Brimming with enthusiasm her first day on the job, the young African-American nurse walks into her very first patient’s room and introduces herself. The patient responds, “You can just get your black a** out of my room.”
Although this painful incident happened to Valda Boyd Ford, MPH, MS, RN, many years ago, new minority nursing graduates tell her that the same thing still happens to them today.

How should minority nurses handle patients who make racist remarks, or even refuse to be cared for by a nurse of color? Is it better to turn the other cheek or to stand up for yourself? Many minority nursing leaders who have “been there” suggest trying to ascertain the patient’s intent in making the remark. Did the patient make a direct and obvious derogatory comment? Or did he or she seem frustrated or confused and blurt out a culturally insensitive remark unaware of a more appropriate thing to say?

 Ruth Brinkley, CHE, RNRuth Brinkley, CHE, RN

“You have to try to put yourself in the place of the patient,” says Ruth Brinkley, CHE, RN, an African-American nurse executive who is president and CEO of Memorial Health Care System in Chattanooga, Tennessee. “If you were under duress and very ill, who knows what you might say? We all have our own biases.”

Ford, who is director of community and multicultural affairs at the University of Nebraska Medical Center, agrees. “You have to balance the comment with the fact that patients are in their most vulnerable state. Sometimes we as nurses have to put our feelings aside to consider what’s best for the patients,” she says, recalling her years as a nurse in a burn unit. “Nothing I could do for the patients was any good because in their mind they didn’t want to be there.”

Telling the patient that the comment was offensive is appropriate as long as it’s done in a polite manner. The nurse may want to say something further–for example, “I’m sorry you feel that way. I hope it won’t get in the way of my taking care of you.” However, Pilar De La Cruz-Reyes, MSN, RN, chief nurse executive at Fresno Heart Hospital in California, doesn’t think the nurse should make too big of an issue with the patient. “You’re not going to change the patient’s mind, especially during the time that he or she is in the hospital worrying about his or her health,” she points out.

Gene Tranbarger, EdD, RN, FAAN, president of the American Assembly for Men in Nursing, recalls a situation involving a Caucasian patient and an African-American nurse who was very light-skinned. When the nurse entered the room, the patient said, “Thank goodness, you’re the first white nurse I’ve seen.” Deeply offended, the nurse went into a tirade. Tranbarger intervened; he decided to reassign the nurse because she was so angry at the patient that he couldn’t see how the relationship could be mended. He tried explaining to the patient why what she said was offensive, but he was never convinced that the elderly Southern lady understood.

Get Management Involved

The next step is to inform your supervisor of the patient’s comments. “If you do not let management know that a situation exists,” Ford cautions, “it may escalate, which could be troublesome for you, the patient and the hospital.”

What happens next is crucial. The nurse manager should approach the patient to give him or her an opportunity to explain what happened. More often than not, when a patient is confronted the issue dissipates, says Ford. But the nurse manager’s actions show that he or she is supportive of the nurse and didn’t dismiss the situation as trivial.

“The most painful thing that has happened to me regarding racism is when the nurse manager says the patient doesn’t mean anything by it,” Ford adds. She remembers that the head nurse at that first job suggested that Ford’s first patient was “just a grouchy old man who needed time to warm up to her.” Management’s failure to respond not only diminishes the nurse’s pain but may also set the stage for an environment in which the nurse can’t advance because he or she may be considered a troublemaker or overly sensitive.

If the situation with the patient is untenable, the nurse should be reassigned, Brinkley advises. Additionally, staff should be debriefed about the event. “These things have to be discussed,” she says, adding that Memorial Health Care System maintains a workplace culture based on reverence, integrity, compassion and excellence. “Reverence means respecting everybody, patients and employees alike,” Brinkley asserts. “Because of our values-based culture, we support our associates through difficult situations like this.”

Clueless Co-workers

Patients aren’t the only source of bias in the nursing workplace. How should minority and male nurses handle the situation when a co-worker, supervisor or physician is the one making a biased comment or displaying cultural insensitivity or gender discrimination? Most experts agree that confronting the individual is the best approach.

When Tranbarger was an educator at East Carolina University in Greenville, N.C. (he is now professor emeritus), he was constantly reminding the dean and other faculty members who used the female pronoun exclusively for nurses that men are nurses, too. “[Having to do that all the time] got tiresome, but it irritated me and [eventually] the language changed,” he says.

As a light-skinned Latina, De La Cruz-Reyes has heard her share of culturally insensitive remarks. “People have said to me, ‘I don’t think of you as being Mexican.’” Her response is that they need to be sensitive to the fact that she is indeed Mexican American and that a comment like that bothers her.

She recalls an incident in which she was investigating a patient complaint when a discussion ensued between her and a physician. The doctor suggested that she “go back where she came from.” De La Cruz-Reyes replied that she was an American citizen and had as much right to be here as he did. Although the physician insisted that she report herself to the human resources office, he never made another derogatory comment to her again.

When such exchanges occur between staff members, it should be the organization’s policy to talk to both parties to determine what happened, says Brinkley. “In the heat of the moment, people can hear things differently from the way they were intended,” she explains. “Many times these situations can be handled by a sincere apology.” But if it happens again, the individuals should be counseled. “We want to make sure that people know those kinds of comments are unacceptable,” she stresses.

The Glass Ceiling

Have you ever felt that you’ve been passed over for a promotion, or unfairly singled out for disciplinary action, because of your race? If so, you’re not alone. Minority Nurses in the New Century: Characteristics and Workforce Utilization Patterns, a 2002 American Nurses Association study led by Hattie Bessent, EdD, RN, FAAN, surveyed a sample of more than 5,000 minority and Caucasian nurses nationwide. Almost 60% of African-American respondents, 53% of Asian/Pacific Islander respondents and 46% of Hispanic respondents said they felt they had been denied a promotion because of their race or ethnicity.

What should you do if you believe you are the victim of this type of employment bias? The experts we interviewed agree that the first step is to do some serious reality testing. Before jumping to the conclusion that you’ve been discriminated against, you should conduct an honest self-assessment. Rule #1 is: Never assume anything about a situation. Rule #2 is to get all the facts.

Then, says De La Cruz-Reyes, “look in the mirror and ask yourself, ‘Do I meet all of the qualifications for the position? Do I have the education, experience, skills and personality?’ If the answer is ‘yes,’ then talk to someone about it. If the answer is ‘no,’ then do something about it, other than just complain.”

Doing something about it could mean asking a trusted co-worker or the person making the decision about the promotion why they think you didn’t get it. If you’re told that you lack certain skills, for example, you can obtain them for the next time a promotion opportunity comes around. Learning what skills and education the other candidates brought to the table may also help you improve any areas where you may be lacking.

It’s important to document this process. That way, the next time you apply for a higher-level position, you can prove that you have since obtained those skills you were told you lacked the last time–for example, by completing a master’s degree or taking a course.

But if you are still denied the promotion, then it may indeed be a matter of discrimination. Take a look your organization’s previous track record in the area of equal opportunity hiring and advancement. If there has been a pattern of large numbers of minority nurses applying for promotions but only a small number of nurse managers who are nurses of color or men, you may have an actionable case.

Where to Turn

So what’s the next step? One option is to meet with someone from the human resources department to voice your concerns.

“[At our health system], HR does a lot to see that these situations are talked through before they escalate to the point of strife,” says Brinkley, who adds that Memorial has a hotline that employees can call anonymously. The organization uses a group interview process for promotions. In almost all cases, the individuals who don’t get the job are spoken with and informed what they need to do to prepare for the next promotion that opens up. A few days later, there is a follow-up meeting to make sure the employee understood.

If you consider your workplace a hostile environment, HR needs to do something about it, says De La Cruz-Reyes. “Sometimes you have to take action, but always go through the chain of command. If nothing is done about it internally, then seek [legal] counsel.”

Ford cautions that sometimes people in HR are more concerned about maintaining a complaint-free reputation, so they may not be that helpful. For example, they may neglect to explain that you have 180 days from the date of the alleged violation to file a claim with the Equal Employment Opportunity Commission (EEOC). “By the time you decide to do something about it, it’s too late,” she says.

If there’s a pattern within the organization of not promoting racial and ethnic minorities, the EEOC is the best place to turn, Tranbarger advises. However, he believes the EEOC is not sympathetic to male nurses who feel they’ve been denied a promotion because of their gender. Tranbarger contends that the EEOC will not investigate charges of discrimination by a white male, who has a better chance if he negotiates with the facility or seeks legal advice.

Paying a lawyer to determine if you have an actionable case may be money well spent. If nothing else, you will learn the type of evidence you need in order to prove discrimination, such as documenting the events and gathering witnesses.

Many states have Fair Employment Practices Agencies responsible for enforcing anti-discrimination laws, along with a local Office of Civil Rights. Your state nursing association and national minority nurse associations may be of help as well.

Unfortunately, the downside of filing a discrimination complaint is that you’ll have to be prepared for a potential backlash. This can be anything from being shunned on the unit or assigned a less flexible schedule to getting a lower than expected pay raise. Additionally, there may be friction between the nurse and the person whom the complaint was lodged against. When Ford informally complained on behalf of her students while working for a previous employer, her teaching assignment was changed and she had a more difficult time rescheduling classes. The HR person avoided her at all cost.

“You have to decide how much you are willing to do,” says Ford, who decided to leave the organization when the stress of the situation resulted in her becoming physically ill. “If you’re the only black nurse in a town that you want to live in for the rest of your life, do you really want to fight the hospital that is seen as a friend to the community?

“I found it rewarding that I had an impact on some of the things I spoke up about,” she continues. “It didn’t help me, but it helped people who came after me. And isn’t that the legacy of the minority saga in this country?”

Creating Bias-Free Workplaces

What can health care facilities and nursing schools do to foster a climate of equal opportunity and zero tolerance for discrimination in their workplaces? First, the organization’s leaders should push to have an organizational assessment conducted to determine the climate of the workplace. However, most organizations conduct diversity training first, which is a mistake, says Ford, who as CEO and president of the Center for Human Diversity has given many presentations across the country on this subject.

Instead, she recommends, they should start by studying their employment demographics to determine if they are reflective of the population in the community. How does the management structure stack up? If the staff reflects the demographics of the area it serves but not at the management level, then the processes to advance staff should be re-evaluated and revised. If minorities are applying for jobs but not moving up the career ladder, find out why. Determine if this is a trend only on certain units or across the system.

Organizations can do this by conducting focus groups with the individuals who do the hiring and by conducting follow-up interviews with candidates who didn’t get the promotion to ask them why they think they didn’t succeed. Sometimes this step requires bringing in consultants who understand how to obtain this type of information without alienating the employees, Ford notes. Once the organization identifies the barriers, they should earmark financial and personnel support to improve the climate. Then they should conduct the diversity training.

When this type of assessment was done at Nebraska Medical Center, management learned that the facility’s past diversity efforts had been done ineffectively. They were seen more as cultural celebrations, says Ford. In addition to bringing in consultants and revising policy, the organization sent its chancellors, vice chancellors and directors to classes to learn about how unconscious bias shows up in the workplace.

“You have to develop a climate that supports people being able to talk openly about things that bother them,” she adds. “We talk a lot about race, but we don’t talk about racism. People are afraid that if we broach the subject it means that we’re ignorant or racist.”

Know Your Rights–and Your Resources

Title VII of the federal Civil Rights Act of 1964 protects individuals against employment discrimination on the basis of race and color, as well as national origin, sex and religion.
According to the Act, it is unlawful to discriminate against any employee or applicant for employment because of his/her race or color in regard to hiring, termination, promotion, compensation, job training or any other term, condition or privilege of employment.

Title VII also prohibits employment decisions based on stereotypes and assumptions about abilities, traits or the performance of individuals of certain racial groups. Furthermore, it prohibits both intentional discrimination and neutral job policies that disproportionately exclude minorities and that are not job-related.

For more information on the Civil Rights Act or employment discrimination, including how to file a complaint with the Equal Employment Opportunity Commission, visit the EEOC’s Web site at

Another good resource is the new Employee Rights Center on ( This Web site is a one-stop legal resource to help employees understand their rights and obtain legal help. It contains articles about employment rights issues, including discrimination, plus it provides state-specific resources, lists of lawyers specializing in employment law and tips for working with an attorney.

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