Robert Wood Johnson Foundation’s VP on racism in nursing

Across the nation, nurses are demanding a seat at the table to drive meaningful, long-overdue policy changes and improvements to their working conditions—and lawmakers and healthcare leaders are paying more attention than ever.

Nursing has been considered the most trusted profession by Gallup polling for 20 straight years. But nurses, and particularly nurses of color, frequently lack a supportive and inclusive work environment. Instead, inequitable and unsustainable working conditions—coupled with alarming reports of patient and colleague racism—have led to a burned-out, depleted nursing workforce clamoring for change.

Related: How health inequity maps out across America

The recent Supreme Court ruling that will severely restrict race-conscious admissions policies will likely worsen the field’s already-tenuous pipeline and diversity issues.

All nurses deserve to live and work without having to sacrifice their safety, well-being and health. Their patients, too, deserve high-quality, empathetic and culturally relevant care. Fortunately, many solutions are available—including providing nurses better wages, more flexible schedules and access to mental health services. But those alone will not address the scourge of racism that still plagues the profession.

It’s up to lawmakers, healthcare executives and nursing leadership to ensure that any solutions put forward are not only driven by nurses’ experiences, but also explicitly address the discriminatory policies that have perpetuated unsafe working conditions and systemic racism in the profession. This begins with listening to nurses of color and ensuring their perspectives are driving forces for change. Achieving health equity—a future in which everyone has a fair and just opportunity for health and well-being—hinges on this approach and demands that healthcare leaders step up their own care for caregivers.

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Over the past three-plus years, nurses have suffered the realities of staffing shortages, poor working conditions and continued trauma as a result of the COVID-19 pandemic. In this overwhelmingly white workforce, nurses of color have faced the compounding effects of racism. Researchers at Rutgers University found that nurses of color in New Jersey experienced a “dual pandemic” induced by a toxic combination of fears engendered by COVID-19 and reactions to workplace racism.

A recent survey conducted by the Robert Wood Johnson Foundation and NORC Center at the University of Chicago revealed similar trends nationwide. Nurses report a high prevalence of racism and discrimination in the workplace and in their interactions with both patients and colleagues.

These dynamics begin early: More than half of nurses report a culture of racism or discrimination existed in their nursing school, and less than one-third say they were taught about racial bias or systemic racism in healthcare at their schools. The pervasive racism in the system affects patients too: Study after study shows how systemic racism causes patients of color to receive subpar care.

It doesn’t have to be this way. The nursing field must reckon with its own history of racism. Many nursing associations, including the American Nurses Association, have begun to do this work. In 2021, the ANA, together with the National Association of Hispanic Nurses, the National Black Nurses Association and the National Coalition of Ethnic Minority Nurse Associations, launched a commission to examine how racism affects nurses, patients and healthcare systems and to motivate all nurses to confront systemic and individual racism.

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Together, they have issued a foundational report on racism in nursing and hold regular forums for nurses to discuss how racism shows up in their profession and what skills can help them confront the issue.

As the RWJF/NORC survey findings suggest, however, the work to dismantle racism must begin as early as nursing school. For example, the history taught in nursing schools often omits the achievements of groundbreaking nurses such as Mary Seacole, a Jamaican nurse who cared for fallen soldiers in the Crimean war, and the Black Angels, a group of Black nurses who treated tuberculosis patients in New York in the mid-1900s. Instead, nursing history often focuses on white nurses like Florence Nightingale, who, while she made many contributions to what we know as modern-day nursing, also supported British colonialism and justified the genocide of Indigenous populations as a necessary “sacrifice.”

Anti-discrimination policies are only one piece of the puzzle to address nurse shortages and burnout. Healthcare leaders must take complementary steps that will benefit all nurses by ensuring safe working conditions, grief and mental health support, fair wages and flexible schedules. Policymakers, too, should remove regulatory and other barriers that keep nurses from practicing at the top of their education and training. Nurses who feel happy and supported in their jobs will be able to provide even better care, improving the system for all.

The complex and intersecting crises in nursing are not insurmountable. With the moral will to dismantle systemic racism, leaders in government, education, hospitals and health systems can take these and many other steps to ensure everyone—nurses and patients alike—has an equal chance at achieving their best possible health and well-being. 


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