The History of Racism in Nursing

[Doctors of Nursing Practice, Inc.]

This report centers the experiences of nurses of color in U.S. history and how structural and systemic racism have hindered access to educational and professional opportunities as well as institutional power. The report also reviews some of the ways in which these nurses resisted, challenged, and achieved within the structures of racism.

Additionally, the report explains and critiques the central place that whiteness has occupied in histories of American nursing. More contextualized historical studies about the experiences of nurses of color and studies that explore the complicity of the nursing profession in perpetuating racism are needed.

Read this section and others found on the main page provide. Again, HERE’S THE LINK

[anjelica]

This was an eye-opening read. Thank you for posting and spreading awareness. Several topics stood out to me, most notably racism showing up in policies. Some of the best intentions can have harmful consequences. Requiring entry-level nurses to have a bachelor’s degree sounds innovative. However, this places minorities at a disadvantage. Many entry-level nurses have associate degrees and later acquire their bachelor’s. With the rise in Magnet-status hospitals, many ADNs are being excluded from inpatient care and other career-building opportunities. On the surface, these hospitals have well-educated staff, but at the expense of cultural inclusivity.
These policies often have a domino effect on other work-related policies, such as professional appearance and what is considered acceptable. Many hospitals require you to cover visible tattoos at work. In Eurocentric cultures, tattoos are a means of expression and individualization but don’t often carry spiritual or religious significance. However, a Moko or facial tattoo carries significant cultural and spiritual meaning in the Polynesian and Pacific Islander communities and represents coming of age and ancestral history. These policies aren’t limited to staff but affect the care we provide for our patients. My department recently allowed visible tattoos and specific body piercings to be worn at work. This opened a dialogue about skin and hair care products and how our hospital has a limited variety of patient toiletries. This led to our department stocking shampoo and conditioner catered to curly hair and providing new education on using them. Without the personal stories of my coworkers, we would have remained ignorant of our shortcomings and continued to underserve our patients. Inclusivity affects us all and we must me mindful of those being excluded.

[Ryan]

Thank you for the link to the National Commission’s Foundational Report on Racism in Nursing. Considering the history of the United States, it does not surprise me that the history of nursing also reflects the same history of racism. As we can see in the Report, despite the origin of goodwill and effort to help those in need, the field of nursing was still susceptible to the dark side of humanity. Education and communication are important to helping each other understand different cultures, perspectives, beliefs, and values. Both the person providing information and the one receiving information need to have an open mind and heart. I feel that disputes usually occur because someone has built a wall in that exchange of information.

[Jackie]

This report highlighted a significant issue tackling the healthcare system over many years. It has affected nurses and other healthcare professionals providing direct patient care. As the report mentions, our personal experiences and biases often influence our relationships and profession. Unconscious bias and racism have contributed to multiple health disparities. Working in the healthcare field, I have seen its daily practice, and sometimes people are unaware they are contributing to this bias. “Unconcious bias refers to stereotypes and cultural concepts that all people give, which influence decisions and behaviors apart from conscious realization or intentional control” (Schultz & Baker, 2017, p. 692). Understanding the concept of unconscious bias is critical because sometimes it is hard to know if we are also guilty of this action without knowing it. Unconscious bias can be applied in various cultural and underserved communities, such as people experiencing homelessness. It is vital to be culturally competent in caring for all people. Acknowledging that bias and racism exist and understanding their implications toward care can help change our thinking and actions when serving patients daily. As a result, it can reduce stigmatization among patient populations.

Many things stood out in this report, but most importantly, how white nurse researchers conduct overwhelming nursing research. The report addresses the top themes identified, but one reason I have seen firsthand is the systemic and institutional roadblocks among decision-makers, academia, and governmental agencies. Minority nurse researchers (including DNPs) are essential to addressing health disparities and inequities and appropriately disseminating funding. As prospective DNP leaders, it is vital to understand and become involved with policies and reforms. It is important to know that despite these huge issues, it is essential to keep pushing. Minor changes and advocacy can invoke an array of modifications and influence others to do the same.

[Wendy]

Racism in nursing practice is something I have experience first hand at my workplace; One of the nurses had a bit of an accent and the patient humiliated the bedside nurse due to her accent and the nursing assignment was changed mid- shift due to this discriminator event. Having an inclusive environment and providing safe spaces for bold conversations where nurses may confront racism freely and learn how unconscious prejudice can affect patient care are essential components of a successful healthcare. Organizations must mitigate obstacles impeding the realization of these values and must react to overt the need for structural reform to address health, and covert racism inequities, particularly in disadvantaged communities. It is important to not undervalue the nurse’s emotional suffering. Keeping patients’ humanity while delivering treatment might be difficult for nurses when patients engage in discriminatory conduct. Organizations that provide healthcare must promote core principles that ensure a racism-free environment. If institutions are to successfully carry out their anti-racist purpose, strong organizational leadership and support are essential. Nurses must be aware of the effects of racism on the healthcare system since it can have a significant impact. Racism, which is referred to as a disruptive behavior in certain research, and its effects put at risk not just patient safety but also the wellbeing of nurses and their capacity to do their professions effectively.

[Doctors of Nursing Practice, Inc.]

Wendy – thank you for your post. I’m curious about the dynamics surround the patient that did not like the nurse due to an accent. Was this the one that was accommodated by changing the nurses’ assignment? Does your facility have a policy that documents that all patients will receive equitable services by a diverse group of professionals? It seems to me that if a patient cannot abide by these rules the next step for the hospital would be to help arrange for the patient to be transferred to a different facility – at the patient’s expense. Is this approach I offer too harsh?

[Wendy]

Dear author,
The accommodation was done for the patient and the nurse was more than happy to have the assignment change as no one gains pleasure from humiliation; however, as DNP educators I firmly believe that we need to educate the patient population. I do not feel that your suggested approach is too harsh. We as healthcare providers are trained to accept cultural diversity and respect and deserve the same. Health organizations must follow a different customer service method than the traditional “customer is always right” as we are not selling luxury products. However, it is sad to see healthcare services adopt traditional business methods often which may not apply to healthcare settings.

[Norma]

Greetings,
this article opened up a whole can of worms for me, coming from a country with purity and pollution rules. In India for the past 3 millennium the artificial system of stratification, dividing people into castes, would cite purity and pollution rules that would separate people, historically into the Brahmins (Priest class), Kshetriyas (Warrior class), Vaishyas (Merchant Class), Sudra (Servant class) and then the Ati-Sudras (commonly known as Dalits). The Dalits were known to be the untouchables, as they would rest at the bottom of this perverse hierarchy. They were the ones called upon to do the menial jobs such as broom, basket and rope making, to be sex-workers, and/or domestic labors, and would be linked with scavengers, sweepers, rag-pickers, coolies, those jobs that were considered to be dirty, unimportant and unhygienic and hence associated with religious notions of purity-pollution, as would be called upon to clean up the sewer systems of human excrement, without any protective gear or apparel. Those from this class were prevented a proper education, living conditions, or even adequate health-care (Douglas, 1966).

According to Human Anthropology expert Louis Dumont, stated that those outside of this Hindu caste system altogether, such as Christians, were seen as the most impure of all (Nair, Healey, 2006). Nursing in India, would morph out of those who were given the task of doing menial unhygienic, and would involve intimate touch and close proximity to different caste members, especially those of the untouchables, and would thus be considered as a profession for the dregs, lowest in society’s hierarchy. Nurses were shunned from families, could experience a decrease in marriage prospects and would be considered to bring ill-reputation to the family’s honor.

Nursing has come a long way, to be seen as a noble profession, with the likes of Mother Teresa caring for those in the lower castes, living among them in the slums of Calcutta, India, thus bringing in notoriety and value, being praised the world over. With the Mahatma speaking against Untouchability, there has been a drastic shift in perception of care, in as much as Christians would care not just for the poor, but for those in the higher castes as well, nursing these days is considered to be noble job, demanding a higher renumeration, the world over. While we consider the ugly face of racism, in the United States, there are other faces of this social divide. Let us consider the welfare of all, as the golden rule suggests, To do to others, as we would want them to do to us.

Reference:

Douglas, M. (1966). Purity and Danger. London: Routledge.
Nair, S., Healey, M. (2006). A Profession on the margins: status issues in Indian Nursing. New Delhi: Center for Women’s Studies.

[Author]

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