Written: 6/17-6/18

"Today it is Black Lives Matter. Tomorrow it could be Hispanics, Asians, LGBTQ, mental health… The discrimination faced today sets a precedent for all." - Carter Todd, MS, RN, CCRN, President of Capitol City Black Nurses Association

Racism in healthcare is an under-discussed topic...

And there are many barriers that contribute. In this issue of the Pioneer, we unpack our findings on what those barriers are as we develop plans for action.

It is important to remember, that while we, the nursing profession, are particularly focused on racism against Black lives at this time, these same barriers will occur as discrimination is highlighted elsewhere. We do not expect Black nurses to stand alone in this fight, nor should we expect anyone else experiencing discrimination to.

Also, a special thank you to Brooke Newman, MSN, RN, our ANA\California Volunteer, who helped gather key pieces of information to support this issue.

Together, we march on...

-Your ANA\California Team

48% of nurses have experienced racial discrimination or disadvantage directly in the past 12 months. But even for those who haven't experienced it directly, nearly two-thirds of nurses say they've observed racism, according to a survey of 1,000 nurses.

But despite racism's prevalence in the workplace, it is rather difficult to quantify. And that's likely because...

Racism isn't always a bold display of discrimination... it lives just as strong in small omissions and negligence. "The racism perceived by nurses was covert in most cases, but in some cases it was quite obvious, and it caused them considerable distress and confusion, " stated research conducted by the British National Health Service (NHS)

With an ethical obligation to provide care without discrimination, it's no surprise nurses stand in unity against racism. Thousands of nurses attended Black Lives Matters protests in recent weeks, speaking out against racism, starting #whitecoatsforblacklives, and aiding injured protesters.

Yet, attending protests, while a strong act of support, won't create the change needed to eliminate racism against our fellow colleagues. Instead, looking at diversity and inclusion measures within our own workplaces will help us create a list of asks like this.

Simple, right? Let's start the discussions. Hold on, not so fast... Despite a shared need to advocate against racism, many nurses find their well-intended conversations often devolve into heated debates about political ideologies and semantics. And nurse managers were no exception to this.

Last Thursday we started our first Racism in Healthcare Dialogue Forum , seeking to uncover barriers like this facing nurses in California. So we invited Carter Todd, MS, RN, CCRN (President of Capitol City Black Nurses Association), Phillip Bautista, BSN, RN, PHN (Board Vice President of ANA\California), and Annie Tat, MS, BSN, RN-BC, PHN, to join Dr. Marketa Houskova DNP, MAIA, BA, RN (Executive Director of ANA\California) to better understand the context behind racism in healthcare.

"I'm an Asian-American, and that makes me a person of color, but that does not mean I've gone through the struggles that my Black brothers and sisters have, nor do I fully understand their struggle," Annie Tat explained as she recalled a recent experience she had with co-workers.

Two Sigma Theta Tau nurses we reached out to - one in management - echoed this sentiment saying they were "uncomfortable" with the topic... even opting for anonymity because they were terrified of employer retribution.

Queue, barrier number one... albeit a complex one:

  1. How do we advance our actions against racism in healthcare if staff nurses are unable to have constructive conversations among each other?
  2. How does management help facilitate group conversations when even they are uncomfortable leading the dialogue?
  3. And finally, how do we protect nurses' employment as they try to navigate these conversations?

This isn't to say nurses haven't been educated on racism in healthcare... Bachelor programs often include courses on cultural competency, and Master and Doctorate programs include discussions on diversity and inclusion in healthcare.

While undoubtedly important conversations, these courses discuss racism through one lens - institutional racism in healthcare towards patients. They do not focus on racism towards healthcare professionals. Perhaps this is because educators, too, face uncomfortability in discussing racism with fear of retribution. One thing is for sure, this topic hits close to home...

“No one talks about racism and the impact. I recommend that we start the education process in nursing school. I have been discriminated against for being a black nurse on the unit. I will not stop until people discontinue race qualification,” says Kechinyere "Kechi" Iheduru-Anderson, DNP, RN, CNE, CWCN, Director of Nursing at Central Michigan University and published author with evidence-based literature on this topic.

Queue, barrier number two...

  1. If our nursing students are not taught about racism encountered in the workplace, when will they learn how to have constructive dialogue about a topic two-thirds of our nursing population is encountering?
  2. How to do develop resources and tools to help educators facilitate these discussions often among large and diverse groups?

But it's not all doom and gloom. Healthcare leaders are taking steps to advance conversations about racism in healthcare, diversity, and inclusion.

On June 5, 2020, UC Davis Health's Associate Vice Chancellor for Health Equity, Diversity, and Inclusion, Hendry Ton, M.D., M.S., announced an Action Plan. "There is a longstanding epidemic of racism that manifests in loss of life and health and creates barriers to education and economic well-being... On its own, though, this message is just words if not followed by determined action," Hendry Ton said, highlighting four key areas of their plan: healing together, learning together, acting together, marching together.

In particular, the Action Plan includes  training faculty and clinicians to address racism and other forms of bias in the learning and training environment. "Upon completion of this series, participants will be able to apply cultural humility to empower their teaching, identify the key elements of curricular content that contribute to the cultural microaggressions that impede learning, and develop self-management and communications skills to navigate difficult interactions that impact cultural safety."

And so we're already setting up our second Racism in Healthcare Dialogue Forum to gather additional recommendations to the barriers discussed in this newsletter. We've invited executive leadership such as the President of California Association of Healthcare Executives, the 15th President (2012-2014) of the National Association of Hispanic Nurses and Board Member (2019-2021) of the American Academy of Nursing, Chief Nursing Officers from southern California and many others, so stay tuned!

Note #1: As we move beyond discussions towards action, it is important to evaluate the effects of our planned actions the same as we would with a sick patient. Will a policy statement on it's own change the culture within our care facilities? Probably not. As this nurse expressed, "I too would like to see Sigma have a more active role besides policy statements that are empty if not followed up with action. I'm an older white guy who would be happy to serve on a team, committee, whatever, to really start to address this with action, not with just policy statements. I challenge the BOD to actively start working on this issue!” (Sigma Theta Tau anonymous nurse)

Note #2: You may have noticed there was no discussion about the involvement of elected officials in this Pioneer. This does not go unnoticed. The relationships we do - or don't - have with state and local representatives stand to benefit from the same conversations nurses are trying to have within their workplaces. It is important to record the consensus among nurses, through stories and data, and distribute this to those who represent us at the highest levels. At ANA\California, we're interested in collecting your stories to use in messaging to state representatives, media, and other influencers in California. Email us.

Additional Resources for you:


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