ANA\California Launches Taskforce To Address Racism in Nursing
This is a guest article contributed on behalf of the American Nurses Association\California. It is co-authored by: Charlotte Gullap-Moore, DNP, APRN, ANP-BC, Kim Brown Sims, MBA, RN, FACHE, NEA-BC, & Tasha Haley, BSN, RN.
As of June of 2020, the American Nurses Association\California (ANA\C) executive team decided to create a Taskforce of scholars that would collectively design an Anti-Racism toolkit for members in the nursing profession.
The first step towards making the toolkit is to conduct a pilot survey intended to collect data and begin the initial steps towards educating nurses in California about the systemic and institutionalized racism against Black, Indigenous, and Persons of Color (BIPOC).
The ultimate goal is to establish a toolkit that will help identify and begin eradicating racism, injustice, inequity, inequality, and how to foster sustainable and equitable inclusion in the nursing profession and healthcare.
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In a recent interview, some of the Taskforce members shared examples of three Anti-Racism transformational change areas for the nursing community to focus on,
- Facilitate constructive and sustainable conversations
- Implement reporting systems that support accountability and follow-up
- Standardize actions among key decision-makers.
Read on to learn why these three focus areas are important to the nursing community.
Facilitate Constructive and Sustainable Conversations
There is a critical need for the nursing community to intentionally and actively address racism in the profession and stop propagating a culture of silence.
Staff nurses and management alike feel the need to advocate against racism in healthcare but may lack the communication skills to create constructive and sustainable conversations. Those nurses who have tried to conduct these types of conversations often find their discussions devolve into arguments about political ideology, proper terminology, and personal experiences.
According to the Gallup Poll (2021), America's most trusted profession erosion of trust results from implicit bias, socio-economic injustice, and institutional racism. The oppression and discrimination of Black, Indigenous, and other Nurses of Color have been well documented throughout the years. Racism is present within our ranks, toward patients, and patients toward nursing and medical staff (Williams & Rucker, 2000).
To achieve racial justice within nursing and healthcare, a framework must be required to allow a starting point of discussion about racism within the work environment and academia. The desired outcome of the work done by the ANA\C Taskforce is to establish accountability and transparency when beginning to discuss racism as an individual or organization within the nursing profession.
Ethically nursing has been a pillared profession of advocacy, advocacy for the health and well-being of patients, peers, and society (American Nurses Association, 2015). The Taskforce asks for nursing to utilize its legacy for having the people's trust and initiate the path for speaking up fearlessly to facilitate a sustainable change in the landscape of racial justice within the profession and healthcare.
"Racism is a system of structuring opportunity and assigning value based on the social interpretation of how one looks (which is what we call "race"), that unfairly disadvantages some individuals and communities, unfairly advantages other individuals and communities, and saps the strength of the whole society through the waste of human resources," Camara Phyllis Jones, MD, MPH, Ph.D.
Implement Reporting Systems That Support Accountability and Follow-Up
We live in a time where 61% of the United States employees experience or witness some form of discrimination based on race, gender, age, and sexuality (Zheng, 2020).
However, the Equal Employment Opportunity Commission found that only 30% of discrimination cases are documented internally, and less than 15% have formal legal charges (Feldblum & Lipnic, 2016).
Organizations are recommended to implement systems, policies, and procedures that encourage staff to report experiences of discrimination and create a culture in their organization that ensures these experiences are investigated and actions occur. When organizations set up transparent and accountable processes, such as collecting and tracking data related to discriminatory practices, evidence shows that disparities throughout the organization improve (Hirsh & Tomaskovic-Devey, 2020).
Typically nurses who file complaints never receive follow-up or are asked additional questions regarding the complaint. Additionally, no other alternate channels are offered to continue the complaint filing process if the initial management response or follow-through is negligent.
According to Yang & Lui (2021), internal enforcement systems lack retaliatory protections. Follow-up should not fall to the individual employee. Compounded further by the power imbalance between employees and employers is the allowance of employee rights to be stripped away, thus undermining the use of effective enforcement of arbitration clauses and nondisclosure agreements.
Standardize Actions Among Key Decision-Makers
Addressing discriminatory practices through policy change, transparency, and regulatory accountability is the foundational work undertaken by the Taskforce. Ultimately creating sustainable change, thereby shifting the power balance towards equitable equality to mitigate racism and discrimination.
It is documented that racism and not race are among the significant root causes of the disproportionately higher rates of Black poverty, diseases, hospitalizations, and mortality rates (Mays et al., 2007). However, our health care institutions, academic publications, and peer-review journals continue to allow the omittance of factual and scientifically based data that connects race to various diseases or treatment responses (Keeton., 2020).
If we do not create a higher standard for publication to shift the unfounded biological explanation to an evidence-based context; then health care providers will continue to educate themselves, students, and the patient population at large that being Black, Indigenous, or a Person of Color is a predictor of epidemiological risk – based solely on the color of their skin.
The biomedicine that should be interpreted is how health disparities are largely connected to inequalities and inequities perpetuated by the various socio-economic policies and current anti-Black health care infrastructure (Freedman & Spillman, 2016).
Goals of the Taskforce
Historically, nursing has been complicit while perpetuating an anti-Black presence in academia, 85% of nursing faculty nationally are white, and unsuccessful efforts to decolonize the student curriculum to an all-inclusive pedagogy (Burnett, et al., 2020 and National League for Nursing, 2015). In addition, deliberate implementation of sustainable and equitable actions must be made by leadership to improve access to nursing programs for BIPOC students and tenured faculty members.
Merely having cultural competency training or a member of the BIPOC community to lead a Diversity, Equity and Inclusion (DEI) effort is not enough to address the socio-political and socio-economic processes that maintain prevailing health disparities (Waite and Nardi, 2019).
The ultimate goal for the Taskforce is to analyze the data-driven by the pilot survey and design an Anti-Racism toolkit with various educational resources that will become the standard methodology for individuals and organizations within the nurse profession. Intentional and equitable actions are necessary to eliminate complicity by confronting institutional and structural racism and the various forms of racial policies within the nursing profession.
We must stop hiding behind our nursing code of ethics as if racism does not exist in nursing, but be purposeful about transforming deeply embedded behaviors and racist ideology.
ANA/CA Assessment
The American Nurses Associaion\California aims to create a plan to eradicate systemic racism of Black, Indigenous, and Nurses of Color. Nurses can participate in their staff or management assessment here.
"Racism is a public health crisis. Racism in nursing and healthcare is a longstanding health crisis in California that needs our attention. As nurses, we are obligated to first address the systemic racism within our own nursing profession. Only then can we hope to adequately and comprehensively address the larger issue of racism in healthcare.
ANA\California has convened nursing and healthcare leaders to create an assessment and action plan for both Nursing Staff and Nursing Management. This work will serve as a catalyst for sustainable change as well as a roadmap to facilitate that change based on individual and organizational awareness."
References
American Nurses Association. (2015). Code of ethics for nurses. American Nurses Publishing.
Burnett, A., Moorley, C., Grant, J., Kahin, M., Sagoo, R., Rivers, E., Deravin, L., & Darbyshire, P. (2020). Dismantling racism in education: In 2020, the year of the nurse & midwife, "it's time.". Nurse education today, 93, 104532. https://doi.org/10.1016/j.nedt.2020.104532
Feldblum, C., Lipnic, V. (2016). Select Task Force on the Study of Harassment in the Workplace. https://www.eeoc.gov/select-task-force-study-harassment-workplace
Freedman, V. A., & Spillman, B. C. (2016). Active life expectancy in the older US population, 1982–2011: Differences between blacks and whites persisted. Health Affairs, 35(8), 1351-1358. https://doi.org/10.1377/hlthaff.2015.1247
Gallup Poll: U.S. Ethics Ratings Rise for Medical Workers and Teachers. Retrieved May 2020. https://news.gallup.com/poll/328136/ethics-ratings-rise-medical-workers-teachers.aspx
Hirsh, E. & Tomaskovic-Devey, D. (2020). Metrics, Accountability, and Transparency: A Simple Recipe to Increase Diversity and Reduce Bias, What Works: Evidence-Based Ideas to Increase Diversity, Equity, and Inclusion in the Workplace. Retrieve from: https://www.umass.edu/employmentequity/sites/default/files/What_Works.pdf
Keeton VF. What's Race Got to Do With It? A Close Look at the Misuse of Race in Case-Based Nursing Education. Nurse Educ. 2020 May/Jun;45(3):122-124. doi: 10.1097/NNE.0000000000000707. PMID: 31335625.
Mays, V. M., Cochran, S. D., & Barnes, N. W. (2007). Race, race-based discrimination, and health outcomes among African Americans. Annual review of psychology, 58, 201–225. https://doi.org/10.1146/annurev.psych.57.102904.190212
National League for Nursing. (2015). Rank of full-time nurse educators by race-ethnicity, 2015. Retrieved from http://www.nln.org/newsroom/nursing-education-statistics/nurse-educator-demographics
Waite, Roberta, and Deena Nardi. "Nursing colonialism in America: Implications for nursing leadership." Journal of Professional Nursing, vol. 35, no. 1, 2019, pp. 18-25.
Williams, D. R., & Rucker, T. D. (2000). Understanding and addressing racial disparities in health care. Health care financing review, 21(4), 75–90.
Yang, R. J., & Liu, J. (2021). Strengthening accountability for discrimination: Confronting fundamental power imbalances in the employment relationship. Economic Policy Institute. Retrieved from https://www.epi.org/unequalpower/publications/strengthening-accountability-for-discrimination-confronting-fundamental-power-imbalances-in-the-employment-relationship/
Zheng, L. (2020). Do your employees feel safe reporting abuse and discrimination? Harvard Business Review. Retrieved from: https://hbr.org/2020/10/do-your-employees-feel-safe-reporting-abuse-and-discrimination
