going to be vying for the same positions or jobs, so ‘we can't let that happen.’”
CONTINUING HER EDUCATION (1964-1991)
In Washington, DC, Lacey went to work at St. Elizabeth's Hospital. She wanted to continue her education, and St. Elizabeth's offered to pay for her attendance in a BSN program. Howard University had not yet started its baccalaureate program, so Lacey applied to and, in 1969, successfully completed Georgetown University's BSN program for RNs returning to school. She was one of the first black students to be admitted to this institution. Lacey explained, “Friends would say, ‘I didn't know that they let blacks into Georgetown’. . . . I was the only one in this [program], and they asked, ‘How are you being treated?’ And I said, ‘Well, very well.’”
Because Lacey was one of the first black nurses to attend Georgetown's RN–BSN program, researchers Edilma L. Yearwood and Brian Floyd conducted an oral history interview with her in the summer of 2018 about her time at the school. Yearwood and Floyd are the principal investigators of an oral history project that aims to include Lacey and the few other black students who attended the school in the 1960s in the institution's written history, from which they had been omitted (SBL has served as a consultant on this project).21
Lacey continued to advance her education and received an MA in sociology from Howard University in 1985 and completed her EdD at Teachers College, Columbia University, in 1991.
SUPPORTIVE NETWORKS AND MENTORING
Lacey attributes her success in nursing to many mentors and the strong support network she developed throughout her career. Her earliest recollection of support comes from her mother's unfailing belief in her ability to succeed. Then there were the black nurses who worked in Mississippi Baptist Hospital's annex building, which was a separate section for black patients. Although these nurses ran the segregated units, they were supervised by white nurses, a long-standing practice in the South.22 Lacey worked part time in this section of the hospital to support herself while in nursing school. These nurses, often alumnae of the Gilfoy School of Nursing, understood what it was like to attend a segregated school and face the racist attitudes of the faculty. They provided mentorship to students like Lacey, helping them to successfully navigate the system.
Lacey also mentioned being supported by some of the hospital's other black workers, who weren't nurses but watched out for her. She talked about the people who worked in the kitchen, for instance. Lacey and her black classmates weren't allowed to eat in the dining room, so they took their meals in the kitchen, with the hospital's other black workers and kitchen staff. When the kitchen was closed in the evenings, the staff would bring brown-bag dinners to the black students working evening and night shifts. They looked out for the well-being of the black students and wanted them to be successful, said Lacey. Such support networks provided a buffer against racism and sustained her as she progressed in her career.
Lacey also described the lifetime mentorship of other black nurse leaders who became deans, administrators, presidents, provosts, and researchers. Two of the notable people who guided her along the way were Rhetaugh Dumas, who held positions as dean of the University of Michigan School of Nursing and vice provost, as well as president of the National League for Nursing, and Gloria Smith, who was vice president for health programs at the W.K. Kellogg Foundation and former dean of nursing at Wayne State University.
Lacey also served as a mentor to others. During her acceptance speech last year at the American Academy of Nursing's Living Legends award ceremony, Catherine Alicia Georges, chair of the nursing department at Lehman College of the City University of New York and a member of AARP's board of directors, credited Lacey as one of her mentors. Lacey reflected on the many students, nurses, and others whom she has mentored, saying she also gained much insight from them. One of the most satisfying mentoring experiences Lacey described occurred when she helped to start one of the first nurse-managed health clinics for the homeless at Federal City Shelter in Washington, DC.23, 24 She attributed much of her success to listening to what her patients said they needed. She valued and respected their ideas and tried to bring them to fruition. She described meeting two women who lived at the shelter and mentoring them as they embarked on careers in nursing. Lacey was working as a faculty member at Howard University's College of Nursing at the time:
There were two women . . . one had one year of college, and one hadn't had any, but she was very smart. I went to Howard University to the department of social work and asked them if we could find a way to get these two women out of the shelter and into housing, so they could have a little bit of privacy and be able to study. I asked them to allow them to take some remedial courses in reading, English, and math and work with social services. They got a job as nursing assistants, and they are now registered nurses with bachelor's degrees.
Lacey's experiences had allowed her to see past labels to the inherent value in each person. She found a way of focusing on people's strengths and worked with them. She explained that if these two women were able to “live on the street, they've got some strengths that we need to capitalize on.”
SPARKING A CONVERSATION
Lacey's story takes place during a time when many nurses were participating in the civil rights movement, while others, especially in the South, maintained the status quo of segregation in nursing schools and hospitals.25 She came of age—personally and professionally—during turbulent times in the country's history. Lacey described how when she grew up, “You were taught not to walk in front of a white person.” She recognized that it might be difficult for some today to understand this kind of racism:
Some students now would say they would not take it . . . but then you would not have any recourse. . . . Looking back to understand what it really means talking about equity and equality. . . . Those words were not part of a conversation . . . even the willingness to have this kind of conversation . . . it was a different time. . . . But it is time now to have these kinds of conversations . . . folks are still angry . . . because of a remembrance of a time when there was no equality.
Given the implicit bias that continues today and the lack of diversity and inclusivity in nursing and health care, Lacey believes that her story will give nursing students a point of reference from which to begin discussions about racism.
Her upbringing during segregation never stopped Lacey from pursuing her professional goals. In fact, it often made her more determined. When asked what she would recommend to today's students, she said she hoped every nurse—no matter her or his ethnicity, race, religious beliefs, or gender—would develop a strong sense of self, seek opportunities to advance in education and practice, and develop networks in which mentors and mentees can learn from and support each other. Above all, she hoped they would learn about the past, reflect on their own experiences, raise questions, and broaden the historical narrative to include all voices. “To understand things now,” she said, “you have to go back to see the root of this anger.”
Including voices like Lacey's in nursing history adds to the body of knowledge about racism in the profession and health care industry—topics that are too often omitted from the historical record and discussions. Knowing what we've chosen to keep records of is the key to broadening history. The voices of black nurse leaders like Lacey don't fit into a white-centric record of the profession and thus bear examination and preservation as we strive for the diversity and inclusion that is so necessary to the health of the population. Lacey's history can help to start an authentic conversation that permits us, as Fairman asserts, to “question deeply held assumptions” and learn from different perspectives.25 It's our hope that Lacey's story, as told here, will spark such a discussion.