Background: Racism has long been identified as creating inequity in health care. The landmark report of the Institute of Medicine (Smedley, Stith, & Nelson, 2003) and the more recent National Academy of Sciences workshop on racism and ethnicity (2016) clearly state the objective of raising awareness in the healthcare sector about racism and its impact on health. Much has been published about the ill effects of long term exposure to racism, the stress this causes, and resultant consequences. For example, disproportionately high levels of hypertension, poor birth outcomes and increased maternal morbidity and mortality among blacks have all been linked to living in environments that are both interpersonally and institutionally racist. Studies have shown that blacks experience decreased quality of healthcare due healthcare provider bias (e.g., not listening attentively to patients or providing adequate explanations, ordering needed testing or appropriate medications less often). In addition, black providers have voiced that they too experience biased interactions with white patients some of whom specifically request a white provider. Examples of institutional racism that result in disparities among blacks include housing and environmental policies that result in disproportionate exposure to toxins.
Academia and schools of nursing are not immune to the issues surrounding racism. Articles have been published about black students who tolerate blatant as well as subtle negative references to or characterizations about blacks (Minority Staff, 2013). This can be from peers, faculty, or school staff. Black faculty have voiced that they often do not feel respected and/or supported in schools of nursing, and that they take on additional work related to supporting students of color and/or diversity initiatives in their institutions without additional compensation or workload reductions in other areas (i.e., the “brown tax”). That this environment exists is not a surprise. If the nursing profession is to truly meet our goal of having a workforce that mirrors broader society and is poised to address race-based health disparities, then a deep examination of racism and a genuine effort to address it must be undertaken formally and informally in schools of nursing.
Many faculty possess a cognitive understanding of the role race and racism play in inequities of health and education. This however does not assuage the discomfort these discussions inevitably generate. This discomfort is due in large part to historical events in the United States, the current state of race relations in this country and ignorance about either or both by parties included in the discussion. This discomfort is a major barrier and often leads to ignoring “the elephant in the room” by faculty, staff and students.
The project: Faculty at a large University in central Texas were concerned about reports from students in clinicals about witnessing biased care, experiencing bias directed at them personally by patients or staff (as has happened with students of color), and about ongoing population-level racial/ethnic disparities that are influenced by racism and discrimination. While some individual faculty discuss racism in their courses, there is no coordinated, school-level effort to thread concepts of racism throughout the curriculum (e.g., through a required course on racism or through objectives inserted into each course syllabus).
The issue was brought to the attention of faculty in the School of Nursing during a division meeting. After much discussion, it was suggested that before any large-scale, coordinated efforts to thread racism throughout the curriculum, measures must first be taken to help faculty feel more confident and comfortable in approaching this topic with each other and with students. Faculty agreed that they were open to initiating measures that would ultimately lead to the inclusion of racism in the nursing curriculum.
As a first step, faculty agreed to start a book club that was held as a brown bag event during the lunch hour. Those faculty and staff who could and were interested, would meet for 60-90 minutes to discuss chapters they had read in a book about racism (Oluo, 2018). This proposal was very successful. In two meetings during the spring semester, many faculty attended the book club and agreed that they would like to continue meeting in future semesters.
Meanwhile, it was proposed that a school-wide movie night be implemented to begin a discussion of racism among students. During spring semester, the documentary “13th” about mass incarceration was advertised. Some faculty offered extra credit for students who attended this after hour showing. Upwards of 50 undergraduate and graduate students attended. Two faculty directed the discussion which included handouts and stopping the film at different time points to engage students in discussion and small group work. Many students expressed being energized and commented on the usefulness of the movie showing and discussion. They stated they hoped the school would have similar events in the future.
Our first steps at addressing racism in the School of Nursing have energized faculty, and we plan to continue discussions in upcoming academic years and evaluate their impact on faculty, staff, and student attitudes towards addressing racism. We plan to continue engaging faculty, staff, and students in dialogue, with an eye to eventual changes in the overall curriculum. In recounting and sharing this experience, it is hoped that other schools will be encouraged to do likewise.