The goal of promoting diversity, inclusion and equity in healthcare is to decrease healthcare disparity. Black African/Caribbean born nurses and student nurses (BABCN&SN) are underrepresented in the United States (U.S.) healthcare systems, accounting for 6.2% of the nurses in the U.S. (Smiley et al., 2018). The National League for Nursing (NLN) and other authority agencies agree that the lack of diversity in the nursing workforce and faculty hampers the ability of nursing to decrease healthcare disparity.
The purpose of this integrative review is to:
- Describe the experience of ‘being outsiders’ in nursing and nursing education as described by BABCN&SN in the U.S.
- Discuss the implications of the BABCN&SN othering on the U.S. Healthcare system.
- Give voice to their experiences and offer opportunity for open dialogue in nursing schools and healthcare settings to address the racial bias.
- Offer recommendations based on the nurses and students’ statements.
Electronic and manual database searches of nursing journal articles published from 2008 to 2019 were conducted. The authors independently reviewed full articles using pre-established inclusion criteria. Integrative review approach by Whittemore and Knafl (2005) guided the review. Of the 99 articles reviewed, 13 met the inclusion criteria. Inductive content analysis described by Elo and Kyngas (2008) was used to extract, analyze, and interpret data from the eligible studies.
Results:We reviewed 13 studies to describe the experiences of BABCN&SN in the U.S. The following themes emerged from this study which as engender a feeling of outsiders: Unwelcoming environment; Racism/discrimination; Duplicity; Stereotype; Stress related symptoms; Abuse of power/authority; Rising above; and Having Lifeline.
BABCN&SN reported exclusion, devaluation, and othering stemming from institutionalized racism, a cultural norm that allows individuals to discriminate against them based on skin color or accent. However, racism remains a cultural concept seldom discussed in nursing (Barbee, 1993; Hall & Fields, 2013).
Perceptions of discriminatory educational climate and lack of faculty support negatively affected students learning and academic performance (Ezeonwu, 2019; Graham, Phillips, Newman, & Atz, 2016; Torregosa, Ynalvez, & Morin, 2016). There are consequences for nurses who felt excluded in the workplace. They may not speak up even when safety issues are observed for fear of retribution (Baptiste, 2015; Iheduru-Anderson & Wahi, 2018; Jose, 2011; Smith & Smyer, 2015).
Conclusion:Creating an environment that supports all individuals, despite their physical differences is essential to promoting a diverse and inclusive environment that is essential for addressing healthcare disparity in the U.S. Achieving cultural competence and reducing healthcare disparity without having authentic conversations about racism in nursing will prove difficult.
Understanding the relational pattern that guides the BABCN&SN socialization into nursing is essential to developing targeted support especially when entering the clinical practice environment (Mitchell, Del Fabbro, & Shaw, 2017). Nurse educators need to be more aware and use language that is more inclusive with students (Sommer, Beitzel, Osuri, & Rosfeld, 2019).
Nursing leadership need to do more with the assessment of workplace culture that perpetuates the othering of its constituents. Nursing must create safe spaces for authentic discussion of the underlying racial issues contributing to these ongoing problems.