DiversityNursing Blog

The National Commission to Address Racism in Nursing defines racism as "Assaults on the human spirit in the form of biases, prejudices, and an ideology of superiority that persistently cause moral suffering and perpetuate injustices and inequities."

The Commission surveyed over 5,600 Nurses and found racism to be a significant problem in the field. Results show:

63% of Nurses personally experienced an act of racism in the workplace with the transgressors being either a peer (66%), patients (63%), or a manager or supervisor (60%).

56% of Nurses say racism in the workplace has negatively impacted their professional well-being.

“We are still living through the structural racism that is embedded in America,” says Quanna Batiste-Brown, DNP, RN, Chief Nursing Officer in Ambulatory Care at UCLA Health. “I think addressing it in Nursing is one of the things we can do to move forward.”

Along with addressing the issue, health systems are using various strategies to help eradicate Racism in Nursing.  

Establishing A Task Force

A task force or Council is usually a group consisting of healthcare leaders such as Chief Nursing Officers (CNO), Chief Diversity Officers (CDO), clinical and non clinical staff.

Seattle Children's task force is comprised of Nurses, coaches, Inclusion Network members, Physicians, support staff, scientists and leaders who developed the Health Equity and Anti-Racism Action Plan. 

Nurses at UCLA Health established a council called Unity in Diversity (UID). The primary purpose of UID is to assess, plan, implement and continuously improve actions toward establishing an authentic environment of equity, diversity, and inclusion for patients, trainees, and Nursing staff. 

Karen Grimley, PhD, MBA, RN, Chief Nursing Executive for UCLA Health told Becker's Hospital Review, "That group dovetails into the health system steering committee that's been created by our Chief health, Equity, Diversity and Inclusion Officer. So, we've tried to put a system in place that's going to identify and begin to address cultural norms that may be contributing to systemic bias and racism."

Education And Training

Mount Sinai Health System created the United in Solidarity Resource Guide. This guide is a catalogue of educational articles and resources to learn about racism, prejudice, and bias in America as well as causes to support the fight against injustice. 

Mass General Brigham launched its first system-wide anti-racism educational program, titled Stepping Stones. Stepping Stones was designed to allow viewers to understand how racism exists and functions in our society - and how they can combat it.

RWJ Barnabas Health compiled a list of educational anti-racism resources such as implicit bias tests, white privilege checklist, and a systemic racism video series. 

Diverse Leadership

Hiring Nurses that represent diverse communities is essential. They provide opportunities to administer quality care because of their understanding of various cultures, languages, gender identities, ethnicities, etc. Having diverse Nurses in leadership positions can play a crucial role in breaking down barriers such as discrimination in Nursing.

Staff from diverse backgrounds with histories of discrimination in healthcare may feel reassured when they see people who look like them in leadership positions. They may also feel more comfortable coming forward and reporting an incident of racism or discrimination.

No matter which initiatives a hospital implements, it must start with awareness and identifying any structural biases or barriers.

Marcus Henderson, MSN, RN, lecturer from the University of Pennsylvania’s Department of Family and Community Health, said “To adequately and effectively address health inequities and social determinants of health, Nursing must first look inward to address the inequity, lack of diversity, discrimination, and racism that lies within the profession. It’s not hiding. It has always been in plain sight.”

Ingrid Silva, a ballerina of The Dance Theatre of Harlem, is using the current closing of theaters and performance venues to expose racial bias in healthcare. In the past, Ingrid received praise and recognition for creating a line of ballet shoes in an array of skin tones for dancers of all races and cultures.

Silva founded a nonprofit organization called EmpowHer. EmpowHer NY is a social catalyst that ignites the conversation about women who break through the glass ceiling imposed by society and live authentically according to their truth.

Recently EmpowHer and The Bloc teamed up to create a video called 'The Call Project'.

According to Forbes, this project is an experiment where actress Corin Wells made multiple calls to a 24-hour Nurses health hotline. Wells used a white-coded name and voice as well as a Black-coded name and tone. The results showed that 77% of her “black” alias calls ended with a recommendation to go to an urgent care facility, a protocol for minor health issues. However, her “white alias,” using the same script, was advised to go to the ER, which is protocol for any patient with urgent symptoms of an appendicitis.

Empowher believes, "When it comes to getting proper healthcare, it shouldn’t matter what your name is or how you sound like. Your pain shouldn’t be underestimated because of biological myths that are not only scientifically false but also fantastical in nature."

The goal of this experiment is to address racial biases in healthcare and to make unconscious bias training mandatory for hospitals and healthcare to ensure quality healthcare.

Silva said, “It’s been past time for us to speak up on this matter for the black community worldwide. This is our way of saying enough already!”

You can join the movement in the fight for equality in healthcare. EmpowHer is offering a petition to make unconscious bias training a mandatory requirement for hospitals across the country. You can sign the petition here.

Women of color in the United States suffer unacceptably poor maternal health outcomes, including high rates of death related to pregnancy or childbirth.

The Pregnancy Mortality Surveillance System started in 1987 and since then, the number of reported pregnancy-related deaths in the United States increased from 7.2 deaths per 100,000 live births to 17.2 deaths per 100,000 live births in 2015.

Considerable racial/ethnic disparities in pregnancy-related mortality exist. During 2011–2015, the pregnancy-related mortality ratios were—

• 42.8 deaths per 100,000 live births for black non-Hispanic women.
• 32.5 deaths per 100,000 live births for American Indian/Alaskan Native non-Hispanic women.
• 14.2 deaths per 100,000 live births for Asian/Pacific Islander non-Hispanic women.
• 13.0 deaths per 100,000 live births for white non-Hispanic women.
• 11.4 deaths per 100,000 live births for Hispanic women.

Variability in the risk of death by race/ethnicity indicates that more can be done to understand and reduce pregnancy-related deaths.

According to a report from the Centers for Disease Control and Prevention, African American mothers die at a rate that's 3.3 times greater than whites, and Native American or Alaskan Native women die at a rate 2.5 times greater than whites.

Pregnancy-related mortality rates are also high among certain subgroups of Hispanic women. A Science Direct article says, pregnancy-induced hypertension was the leading cause of pregnancy-related death for Hispanic women.

The CDC report also shows roughly 3 in 5 pregnancy-related deaths are preventable. But, the health care system fails to listen to diverse population's health concerns and so the maternal mortality rate keeps rising.

According to the Healthy People Final Review, Approximately 25% of all U.S. women do not receive the recommended number of prenatal visits.  This number rises to 32% among African Americans and to 41% among American Indian or Alaska Native women.

An article from the Center for American Progress believes there is little research on what social factors contribute to poor delivery and birth outcomes for American Indian and Alaska Native women because of the small population size and racial misclassifications. But they do know these women face many barriers when it comes to getting healthcare.

The National Partnership for Women & Families explains African American women experience more maternal health complications. 

• African American women are three times more likely to have fibroids than white women. Fibroids are benign tumors that grow in the uterus and can cause postpartum hemorrhaging. Also the fibroids occur at younger ages and grow more quickly for African American women.
• African American women display signs of preeclampsia earlier in pregnancy than white women. Preeclampsia involves high blood pressure during pregnancy and can lead to severe complications including death if not properly treated.
• African American women experience physical “weathering,” meaning their bodies age faster than white women’s due to exposure to chronic stress linked to socioeconomic disadvantage and discrimination over the life course, this makes pregnancy riskier at an earlier age.

The CDC report also shows that more than a third of pregnancy-related deaths were due to cardiovascular conditions. Cardiovascular disease is more common among black women and can occur at earlier ages than in white women.

It is very clear that health disparities have a lot to do with racism. Until it is addressed and programs are put in place to combat racism in healthcare, mortality rates will continue to rise.