Nurses Must Fight Against Racism. ANA's President Shares How

Ernest J. Grant, president of the American Nurses Association, discusses how racism is a 'public health crisis' and affects nurses and patients.

Protests calling upon Americans to address racism and its effects have taken place in multiple cities across the country in recent weeks. The most recent catalyst for these events was the death of George Floyd, a 46-year-old black man, who died while a Minneapolis police officer knelt on his neck for over 8 minutes. The four Minneapolis police officers involved in the incident have been arrested and charged in connection to his death.

Multiple nursing groups, including National Nurses United, the American Association of Colleges of Nursing, the American Association of Nurse Practitioners, and the American Nurses Association, have issued statements regarding Floyd's death and the issue of racism in the United States.

"As a nation, we have witnessed yet again an act of incomprehensible racism and police brutality, leading to the death of an unarmed black man, George Floyd. This follows other recent unjustified killings of black men and women, such as Ahmaud Arbery and Breonna Taylor to name a few," said Ernest J. Grant, PhD, RN, FAAN, president of the ANA in the association's statement. "As a black man and registered nurse, I am appalled by senseless acts of violence, injustice, and systemic racism and discrimination. Even I have not been exempt from negative experiences with racism and discrimination. The Code of Ethics for Nurses obligates nurses to be allies and to advocate and speak up against racism, discrimination and injustice. This is non-negotiable."

I recently spoke with Grant about racism, its effects, and how nurses can work for change.

The following is a lightly edited transcript of our conversation.

HealthLeaders: I think, in today's society, there's a misconception about what racism means. People think, "I'm not racist. I'm not mean to other people. I don't discriminate against them." What they're not realizing is that racism can come from unintentional bias and that it is also systemic. Could you explain what forms racism takes?

Ernest J. Grant: Off the top of my head, I can think of three examples. The first one is in education. For the black community, there are perhaps less opportunities for an even playing field, if you will. There are stumbling blocks in the way and [black men and women] may feel they have to work a little harder to achieve the same things that their white counterparts do.

Second, there's an unconscious bias that happens in the healthcare setting as well. For example, two people come to the emergency room with identical chest pain and symptoms, but one may be given a stronger medication or receive a more extensive workup than the person of color receives.

And the third one is stereotypes. Sometimes just because of a person's skin color or their culture or religious belief, [people] automatically [assume] things.

HL: How does racism in the healthcare work environment affect patients and nurses?

Grant: [In the work] environment, obviously if left unchecked, [racism] is allowed to perpetuate so it just becomes deep rooted and ingrained. Pretty soon, you've got a culture of, "Well, we've always done it this way." Or if someone is from a certain part of the community or town they may not be treated in the same fashion as someone who's from another part of town.

Nurses need to speak up whenever they see racism going on. [It doesn't] matter if it's a physician or another nurse or another member of the healthcare team, we need to call it out.

The other thing along those lines is that, from a nursing perspective, if you've got a patient from a different culture, they should be able to receive [care] from someone who is familiar with that culture, or who at least understands that culture and their healthcare beliefs.

HL: Do you think the environment within a healthcare system can prevent people of color from attaining leadership level positions?

Grant: I do. One of the things that I've always said is I think management should be reflective of the people we care for. So, [as a healthcare system] if you look at your management team and they are all white, then there's something wrong, especially if most of the patients that you care for are from the black and brown communities.

HL: You touched on it a little bit with your example about two people getting a different workup for the same symptoms, but could you explain the role racism plays in the health of minority communities and populations?

Grant: Sure. One, its effect on access to care. We are well familiar with healthcare deserts, [which is] when someone from the black community has to travel, maybe to the other side of town, to get healthcare. That could mean they miss a whole day's worth of work in order to have that 15- or 20-minute visit with the physician or the nurse practitioner. Also, when the healthcare system doesn't address social determinants of health, that perpetuates poor health in certain communities. For example, when you have poor drinking water or air pollution or other conditions that can perpetuate illnesses.

Another example is food deserts. If a person has to go to the corner store or the dollar store to buy canned goods, which tend to be much higher in sodium, but they have a heart condition, high blood pressure or kidney problems, that doesn't help them [manage their disease].

Those are some of the examples that racism may play in the health of a community. If the resources are not there to create a better community, then it perpetuates the cycle of the community remaining unhealthy.

HL: In the ANA news release, you mentioned you personally have had "negative experiences with racism and discrimination." I know those experiences can be difficult to recount but do you have any examples you are willing to share?

Grant: One example is applying for a position or for a promotion, and even though [I] was just as qualified or even more qualified than the person who got the promotion, when I asked, "What are some ways I can improve myself?" you're given the usual evasive talk.

Another [experience is] taking care of a patient and then having the nurse manager be approached and asked, "Is there someone else who can care for my family member?" That happens all the time. I've taken care of patients who were white supremacists and they made it very blatant that they did not want any black person taking care of them. It's something that we experience in healthcare all the time.

HL: What can nurses do to adhere to the ANA's Code of Ethics to be allies and advocates against racism?

Grant: The Code of Ethics obligates us to speak up when we see [racism]. As I mentioned before, if we see [it], then we need to call it out, and make sure there is a system in place that allows for it to be addressed. The only way we're going to see change is if people don't become complacent and they speak up and be the voice of change.

Racism is a public health crisis, and I think as nurses, the most important thing that we can do is to educate ourselves and use the fact that we do have the trust of the [public] to influence and educate others and to realize the systemic injustice that is going on. And, of course, [nurses can] encourage people to educate themselves and to vote for political candidates who have a proven track record of working against racism and injustice. What's going to help to promote change is to realize the power of the vote that you have and the power of the voting box to help bring about change and reform.