Moving Towards Antiracist Nursing Practice

Jun. 24, 2020

By: Minnie Wood  (MS, APRN, ANP-BC, Lecturer and Clinical Instructor)

 

Every nurse I know springs into action upon hearing a patient say the words: “I can’t breathe.” Using evidence-based and time-tested strategies, nurses are trained to provide care, comfort and deliver life-saving measures. But what about when not only one Black person—killed with a knee on his neck for almost nine minutes—but an entire community is saying: We can’t breathe. How are we compelled to respond?

I was raised in Yonkers, NY, in the midst of a desegregation battle. A federal court ruled that the place where I grew up had intentionally segregated both housing and the public school system by race. When court-ordered to desegregate schools and build low-income housing in traditionally white neighborhoods, a decades long battle commenced, led by white residents who resisted the integration of their neighborhoods. To say that experience helped to form me would be an understatement. Bearing witness to the abhorrent racism in my city and, especially, in my high school, offered me an understanding of systemic racism that I’m not sure I would have otherwise developed so quickly. But this situation was by no means unique. Redlining policies created segregated neighborhoods and concentrations of poverty throughout our country…Yonkers just got caught in a legal battle. Most communities haven’t.

 My experiences in Yonkers didn’t just expose me to the intricacies of hate, power and white privilege, but they formed a bridge to my professional nursing career. I chose to ground my nursing practice by work in Federally Qualified Health Centers, created to care for underserved people.  For the past four and a half years, my teaching has focused on community health nursing and there have been consistent opportunities to discuss racism and its impacts on the health of our community. In fact, our students have often been my greatest teachers, pointing out disparities, exclusions and biases. Some of the questions I have heard: Why are there no Black board members on the State Board of Nursing? Why are Black people overrepresented in the homeless population in Las Vegas? Why does our textbook make sweeping generalizations about race and culture? Why do most of the mannequins and simulators we use have a light skin color?

I’d like to add some more questions to this list. Why do we relegate discussions of racism and the “social determinants of health” to a single course focused on community health nursing? Why are Black and brown people underrepresented in our student body, among our faculty and among nurse leaders? Why don’t we emphasize how racism is killing our Black patients? Why do so many focus on individual health behaviors and neglect the impact of sweeping economic and other policies that impact our country and the entire world?

If you are a faculty member or nurse leader who hasn’t heard these questions from students or staff or other colleagues, then I would offer that it’s our job to invite conversations about racism. Though this may feel unfamiliar, we have the “novice to expert” framework in nursing to use as our guide. If we don’t have practice discussing race, racism, white supremacy, systemic racism, and health disparities, then we simply need more practice.

Since George Floyd’s death, I have spent much of my time learning. About policing as a public health problem, prison abolition, the inextricable link between racism and capitalism, and getting familiar with the language of “decolonizing nursing.” I have been learning from other health care providers who are out in the streets in their communities demanding justice. I have been noticing and acknowledging the places where I am stuck.

For us nurses, being patient advocates and educators may seem easy. But this ease often comes from a position of privilege. We need to understand how our perspective, privilege and lens impacts how we see the people and the world around us. And until we begin to dismantle this internally, we can’t address this in our work. We can start educating ourselves about racism and healthcare in the same way we ask our patients who are diagnosed with a new chronic condition. There is so very much information out there about racism, antiracist work and white privilege. Read books, listen to podcasts, watch webinars, talk about it with colleagues, create journal clubs and discussion groups. The possibilities are endless. That’s where we begin. And once we begin, how do we proceed?

We can look unflinchingly at ourselves and address how racism impacts our personal attitudes,   practices and systems.  We can introduce antiracist discussion and activities in the classroom and in our hospitals and clinics. We can work to make sure our outreach, admission, retention and promotion policies are antiracist. We can build on our current programs (https://www.unlv.edu/news-story/simulating-poverty-better-nurses-and-better-healthcare) to extend our understanding about the impact of systemic racism and profit-driven healthcare on our patients. We can resist the temptation to slip time and time again into only discussing individual health behaviors and “noncompliance” while ignoring systemic impacts. We can advocate for public policies that are anti-poverty and that see health care and housing as a human right, to name just a few.

Nurses are advocates. But now nurses must not be individual advocates for individual patients only, but advocates for a more just and equitable society as a whole, that questions and struggles against white supremacy at every turn. We can and should advocate for our Black patients, students and colleagues not just when they are sitting in the office or the ED, but long before they get there. We can continuously and relentlessly do this work because none of us is truly free until we all are. The only thing preventing us from becoming antiracist nurses, teachers, scholars and leaders is ourselves.