In the spring of 2020, the coronavirus pandemic first gripped the world by the throat and its deadly menace continues to unfurl with renewed ferocity. In the United States, medical and scientific experts issued a series of early recommendations to slow or halt the spread of the virus that causes the disease COVID-19. Such public health measures are clearly warranted. As of this writing, over 285,000 Americans have perished from COVID-19 and the infection numbers are soaring across much of the country. Recommendations to combat the virus spread include handwashing, covering the face when coughing and sneezing, wearing a mask when in public spaces, and social distancing. The most challenging anti-virus measure was the lockdown or stay-at-home orders issued by state and local governments. In many communities, people rushed out to stock up on food, water, and household supplies before they began sheltering in place. The lockdown preparations and implementation clearly highlighted the pervasive and persistent inequalities impacting every aspect of American life that are attributable to social determinants of health (SDH). The World Health Organization defines SDH as “the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.” During the current public health crisis one key question for researchers, policymakers, and clinical providers alike to ask is: Which populations in the U.S. are most likely to experience adverse effects from SDH?
As an academic nurse researcher with expertise in health disparities, I closely monitored news about how the spring lockdowns were impacting various population groups. I paid special attention to the dramatically different experiences of white-collar employees, many of whom had the privilege of safely sheltering in place while working from home, and front-line essential workers who had no such option. This later group, often employed in grocery stores, meat-packing plants, bus stations, and other crowded environments, had higher risk of exposure to the coronavirus. Many of these essential workers are people of color and the devastating consequence of this reality was all too predictable. According to the U.S. Centers for Disease Control and Prevention, communities of color have experienced considerably higher rates of infection, severe illness, and death from COVID-19. This population includes approximately 100,000 individuals, largely African American, with sickle cell disease (SCD), an inherited red blood disorder. The major symptom of this disease is persistent, disabling pain, including excruciating episodes known as a pain crisis. SCD is a lifelong illness with a life expectancy of 48 years for women and 42 years for men.
With a primary research focus on pain management disparities experienced by SCD patients, I worry how coronavirus-related stressors are exacerbating the considerable pain already endured by these individuals. My research indicates that systematic stressors such as healthcare injustice—defined as unfair treatment an individual receives from important medical figures such as healthcare providers — predicts increased pain in patients with SCD. They are particularly vulnerable at this time because the coronavirus pandemic can magnify the negative SDH already experienced due to their race and disease trajectory.
I am concerned about how SCD patients are coping with today’s magnified societal stressors, particularly when trying to avoid a stress-related pain crisis that would require hospitalization and potential exposure to the coronavirus. Given the comprised hematologic profile of patients with SCD, which reduces oxygen circulation, these individuals are at elevated risk for both COVID-19 severity and mortality. Statistics from early in the pandemic document this grim reality. A recent study found that between March and May 2020, 178 infected individuals were entered into the SCD-coronavirus disease case registry. Of these, 122 (69%) were hospitalized and 13 (7%) died. (These hospitalization and death rates are much higher than for infected individuals in the general population.) Healthy stress management techniques that decrease emotion-triggered pain crises could greatly improve the well-being of SCD patients and potentially reduce their hospitalizations and deaths. Healthcare professionals can play a key role in encouraging patients to consistently utilize non-drug coping strategies to complement medication regimens for pain management.
Our research team found that patients with SCD who experienced healthcare injustice from nurses reacted to this psychological stressor by isolating themselves. Meanwhile, those who experienced healthcare injustice from doctors reacted by both isolating and pain catastrophizing. These negative coping strategies are associated with poor health outcomes. For example, pain catastrophizing corresponds to lower health-related quality of life for patients with SCD. On a more positive note, patients who experience healthcare justice also cope with prayer and hopeful thinking. These healthy strategies have long been endorsed within African American communities, where deep spiritual beliefs and regular religious practices have helped them deal with the harsh realities of slavery and the systemic racial discrimination and injustice that sadly remains a powerful force in American culture.
Another coping strategy for SCD patients dealing with stress and pain is guided relaxation. This can include deep breathing and counting backwards from 10 to 1 while focusing on a specific spot within an object. This technique has been shown to effectively reduce stress and pain for adults with SCD. Another recent study found that music therapy also reduces pain and improves mood. It is important that these vulnerable patients know there are a number evidence-based drug-free strategies they can utilize during this unprecedented and pressure-filled coronavirus pandemic.
Unfortunately, SCD patients in the United States, like other citizens the world over, cannot individually control the course of the pandemic and the havoc it is wrecking. However, these patients do wield tremendous control over how they choose to cope with coronavirus-related stressors that can intensify their SCD pain. In addition to the non-drug options described above, individuals can explore and try other safe coping strategies to better manage their physical and emotional health challenges. It is vital that patients are proactive on an ongoing basis to reduce their stress and pain and improve their overall well-being as the world awaits better coronavirus treatments and an effective vaccine.
As an academic nurse researcher from an underrepresented minority background, for years, I was plagued by a certain phenomenon: specifically, the imposter phenomenon. In 1978, psychologists Pauline Rose Clance and Suzanne Imes coined this term to describe the internal experience of “intellectual phoniness” that is prevalent in high-achieving women who, despite their academic and professional triumph, feel that they aren’t smart enough, that they have somehow deceived others to view them as successful, and that they will soon be exposed as frauds.
Of course, this phenomenon isn’t limited to women: a 2011 review article published by Jaruwan Sakulku and James Alexander suggests that 70% of all individuals experience imposter phenomenon at some points in their lives. However, in my article, I focus on how I myself experienced the imposter phenomenon as a woman with African roots within Western academia. More importantly, I share my experience to express how detrimental the imposter phenomenon is to educators in academia. Today, I feel obligated to share my story with my students through my teaching and mentoring.
What are the attributes of the imposter phenomenon? From the definition of the term, I identified at least three destructive factors that contributed to my personal experience of it: namely, self-doubt, negative self-statements, and socialization as an African female.
An individual who sports self-doubt lacks confidence in her own capabilities and thus relies upon others to assess her accomplishments, failures, and reality. Naturally, self-doubt fuels negative self-statements that this individual utters about herself and eventually comes to believe about herself. And her negative self-statements will ultimately reinforce what her society and culture demands of women. If this individual is African like me, she will be haunted by her society’s belief that women are a weaker sex, that they should not be heard but only seen, that they are given things and will never truly earn them, and that they are meant to be taken care of by men and other authority figures in their lives.
So, how did this series of negative reasoning come to plague me? It was several weeks after starting my new position as a Sickle Cell Scholar through a grant funded by the National Institutes of Health. A staff colleague was trying to get my attention as I walked through a hallway to my office and she whispered, “Dr. Ezenwa.” I cringed and quickly turned my head around to figure out who she was addressing. Of course, it was me. We were the only two people in that space. I thought, “Wow. Dr. Ezenwa, my foot!”
As soon as this astonishment faded, I went into my office and was arrested by a severe panic at the thought of my “lies” being discovered. My body felt hot, my heart clapped with a chaotic chorus of groans, and my stomach fluttered like a butterfly rain forest. Pearls of cold sweat dripped from my palms. I felt like a deceiver, a trickster. An imposter.
Slowly, my self-doubt magnified and my anxiety about achieving success intensified. I began to question myself: Did I learn enough in my PhD program to be an independent researcher? Do I know enough to teach at the undergraduate, graduate, and PhD levels? What was I going to tell my students? What if I ruin their lives and academic careers because I teach them the wrong things and extinguish their drive for continuous learning and growth? Will they even understand a word I say to them through my African accent?
These self-doubts naturally morphed into destructive self-statements: I am not good enough. I am not smart enough. I am not worthy. Then, perhaps most devastatingly, these destructive self-statements made me feel boxed in and limited by multiple historical and social orientations forced upon women, even though I had escaped them long ago.
As an African immigrant in Western academia, I worked hard to break through multiple levels of convention. I broke through many societies’ beliefs that the proper place for a woman is at home and her role is to bear children, cook meals, and clean up messes. I broke through the pressure of growing up poor and earning the opportunity to reach greater heights without any real road map or directions. I broke through to success as a black woman who American society believes is lesser than her white counterparts thus deserves less in life. I, as an immigrant, broke through the culture shock of living and working in America and always sought peaceful resolutions to clashes in culture.
But under the spell of self-doubt and negative self-talk, I began to think that even the actuality that I’d broken out of these social constructions was all a big lie. These feelings only magnified and manifested as psychological and cognitive obstacles that cornered me into mental blocks. I soon lacked the confidence I needed to effectively teach and conduct research, as well as to see myself as successful and accomplished.
Now, I first learned about the concept of the imposter phenomenon many years ago during my graduate program. Back then, I brushed the idea aside as silly. How could individuals who paid with blood and sweat to accomplish their goals diminish their accomplishments? But after spiraling into such depths upon simply being called by my appropriate doctorate title, I realized that I was not above this sort of destructive thinking. I had to take control of this phenomenon if I was going to effectively and full-heartedly serve my students, my institutions, and, most importantly, myself.
So, how did I cope with the imposter phenomenon? There are three major strategies that I endorse and have taught my students: self-accountability, accountability with a trusted partner, and continuous self-love.
First, self-accountability: I began by recognizing that I am accountable to myself to be the best I can be in all my life’s endeavors. I am accountable for the outcomes of my actions and inactions, as well as my failures and successes. Once I accepted this fact, I engaged in bone-deep self-reflection about the imposter phenomenon that I had allowed to take up residence in me. I asked myself, “Why do you think you’re not bright enough? Why do you think you’ve fooled anyone who believes otherwise? Why do you think you’re not good enough, that you’re unworthy?”
I wrote down my thoughts on a piece of paper and waited a few days to return to it. When I saw all the questions and my initial answers written out, other realizations came to mind. I, for instance, suddenly understood that the imposter phenomenon had been creeping up on me my entire life. Growing up, everyone had told me that I was “so smart” and openly assumed that I would become a medical doctor. I had always been afraid that I might not live up to this idea of intellectual perfection that my family and friends held about me, and, even after I became an academic doctor, I felt that I was not the genius everyone believed that I was.
When I had excavated my mind of these recognitions and purged any negative ideas that imprisoned my capabilities, I reached out to my accountability partner for a meeting. I shared with her the result of my self-reflection honestly and openly and, in turn, she worked with me on enhancing my confidence. My accountability partner assisted me in three important areas: changing my mindset, developing a strategic plan of action to combat the imposter phenomenon, and constantly checking in to see if the plan was on track.
To shift my mindset, my accountability partner coached me to see the opposite side of my negative thoughts. For example, if I doubted that I was not smart enough to have accomplished the current goals in my life, she empowered me to believe that my current achievements were not handed to me for free like Halloween candy. Instead, I had to earn them through a combination of my intelligence, efforts, and wise leveraging of available resources. She assured me that I already had a long record of accomplishments, and there was no reason for that trend to stop so long as I was willing to challenge myself and do the work required.
Once this mindset shift was underway, my accountability partner helped me develop specific, time-bound goals and strategies to succeed in my current endeavors. Finally, we set a timeline with consistent, scheduled follow-up meetings to assess my progress. During these follow-ups, we reevaluated my goals and strategies, as well as adjusted my timeline as necessary.
The third and final strategy I used to combat the imposter phenomenon was practicing continuous self-love. As a woman, both in African and American society, I was socialized to care for everyone else before thinking of myself. Consequently, I was petrified to upend the status quo and focus on myself for once in my entire life; after all, I had equated self-love with selfishness.
So, to successfully exercise self-love, I had to be intentional. I worked tirelessly to reprimand myself every time I felt guilty for focusing on my needs over other obligations. I reminded myself that, when I am overflowing with love for myself, I will have enough energy to achieve my goals and dreams and also healthily give to my family, career, academics, and finances. I made sure I celebrated my successes, both big and small. Every night in front of the mirror, I stood and told myself how deserving I was of all the accomplishments I worked so hard to earn.
So, with all three strategies combined, did I beat the imposter phenomenon? That I am still a professor and a researcher in one of America’s top ten public universities is a testament to how I conquered self-doubt and negative self-statements and how I refused to allow my ancestral background and cultural identity to confine me from living in my highest potential. That I was recently inducted as a Fellow in the American Academy of Nursing is evidence that my research on health disparities in pain management in patients with sickle cell disease or cancer made a difference in peoples’ lives locally, regionally, nationally, and internationally. That I am now an entrepreneur is a manifestation of my mindset that now asserts, “You are good enough. You are smart enough. You are worthy.” So, yes, these strategies worked!
The imposter phenomenon is a monster, and the struggle to overcome it is real. Successful women have systematically been robbed of important opportunities because of our own self-doubts, negative self-statements, and our giving into social orientations that seek to confine us. But there is hope and there is help. The strategies I mentioned here, as well as with professional help from psychotherapists, can move us toward controlling the phenomenon and casting it out of our lives.
The question is, are we willing to confront the imposter monster in ourselves? Are we willing to tear down limiting beliefs about academic success, professional success, business success, financial success, and whatever else we desire? Are we willing to free ourselves from the bondage of history, cultural codes, and oppressive gender roles? Are we willing to look in the mirror and say “I am good enough, I am smart enough, I am worthy?” Are we willing to do the hard work to love and respect ourselves?
And, finally, are we willing to do the work now? Not next year, next month, next week, or tomorrow. Now.
Are you willing to take the challenge?
You may write me down in history
With your bitter, twisted lies,
You may trod me in the very dirt
But still, like dust, I’ll rise.
In May 2015, I joined the faculty at the University of Florida College of Nursing (UF CON) as an associate professor. Fourteen months later, I became a single adoptive mother to a newborn. My successful journey through single motherhood while balancing my academic responsibilities was due, in large part, to the overwhelming support I received from the entire body of the CON including the dean, department chair, faculty, staff, and students.
Working From Home
When I think about the reaction of my senior colleagues when I shared the news that I adopted a newborn, I am in awe. My department chair was elated, and after congratulating me, the first words she uttered were,“Miriam, you have my support. I am here to provide you with whatever resources you need to succeed at motherhood and your academic career. You can take maternity leave, work from home to direct your research, teach online, and teleconference as needed.” Before I could respond, my department chair excitedly went next door to inform the dean, who glowed with joy about my news, grabbed my hands, and stated emphatically, “You are taking maternity leave.” I was stunned.
I was surprised about the reactions I received from the administrators because I was not sure what to expect. I was a newly hired associate professor trying to build my research program following relocation from another institution. Because I was a relatively new hire, I was afraid they would express misgivings about my status as a single mother with no family support, which might affect my productivity as an employee; however, these fears were not realized. Although the administrators strongly encouraged me to take maternity leave, I opted to work primarily from home and hire a babysitter to assist me, who cared for my son when I travelled to campus to teach and to attend research team meetings. Incredibly, senior colleagues encouraged me to bring my son to our hour-long meetings and to classes after students requested it. As a result of their kind support, I brought my son to research team meetings, where my colleagues enjoyed meeting him, and to class, where my students happily posed for photos with my son and me.
Was it Unprofessional to Bring a Baby to Work?
Despite the tremendous support I received to bring my son to the CON, at times, I felt that it was unprofessional. Realizing that I was projecting upon myself the negative stereotypes about motherhood and child-rearing, I asked myself several key questions: What is unprofessional about being a mother? What is unprofessional about role modeling to my son the importance of strong work ethics? What is unprofessional about exposing a baby to intellectuals who are positive role models? I surmised that exposing my son to an environment replete with kind, smart, and diligent professionals could only help him learn the behaviors he needs to become successful in life.
It has been nineteen months since I started my motherhood journey, and I am still breathless about the kindness and support I received and continue to receive from my colleagues. Knowing that I had the option of taking maternity leave as well as the full support of the administrators who were not concerned about my productivity was reassuring.
His Majesty, Kasi, Among Nurses By Miriam O. Ezenwa, PhD, RN
Nurses, my Angels
They gather to do what they do best
Fix the ills around the world
Care for those needing their healing presence
Enters, His Majesty, Kasi, drawing attention
Heads turn left and back, eyes twinkle starry-like
Smiles everywhere, hearts blooming light
Love! Love in the air for His Majesty
Calm nurses, my Angels, research retreat in progress
Work in teams, way of the future
Stand strong, hands locked in place
Embrace people from far and wide
Including those who don’t look alike
We are stronger in the spirit of the rainbow
Need to rest from the trip to here
Nurse Karen holding tight, heart pumping peace
The future is smart for His Majesty, nurses’ wisdom grows in strength
His Majesty needs a diaper change
Nurse Jeanne-Marie and nurse mommy to the rescue
Now, where were we?
Back to fixing the world
How about fixing how we secure our existence?
Many ways of teaching, the more the merrier, the merrier the better
Sleepy-sleepy, growth in rapid measure
Uncle Yingwei got this one, his manly touch is much needed
Once! Twice! Hunger and starvation
Hurry Mommy! Tummy thunders, feels like no end in sight
Mommy doting, needs now met
Sorry for my interruptions, I am just a baby
To resume business, let’s take stock
Goals are important, set now, assess in time
We are nurses, born to fix ills, from birth to death
Yes, nurses fix ills all the time
His Majesty needs a break, nap is golden
Nurse Versie won the prize, His Majesty is a treasure
Mommy close by inspecting every touch
New mommy, but instincts never fail
Back to research retreat, His Majesty is listening
Teams assembled, lead authors identified. Here! Here!
Oh no! Nature calls again, can’t ignore
Nurse Cindi in charge this time
Mommy always in tow, my bag in hand
Back again to wrap up, day went well
We must tell our story, stir the soul
His Majesty must depart now
The throne at home beckons, Queen Mommy in charge
Car must be readied, His Majesty commands comfort
Uncle Yingwei again to help, he has been there from day one
Goodbye, nurses. His Majesty must retreat
Till we meet again, a year from now
Assess your outcomes, inform His Majesty
Did I say that nurses are great?
Lest I forget, nurses are magnificent
You are my tribe, away from home
His Majesty, Kasi, enjoyed your company
Spread the word, it takes a tribe
A tribe of nurses, best any time
It helped me focus on enjoying motherhood and have the peace of mind related to a secure livelihood. I remind myself of how blessed I am for the inherent flexibility of my academic position. This feeling of gratitude propels me to work harder so that I do not disappoint myself or the trust the administrators bestowed upon me, to find an appropriate work-life balance required for success in academia.
My Tribe Away From Home
When my son was six weeks old, the CON had a faculty research retreat, and although I did not have a babysitter, I did not want to miss the retreat. I talked to my department chair about this problem, and she suggested that I bring my son to the retreat. The entire faculty in attendance surprised me with their support. At that moment, I knew that I had found my tribe at the UF CON even though I was 6,000 miles away from my home country, Nigeria. I captured the interactions between my son and my newly found tribe in the poem, His Majesty, Kasi, Among Nurses.
Take Home Message
Current knowledge suggests that many mothers in academia struggle to succeed as they balance motherhood and academic responsibilities. These challenges could be quadrupled for single mothers in academia who are immigrants and who may not have family support. I experienced many challenges being a single adoptive mother, particularly on the days that my son was sick; however, I always had the help of my colleagues, who personally assisted me in caring for him. Their support enabled me to excel at motherhood and my faculty role, and I am immensely grateful for this support. Based on my positive experiences, I encourage other universities around the United States to emulate the actions of the UF CON administrators and support mothers in academia as they balance two important aspects of their lives: motherhood and an academic career.
What is diversity? According to the Oxford English Dictionary, it is “the condition of being diverse, different, or varied; difference, unlikeness.” This simplistic definition of diversity does not assign any judgment or negative connotation to any of the words used to define it. However, the word “diversity” evokes multidimensional judgements, reactions, ideas, emotions, and actions, some of which could have adverse social and health consequences for generations of individuals in the United States.
Nursing, as the largest health care workforce in the United States with over 3 million nurses, is well positioned to champion diversity efforts. In 2010, the Institute of Medicine (IOM) published a landmark report, The Future of Nursing: Leading Change, Advancing Health. In this report, the IOM indicated that the nursing profession was not diverse to care for diverse populations across the lifespan. The IOM recommended that a diversity agenda be promoted, especially with increasing the diversity of nursing students. In partnership with AARP, the Robert Wood Johnson Foundation (RWJF) launched a campaign to implement the IOM recommendations from its 2010 report. Subsequently, commissioned by the RWJF, the IOM evaluated the state of affairs regarding these recommendations. In 2015, another report, Assessing Progress on the Institute of Medicine Report The Future of Nursing, was published. In this report, the IOM specified that nursing has improved on the recommendation to diverse the nursing workforce. Nonetheless, there remain gaps that must be addressed to meet the diversity goal for the nursing profession. Consequently, the new recommendation for nursing is that diversity must continue to be a priority that is paralleled with a series of actions to promote it. Before nursing can accomplish this noble goal, there should be a well-vetted strategic plan on diversity and inclusion in all nursing programs, schools, and colleges in the United States. Students, faculty, and staff must be an integral part of the dialogue to promote diversity within the nursing profession.
At the University of Florida College of Nursing (CON), we held our inaugural “Diversity and Inclusive Excellence” workshop in December 2015. This two-day workshop was designed for staff and faculty. As a member of the Diversity taskforce, I collaborated with the other taskforce members to invite G. Rumay Alexander, EdD, RN, FAAN, to lead the CON on this discussion. Alexander is director of the Office of Inclusive Excellence in the School of Nursing at the University of North Carolina at Chapel Hill, a nationally known expert with vast knowledge and expertise on diversity and inclusive excellence, and president-elect of the National League for Nursing.
During the early morning hours of December 3, 2015, my individual lesson on the topic began with Alexander as I had breakfast with her. My antenna on the topic sharpened following our conversation. After introducing her to my fellow Diversity Taskforce members, I hurried to pack my car and return to the CON to proceed with the plans of the day. I noticed the dean, Anna McDaniel, PhD, RN, FAAN, from a distance. I hurried up to keep her pace. “Good morning, Dean,” I greeted in my usual manner. McDaniel responded with a broad smile and a twinkle in her eyes that I perfectly understood. I surmised that McDaniel had finally accepted the fact that I love referring to her as the “Dean.” We conversed as we headed to the CON and into the elevator. I noticed the necklace McDaniel wore. The costume necklace had different shapes, colors, sizes, lengths, and mosaic designs. They were
audaciously woven, yet unintimidating;
different, yet complementary;
individually, unassuming — yet, together, a paragon of beauty, inviting;
all held by a perfectly thin strand, yet unbreakable.
“That’s a beautiful necklace,” I uttered. “It belonged to my mother, who died twelve years ago,” McDaniel shared. “Each bead came from a different country. I have a brochure that provides a description of each bead, including the country of origin and its material composition.” Then, McDaniel voiced the word that gladdened my heart. “I wore this necklace today because it’s appropriate to celebrate diversity, the topic of the CON workshop.”
McDaniel had appointed the Diversity Taskforce and provided us with her full support. But, the fact that she actually thought of and adorned herself with a necklace that I now coined as a “diversity necklace” to celebrate the CON inaugural diversity workshop was admirable to me.
Someone not sensitive to the current diversity concerns around the United States, and the racial unrest related to such matters, may not appreciate my exhilaration upon hearing the history of the necklace. At issue is that, in several communities around the United States, numerous individuals are thoughtless about the devastating effects of antidiversity rhetorics and actions on the lives of its victims. Many may not realize that any action, whether good or evil, begins in the mind. Conversely, any work to combat uncelebrated diversity and exclusivity must begin in the mind. When people think about and proactively perform small acts, such as expressing recognition of diversity through a piece of jewelry or other special actions to celebrate diversity, it goes a long way. It could change the thought process from exclusion to inclusion. When people are attentive to their behaviors and understand the detrimental effects their actions could have on other human beings, things might change for the better. I believe that, as a nation, we must check the poisonous thoughts that percolate in our minds and subsequently manifest in forms of antidiversity rhetorics and behaviors, unacceptance, and racism. Confronting monstrous suggestions in the mind is the first step that many of us need to take to begin to challenge the subtle and insidious systemic diversity-aversion and exclusion in the United States.
As I thought about this issue of diversity and the role that nursing can play to eliminate it, I reminisced about how the imperfections of people categorized within the social construction of race stimulate antidiversity and anti-inclusive sentiments and movements. I wondered how nursing can care for these individuals, many of whom are marred with scars of history. My poem, “The Color of Justice,” captures my perceptions of the undeniable genesis of these historical blemishes that shockingly remain, overtly or covertly, as status quo in various parts of this country.
The Color of Justice
What color is justice?
Absorbing pain, insults, and lashes
Ancestors packed shoulder-to-shoulder, hip-to-hip,
chained like fire woods
Bones of the feeble lie un-mourned in ocean deep
across the Atlantic
Their sweat built the wealth in the new world, but
crumps have become their portions
This name sound like them, we have filled the position,
they need to go away
Low-hanging pants, cove-hopping birds,
We cannot deal with the anger, we are better off
with the accent, intra-color battle ignited
Round them up, throw away the key, population control
Babes on the breast, mama and grandmamma, sitting
on the front porch pondering about the next check
Hair tightly woven, fried, or twisted, nails freshly manicured, next bun in the oven
The fortunate may triumph at the end, treacherous roads treaded, stress claims the wounded body after all
That they survive is still a mystery that ought to win
them a trophy
Who are they?
What color is justice?
Reflecting heat, demanding respect, crushing heads
Rolled into the new world in Mayflower boasting of
prostitutes, thieves, and prodigal sons
Raised arms against raised tea taxes, won freedom
but deny it to another
Melanin deficient hue suggest superiority
Blood by blood, noose on hand, destroyed a generation,
Deeds done in the name of God, He must be weeping
Damages proudly scattered in museums, we pay to
relive the tragedy
Privileges left and right on the backs of the poor
Man in bow tie, lady in heels, rear the children, your lavatory in the rear
Own your history, mend your ways, teach your babes right
Who are they?
What color is justice?
Broad face, warm hue, and welcoming gesture
Land is supreme and cares for the offspring
Infected with strange diseases, killed with gun powder, survivors kept in special places devoid of opportunities
Culture deconstructed, the sacred used as mascots
Surviving by balancing mind, body, and spirit, harmony
in the land is their mantra
Not many left but their spirit is strong
The land beckons for their touch, to purge its roots of deadened souls
What does the Unites States’ constitution say about them?
Who are they?
What color is justice?
Messiah has come, awaiting messiah, there is no messiah
We profess peace, spiritual path is the way
Whose belief is superior?
When six feet under, belief quenches, but tainted
souls still suffer
Where are their senses?
Who are they?
What color is justice?
Light? Energy? God?
Penetrates Black, White, Red hue, religious, non-religious
Building block of things created
Revitalizes without questioning, unites all things created
Shines for Black, White, and Red hue, religious and
Knows no foolishness but shines for fools
Knows no discrimination but supports the life of discriminators
Invites reconciliation until judgement day
Come unto me Black, White, and Red hue, religious,
My light is your strength, unity, and peace
One may wonder how a nurse who is an advocate for a diverse, inclusive, and just world could pen “The Color of Justice.” This poem reflects my dual perceptions as a black woman and a nurse, of how the historical racial unrest that has plagued the United States for centuries has been subtly perpetuated even today. But, they ought not have continued, had the United States paid real attention and reconciled both the apparent and undercurrent narratives of this poem after the abolition of Jim Crow laws. As a black woman, I think that the first relevant question ought to be: How do individuals from diverse backgrounds interpret their historical or lived experiences in the United States? I encourage each one of us to answer this question individually or as a family, church, academic institution, or financial organization. I assert that there must be a recognition and acceptance of the different dimensions of diversity of thoughts, ideas, and experiences. This recognition must be matched with “courageous dialogue” on diversity and inclusion. In addition, there have to be concrete and measurable action plans for allocating resources to implement iterative strategies to address identified diversity concerns. This exercise could be so powerful that diversity and inclusion become strengths and not detriments to our collective humanity.
As a nurse, I think the second pertinent question must be: What role can nursing play to mitigate the adverse generational effects of antidiversity and anti-inclusivity experiences on marginalized and excluded individuals? I contend that, in order for nursing to be professionally and culturally relevant in the future and to continue to have the public trust as a caring discipline, we must identify ways to champion the diversity and inclusive excellence agenda. There should be constant and mandated training on diversity for university staff and faculty, with measurable outcomes. Nursing as a profession should develop a curriculum with a diversity and inclusion plan threaded throughout it. One approach to operationalize this suggestion is to equip nursing students with skills necessary to be culturally competent, diversity-savvy, and inclusive-perceptive in order to encourage these values in their work settings. Patients and clients at the receiving end of compassionate, culturally competent care infused with the spirit of diversity and inclusiveness should remember the feelings associated with that care, and hopefully pay it forward. Slowly, the culture of superiority and nontolerance directed toward individuals from diverse backgrounds could dissipate and a new world facilitated by nursing and inhabited by truly compassionate and empathetic humans would emerge.
Nursing students are the future of the nursing profession. Therefore, nursing must constantly remind students that antidiversity and anti-inclusion rhetorics and behaviors, historically and contemporary, breed racism in the United States. They should also learn to celebrate how much improvement we have made as a profession. But, recognize that diversity work is lifelong. The juxtaposition of the history of racism in the United States with the improvements made toward eliminating it is useful for at least two reasons: The contrast provides the space for constructive discourses and opportunities to develop positive avenues for endorsing diversity, and it allows for future and ongoing actions to completely obliterate racism heralded by antidiversity and anti-inclusive beliefs in the United States. Consequently, bead by bead—though diverse in shapes, colors, sizes, lengths, mosaic designs, and historical origins—we can hang unbreakably strong on the perfect strand of humanity, which unites us as “one Nation under God.”
The issue of embittered race relationships in the United States has been on my mind since August 9, 2014, when a white police officer named Darren Wilson shot and killed Michael Brown, an unarmed black teenager, in Ferguson, Missouri. The violent protests that erupted after the shooting culminated in even more pronounced violent protests in the early morning hours of November 25, 2014, following the grand jury decision not to indict Officer Wilson for the fatal shooting of Brown.
Not being close to the case, or having examined the evidence upon which the decision not to indict was based, I wondered whether that decision was purely based on evidence, or whether historical and institutionalized racism, discrimination, and injustice against blacks in the United States played a role. While I have no answers to my question, I struggled to think about what we, as a nation, can learn from Michael Brown’s death that will help this nation heal.
I believe that each one of us in the United States needs to think long and hard about race relations in this country. I allowed my mind to wander as I took this journey myself. I thought about the Institute of Medicine report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. In this report, the committee—charged by Congress with identifying and recommending strategies to eliminate racial disparities in health care in the United States—chronicled the pervasiveness of poor health outcomes for minorities.
As a minority and an academic nurse researcher with a focus on health disparities in pain management, I thought about historical and institutionalized racism, discrimination, and injustice that contribute to poor pain management for patients with sickle cell disease—an inherited blood disorder suffered by an estimated 100,000 Americans, mostly of African descent—and for patients with other pain conditions. I thought about an article I had written for Minority Nurse back in 2003 titled “Mentorship in Black and White,” where I narrated my experience of being mentored by a white senior professor when I was a nursing student. This mentorship experience affirmed my belief that humanity is inherently good, but social constructions such as race taint our good nature. I thought about my current experience as an assistant professor of nursing in higher education and how I have reacted when I encountered interactions I felt were unjust. I wondered about how I have interacted with students in my capacity as a nursing faculty where I have the opportunity to teach and mentor both black and white students. I wonder if I have done everything humanly possible and within my power to pay forward the inherent human goodness to improve race relations with my students, colleagues, and friends.
I thought about the slave ship captain and later an abolitionist, John Newton, who, after his repentance, wrote the hymn “Amazing Grace.” This hymn is sung in Christian churches around the world by many Christians to confess and repent of sins and enlighten the spirit. The song has also become the mainstay of funeral services around the globe— a way to send the dead home believing they had the chance to repent of their sins at the time of death.
Now, in the United States, we must sing “Amazing Grace” in unison. Why is amazing grace important in this moment of pain and hurt, loss of faith in humanity, and lack of trust in race relations in the United States? The nurse in me feels that this nation needs healing. We must repent for whatever we might have done consciously or unconsciously, overtly or covertly, to contribute to racial unrest and the suffering of blacks and other minorities in the United States,. We will not stand and just sing the lyrics of the hymn paying lip service. We must be on our knees and feel the words break through our hearts, minds, and spirits. The words must purge us of the biases, injustices, discriminations, racism, sexism, ageism, and other “isms” that have deadened our spirits in this country. We have to let the spirit that connects us as humans and make us one with the universe—the trees, the oceans, the winds, and the animals—emerge to help us heal. We must let the light of our spirit unite us, and together we can outshine the darkness in our hearts and minds that we use to oppress others who look different than us.
We must heal our nation by checking our individual biases that encourage us to treat others unfairly. Like Newton, we must repent so that God and the universe will shower our spirits with the everlasting peace that comes with positive race relationships in the world full of turmoil and unrest. We must heal our nation, the United States of America.
Miriam O. Ezenwa, PhD, RN, is an assistant professor in the Department of Biobehavioral Health Science at the University of Illinois at Chicago, College of Nursing.
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