Nurses have had a particularly challenging year. This year, we’ve seen an intense pandemic strain healthcare workers while simultaneously experiencing a powerful social uprising against racism in the United States. The two major events have some common touchpoints where social, health, education, and economic disparities intersect and are highlighted.
Minority Nurse recently spoke with Lillian Pryor MSN, RN, CNN, and president of the American Nephrology Nurses Association (ANNA), about how this year, in particular, could cause a sea of change across the nation. The process isn’t going to be easy, she says, and it’s only the beginning. But it’s needed, necessary, and long overdue.
“This is a very unprecedented, pivotal kind of moment,” Pryor says. It’s not just one event or even a couple that have brought the nation to this point, she says. “The emotional and physical impact of a pandemic is universally affecting all nurses, although studies have shown that COVID-19 is disproportionately affecting our Black and brown patients. There are social determinants of health that are disproportionately egregious against people of color. You have to think about poverty. It’s not just racism—it’s poverty and not having equitable access.”
And while COVID-19 dominates the lives of healthcare workers, the Black Lives Matter movement has continued to grow, evolve, and impact different people—from those who have grown up with the impact of systemic racism on their own lives to those who have never given racism much thought because it never impacted their lives in a negative and direct way. “I’ve talked with my colleagues about this, and it’s something we’ve had to deal with for a long time,” says Pryor. “I think that Black nurses have always had to face racism and yet continue to function in a manner that embodies the true meaning of nursing.”
As nurses, their job is to help people, and they do that even with patients who are openly racist, she says, but that takes an emotional toll. Sometimes the interactions can lead to something more meaningful—especially if the nurse is able to call attention to the action. A patient who didn’t realize a comment was racist, may be able to hear how it impacted the person it was directed at. In those cases, Pryor says she calls on her ability to be forgiving. But sometimes, it’s intentional, she says. “For so many of us, that’s what we’ve been doing for a while—we just keep going,” she says. “As long as I’m not threatened, I’m going to keep taking care of you because that’s what I’m here to do. Sometimes you get angry.”
What’s happening with the Black Lives Matter movement right now seems to have started a new opportunity. “I believe we just have to start the conversations,” Pryor says. “For sure, education needs to happen, but more than just education; intentional, meaningful awareness of ‘unconscious bias,’ the realities of racism, those written and un-written ‘rules’ that continue to perpetuate systemic inequality to disrupt and then transform this into action.”
Pryor is encouraged by what she sees, even as she knows it’s not going to be immediate. Black nurses need to feel they are able to speak up when something is wrong without being concerned about repercussions—emotional, physical, or professional. They also shouldn’t shoulder the responsibility to correct the wrongs, and that’s where organizations can begin to lead the way by implementing the training and ongoing conversations that will begin to make a change. “You have to be aware and you have to pay attention to it,” she says.
“I believe nursing, will, as the most trusted profession, use our voice to speak out about health inequality, advocate for fair and just health policy, point out institutional racism in our schools, places of work, etc.,” she says. “Then we must promote safety where racism and inequality can be challenged so that equity, inclusion, and diversity can be the experience of all. ANNA recently released a statement against racism pledging to do our part to create systems that support advancement and equality for all.”
When thinking of what nursing can do and continue to do, Pryor recalls the words of ANA president Ernest Grant who stated, “Commit to sustainable efforts to address racism and discrimination…and hold ourselves and our leaders accountable.”
Those words resonate for Pryor. “It’s the time to do this and everyone is willing,” she says, “and that encourages my heart. I’m hopeful it will get better. Never give up hope.”
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.’”
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