Making History

Georgie Conoly Labadie, RN, BSN, EdD, a longtime professor of nursing at the University of Miami, may be 66 years old, but a youthful feistiness creeps into her voice as she recalls the part she played as a young student nurse in battling the blatant racial segregation that existed in many hospitals, particularly in the South, in the late 1950s and early ‘60s.

Like other wards in the now-defunct Florida A&M University Hospital, Labadie recalls, the OB unit where she worked was split in half. Black mothers and their babies occupied one side of the floor; white moms and their babies were placed on the other. Labadie, who is African American, had no patience for this system, which was not only dehumanizingly racist but also impractical. It created unnecessary inefficiency and extra work for the nurses, who constantly had to shuttle back and forth to take care of particularly high-maintenance infants.

So she did something about it. Every time she’d show up for her shift, she’d rally the other student nurses assigned to the nursery to move all the premature babies together, regardless of color. Labadie’s excuse was logistics, “so we didn’t have to keep running all over the place to take care of them.” But the move represented much more.

“We clearly thought the whole thing was stupid,” she says. “And it truly was, because if you think about it, it made much more sense for all the patients who had the need for more watchful care to be close together.”

Labadie’s supervisors knew about the switch all along, she says, but they chose to look the other way. This was partly because the students would diligently move the babies back to their segregated ranks when their shift ended, and also “because they figured we would have created a scene [if they tried to stop us], which was true.” A rash of rebelliousness? Labadie would rather call it being “respectfully gutsy.”

The young nurse’s spunk was a vestige of her upbringing in Tallahassee, Fla., where Jim Crow laws legalized segregation in public facilities, including public and private hospitals. Her parents had taught her “to be respectful of people, but also [to believe] that we didn’t have to take everything that was put in front of us,” she says. “The assumption was, ‘This [segregation] can’t last through your lifetime, so you need to be prepared to step up and do what you can when the time comes.’”

Labadie also cites as inspiration for her activism the examples set by a few strong black nursing leaders who were already beginning to break down the barriers of segregation within the health care system. These included M. Elizabeth Carnegie, who became the first black nurse appointed to the Florida Nurses Association, paving the way for the integration of African Americans into the American Nurses Association in 1951.    “We knew that we were going to have to keep pushing the envelope,” Labadie explains, “and now we had the role models.”

And push the envelope they did. Alongside heroes of the 1960s Civil Rights movement like Rosa Parks and the Reverend Martin Luther King, Jr., black nurses played a significant role in desegregating the nation’s hospitals, nursing schools, nursing associations and the military—in some cases even leading the way.

Hospitals of a Different Color

“Nurses have always been the conscience of the health care system,” states David Barton Smith, PhD, professor and program director of the Healthcare Management Program at Temple University in Philadelphia, and author of Health Care Divided: Race and Healing a Nation (University of Michigan Press, 1999). “I think their voices have been heard and continue to be heard in terms of [race-related] problems and disparities in treatment.”

Until the Civil Rights Act was passed in 1964, many hospitals, like other public places, were divided by color, especially in the southern states, Smith says. “There were either separate all-white and all-black hospitals if a community was large enough, or if there was only one hospital, black patients were cared for in a separate annex or floor, or in a basement.” 

Segregation was more “informal” within hospitals in the North, he explains. “There weren’t any laws that said you had to segregate patients, but white physicians understood where they were supposed to send their black patients, and black physicians weren’t given privileges at white hospitals.”

Emma Felder, RN, PhD, professor emeritus of nursing at the University of Wisconsin, Milwaukee, recalls the inequality in patient care between black and white hospitals in Richmond, Va., that she had witnessed as a nursing student at Hampton University in the 1950s. The black hospital was “a little shack” with 30 or 40 patients per unit and few staff to take care of them, she says. Next door was the Medical College of Virginia Hospital, “a big beautiful building” for white patients.

This disparity in the quality of care—along with white nursing instructors’ attitudes toward black students like herself—was upsetting to Felder, but not surprising. “My home was in Arkansas, so I knew what segregation was like in the South,” she explains. “So while I wasn’t pleased with it, we learned to cope with it over the years.” Still, Felder didn’t accept it without pointing out the inequities. She recalls challenging a supervisor who had made derogatory comments about a black patient. “She was talking about how dirty he was and how did he expect to be receiving care when he comes in looking like that and being in that condition,” Felder remembers vividly. “I told her she wasn’t fair or right, that the patient needed respect and someone who would care for him and wouldn’t look at him as if he were an animal. I remember [using] that word, animal.”

Felder wound up getting an “A” in the course, but more importantly, she gave her instructor a much-needed education. “I think she really thought about it and saw that I probably was right in what I had said and what I felt I had observed from her. I really do.”

Black nurses themselves were also the target of prejudice in hospitals. Felder recalls quitting at the end of her first day on the job at Children’s Hospital in Milwaukee in 1959 because despite having a bachelor’s degree, she was assigned to rocking and bottle feeding one baby for the entire day.
“I was very highly educated, but I was treated like a nurse’s aide,” she says. “I told the head nurse that I felt they had discriminated against me.” When the head nurse refused to respond, Felder adds, “I just walked out and didn’t return.”

Actually, according to Smith, the first real breakthroughs in achieving integration among hospital personnel occurred in nursing, primarily because hospitals in the 1940s were experiencing a nursing shortage due to World War II. It wasn’t so much an altruistic effort as a practical one, to keep hospitals fully staffed. “Basically it was a marriage of convenience,” Smith notes. “It was more just [a question of] ‘How the hell do I get staffing?’”

The Times They Are a’ Changin’

During the Civil Rights era in the 1960s, President Lyndon Johnson led the movement to desegregate the U.S. health care system. As with school desegregation, hospital integration quickly became a battleground. Even though Title VI of the 1964 Civil Rights Act mandated integration of hospitals, some facilities in former Jim Crow states like Alabama defied federal pressure and refused to desegregate. Others used the ruse of “paper compliance,” finding creative ways to comply with the letter of the law without achieving “real” integration.

Here, too, black nurses played an important and courageous role, becoming some of the most vigilant whistleblowers against health care facilities that were receiving federal funds but ignoring orders to integrate, or that were creating a phony appearance of integration to fool federal inspectors sent to check on their Title VI compliance.

“The reason why hospitals got integrated so quickly and quietly and efficiently,” Smith believes, “was that all hospitals had black nurses and black aides [working toward the goal], and in many cases, members of the local chapters of the NAACP and other civil rights groups were also involved.”

If a hospital tried to circumvent the inspections, nurses would get on the telephone and call either the NAACP, one of its local chapters, the Office of Civil Rights or the Office of Equal Health Opportunity in Washington, Smith explains. In other instances, inspectors would meet secretly with black nurses the day before inspections to get briefed about floor plans with segregated locations, such as nurses’ changing rooms or lunch rooms. Otherwise, hospital tours could be very selective, he says.

Some facilities tried to get away with what Smith calls “the HEW (Department of Health, Education and Welfare) shuffle.” For example, he says, hospital employees would temporarily integrate infant bassinettes so that when inspectors came through the nurseries “they would see little black faces and white faces next to each other. Then, as soon as the inspectors left, they’d pick them up and separate them again…poor babies. Of course there would be a telephone call [from the black nurses] afterwards.”

Labadie remembers how the Civil Rights Act prompted long-overdue changes in rules and regulations regarding patient admissions and employment of personnel. “Things had to at least have the semblance of fairness,” she says. On the downside, however, Labadie notes that black hospitals were dismantled, and although some of the staff in charge were hired at other facilities, “the positions of authority that black [health care providers] held in many instances were no longer open to them.”

Changing the Face of Nursing

Helping to break down racial barriers within the nation’s health care institutions was by no means the only area in which African-American nurses made history during the Civil Rights era. They also took the lead in bringing diversity and inclusiveness to the nursing profession itself, from nursing schools to professional associations.

 

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Although it may seem hard to believe today, black nurses were unable to fully participate in the American Nurses Association until the 1940s. A significant hurdle that blocked integration of the ANA was that many state nursing associations prohibited black membership, especially in the South. Since state membership was required to be part of the ANA, blacks were essentially banned from the national organization as well.

 

In addition, many black nurses in those days were members of the National Association of Colored Graduate Nurses (NACGN), and this dual membership denied them the ability to belong to ANA. In fact, working to open the doors of ANA membership to black nurses was an issue that merited most of the time and efforts of the NACGN and its leaders, such as Mabel Staupers, who served as president until the group dissolved in 1951.

As a result of these efforts, and with the national ANA’s encouragement, state nursing associations began to drop their color bans in 1942, with Delaware, Florida and Maryland leading the pack. M. Elizabeth Carnegie, RN, DPA, MS, PhD, recalls her groundbreaking achievement as the first black nurse appointed to the board of the Florida Nurses Association. Even then, her struggle didn’t end until 1949, when she was officially elected as a legitimate, not just courtesy member, of that board.

“Up until then, we were limited to [attending] maybe one business meeting,” says Carnegie, author of The Path We Tread: Blacks in Nursing Worldwide, 1854-1994 (Jones and Bartlett Publishers, Third Edition, 2000). “That was the main thing that I fought for.” When Carnegie ran for election to the board, she received the highest number of votes of any candidate and was elected first to a one-year term, then a three-year term.

Labadie remembers Carnegie’s pioneering step forward as “a big deal [for other black nurses]. When we were students and went to the district nurses’ association meetings, we had to sit in a corner in the back of the room behind a post, because black people weren’t allowed to sit up front.”

During this same period, black nurses were also making gains in attaining positions of leadership in nursing schools, says James Banks, professor emeritus at Cuyahoga Community College and founder-director of the Crile Archives and the Center for History Education. Banks has compiled a history of African-American nurses called “Healing Others: Healing Ourselves” at http://www.crile-archives.org/ (click on “Current Project”).

According to Banks, these changes came about because “major nursing schools that had been traditionally white began realizing that not only was there a shortage of nurses, but they were also wasting a tremendous pool of talent by not [recruiting] the African-American nurses who were in touch with issues whites were not aware of, like the health needs of the urban poor.”

As with other areas of health care integration, the black nurses who first blazed trails into the academic arena did not have it easy. Felder recalls having to fight for her salary, status and tenure at the University of Wisconsin, Milwaukee because she was the only black faculty member with an advanced degree. She even had to battle white students who lied about her on evaluation forms.

How did she cope? Some black colleagues at other nursing schools helped her by providing “hints on how to deal with the situation, and there were some whites that stood with me through all of these things, but it was very hard,” she says. “I had to fight just to be who I was—a black woman who was in education, who was trying to be as educated as I could and was trying to help people. But I fought it and stood up for my rights and God helped me, that’s all I can say.”

Passing the Torch

Despite the major civil rights advances that have occurred over the past half-century, numerous studies confirm that racial inequities in health care treatment still persist today. And for all the ground they have broken to achieve their rightful place in the nursing profession, African-American nurses are still severely underrepresented in the RN workforce. While approximately 12% of the total U.S. population is African American, blacks account for only 5% of the RN population.

Part of the reason for the disparate percentage of African-American nurses, Labadie believes, is the racial gatekeeping that still goes on in higher education, in terms of both student admissions and faculty hiring.

“When the people who are making the decisions are primarily white,” she argues, “then [whites will] make up about 82 to 84 percent of the faculty in colleges and universities in this country. It just locks out other people.”

Labadie says she has remained vigilant since the ‘60s about sitting on admissions boards at the universities where she has taught, to help improve the racial mix among both students and faculty—or, as she puts it, “to make sure people are able to set aside some personal idiosyncrasies in order to look at candidates a little bit more fairly.

“I don’t think those things ever go away,” continues Labadie, who is a former associate dean at the University of Miami. “There always, in my opinion, needs to be a moral watchdog in the room. These people are rarely appointed; they usually just rise to the occasion to convince people that it really doesn’t hurt to take the high ground.”

She believes her efforts have paid off. “People come back and tell me something I did or something I said that changed the way they thought [about racial equality], and many times it’s changed the way that they look at people.”  Some African Americans can be just as prejudiced and need to be challenged, too, she adds. “You can’t ask people to be fair with you if you’re not going to be fair.”

Felder, too, has continued in her activist role, remaining committed to serving the needs of disadvantaged minority patients. After quitting the Children’s Hospital job in 1959, she found her calling at Milwaukee County Hospital. “I felt those [patients] really needed me,” she explains. “I had a great desire to help my people, and that was what motivated me from the very beginning to keep going to school even though I had a lot of odds against me. I wanted to be in a position where I could contribute something to my people.”

In 1980, Felder created a cultural diversity center at UW-Milwaukee, one of the first of its kind in a school of nursing. She also established a nursing center that provides community outreach to minority and disadvantaged neighborhoods by sending nursing students out into the community to deliver health education and health promotion services.

Today, many black nurses who have followed in the footsteps of pioneers like Carnegie, Staupers, Labadie and Felder say they are grateful for the inspiring examples these leaders provided. The generation of black nurses who fought fearlessly for equality and inclusion in every aspect of the nursing profession “were the ones who did the work,” says 74-year-old retired Brigadier General Hazel W. Johnson-Brown, RN, PhD, FAAN, who in 1979 became the first African-American woman general in the history of the U.S. military services.

“I’m just standing on their shoulders,” Johnson-Brown emphasizes proudly. “I couldn’t have done what I’ve done unless they had done what they did.”