Rooting out Racial Bias in Nursing: Hope and Grace

Dr. Susan Moore died of complications related to COVID-19. Prior to her death, she detailed what she felt was racial bias in her care. This article explores our own responses and how we can find the hope and grace to keep moving forward in a positive direction. Specialties General Specialties Article

Rooting out Racial Bias in Nursing: Hope and Grace

Dr. Susan Moore, 52, died of complications related to COVID-19 in St. Vincent Carmel Hospital in Carmel, Indiana. A Black physician, she posted on social media about her treatment in and discharge from another area hospital. Her post describes what she felt was “racist” treatment by her medical team and her attempts at self-advocacy in the midst of her severe disease.

Racial and Ethnic Minority Group Disparity

Her course of treatment and subsequent death highlight the disparities some persons of color face in their care. The disparities have become more visible during 2020 with the coronavirus pandemic. The inequities in health care may have been in the background all along, but they have begun to stand out starkly in the past few months as Blacks and persons of color suffer and die disproportionately.

Long-standing systemic health and social inequities have put many people from racial and ethnic minority groups at increased risk of getting sick and dying from COVID-19. The term “racial and ethnic minority groups” includes people of color with various backgrounds and experiences. But some experiences are common to many people within these groups, and social determinate of health have historically prevented them from having fair opportunities for economic, physical, and emotional health (CDC.gov).

"If I Were White"

Dr. Moore posted several times to social media during her course of treatment. She described, with the knowledge of a physician, her plan of care, and necessary actions. She was diagnosed with COVID-19 on November 29 and was hospitalized for treatment of respiratory symptoms. During that hospital stay, she reported her symptoms, treatment, and concerns that she was being treated differently because of her skin color. She said, “I put forth, and I maintain, if I were white, I wouldn’t have to go through that.”

While the particulars of her case are difficult to ascertain, the CDC and the U.S. Department of Health and Human Services have determined significant disparities in the Social Determinates of Care and access to related to ethnicity, poverty,  discrimination, and access to care (healthypeople.gov).

As professional nurses, we are part of the access and delivery of treatment outside the hospital and at the point of care. What is our role in identifying discrimination and inequities and addressing those?

Surely we would never discriminate against a patient because of the color of their skin. Would we? Not on purpose, anyway. The problem of possible racism and inequality of treatment based on skin color is impossible to deny and monumental to address.

What Can We Do in Our Day-to-Day Practice that Makes a Difference?

Assess

While we may not feel we are racist in any way, studies and our own experience show us that we all have a racial bias. Often it is hard for us to see and acknowledge racist attitudes in ourselves. Still, it is a first step in addressing the problem, especially as it relates to our professional behavior. Attending training, reading, watching movies, educating ourselves can all be steps to help us, but in the end, we must sit with the fact that we all have work to do as humans. None of us is exempt. But there is hope. With grace, compassion, and love we can come together to see the problem and do something about it. Grace and love are the only actions that can truly change racism. Everything else just points a finger at it and stirs it around.

Acknowledge

Acknowledge that the change begins with me. As Mahatma Gandhi said, “If we could change ourselves, the tendencies in the world would also change. As a man changes his own nature, so does the attitude of the world change toward him.” It is always easier to point fingers and shame/blame others for their bad behavior. But for racism and racial bias and discrimination to stop, we must come together to identify the problem and pull it out by its roots—every day. This is not a training session that we can attend to fix what is wrong—this is an attitude of the heart.

Advocate

When you hear labels being tossed about—“ drug addict” or “difficult patient” or “trouble maker”—be aware and alert to your own feelings and the possible need to speak out. Advocacy is not mean, and it doesn’t employ shame. It simply provides a human perspective. People who are hurting need care—even if they aren’t nice or thankful or kind themselves. While we all know this and practice it every day, we all need encouragement to stay the course. It can be wearing to care for someone who doesn’t reciprocate with appreciation. A friend once said, “Hurt people, hurt people.” We don’t know what our patients are going through and what their lives are like outside of their illness. When they lash out, we cannot strike back. We provide care. Excellent care. Every time and to every patient.

Appreciate

As nurses, we get tired. We have bad days, too. As we walk through difficult days, we want to continue to help each other be our best selves. This begins by not denigrating other staff or talking negatively about our patients in the lounge's privacy. Negativity breeds negativity, and soon the contagion overwhelms the unit with discouragement. Be aware of co-workers who have a tendency toward negativity and work to maintain a positive balance. While we don’t want to be always countering with “the bright side,” we also don’t have to enter into the negativity. We can stay the course, remaining neutral. If we are in a leadership position, we help set the tone: finding ways to express appreciation and allowing nurses to vent when they need to in appropriate and supportive ways.

Hope and Grace

Dr. Susan Moore was a Jamaican-born immigrant who graduated from the University of Michigan Medical School. According to Alicia Sanders, who has established a GoFundMe account, “Susan was a phenomenal doctor. She loved practicing medicine, she loved being a member of Delta Sigma Theta Sorority, Inc, she loved helping people, and she was unapologetic about it.” May she rest in peace, and may her self-advocacy propel us forward on our journey toward more compassionate care.

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jeastridge

About jeastridge, BSN, RN

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Joy is a Faith Community Nurse who enjoys reading, cooking for crowds and playing with her grandkids. She has been a nurse for 35+ years in a variety of settings.

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I wish there more details divulged about her situation with racism. I do know for a fact that America as a society is obsessed with racial matters. 

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Says a non person of color. 

I have just experienced this as a patient in the hospital.  After a Diep procedure I was not given pain meds for 7 hours. Correct seven hours.  When the resident came to my bedside, he told me I would have to endure "some pain".  I didn't have a call bell, nor my phone... I was kept in PACU because ICU was full of CV19 patients, I finally got a UAP to get my phone out of my overnight bag, and I called my boss. It was because she has an connection to this hospital, my nurse walked by my curtain, and said to the resident I could not have been in too much pain, because I was on the phone.  My boss, who by the way was not really believing me either, heard that comment and said put me on speaker, my boss told the nurse that this was not a social call and to get me pain meds ASAP or she was calling such and such to report her.  When the dust settled down, this was PACU and the nurse assigned to me was not an ICU trained nurse, nor did she read my chart.  She never checked to see if I should have been given pain meds, she was just told to round on me every hour because of the Diep, she didn't know how to read the machine that detects oxidation to my breast flaps, it was going off every 5 minutes for 20 minutes...   She just was told she could stay more hours if she wanted.  When the resident was telling me I have to endure some pain, he meant 2 or 3 out of 10, and he was under the impression that I had 2 rounds of pain meds and was drug seeking as he felt it should have taken care of my pain level.  To say I was livid is an understatement.  When I calmly advocated for myself I was ignored and told my MD said I didn't need pain meds, when I became the "angry Black woman" I was drug seeking and unreasonable, when I called my white boss, she thought I was not sure of the facts, 7 hours is a long time without pain med and needed to just rest... but when she heard the conversation around me, all of the sudden her White privilege was heard and acted on within 30 minutes.  The resident apologized, the nurse said I just didn't act or look like I was in pain, because I seemed "so strong", she was careful not to say strong Black woman,  so she didn't check the orders.... I had 7 incisions, the longest was 19 inches long, could not use my abd muscles and no one to advocate for me.  I was scared to DEATH.  THIS IS A REAL THING!! oh and the day after when I complained to the nurse manager, she just smiled and nodded and said well its over now.   

 

 

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Specializes in Mental health, substance abuse, geriatrics, PCU.

I watched Dr. Moore's facebook video describing her experience. I have no reason to doubt her experience as there are glaring problems with our healthcare system and persons of color. I've read some really disturbing things about maternity care or lack there of for women of color and it's embarassing that it still happens in our country.

It is so important that we examine our own behaviors and beliefs in regards to the care we provide. No one thinks they are racist and yet many people endorse beliefs that are prejudicial towards at least one minority. I just think it's important we challenge those beliefs in order to improve the quality of care we provide.

No one deserves for their pain to be uncontrolled for 7 hours just because you think they are "drug seeking" in the acute setting. Even with acute pain just because someone is stoic doesn't mean they're not hurting. I think one of the bad things with the opioid crisis is that we've become too cavalier with pain control thinking that everyone asking for pain relief is seeking and that's just not the case.

I did read that once Dr. Moore was transferred to another facility she stated her care was much improved but sadly by then it was too late and she died shortly there after. 

 

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Specializes in Cardiology.
8 hours ago, 2ndcareerchange said:

Says a non person of color. 

I have just experienced this as a patient in the hospital.  After a Diep procedure I was not given pain meds for 7 hours. Correct seven hours.  When the resident came to my bedside, he told me I would have to endure "some pain".  I didn't have a call bell, nor my phone... I was kept in PACU because ICU was full of CV19 patients, I finally got a UAP to get my phone out of my overnight bag, and I called my boss. It was because she has an connection to this hospital, my nurse walked by my curtain, and said to the resident I could not have been in too much pain, because I was on the phone.  My boss, who by the way was not really believing me either, heard that comment and said put me on speaker, my boss told the nurse that this was not a social call and to get me pain meds ASAP or she was calling such and such to report her.  When the dust settled down, this was PACU and the nurse assigned to me was not an ICU trained nurse, nor did she read my chart.  She never checked to see if I should have been given pain meds, she was just told to round on me every hour because of the Diep, she didn't know how to read the machine that detects oxidation to my breast flaps, it was going off every 5 minutes for 20 minutes...   She just was told she could stay more hours if she wanted.  When the resident was telling me I have to endure some pain, he meant 2 or 3 out of 10, and he was under the impression that I had 2 rounds of pain meds and was drug seeking as he felt it should have taken care of my pain level.  To say I was livid is an understatement.  When I calmly advocated for myself I was ignored and told my MD said I didn't need pain meds, when I became the "angry Black woman" I was drug seeking and unreasonable, when I called my white boss, she thought I was not sure of the facts, 7 hours is a long time without pain med and needed to just rest... but when she heard the conversation around me, all of the sudden her White privilege was heard and acted on within 30 minutes.  The resident apologized, the nurse said I just didn't act or look like I was in pain, because I seemed "so strong", she was careful not to say strong Black woman,  so she didn't check the orders.... I had 7 incisions, the longest was 19 inches long, could not use my abd muscles and no one to advocate for me.  I was scared to DEATH.  THIS IS A REAL THING!! oh and the day after when I complained to the nurse manager, she just smiled and nodded and said well its over now.   

 

 

I would like to add something regarding the pain meds. This happens with all races. I have taken care of white patients who had pain meds prescribed through a pain clinic that were not ordered while they were inpatient. All they had ordered was 650 of Tylenol....which enraged them (and rightfully so). Unfortunately because of the opioid problem and overprescription doctors are now hesitant to order pain meds even if the meds are being managed by a pain clinic physician. Im not saying it's right, Im just saying that's the case. Anyone wanting pain meds is automatically assumed to be drug seeking and that's not right.  

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Specializes in Faith Community Nurse (FCN).
17 hours ago, 2ndcareerchange said:

Says a non person of color. 

I have just experienced this as a patient in the hospital.  After a Diep procedure I was not given pain meds for 7 hours. Correct seven hours.  When the resident came to my bedside, he told me I would have to endure "some pain".  I didn't have a call bell, nor my phone... I was kept in PACU because ICU was full of CV19 patients, I finally got a UAP to get my phone out of my overnight bag, and I called my boss. It was because she has an connection to this hospital, my nurse walked by my curtain, and said to the resident I could not have been in too much pain, because I was on the phone.  My boss, who by the way was not really believing me either, heard that comment and said put me on speaker, my boss told the nurse that this was not a social call and to get me pain meds ASAP or she was calling such and such to report her.  When the dust settled down, this was PACU and the nurse assigned to me was not an ICU trained nurse, nor did she read my chart.  She never checked to see if I should have been given pain meds, she was just told to round on me every hour because of the Diep, she didn't know how to read the machine that detects oxidation to my breast flaps, it was going off every 5 minutes for 20 minutes...   She just was told she could stay more hours if she wanted.  When the resident was telling me I have to endure some pain, he meant 2 or 3 out of 10, and he was under the impression that I had 2 rounds of pain meds and was drug seeking as he felt it should have taken care of my pain level.  To say I was livid is an understatement.  When I calmly advocated for myself I was ignored and told my MD said I didn't need pain meds, when I became the "angry Black woman" I was drug seeking and unreasonable, when I called my white boss, she thought I was not sure of the facts, 7 hours is a long time without pain med and needed to just rest... but when she heard the conversation around me, all of the sudden her White privilege was heard and acted on within 30 minutes.  The resident apologized, the nurse said I just didn't act or look like I was in pain, because I seemed "so strong", she was careful not to say strong Black woman,  so she didn't check the orders.... I had 7 incisions, the longest was 19 inches long, could not use my abd muscles and no one to advocate for me.  I was scared to DEATH.  THIS IS A REAL THING!! oh and the day after when I complained to the nurse manager, she just smiled and nodded and said well its over now.   

 

 

I am sorry you had such a traumatic experience. Thank you for sharing your story with us. Joy

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14 hours ago, OUxPhys said:

I would like to add something regarding the pain meds. This happens with all races. I have taken care of white patients who had pain meds prescribed through a pain clinic that were not ordered while they were inpatient. All they had ordered was 650 of Tylenol....which enraged them (and rightfully so). Unfortunately because of the opioid problem and overprescription doctors are now hesitant to order pain meds even if the meds are being managed by a pain clinic physician. Im not saying it's right, Im just saying that's the case. Anyone wanting pain meds is automatically assumed to be drug seeking and that's not right.  

I understand what you are saying, but in this case it was a Diep procedure that lasted 9 hours and no pain meds were ordered?? 7 seven incisions, the longest being 19 inches, and it was not questioned?? And when requested told I need to be "strong". This nurse was condescending and just looked at my face and not my chart. At least the Resident who was middle eastern after making excuses, came back and apologized and said he realized he believed the nurse over me because I was Black; and he said in future he will trust the nurse, but verify with the chart which is what he should have done, not wait 7 hours later until my White boss starting threating with upper CEOs to get involved.  It just needs to stop.  Thank God my boss finally got on board because even she was a bit like oh just rest... this woman worked with me for 4 years, 2 of them thru chemo, radiation, me coming in without complaints , having a barf bag with needed, and yet when I told her SHE even thought I was being over the top.  (She has since apologized as well) This ranks right up their with being stopped at night in the middle of no where with not cell signal by a White policeman in the South.  SCARED TO DEATH!!

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Specializes in ICU, trauma, neuro.
1 hour ago, 2ndcareerchange said:

I understand what you are saying, but in this case it was a Diep procedure that lasted 9 hours and no pain meds were ordered?? 7 seven incisions, the longest being 19 inches, and it was not questioned?? And when requested told I need to be "strong". This nurse was condescending and just looked at my face and not my chart. At least the Resident who was middle eastern after making excuses, came back and apologized and said he realized he believed the nurse over me because I was Black; and he said in future he will trust the nurse, but verify with the chart which is what he should have done, not wait 7 hours later until my White boss starting threating with upper CEOs to get involved.  It just needs to stop.  Thank God my boss finally got on board because even she was a bit like oh just rest... this woman worked with me for 4 years, 2 of them thru chemo, radiation, me coming in without complaints , having a barf bag with needed, and yet when I told her SHE even thought I was being over the top.  (She has since apologized as well) This ranks right up their with being stopped at night in the middle of no where with not cell signal by a White policeman in the South.  SCARED TO DEATH!!

While systemic racism is definitely an issue having worked about 10 years in ICU for an HCA facility I would endorse that we gave the same level of poor service and care to people of all races, sexes and creeds. 

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5 hours ago, myoglobin said:

While systemic racism is definitely an issue having worked about 10 years in ICU for an HCA facility I would endorse that we gave the same level of poor service and care to people of all races, sexes and creeds. 

In your eyes, it was the same level of poor care to everyone. There’s anecdotes then there’s facts. The former can easily be skewed by narrow-mindedness and bias, especially if you have the complexion for the connection. 

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Specializes in Faith Community Nurse (FCN).
On 12/30/2020 at 12:52 AM, TheMoonisMyLantern said:

I watched Dr. Moore's facebook video describing her experience. I have no reason to doubt her experience as there are glaring problems with our healthcare system and persons of color. I've read some really disturbing things about maternity care or lack there of for women of color and it's embarassing that it still happens in our country.

It is so important that we examine our own behaviors and beliefs in regards to the care we provide. No one thinks they are racist and yet many people endorse beliefs that are prejudicial towards at least one minority. I just think it's important we challenge those beliefs in order to improve the quality of care we provide.

No one deserves for their pain to be uncontrolled for 7 hours just because you think they are "drug seeking" in the acute setting. Even with acute pain just because someone is stoic doesn't mean they're not hurting. I think one of the bad things with the opioid crisis is that we've become too cavalier with pain control thinking that everyone asking for pain relief is seeking and that's just not the case.

I did read that once Dr. Moore was transferred to another facility she stated her care was much improved but sadly by then it was too late and she died shortly there after. 

 

"It is so important that we examine our own behaviors and beliefs in regards to the care we provide. No one thinks they are racist and yet many people endorse beliefs that are prejudicial towards at least one minority. I just think it's important we challenge those beliefs in order to improve the quality of care we provide." 

 

Thank you for your comment. Your second paragraph (noted above) summarizes the point of the article and the discussion. We can do better! Joy

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Specializes in Travel, Home Health, Med-Surg.

I think it would do us all well to tread lightly before calling people racist. None of us were there and therefore know zero about the actual interactions between the pt and her healthcare providers. Accusing someone of being racist is not helping the situation or our society move forward in a positive way. I am not saying that people never are racist but it goes across the board in all directions and should stop. I am just saying that taking a person's perception of the situation and laying blame is not helping our society to move forward to unity. Just my opinion. Also, people have hardly ever recieved the care they would like and now with covid and the opiod issues it is even worse!

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Specializes in Mental health, substance abuse, geriatrics, PCU.
25 minutes ago, Daisy4RN said:

I think it would do us all well to tread lightly before calling people racist. None of us were there and therefore know zero about the actual interactions between the pt and her healthcare providers. Accusing someone of being racist is not helping the situation or our society move forward in a positive way. I am not saying that people never are racist but it goes across the board in all directions and should stop. I am just saying that taking a person's perception of the situation and laying blame is not helping our society to move forward to unity. Just my opinion. Also, people have hardly ever recieved the care they would like and now with covid and the opiod issues it is even worse!

If people would tread lightly with the way treat others, perhaps their behaviors wouldn't be prejudicial. It has been proven the people of color do not receive the same quality of care that white people receive, it's not this rare occurrence that health care providers are providing different quality of care to minorities. Everyone has their own biases, everyone does regardless of their race. And I think that in order for us to move forward we have to openly talk about those biases and how they can be overcome. Dr. Moore died shortly after talking about her experience, perhaps she would have died regardless of the care she received, but maybe not. Maybe if her care team truly listened to her concerns as a person as opposed to treating her under their preconceived notion that she was a "drug seeker". And her story is not new, there is a ton of literature out there about how persons of color do not have equity when it comes to health care.

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