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Health Disparities, Social Injustice, and the Culture of Nursing

Giddings, Lynne S.


Background: Nurses are well positioned to challenge institutionalized social injustices that lead to health disparities.

Objective: The aim of this cross-cultural study was to collect stories of difference and fairness within nursing.

Methods: The study used a life history methodology informed by feminist theory and critical social theory. Life story interviews were conducted with 26 women nurses of varying racial, cultural, sexual identity, and specialty backgrounds in the United States (n = 13) and Aotearoa New Zealand (n = 13). Participants reported having some understanding of social justice issues. They were asked to reflect on their experience of difference and fairness in their lives and specifically within nursing. Their stories were analyzed using a life history immersion method.

Results: Nursing remains attached to the ideological construction of the "White good nurse." Taken-for-granted ideals privilege those who fit in and marginalize those who do not. The nurses experienced discrimination and unfairness, survived by living in two worlds, learned to live in contradiction, and worked surreptitiously for social justice.

Discussion: For nurses to contribute to changing the systems and structures that maintain health disparities, the privilege of not seeing difference and the processes of mainstream violence that support the construction of the "White good nurse" must be challenged. Nurses need skills to deconstruct the marginalizing social processes that sustain inequalities in nursing and healthcare. These hidden realities-racism, sexism, heterosexism, and other forms of discrimination-will then be made visible and open to challenge.

Lynne S. Giddings, PhD, RN, is Associate Professor, Auckland University of Technology, New Zealand.

Accepted for publication May 6, 2005.

Thank you to the 26 courageous women who dare to acknowledge and make visible their difference in nursing. They are the everyday leaders and heroes who challenge the institutionalized systems and processes of discrimination that underpin healthcare disparities. Thanks to my partner Kate Prebble and many friends who said "just do it."

Corresponding author: Lynne S. Giddings, PhD, RN, Auckland University of Technology, Private Bag 92006, Auckland 1020, New Zealand (e-mail:

© 2005 Lippincott Williams & Wilkins, Inc.