- Nearly half of all nurses report they have experienced racism in the workplace.
- Combating racism in healthcare helps promote healthcare equity, where everyone has a fair opportunity to attain the highest level of health.
- Nursing plays a unique and critical role in developing and implementing anti-racism resources that can help promote health equity.
According to 2021 findings by the National Commission to Address Racism in Nursing, nearly half of nurses reported they experienced racism in the workplace. More than 5,600 nurses responded, telling the researchers that the racist acts were principally from colleagues and others in positions of power.
While 57% said they challenged racism at work, 64% of those said there was no change that resulted from that challenge. Combatting racism in healthcare helps promote health equity, even when racist acts are aimed at colleagues.
Explore health equity, how racism impacts it, and resources for nurses to combat racism and advocate for health equity as a nurse.
What Is Health Equity?
According to the Centers of Disease Control and Prevention (CDC), health equity "is the state in which everyone has a fair and just opportunity to attain their highest level of health." The Robert Wood Johnson Foundation adds to the definition removing obstacles and lack of access, including poverty, discrimination, and healthcare. They base this definition on ethical and human rights principles.
This is to provide greater clarity, which may lead to improved health equity across populations. The foundation believes there are four key steps to achieving health equity:
Identifying health disparities that are rooted in inequities in opportunities and resources
Changing and carrying out policies, laws, and practices to reduce inequity across opportunities and resources
Evaluating and monitoring efforts using specific short- and long-term measurements
Reassessing these strategies in light of the outcomes and planning next steps
The authors of the report note that equity is not the same as equality and those who have fewer resources and worse health may need greater effort to improve their health. Resources that promote health equity include food security, access to healthcare and a safe environment, and safe housing.
Achieving the promise of health equity requires that people are valued equally. This requires society to focus on contemporary injustices, overcoming economic and social obstacles, and eliminating preventable health disparities.
According to the CDC, preventive efforts may be affected by social determinants of health, like poverty, lack of education, and racism. The occurrence of diseases in greater numbers in some groups of people — such as HIV, sexually transmitted diseases and infections, and tuberculosis — demonstrates health disparities in these groups.
The Nurse's Role in Health Equity
The COVID-19 pandemic highlighted many of the health disparities and inequities in the current healthcare system. Although progress has been made in the past decade, more resources should be devoted and more attention paid to the conditions that affect access to healthcare and overall health and wellness.
Nursing plays a unique and critical role in the development and use of these resources. Much of nursing education focuses on the treatment and management of disease. However, this has been changing to include social determinants of health and addressing social needs that improve healthcare access.
Nurses are strong patient advocates who have addressed the social needs of patients in a clinical setting for decades. Yet a nurse's work does not end when they go off shift. Nurses are perceived as healthcare experts in the community and their role in engaging in the community is expanding.
Before advocacy, healthcare professionals must be aware of the challenges, understand the assistance that may be available, and align themselves with these assets to invest and deploy them.
Only then are advocacy activities beneficial as they address the current needs of those who do not experience health equity. Frontline workers are vital in identifying health disparities and partnering with healthcare and community organizations to make resources available to patients.
Nurses' central advocacy role does not end in healthcare but extends to legislative efforts. Legislation can establish financial support for programs aimed at populations of people with poor access to healthcare and who live in unsafe environments.
Combatting Racism in Healthcare Promotes Health Equity
Health inequities during the pandemic took a disproportionate toll on Black and brown people. Leaders within the healthcare system have named racism a public health threat and pledged to reverse policies and practices promoting racist behaviors.
An open letter published by the University of Chicago Medicine was signed by 36 Chicago hospitals. It called for actions to reduce health disparities by investing in communities of color and creating more equitable workplaces for employees.
The letter named contributing factors, including housing, schools, food insecurity, poor access to healthcare, and violence. It said, "All of these factors contribute to health inequities in our communities. And they serve as a recipe for pain, suffering, premature mortality — and understandable civil unrest."
Systemic racism raises generational trauma and poverty. It can also trigger higher rates of illness and death. The hospitals recognized that many who work in them do not understand the struggle that racism creates. However, they committed to overcoming this significant factor contributing to healthcare disparities.
Healthcare providers and legislators must acknowledge that hate, racism, discrimination, implicit bias, and microaggression have historically played, and continue to play, a role in contributing to health disparities.
5 Anti-Racism Resources for Nurses
It is necessary for nurses to acknowledge their biases and racist beliefs while educating themselves to be aware of their word choices and actions using anti-racism resources for nurses.
Nurses are in a crucial position within the healthcare system to influence others and promote greater healthcare equity. These five categories of resources can help nurses reach this goal.
Start at Home
The American Nurses Association is a strong advocate for diversity, equity, and inclusion across education, research, and practice. Nurses can begin by taking small steps at home that help them to address their discriminatory behaviors.
It is essential to acknowledge societal inequities even if you have not personally encountered racism. Next, evaluate your thoughts and feelings relating to people of color or a different culture. Racism is often subtle. A change in body language, a joke, or a remark under your breath are patterns that you may have learned at a young age.
Understanding and acknowledging biases as well as cultural competency can help nurses to support systemic change in the organization, community, and government. Adopting a patient-centered approach that respects a patient's religious, spiritual, and cultural preferences is a smart first step toward creating an environment to reduce healthcare inequity.
Unconscious Bias Training
This anti-racism resource for nurses was developed by the University of California, San Francisco. It acknowledges that while popular, it does not have evidence that this resource changes behavior.
However, unconscious bias training is a step toward greater awareness of your own biases that can affect patient care and your social relationships.
- Together, We Can Make a Difference: A 12-Step Plan to Address Racism and Unconscious Bias:
Conversations or initiatives that address inclusion or reducing racism can be overwhelming. This toolkit offers 12 steps to help organizations begin including initiatives that address racism and health disparities.
- Diversity Toolkit: A Guide to Discussing Identity, Power, and Privilege:
This guide was developed by the University of Southern California and offers information and group activities to identify bias and racist behaviors. Group discussions and activities help individuals break down barriers. It also offers opportunities to develop strategies within the organization to address racism and healthcare inequities.
Videos, Books, and Podcasts
Several organizations have developed lists of anti-racism resources for nurses that you can access:
- Anti-Racism Resources:
This Google Document starts with links to help parents or guardians raise anti-racist children. The document continues with lists of articles, podcasts, books, videos, and films to broaden your horizon, identify your biases, and inform.
- "I Can't Breathe": A Call for Anti-Racist Nursing Practice:
This call to action asks nurses to recognize their biases, confront inequities, and take a new approach.
- Do Words Matter? Stigmatizing Language and the Transmission of Bias in the Medical Record:
This study looks at stigmatizing language used in medical records.
- Amanpour and Company: Robin DiAngelo on "White Fragility":
Excellent 10-minute interview addressing recognition of the author's own unconscious biases.
- The Impact of Racism on Child and Adolescent Health:
You can access The American Academy of Pediatrics policy statement on the impact of racism in children.
- Anti-Racism Resources for Healthcare Professionals:
This list from Seattle Children's Hospital includes links to readings, articles, podcasts, interviews, and webinars.
Websites and Organizations
- The African American Policy Forum
- Asian American/Pacific Islander Nurses Association
- Healthy African American Families
- National Alaska Native American Indian Nurses Association
- National Association of Hispanic Nurses
- National Association of Indian Nurses of America
- National Black Nurses Association
- North Carolina Environmental Justice Network
- Nurses for Social Justice
- Philippine Nurses Association of America
- Society for the Analysis of African American Public Health Issues
Defining health disparities. (2020). https://www.cdc.gov/nchhstp/healthdisparities/default.htm
Health equity. (2022). https://www.apha.org/topics-and-issues/health-equity
How to combat racism in nursing. (2021).
It is undeniable: Racism is a public health crisis. (2020). https://www.uchicagomedicine.org/forefront/news/it-is-undeniable-racism-is-a-public-health-crisis
Survey shows substantial racism in nursing. (2022).
The role of nurses in achieving health equity. (2022). https://www.community-insights.org/blog/the-role-of-nurses-in-achieving-health-equity#!
What is health equity? (2022). https://www.cdc.gov/nchhstp/healthequity/index.html
What is health equity? (2017). https://www.rwjf.org/en/library/research/2017/05/what-is-health-equity-.html
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