“Now more than ever, our profession needs to move toward racial healing. There is an urgent need for nursing to acknowledge its history of racism, boldly confront racism wherever it shows up, and address the racism that nurses witness when delivering care to those they serve. This will not happen until nurses engage in self-awareness and reflection as well as confront any personal racist attitudes and behaviors. When nursing demonstrates a commitment to creating an antiracist culture within the profession, nurses and patients, both in need of healing, will be better served.

It is our hope that this report will open a window of opportunity for nursing to acknowledge its history of racism and resolve to solidify a future that is welcoming, respectful, and supportive of all nurses regardless of race, ethnicity, or any other unique attributes. Anything less is counter to the core principles of a profession that demands caring, compassion, and respect for everyone.”

Janice Phillips and Katie Boston-Leary are nurses.

They share their stories and discuss their KevinMD article, “Nurses are in need of racial healing.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow.

Today on the show we have Janice Phillips and Katie Boston-Leary. Janice is an associate professor at the College of Nursing at Rush University and the director of nursing research and health equity. Katie is the director of nursing programs at the American Nurses Association. Together they wrote the KevinMD article “Nurses are in need of racial healing.” Janice and Katie, welcome to the show.

Janice Phillips: Thank you.

Katie Boston-Leary: Thank you.

Kevin Pho: So I’m going to ask each of you just to briefly share your stories and journeys to where you are today. Janice, why don’t you go?

Janice Phillips: I’m Janice Phillips, and I’ve been a nurse for a number of decades now, and I was very excited to be selected to be on the National Commission to Address Racism in Nursing. I personally have experienced racism in nursing, but I was a little surprised to know that it was as widespread as it is. I think my colleagues and my friends who are in the profession all have our own stories, but it’s pretty disturbing to know that our profession is being plagued with such widespread racism. My colleague and I, Dr. Boston-Leary, decided to try to leverage more platforms to get the word out about racism in nursing.

Kevin Pho: Perfect, and we’re going to be talking about that article in a little bit. But before we do, Katie, just briefly share your story and journey to where you are today.

Katie Boston-Leary: Sure, thank you, Dr. Pho. I’ve been a nurse as well for a couple of decades. I hate seeing that description, but specifically, 28 years. I worked through the ranks. My specialty was the operating room, and then I got into executive leadership. Now, after I got my doctorate, I want to do something along the lines of social change and broader impact. So the American Nurses Association found me as much as I found them, and it’s been a nice marriage. That’s where we tackle issues like this, racism in nursing, staffing, you name it, anything that is impacting the nursing profession, and it gives us the opportunity to leverage resources and get some political attention. That’s what we do. I also teach at the University of Maryland, which is also something that I love. So that’s me, and I’m excited to be here.

Kevin Pho: All right, so let’s get into that article that both of you wrote. It’s titled “Nurses are in need of racial healing.” Now, for those who do get a chance to read that article, Janice, can you just briefly share the story of why both of you decided to write it and summarize it for my audience?

Janice Phillips: Absolutely, and thank you, Dr. Pho. The National Commission to Address Racism in Nursing is a collective of a number of our leading nursing organizations and minority nursing organizations. It conducted a survey of about 5,600 nurses to get their perspectives around racism, and the findings show that we have a problem. Sixty-three percent of those who responded reported having experienced some form of racism, mainly by their peers or their managers or their supervisors. The report sends a clarion call to all members of our profession that this will not be tolerated.

Racism, as we all know, undermines some of our most treasured values. Our core values are built around respect and caring and compassion. So the report hopefully will help to intensify not only those conversations, but those actions around addressing the problem that we see in our profession right now. When the report came out, Katie and I decided to do whatever we could to utilize more outlets, whether it be social media platforms or whatever it would be, to get the word out, to issue a stronger call to action. I’m hoping that anyone who’s listening today will be very curious to read the report, but also take a good look at themselves, individually and collectively, to see what we can do to address this issue.

Kevin Pho: And Janice, one of the things that you mentioned earlier was that the extent of racism within the nursing profession was surprising. Why was it surprising?

Janice Phillips: Well, when you think about it on a personal level, I’ve experienced racism. I have colleagues, and after four decades in the profession, I know it exists. But to see the numbers, and to see that there’s a lot more discussion around racism. I can never recall any time in my four decades of practice that we have ever turned our attention to racism. Now we have the data, we have the evidence, we have the testimonies. So it’s not just my own personal perspective. It’s not just the perspective of my colleagues that I work with every day or throughout my career. It’s the perspectives and the real experiences of a large number of nurses, which makes it really, really troubling. It’s not an isolated incident. It’s not all in my mind, not in my head, that maybe it’s just me. There’s a large number of nurses who are experiencing racism.

Kevin Pho: And Katie, one of the things that Janice mentioned was that a lot of the racism comes from peers and managers. I was wondering, can you share some stories that you hear from other nurses that really paint a picture of some of the scenarios of racism, so my audience can really understand what’s going on?

Katie Boston-Leary: Sure. I could actually add in some of what I experienced, but it’s interesting, because we started off with doing listening sessions, and those listening sessions were quite revealing. That’s how we dipped our toes into understanding the landscape of what was going on. We heard stories that, when you hear them, you would think were something that played out probably in the civil rights era, during that struggle, but it’s happening today.

We had a nurse who explained to us, tearfully, how her assignment got switched because her patient didn’t want her in the room. She knew that there was a dynamic that was going on, but she was fulfilling her social contract to care for anyone and everyone, because that’s what we do as nurses. Her supervisor pulled her out of the room and switched her assignment, and she was dismayed at that. When she asked, “Tell me what’s going on. Why is this happening? Is it me?” her supervisor told her, “Well, don’t blame the patient, because at night, when you come in, when you smile, all he sees is your teeth, and that scares him.”

There are other stories around nurses who have a fear of even taking a break or going to lunch, because the settings on their vents or their drips will be changed, because of an effort to get them out, because they’re not, quote-unquote, fitting in. There is also the impression, and I’ve had conversations with some of the Black nurses around this, where culturally we’re taught to not eat everybody’s food and to watch who you engage with socially. Because of that, because they’re not engaging in potlucks, they’re seen as not being team players, and they’re excluded and weeded out.

Sadly, because of some of the stories, with all of these trends in these stories, you find that a lot of our nurses of color are reducing the relationships they have with their managers and their peers to being purely transactional, which is not where we want to be, right? It’s about, “OK, if you’re not going to love on me, if nursing is not going to love me back, at least I earn a living, and that’s all I’m going to reduce this relationship to.”

So our goal is to lift and rise above that with this work, and make sure that it’s understood that, yes, it’s hard, and we have our work cut out for us, but we are relentless, and we’re going to continue to raise the issue that this is real. Unfortunately, we do have a good segment of nurses who are saying that this is all political, and why are we doing this? So that’s the truth and reckoning that has to happen for this to take effect, for us to move toward racial healing.

Janice Phillips: And Dr. Pho, I’d like to add that this is across all levels of nursing. You think, well, you’ve got a PhD, or you’ve got some extra credentials or extra alphabets behind your name. Even for me, with as many years of experience in academic practice and research, we are not exempt from racism. It’s not just the bedside nurse. It’s the nurse executive. It’s the nurse who has advanced education. It’s across all levels of roles and settings.

Kevin Pho: So Janice, give us an example in the nurse executive setting, stories that you hear of racism in that setting.

Janice Phillips: Well, let me give an example with myself. I remember having earned my PhD, and I was in Washington, D.C., and I was all excited about my first interview for a position to serve as a consultant for a nationally recognized nursing organization. When I showed up at the front desk for my interview, the front desk clerk said, “The temporary secretaries, they check in upstairs.” Now, mind you, I was dressed in a nice suit, with my briefcase. I don’t know what gave that person the impression that an African American woman, any African American woman who came to that desk at that moment, had to be the temporary secretary.

I was a little offended by that, but I was also taken aback, because I really wasn’t sure how to address that. I was a nurse who was relatively new with a PhD degree, very well credentialed, with many, many years of experience and expertise, and even national visibility. But to have someone approach me like that was very, very disturbing.

Katie Boston-Leary: Yeah, I can echo that too, to piggyback on that experience, as a chief nursing officer. This was not that long ago, and it was an institution that I was working at in Maryland, which is pretty diverse. I was a chief nursing officer there, and my secretary was white. Whenever we walked into a room together, whether with external people or people who were looking for positions, they would always gravitate to her because of the fact that she’s white. It was something that we ended up laughing over, after we got over how often it occurred. It became a game for us, like, “Watch this. We know it’s going to happen again.” They would always shake her hand first when we were both walking into the room together.

Kevin Pho: Katie, if a nurse experiences an episode of racism, what kind of recourse does he or she have? What are the next steps?

Katie Boston-Leary: That’s a great question, Kevin. We actually just received a call on our hotline from a nurse, because of the work that we’re doing. The recording was this: “Hello, my name is so-and-so, and I’d like to report racism that I’m experiencing in my school of nursing.” My initial response was, you go through the proper channels within your institution, and report it, and escalate it if you don’t see results.

Janice hit on the numbers, in terms of the fact that 64 percent of our respondents said that there’s no proper follow-up when they report incidents of racism. So when I thought about that response, I said, “Well, is that actually the right response?” Because you do find, again, with that data, that the follow-up is not as effective, right? It doesn’t necessarily get to the heart of the matter, and there’s an avoidance too.

White fragility is real as well. We heard it even yesterday, when we were conducting some Project ECHO sessions to talk about scenarios of racism, and there is a defending that comes out: “My husband is Black. My friend is Black. Oh, I know this person. They would never do this,” blah, blah, blah.

So it is a tough question. Of course, you have to start in the organization and manage it through those policy structures and things like that, but those structures are not sound. That is why a lot of what we’re trying to enforce is that we have to look at these policies. It’s less about the person next to you and their beliefs and trying to change them. It’s really about focusing on these policies and the structural racism that exists that prevents people from raising these issues. So it’s long-winded, but it’s a very complicated answer. You have to start within the institution, and that comes with a risk, but that’s where you have to start.

Kevin Pho: So Janice, let me ask you a similar question in terms of next steps. Now that you’ve brought attention to the commission’s findings, what should be the next steps that institutions should implement? Medical institutions, after they read these findings, what are the next steps they should take?

Janice Phillips: Well, I think also on an individual level first, we all could benefit from a little bit of self-reflection, self-assessment, if you will. What are our own internal biases? I think we have a little bit of homework to do on an individual level. But on a broader level, on an organizational level, we’d like to say, don’t put your head in the sand. This is real. Read the report. Figure out what you need to do to make sure that everybody feels welcome, included, and respected.

We expect that our nurses will deliver stellar care to our diverse populations. They cannot do that if they’re dealing with the racism themselves, either they are exhibiting racist behaviors themselves, or they are perpetuating racism in the organization. Again, in alignment with what Katie said, we need to look at our policies, but we need to be able to come front and center and have these critical and crucial conversations. There’s no time like the present, and we cannot continue to say, “Oh, that’s just an isolated incident,” or, “It’s all in their head.” It’s very real. We have the evidence. We have the data. Let’s have a collective conversation, but more importantly, let’s figure out what we need to do from a policy perspective. There’s no room for racism in nursing and in health.

Kevin Pho: So Janice, I want to follow up. One of the things you said is that on an individual level, there should be some self-reflection. So what exactly would that look like? Are there any resources that you could point my audience to?

Janice Phillips: There are a number of resources, self-assessment tools, on the American Nurses Association web page. There are resources, and there are toolkits that individuals can take to look at their own individual implicit bias. Thankfully, our nursing organizations and our health care organizations are now requiring that individuals take these types of assessments. There’s legislation right here in our own state that says that we have to be much more aware of these issues. So there are tools out there. We just have to be willing and open to using them, and let that be the fuel to help us be better prepared to have these larger conversations.

We need to empower ourselves. We need to empower others. When we see things happening, not to sound cliche, if you see something, say something. But if we see something, we have to be able to say something. But it all starts with ourselves, on the individual level first.

Kevin Pho: We’re talking to Janice Phillips and Katie Boston-Leary. They wrote the KevinMD article “Nurses are in need of racial healing.” Now I’m going to ask each of you for your take-home messages to the KevinMD audience. Katie, why did you go first?

Katie Boston-Leary: So my take-home message is really to understand, and Jan has hit this, that we all have biases and we’re all learning. I think if we start with that place of humility, to understand that this is something we’re all experiencing and going through, and that there’s grace in this process to understand everyone’s viewpoints, and also recognize that we all have to do our parts and not put it upon others to learn more and learn what there is to learn. Because that’s part of what we’re seeing too: “Educate me.” There are so many tools out there at this point, and you have to start there and not make it someone else’s responsibility to educate you.

Once you have some more information about where you should be and what you need to do, then you take it forward to having really crucial conversations around this issue. But it’s really important to understand that this is an issue in nursing. This is not made up. We have the data, qualitative and quantitative, that indicate that it is, and there’s an urgency for us to deal with it. Then we can get past it and get to a point of healing and transformation.

Kevin Pho: Janice, what are some of your take-home messages?

Janice Phillips: I could have said it better. I say, read the report. Take it seriously. And for those nurses who are experiencing racism, know that they are not alone. There are now increasing forums and platforms to talk about this, to get some support, to help become better educated. Like Katie said, I think all of us play a role in terms of addressing racism in nursing, and we want to do our very best to make sure that we are preserving those core values of compassion, caring, and respect for all people, and that includes our colleagues as well.

Kevin Pho: Janice and Katie, thank you so much for your time and for sharing your insight.

Janice Phillips: Thank you.