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.
