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Laying the groundwork for anti-racism in nursing schools

Creating an environment of inclusivity, and not just diversity, is key to anti-racism in nursing schools.

Nursing schools nationwide are laser-focused on promoting anti-racism in medical education, but it's important to fertilize the soil before planting the proverbial health equity seeds, according to Kenya Beard, EDD, one of the commissioners for the National Commission to Address Racism in Nursing.

Said otherwise, diversity in nursing schools and medical education can't come before cultivating inclusivity, Beard said on the Healthcare Strategies podcast.

"We need to recognize the need for greater acceptance of difference," Beard asserted. "Inclusivity was introduced into the discourse after diversity. We focused on diversity, and then inclusivity came later."

As a result, the road to health equity and better medical and nursing education isn't leading to the industry's ideal destination -- at least not yet.

Instead, healthcare continues to stare down a significant racism and discrimination problem.

A third of Americans agree that racism is a problem in healthcare, according to a February 2024 poll from KFF. Meanwhile, 60% of Black patients and 43% of Hispanic patients told the poll they'd experienced racism or discrimination in healthcare in the past year.

And it's not just patients who are affected by racism in healthcare. Nearly two-thirds of nurses have experienced racism in the workplace, including 92% of Black nurses, a 2022 survey from the National Commission to Address Racism in Nursing found.

Nursing commits to anti-racism education

The healthcare industry has flagged its discrimination problem in recent years, and among the many avenues for promoting anti-racism in medicine, it's zeroed in on medical education. But according to Beard, there's room to continue to refine industry efforts to promote anti-racism in nursing.

"Despite progress, some nurses still face repercussions for addressing racism openly, including termination or even being labeled as 'troublemakers,'" she said. "While many institutions claim to value diversity, some still uphold policies and practices that really contradict this assertion."

However, I feel like we planted the seeds without fertilizing the soil. Just like desegregation efforts, we put students into environments where the environment was not ready for them.
Kenya Beard, EDDCommissioner for the National Commission to Address Racism in Nursing

For example, some nursing programs might espouse ideals of equitable and diverse recruitment. But as long as those schools continue to require certain standardized testing for admission, which data has shown favor applicants from affluent backgrounds, they aren't delivering on their health equity promise.

More nursing schools are dropping standardized testing requirements, Beard added, and the American Nurses Association (ANA) continues to advocate for more schools to drop the requirements. But still, there is room for cultural growth in terms of inclusivity.

"Diversity initiatives were often implemented in a manner that was kind of reminiscent of desegregation efforts," Beard explained. "However, I feel like we planted the seeds without fertilizing the soil. Just like desegregation efforts, we put students into environments where the environment was not ready for them."

That's had some adverse effects.

As noted above, nurses are still reporting racism and discrimination in the workplace. Meanwhile, a 2024 report from the Commonwealth Fund found that healthcare workers, especially those ages 18 to 29, are still finding their workplaces hostile.

Around half (48%) of younger healthcare workers said they'd be worried about reporting workplace discrimination out of fear of retaliation. Another half said they wouldn't speak up during workplace discrimination training sessions because they feared they'd get in trouble.

Another 2022 report showed that Black nurses are twice as likely to say they plan to leave the field compared to white nurses, with emotional distress being one of the leading causes of a job change.

"So many of these initiatives have failed to address the underlying climate," Beard pointed out. "This results in outcomes that jeopardize psychological safety, emotional wellbeing, students' persistence and even their self-esteem."

But it doesn't have to be that way, Beard added, and that's one of the Commission's key goals.

"We are trying to adopt an equity lens to ensure that resources and support are tailored to meet individuals at their level of need," she stated. "And that's great for nursing because that's what we do all day. We meet patients at their level of need. So, as healthcare systems increasingly prioritize health equity, this language resonates with our core values of the nursing profession."

Reframing anti-racism in nursing schools

The industry's push to promote anti-racism in medical education and nursing schools is just in its nascency; there is room to course correct to promote a better landscape.

"You've got to prepare the ground before planting the seeds," Beard advised. "We need to approach this with a 'me,' 'you' and 'us' perspective."

On the "me" level, individuals within the nursing school system need to evaluate and engage in deep reflection. What are your fears? How will you address them? And what knowledge do you need and how will you overcome challenges and celebrate your successes?

On the "you" level, Beard encouraged individuals to consider who they will partner with in their anti-racism journey. Who can you learn from, and who can you assist?

Finally, in terms of the collective "us," nursing schools need to carry their missions out into society.

"You have to think about how power will be shared," Beard said. "If you're not willing to share power, you're really not interested in bringing diverse perspectives to the table."

Nursing schools should evaluate the integration of their DEI efforts throughout their policies, practices and curricula. From there, developing a 360-degree framework for measurement and evaluation is paramount, according to Beard.

"We measure what's important and what we don't measure, we rarely, rarely bring it to fruition," Beard stressed. "I want to make sure that we emphasize the fact that we need to do end-of-year evaluations, 360-degree assessments, and bake that into the culture so we can really gauge the progress along the equity journey."

That assessment and analysis needs to move in all directions, both retrospectively and prospectively, Beard added.

"A climate survey is a lagging indicator. It's going to tell you where you're already at, the harm that has already occurred," Beard concluded. "To truly address diversity, equity and inclusion in nursing education, we've got to examine the curriculum upstream, examine the environment upstream and evaluate inherited policies that may implicitly hinder educational equity."

Sara Heath has been covering news related to patient engagement and health equity since 2015.

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