Black Lives Matter. These three words have been used countless times in protests and in the media. As a result of the protests, more people are talking about racism and how it affects people who are BIPOC (Black, Indigenous, and People of Color).
Many nurses have experienced it. We interviewed three Black nurses to listen to their experiences with racism, learn how to begin conversations about it, and how allies can help.
Shantay Carter, BSN, RN, founder of Women of Integrity and best-selling author of Destined for Greatness, and nurse of more than 20 years, encountered racism back in nursing school. She recalls that some instructors would “try to wean students of color out of the program.” “I had instructors accuse me of cheating on tests or tell me that I would never become a nurse,” says Carter. Early in her career, she says, “I had patients say that they didn’t want a colored nurse taking care of them…I have had patients call me the N-word or threaten to hit me….I also experienced medical providers speaking down to me because they assumed that I am dumb.” Carter also got asked, “Are you the nurse?”
Bianca Austin, RN, BSN, CCRN, has been a nurse for 19 years. She works at an inner-city Level I Trauma Center as an intensive care nurse and is also a Major in the Army Nurse Corps, U.S. Army Reserves. Austin recalls an instance in which she and three other nurses, all dressed alike in navy scrubs, were waiting for their assigned rooms. The pod leader made the assignments based on having three nurses on duty. She had to be told that Austin was a nurse, even though she was dressed like the other nurses and wore a badge with her credentials.
Glenda Hargrove, BSN, RN, owner of Pill Apparel, has been a nurse for 11 years. She says that once a patient didn’t want her as their nurse because she is Black. Another instance occurred when she was the only Black nurse working on a unit and also the only nurse who was never invited to after-work staff outings. “At first, I tried to brush it off—until even the new nurses were invited, and I was not,” she says.
We asked all three nurses to weigh in on their experiences with racism and how to start the conversation.
If nurses experience racism, what would you suggest they do? How should they react?
Carter: “In situations where the patient is being really disrespectful, I have asked another nurse to care for that patient. As a nurse, I don’t have to be subjected to or tolerate someone’s ignorance. I also make sure to know the policy when it comes to escalating a situation to management. Knowing my rights as a nurse and employee of the institution that I work in is very important. If you encounter racism, I strongly recommend that you make your manager aware and HR if necessary. Racism and any other forms of discrimination should not be tolerated at any institution.”
Austin: “Use it as a teaching moment. Always be gracious.”
Hargrove: “There is really no easy way to answer this question. Racism has different types—it can be overt or covert. As the nurse, we have to always remain professional because like Michelle Obama said, ‘When they go low, we go higher.’ In some medical spaces, there is no one else who looks like you or even believes racism is occurring. As nurses, we are taught to advocate for our patients, but when experiencing racism, you have to essentially advocate for yourself and your right to practice in a racist-free clinical setting.”
How can nurses start the conversation about racism—and this may be different with patients, coworkers, and facility management? What steps should they take to make sure that if racism occurs, it doesn’t continue.
Carter: “As nurses, we have the power to create change. In order to have a discussion about racism, the hospital, community, and country has to be willing to talk about implicit bias, and system oppression. Joining an employee resource group or (BERG) is a great way, to encourage employees and leadership to come together to address the issues that are affecting their employees and finding solutions to make the workplace a better, more diverse, and safer environment for all. There also have to be policies in place to address those issues and have training on Diversity & Inclusion as well as on Implicit Bias. The culture and tone have to be set by the hospital leadership. Racism is something that can’t be tolerated or accepted.”
Austin: “The steps to take to make sure that racism is stopped is to not let an opportunity pass by to educate someone. Kindly let the person know the offense and explain why you were offended. They would tell us if we said something to offend them.”
Hargrove: “Nurses must start the conversation about racism by acknowledging the African-American nursing pioneers. Every nursing student learns about Florence Nightingale, but the majority have no idea who Mary Mahoney is. She was the first African-American Nurse to work professionally in the United States in 1879. When I started the brand, Pill Apparel, the mission has been to educate and acknowledge Mary Mahoney and her historic contribution to our profession.
“If racism occurs the only way to make sure it doesn’t continue is to NOT ignore it. Don’t let racism be the ‘elephant in the room’ but acknowledge it in order to learn from it and prevent it in the future.”
How can the community at large be an ally or offer support to BIPOC nurses in these situations?
Carter: “The community at large can be our allies by calling people out on their racist behavior towards others and standing with them in solidarity. BIPOC nurses would appreciate their friends and colleagues to stand up for them. We have to come together as one in the face of adversity. Just because you are not a BIPOC nurse, doesn’t mean you can’t fight against what’s morally and ethically wrong.”
Austin: “The facility I work for makes annual statements that they encourage diversity. It is a major player in the community with many business alliances. I would like to see more recruitment of BIPOC nurses, starting in high school. I believe the University and the hospital could improve enrollment and employment of BIPOC nurses if they start at that level, and the community could offer resources such as money, opportunities for shadowing, and help with preparation for nursing school.”
Hargrove: “We all know the difference between right and wrong. Martin Luther King Jr. said it best, ‘The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy.’”
The UConn School of Nursing is pleased to announce it has received a nationally competitive grant award from the U.S. Health Resources and Services Administration for a groundbreaking program. The innovative “PATH to PCNP” Clinical-Academic Partnership aims to increase diversity among primary care providers in medically underserved communities in Connecticut.
The nearly $3 million grant will provide scholarship support to 24 undergraduate students with disadvantaged backgrounds each year for five years. Six students from each academic year – freshman, sophomore, junior, and senior – will receive scholarships starting in the 2020-21 academic year.
“The mission of the School of Nursing is to educate nursing scholars, clinicians, and leaders, with the goal of advancing the health of individuals, communities, and systems,” says School of Nursing Dean Deborah Chyun. “The funding provided through this innovative program for underrepresented students will enhance their ability to focus on their education and graduate with minimal debt, in the hopes that they will go on to serve the areas of our state that are most in need.”
The group of faculty members leading this initiative at the School of Nursing includes: Ivy Alexander, Ph.D., APRN, ANP-BC, FAANP, FAAN; Natalie Shook, Ph.D.; Marianne Snyder, Ph.D., MSN, RN; and Thomas Van Hoof, MD, EdD, FACP.
Despite efforts to recruit registered nurses with disadvantaged backgrounds to the School of Nursing’s primary care nurse practitioner (PCNP) master’s program, numbers of such students remain low, according to Alexander. In order to increase diversity among PCNPs, the School must first increase successful completion of the bachelor’s program among disadvantaged students, and without overwhelming debt.
The objective of “PATH to PCNP” (Provide Academic Transformational Help for disadvantaged nursing students to become Primary Care Nurse Practitioners) is to help such students graduate on time through a “fast track” undergraduate program. The partnership will: increase educational support for students with disadvantaged backgrounds; foster a sense of belonging and ability for positive self-care to reduce stress, anxiety and depression; and infuse primary care curriculum and experiences in medically underserved communities.
“Students participating in the ‘PATH to PCNP’ Program will have primary care experiences during their undergraduate nursing education and graduate ready to begin graduate school to become primary care nurse practitioners,” the faculty team says.
“PATH to PCNP” is a partnership between the UConn School of Nursing and Community Health Center Inc. Senior-level students in the program will complete a capstone clinical rotation at CHCI, gaining experience providing primary nursing care to patients with complex health issues in medically underserved communities. CHCI’s Chief Nursing Officer Mary Blankson, DNP, APRN, FNP-C, will lead the initiative at CHCI, which is one of the largest federally qualified health centers in the country.
National Association of Indian Nurses of America (NAINA) is celebrating the ‘Year of the Nurse and Midwife’ with a variety of activities throughout the year. NAINA, a professional organization for nurses of Asian Indian origin and heritage, collaborates with other national and international nurses associations in its journey towards professional excellence and improving global health. In 2019, NAINA joined the ‘Nursing Now’ global campaign. For the ‘Nursing Now’ campaign, NAINA selected three focus areas: enhancing clinical practice by continuing education, empowering nurses to become leaders at the bedside and beyond, and sharing examples of best nursing practices. In January 2020, NAINA joined the American Nurses Association’s Healthy Nurse, Healthy NationTM campaign as a champion organization to positively impact the health of its members and advance the goals of ANA.
NAINA’s upcoming national event on April 18th, 2020 will advance the goals for ‘Nursing Now’ and its commitment to the Healthy Nurse, Healthy Nation challenge thereby empowering nurses to take charge of their health and the health of the nation. NAINA’s 4th Leadership conference will be held at Howard Community College, Columbia, Maryland. This conference is designed for licensed health care professionals and pre-licensure students as well. This one-day event is designed to augment the knowledge, understanding, and appreciation for self-care, workplace safety, and promote resilience in nurses. The event will promote interprofessional learning and it will highlight how nurses can lead interprofessional teams from the bedside to the boardroom and promote health for themselves and others to build a healthy nation.
Deborah J. Baker, DNP, CRNP, NEA-BC, Senior Vice President for Nursing, Johns Hopkins Health System and Vice President of Nursing & Patient Care Services, Johns Hopkins Hospital will give the keynote address.Lois Gould, MS, PMP from American Nurses Association will address the participants on the topic of ‘Healthy Nurse, Healthy Nation: The Grand Challenge’. Mary Kay DeMarco, PhD, RN, CNE, past president, Maryland Nurses Association, Georgene Butler, PhD, RN, CNE, Dean, Health Sciences, Howard Community College, Maryland, and Bobby Varghese PhD, RN, CNE, Professor of Nursing, Broward College, Florida will speak on various topics related to the theme of the event: Healthy Nurse, Healthy Nation: Leading from the Bedside to Boardroom. Viji George, MA, BSN, RN, RNC-NIC will moderate the panel discussion on the domains of ‘Healthy Nurse, Healthy Nation grand challenge’ . Teams from several state chapters of NAINA will enact how to create joy and find meaning at work amid challenges and pressure.
NAINA is an ANCC accredited provider of nursing continuing professional development and nurses may earn up to 6.5 contact hours by completing this conference activity. Registration is open to nurses for this great educational event for an affordable price of $50.00. Please visit the NAINA website for details of the conference and other monthly NAINA webinars (www.nainausa.com).
For more than a century, nursing has been thought of as the domain of women. But that has fluctuated over the last few centuries. Men actually dominated nursing through the mid-19th century. During the Industrial Revolution, men began leaving nursing for factory jobs. Florence Nightingale led the advancement of women in nursing, targeting upper and middle class women for nurse training. In fact, men were not allowed to serve in the Army Nurse Corps during World Wars I and II. Today, as workplaces evolve, more men are entering the profession again amidst a nursing shortage.
About 13% of nurses in the U.S. today are men, compared with 2% in 1960, according to the Washington Center for Equitable Growth. However, in the high-paying specialty of nurse anesthetist, there is an equal number of men and women.
The United States is leading the way in the increase in the number of male nurses. While the U.S. rate of men in nursing was not much higher than in Switzerland and Brazil in 1970, it rose rapidly over the next several decades and far surpassed these countries in addition to Portugal and Puerto Rico.
The rise of men in nursing is due in part to a shift in available jobs, especially as traditionally male-dominated jobs in manufacturing jobs like automakers have been taken over by automation or moved overseas for cheaper labor. A recent study published in the journal Social Science Researchreviewed eight years of Census data. The study found that of men who had worked in male-dominated industries and then became unemployed, 14% decided to enter industries dominated by women, such as nursing. Eighty-four percent of men who didn’t lose jobs moved onto traditionally female jobs. Unemployed men who got jobs in female industries received a pay increase of 3.80% when making the move.
California is expected to have the highest shortage of nurses, and Alaska will have the most job vacancies. Other states that will face shortages of nurses in the next few years include Texas, New Jersey, South Carolina, Georgia, and South Dakota.
One driver of the need for more nurses is the growth of the aging population, who will require more medical care. Job growth is expected in long-term care facilities, especially for the care of stroke and Alzheimer’s patients. The need for nurses treating patients at home or in retirement communities will continue to grow. The rise in chronic conditions such as diabetes and obesity also means more nurses will be needed.
Pay and Training
The median annual wage for registered nurses was $71,730 in 2018, according to the BLS. The lowest 10% earned less than $50,800, and the highest 10% earned more than $106,530. Those working for the government and hospitals earned the most.
But like many other professions, men are outpacing women in pay. Male RNs make an average of $5,000 more per year than their female counterparts, according to a study published in the Journal of the American Medical Association. This salary gap hasn’t improved since the first year the salary survey was done in 1988. The difference in pay ranges from $7,678 per year for ambulatory care to $3,873 for work in hospitals. The largest gap, $17,290 for nurse anesthetists, may explain why so many men enter that specialty.
The researchers note that increasing transparency in how much employees are paid could help narrow the gap. In addition, part of the pay gap may be due to women taking more time out of the workforce for raising their children. FiscalTiger.com suggests that offering adequate leave to both mothers and fathers after the birth of a child could have a role in making pay more equitable.
The Washington Center for Equitable Growth’s report suggests that the amount of formal training required to become a registered nurse may bring men into nursing from other occupations later in their careers. The minimum training for registered nurses is an Associate Degree in Nursing. Increasingly, employers are demanding more education, however. That includes earning a Bachelor of Science in Nursing (BSN) degree. RNs in the U.S. military must have a BSN, and the Veteran’s Administration, which employs the most RNs in the country, requires a BSN for promotion.
While men are still a minority in nursing, various programs offer support and networking. The American Association for Men in Nursing was founded in 1971 but shuttered in a few years. In 1980 it was reformed and now has thousands of members. It encourages men of all ages to become nurses and supports their professional growth.
Some nursing schools also have groups to support male nursing students. New York University, for example, has Men Entering Nursing (MEN), open to all nursing students at the Rory Meyers College of Nursing to discuss the concerns and perceptions that affect men and what it means to be a male in the field of nursing.
Today nurses practice in many arenas, from hospital bedsides to executive office suites to research laboratories to the halls of the United States Congress. Our Code of Ethics charges all of us to be involved in the political process to influence policies affecting the nursing profession and the health and well-being of all people. Our national professional organization, the American Nurses Association (ANA), encourages all nurses to be politically active to ensure safe and effective care for all patients, to elevate the profession, and to work to eliminate health disparities across our country.
Many early nursing leaders were suffragists and some even went to jail for advocating for women’s right to vote. As soon as the 19th Amendment passed in 1920, nurses were elected to local and state offices. Margaret Laird, a New Jersey nurse, was one of the first two women elected to the New Jersey Legislature in 1920. Between 1920 and 1992 nurses served in state legislatures in many states including North Carolina, Virginia, West Virginia, Massachusetts, Maine, and California. Iowa nurse JoAnn Zimmerman served as her state’s Lieutenant Governor from 1987 to 1991. While a nurse has yet to win a governorship, U.S. Senate seat, or Presidential election, eight nurses have served and/or are serving in the United States House of Representatives.
Texas nurse Eddie Bernice Johnson became the first nurse to win a national office in 1993 when she was elected to serve the 30th Congressional District of Texas in the United States House of Representatives. Twenty-six years later, Johnson continues to serve her district. In the intervening years she has been joined by seven other nurses from across the country. The group of Congressional nurses are African American and white, Democrat and Republican. They range in age from 32 to 84. As a group they represent all areas of the country and a cross section of race, age, and political affiliation. They have all brought their professional experiences, ethics, and commitment to caring with them into the political arena. To kick off Minority Nurse’s new Nurses in Congress series, I will share brief biographical sketches of each of the eight Congressional nurses starting with Congresswoman Johnson.
Eddie Bernice Johnson, RN, BSN, MPA
Democratic Representative, 30th Congressional District of Texas, 1993-present
“Whatever discussion I am a part of, I never miss the opportunity to talk about the value of professional nurses, the value of investment in the profession and the value of attempting to look at the full potential of nurse’s abilities.” —Rep. Eddie Bernice Johnson, Nurse.com
Throughout her life, Congresswoman Eddie Bernice Johnson has been a pioneer. As an African American female growing up in rural Texas during the time of legal segregation, her future may have appeared limited. However, as Mr. James Daniels noted in an interview with Johnson:
Mrs. Johnson, your accomplishments are impressive and even astonishing. Your firsts set you apart as a genuine trailblazer. You are the first woman ever elected to represent Dallas in the U.S. Congress. You are the very first chief psychiatric nurse of Dallas; first African American elected to the Texas House of Representatives from Dallas; first woman in Texas history to lead a major committee of the Texas House of Representatives; first African American appointed regional director of U.S. Department of Health, Education, and Welfare; and the first female African American elected from the Dallas area as a Texas senator since Reconstruction. Your crowning accomplishment, however, is as the first nurse elected to the United States House of Representatives. —James Daniels, MinorityNurse.com
Johnson was born on December 3, 1935 to Lee Edward and Lillie Mae White Johnson in rural McLennan County, Texas to a family of limited means, but with a reverence for education. Johnson graduated from A.J. Moore High School in Waco, Texas in 1952. She wanted to become a nurse, but no accredited nursing school in Texas would accept African American students, so she enrolled in St. Mary’s College in Notre Dame, Indiana. In 1956, she graduated with her nursing diploma. Johnson continued her education earning her BSN from Texas Christian University in 1967, and in 1976, she was awarded her master’s degree in public administration from Southern Methodist University.
Johnson’s early nursing career was spent as a psychiatric/mental health nurse, psychotherapist, and nursing administrator for the Veteran’s Administration (VA). After ten years working for the VA, she achieved the rank of chief psychiatric nurse at the VA Hospital in Dallas. In 1977, Johnson was promoted and became a regional director of the U.S. Department of Health, Education, and Welfare.
In 1972, while working at the VA, Johnson was elected to the Texas House of Representatives, making her the first African American woman to ever win an election in Dallas. Johnson waged a successful campaign for a seat in the Texas Senate in 1986, which she gave up in 1992 to run for the U.S. Congress. She won in a landslide and became the first nurse to serve in Congress. She has retained her seat for twenty-seven years.
Johnson is widely recognized as one of the most effective legislators in Congress. She is credited with authoring and co-authoring more than 120 bills that were passed by the House and Senate and signed into law. Over the decades Johnson has served on and chaired many committees and subcommittees in Congress, including as a senior member of the Transportation and Infrastructure Committee and Chairwoman of the Science, Space, and Technology Committee. Her subcommittee appointments include: the Subcommittee on Water Resources and Environment, which has jurisdiction over water conservation, pollution control, infrastructure, and hazardous waste cleanup as well as reauthorization of the Clean Water Act; the Subcommittee on Aviation; the Subcommittee on Railroad, Pipelines, and Hazardous Materials; the Subcommittee of Research and Science Education; and the Subcommittee on Energy and the Environment. She has also been a Senior Democratic Deputy Whip and Chair of the Texas Democratic Delegation. As chair of the Congressional Black Caucus from 2001 to 2003, Johnson was praised for her ability to build coalitions with business interest group as well as labor unions and civil rights organizations.
Johnson introduced the National Nurse Act of 2011, which would elevate the importance of the Chief Nurse Officer of the United States Public Health Service and appoint a National Nurse to work with the Surgeon General to promote wellness and health literacy. She is also passionate about improving mental health and increasing federal funding for women pursuing science, technology, engineering, and math education.
Teaching in the field of nursing is a rewarding experience and an opportunity to give back to nursing. Education in the faculty role allows for providing insight into current practices based on lived experience and present evidence-based guidelines. Overall, Caucasians and Asians are overrepresented in nursing in comparison to African American and Hispanic nurses, according to a study published in the Journal of Cultural Diversity. As a result of this disparity, there are also problems with equal representation of minority nurse faculty. Those considered faculty of color have continued to represent less than 13% of nursing faculty. As a nurse educator, I have a direct impact on one’s future practice when caring for patients. I am concerned about these known truths and have a few questions for one to consider:
Why is there not an equal representation of minority faculty when compared to the majority?
Are individuals given a fair chance?
It is a tedious process to complete applications for faculty roles and often discouraging to obtain feedback from an automated email generated message about qualifications not matching. I encourage all minority potential faculty candidates to increase their visibility in becoming part of a nursing faculty and continue to be persistent. There does need to be interest in nursing research to be considered competitive for some positions. There are overwhelming amounts of candidates with clinical experience as registered nurses or nurse practitioners. Students more than ever need to see someone who “looks like me” at some point in their curriculum with whom they identify with. This is important in ensuring self-efficacy is present throughout their program.
Often, the hiring process is screened by human resources and not nursing departments. Specific to nursing may be the change of having administrative involvement with applications submitted for faculty roles. Anyone who knows me both personally and professionally understands my passion for nursing education. A majority of my close friends have been convinced to give back to nursing in becoming professors. As an African American female, I disproportionately represent a minority faculty. I am grateful for my opportunities. However, we have more work to do in the recruitment and retention of minority nurse faculty.
Colleges and universities must consider diversity within the workplace, particularly for nursing. This is an initiative for the American Association of College of Nursing (AACN). Their initiative involved the inclusion of a diversity of both students and faculty in schools of nursing across the country. An inclusive learning environment can be shaped by the active recruitment of minority faculty. Should there be a representation of diversity in the hiring process, such as within a search committee? This endorsement by AACN is a step in the right direction in the solution to improving a diverse workplace and learning environment for students. Recognition is the first step in making strides to consider those who are minorities from diverse backgrounds.