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Editorial
Racism and Nursing:
A Preliminary Reflection on
Literature
Zane Robinson Wolf, PhD, RN, CNE, FAAN
La Salle University, Philadelpia, pennsylvania
The death of George Floyd and subsequent Black literature on nursing and racism. I needed to learn
Lives Matter protests made me confront the fact and to reflect on my implicit biases. Although I
that my “Silence is not an Option” (Lemon, 2020a). had confronted my implicit biases because of one
Since I watch CNN news every day, most often of my Doctor of Nursing Practice student’s project
when working on my computer, some might (Johnson-Coleman, 2019), I worried that as editor-
say that my information is biased. Nonetheless, in-chief of the International Journal for Human Car-
I continue to watch and to focus on the facts as ing, I needed to gain some surface understand-
presented, chiefly facts associated with protests, ing by a check on the history and implications of
community member–police incidents, COVID 19 whiteness that I did not understand. “I needed to
reports, healthcare topics, and media reports that get trained up” (Lemon, 2020b). I had a problem.
for me contextualize issues in the United States of Not surprisingly, I intellectualized my
America. That America is now portrayed on occa- approach. I searched La Salle University’s Sum-
sion as a white supremacist environment. Follow- mon database. The search terms were racism,
ing George Floyd’s death and the ensuing protests, whiteness, nursing, and leaders. I added leaders
my thoughts have been predominated by and wor- last because the initial results came out of nursing
ried about the need to carry out an initial self- education and I wanted clinical literature as well.
assessment of my implicit racism. So, I offer the following as an opportunity to share
The United States’s situation is not entirely dif- some perspectives based on the following account
ferent from what goes on in the world. This sug- of a small sample of literature.
gests that I want to share the blame for major
world problems with other countries. I do not,
Selected Literature
but realized that I had an opportunity to deepen
my understanding of what my whiteness means. Garneau and Varcoe (2017) pointed to nursing’s
I decided to focus this editorial on racism in nurs- engagement in social justice initiatives and ana-
ing. I agreed that “ . . . my understanding of lyzed it using critical antidiscriminatory pedagogy
whiteness is recognition of the centrality of racial (CADP). They focused on nursing education pro-
beliefs as an organizing principle of the mod- grams and contended that nursing was dominated
ern world that exerts as profound an impact on by liberal individualism. The authors connected
nursing as it does on other aspects of everyday social inequities with health and many other prob-
existence” (Puzan, 2003, p. 193). In addition to lems and asserted that the World Health Organi-
listening to Don Lemon’s podcasts, I searched the zation (n.d.) cited racism as a social determinant
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International Journal for Human Caring, Volume 25, Number 1, 2021 © 2021 International Association for Human Caring 1
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of health inequities. They cautioned that race and suggested that teaching strategies needed to be
racism had not been well integrated into nurs- developed to position nursing practice in knowl-
ing curricula and that racial discrimination was edge of health inequities and the development of
magnified through poverty, addiction, and stig- power.
matizing chronic conditions. They applied CADP Schroeder and DiAngelo (2010) submitted that
in an analysis of social justice issues and nurs- antiracist education was emancipatory, because it
ing’s need to understand the systemic, structural addressed social, cultural, and institutional dimen-
nature of many forms of discrimination. Although sions that maintain white supremacy and assist
social justice is a nursing norm, the authors noted, white power and privilege to remain invisible.
it may be absent or just rhetorical. Furthermore, According to the authors, whiteness equates with
nursing faculty’s teaching on health inequities characteristics of racism that elevate white indi-
had been focused on cultural sensitivity and cul- viduals over people of color. They developed
tural competence theories and models and the a school of nursing project including antiracist
need for nursing to provide culturally congru- workshops for faculty and staff and implemented
ent care. They explained that individuals’ choices a diversity statement requiring continued, antiop-
were consequences of racialized social and eco- pression action. Further, the school leaders exam-
nomic disadvantage and resulted in limited access ined: the social isolation and lack of support of
to care. According to Garneau and Varcoe con- underrepresented faculty and staff of color; the
cepts of racism, discrimination, and institutional- difficulties of students of color when witnessing
ized racism need to be compared to individualiz- racist comments in class without faculty com-
ing and Euro-centric focuses in curricula through ment and unfair faculty and preceptor evalua-
discussion. tions; and faculty-staff relationships during stress-
Garneau and Varcoe (2017) proposed CADP, ful work situations. They scrutinized a curriculum
as a contextual, structural approach to under- and identified it missing a systematic examination
stand racism and discrimination, using intersec- of power, white privilege, and racism/antiracism.
tional and cultural perspectives. CADP includes They identified the unacknowledged structural
antiracist pedagogy as an initial start toward advantage of whiteness based on the school’s and
the inclusion of social justice in the curriculum. the United States’s demographic characteristics of
Adding antidiscrimination content systematically, nurses. Schroeder and DiAngelo fostered school
followed by continuing nursing education after initiatives that led to acknowledging that a pro-
graduation, could foster development of nursing fession characterized as caring created and main-
students’ and registered nurses’ critical conscious- tained color blindness. The dean publicly apolo-
ness. Discrimination against patients, students, gized for the school’s institutionalized racial dis-
and nurses also warranted inclusion. The authors crimination. The school’s initiatives expanded to
explained that CADP is evidence-based and takes the university, beginning with a self-appraisal and
a broader look at discrimination and institutional a report on diversity.
and societal influences on health and healthcare. To influence the nursing school’s climate,
It is grounded in intersectional approaches as they workshops on Un-Doing Racism were imple-
influence health: “complex dynamics of racism, mented, presented by a national organization
gendered inequities, economic disparities, stigma, offering transformative antiracism workshops
and other social processes” (p. 4). Power rela- (Schroeder & DiAngelo, 2010). A formal curricu-
tions are also examined. Transformational learn- lum on the dynamics of white privilege followed
ing is emphasized as praxis learning, and shifts on the school’s institutional context, structural
occur in students’ premises of thought, feelings, dynamics, psychological dimensions, and behav-
and actions. Reflection and action help learners ioral dimensions that support a climate of diver-
to develop critical consciousness. Reflexive dialog sity in the workplace and classroom. Conflict
encourages students to address racism and dis- arose among participants, and strategies were
crimination. Attention is also paid to antiracism implemented on leadership/dominance and other
and antidiscrimination. Additionally, as framed issues. Innovation diffusion methods were ini-
by CADP, educators are expected to develop dif- tiated along with action plans to improve the
ferent teaching methods that foster critical con- school’s inclusivity. Examples of action plans
sciousness and to acknowledge the collective consisted of a discussion on racism/antiracism
responsibility of both students and learners. They at monthly meetings, a diversity committee, and
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a course on privilege, oppression, and social jus- circumstances, such as oppression, and leads to
tice in healthcare. A new diversity statement was invisibility. They asserted that power was also crit-
also developed. The project’s outcomes showed ical in examining domination in social organiza-
positive changes for participants. tions. In nursing, race has had a great effect on
Not only is racism evident in mentor–student power relations. Oppression operates in nursing
relationships (Scammell & Olumide, 2013), it is schools and hospitals; hidden racism is normal-
known in the work life of diverse nurses who have ized in policies, procedures, and practices. Racism
experienced otherness and discrimination (Vukic is found in textbooks, too, as stereotypes appear as
et al., 2012). Racism also shows in the experi- assessment findings. Perspectives on black leaders
ences of black nurse leaders. For example, Jef- in nursing depends on subjectivity and how they
feries et al. (2018) studied discrimination, invis- position themselves and discriminatory practices
ibility, and underrepresentation of black nurses restricted career movement. Jefferies et al. (2018)
in formal and informal leadership roles in the observed that strong, black women may be nur-
workforce. They indicated that black nurses face turing and caring, sometimes to their own detri-
many challenges in the nursing profession and the ment, and act in a specific manner and avoid voic-
healthcare system. Policies, practices, and assump- ing challenges, difficulties, or stress in their roles.
tions have been normalized, based on historical For the black nurse leader to be valued, the domi-
and structural harms and the oppression fell by nant patriarchy needs to be taken apart.
marginalized groups. The authors used a black
feminist, poststructuralist framework to examine
nursing education and clinical practice challenges Conclusion
of the nurses. Their critical analysis of the literature
described marginalization and oppression of black Although my initial search located a large amount
nurses as leaders, leading to invisibility. of relevant literature, I stopped this review and
In a discursive analysis of the literature, Jef- committed to reading more literature on racism,
feries et al. (2018) observed that Canadian and such as the work of Waite and Nardi (2017), and
American nursing schools have excluded admit- other literature on discrimination in nursing and
ting and training black people, leading to signif- healthcare. I was encouraged by the efforts of the
icant underrepresentation in the profession. They persistent work of ethnic nursing organizations
shared that curricula were oppressive and restric- that have provided some solutions to increasing
tive for black nurses, and that applicants’ academic the number of ethnically diverse nurse leaders
and financial barriers complicated acceptance. On through membership activities (Matza et al., 2018).
enrollment, few if any black faculty were available I also have appreciated the perspectives that the
as mentors. High attrition rates were also evident. diversity of the workforce has been identified as
Therefore, the outcome of low numbers of black a factor adding to the quality of patient care and
students was underrepresentation of them in the that a linguistically-prepared nursing workforce is
workplace. The authors cited research, confirming needed to care for emergent majorities.
a tremendous amount of discrimination, racism, My overwhelming concern about this journal
marginalization, and oppression in the nursing and the International Association for Human Car-
profession. Black nurses may be over-supervised, ing is this: discrimination and intolerance are anti-
disciplined, and terminated more than nonblack thetical to the ethical principles grounding caring
nurses. Discriminatory and racist practices also concepts, theories, and action. However, it is in
limited career advancement, so that upper level caring action that I think I have failed. I need to
manager and head nurse positions were few. Overt continue to get “trained up” and to act. I need
racist behavior and microaggressions had a signif- to speak up when hearing biased speech and to
icant impact on black nurses’ self-perception, con- learn first from the diverse members of my fam-
fidence, physical stress, emotional pain, not feeling ily so that I might understand more about their
trusted, and health problems. lived experience of being members of marginal-
Jefferies et al. (2018) next explained that black ized groups suffering from intolerance and hate. I
feminist poststructuralism helped to achieve an in- also need to continue my promise not to hate any-
depth analysis of the many ways power affects one and to know that all of us, even those dra-
the intersections of race, class, and gender and matically opposed to our views and ethics, are
how such intersections influence black nurses’ humans worthy of respect. Finally, I am compelled
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by Schroeder and DiAngelo’s (2010) statement andAQ1 *-4ptguid=24453f58-1b68-471b-994a-abec001274dc
ask us, does the caring that we have created main- Matza, M. R., Garon, M. B., & Que-Lahoo, J. (2018). Developing
tain color blindness and a lack of vision about other minority nurse leaders: The anchor and the rope. Nursing
marginalized groups? Forum, 53, 348–357. http://doi.org/10.1111/nuf.12261
Puzan, E. (2003). The unbearable whiteness of being (in nurs-
ing). Nursing Inquiry, 10(3), 193–200. https://doi.org/
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approaches toward a critical antidiscriminatory peda- the mentor-student relationship: Nurse education
gogy for nursing. Nursing Inquiry, 25, 1–9. http://doi.org/ through a white lens. Nurse Education Today, 32, 545–550.
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Jefferies, K., Goldberg, L., Aston, M., & Murphy, G. Schroeder, C., & DiAngelo, R. (2010). Addressing white-
T. (2018). Understanding the invisibility of black ness in nursing education: The sociopolitical climate
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World Health Organization. (n.d). Fact file on health inequities.
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Lemon, D. (2020b, June 18). Silence is not an option: Why not
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being racist is not enough [Audio podcast]. CNN. https://ww
w.cnn.com/audio/podcasts/don-lemon-silence-is-not-an
Correspondence regarding this article should be directed
-option?episodeguid=670aa397-c1b2-481f-aa6e-abde0057
to Zane Robinson Wolf, PhD, RN, CNE, FAAN, School
44e6 of Nursing and Health Sciences, La Salle University,
Lemon, D. (2020c, June 2). Silence is not an option: Schooling the 1900 West Olney Avenue, Philadelphia, PA 19141. E-mail:
system [Audio podcast]. CNN. https://www.cnn.com/audi wolf@lasalle.edu
o/podcasts/don-lemon-silence-is-not-an-option?episode
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Author Queries:
AQ1: AU: Lemon (2020c) is not cited in the text. Please provide text citation or remove from reference list.
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