Starting a New Revolution in Nursing

Abstract

The onset of COVID-19 and the murder of George Floyd shed light on social justice inequities, disparities in health care and the continuing rise of racism within society. Studies conducted by the American Nurses Foundation also revealed acts of racism within the nursing profession. The creation of the National Commission to Address Racism in Nursing and the American Nurses Association's issuance of an apology through its Racial Reckoning work have begun a revolution within the nursing profession to address this phenomenon. This commentary will provide a brief overview of collaborative initiatives currently underway and address ways in which nurses can do their part to obliterate racism from the nursing profession.

Implications for Practice and Research

More diverse nursing workforce that is reflective of society as a whole

Better healthcare outcomes

Helping our society address the growing racial disparities in health care and health outcomes.

When I entered the nursing profession in the 1970s in North Carolina, I looked around and didn’t see many nurses who looked like me. Our profession did not reflect the diversity of the patients we cared for. I wanted to change that. There is no doubt that in the ensuing years, there had been considerable progress over time, with more opportunities for Black, LatinX, and other minority Americans to enter the profession. But I also saw that minority nurses still represented fewer than one in five of those in the RN workforce. That was not, and still is not, reflective of the minority population as a whole, which is growing proportionally and will represent more than half the total population in this country by mid-century (United States Census Bureau, 2016).

When I was elected president of the American Nurses Association (ANA) one of my top priorities was to promote efforts that would increase the diversity of nursing. I have long believed that health-care professionals need to better reflect the diversity of the patients for whom we care. The more diverse the nursing profession is, the more effective we can be in helping our society address the growing racial disparities in health care and health outcomes. It means higher quality care for patients. As I began working to achieve that goal, a little bug called COVID-19 came along and derailed those plans … or so it seemed.

We’ve all seen, heard, and read how the COVID-19 pandemic shone a light on social injustice and health-care inequities. This perception was further emphasized by the murder of George Floyd that forced humanity to look at inequities and injustice around the globe. Such inequities not only occurred within society but also within the nursing profession itself. The American Nurses Foundation conducted a series of surveys at the start of the pandemic called Pulse on the Nation's Nurses. One of the first survey results showed that Black and LatinX nurses were more likely than their White colleagues to be in roles of providing direct care to infected patients—and they themselves were more than twice as likely to become infected with the virus (American Nurses Foundation, 2020). In another survey conducted by the National Commission to Address Racism in Nursing, 63% of nurses surveyed said they have personally experienced an act of racism in the workplace, with the transgressors being a peer (66%), patients (63%), or a manager or supervisor (60%). Additionally, 57% of nurses said they have challenged racism in the workplace, but more than half of those said their efforts resulted in no change (American Nurses Association's National Commission to Address Racism in Nursing, 2022a).

At a time when Americans were in the grips of both a global pandemic and national unrest, overcoming health disparities and finding equity in health care as well as social justice has never been more critical. As health professionals, we have an opportunity to speak with one strong voice—as leaders and role models of compassion and empathy for our patients, families, and communities. Our voice is our commitment to making a difference—in all that we do for those we serve.

American Nurses Association's Racial Justice Resolution

As a result of the murder of George Floyd in May of 2020, the ANA Board of Directors and our Membership Assembly, our highest governing body, adopted a wide-ranging resolution on Racial Justice for Communities of Color (American Nurses Association, 2020). It reaffirms ANA's positions against racism, discrimination, and health-care disparities. In addition, the resolution outlines the actions ANA, along with the Constituent/State Nurses Associations and the ANA Individual Member Division, pledge to take:

Oppose and address all forms of racism and discrimination.

Condemn brutality by law enforcement and all acts of violence.

Champion the Code of Ethics for Nurses which calls on us to recognize human dignity regardless of race, culture, creed, sexual orientation, ethnicity, gender, age, experience, or any aspect of identity. 

In partnership with nurses everywhere, educate, advocate, and collaborate to end systemic racism, particularly within nursing.

Advance institutional and legislative policies that promote diversity, equity, inclusion, and social justice for all.

Advocate for the ending of health inequities within communities and health-care systems that stem from systemic racism.

Promote deliberate and respectful dialogue, effective listening, and commitment to change as a means to improve the health of all individuals and the communities where they live and work.

To read the full resolution, please visit https://www.nursingworld.org.

While debating this resolution at the Membership Assembly meeting, I reiterated that, in accordance with the ANA's Code of Ethics for Nurses with Interpretive Statements, it is the ethical duty of nurses to recognize human dignity and protect human rights (ANA, 2015). Even though the passage of the resolution reaffirmed ANA's position against racism, if we were going to recognize and champion health equity, we still had strong indications that racism was still a problem … a big problem … right in our own ranks at the ANA. It would be difficult for ANA to champion the fight against racism without recognizing its own past discriminatory behavior. For example, from 1916 until 1964, ANA purposely did not allow Black nurses to become members, and the consequences of that policy lingered in the organization and throughout the profession. In partnership with nurses everywhere, ANA has vowed to educate, advocate, and work together to end systemic racism, particularly within the nursing profession.

National Commission to Address Racism In Nursing

In 2021, the ANA Board of Directors established the National Commission to Address Racism in Nursing, (hereafter the Commission). The Commission's leadership is composed of the ANA, the National Black Nurses Association, the National Association of Hispanic Nurses, and the National Coalition of Ethnic and Minority Nurses. There are 39 other nursing organizations representing a broad continuum of nursing practice, racially and ethnically diverse groups, and regions across the country, that serve as affiliates to the Commission. The Commission's goal is to address racism within the profession in four distinct areas: Nursing Education, Clinical Practice, Nursing Research, and Policy. It examines the issue of racism within nursing nationwide, focusing on its impact on nurses, patients, communities, and health-care systems, to motivate all nurses to confront individual and systemic racism (American Nurses Association's National Commission to Address Racism in Nursing, 2021a).

Since its founding, the Commission has been leading a national discussion to address racism within the profession of nursing. In order to capture nurses’ experiences with racism throughout their careers, five listening sessions were held across the country to collect their personal stories. Following these sessions, the Commission also held a virtual feedback summit and wrote a definition of racism as it applies to nursing. It defines racism as:

Assaults on the human spirit in the form of actions, biases, prejudices, and an ideology of superiority based on race that persistently cause moral suffering and physical harm of individuals and perpetuate systemic injustices and inequities. (American Nurses Association's National Commission to Address Racism in Nursing, definition of Racism, November 2021c)

The Commission's Project ECHO® is a series of forums and educational offerings designed to inform and enhance nurses’ knowledge about racism within the profession and is available on the ANA website (American Nurses Association's National Commission to Address Racism in Nursing, 2022b). Additionally, in 2022, the Commission released a foundational report which examined the historical context of racism in nursing as well as its contemporary context and real examples of continuing problems.

Racial Reckoning Statement

As previously mentioned, the ANA itself had a history of discriminatory practices. In June 2022, the organization took a major step to correct that past behavior. The ANA Membership Assembly voted unanimously to approve a strong, impactful racial reckoning statement. This statement was outside the Commission's scope, but was sorely needed if the work of the Commission was to be taken seriously. The purpose of the racial reckoning statement is to create a space for the ANA, as well as individual nurses, to examine past behaviors and policies that contributed and continue to contribute to marginalizing and harming nurses based on their race and ethnicity. The ‘reckoning’ aspect involves acknowledging past harms, apologizing and seeking forgiveness, and establishing accountability so that these behaviors, actions, and policies will never occur again (ANA, 2022). Even though the statement appears to be a foundation for a new revolution in nursing, there is still a lot of work to do.

There is ongoing collaboration among ANA and various minority nursing organizations to implement the aspects of the reckoning statement. It is imperative that every group who is at the table realize that this is journey … a sustainable journey that will take time, energy, and a lot of work to lay a foundation for a new revolution in nursing, one in which every nurse is treated with dignity and respect and feels a sense of belonging regardless of their race, ethnicity, or other labels or identifiers. The success of this collaborative endeavor will be to create a capacity to bring real, lasting positive change, not only within the nursing profession but also in society at large. I reiterate my prior comment that through building a broader, more reflective, diversified, and equitable nursing profession, we can make our profession better and deliver more for our patients and society at large.

As this initiative has progressed, some nurses have commented, “Why am I being held accountable for a wrong that was done a long time ago? If it's still happening today, I certainly do not condone it.” “I’m not a racist … I treat everyone the same.” “I don’t see color when I am providing care.” Such comments emphasize the need to educate and have those difficult conversations with nurses who feel threatened, confused, and accused, so that they may be helped to realize the experience their minority nurse colleagues may have endured. I call these “take a walk in my shoes moments” so that individuals can really experience what it is like to have their ability to be a nurse called into question, whether by a patient or a colleague. We are all a part of the problem, and we are all part of the solution … We have to be. In order to maintain forward movement on this issue, we need to ensure that our efforts are grounded in the frank acknowledgement and shared understanding of what really happened in the past and make sure that history does not repeat itself. This is not about assigning blame as some individuals might see it. Rather, it's about creating a starting point from which we can come together and drive real change at every level.

This change starts with each of us. Why? Because we all have a part to play—in the way we work, the culture of the organization in which we work, the decisions we make, and most importantly, the way we interact with each other. Individuals may be asking how they can help in this endeavor or, better yet, how can I as an individual really make a difference?

Top Ten Ways to be an Antiracist in Nursing

The Commission anticipated such questions and developed the Top Ten Ways to be an Antiracist in Nursing (American Nurses Association's National Commission to Address Racism in Nursing, 2021b). These are ten simple steps that each of us could use to begin chipping away at racism. These steps also present a learning opportunity to adapt and use in our everyday work environment as well as in other parts of our lives.

Step 1: Become Story Catchers

The main emphasis here is to constantly listen to and learn from others. It is important to ACTIVELY listen to the experiences of your colleagues. To hear is to learn and understand, which also leads to empathy with that individual.

Step 2: Be Genuine

Think of this as an opportunity to build trust and to be an ally to others. It is important that you keep your word and do whatever you say you will do. You will gain impact because others will notice what and how you act and do things.

Step 3: “Manage Me”

The objective of this step is to “think about what you are thinking.” In other words, don’t let prior experiences or generalizations cause your emotions to take control of your ability to reason. Resist … resist!

Step 4: Maximize Curiosity. Minimize Certainty

I see this step as a continuation of Step 3. You should ask yourself, “Why am I thinking about this person?” “Where did this thinking originate from?” “Do I know that what I think I know is true?”

Step 5: Distribute Power

This step is particularly useful in the workplace. This presents an opportunity for you to support those who have no power. Try to give them voice. Minimize power plays that may influence promotion, hiring, or patient assignments.

Step 6: Preserve the Dignity of Others

This step requires that you put human dignity at the top of your workplace agenda. You should strive to see the humanity in others. If upon inner reflection you find yourself viewing a colleague as a deficit to your team instead of an asset, try to understand why. And deal with that.

Step 7: Stop Labeling Others

It is important to see people as people. Eliminate ideas about superiority, inferiority, and where to place people in a hierarchy. When you see incidents of this happening, you have a duty to address it.

Step 8: Expose Unwritten Rules

Be vigilant in your efforts to look at the systems in our work environment. Are there biases in policies or job descriptions that may limit advancement opportunities? Such policies should be revised.

Step 9: Support Authenticity

This step encourages building up the authenticity of others. Accept individuals regardless of their differences. It is also important to help them promote their uniqueness. This will help them to trust you and build trust across the work environment.

Step 10: Manage Perception

This step refers to the ability to be aware of how decisions and policies will affect those who are not part of the decision process. Sometimes our own good intentions are only a part of the equation. The key is to understand the impact such decisions may have on colleagues.

A New Revolution

For progress, change and a new revolution that will obliterate racism within the nursing profession, it is clear to me that it all starts with each of us. We need to be and model the change behavior that we want to see happen within the nursing profession. It takes all of us, from students to early career nurses to nurses at the highest level of management, to denigrate this evil. We can never stop being the change we want to see. As leaders, we must come together at the local, state, and national level and commit to sustainable efforts to address racism and discrimination and basic human rights. We must hold ourselves and our leaders accountable for committing to reforms and action.

Disclosure

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.