Racism is not new in nursing and healthcare. However, it continues to be widespread, and hospitals and health systems must take innovative steps to address the issue in today's culture and industry environment.
A new report released last month by the Commonwealth Fund and the African American Research Collaborative found that 52% of healthcare workers reported racism or discrimination based on race or ethnicity against patients is a crisis or major problem. The report, based on a survey of 3,000 healthcare workers across various settings, also found that nearly half of healthcare workers (47%) reported personally witnessing discrimination against a patient based on race or ethnicity.
Additionally, in January 2022, the National Commission to Address Racism in Nursing released the results from a survey of over 5,600 nurses with findings showing racism is a substantial problem within nursing. The survey found nearly two-thirds of nurses experience racism in the workplace, including 92% of Black nurses.
Against this backdrop in the industry, Becker's interviewed Charlie Hawknuff, MSN, APRN, director of clinical education at Urbana, Ill.-based Carle Health, and Jennifer Mensik Kennedy, PhD, RN, president of the American Nurses Association, to gain insights on racism in nursing and discuss tools, strategies and educational opportunities organizations are using to advance anti-racism.
Overcoming barriers to advancing anti-racism
Dr. Mensik Kennedy said many organizations focus on employee education when it comes to anti-racism initiatives, and workers go through a module online.
"Too many organizations are still at that point, and to some extent, based on different states and different laws and anti-DEI initiatives, organizations in some places of our country are worried about doing much more than that to not get in trouble," she said.
But she called on hospitals and health systems to view anti-racism initiatives from the employee and patient perspectives. This means asking, "What are we doing to improve care?"
"So, first, I think we have to have more organizations than not working on solutions or not being afraid to take this seriously," Dr. Mensik Kennedy said. "We need to have a complete 'no tolerance for racism.' Absolutely none from patients, from employees, staff, there should be no racism period."
Dr. Mensik Kennedy noted one barrier to anti-racism initiatives: Health systems don't always have money in the budget to implement the initiatives they desire to move forward with. This is why the National Commission to Address Racism in Nursing, with funds provided by the American Nurses Association, offered grants to organizations.
"We had over 130 proposals requesting money to be able to work on DEI initiatives," Dr. Mensik Kennedy said. "And I think that demonstrates the need that is out there."
Putting the grants to work
One example is Carle Health, which will use grant money to provide anti-racism education and training through a one-hour event followed by 20 weeks of ongoing microlearnings directed at patient care nursing leaders and their staff.
Ms. Hawknuff said the idea began last fall with Cecilia Lopez, MSN, RN, a manager at Carle Foundation Hospital.
Ms. Lopez "said she felt like there was a lot of education focused on professional roles and even on leadership, but not as much focused on those who are actually interacting with the patient," Ms. Hawknuff told Becker's.
"We knew that in order for us to impact those taking care of the patients, we still had to use the leadership structure to get to those folks. So, we designed this education in the hopes of actually impacting change for the front-line team member and the care that's provided to our patients across all of Carle Health."
Now, an internal planning team at Carle Health is meeting regularly to put together the one-hour event. Once those details and plans are set, the health system will work on the microlearnings.
Ms. Hawknuff said the microlearnings will reinforce the concept from the initial education and include resources for someone to dig into the topic if they would like to or if they have further questions.
Carle Health has more than 16,500 employees total, and the initiative will initially focus on nursing leadership. The goal is for 80% of nurse leaders to attend the event, which will also be recorded, in the third quarter of 2024. Ms. Hawknuff said she'd also like to see 80% of nurse leaders submit one strategy after the event that they will deploy within their unit, department or service line to combat racism as part of their engagement or cultural safety planning.
Overall, "we want learners to be able to identify systemic racial inequity within healthcare," Ms. Hawknuff said.
"Discuss problematic outcomes of social and systemic racial injustice within healthcare. Explain how bias can impact one's perspective and actions. And then, most importantly, articulate pathways of combating systemic racial injustice in healthcare. And then we do have some key performance indicators as well that will let us know that we're succeeding."
Another example is Children's National Hospital in Washington, D.C., which is using their grant money to create a national practice standard that supports proper hair care for hospitalized adolescents and children across ethnicities.
Dr. Mensik Kennedy said some organizations are also focusing on providing culturally relevant pictures of patients in different scenarios.
For example, "libraries of these academic medical centers now have culturally appropriate pictures. So, if you have a picture of traditional cyanosis, which is someone who's not getting enough oxygen in their skin, and that blueness of white skin looks very different than it does on a Black person. But traditionally, we orient staff with, 'Here's what cyanosis looks like in the model white person.' And so now we're utilizing photos of other people of other ethnicities to say, 'Here's what this also could look like if you have an African American patient, or a Hispanic patient,'" she said.
She also pointed to New York City-based Mercy University School of Nursing, which is developing a nurse faculty residency program to facilitate the transition of nurse educators into the role of health equity influencers.
"That's really closely tied in with racism when we look at equity and practice, particularly during COVID. And we created standards of care and structures quickly but didn't necessarily do it through an equity-minded lens," Dr. Mensik Kennedy said.
Making space for the hard conversations
She recommended that more organizations focus on hard conversations and allowing forums where employees may bring forth their examples of personal experiences with racism.
"We can't continue to say, 'Well, that's not what they meant or they didn't mean to say that, or that didn't mean to come across that way,'" she said. "It's about their perception of pain and what their experience of pain is. It's the same for employees and patients. If they said they felt discriminated against, if they felt it was racist, then it was, and we need to stop at that and not try to justify it."
She said this means creating safe structures for people to provide specific scenarios and examples.
"I think people sometimes accidentally or purposefully might say something that might be racist and they don't think it is," she said. "And no one calls it out or no one feels safe enough to call it out. But we have got to get to the point where we call out each other."