“Racism assaults the human spirit in the form of biases, prejudices, and an ideology of superiority which persistently causes moral suffering and perpetuates injustices and inequities.”

Nursing’s Racist Roots

African women who were enslaved provided the bulk of nursing care (https://nursingclio.org/2021/01/07/african-americans-slavery-and-nursing-in-the-us-south/) on U.S. plantations in the early 1800s. In 1879, Mary Eliza Mahoney became the first Black nurse to graduate from a formal program but later left nursing because of incessant discrimination (https://www.womenshistory.org/education-resources/biographies/mary-mahoney). In 1925, Ethel Johns, a nurse from Canada, documented racism in nursing across the United States, but the Rockefeller Foundation never released the report, Henderson said.

Since the desegregation of the military, including the Nurses Corps (https://www.smithsonianmag.com/history/armys-first-black-nurses-had-tend-to-german-prisoners-war-180969069/#:~:text=Despite%20the%20discrimination%20they%20faced,the%20entire%20military%20in%201948.), in 1948, nursing associations have revised outdated bylaws and eliminated membership exclusions based on race. However, Henderson explained, BIPOC nurses still face explicit and implicit bias, microaggression, and overt discrimination (https://voice.ons.org/stories/what-it-feels-like-to-be-a-nurse-of-color) from patients and colleagues.

The Reality for BIPOC Nurses

Henderson said racism is prevalent in nursing education and persists from entry to executive levels. BIPOC nursing students face unfair assumptions and barriers when obtaining degrees and certifications, including:

• Dissuasion from pursuing a nursing career
• Lack of acknowledgment of their role or credentials
• Perpetuation of stereotypes
• Presumption of incompetence
• Retaliation

The discrimination continues after graduation, Henderson said. Some of the barriers BIPOC nurses confront, invisible and observed by others, include:

• Credit stolen by peers
• Disparities in wages
• Outright denial of opportunities and advancement

As a result, less than 1% (https://www.nursingworld.org/news/news-releases/2021/leading-nursing-organizations-launch-the-national-commission-to-address-racism-in-nursing/) of university deans and chief nursing officers come from diverse backgrounds.

How to Improve Practice

Systematic racism has detrimental effects on all members of the healthcare community, from patients and providers to institutions and communities. Henderson urged fellow nurses to take accountability (https://voice.ons.org/stories/nurses-have-a-role-and-responsibility-in-ending-racism). Clinicians have a responsibility to educate themselves on the perspectives of their BIPOC patients and colleagues. As a nurse, have the difficult conversations about power and privilege. Gain understanding about how racism shapes the student and nurse experience. Advocate for antiracism throughout health care.

Henderson also said that personal reflection to gain self-awareness is just as crucial as assessing and changing exclusionary policies, practices, procedures, regulations, and traditions.

In How to Be an Antiracist (https://www.ibramxkendi.com/how-to-be-an-antiracist), author Ibram X. Kendi discussed the ethics, history, legislation, and science surrounding racism in the United States. Henderson also referenced the National Black Nurses Association (https://www.nbna.org/history) and the National Association of Hispanic Nurses (https://www.nahnnet.org/), two organizations that partnered with other nursing leaders to form the National Commission to End Racism in Nursing (https://www.nursingworld.org/news/news-releases/2021/leading-nursing-organizations-launch-the-national-commission-to-address-racism-in-nursing/), which meets monthly to discuss and develop strategies to address systemic racism. Nurses can also review the National Academy of Medicine’s Future of Nursing report (https://voice.ons.org/advocacy/the-future-of-nursing-charts-a-path-to-achieve-health-equity) for more strategies for advancing health equity. 

Henderson closed the keynote with a quote from fellow nurse and diversity advocate Katie Boston-Leary, PhD, MBA, MHA, RN, NEA-BC:

“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.”