Unmasking Racism in Nursing

By | 2022-02-07T17:59:20-05:00 June 16th, 2008|0 Comments

The historic campaign for the 2008 democratic presidential nomination between U.S. Sen. Barack Obama (D-ILL.) and U.S. Sen. Hillary Clinton (D-N.Y.) has peeled back the subtle layers of racism that still exist in this country and brought the issue to the forefront. As nurses, we like to believe we rise above attitudes that would harm our patients or ourselves. But a more honest self-examination might find we sometimes harbor racist feelings toward our own colleagues who have different racial or ethnic backgrounds, say nurse experts in cultural diversity interviewed by Nursing Spectrum.

Fortunately, attitudes are changing. Nursing leaders in hospitals and in schools of nursing are creating workplace and educational programs to help nurses overcome discriminatory feelings they may consciously or unconsciously hold toward colleagues or patients. They are fostering open environments in which students can discuss racism and how it might affect their own nursing practice when they enter the healthcare workplace.

What’s in a word?

“Racism is a hard word,” says Antonia Villarruel, RN, PhD, FAAN, professor, University of Michigan School of Nursing, Ann Arbor. “It means discrimination — the treating of people unfairly based on race or color that manifests itself in terms of attitudes.”

Within health care, racism can manifest itself through negative assumptions surrounding job capabilities. You might hear it in snide remarks during report that devalue others or in the language of disrespect in what should be mentoring situations, such as the orientation of new hires. Racism can even lead to minority hospital or faculty members being passed over for higher positions because of false beliefs they cannot perform at that level.

“To admit to the presence of racism in health care is something that most in nursing do reluctantly,” says Deborah Washington, RN, MSN, director, diversity patient care services, Massachusetts General Hospital (MGH), Boston. “Racism is an issue that requires censure and takes attention and commitment from a leadership structure that holds others accountable for unacceptable behavior.”

Betty Smith Williams, RN, DrPH, FAAN, president of the National Coalition of Ethnic Minority Nurse Associations, believes nurses are less prejudiced than other groups. “I think nursing exhibits less racism compared with other groups that do not have [regular] contact with people or who do not focus and pride themselves on understanding people. Racism is about not knowing and understanding people and then assuming generalizations about them.”

However, Smith Williams has witnessed the racism that does exist within the profession. In academe, where she has spent most of her career, Smith Williams has heard professors voice assumptions that black nursing students could not conceptualize or formulate abstract thoughts from their learning and experiences. “This is happening less, as nurses [like the rest of the country] have become more informed,” she says.

Hidden agenda

“Minorities, underrepresented in the nursing workforce, aren’t given the same consideration [for job opportunities],” says Sandra Webb-Booker, RN, PhD, coordinator for the Chicago Public Schools Practical Nursing Program. “For example, nurses and physicians [from other units] seek out Caucasian RNs when looking for the person in charge,” she says. The absence of blacks in administrative positions fosters this attitude, she believes.

Webb-Booker, past president of the Chicago Chapter of the National Black Nurses Association, says people are mystified when they discover she has a bachelor’s degree in nursing and that she has been awarded a doctorate.

Cherry Sloan-Medrano, RN, BSN, CCM-BC, OCN, case manager, MD Anderson Physicians Network/Cancer Manager Program, MD Anderson Cancer Center in Houston, recalls an instance regarding wage discrepancy at a healthcare facility where she previously worked. When she learned that the starting salary of an inexperienced white, associate-degree graduate nurse was higher then hers as an experienced inservice coordinator, Sloan-Medrano questioned the discrepancy. Her persistence paid off with an equitable salary adjustment for foreign-educated nurses.

“There’s a long history of some institutions treating Filipino and other foreign-educated nurses differently,” says Sloan-Medrano. “We have to make [racism] visible through the proper channels so you can make a difference for all those who come after you,” she says.

Confronting the issues

Nursing and health care in general have avoided the crucial need for conversations about multicultural issues, whether they refer to gender bias, ageism, or racism, says G. Rumay Alexander, RN, EdD, director of the office of multicultural affairs, University of North Carolina School of Nursing, Chapel Hill.

“I hear more open discussion, which is good,” she says. “It takes courageous dialogue to get into these issues and the creation of a safe environment to allow people to bring their voices to the table.”

At the University of North Carolina School of Nursing, students are told at orientation that multiculturalism is an important part of their education, and they are expected to emerge with a sense of how to care for [and work with] all people and what to do when faced with diversity issues, says Alexander. Students recognize that their own beliefs can intentionally and unintentionally impact their behavior and patient care, that we all have provider bias, and that self-awareness is essential to understanding, she says.

“Advocacy around basic rights and the giving of respect to culture and values is another key piece in health care,” says Alexander. Students are presented with diversity scenarios and learn practical knowledge regarding how to handle them, outside of a potentially emotionally charged situation.

Massachusetts General Hospitals’s Washington says confronting racism the moment it happens requires skills that should be the result of an organization’s commitment to staff development and the creation of an inclusive work environment.

“Antiracism or any form of discrimination is an explicit part of strategic planning, human resource efforts, and leadership training,” says Washington. A curriculum at MGH builds skills and raises awareness about bias and prejudice, she says. Unit-based cultural rounds discuss real time issues and incidents; and conflict management helps individuals to expressly work through their difficulties in a safe and supportive setting.

Villarruel encourages a safe environment in academe where nurses and students can discuss racial issues and confront unacceptable behaviors. Lack of diversity among faculty is a major issue in schools of nursing — and it’s this group’s responsibility to prepare graduates to function with others different from themselves, she says.

“Drawing from her military background as a U.S. Army Reserves commander, Webb-Booker says nurses, as part of this large multicultural society, must get to know each other and proceed as if they were in a foreign country when it comes to interacting with someone different from themselves. Her many culturally enriching experiences with the military have taught her to seek genuine understanding of others, ask questions, and show respect.

“With newfound understanding gained from multicultural encounters, nurses can decide how to work with people of diverse cultures to promote growth and resolve issues,” she says. “No one wants to admit that they have biases. We all want to be painted in the most positive light. It isn’t until we admit it and face what’s making us uncomfortable that we can make adjustments,”

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