Racism in Nursing - How Nurses Can Lead Restorative Justice Initiatives (2 of 2)

Racism in Nursing - How Nurses Can Lead Restorative Justice Initiatives (2 of 2 - Part 1 here)

by Kaz Weida and Gerard Soucy, RN CHPN

To better understand the scope, quality, and effectiveness of anti-racism initiatives in modern nursing, the Manning Price Spratlen Center of Anti-Racism & Equity in Nursing at the University of Washington School of Nursing conducted a study comprised of in-depth interviews of more than 40 nurses and nurse educators. The goal was not only to elicit challenges but also to identify best practices in addressing racism in healthcare settings. The result - Mapping the Landscape of Anti-Racism Efforts in Nursing was conducted with the support of the Robert Wood Johnson Foundation.

When George Floyd’s murder and the Black Lives Matter movement swept the country in 2020, many professional outlets and organizations such as the New England Journal of Medicine (NEJM) and the American Nurses Association (ANA) attempted to address harm by acknowledging their roles in perpetuating racism in healthcare, medicine and nursing.

While some efforts continue, many of those interviewed for the study believed a more robust restorative justice approach is needed to truly combat structural racism in modern nursing.

Learn more: Read the full report Mapping the Landscape of Anti-Racism Efforts in Nursing

Central themes from Mapping the Landscape of Anti-Racism Efforts in Nursing

• Data is necessary but insufficient for change; in fact, a preoccupation with data collection can inhibit the actual work needed to advance anti-racism efforts.
• While gathering information on equity in nursing can be critical, study participants warned data gathering can undermine the real work of combating structural racism in healthcare.

“Participants were clear that the data must be used to drive change. Making data visible to front line staff was crucial in one hospital unit’s effort to reduce racial disparities in breastfeeding practices; but using data to hold staff accountable for improving outcomes is key.”
Mapping the Landscape of Anti-Racism Efforts in Nursing

• Without prioritizing solutions for addressing racism, and accountability for engaging in long-term and meaningful restorative justice approaches, anti-racism efforts in healthcare are likely to flounder and stall.

Learn more about the data on diversity and the history of racism in modern nursing in Nursing Foundation Violence and Absolutely No Place

• Diversity, Equity, and Inclusion (DEI) officers and other individuals responsible for the activation, policies and procedures for ensuring anti-racism approaches have mixed results.

The study found that simply hiring a diversity, equity, and inclusion (DEI) officer and assigning a meager part of the budget towards their efforts is not sufficient and can actually be counterproductive to advancing anti-racism efforts in nursing. 

Instead of siloing efforts in one position or department, participants reported that diversity and equity was better advanced when it was framed as everyone’s responsibility regardless of position. This study highlighted that HR remains a barrier to enacting effective initiatives and that without the ability to hold people accountable, DEI officers are set up to fail.

“Participants noted that their DEI officers were effective when they had the financial resources (i.e., budgets for anti-racism work) and authority to hold individuals and the organization accountable for addressing structural racism. The authority that comes with the position can be particularly complicated based on setting.”
Mapping the Landscape of Anti-Racism Efforts in Nursing

Learn more about how complicated hierarchical structure in modern nursing can hinder accountability for racial equity in The Enterprise and Civility is a Most Treasured Value.

• Rapid and clear responses to racism are necessary to shift culture; but long-term accountability and sustainability need to be built into organizational mission, priorities, and processes.

Feedback from study participants repeatedly highlight the need for more complex restorative justice efforts that focus on building trust in those harmed by structural racism within modern nursing and society at large.

“But dismantling structural racism is not a quick fix. It will require a long-term commitment to the work. Participants repeatedly spoke of their concern that the current expectation that individuals and organizations address racism in a focused, “all-hands- on-deck” way will wane, when some other issue emerges in the news cycle.”
Mapping the Landscape of Anti-Racism Efforts in Nursing

• This commitment to ongoing work must be expressed at every level of the organization, and to both patients and nursing colleagues who have long been harmed by structural racism in healthcare.

Learn more about the role adapting nursing protocols and processes can take in either perpetuating or combating racism in modern nursing in Just Culture Algorithm and Characterized by Malice.

• Nurses can and should lead this work.

The most significant finding from this study is that nurses not only can lead this work but that they absolutely should in order to effectively engage in successful restorative justice efforts for the benefits of patients, colleagues, themselves and modern nursing in general.

As in the Black Lives Matter movement, it is critical that nurses of color not be expected to shoulder the additional burden of educating and holding colleagues accountable.

“If white nurses are in positions of power, they need to be allies and mentors/colleagues, engaging in the work with nurses of color and not merely expecting them to do the work,”
Mapping the Landscape of Anti-Racism Efforts in Nursing

Learn more about disparities in racial equity in modern nursing and how nurses can be part of the solution in My Third Daisy Nomination.

To learn more about Dr Monica McLemore and related work - see the journal Health Equity and the University of Washington School of Nursing website.

Kaz Weida is an editor and journalist covering topics in health, education, science, technology, social issues and advocacy.

Gerard Soucy, RN CHPN is a nurse and blogger practicing in serious illness, end of life, death care, final disposition, bereavement and legacy.