When clinical leaders talk about nurses and their work during the COVID-19 pandemic, they are quick to point out their resilience and empathy.
The country as a whole has also noticed the strengths of nurses. This year, Americans voted nurses the most honest and ethical professionals for the 20th time in a row, for example.
But most clinical leaders also know that nurses are always sensitive to racism and prejudice.
“Racism exists in nursing and in society. [Nursing is] a microcosm,” said Karen Grimley, PhD, MBA, RN, chief nursing officer for Los Angeles-based UCLA Health. “It exists on many levels in the profession and also in the health care sector. We see it with social inequalities all the time. Because we’ve always been so busy looking outward, maybe we haven’t really paid attention to ourselves as a profession when it comes to the specifics of racism.”
A survey released on January 25 by the National Commission to Combat Racism in Nursing also found racism to be a significant problem within nursing, with more than half of nurses saying they had personally experienced a racist act on the job. workplace.
“Racism in nursing is a problem, and the number of published studies sharing reports of racism and perceptions of racism there, we cannot ignore,” said Deedra Zabokrtsky, DNP, RN, network head nurse for Scottsdale, Arizona. based on HonorHealth. “The recent study results have been disappointing to read and heartbreaking to read. But there’s also a lot of effort around it. I think we have to acknowledge that it exists and then we have to learn what it is.” is and how best to face it to fix it.”
Becker’s spoke with Dr. Grimley and Dr. Zabokrtsky to understand what racism in nursing looked like during the pandemic and how their healthcare systems are working to combat it.
How Racism Shows Up in Nursing
Racism can exist in various forms, according to the National Commission to Combat Racism in Nursing.
The commission’s new definition of racism: “assaults on the human spirit in the form of actions, biases, prejudices and racially based ideology of superiority that persistently cause moral suffering and physical harm to individuals and perpetuate systemic injustices and inequalities”.
Dr Grimley said nurses need to be aware of these biases. She also advocated for nurses to be culturally humble and situationally aware.
Otherwise, “we may superimpose our beliefs or our attitudes on someone, whether it’s a colleague or a patient or a member of the community,” she said. “So that inclusion that you need can sometimes be difficult, because some of that comes from systemic behaviors and attitudes in health care that have existed over the years. You read about it. You read information about nurses eating their little ones. as subordinates by doctors. Even some of the stereotypical things you see on TV. All of this predisposes all of us to thinking in a biased way that might not be accurate to about the people or person you are meeting.
Fighting Racism in Nursing
Drs. Grimley and Zabokrtsky agreed that raising awareness is a key part of making progress in eradicating racism.
Here are 11 strategies they identified to combat the problem.
1. Hiring of a Head of Health Equity, Diversity and Inclusion. UCLA Health has appointed Medell Briggs-Malonson, MD, to this position. It started in April 2021.
2. Setting up a board. UCLA Health nurses created a council called Unity in Diversity, which meets monthly. Dr Grimley said the council is responsible for identifying opportunities to improve diversity and inclusion and ensure fairness for staff and patients. Dr Grimley said the board plans to continue working on understanding social inequalities and integrating patient demographics, including social determinants, to provide more individualized care.
“This group fits into the health system steering committee that was created by our head of health, equity, diversity and inclusion,” she explained. “So we’ve been trying to put a system in place that’s going to identify and start addressing the cultural norms that can contribute to systemic bias and racism. This systemic stuff that we haven’t quite acknowledged yet.”
3. Develop response teams focused on addressing concerns or complaints about sexual harassment and violence, discrimination and racism. Dr. Grimley said UCLA Health is performing detailed event analyzes to identify the actions needed to address the issue, whether at the organizational or individual level.
4. Creation of educational materials for staff around diversity, equity and inclusion. Health system education includes modules that introduce the concepts of implicit bias, cultural humility and situational awareness.
These modules are “important in the overall architecture of how to proactively understand and identify issues, but also to better prepare individuals to ‘see something, say something,'” Dr Grimley said.
5. Conducting an annual employee engagement survey. Dr. Zabokrtsky said the survey presents questions about perceptions of diversity, equity and inclusion. The health system is transparent in sharing results on a large scale.
6. Obtain information from departing employees. Dr. Zabokrtsky said HonorHealth uncovers the reasons employees leave to identify opportunities for health system improvement.
“We review this data and compile any trends. We encourage employees to raise concerns. We do a lot in terms of monitoring and asking for feedback, to keep our teams on the pulse and address concerns openly.”
seven. Use a “just culture” concept. Dr. Zabokrtsky said HonorHealth uses this concept to inform the decisions it makes.
“We look through a just culture lens when exploring an issue, whether safety, quality or social, and this discipline helps guide our response and resolution,” she explained.
8. Create a Diversity, Equity and Inclusion Steering Group. This committee is well attended and participation is strong, which Dr. Zabokrtsky says shows that diversity, equity and inclusion efforts resonate throughout the health system.
“We learn a lot from these forums, which help us develop our strategy on how to move forward to improve. We have also brought in a consultant to begin work with our leaders and our entire management staff,” she said.
9. Establish human resource groups. Dr. Zabokrtsky said these employee-led volunteer groups are financially supported by HonorHealth’s organizational development team and have a budget to promote activities that help others understand the issues their group is facing. confronted. She said they also have access to a mentor to lead their group and an executive champion to break down barriers they can’t overcome. One of the first human resources groups established was that of the Hispanic community. There is also a resource group for military veterans, and other groups are forming.
ten. Support the HonorNurse program. This is a voluntary program for nurses in the healthcare system that emphasizes professional growth and development.
“These are nurses who want to continue their professional development and support our Magnet culture,” Dr. Zabokrtsky said. “We have five Magnet-designated hospitals in our network. Recently, HonorNurses hosted a Cultural Diversity Fair and shared information about how various groups we care for have been impacted by the pandemic. They select a theme each year and then each unit creates a poster to share in the hospital lobby It is rewarding to learn and share with employees throughout the hospital.
11. Provide information to staff on lived experiences. This effort recently included providing information about Black History Month and Lunar New Year.
“Hearing about the cultural traditions firsthand from the members of that culture is so [richer]and you appreciate the meaning of it so much more,” Dr. Zabokrtsky said.
What can hospitals do to address racism in nursing?
No matter how hard hospitals try to address racism in nursing, Drs. Grimley and Zabokrtsky agree that it starts with raising awareness and putting structures in place for change and improvement.
Dr Grimley said healthcare workers and leaders need to know their own biases and be aware of the language they use. For example, she describes an employee as a person, rather than calling them a woman or a man, giving them credit for doing a good job.
“You present the person and their accomplishments in a way that removes a bit of bias if someone doesn’t think a man or a woman can do that particular thing,” she said.
Dr. Zabokrtsky encouraged healthcare leaders to recognize that there are opportunities to make a difference and that it is their responsibility.
She also encouraged leaders to strive to better understand racism.
“If that means we have to bring in people to help us figure that out, then so be it. We have to read well and be aware of what’s in the literature, including non-fiction. There are some great books out there that have helped raise my awareness,” she says. “When we can do that and meet the needs of our entire workforce, they’ll start to open up and share their experiences more. openly.”