American nursing history, as it is usually taught, credits Florence Nightingale as the pioneer of the modern nursing model, often excluding the black nurse experience and leaders. But there was another “lady with a lamp,” Jamaican nurse Mary Seacole. She worked as a volunteer nurse during the Crimean War along with Nightingale.
Though she was not chosen to go to the frontlines in Nightingale’s nursing envoy, Seacole used her own money to travel and care for wounded soldiers.
Other figures of note in the history of nursing include Lawrence Washington, who in 1967 became the first black man to receive regular commission in the U.S. Army Nurse Corps. James Derham, a slave from New Orleans, bought his freedom while working as a nurse; subsequently, Derham became the first black person to practice medicine as a physician. In 1931, Estelle Osborne became the first black nurse in the United States to earn a master’s degree, and in 1955, Elizabeth Lipford Kent became the first black nurse to earn a Ph.D. These pieces of history should not be overlooked.
Throughout my years as a nurse, I’ve often found myself looking for a familiar face. I do not see many minority leaders in the workplace. While black RNs and LPNs continue to move up the educational and professional ladders, we seem to have reached a plateau when it comes to executive and leadership positions.
Nurses of all races continue to struggle for equality in the workplace. While attempting to write about this difficult subject, it occurred to me that I might have bitten off more than I could chew. Despite the efforts of multiple parties, including the National Black Nurses Association and the federal Health Resources and Services Administration, research relating to minorities in nursing leadership positions was, at best, dated or nonexistent. More than anything, this reinforced my belief that the subject needs exposure. The goal of this article is to encourage a dialogue within the profession and promote resources for black nurse leaders.
Nurses of color, as well as men, comprise a disproportionate number of nursing professionals compared to the U.S. population. The most current research from the U.S. Department of Health and Human Services shows African Americans and Hispanics represent 4.2% and 3.1% of nurses respectively. (The numbers of Asians, Native Americans, and American Eskimos are considerably lower.) In the larger national population, African Americans and Hispanics comprise a full 25%. Nurses must discuss the issue of race openly and honestly, with love and respect.
Barriers
Nursing is an excellent career field offering a myriad of varied opportunities and a way to give back to one’s community. It’s also a field requiring ample education. A significant barrier minority youth face when applying for college admission is a lack of preparation for higher studies. Minorities must be exposed to the field while still in elementary and middle school to ensure they see nursing as a viable profession. A universal effort must be made to increase the number of blacks and other ethnic minorities entering nursing programs. Part of that effort falls on the shoulders of current nurses, whose community involvement, advocating for nursing in schools and even at home, can help introduce young people to this promising and fulfilling career. However, completely “leveling the field” in education requires changes in public policy. Vital partnership programs that meaningfully bond nursing schools with local schools and youth organizations are needed to support and develop an education channel. In short, a universal effort must be made to increase the number of blacks and other ethnic minorities entering nursing programs. Nurses can and do make a difference in government policy by contacting their congressional representatives, writing editorials for newspapers and magazines, and working with community organizations to make their voices heard.
The melting pot
According to an April 2000 report prepared by the National Advisory Council on Nurse Education and Practice, a culturally diverse nursing workforce is essential to meeting the health care needs of the nation’s population. Black nurses are essential to the provision of health care services and influential in the development of models of care that deal with the unique needs of the black population.
This is not to say that outright racism has prevented nurses of color from moving up, necessarily. But where we see inequality, we must stamp it out.
Understanding how race is viewed in the working environment is an example of a complex task a nurse administrator is expected to deal with. Viewing the nursing profession as a melting pot is a great theory a nurse administrator could embrace and live by. Institutional prejudice in nursing may be grounded in maintaining it as the “all-white female profession.” However, this cannot be allowed.
The lack of black nursing and ethnic leadership has several economic implications as well, propelled by the nursing shortage. Research suggests this multifaceted shortage will continue for several years, increasing in severity and affecting virtually every area of health care. With the increasing need for nurses and nurse educators, employers need to be resourceful, encouraging the recruitment and promotion of minority nurses. Nurses need experience and advance degrees to fi ll faculty vacancies in nursing schools so these programs can expand to meet the current need.
Race remains a serious hurdle in the nursing field for blacks, even those with higher-level educations. I challenge nurses everywhere to reflect and take a closer look at their place of employment. Do they see diverse faces walking the halls? Does every nurse have access to the same opportunities, mentors, networks, and support systems? Can they turn to nurse leaders or mentors from diverse racial backgrounds?
It should be obvious to the nursing community that the black nurse is still struggling to achieve executive status in most cases. The proof is in the lack of research on this important subject. It is simply smart business for the nursing profession to draw their leadership from a widely diverse talent pool, one that is sufficiently represented by blacks and other minorities. Many areas of health promotion, education, prevention, and treatment have deeply embedded cultural factors. The advancement of black nurses to executive and leadership positions, because they have firsthand knowledge of these cultural health and lifestyle practices, may help ensure a higher quality of care for the black patient.
According to the American Medical Association, “Disparities in health care exist even when controlling for gender, condition, age, and socioeconomic status.” Recent studies conducted by the AMA show that despite the steady improvements in the overall health of the United States, racial and ethnic minorities experience a lower quality of health services, are less likely to receive routine medical procedures, and have higher rates of morbidity and mortality than non-minorities.
Looking forward
To assist in alleviating racial disparities in nursing, nurse leaders and nurses of all colors must take an active role in standing up for their underrepresented peers. Black nurses will continue to struggle to attain positions of leadership until productive methods to address racial issues are planned and fully implemented. Just like the United States Army has an aggressive and effective recruitment strategy, current leaders in the nursing profession might benefit from adopting some of their effective ideas and practices. These recruiting solutions need to be direct, enforced, and fully funded. Nurses must come together and work together to create and implement solutions that eliminate the struggle for ethnic advancement in nursing. The health of the American nursing profession, in addition to the health of all patients and consumers, depends on the continuous promotion of diverse health care employment, advancement, and education. The time for action is now.
References
Carnegie, M. (2005). Educational Preparation of Black Nurses: A Historical Perspective. ABNF Journal, 16:1, 6–7. Retrieved from CINAHL with full text database.
Davis, A. T. (1999). Early Black American Leaders In Nursing. Sudbury, M.A.: Jones and Bartlett Publishers.
Harrington, C., and C. E. Estes. (2004). Health Policy: Crisis and Reform in the U.S. Health Care Delivery System. Sudbury, M.A.: Jones and Bartlett Publishers.
Mingo, A. (2008). Barriers and Facilitators Affecting African Americans Continuation into Graduate Programs [sic] in Nursing. ABNF Journal, 19:2, 51–63. Retrieved from CINAHL with full text database.
Minority Nurse. (2000). Retrieved June 21, 2008, from: www.mndivi.wpengine.com.
U.S. Department of Health and Human Services (DHHS). Health Resources and Services Administration (HRSA). (2010). www.hrsa.gov.
A reader responds
We received the following message from Kahlil Demonbreun, R.N.C.-O.B., M.S.N., W.H.N.P.-B.C., A.N.P.-B.C., in response to one of our fall 2010 Second Opinion pieces, “Looking for Black Nurse Leaders: A Call to Action,” by Regina G. Goldwire.
“I wanted to take several moments to state how much I enjoyed her article,” Demonbreun writes. As a nurse of male gender who has practiced roughly 10 years in labor and delivery (holds national certification as an inpatient obstetric nurse), 12 years in women’s health (nationally certified as a women’s health nurse practitioner)—not sure if there are any other males in the country holding those credentials—and nationally certified as an adult nurse practitioner, who is also African American, I agree: ‘The health of the American nursing profession, in addition to the health of all patients and consumers, depends on the continuous promotion of diverse health care employment, advancement, and education.’ The time is now [to recognize] my unique multiple minority status—we are out here!”
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