Barriers to and strategies for sustainable progress

Racism in nursing not only contradicts the core values of our profession but also undermines the quality of care we provide. Racist attitudes, biases, and behaviors against nurses of color have no place in nursing, yet they persist, disrupting workplace satisfaction, career mobility, and nurses’ ability to advocate for ourselves and our patients. The following explores four systemic barriers to addressing racism in nursing, using data from ANA\California’s case study with two ANCC Magnet®-recognized hospitals in California and strategies from their forthcoming benchmark report.

Lack of sustainable conversations

Despite a desire among nurses and managers to dismantle racism, the absence of a shared language and effective communication tools hinders these efforts. Conversations about racism frequently devolve into political debates or personal disagreements. Less than half of respondents in our study could correctly define terms like “institutional racism” (47.8%) or “equity” (40.6%). And although 70% of nurses felt comfortable discussing racism with their manager, only 55% of managers believed staff would feel comfortable doing so.

Lack of accountability

Many nurses lack confidence in their organization’s reporting systems for racism and discrimination, leading to underreporting. In our study, only 45% of managers said they felt comfortable reporting racism, compared to 73.3% of non-managers. Less than half of respondents believed their organization had clear disciplinary or mitigation plans in place, discouraging nurses from speaking up and perpetuating a cycle of inaction.

Lack of awareness among decision-makers

Hospital leaders may not fully recognize the severity of racial disparities or the need for systemic change. Although diversity, equity, and inclusion (DEI) initiatives exist, they’re often underutilized due to gaps in awareness. Both hospitals in our case study had DEI officers, but only 60.9% of staff knew about the role.

Lack of diversity in leadership

Leaders within hospitals and health systems don’t reflect the diverse populations they serve. Nationally, 31% of patients are racial minorities, but only 11% of hospital executives are minorities, with just 3% of C-suite roles filled by minority women. In our study, only a quarter of respondents believed that their organization had a formal plan to hire or mentor staff who reflect their patient demographics. Without diverse leadership, health systems struggle to create policies that address staff and patient needs.

Solutions

Effectively combatting racism in nursing requires a coordinated approach with staff and leaders’ engagement. Consider the following initiatives:

• Implement an anti-racism strategic plan with a clear focus on DEI.
• Establish a lead, council, or committee to drive these efforts.
• Conduct regular assessments, analyze data, and report findings to track progress.
• Implement, monitor, and adjust evidence-based strategies, such as anti-racism training, hiring and mentoring plans, and professional development programs.
• Review and revise policies to support efforts to combat systemic racism.

Equity in nursing requires intentional bridge building and sharing of historically out-of-reach opportunities with well-deserving communities. Nurses and leaders play crucial roles in counteracting racism in nursing—for the sake of our profession and the communities we serve.

Marketa Houskova is CEO of ANA\California. Carter Todd was the 2022 ANA\California Advocacy Institute fellow on racism in nursing. Aron King is a member of the ANA\California Racism in Nursing Taskforce.

American Nurse Journal. 2024; 19(11). Doi: 10.51256/ANJ112423

References

American Nurses Association. Racism in Nursing. nursingworld.org/practice-policy/workforce/racism-in-nursing

ANA\California. Assessments to eradicate racism in nursing. anacalifornia.org/racism-in-nursing-and-healthcare