Power, racism, and the imperative of advocacy in the nursing profession: A call to action from the Tennessee Three

Contributor: Jean Croce Hemphill, PhD, FNP- BC

The power of position, of conferred authority, and the power of societal and cultural privilege, converged this month in the state of Tennessee resulting in the silencing of diverse voices demanding action against gun violence. Given the moniker, the Tennessee Three, Justin Pearson, Gloria Johnson, and Justin Jones, all members of the Tennessee House of Representatives, experienced that convergence of power and privilege when they were forcibly silenced after they demanded action on addressing gun violence from their fellow law makers after the horrific murder of 6 people, 3 of them 9-year-old children, in their classrooms on March 27, 2023.

Source (Photo credit: Michael Fleshman)

Just six days later, the Tennessee House of Representatives, voted on a resolution to expel the three members. Two were voted to be expelled, Jason Jones of Nashville, and Jason Pearson of Memphis, both black, and both representatives of districts with large populations of marginalized persons; marginalized by race-ethnicity, immigration status, and poverty. One was spared expulsion, Gloria Johnson, a white woman from Knoxville, TN, whose district is also checkered with areas of persistent poverty that include people of all colors, and immigrants. Gloria Johnson missed expulsion by one vote. When asked why, she said, …”it might have to do with the color of our skin…Well, I think it’s pretty clear. I’m a 60-year-old white woman and they are two young Black men. In listening to the questions, and the way they were questioned, and the way they were talked to… I was talked down to as a woman, mansplained to, but it was completely different from the questioning they got. And this whole idea that […] you have to almost assimilate into this body to be like us…I hear racist statements all the time”. Justin Jones: “our microphones were shut off… [they are] “silencing any voices against the dominant narrative” (CNN, April 7, 2023; Democracy Now, April 5, 2023; Democracy Now, April 28, 2023)

How do these actions of silencing parallel marginalization of nurses of color, or those we as nurses purposefully silence? The sponsor of the bill to expel the Tennessee Three said he may not have agreed with the decision but “leadership” asked him to sponsor it. Do we as nurses ignore the othering of our colleagues of color, or of those who are different from whatever is defined as normal because obedience and conformity are expected? Because we might be punished for stepping out of line? For 28 years, I have been practicing nursology with marginalized persons; persons who do not have the power of money, who do not have political connections, who are different when expressing their gender identities, or have religious traditions different from the dominant. I see first-hand the consequences of the structures of our dysfunctional health care system. Looking into the eyes of the suffering should be a call to action. However, as Justin Jones reminded us, “It is easier to get a gun than to get healthcare in Tennessee” (Justin Jones, Democracy Now, April 5, 2023).

Working with our Diversity, Equity, and Inclusion committee at my university, I developed an educational activity for graduate nursing students with the objective to guide recognition of implicit bias and discriminatory practices when caring for patients. Students interviewed a standardized patient who acted out an archetypical clinical case. In the case scenario, both suffered from stigmatizing health conditions. One man was white and one man was black. The white man had a profession and was highly visible in the social hierarchy. The black man lived houseless, unsheltered, unknown, and unheard. The lessons learned were interesting. What stood out were the stereotypical, biased words, used when talking with a poor, houseless black man versus those used when talking with a professional, privileged white man. We all learned that explicit and implicit racism, and bias were real. When unrecognized, there can be no speaking out against it. We also learned that those implicit biases were shaped and influenced by the dominant cultural lens through which we view peoples of color, immigrants, those living in poverty, or living with different worldviews.

Are we nurses as brave as the Tennessee Three? Will we as nurses demand the end of violence in all forms: racial, physical, psychological, and the silencing that comes from erasing the knowledge and creativity of the not so privileged? Will we as nurses, supposedly patient advocates, bring transparency to our own professional silence? Do we recognize how we silence the voices speaking against the dominant narrative? Are we complicit in silencing so we can fit in?

Sadly, in east Tennessee, I see the silencing of those marginalized patients. I hear the microaggressions spoken by nurses against undocumented people in our region who are mostly of color. I feel the pain when those who try to speak out, who are not favored, who are not privileged, who are not white, or speak with an accent, try to advocate for themselves. Justin Jones reminds us of what happens when some speak out; when some promote advocacy and expose the ugly underbelly of racism, authoritarianism, and silencing: “we speak up in committees… silencing the voices against the dominant narrative…what we saw yesterday was a public lynching (Justin Jones, Democracy Now, April 5, 2023).

Oppression, dominance, silencing, erasing the other from full participation as human beings is a type of lynching. These microaggressions are frequent, cumulative, and dangerous. Microaggressions are intentional attempts to discriminate and marginalize. They are used to perpetuate authoritarianism and racism which are one and the same. Representative Johnson, who lived through a school shooting in Knoxville, went on to explain that the three of them received three other “punishments” that they were not aware of until they attempted to go about their responsibilities. Silent, hidden punishments, these micro aggressive behaviors, are effective controls used by the authorities, including those in nursing education, aimed to dominate the other. Effective silencing results when counter narratives are suppressed, and when connection and collegial networks are purposely broken (Pusey-Reid, & Blackman-Richards, 2022).

How can we as nurses tolerate this situation? We as a profession and we as nurses must think long and hard about the broader implications of our role as patient advocates. We must examine our commitment to support the marginalized and the suffering and remind larger society of our social responsibility to hear and act for the voices of the marginalized, those of color, and undocumented who are continuously silenced. If, as Florence Nightingale said, that nurses control the environment of healing, then we as nurses have an obligation to remove the social structures that maintain oppression so that we can promote healing (see Nightingale’s Neglected Upstream Advocacy). Nurses need to care for and nurture each other so that we can work to stop the cruelty of silencing and the cruelty of racism and structural oppression suffered by so many.


CNN April 7, 2023: https://twitter.com/atrupar/status/1644160381172998144

Democracy Now April 4, 2023: https://www.youtube.com/watch?v=XvOoLYI3NOc

Democracy Now April 28, 2023: https://www.youtube.com/watch?v=begxgaPsgoo

Nightingale, F. (1859/1993). Notes on nursing, Commemorative edition: What it is and what it is not (1st ed.). Lippincott, Williams & Wilkins.

Pusey-Reid, E., & Blackman-Richards, N. (2022). The importance of addressing racial microaggression in nursing education. Nurse Education Today, 114, 105390. https://doi.org/10.1016/j.nedt.2022.105390.

About Jean Croce Hemphill

I have over 23 years of experience as a nurse educator in higher education, and over 36 years as a family nurse practitioner, including as director of a nurse managed clinic serving houseless, marginalized, and underserved populations. My experiences partnering in health care with persons living within social and economic poverty changed my worldview profoundly. My research focuses on providing strengths-based care in partnership with persons who are unsheltered, homeless, vulnerable, underserved, persons of color, and those living within violence. Sharing my experiences and insights as a mentor and preceptor to undergraduate and graduate nursing students, and multiple students in a wide variety of disciplines, helps me and the students understand our common humanity.

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