Most Nurses of Color Report Workplace Racism

In 2013, an act of racism that seemed torn from the pages of a medical ethics textbook led to a lawsuit in Michigan: a white supremacist with a newborn in the hospital asked that no Black nurses be allowed to touch his son, and the hospital allegedly honored that request.

While the lawsuit between the four nurses and the hospital was settled “amicably,” per the health system, the damage was not so easily undone. Almost a decade later, nurses are still reporting racist incidents, not only with patients, but also their colleagues. Some call it the “open secret” of nursing, and like many U.S. institutions, healthcare and nursing retain an enduring legacy of racism.

In a new survey from the National Commission to Address Racism in Nursing, nurses of color reported discrimination from patients and their families, but also from their co-workers and supervisors.

The convenience-sampling-based survey was done in October 2021, and sent to American Nursing Association (ANA) members along with members of other nursing organizations. Ultimately, 5,623 complete responses were analyzed. Most of the survey participants identified as either Black (37%) or white (37%), while 90% identified as female. A little over a third were ages 55 and older, with 40% reporting that they worked in acute care.

According to the results, 92% of Black nurses surveyed (n=1,972) reported that they had personally experienced racism in the workplace, as did 69% of Hispanic nurses (n=369), 73% of Asian nurses (n=461), and 74% of other or multiple races (n=531).

Among 3,523 respondents, 70% of Black nurses said they had experienced racism from a manager, supervisor, or administrator, as did 51% of Hispanic nurses, 57% of Asian nurses, and 60% of other or multiple races. Similarly, 41%, 26%, 34%, and 38%, respectively, said they had experienced racism from a physician or doctor.

In the survey, the commission defined racism as “assaults on the human spirit in the form of biases, prejudices, and an ideology of superiority which persistently causes moral suffering and perpetuates injustices and inequities.”

The survey also revealed racism in nursing structures, such as training, promotions, and compensation, and this pattern may have manifested more in the results for Black nurses than other nurses of color, said ANA racism scholar-in-residence G. Rumay Alexander, EdD, RN, clinical professor at the University of North Carolina at Chapel Hill School of Nursing.

She pointed out that “there’s been this decade upon decade upon decade of denial of those African-American nurses who went to the right schools, got the pedigree and the card and still were being denied the opportunity to move up; to be able to take advantage of positions that others had — that somehow, even though they met all the criteria, they never got the jobs. And they kept absorbing and absorbing that.”

Quotes from survey respondents included:

• “‘I have been called the n word by multiple patients on multiple occasions. I have been asked to not care for a few patients by the patient themselves because I am Black.'”
• “‘Nurses of color with the same credentials as their white counterparts are overlooked for recognition or promotions.'”

Over half the respondents said they had spoken up about racism in the workplace, but 65% said that it had resulted in no change. One nurse wrote that following an instance of racism, “An open discussion was held between nursing instructor and students. While this was positive, it resulted in no changes.”

Alexander said that one way to combat workplace racism is to increase awareness of how racism manifests, and when. She compared the brain processing a racial stereotype to a window on a computer screen: “Minimize certainty, maximize curiosity. Curiosity means you ask questions. You validate and you do your cultural due diligence around who the person is, what they’re about, what their capabilities are.”

The nursing profession must also re-evaluate policies that disadvantage some nurses but not others, Alexander stressed. “We have to do the structural work, looking around the table and asking ‘Who’s missing? Whose voice haven’t we heard?'” she stated. “Now, I know these sounds these things sound simple, but these are not things that just typically occur.”