Racism and Covid-19: The Unmasking of Two Pandemics

This article discusses racism in nursing and how organizations can recognize racism and implicit bias. Commentary by Stacy Winters, CRNP

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Racism and Covid-19: The Unmasking of Two Pandemics

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 sporifice. 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

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Stacy Winters

About Stacy Winters, MSN, APRN, NP

Stacy Winters, M.Ed MSN CRNP is a nurse practitioner in Maryland working with diverse populations.

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Specializes in Med Surg, Tele, Geriatrics, home infusion.

I care for primarily adults, generally older and white, and I'm tired of "the patient is always right" when their prejudice and disrespect towards my coworkers of color is incredibly offensive to me. I generally take the route of telling them they don't deserve to receive care from an individual they won't treat with respect. I let my staff decide if they would prefer to swap out with another person, which they generally chose to do so. But I agree endorsing someone's racist behavior is pretty common place, especially in geriatrics. And passive accommodation has brought us to where we are today.

Excellent post. Thank you for sharing your experience!

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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.

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Specializes in ICU, LTACH, Internal Medicine.

There is also quite a thick level of xenophobia and anti-immigrant attitudes, both among nurses and public. Both are condoned and in some places receive tender loving care under premice of "complete customer satisfaction".

Having been through all of that innumerous times including going through EEOC (formally won the case, in reality it ended up as a wiggle of a finger toward facility which systematically did and, AFAIK, still discriminates against minorities and immigrants), I can tell you that in the vast majority of cases it should be possible to show abusers their proper place, "customer service" or not. But it takes acceptance of certain degree of risk for your job and career, among other things.

One time when I work agency, I had an assignment in an ICU unit where such discrimination was widespread. There were two of us agency RNs, myself (an immigrant) and an African descent girl, younger and very quiet and meek and also an immigrant. When we came to take our assignments, we found out that patients were distributed in extremely unfair and unsafe manner, pretty much guaranteeing everyone else a pizza night and us jiggling with human lives non-stop with very sick 3 patients each (everyone else got only two or even one, all out of category "babysitting/watching/waiting transfer").

When I asked the charge about it, he chuckled and said: well, you ladies need to prove that you are worthy of living in MY country, after all.

I took my agency mate by her hand and pretty much dragged her, crying in shock, out of there accompanied by screaming of the charge that we abandoned patients and will be reported to Board, agency, ICE, FBI and KGB and lose our licenses and everything else we know and love.

We sat in my car for exactly 10 min (5 min after shift start) while I tried to explain the other nurse that, since we did not accept assignmen, there was no abandonment. Then, another nurse emerged and in exceedingly polite way asked us to please come back as there were no volunteers to take 4 patients in ICU setting. There were no apologies for the atrocious treatment we received but we were given fair assignments and charge took the sickest one, made it 1:1 and was not seen or heard till the end of the shift. We were not reported anywhere. And my younger mate realized what does it mean "to take your stand".

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I really did enjoy your post as well. And I feel as you made a good point about the first thing we need to do is acknowledge it exist. Especially when it comes to healthcare outcomes within the minority group. It’s scary to me how many healthcare professionals are walking around here claiming they care for people but then believe that racism doesn’t exist. I do feel like we can make a change, but it has to start from the ground up.

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Specializes in SCRN.
46 minutes ago, KatieMI said:

There is also quite a thick level of xenophobia and anti-immigrant attitudes, both among nurses and public. Both are condoned and in some places receive tender loving care under premice of "complete customer satisfaction".

Correct. Patients and nurses give out endless stereotypes when it comes to any unfamiliar cultures. I listen to it, and at some point just tell them to stop insulting me.

I have heard the statement: "I don't want the white nurse" as well.

All people are created equal and should be treated as such.

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Specializes in SCRN.
2 hours ago, KatieMI said:

When I asked the charge about it, he chuckled and said: well, you ladies need to prove that you are worthy of living in MY country, after all.

WOW!!, what a *****!

Good for you standing your ground!

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Specializes in Med Surg, Tele, Geriatrics, home infusion.
3 hours ago, KatieMI said:

There is also quite a thick level of xenophobia and anti-immigrant attitudes, both among nurses and public. Both are condoned and in some places receive tender loving care under premice of "complete customer satisfaction".

Having been through all of that innumerous times including going through EEOC (formally won the case, in reality it ended up as a wiggle of a finger toward facility which systematically did and, AFAIK, still discriminates against minorities and immigrants), I can tell you that in the vast majority of cases it should be possible to show abusers their proper place, "customer service" or not. But it takes acceptance of certain degree of risk for your job and career, among other things.

One time when I work agency, I had an assignment in an ICU unit where such discrimination was widespread. There were two of us agency RNs, myself (an immigrant) and an African descent girl, younger and very quiet and meek and also an immigrant. When we came to take our assignments, we found out that patients were distributed in extremely unfair and unsafe manner, pretty much guaranteeing everyone else a pizza night and us jiggling with human lives non-stop with very sick 3 patients each (everyone else got only two or even one, all out of category "babysitting/watching/waiting transfer").

When I asked the charge about it, he chuckled and said: well, you ladies need to prove that you are worthy of living in MY country, after all.

I took my agency mate by her hand and pretty much dragged her, crying in shock, out of there accompanied by screaming of the charge that we abandoned patients and will be reported to Board, agency, ICE, FBI and KGB and lose our licenses and everything else we know and love.

We sat in my car for exactly 10 min (5 min after shift start) while I tried to explain the other nurse that, since we did not accept assignmen, there was no abandonment. Then, another nurse emerged and in exceedingly polite way asked us to please come back as there were no volunteers to take 4 patients in ICU setting. There were no apologies for the atrocious treatment we received but we were given fair assignments and charge took the sickest one, made it 1:1 and was not seen or heard till the end of the shift. We were not reported anywhere. And my younger mate realized what does it mean "to take your stand".

Being agency in and of itself is tough. Add doing it in a country that I wasn't born in...I can't imagine. Give you credit for standing your ground ? good for you!

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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.

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8 hours ago, Bobognnp said:

I really did enjoy your post as well. And I feel as you made a good point about the first thing we need to do is acknowledge it exist. Especially when it comes to healthcare outcomes within the minority group. It’s scary to me how many healthcare professionals are walking around here claiming they care for people but then believe that racism doesn’t exist. I do feel like we can make a change, but it has to start from the ground up.

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.

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16 hours ago, scribblz said:

I care for primarily adults, generally older and white, and I'm tired of "the patient is always right" when their prejudice and disrespect towards my coworkers of color is incredibly offensive to me. I generally take the route of telling them they don't deserve to receive care from an individual they won't treat with respect. I let my staff decide if they would prefer to swap out with another person, which they generally chose to do so. But I agree endorsing someone's racist behavior is pretty common place, especially in geriatrics. And passive accommodation has brought us to where we are today.

Excellent post. Thank you for sharing your experience!

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

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Specializes in OB.

Thanks for this article!

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