As we spend February reflecting on Black Americans’ history, humanity, and contributions, let’s also consider how to improve the systems and structures that impact Black lives moving forward.
We can start with health care. Retention and recruitment are challenging, especially for nurses from underrepresented groups in nursing, according to the American Association of Colleges of Nursing (AACN).
As a Black, Chicago-based nursing researcher, I see first-hand the changes needed to make the medical field more equitable for the people who are served by it and those who work within it. One way to do that is to truly listen to Black nurses and learn from their experiences.
While real-time data provide a means to understand the disproportionate burden of COVID-19 on Black communities, I find qualitative data collection invaluable in gaining insight into the lived experience of affected communities. We must prioritize listening to people within vulnerable populations and their nurses if we are to address systemic inequities and achieve better health outcomes effectively.
As the leading qualitative nursing scientist of a large-scale study recently published through the Maternal Child Health Initiative, my research team and I explored the experiences of Black nurses practicing during the COVID-19 pandemic. We found that they face a dual pandemic.
Our findings revealed that social support was inadequate for Black nurses, meaning they did not work in a supportive environment with proper infrastructure or resources. Specifically, Black nurses reported limited emotional support, appraisal support, informational support, and instrumental support to counteract the contemporary challenges brought forth by the COVID-19 pandemic.
These challenges play out even as COVID-19 disproportionately affects members of their own Black community—in the severity of illness, hospitalizations, and the number of deaths.
My research is dedicated to reducing health disparities in underrepresented racial and ethnic groups.
In my work, I call for a deep reflection on how some populations’ life expectancy is shortened due to the disproportionate impact of chronic diseases—the very diseases that can make COVID-19 more deadly for people who experience it.
But these disparities in health care pre-date, and transcend, the COVID-19 pandemic as reinforced by the Healthy People 2030. In eliminating health disparities and advancing health equity, we must provide opportunities for people to live healthy lives. And evidenced by the tireless efforts of the Centers for Disease Control and Prevention (CDC) in developing the science on strategies for reducing disparities.
The CDC indicates chronic diseases, including heart disease, cancer, and diabetes, disproportionately impact Black individuals, shortening this population’s life expectancy due to adverse health outcomes. According to the CDC, maternal mortality among Black women is also a growing health crisis, highlighting the racial and ethnic inequities in obstetrics and gynecology health services. These adverse health outcomes are social determinants of health (SDOH)–environmental conditions where people are born, live, learn, work, play, worship, and age that affect health and quality of life, according to Healthy People 2030. SDOH includes five areas: economic stability, education access, and quality, health care access and quality, neighborhood and built environment, and social and community context. Given the nurses’ holistic approach to care, social and environmental factors are considered in the provision of patient care. Many Black nurses work and live within populations that experience health disparities.
In a recent statement, the American College of Obstetricians and Gynecologists declared: “Racial and ethnic inequities in obstetrics and gynecology cannot be reversed without addressing all aspects of racism and racial bias, including sociopolitical forces that perpetuate racism. The actualization of an equitable health care system which serves all people can only occur through acknowledgment of the historical context from which modern health inequities grew, including reproductive injustices.”
With proper support, Black nurses can be a crucial part of the work necessary to address and alleviate those inequities and injustices—across all medical specialties. Black nurses’ personal experiences should be elevated and considered in developing strategies that make these impactful, overdue changes.
To be sure, Black nurses are not alone in facing challenges during the pandemic, as revealed in our larger qualitative study. In the qualitative examination of the interviews with Black nurses, Black nurses told us they feel vulnerable and expendable. When asked what meaningful social support would look like, they described emotional support from their organizations, family, friends, and other nursing colleagues. Our findings reinforce evidence of the integral role of a supportive work environment in providing quality patient care—and how vital good communication skills for staff nurses and nurses in leadership roles is.
In recent weeks, thousands of nurses went on strike in New York City. This was on the heels of similar protests or strikes in California, Oregon, Minnesota, and elsewhere. In fact, nurses led a quarter of the top 20 major work stoppages tracked by the Bureau of Labor Statistics in 2022, according to the Washington Post. Nurses cite understaffing, stress, burnout, long shifts with no breaks, and unsafe working conditions as some of the reasons for striking.
With the critical role of nurses in coordinating care, as noted in the American Nurses Association’s position statement, addressing the nursing workforce shortage is necessary to meet the needs of the growing diverse patient populations.
Given the nursing workforce shortage in the United States and the invaluable insights, knowledge, and expertise that nurses bring to the fight against health care disparities, we can’t afford to keep turning a blind eye to their needs. Moreover, understanding how to optimize the health and well-being of Black nurses will be critical to ensuring the industry becomes—and remains—a healthier place. Collaborative efforts must focus on ensuring all voices are incorporated in developing policy solutions.
Shared governance is crucial, as revealed in a recent study where interviews were conducted among six senior leaders in a U.S. hospital. Examples of effective strategies as modeled by these leaders included effective communication, nurse recognition, and instrumental support such as sign-on bonuses, preceptor incentives, and tuition reimbursement are highly recommended.
Nursing leaders must create healthy work environments to reduce stress and its adverse effects. Identifying and removing institutional barriers and more intentional, equitable recruiting, hiring, and retention practices should be prioritized.
Although the findings from my recent study are not generalized for all Black nurses during the first wave of the COVID-19 pandemic, they nonetheless sound an alarm. We must obtain a greater understanding of the unique experiences of Black nurses and how to support them to obtain better health outcomes adequately. This worthy undertaking must last far beyond February.
Kashica J. Webber-Ritchey is an assistant professor of nursing.