When clinical leaders talk about nurses and their work during the COVID-19 pandemic, they are quick to point out their resilience and empathy.
The country overall also has noticed the strengths of nurses. This year, Americans said nurses are the most honest and ethical professionals for the 20th consecutive time, for example.
But most clinical leaders also know that nurses are still susceptible to racism and biases.
"Racism exists in nursing and society. [Nursing is] a microcosm," said Karen Grimley, PhD, MBA, RN, chief nursing executive for Los Angeles-based UCLA Health. "It exists on a couple levels in the profession and also in the business of healthcare. We see it with social inequities all the time. Because we've always been so busy looking outward, we might not have really paid attention to us as a profession as it relates to the specifics of racism."
A survey released Jan. 25 by the National Commission to Address Racism in Nursing also found racism to be a substantial problem within nursing, with more than half of nurses reporting they have personally experienced a racist act in the workplace.
"Racism in nursing is an issue, and the number of studies published sharing reports of racism and perceptions of racism out there, we can't ignore those," said Deedra Zabokrtsky, DNP, RN, network chief nurse executive for Scottsdale, Ariz.-based HonorHealth. "The results of the recent study were disappointing to read and heartbreaking to read. But there are a lot of efforts around this as well. I think we have to acknowledge that it exists and then we need to go about learning what it is and how best to confront that to correct it."
Becker's spoke with Dr. Grimley and Dr. Zabokrtsky to understand what racism in nursing has looked like during the pandemic and how their health systems are working to combat it.
How racism presents in nursing
Racism can exist in various forms, according to the National Commission to Address Racism in Nursing.
The commission's new definition of racism: "assaults on the human spirit in the form of actions, biases, prejudices and an ideology of superiority based on race that persistently cause moral suffering and physical harm of individuals and perpetuate systemic injustices and inequities."
Dr. Grimley said nurses must be aware of these biases. She also advocated for nurses being culturally humble and having situational awareness.
Otherwise, "we may superimpose our beliefs or our attitudes onto someone, whether it's a colleague or a patient or a member of the community," she said. "So that inclusion you need to have can sometimes be hard because some of this comes from systemic behaviors and attitudes in healthcare that have existed over the years. You read about it. You read about nurses eating their young. You read about nurses getting treated as subordinates by physicians. Even some of the stereotypical things you see on TV. It all predisposes any one of us to think in a biased manner that might not be accurate about the population or the person you're encountering."
Combating racism in nursing
Drs. Grimley and Zabokrtsky agreed that awareness is a key part to making strides to stamp out racism.
Here are 11 strategies they identified to combat the issue.
UCLA Health
1. Hiring a chief of health equity, diversity and inclusion. UCLA Health appointed Medell Briggs-Malonson, MD, to this position. She began in April 2021.
2. Establishing a council. Nurses at UCLA Health have established a council called Unity in Diversity, which meets monthly. Dr. Grimley said the council is tasked with identifying opportunities to enhance diversity and inclusion and ensure equity for staff and patients. Dr. Grimley said the council plans to continue working on understanding social inequities and incorporating patient demographics including social determinants to provide more individualized care.
"That group dovetails into the health system steering committee that's been created by our chief health, equity, diversity and inclusion officer," she explained. "So, we've tried to put a system in place that's going to identify and begin to address cultural norms that may be contributing to systemic bias and racism. That systemic stuff that we haven't quite acknowledged yet."
3. Developing intervention teams focused on addressing concerns or complaints around sexual harassment and violence, discrimination and racism. Dr. Grimley said UCLA Health conducts detailed analyses of events to identify actions needed to resolve the issue, whether it's at an organizational level or an individual level.
4. Creating educational materials for staff around diversity, equity and inclusion. The health system's education includes modules that introduce concepts of implicit bias, cultural humility and situational awareness.
These modules are "important in the overall architecture of how to understand and identify issues in a proactive way, but also to better prepare individuals to 'see something, say something,'" Dr. Grimley said.
HonorHealth
5. Conducting annual staff engagement survey. Dr. Zabokrtsky said the survey presents questions about perceptions of diversity, equity and inclusion. The health system is transparent in sharing results widely.
6. Obtaining information from departing employees. Dr. Zabokrtsky said HonorHealth finds out reasons why employees left to identify opportunities for the health system to improve.
"We're looking at that data and compiling any trends. We encourage employees to bring forth any concerns they have. We're doing a lot in terms of monitoring and asking for feedback, so that we keep the pulse of our teams and address concerns openly."
7. Using a "just culture" concept. Dr. Zabokrtsky said HonorHealth uses this concept to inform decisions it makes.
"We look through a just culture lens when we're exploring an issue, be it safety, quality or social, and that discipline helps guide our response and resolution," she explained.
8. Creating a diversity, equity and inclusion steering group. This committee is well-attended, and participation is robust, which Dr. Zabokrtsky said shows that diversity, equity and inclusion efforts are resonating across the health system.
"We are learning a lot from these forums, which are helping us develop our strategy on how to move forward to improve. We've also brought in a consultant to begin the work with our leaders and our entire executive staff," she said.
9. Establishing people resource groups. Dr. Zabokrtsky said these employee-led, voluntary groups are supported financially through HonorHealth's organizational development team, and they have a budget to promote activities that help others understand issues their group faces. She said they also have access to a mentor to facilitate their group and an executive champion to clear barriers they can't overcome. One of the first-established people resource groups is one for the Hispanic community. There is also a resource group for military veterans, and more groups are forming.
10. Supporting the HonorNurse program. This is a voluntary program for nurses at the health system that focuses on professional growth and development.
"These are nurses who are interested in furthering their professional development and supporting our Magnet culture," Dr. Zabokrtsky said. "Our network has five Magnet-designated hospitals. Recently, HonorNurses hosted a Cultural Diversity Fair and shared information on how various groups that we care for have been impacted by the pandemic. They select a theme every year, and then each unit creates a poster to share in the hospital lobby. It is rewarding to learn and share with employees throughout the hospital."
11. Providing information to staff about lived experiences. This effort recently has included providing information about Black History Month and the Lunar New Year.
"To hear about cultural traditions firsthand from members of that culture, it's so much [richer], and you appreciate the meaning so much more," Dr. Zabokrtsky said.
What can hospitals do to combat racism in nursing?
No matter what efforts hospitals put in place to address racism in nursing, Drs. Grimley and Zabokrtsky agree it starts with awareness and putting structures in place focused on making changes and improvements.
Dr. Grimley said healthcare workers and leaders need to know their own biases and be aware of the language they use. For example, she describes an employee as a person, rather than calling them a woman or man, when crediting them with doing a good job.
"You're presenting the person and their accomplishment in a way that eliminates a little bias if someone doesn't think a man or a woman can do that particular thing," she said.
Dr. Zabokrtsky encouraged healthcare leaders to acknowledge there are opportunities to make a difference and that doing so is within their responsibility.
She also encouraged leaders to work on gaining a deeper understanding of racism.
"If that means we need to bring in people to help us understand that, then so be it. We need to be well-read and be aware of what's in the literature, including the nonfiction literature. There are great books that have helped raise my awareness," she said. "When we can do that and address the needs of our entire workforce, they will begin to open up and share their experiences more openly."