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Overcoming Systemic Racism in US Nursing Schools Requires Reflection, Commitment, and Action

Overcoming Systemic Racism in US Nursing Schools Requires Reflection, Commitment, and Action

The events of 2020 highlighted the inequities in health and the injustices faced by Black and Indigenous People of Color (BIPOC) in Minnesota. Many across the state have been awakened to the realities of racism and injustice. On a national level, we witnessed the devastation of COVID-19 and its disproportionate effects on Black and African-American communities.

On a local level, we witnessed the public murder of George Floyd in our city of Minneapolis. At the University of Minnesota School of Nursing , our faculty, students, and staff engaged and reflected with open eyes, ears and hearts the subsequent call to action. There is an unjust dual system that has been carefully woven into the very fabric of our society, including academia and yes, nursing. We acknowledge that white privilege and white supremacy has been institutionalized in academic settings. White supremacy is an insidious, toxic, and expansive system that must be renounced, including within our own schools of nursing.

Many schools of nursing in the United States have renewed their commitment to the courageous work of dismantling systemic racism in their schools and curriculum.   The University of Minnesota School of Nursing is, likewise on a courageous transformational journey toward becoming more inclusive, equitable and diverse. As a place dedicated to educating nurses and transforming the healthcare system, our school has committed to unapologetic and unequivocal advocacy to address injustice and create sustainable change.

We, as the School’s Inclusivity, Diversity and Equity Director and Co-Director, recognized that leading a school toward anti-racism requires a combination of reflection, commitment and action. Paulo Frieree, Brazilian educator and philosopher, best known for his text Pedagogy of the Oppressed, said “Reflection and action must never be undertaken independently”.  Reactive changes rarely provide the depth of understanding necessary to deal with deep issues of racism in healthcare, nor are they sustainable. We started by analyzing our school’s policies for student recruitment and admission,our systems of faculty hiring and promotion, and our fundraising and communication strategies.

U Minnesota school of nursing is dedicated to eliminating inequities and racism.
U of M School of Nursing students practicing clinical skills in the Bentson Healthy Communities Innovation Center.

In our experience, faculty needed time to reflect, learn about historical and systematic inequities, and the space to unpack the complex baggage of white supremacy and privilege that persists in our nation. As a school community, we created opportunities for safe and honest sharing and learning through listening sessions and discussion groups. Faculty were provided with resources to unlearn unconscious bias and deepen understanding about institutional racism in healthcare. Similar opportunities were offered to students across programs, from classroom learning, deep day activities, to monthly affinity group forums.  Reflection is necessary, yet reflection without action is essentially the same as inaction. Without action, reflection can become a passive, self-absorbed pastime and is not helpful in creating substantial and sustained systemic change. Reflective and intentional planning, coupled with committed action is needed to bring about the changes in nursing education and dismantle places in our school where inequities persist.   We are empowering faculty to recognize and interrupt microaggressions in the classroom. We are providing them with resources to make curriculum changes so social justice and antiracism content can be purposefully woven throughout nursing education.

The courageous and transformational journey is not a sprint, rather it’s a marathon that requires long-term commitment. At the center of this change is community because the commitment is ours to share.  There is room for each person in the school community to work for equity and inclusion – from book clubs to policy writing; from recruitment and support of students to search, selection, and faculty development; from teaching antiracism curriculum to highlighting antiracism research.  Reflection, coupled with commitment and action will lead to transformational change in nursing education and healthcare systems.​​ ​

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“Action is the only solution.” Nurse of the Week Marie Manthey Talks About Systemic Racism, White Allyship

“Action is the only solution.” Nurse of the Week Marie Manthey Talks About Systemic Racism, White Allyship

Nurse of the Week Marie Manthey is a very busy 85-year-old nurse, entrepreneur, advocate, and activist in the anti-racism movement. After the American Academy of Nursing presented her with a Living Legends award in 2015 for her pioneering work in developing the Primary Nursing model, she did not retire to rest on her laurels. Manthey continues to host her Nursing Salons (regular gatherings in which nurses meet to share conversations and support), works with the company she founded and is still an active advocate for nurses suffering from substance use disorder.

Marie Manthey, 85-year-old AAN Living Legend nurse and anti-racism activist.
Marie Manthey, at a U Minnesota celebration of the Marie Manthey Professorship.

Manthey is also a leader among nurses in the anti-racism movement. After the summer wave of anti-racism protests, she met with DailyNurse to talk about what it means to take action against racism, her journey as a White ally, and her latest Creative Nursing article, which takes a look at trailblazing Black nurse Frances McHie (pronounced “mic-hye”) and the struggle to overcome racism at the University of Minnesota School of Nursing.

DailyNurse: How did you first hear about Frances McHie?

Marie Manthey: “The school of nursing at University of Minnesota has long had a group of very strong volunteers who have a very extensive collection and data [on the history of the nursing school]. So this group of alumni volunteers—who care passionately and energetically about the history of the school of nursing—are responsible for managing historical documents.

And in that documentation area, we found that our first African-American student, Frances McHie, had only been admitted by demand of the legislature. (We recently celebrated the centennial of her admission, which was attended by some of her descendants).”

DN: How did you become involved in the anti-racism movement?

MM: “My awareness began when, 4 or 5 years ago, the Dean of the University of Minnesota School of Nursing, Connie Delaney—who is a phenomenally transformative leader—brought in a speaker to talk about white privilege. That was the first time I had heard that term. She also brought in a university-wide task force on diversity and equity, and I attended some of their open discussions about what is happening to African-American students in our school today.

The next step for me, was I became friends with an African-American person. Her name is Tammy, and she’s a nurse in an administrative position at a local hospital. Well, we met at a statewide leadership meeting, where we made a commitment to develop our relationship and became friends. Tammy started to come to the nursing “salons” I had formed earlier—where we would have dinner, and talk, where the question would be asked, “what’s on your mind about nursing?” and at the end of the evening we would go around and respond to the question “what’s on your mind about nursing now?” After Tammy joined us, we often found ourselves discussing issues affecting nurses of color, and Tammy went on to open a Black nursing salon. We held the first one at my house, and mine was the only white face there. That was part of my leap to a different level of understanding because I listened to what these nurses were talking about. And as I’m listening to them, I’m hearing about what systemic racism really looks like! I had not understood it before; I thought it was about the way we individually deal with racism.

[At the Black Nurses’ Salon] I began to understand what the system has done. It was a big breakthrough. I could finally see where I was in the system as a nursing leader. I could see where some of the decisions I made that involved a person of color versus a White person going for a promotion or better hours, and my decision would sometimes be ‘well, it would work out better if we give this to a White person; she’ll get along better.’ And I didn’t see that until I heard these nurses talk about what it’s like to apply for better hours or something, and despite equal education, equal experience, the white nurse will get it. Also, until now, I didn’t really understand White privilege. Now—at the age of 85—I finally get how being born white has affected everything from my thought processes to my life experiences. It’s very clear to me that action is the only solution.

Tammy and I are going to start another Salon on diversity in nursing with an equal number of nurses of color and nurses who are white. To get us talking to each other.”

DN: It’s complicated. On one hand, it’s not the job of Black people to tell Whites, “this is what you need to do to stop being racist,” but at the same time, we can only learn by communicating in an open, willing dialogue.

MM: “I had to learn how to listen without judgment. At the Black Nurses Salon, I went in ready to just accept what everyone was saying without deciding whether I agreed with everything that was being said.”

DN: One of the biggest obstacles we face is that we are living in an age of “I’m not a racist” racism.

MM: “That’s very true. I discuss that in some detail in a piece I wrote on my journey toward becoming an anti-racist. I went from proudly saying, “I’m not racist!” to actually taking on responsibility for taking steps to dismantle systemic racism and acknowledging that my people with my skin color have been building this system for 400 years At the salons, I began to accept responsibility for what happened. I didn’t ask for it or personally cause it to happen, but it was part of my culture. People of color certainly didn’t ask for it either…..and both of us have experienced the impact of systemic racism.

After taking responsibility, I began to understand that the only solution—I’m a big follower of Nelson Mandela and the idea of reconciliation; it’s a big part of my value system—is reparations. I don’t necessarily mean financial, but the way I am in my world, how I present myself, how accept what other people are saying to me.”

DN: That brings us to the Frances McHie nursing school scholarship, which is a form of reparation, right?

Frances McHie Rains, first Black nurse to graduate from University of  Minnesota, was a lifelong anti-racism activist.
Frances McHie Rains (1911-2006)

MM: “Yes. When the idea of a scholarship in Frances McHie’s name came up, we found a relative of hers who was a nephew and began putting some flesh on the idea. And with his help, we established the Frances McHie Scholarship for nurses of color [at the University of Minnesota School of Nursing]. That was an action step following a public apology to the McHie family. Dean Connie Delaney made a public statement reflecting that the Frances McHie scholarship was a step in reparations and in accepting the school’s responsibility for racism.”

DN: What other actions are nursing schools taking to reduce the effects of systemic racism?

MM: “Some are changing admissions criteria from a hard GPA requirement, and are taking a person’s story into account as well. I think that’s a good idea. There’s no doubt that people of color don’t have equal opportunities. I have a book that was published in 1933, [Carter G. Woodson’s] The Mis-Education of the Negro. It tells the story of how Jim Crow schools started. It says they were teaching them at a lower level, and that’s been carried on through the years.”

DN: What sorts of things can individuals do to fight racism, on an immediate level?

MM: “We can look at big-picture issues—who we elect as our representatives, our senators, etcetera, but we also have to work on a personal level. We need to make deliberate, conscious, intentional choices about the way we live our lives. What is my circle of responsibility and control, and how do I want to be in those areas? I have to look at the way I interact with my children, my friends, my family, my associates, and ask “what are the things that I can influence?” For me writing—for instance, the article [on Frances McHie] and my personal story about my journey—can help me to influence others to work toward change. I just feel that that is what I need to be doing at this point in my life. This is a personal choice we make: are we going to continue to be the way we’ve been, or are we prepared to step into an area where we can’t predict what people’s reactions will be?”

DN: Are more people sincerely examining their own views and trying to move forward?

MM: “I feel very hopeful because so many people are having these conversations. I have these conversations with a lot of my friends. A lot of [other White people] are talking to me about racism. And my company is creating a task force; we are engaged in looking at everything we do.

I’m also the chairman of the board of Directors of the Nurses Peer Support Network, which helps nurses who have been struggling with addiction and are trying to regain their licenses. I’ve been asking people, “can you help me find African-Americans or other people of color for our board?” We recently added our first Black board member, and we have two more we are considering for our [organization. And I think that I’m not the only person who is doing this. Best Buy is looking for enough people of color and women to make up 30% of their new hires. A number of companies are taking action, and I think that’s a hopeful sign.”

Marie Manthey is the author of the award-winning book, The Practice of Primary Nursing, and is a co-founder of the journal Creative Nursing. Manthey’s recent article on Frances McHie—the nurse, activist, and entrepreneur who broke the color barrier at the University of Minnesota School of Nursing—is available here.​​

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MI Gov: Provide Implicit Bias Training for All Healthcare Workers

MI Gov: Provide Implicit Bias Training for All Healthcare Workers

Michigan Governor Gretchen Whitmer is taking action to fight implicit bias and racial discrimination in the state’s healthcare system. In a July 9 Executive Directive , the governor called upon the state Department of Licensing and Regulatory Affairs to “establish new rules requiring all health care professionals to receive training on implicit bias and the way it affects delivery of health care services.”

Implicit bias, according to the directive, encompasses “thoughts and feelings that, by definition, often exist outside of conscious awareness, and therefore are difficult to control.” Bias of this sort “can shape behavior, including the behavior of health care professionals. One way to reduce disparities in health outcomes, therefore, is to seek to eliminate the unconscious biases, misconceptions, and stereotypes…”

Whitmer’s implicit bias directive is the result of a recommendation by her Michigan Coronavirus Task Force on Racial Disparities, which has been mandated to seek out “solutions to the disparate effects of COVID-19 on people of color.” Overcoming implicit bias is a vital step toward reducing health disparities, as Black, Latinx, and indigenous patients often receive substandard care—such as inadequate pain relief, dismissiveness, and treatment based on physical and cultural misconceptions—as a result of discrimination on the part of healthcare providers.

The implicit bias initiative emerged from a task force that was created after legislators became aware of the wildly disproportionate impact of COVID-19 on people of color. According to Lieutenant Governor Garlin Gilchrist, Michigan is “one of first—and sadly, one of the few states—that reports [COVID] cases and deaths by race and ethnicity.” In her directive, Whitmer observes: “As of July 5, 2020, Black Michiganders represented 14% of the state population, but over 35% of confirmed COVID-19 cases where the race of the patient was known…. And Michigan is no outlier. According to the Centers for Disease Control and Prevention (CDC), ‘non-Hispanic Black persons have a [COVID-19 associated hospitalization] rate approximately 4.7 times that of non-Hispanic White persons.’ Moreover, Black and Latino people have been nearly twice as likely to die from the virus as white people, according to CDC data. Indigenous populations have experienced a hospitalization rate even higher than that of Black Americans.”

Other task forces to combat racial bias have recently been formed by the US Navy, the Duke University Global Health Institute, and the state of North Carolina.

Local Officials Across US Declare Racism a Public Health Crisis

Local Officials Across US Declare Racism a Public Health Crisis

From Boston to San Bernardino, California, communities across the U.S. are declaring racism a public health crisis.

Fueled by the COVID-19 pandemic’s disproportionate impact on communities of color, as well as the killing of George Floyd in the custody of Minneapolis police, cities and counties are calling for more funding for health care and other public services, sometimes at the expense of the police budget.

It’s unclear whether the public health crisis declarations, which are mostly symbolic, will result in more money for programs that address health disparities rooted in racism. But officials in a few communities that made the declaration last year say it helped them anticipate the COVID-19 pandemic. Some say the new perspective could expand the role of public health officials in local government, especially when it comes to reducing police brutality against Black and Latino residents.

The declarations provide officials a chance to decide “whether they are or are not going to be the chief health strategists in their community,” said Dr. Georges Benjamin, executive director of the American Public Health Association.

“I’ve had a firm view [that] what hurts people or kills people is mine,” said Benjamin, a former state health officer in Maryland . “I may not have the authority to change it all by myself, but by being proactive, I can do something about that.”

While public health officials have long recognized the impact of racial disparities on health, the surge of public support for the Black Lives Matter movement is spurring calls to move from talk to financial action.

In Boston, Mayor Martin J. Walsh declared racism a public health crisis on June 12 and a few days later submitted a budget that transferred 20% of the Boston Police Department’s overtime budget — $12 million — to services like public and mental health, housing and homelessness programs. The budget must be approved by the City Council.

In California, the San Bernardino County board on Tuesday unanimously adopted a resolution declaring racism a public health crisis. The board was spurred by a community coalition that is pushing mental health and substance abuse treatment as alternatives to incarceration. The coalition wants to remove police from schools and reduce the use of a gang database they say is flawed and unfairly affects the Black community.

The city of Columbus and Franklin County, Ohio, made similar declarations in June and May, respectively, while Ingham County, Michigan, passed a resolution June 9. All three mention the coronavirus pandemic’s disproportionate toll on minority residents.

Those localities follow in the footsteps of Milwaukee County, Wisconsin, which last year became the first jurisdiction in the country to declare racism a public health crisis, citing infant and maternal mortality rates among Blacks. The county’s focus on the issue primed officials to look for racial disparities in COVID-19, said Nicole Brookshire, executive director of the county’s Office on African American Affairs.

Milwaukee County was training employees in racial equity and had launched a long-term plan to reduce disparities in health when the pandemic hit. “It was right on our radar to know that having critical pieces of data would help shape what the story was,” said Brookshire.

She credits this focus for the county’s speedy publication of information showing that Black residents were becoming infected with and dying of COVID-19 at disproportionate rates.

Using data to tell the story of racial disparities “was ingrained” in staff, she said.

On March 27, the county launched an online dashboard containing race and ethnicity data for COVID-19 cases and began to reach out to minority communities with culturally relevant messaging about stay-at-home and social distancing measures. Los Angeles County and New York City did not publish their first racial disparity data until nearly two weeks later.

Declaring racism a public health crisis could motivate health officials to demand a seat at the table when municipalities make policing decisions, and eventually lead to greater spending on services for minorities, some public health experts say.

The public is pressuring officials to acknowledge that racism shortens lives, said Natalia Linos, executive director of Harvard’s Center for Health and Human Rights. Police are 2½ times as likely to kill a Black man as a white man, and research has shown that such deaths have ripple effects on mental health in the wider Black community, she said.

“Police brutality is racism and it kills immediately,” Linos said. “But racism also kills quietly and insidiously in terms of the higher rates of infant mortality, maternal mortality and higher rates of chronic diseases.”

The public health declarations, while symbolic, could help governments see policing in a new light, Linos said. If they treated police-involved killings the way they did COVID-19, health departments would get an automatic notification every time someone died in custody, she said. Currently, no official database tracks these deaths, although news outlets like The Washington Post and The Guardian do.

Reliable data would allow local governments to examine how many homeless or mentally ill people would be better served by social or public health workers than armed police, said Linos.

“Even symbolic declarations are important, especially if they’re accurately capturing public opinion,” said Linos, who is running to represent the 4th Congressional District of Massachusetts on a platform of health and equity. “They’re important for communities to feel like they’re being listened to, and they’re important as a way to begin conversations around budgeting and concrete steps.”

Derrell Slaughter, a district commissioner in Ingham County, Michigan, said he hopes his county’s declaration will lead to more funding for social and mental health as opposed to additional policing. Slaughter and his colleagues are attempting to create an advisory committee, with community participation, to make budget and policy recommendations to that end, he said.

Columbus City Council members coincidentally declared racism a public health crisis on May 25, the day Floyd died in Minneapolis. Four months earlier, the mayor had asked health commissioner Dr. Mysheika Roberts for recommendations to address health issues that stem from racism.

The recent protests against police brutality have made Roberts realize that public health officials need to take part in discussions about crowd control tactics like tear gas, pepper spray and wooden bullets, she said. However, she has reservations about giving the appearance that her office sanctions their use.

“That definitely is one of the cons,” she said, “but I think it’s better than not being there at all.”

Published courtesy of KHN (Kaiser Health News) is a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation), which is not affiliated with Kaiser Permanente.

Nursing Associations Call for Action Against Racism

Nursing Associations Call for Action Against Racism

Over the past month, a growing number of nursing associations have been calling upon members of the profession to take action against racism.

The first official remarks appeared the day after George Floyd’s death. On May 31, the Minnesota Nurses Association issued a press release stating that “nurses continue to see the devastating effects of systematic racism and oppression targeting people of color in our communities. We demand justice for George Floyd and a stop to the unnecessary death of black men at the hands of those who should protect them.”

The Board of Directors of the New York State Nurses Association declared, “As nurses, we mourn for the hundreds of Black men and women killed by the police every year, like Breonna Taylor, an EMT studying to be a nurse in Louisville, Kentucky.” The NYSNA called upon nurses to “fight against the bigotry, intolerance, and hate fueling current politics and feeding an armed white supremacist movement that threatens our democracy.”

This is “a pivotal moment,” according to ANA President Ernest J. Grant. In a June 1 statement, he urged US nurses “to use our voices to call for change. To remain silent is to be complicit.”

Calling racism “a public health crisis,” the Washington State Nurses Association said, “Racism has a 400 year history in America – and the hand of racism rests heavily on the health care system and public health. We know that people of color face systemic barriers to accessing health care and being listened to or heard. It is the reason African American women face higher rates of maternal death and why the burden of the coron­avirus pandemic is falling more heavily on people of color. It is why African Americans have the highest death rate and shortest survival of any racial and ethnic group in the US for most cancers. It is why African Americans are almost twice as likely to die from a firearm than their white counterparts. And, it is why we as nurses must look racism in the face and call it what it is.”

The Oregon Nurses Association commented, “As nurses, it is our duty and our calling to protect and serve the health and well-being of the entire community. That duty extends particularly to people of color who are especially vulnerable in this healthcare system.” In an interview with Austin station KXAN, Dr. Cindy Zolnierek, CEO of the Texas Nurses Association, echoed Grant’s statement, saying, “This is core to our ethics. It’s human rights so we cannot stand on the sidelines. To be silent is to be complicit. So, we have a role in this. We have a role to play in advancing human rights – in advancing health care.”

The Kentucky Nurses Association released a seven-point action plan to combat racism both in the profession and in the culture at large. The plan includes goals such as “training for nurses regarding racial disparities,” promoting the “recruitment of African American nurses and other nurses of color to serve on boards and commissions and leadership positions within our organization as well as others that focus on health,” and the addition of “cultural competency training, bias training and disparity education in every Kentucky nursing school curriculum.”

The Massachusetts Nurses Association also spoke out: “As nurses and healing professionals… we recognize institutional racism and the systematic oppression of communities of color as both a crisis in public health and a pervasive obstacle to achieving the goals of our work in both nursing practice and in the labor movement.”

Other nursing organizations issued anti-racism action statements as well, including the American Academy of Nursing, the International Family Nursing Association, the Rheumatology Nurses Society, and the Association of Rehabilitation Nurses.