Overview and Summary: Racism and Nursing: Diverse Perspectives

Over a decade ago, I was a new PhD and a new faculty member who was working hard to publish my first article. I had done a study about the experiences of Latinx student in nursing (Moceri, 2010). A reviewer of the first journal where I submitted objected to my use of the term “racism” noting, “There is no racism in nursing because nurses care and therefore they cannot be racist.” I saved that quote for just this time. Later, I did publish in a different journal, but when I undertook another study about the prevalence and experiences of racism in the nursing workplace as experienced by Latinx nurses (Moceri, 2012; Moceri, 2014), I was much more cautious. Instead of calling the phenomenon I was exploring “racism” in the nursing workplace, I softened the term to “bias.” As I look back in light of how much I have learned about racism, I see that I chose to make an editorial decision that muted the topic of racism. Further, I now believe that feeling forced to change language in order to be published is in itself a form of oppression.

Over the past decade, there have been several nurse scholars who have studied and written about racism, but the information has not necessarily reached the broader nursing audience. It is my observation that congruent with my experience, there has been a sense that speaking of racism in a more nuanced fashion might help those who have difficulty accepting that it is endemic in nursing to hear more easily. However, the murder of George Floyd and the subsequent social unrest of the summer of 2020 demonstrates that it is past time for louder, more plain-speaking voices about racism and professional nursing’s role in not only supporting change, but providing solutions in both the realms of nursing education and nursing practice. In fact, The National Academy of Medicine’s newly published “The Future of Nursing 2020-2030” (NASEM, 2021) calls for nurses to lead in addressing racism and promoting health equity.

I would not be the first person who draws a similarity between racism and cancer, but as a cancer survivor, the analogy is undeniable. First, cancer can be insidious. I attributed my lower back pain symptoms of renal cell carcinoma to poor posture and an ill-fitting office chair. I decided that the overwhelming fatigue I was experiencing must have been from stress. It never occurred to me that I could have cancer until it was spotted as an incidental finding on a computed tomography (CT) scan. Upon reflection, I was able to recognize more than one early symptom of my cancer. Often, it takes deep reflection, along with an unexpected opportunity for a different perspective that helps us to recognize racism for what it is. Second, to eradicate cancer requires immediate, aggressive action. Asking it to simply leave my body or naming it a “minor” growth would not have been effective. Rather, it required excision, followed by healing, and while not my case, it could have required immunotherapy and/or radiation to eradicate it. Racism only fulminates if left unchecked, and so it is imperative to dismantle it. Finally, cancer such as mine requires regular surveillance for many years to come to ensure it has not returned, and then to treat it aggressively if it does. Likewise, racism requires being vigilant that new racist structures and policies do not replace older forms that have gone by the wayside. An example of this is that few people spew racist epithets on a daily basis for all to hear. Rather, it is the structures and policies, and the implicit biases that support those structures that have taken the place of overt racism in most professions like nursing.

The radical efforts required to eradicate cancer are not unlike the radical, often difficult steps that are required to eradicate racism. It may not always be pleasant, and it can often be painful, but the end result will lead to a more just world, and greater health equity. It is worth the effort, lest we risk living in an illusion that diminishes the reality of racism, similar to the illusion that I did not have cancer.

What efforts are we as a nursing profession willing to make? Nursing has often been called the “caring profession” and remains among the most trusted. This contributes to the illusion that racism is not a major issue, and the illusion supports silencing of voices that are striving to be heard. This OJIN topic takes on the issue of racism with the recognition that nurses, nursing students, and our patients and clients suffer as a result of racism. We must work to eradicate it from the nursing profession. This need extends from nursing education, to clinical practice, to leadership at all levels and in all areas of nursing.

The introductory articles in this issue, when taken as a whole, are a powerful call to action, both personally and professionally. They provide a wide range of ideas and concerns that demonstrate not only how pervasive the problem of racism is, they also provide useful insights and strategies to address racism in multiple realms related to nursing. These articles will provide you with valuable insights, novel approaches, and an opportunity for deep reflection as you are invited into the work of recognizing, dismantling, and eradicating racism from the nursing profession.

The article by Iheduru-Anderson and Wahi, “Race and Racism Discourse in U.S. Nursing: Challenging the Silence” walks us through and addresses a history of nursing discourse around racism in the United States. Its review of how racism has been discussed or avoided in nursing in the past, with a critique of the usage of the term “cultural competence” as an early means of addressing diversity, but one that also supported silence related to racism, is an interesting read. The authors describe how a white colorblind ideology effectively mutes meaningful discourse about racism in nursing, which has been historically difficult for nurses to acknowledge and discuss. The authors go on to provide several theoretical approaches to address racism in nursing including strong support for Critical Race Theory, anti-racist interventions, and specifically norm-critical skill building. The article concludes with a call to nurses, and especially nurse leaders, to cease teaching about cultural competence and replace it with teaching norm-critical discourse and thinking, because former and currently employed discourses have not reached their intended goal of addressing racism in nursing.

“Rhetoric, Racism, and the Reality for the Indigenous Māori Nursing Workforce in Aoteroa New Zealand“ is a call to account by authors Wilson, Barton, and Tipa that provides a profound summary and critique of issues related to racism faced by Indigenous Māori nurses in Aoteroa (New Zealand). This is in contrast to the rhetoric around ending discrimination the authors also describe. The article traces the history of equity work by Māori nurses, with a focus on cultural safety as essential for supporting the cultural and spiritual needs of Māori patients, nurses, and nursing students. It provides compelling information about the burden to provide cultural safety to Māori patients that Māori nurses feel, as well as the burden of responsibility to address issues of racism. The article describes how health equity would be improved by more Māori people in the nursing workforce with a greater voice in support of Indigenous patients. This information is applicable to Indigenous people in many areas of the world, so as you read, I encourage you to make the added effort to apply it to your country of residence.

The third introductory article by Fields, Wharton, Ackerman-Barger, Lewis, and Beard, “The Rise of Diversity, Equity, and Inclusion (DEI) Practitioners in Academic Nursing” begins with the premise that diversity in the nursing workforce is a value of nursing, and continues with an insightful discussion about why the nursing profession has had difficulty in realizing its objective of increasing diversity in nursing. Their data on the racial/ethnic composition of nurses in the United States compared to the general population is thought-provoking, albeit discouraging, with its demonstration that past efforts and strategies have been insufficient. The data is then used to support their proposal for including a DEI practitioner in schools of nursing. Many colleges and university have diversity officers, but the authors make a strong case for why it is necessary in the unique setting of academic nursing. They set forth important, practical information on best practices for hiring and implementation of a DEI practitioner in schools of nursing. Their descriptions of scope, title and authority, time needed, salary, and resources provide a clear pathway toward acquiring and supporting a DEI practitioner in nursing education. Finally, they describe the impact such a position could have to support improved health equity.

The themes in “Black Nurses Scholars’ Experiences in an Interdisciplinary Postdoctoral Fellowship,” by Montgomery and colleagues, provides a compelling window into the barriers and supports that have impacted these scholars' firsthand experiences. The themes presented from the study describe a journey of discovery that begins with working as a member of an interdisciplinary team of postdoctoral students and concludes with the scholars engaging in work to promote equity and inclusion. Tracing the progression of these themes with the supporting quotes was moving in terms of how mentoring and social support were particularly meaningful to the Black scholars, as integral components of their collective success. The article stresses the importance of postdoctoral fellowships to increase diversity of scholars, and suggests that part of an interdisciplinary fellowship could be engaging in anti-racist work with communities.

Transracial adoption, and the health implications for adoptees throughout their lives is a topic that may not be top of mind for many nurses, but deserves our attention and action. In “Racial Identity and Transcultural Adoption” authors Castner and Foli introduce us to the unique health disparities of those who are transculturally/transracially adopted. This article provides us with salient information about the history of transnational and transracial adoption in the United States, the relevant laws that have been put in place to address the best interest of the children who are adopted, as well as some of the challenges adoptees face as they work through developing both a family and racial identity. I found it compelling to read how the "best interest” of children has been socially constructed over time, and how it often stemmed from a lesser view of Black families as being qualified for adoption or even keeping their birth children. Of key importance is the approach of using trauma informed care as a way for nurses to best provide care and mitigate discrimination, bias, and stigma, all of which lead to health disparities in this population. Of particular use is the clear description of trauma informed care practice, and then a table of how to implement trauma informed care in various scenarios for this special patient population.

The journal editors invite you to share your response to this OJIN topic addressing Racism in Nursing either by writing a Letter to the Editor or by submitting a manuscript which will further the discussion of this topic which has been initiated by these introductory articles.

Author

Joane T. Moceri, PhD, RN
Email: moceri@up.edu

Joane T. Moceri is a Professor and Associate Dean for Faculty Affairs at the University of Portland, School of Nursing, where she previously served as Dean. She has taught in DNP, MSN, BSN, and AA nursing programs. She has dedicated her academic nursing career to increasing diversity in nursing through advancing equity. Dr. Moceri has designed holistic admissions programs, focused scholarships, and support structures for underrepresented students in nursing. Her research focus is racism and equity and how to best support new and diverse nursing faculty.