February 25, 2022

As a Chief Nurse, I Sometimes "Felt Like a Black NFL Coach” and This is Why

As a Chief Nurse, I Sometimes "Felt Like a Black NFL Coach” and This is Why

Katie Boston-Leary, Ph.D., MBA, MHA, NEA-BC is the director of nursing programs at the American Nurses Association and an adjunct professor at the University of Maryland School of Nursing

A few years ago, while I worked as a Chief Nurse, I found myself in a position where I had multiple levels and layers of approval for vacant RN positions to be filled compared to my C-suite colleagues. This created holes with my staffing and delayed hiring which was frustrating to me and my staff. I was also a bit perturbed since there wasn’t a similar approval system for my colleagues when they had vacancy requests.  During one of the meetings to justify my need to backfill old positions, I made a half-joking comment to one of my peers that I felt like I am being treated like a Black NFL coach as I must navigate different rules compared to my white colleagues. Needless to say, I received a call from HR. The complaint was from my peer who stated that my comment made him uncomfortable.

The recent class-action lawsuit brought by the ex-coach of the Miami Dolphins, Brian Flores against the NFL and NFL owners alleges racist and inequitable hiring and firing practices that prevent or limit the hiring of Black head coaches. The evidence is quite alarming that there will be only one Black coach in the NFL in 2022 compared to three Black coaches despite the institution of the Rooney Rule 19 years ago which requires league owners to interview ethnic-minority candidates for head and senior operational positions.

The Chief Nurse is the personnel equivalent of the head coach in the National Football League. A Chief Nurse is a leader of professional men and women who make up the majority of personnel in most settings – particularly in hospitals.

According to Zippia (2022)

  • 68% of CNOs are White compared to 10% that are black.
  • Furthermore, the Institute for Diversity in Health Management’s (2016) national survey of over 6000 US hospitals indicates only 14% of hospital board members, 11% of hospital executive leaders, and 19% of first and mid-level managers identified as an ethnic minority.

This is particularly concerning since a recent ANA survey on racism in nursing (5600 survey respondents) found that racist acts were principally perpetrated by colleagues and those in positions of power.

  • 63% of nurse respondents said that they have personally experienced an act of racism in the workplace with the transgressors being either a peer (66%) or a manager or supervisor (60%).
  • Similar to the lack of progress or inaction with the Rooney Rule, 57% of nurses said they have challenged racism in the workplace, but more than half said their efforts resulted in no change.

This is alarming given the importance of diversifying the profession and also sets up the urgent need to diversify leadership which is crucial in addressing the health inequities that COVID-19 exposed. A diverse workforce is as important as having diverse leaders to strategize and build trust with underserved communities that are understandably skeptical of health institutions and providers.

The dynamics that come with low ethnic representation in Chief Nursing Executive roles may be similar to what is being described by Black coaches. According to Dunkley (2020), black CNOs felt the following pressures in the work setting:

1. They needed to live in a constant state of readiness and felt they should be prepared at all times" to advance in their careers—and even be "a step ahead" of their counterparts "by having several certifications" that "their counterparts weren't required to have."

2. They felt they needed to embrace responsibilities beyond their job descriptions particularly if they were the first Black woman to occupy the role, they "had this weight of their community on their shoulders and felt that they couldn't mess up or make a mistake”.

3. They had to overcome unending challenges to progress and be successful in their careers, including obstacles related to discrimination, sabotage, and censorship.

Gallup polls have deemed nurses as the most trusted professional group for the past 20 years. The principles of nursing ethics – autonomy, beneficence, justice, and nonmaleficence have long been values that nurses incorporate into daily practice. These values must also apply to hiring, succession planning, mentorship, and sponsorship practices by organizations. It’s beyond time to close the diversity gap in nursing leadership, senior positions, and board rooms to address the health inequities that this novel virus and the pandemic so indelicately exposed. The unequal and inequitable distribution of health is a public health crisis and addressing this starts and ends with diverse leadership in nursing and healthcare overall.


Dunkley, D (2020). WHAT IT'S LIKE TO BE A BLACK WOMAN AND CNO. Retrieved from HealthLeaders Media  https://www.healthleadersmedia.com/nursing/what-its-be-black-woman-and-cno

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