In 2018, the American Nurses Association Board of Directors adopted a revised position statement on the “Nurse's Role in Addressing Discrimination: Protecting and Promoting Inclusive Strategies in Practice Settings, Policy and Advocacy.”1 This statement defines discrimination and its relationship to health disparities. It lists 11 activities and strategies to combat discrimination through the promotion of inclusive communities of care, a more diverse nursing workforce reflective of the US population, and culturally sensitive, patient-centered care. But what if nurses themselves are the targets of racism? Does the profession have the awareness and the will to deal with racism within its own ranks and institutions?
In my search to answer this question I stumbled upon a 1993 article by Evelyn Barbee2 on “Racism in US Nursing,” published in 1993 in the Medical Anthropology Quarterly. Barbee described her difficulties in writing about racism, which, as a Black nurse, she had experienced firsthand, from her student days to her practice and education roles. Her primary obstacle was in “deciding how to write about a problem that, at least according to the nursing literature, does not exist.”2(p347) She believed that racism in nursing was “deep seated and pernicious.” Using the results of a literature search with scanty yield, Barbee identified 3 types of racism existing in nursing; denial, the color-blind perspective, and aversive racism occurring when “egalitarian group values” collide with hidden negative feelings about Blacks. She further recounts the struggle of Black nurses to become full members of major nursing organizations, which led to the creation of the National Black Nurses Association in 1982. At the heart of Barbee's viewpoint are 3 questions. Can a profession that advances “caring” as a core concept and value engage in overt or inadvertent racist practices, as a group or individually? Can a profession that stands on tradition and homogeneity break free from both individual and structural racism? Can the nursing profession embrace the conflict that often comes with challenging racist practices?
I have never considered my own behavior racist in any way, but as I considered Barbee's insights, I concluded that my own “whiteness” often prevented me from seeing deeply and clearly as in the following situation. Several years ago, I was approached by a Black student nurse who had been dismissed from a nursing program. She thought I might be helpful, given my position and “reputation for tackling difficult problems,” as she described it. This student had experienced some interpersonal difficulties in a clinical course. She was counseled by faculty and school administrators on her “inappropriate attitude” and “difficult behavior.” She asked repeatedly for another chance, given that her academic performance was good and given that the clinical incident used as the dismissal factor had many sides. It did not help that the student left the clinical site using angry language and I pointed that out. Even after apologizing, writing an appeal with which I helped, the dismissal decision was upheld. So much for “tackling difficult problems.”
I firmly believed that I had made my best effort on behalf of this student until I read Barbee's article. I acknowledged to the student that the clinical staff and the school administrator put “rules and protocol” over “understanding, caring, and student advocacy.” However, instead of finding some creative way to influence the school administrator, I encouraged the student to soften her challenges, to “play the game,” “model the school's expected behavior,” “tone down” her anger, and “get advice from a student colleague who had successfully appealed.” I asked the student how much she knew about the traditions of the school and whether she could reflect these traditions in her appeal. And, finally, I emphasized the importance of avoiding confrontation and conflict, especially with the school administrator and petitioning for a second chance to complete the program. The student took my advice but to no avail—the dismissal stood. In retrospect, my guidance was grounded in my experience as a white school administrator—look at the situation, placate the authorities, don't make waves and follow written policy. This guidance was certainly not consistent with my past clinical practice as an assertiveness trainer and the published accounts of my nurse activism.3 I did not listen deeply enough to the voice of this Black student. I considered racism as a possibility but never spoke the word—shame on me!
This reawakening to the issue of racism in nursing led me to the NurseManifest blog site (https://nursemanifest.com/) developed by Richard Cowling, Peggy Chinn, and Susan Hegedorn. The blog site is devoted to giving Black, Indigenous, Latinx, and other Nurses of Color, a platform to tell their stories and to inspire action that will lead to positive change. It is my hope that the readers of Holistic Nursing Practice will join NurseManifest, share their stories, and drive the change so desperately needed to address racism in nursing and health care.
—Gloria F. Donnelly, PhD, RN, FAAN, FCPP
Editor in Chief
1. ANA Center for Ethics and Human Rights, American Nurses Association. Nurse's role in addressing discrimination: protecting and promoting inclusive strategies in practice settings, policy and advocacy. https://www.nursingworld.org/∼4ab207/globalassets/practiceandpolicy/nursing-excellence/ana-position-statements/social-causes-and-health-care/the-nurses-role-in-addressing-discrimination.pdf
. Published 2018. Accessed August 17, 2020.
2. Barbee E. Racism in US nursing. Med Anthropol Q. 1993;7(4), Racism, Gender, Class, and Health (Dec 1993):346–362.
3. Donnelly G, Mengel A, King E. Anatomy of a conflict. Superv Nurse. 1975;6(11):28–38.