For Daniela Vargas, MSN, MPH, MA-Bioethics, RN, PHN, a nursing school textbook presented an early rude awakening to racism in nursing. Vargas, who identifies as an indigenous brown woman and whose family came from Mexico, was shocked by the generalized depictions of people of color in the NCLEX prep book. “It was in a way a precursor to what I started to not only experience myself, but also with colleagues who are people of color, what their experiences were in the profession as I moved through nursing school and then post nursing school as well,” she says.
Vargas, a nurse since 2016, now serves as co-lead for the National Commission to Address Racism in Nursing. In January, the commission released an eye-opening survey on racism within nursing. The national study found that nearly half of the respondents reported widespread racism in the profession.
According to more than 5,600 respondents, racist acts are principally perpetrated by colleagues and those in positions of power, says a press release. Over half (63%) of nurses surveyed say 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%).
A subtler racism
Vargas says that the survey’s findings did not surprise her. Today’s racism, she says, may not be as obvious as the discrimination practiced in previous times. “I would say it’s less blatant and less in your face than it was perhaps in decades past.”
Healthcare institutions, notes Vargas, may come out with public statements against racism. “Yet the cultures that remain in many of the units where nurses work, that has not changed. It’s just they’ve evolved into being less in your face, and in a way people have gotten more sophisticated in how racism gets expressed.”
For instance, management or peers might make it harder for a nurse of color to obtain a promotion, she notes. Or staff nurses would refuse to work with student nurses of color during clinical instruction.
On top of nurse burnout and nurses leaving the profession because of the pandemic, “you have this compounded racism that faces many nurses already,” Vargas says. “And it’s built up over time. Especially for newer nurses, they go into nursing without the tools or the knowledge that this is occurring in the profession, and then once they’re in it, and they’re practicing, then they’re like, Whoa, what just happened? And I have not been taught how to address this, because it’s not something we learned in nursing school.”
“As I continued to go into the profession, I then finally was able to say, this is racism. I’m not just experiencing nurse bullying or incivility. It’s now become much more toxic and insidious than what I thought I was going into when I was in nursing school,” Vargas says.
Seeking solutions
In addressing racism in nursing, “the first thing that needs to be done is acknowledge that it exists,” Vargas says. Also, when onboarding a new nurse to an institution or unit, “there needs to be some built-in curriculum that has an antiracist standpoint to it, that comes with an expectation that this is not tolerated at this institution from the get-go.”
Serious accountability needs to be put into place, Vargas says. “There’s a piece of accountability that needs to be had in regard to what type of accountability measures an institution is doing, because saying that you want to be it is very different than the action.” For example, just as there are whistleblower hotlines for abuse or unethical behavior, hotlines could be established for racist behavior, she suggests.
Similarly, she says, licensing bodies can put in place mechanisms to report racism. “There has to be a real conversation in the nursing profession in regard to accountability of the individual nurse too” because racism affects not only patient care, the patient experience, and the community experiences but also affects colleagues as well. “I don’t think that we have enough measures currently in place that seek accountability on the side of nurses experiencing racism.”
“What this survey did was really allow nurses of color to be able to share their lived experiences,” says Vargas. “And that is important because the voices of nurses of color are now being heard.”
“What this survey is a launchpad for, is to say this is no longer tolerated in the profession. It does not coincide with our code of ethics and we will be the generation that moves the profession forward in not tolerating it and allowing future generations to go without accountability.”
According to the findings of a new national survey of nurses by the National Commission to Address Racism in Nursing (the Commission), nearly half reported that there is widespread racism in nursing, demonstrating a substantial problem within the profession. Comprised of leading nursing organizations, the Commission examines the issue of racism within nursing nationwide and describes the impact on nurses, patients, communities, and health care systems to motivate all nurses to confront systemic racism. Integrity calls on the profession and nurses to reflect on two realities, one as the most trusted profession while also being a product of our environment and culture. It is necessary to work toward connecting these two realities.
“My colleagues and I braced ourselves for these findings. Still, we are disturbed, triggered, and unsettled by the glaring data and heartbroken by the personal accounts of nurses,” said Commission Co-Lead and American Nurses Association (ANA) President Ernest J. Grant, PhD, RN, FAAN. “We are even more motivated and committed to doing this important work justice. Racism and those individuals who do not commit to changing their ways but continue to commit racist acts have absolutely no place in the nursing profession.”
According to more than 5,600 survey respondents, racist acts are principally perpetrated by colleagues and those in positions of power. Over half (63%) of nurses surveyed say 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%).
Superiority continues to surface as a primary driver from nurses representing predominantly white groups along with nurses who are advantaged and privileged by unfair structural and systemic practices. These survey findings move beyond the rhetoric to the reality and should serve as a call-to-action for all nurses to confront racism in the profession.
“Structural and systemic practices that allow the racist behaviors of leaders to continue to go unaddressed must be dismantled,” said Commission Co-lead and National Black Nurses Association (NBNA) President and CEO Martha A. Dawson, DNP, RN, FACHE. “As cliché as it sounds, it starts at the top. Leaders must be accountable for their own actions, set an example for their teams and create safe work environments where there is zero-tolerance for racists attitudes, actions, behaviors, and processes. Leaders must also create a climate that gives permission and support to dismantle institutional policies and procedures that underpin practice inequities and inequalities.”
Of those nurses who report that they have witnessed an act of racism in the workplace, 81% say it was directed towards a peer. Nurses say that they have challenged racist treatment in the workplace (57%), but over half (64%) said that their efforts resulted in no change.
“Nurses are ethically and professionally obligated to be allies and to speak up against racism, discrimination, and injustice for our patients and fellow nurses,” said Commission Co-Lead and National Coalition of Ethnic Minority Nurse Associations (NCEMNA) President Debra A. Toney, PhD, RN, FAAN. “Civil rights and social movements throughout history offer the blueprint, which demonstrates that diligent allyship is key to progress. To the nurses that challenge racism in the workplace, do not get dismayed by inaction, but continue to raise your voice and be a change agent for good.”
Many respondents across the Hispanic (69%) and Asian (73%) populations as well as other communities of color (74%) reported that they have personally experienced racism in the workplace. Overwhelmingly, the survey findings indicate that Black nurses are more likely to both personally experience and confront acts of racism. Most Black nurses who responded (72%) say that there is a lot of racism in nursing compared to 29% of white nurse respondents. The majority (92%) of Black respondents have personally experienced racism in the workplace from their leaders (70%), peers (66%) and the patients in their care (68%). Over three-fourths of Black nurses surveyed expressed that racism in the workplace has negatively impacted their professional well-being.
“The acts of exclusion, incivility, disrespect and denial of professional opportunities that our nurses have reported through this survey, especially our Black, Hispanic and Asian nurses, is unacceptable,” said Commission Co-lead and National Association of Hispanic Nurses (NAHN) President Adrianna Nava, PhD, MPA, MSN, RN. “Racism is a trauma that leaves a lasting impact on a person’s mental, spiritual, and physical health as well as their overall quality of life. As the largest health care workforce in the country, we must come together to address racism in nursing as the health of our nation depends on the health and well-being of our nurses.”
Since its inception in January of 2021, the Commission has been intentional and bold in leading a national discussion to address racism in nursing. The Commission has convened listening sessions with Black, Indigenous, and People of Color (BIPOC) nurses and hosted a virtual summit focused on activism with foremost subject matter experts. Collaborating with top scholars on the issue, the Commission developed a new definition of racism to establish a baseline for holding conversations, reflecting on individual or collective behaviors, and setting a foundation for the work ahead.
“The collective voices and experiences of BIPOC nurses nationally have provided a call for overdue accountability within the nursing profession to acknowledge and address the structural racism rooted within nursing, especially policies that have anti-Black and anti-Indigenous histories,” said Commission Co-lead and Member-at-Large Daniela Vargas, MSN, MPH, MA-Bioethics, RN, PHN. “The next generation of BIPOC nurses deserve more than performative activism and empty words that continue to yield no progress toward structural changes within the nursing profession or racial equity. The breadth of the nursing profession through the Code of Ethics for Nurses holds all nurses accountable for calling out racism and replacing racist policies rooted in white supremacy with ethical and just policies that promote and implement accountability, equity, and justice for nurses and the communities that we serve.”
Nursing’s challenges with the issue of racism are reflective of the larger society. As a profession, we need to confront these same challenges with racial inequities within the profession. As such, the Commission’s work is urgent to create safe and liberating environments for all nurses so that the profession exemplifies inclusivity, diversity, and equity. The Commission urges all nurses across every health care setting and environment to join us in boldly confronting systemic racism. We must address upstream sources of racism in order to build sustained safe and effective environments of optimal care delivery ideal for every nurse and every patient regardless of race, origin or background. Nurses can learn more and share a story of experiencing racism or being an ally for change today.
*Data was collected through a survey administered by the National Commission to Address Racism in Nursing Between October 7-31, 2021, 5,623 nurses completed this survey. *
