Stacy Winters

Racism in healthcare is real. It is so pervasive and sinister, it is expected. Many accept it as an unwelcomed guest, but the White privileged exploit it as a weapon at will. Have you ever walked into a patient's room and been told? " I don't want a Black nurse?" I have. Have you ever applied for a nursing position only to find out that someone with less experience and education was offered the position because the manager "liked" them? I have. Have you ever had a patient say? " You people think since Obama was in office you actually know everything." I have. Nurses and Racism Today, there are approximately 3.8 million nurses in the United States. However, only 9% of Registered Nurses and 6.6% of Nurse Practitioners are African American. Unfortunately, many Black nurses and nurse practitioners experience racism daily. The Nursing Times (2019) stated that two-thirds of nurses working in the National Health Service (NHS) witnesses discrimination and 50% experienced racism. The most prevalent incidents that nurses experienced were: racist language from patients to staff limited career opportunities lack of support by management Discriminatory Acts or Inequalities Large scale studies on discriminatory acts or inequalities against Black nurses in the United States are eerily sparse. Perhaps this reflects the problem itself. However, anecdotal evidence and surveys provide insight into racism in nursing. Black nurses routinely are told by White patients “I don’t want a Black nurse.” Such statements are painful and jolting to Black nurses though not surprising. According to a Johns Hopkins survey (2002), most patients prefer staff that look like them. Results from the Project Prejudice: When Credentials Are Not Enough survey showed that 59% of nurses and 59% of nurse practitioners experienced offensive remarks from patients. Twenty-six percent of the remarks were race-based. What is even more disturbing is the response by hospitals. Hospital leadership from charge nurses to administrators routinely remove Black nurses and reassign a White nurse rather than supporting the Black nurses. Hospitals seem to care more about the patient experience than confronting the White patient. Yes, this is healthcare’s “open secret.” One disturbing example of racism includes an African American nurse in Michigan who sued her hospital after her hospital administration accommodated a White patient who posted a note stating that no African American nurses should care for his newborn baby. This is one story but there are countless untold stories of Black nurses who experience racism. FACT: It’s time to look at racism as a primary driver in healthcare inequality and health disparities. Racism is the Fire but Implicit Bias is the Fuel Implicit bias, the unconscious attitude that contributes to discriminatory practices, must be addressed in nursing. First, implicit bias must be recognized. Organizations must ask the difficult questions: How does implicit bias manifest in my nursing organization? Does my organization reflect my population? Are there Black nurses in leadership? Are there Black charge nurses, clinical nurse specialists, clinical managers, clinical educators or directors of nursing? If not, why? Hospitals can take cues from major healthcare organizations on how to address racism. The First Step in Combating Racism is to Acknowledge it Exists Two major healthcare organizations, American Medical Association (AMA, 2020) and the American Association of Nurse Practitioners (AANP, 2020) have made public statements declaring racism as a public health concern. Both are in lockstep with the current political movement to course-correct healthcare inequality and social injustice in the US. The AANP recognized that George Floyd’s death represented many senseless deaths of Black people in the United States by law enforcement. But one man did not kill Mr. Floyd. Micro-aggressions did. Hate did. Privilege did. Systemic Racism did. It is time for change at the macrosystemic and microsystemic levels. The United States has a long history of inequality in healthcare. Addressing racism and practicing culture humility can act as part of a larger mitigation strategy. It is not enough to mandate culture competency in healthcare. Doctors and nurses must see patients as they wish to be seen not as they see them. Currently, We are Living with Two Pandemics: Racism and COVID-19 The COVID-19 pandemic shed a spotlight on health disparities in the US. African Americans are 14% of the United States population yet comprise 34% of COVID-19 cases. Healthcare must learn to examine chronic disease states in a holistic manner. Chronic disease coupled with race AND food deserts, lack of school lunch programs, lack of safe neighborhoods, and lack of access to quality healthcare must be considered when assessing disease states in African American patients. Are We All in This Together? Remember at the beginning of the pandemic the saying “We are all in this together.” We must adopt this same mantra with racism in healthcare as well. It is time to unmask racism. It is time to dismantle structures and systems that perpetuate inequalities. Today, we move about our environments with our masks on while living with COVID-19. As the pandemic lingers, many people report quarantine fatigue. They are tired of wearing a mask. Some see it as a burden. But, has anyone considered the burden that lay upon Black people in America for 400 years? It is time to unmask racism so all can live a healthier America. REFERENCES 3 Things Patients Want from Nurses (But Won't Tell Them) Prejudice and patient choice: an insidious confluence in medicine The Impact of Racist Patients Credentials Don’t Shield Doctors, Nurses from Bias

I respect your opinion, but it is not based on facts. You have the right to your opinion. Facts are there are many equally qualified people and institutions chose on a myriad of factors. I laid out many based on the BLS data. This information is well known.

Yes. I am aware of that. I am sorry that happens. It should not especially when so many OB/GYNs doctors are male. I support males in nursing 100%.

Thank you for your reply. I respect your opinion, but I also want to offer some data. In nursing, men benefit from affirmative action because there are so few in nursing. Affirmative action does NOT mean that someone who is not qualified and be considered for a position get a position. It simply means that those who have NOT been considered for position BE considered. As a male nurse, you are rare. What does this mean for admissions committees? They MUST consider men as candidates even when they have women who are just as qualified. So chances are YOU benefit from affirmative action. Traditionally, nursing has been a White female profession. Some of this is due mostly due to segregation in education during Jim Crowe and through the Civil Rights era. Today, as you read in my article, there still a small group of of non White nurses and male nurses in the workforce. It is key that nursing consider everyone in the "melting pot." Clarification. What group benefits from affirmative action the most in industry? White Women. Yes, White women benefit the most in business, technology, medicine etc. Preferential treatment is not uncommon. It occurs with Veteran status, Native Americans, wealthy students whose parents make donations, athletes, etc. What affirmative action does is level the playing field. I looks at its industry and asks " who is NOT as the table?" Then looks at all the applicants who are qualified and says, yes we need to consider voices who have not been traditionally part of the conversation. That means--Men in Nursing. African American women and men in leadership in nursing. LGBTQ persons in nursing, etc. Each group and/or individual has something of value to add to the industry. If those voices are routinely shut out then the discussion never changes. BTW. I have worked with some amazing male nurses. It is great to see more entering nursing indeed.

Thank you for your reply. If you want to speak about racism in healthcare or nursing, please feel free to post on that. The United States has a long history on healthcare disparities. I made reference to public health concerns as drivers and indicators contributors to healthcare disparities. The emphasis is on how it impacts health. I am happy to speak to your about healthcare, nursing and racism. Thank you for taking a moment to read. I appreciate that.

Disproportionality is key. Consider these facts. Sadly, the trend of fatal police shootings in the United States seems to only be increasing, with a total 429 civilians having been shot, 88 of whom were Black, as of June 4, 2020. In 2018, there were 996 fatal police shootings, and in 2019 this figure increased to 1,004. Additionally, the rate of fatal police shootings among Black Americans was much higher than that for any other ethnicity, standing at 30 fatal shootings per million of the population as of June 2020. In 2019 data of all police killings in the country compiled by Mapping Police Violence, black Americans were nearly three times more likely to die from police than white Americans. Other statistics showed that black Americans were nearly one-and-a-half times more likely to be unarmed before their death. Most states’ police forces killed black people at a higher rate per capita than white people, with Illinois, New York and Washington D.C. carrying some of the largest discrepancies by state. D.C., with a black population of nearly 50 percent, had 88 percent of all police killings be against black Americans – a discrepancy of over 38 percentage points. Rhode Island had the largest discrepancy of 44 points, albeit with a much smaller sample size of four police killings in 2019 – two of them being African American. My article was not written in a vacuum. First, my article focused on nursing but made reference to the protests related to the death of George Floyd and recent protest. I did not attempt to debate policing in my article, but made an assumption that readers understand the data aforementioned that African Americans are killed by White police officers for nonviolent crimes disproportionately. Clearly, I overestimated based your response. Again, this article is based on nursing. You referred to safe neighborhoods. Public health and social determinants of health indicate that housing, access to food, safe neighborhoods, food deserts, education, healthcare access etc. are key indicators that impact health outcomes. Research on this issue is extensive. Here a brief article for your reference. https://www.focusforhealth.org/sdoh_neighborhood/ African American Males in Nursing You stated, If you took into account that African Americans are 14% of the population (7% African American Females), they would be over represented if you accounted for the complete lack of African American males in nursing." Statistically, you are incorrect. In a recent study by the American Association of the College of Nursing, African-Americans only made up six percent of the nursing workforce, and the figure is even less when looking at black males. The amount of white registered nurses is around 83 percent, significantly higher than that of minority groups. Here is additional information for your review about minorities in nursing. https://www.RN.com/nursing-news/diversity-in-nursing-male-nurses-and-minorities/ https://observer.case.edu/bennett-why-black-males-should-enter-nursing/

There are many assumptions that you have made that I strongly disagree with. I have attached recent story about Black doctors testing homeless patients being arrested. Every day, Black and Brown individuals are pulled over by police regardless of social status or strata. Please read this for reference. https://www.nytimes.com/2020/04/14/us/armen-henderson-arrested-homeless-coronavirus-testing.html Irrespective of a person's educational attainment or position, countless interviews and the data show that racism persists in education, business, medicine, technology etc. Black people can't escape racism. There is no institution in the United States void of racism, bias, and microaggressions. In my opinion, it is extremely important to refrain making generalizations about a person's individual choices as you referenced in your reply. It is more important to look broader and place emphasis on making global, sweeping changes in policies that disproportionately impact Black, Latinx, LGBTQ, the poor and elderly. Reforms in hospital, education, policing policies, etc. are needed now. Additionally, it is key that each individual stand up. Speak up when you see someone being treated unfairly. Educate yourself about the history of First Nations people, African American history pre-slavery, Chinese-American's contributions, etc. Look beyond yourself. We are all challenged to move beyond our comfort zones. it's time to do the work.

Thank you for reading.

Thank you for reading. I appreciate your kind stance toward your coworkers. You are the change. I appreciate you.

Thank you for your thoughtful post. I slightly disagree. What needs to happen is that People of Color need to be at all levels so that racism is less likely to occur. If we are not at the table, "we are on the menu." They, organizations and others, will not consider us at all. This article was written to provoke healthcare leaders to examine their leadership chain. Are they Blacks, Latinx, LGBTQ, etc persons considered for every position? If not, why? Recruitment and opportunities must be extended to everyone who is qualified not simply like those who look and speak like those in the establishment.

First, thank you for your bravery and willingness to stand up for yourself and your patients. Honestly, the type of behavior you experienced not only hurts nurses, such as yourself, but the patients as well. No patient should receive care by nurses who are unduly stressed with extremely difficult and "heavy" caseloads. It is not safe for anyone. The charge RN needed education as well. Who says " You need to prove yourself to be in this country." By your very birth, you are worthy. How dare should another person, especially someone in a leadership position, speak to anyone as if they have no worth. Basically, the charge RN was a bully. Thank you for sharing your story.

Thank you for taking a moment to share your experience as well. It is unfortunate that this article had to be written, but our collective shared experiences matter. Our experiences are not accidental. Healthcare systems are on notice. They hear our voices. Hopefully, healthcare organizations will take the time to re-evaluate their training policies and practices. It's time.