Confronting Institutionalized Racism

Our first featured article in ANS 42:2 is titled “Words Matter: An Integrative Review of Institutionalized Racism in Nursing Literature” authored by Whitney Thurman, PhD, RN; Karen Johnson, PhD, RN, FSAHM; and Danica F. Sumpter, PhD, RN. This article, which provides insights that can guide dismantling racism in nursing, is available for download on the ANS website while it is featured.  Dr. Thurman shared this background about this work:

(l-r) Karen Johnson, Danica Sumpter, and Whitney Thurman

In 1999, the Institute of Medicine released the groundbreaking report, “To Err is Human.” One of the main conclusions of this report was that the majority of medical errors do not result from individual recklessness. Instead, errors are more commonly caused by faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them. Within this integrative review of the nursing literature, we hope our readers can see a parallel between focusing on institutionalized racism as a combination of systems and structures created in a culture that privileges whiteness and therefore requires systems-level solutions, just as medication errors require systems-level solutions. To be sure, similar to individual medication errors, individual acts of racism exist and must be quickly addressed. However, our purpose in conducting this review was to move the conversation past racism as merely interpersonal in order to challenge the nursing profession to understand and accept that racism is woven into the very fabric of this country and all of its institutions, including healthcare. After all, when it was written and signed, the Constitution of the United States did not consider African Americans to be fully human, and the ramifications of centuries of legalized discrimination and segregation did not vanish with the signing of the Civil Rights Act.

As nurses, we pride ourselves in serving our patient populations without judgement. The reality is, however, that all of us hold biases that have been formed– often without our awareness– by the larger culture and systems in which we operate. Similarly, patients bring with them a lifetime of experiences that influence their health beliefs and behaviors as well as their opportunities to be healthy and productive. As nurses with collective expertise and experience in public health, NICU, and pediatric nursing across teaching, research, and practice settings, we suggest that it is time for the nursing profession to reconsider our commitment to non-judgment. We challenge our readers to recognize and confront the systems that perpetuate health inequities, provider-level implicit biases, and individual-level overt and microaggressions. However, the challenge must be done in without re-centering the conversation on individual-level definitions and solutions to addressing racism. With greater intention to institutionalized racism across educational, research, and practice settings, nurses will be better equipped to dismantle systems and structures that perpetuate racial inequities in health.

Our hope with this integrated review is three-fold. First, this is a call to action to our nursing colleagues and students across practice, education, and research settings to engage in continuous self-reflection and dialogue about racism. Second, we challenge our peers to join us in owning our collective responsibility to recognize and challenge institutional policies that perpetuate racism and health inequities. Finally, we hope to amplify the voices– particularly those from communities of color who have been doing this work for ages– calling for us to address racism in our ongoing dialogue about health inequities. Specifically, we hope that the organizations and road maps that guide decision making for nursing and healthcare overall, such as the upcoming Healthy People 2030 and the Future of Nursing 2030 reports, will heed the recommendations of organizations such as the Black Mamas Matter Alliance and provide strong, evidence-based recommendations for nursing’s role in dismantling systems that have perpetuated racial inequities in favor of more equitable systems.