Creative Nursing

The structures that maintain systemic racism frequently keep us from seeing and valuing the full humanity of all those around us, especially when they are of a different race. This article describes a process to create safe dialogues between people of different races to inform our understanding of systemic racism so that we can work together to end its reign.

The National League for Nursing, the American Nurses Association, and the American Association of Colleges of Nursing each have published directives or position statements that support initiatives that would diversify faculty in nursing education; some initiatives very specifically address increasing diversity within nursing faculty leadership ranks. Despite support for these initiatives, there is a lack of faculty members of color in higher-level leadership positions in nursing academia. This article explores two questions that unfold contributing factors. Is the absence of faculty members of color due to historical exclusionary practices of institutional racism? Or is it due to components of internalized racism that may cause faculty members of color to devalue their own potential and ability to rise to leadership roles? Either answer helps explain how entrenched white supremacy continues to be a barrier to diversifying nursing academia. Are we strong enough to dismantle the obstacles to achieving diversity in nursing academic leadership?

In order to promote health equity and support the human rights mandate contained in the American Nurses Association's Code of Ethics for Nurses with Interpretive Statements, the nursing profession must understand historically the creation of race, white supremacy in the United States, and entrenched racial terror and brutality toward black and brown racialized populations. Considering the limited racial diversity in the nursing profession despite its stated mission to increase diversity, the profession must build a path to understanding antiblack racism as a historical trauma that remains to this day, a path that encompasses antiracist ideology. Antiracism education is critically needed at the pre-professional and professional levels, for nursing students, providers, educators, administrators, and researchers to inform our own understanding of bias within the contexts of our educational and health-care systems. Dismantling racism requires an enduring commitment to the ultimate goal of social justice for ourselves, our patients, and our communities. This article presents antiracism actions that nurses should employ to dismantle racism, focusing primarily on personal-level initiatives, with self-work as the starting point.

There have long been challenges associated with integrating knowledge about diversity, disparities, and determinants into nursing curricula. Villarruel, Bigelow, and Alvarez describe these concepts as the three Ds about issues of disconnects and discrimination. These disconnects are evidenced by years of communicating the desire to reduce or eliminate disparities, without improvement in the education of future nurse professionals to prepare them to help achieve this goal. Over 10 years ago, Allen reviewed the literature on evidence to guide teaching on cross-cultural care and antiracism in nursing education, yet very little has changed. It is essential that academic nursing weaves health equity concepts throughout all programs, and establishes and maintains competency in and commitment to addressing health disparities, inequalities, and inequities. This article provides evidence of continued bias and racism, and suggestions for curricular change and student and educator training, in order to rebuild and solidify a nursing curriculum that is nonbiased and inclusive. The suggestions include a deeper look at the structures of the organization and the systemic culture, to ensure that racism is being combated as well.

Discussing racism is challenging for nurse educators and nursing students, because White privilege and racial inequities are deeply embedded and normalized in our societal structures. Avoiding the topic of racism in nursing education renders White supremacy invisible and serves to perpetuate racial discrimination and disparities in health care. Nursing education has the potential to train both faculty and students to recognize and dismantle oppressive attitudes, structures, and practices that have led to negative health outcomes for patients. Equipping nurse educators with the tools to understand and address White supremacy as well as to educate themselves and their students about antiracist language, self-care, and patient care is an important step toward promoting health and creating an antiracist society.

In the United States, nursing education programs at mostly white institutions are led by faculty that are 80% white. This absence of diversity is a symptom of systemic racism and white supremacy reinforced through built systems of inequity and economic constraints that influence accessibility of nursing education programs. White cultural norms drive standards of professionalism and assimilation within nursing education programs. These standards are formulated from white cultural supremacy and contribute to the unconscious biases of nursing faculty. It is necessary to examine these biases to reduce potential and realized inequities for students of color in current nursing education programs. Challenging and changing these cultural norms can contribute to the dismantling of systemic racism and white supremacy in nursing education and the profession of nursing, thereby increasing the diversity of the professional workforce.

Since the early 1990s, the Institute of Medicine has identified the need to increase the number of ethnic minority nurses to improve access to care and eliminate health disparities in these populations (Institute of Medicine, 1994, 2011). American Indians (Al) and Alaska Natives endure the highest rates of poverty, depression, addiction, suicide, domestic violence, and diabetes in the United States (Sarche & Spicer, 2008). With the disadvantages Als face, nursing schools have difficulty recruiting, retaining, and graduating Al nursing students. Based on the guidance needed by Al nursing students, a program called Niganawenimaanaanig was specifically designed to provide holistic support for these students to improve their chances of successfully completing the baccalaureate nursing program. This program, funded through a Health Resource Services Administration Nursing Workforce Diversity grant, was begun at Bemidji State University in Minnesota, proximal to three of the largest Ojibwe reservations in the state. Once enrolled in Niganawenimaanaanig, students are provided comprehensive care within a unique cultural, academic, and social support framework. Tuition scholarships and monthly stipends provide crucial financial relief to students once they are accepted into the 4-year prelicensure or RN-to-BS nursing programs. In Niganawenimaanaanig's first 2 years, the number of Al students declaring nursing as a major increased by over 600%, and the program has retained 100% of their prenursing freshmen. At the heart of Niganawenimaanaanig is a grounding in Al culture that empowers and fosters resilience among nursing students, which is a relevant and recreatable concept for schools seeking to recruit and retain ethnic minority nursing students.

The author, James C. Burroughs II, is Chief Equity and Inclusion Officer at Children's Minnesota, one of the largest freestanding pediatric health systems in the United States. This article presents the structure of a thriving Equity and Inclusion (E & I) Department as well as stories of their successes, culminating in practical suggestions for organizations wishing to develop their own E & I departments and/or initiatives.

Allyship is a term used to describe white people who support, defend, and protect people of color and Indigenous people. This article moves past the notion of “ally” as an identity and “allyship” as a course of action into “antiracism” as a lifelong journey. Addressing her fellow white people—and particularly white Americans—the author handles this subject in three parts: (1) admitting that we live in a world that centers whiteness constantly, (2) using reflection to neutralize our defensiveness and understand our own motives, and (3) understanding our responsibility to stay present even when our trauma has been triggered. The article culminates in a reflection on what it could mean to increase our emotional maturity—that is, to “grow up and grow out” of racist ways of thinking, being, and doing.

Using theory as a framework for community-based interventions in African American members provides the principles and guidance needed to generate nursing knowledge. However, choosing an appropriate theoretical framework to guide community-based interventions can be challenging. The aim of this manuscript is to examine the use of three historical models or theories (the Health Belief Model, the Theory of Planned Behavior, and Bandura's Self-Efficacy Theory), which are still being used today, to better understand their applications in community-based interventions.

After controlling for education, socioeconomic status, and genetic factors, Black and African American patients in the United States are three to four times more likely to die in childbirth than are White patients. The literature is replete with strategies to improve maternal outcomes for Black and African American patients. Existing strategies focus on addressing poverty and individual risk factors to reduce maternal mortality, yet maternal outcomes are not improving for these patients in the United States. Recent literature suggests that a nuanced approach that considers the effects of individual and structural racism could improve maternal outcomes, especially for Black and African American patients. As nurses comprise the largest component of the health-care system, their collective power and influence can provide a powerful tool for dismantling structural racism. Some important concepts to consider regarding the care of the Black and African American population are cultural intelligence (CQ), allostatic load, and humanitarian ethos. By developing CQ and consistently including the four CQ capabilities (drive/motivation, knowledge/cognition, strategy/metacognition, and behavior/action) in all aspects of practice, nurses can help to uproot racism and cultivate experience to improve maternal health outcomes for Black and African American patients.

Historians and scholars from varied disciplines acknowledge the existence of race-based discriminatory policies at the turn of the 20th century. However, little attention has been given to how the Freedmen's Bureau and Black Codes in post-Civil War Reconstruction shaped and impacted social behavior within the nursing profession. This article sheds light on the origins of incivility in nursing by taking a closer look at how early Reconstruction-era policies, structures of hierarchy in the U.S. armed forces, and its nursing corps and in the Red Cross, impacted the profession. The argument is made that the tandem workings of these policies and organizations, which produced racially insensitive and discriminatory practices, primed and erected systems of structural racism that perpetuated incivility within the nursing profession.

As an African American male working in public health, the author has few peers in the field who can related to his experiences from a gender and race standpoint, and even fewer in his work as a doula and lactation educator. His work and experiences as a trail blazer in this field have involved a lot of emotional labor, but have been a blessing and a joy as well as providing him with a unique lens into the world of birth work and how nuances at the intersection of gender and race affect his peers.