Euro-American women who become involved in nursing and who adopt its values with respect to homogeneity and conflict avoidance must be prepared to accept the consequences of reproducing their own traditions and the means by which these traditions maintain racism in their profession and their society.
Barbee, 1993
On September 24, 2022, the Overdue Reckoning on Racism in Nursing reconvened after a summer hiatus. The break was a time to refresh, recharge and reflect on where we have been and where we are going in our anti-racism efforts. Our first discussion focused on American Nurses Association’s Racial Reckoning Statement.
When I initially read the statement, I didn’t feel anything. Then I thought for a minute to understand why. I have been here before only to then experience disappointment. I will explain why I have issues with ANA’s Racial Reckoning.
First, nurses of color cannot be asked to forgive. This is a major flaw that I see in their statement. And in my opinion, it is offensive to ask for forgiveness. I will not forgive, not now. Not without action. What I want is to see action to heal the harm, action to confront daily acts of harm still being heaped on people of color, action to speak openly about racism that persists, action to heed the voices of nurses of color, action to center the voices of nurses of color in creating a just and nurturing new reality for nurses of color. When I see your actions, I will gradually come to trust that your intentions are real. Forgiveness will not build this trust. Only action will.
The actions outlined in the Racial Reckoning statement are a good start. Now we need to see these actions begin to grow into reality. The reason I feel strongly about this statement is because through the writings of Black historians and Black nursing scholars, such as Dr. Darlene Clark Hine, Dr. Mary Elizabeth Carnegie, and Dr. Evelyn Barbee. I learned how racism has always been a part of nursing history.
Racism has existed in nursing since the development of institutionalized nursing programs (Carnegie, 1986; Hine, 1989). Although nursing care existed in Black, Indigenous, and other communities of color, nursing programs denied admission to racialized people solely based on the color of their skin (Carnegie, 1986; Hine, 1989).
The harm from racism in nursing runs deep; lost dreams, lost opportunities, trauma from doing the work without recognition, caring for patients in environments that were not safe. Nurses of color continue to work hard to demonstrate how they belong to all areas of nursing. For example, Filipino nurses were disproportionately assigned to care for the sickest COVID patients, relegated to night shifts, and subsequently suffered disproportionately from COVID, and many died (Nazareno and others, 2021). A painful part of nursing history is when nurses of color have sought the support of professional nursing organizations, such as the ANA, and were rejected. Nurses of color were disappointed by lack of interest in the issues that impacted them (Barbee, 1993).
ANA needs to acknowledge this history and the harm that was caused. The historical beliefs about nurses of color not having the ability to be nurses, policies in place that created challenges for admission to nursing programs, the barriers that prevented nurses of color from having access to the resources for developmental and educational growth or safe working environments that are free of racism (Barbee, 1993; Nazareno and others, 2021; Spratlen, 2006).
Everything about the ANA’s Racial Reckoning Statement is anonymous. There is no indication of who actually wrote any of this — the racial reckoning statement or the FAQs. Who from the ANA wrote the Racial Reckoning statement? Who wrote the questions and responses in the FAQs? The statement made frequent use of anonymous quotes. Accountability requires agency. To demonstrate that one is ready for action, you cannot hide behind anonymity.
It is appropriate for the Apology to come from a “white voice” – but the actions and the intentions moving forward need to reflect the wisdom and leadership of nurses of color.
The FAQ’s are questions that white nurses would ask, but the FAQs require the voices of Nurses of Color.
For nursing to become an anti-racist discipline, decolonization of racist structures is required. This begins by centering primarily on the knowledge generated by nurses of color. We who are Black, Indigenous, Latina/o, and other Nurses of Color, have drawn from our experiences to produce a significant and growing body of knowledge for the Discipline of Nursing. Although our work is underutilized, our literature provides guidance for decolonizing all areas of nursing, policy changes, nursing curriculum, nursing research, and nursing leadership (Barbee, 1994; Canty and others, 2022).
Over the next weeks, months, year, nurses of color, allies and co-conspirators will continue to discuss the ANA Racial Reckoning and how we will move forward.
References
American Nurses Association. (2022) Racial Reckoning Statement. (https://www.nursingworld.org/~4a00a2/globalassets/practiceandpolicy/workforce/racial-reckoning-statement.pdf)
ANA. (2022). Frequently Asked Questions about Racial Reckoning https://epicmsdev.nursingworld.org/practice-policy/racism-in-nursing/RacialReckoningStatement/frequently-asked-questions-about-racial-reckoning/
Barbee, E. L. (1993). Racism in U. S. Nursing. Medical Anthropology Quarterly, 7(4), 346–362.
Barbee, E. L. (1994). A Black Feminist Approach to Nursing Research. Western Journal of Nursing Research, 16(5), 495-506.
Canty, L., Nyirati, C., Taylor, V., & Chinn, P. L. (2022). An Overdue Reckoning on Racism in Nursing. AJN American Journal of Nursing, 122(2), 26–34. https://doi.org/10.1097/01.NAJ.0000819768.01156.d6
Carnegie, M. E. (1986). The path we tread : Blacks in nursing, 1854-1984. Lippincott.
Hine, D. C. (1989). Black women in white : racial conflict and cooperation in the nursing profession, 1890-1950. Indiana University Press.
Nazareno, J., Yoshioka, E., Adia, A. C., Restar, A., Operario, D., & Choy, C. C. (2021). From imperialism to inpatient care: Work differences of Filipino and White registered nurses in the United States and implications for COVID-19 through an intersectional lens. Gend Work Organ, 28(4), 1426-1446. doi:10.1111/gwao.12657
Spratlen, L.P. (2001). African American Registered Nurses in Seattle: The Struggle for Opportunity and Success. Peanut Butter Publishing.
One step forward is to recognize that racism within the entire healthcare system is a social determinant of health and of health disparities. In brief, let’s expand the definition of social determinants of health
BTW, when I make this suggestion to powerful Black and White nurses. I have only been met with silence. Coming from STL, I interpret science as fear or as racist. The real problem is I can’t accurately interpret silence unless someone tells me what it means.
At the same time that we expand the definition of social determinants of health, let’s engage informaticists in the measurement of time-to variables, looking at clinical outcomes such as time to pain control, time to blood pressure control, time to blood cultures in the face of fever, time to sepsis protocol initiation, time to low O2 sat control.
Then let’s compare Black and White time-to’s by institution, unit, provider and use the results for Inter-racial CQI as well as for administrative decision-making.and for open staff discussions and development of action plans.
Next develop specialty specific time-to’s and setting specific time-to’s. Don’t accept excuses about the results by blaming patients for non-compliance- which brings up another issue
Let’s look at racism in the clinical judgements we make. Compare nursing diagnoses and medical diagnoses made between White and Black patients. Look at diagnoses more susceptible to provider bias as a starting point.
The NINR is funding equity research. Let one or more teams study equity in clinical diagnoses and in outcome (time-to) variables. Paggy’s Nursology May be a good place to start team formation.
Feedback?
Mary Ann Lavin, ScD, RN, Charter FAAN
Thank you Mary Ann! Great suggestions for some really useful and interesting research! Yes Yes people who are interested in teaming up for this .. leave your comments here!
Peggy: Thank you for your kind words.
Lucinda: Thank you for your on-target message. I am a critical race theory novice. Yet, critical race theory, to me, seems like a logical framework for times-to and clinical judgment bias research. Perhaps, critical race theory and Watson’s theory of human caring might provide a dual framework for conceptualizing the research. One research question might be the following. Are within- healthcare system and provider (staff nurses, nurse practitioners, physicians) racialized behavior a social determinant of health, health disparities, and inequities?
Jean: As you know, I am not a theoretician — but I appreciate theories as generators of evidence-based diagnoses. The above question seems to me to be one that may generate both critical race risk/harm/trauma diagnoses and types of caring deficits as well as Venn type overlaps between the two.
Everyone: Finally, the research team may want to look at the work of Dr. Chandra Ford (UCLA SPH Center for the Study of Racism, Social Justice and Health https://www.racialhealthequity.org/) especially at how she uses the Center’s pre-research survey method that examines assumptions of the researchers as they become a team.
For myself: I am 81 years old and trust completely and support unconditionally whatever each of you decides. Furthermore, I am old enough to know that ideas that arise from a community/team tend to refocus the original idea completely or enhance it considerably; and, it is only such projects that become sustainable and effect lasting change. Therefore, I leave you with my ideas for you to change completely/adapt/reject as I bow out.
Mary Ann
Thank you Lucinda for your heartfelt, and hard honest response to ANA Racial Reckoning statement – I value and appreciate your critique and calls for a much more systemic, more enlightened/informed response than what has been presented. These racial practices are deeply engrained, embedded in our history and culture; these issues touch on what I think of as Moral injustice beyond Social injustice as currently been addressed. As a profession we share the shadow and light of our history and current policies and actions, which require naming the history and uncovering what has been hidden, so we can reach an inner awakening for authentic informed moral action – in small and grand ways.
In gratitude, Jean Watson