Racism in health care negatively impacts not just individuals, but entire institutions, and it must be combatted on a systemic level.
That was the central message of the keynote address delivered by Kechi Iheduru-Anderson, DNP, RN, CNE, CWCN, during the Nurses Day 2022 Conference held on Zoom on May 6.
She is the nursing program director at The Herbert H. and Grace A. Dow College of Health Professions at Central Michigan University.
Entitled “Promoting Anti-Racism and Inclusive Excellence in Nursing and Health Care,” Iheduru-Anderson first grounded her audience by defining the concepts at the heart of her work: diversity, equity, inclusion, explicit and implicit biases, and the three types of racism—institutionalized, personally mediated, and internalized.
Then she asked rhetorically whether racism exists in nursing, pointing to a national survey that answered emphatically “yes.”
Some 92% of Black nurses said they have personally experienced racism in the workplace, with 70% from their leaders, 66% from their peers, and 68% from patients.
The survey was conducted by the National Commission to Address Racism in Nursing, a multi-organizational collaborative of leading nursing organizations.
What Racism Looks Like in Health Care
How do nurses and health care workers experience racism? Iheduru-Anderson enumerated multiple ways, including:
- Racist jokes, even when those jokes are followed by an apology
- Inequitable work assignments
- Lack of advancement
- Assignment to less desirable shifts
- Dissuasion from pursuing higher-level positions
- Lack of acknowledgement of people’s credentials within their roles
- Perpetuation of stereotypes or presumption of incompetence because of a person’s racial identification
She asked the audience how they’ve seen racism manifested in their workplaces, and the answers ranged from lack of advancement to racist comments made by staff at the nurses’ station to employee resignations.
One person witnessed a patient saying to a colleague “you’re a little Black thing, aren’t you?” and another said a patient mistook her for a housekeeper.
Iheduru-Anderson emphasized that the harms of racism go beyond the individuals who are its target, noting that in 2021 the Centers for Disease Control and Prevention declared that racism is a serious threat to public health. The American Nurses Association has also asserted that racism is affecting care quality.
Best Practices in Combating Racism
How can health care institutions combat racism? Traditional diversity, equity, and inclusion (DEI) initiatives, although well-intentioned, will not solve the problem, Iheduru-Anderson said.
“Celebrating diversity does not result in the transformation of the ‘isms’ or the biases in the workplace …. because they don’t challenge the racial hierarchy that is within the system.”
Inadequately addressing racism may explain why workplaces often see high turnover among marginalized groups, she noted.
“They come into our environments in increasing numbers, but then they leave, because the environment is not inclusive or equitable.”
Instead, institutions need to focus DEI initiatives on action, not celebration. They must prioritize eliminating segregating and exclusionary practices, not merely increasing the representation of people of color or calling out the racist behaviors of individuals.
They must do “organizational climate” surveys to really understand the lived experience of employees of color and take a hard look at organizational structures, policies, and practices and how they contribute to those experiences.
Finally, institutions must be willing to invest substantial resources in this work and build in accountability.
The Cost of Racism in Health Care
The consequences of racism go beyond the damage it does to individuals, which includes anxiety, stress, depression, and burnout, according to Kechi Iheduru-Anderson. And when it reaches levels that drive employees out of the workplace, they take their intellectual capital—their knowledge, skills, and experience—with them.
“We know how much it costs to orient a new nurse, even a nurse with experience, in a new job,” said Iheduru-Anderson.
“The replacement of a nurse is more expensive often than creating a more inclusive work environment to retain those nurses on the job.”
Iheduru-Anderson offered this advice to people witnessing acts of racism at work. She stressed, however, that it’s not the sole responsibility of individual nurses to confront racism. Institutions must have policies and procedures in place that address racism and provide plenty of staff training.
If you hear discriminatory language or ideas, seek clarification about what you may have heard.
Try to understand the person’s position and why they were compelled to speak or act in that way. Ask with a tone of curiosity, not accusation.
Engage with facts, research, and/or personal experiences to help them see a different perspective and why their words/acts are harmful. In situations where patients don’t want a certain nurse to care for them, educate them about the nurse’s qualifications and experience.
Iheduru-Anderson did acknowledge that because McLean cares for patients with mental illnesses, education may in some cases be more complex.
Support others who speak up in order to encourage peers to do the same. You reinforce racism with your silence.
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