Black nurses: a sisterhood of service amid racism and discrimination
Although the focus of this blog is Black female nurses, I acknowledge the contributions of Black male nurses and their unique challenges.
Nurses are my heroes, but despite their crucial roles on the frontlines of patient care, a nationwide shortage of nursing professionals persists.
In April 2023, the National Council of State Boards of Nursing reported that “Approximately 100,000 registered nurses (RNs) left the workforce during the COVID-19 pandemic in the past two years due to stress, burnout, and retirements. Another 610,388 RNs reported an “intent to leave” the workforce by 2027 due to stress, burnout, and retirement.”
Other reasons cited for nurse dropouts are increased workloads, the inability to take breaks, sick days, or turn down extra shifts, inadequate staff support, and no equal pay for equal experience.
Nurses of color face additional hurdles. A study published two years ago in Nursing Outlook showed that compared to white nurses, non-white nurses experienced “higher levels of job dissatisfaction, emotional distress, and workplace racism experiences … Black nurses experienced the highest numbers of workplace microaggression types and the most negative racial climates …”
One Black nurse’s experience
La Toyia Jackson-Terry, MSN-LMN, RN was senior nurse manager in the pulmonary care unit Emory University Hospital when she received a letter of termination. Her impressive resume boasts 23 years nursing experience as clinical nurse educator, healthcare administrator, and nursing faculty.
In January 2022, Jackson-Terry had been thrilled to land her dream job with Emory, a prestigious academic teaching hospital in Atlanta, GA. Three months into the job, however, her team, mostly Black female nurses, complained about ongoing unfair treatment by a white supervisor, who they said showed favoritism toward white staff whenever she created schedules, gave out assignments, or disciplined staff. Jackson-Terry described it as a “culture of favoritism.”
In an interview with WSB-TV Atlanta, Jackson-Terry recalled, “In one incident, a leader came and pointed her finger in one of the (Black) nurse’s faces …. yelled at her … screamed at her … and nothing was done about it.” The nurse reported this encounter to HR.
When Jackson-Terry advised Human Resources (HR) of the nurses’ grievances, she said the HR manager in charge of the investigation accused her of coercing her team into making the allegations. “… it looked like everything was accusatory … and then I didn’t hear anything else…” Three weeks later, Emory fired her.
Consequently, in April 2024, Jackson-Terry filed a lawsuit and an EEOC complaint against Emory Healthcare, Inc. “Something has to change, and if it takes me – and other people like myself to actually speak about what occurs behind closed doors – then this is what we need to do.”
A legacy of sexism, racism, and paternalism
Jackson-Terry’s story underscores the obstacles that Black women have faced in pursuit of nursing careers in the United States since the 1800s.
Historian Darlene Clark Hine, author of Black Women in White, noted “Most of the hospital nursing schools in the North imposed racial quotas while institutions in the South excluded black (sic) women.”
In 1878, Mary Elizabeth Mahoney became the first African American professional nurse. She graduated from the New England Hospital for Women and Children Training School for Nurses in Boston, Massachusetts, which admitted one Black and one Jewish student.
Of necessity, beginning in the late 1800s, Black physicians began to establish Black hospitals, including Colored Hospital and Nurse Training School in Charleston, SC, Freedman’s Hospital in Washington, D.C., and the School for Philadelphia Nurses, Philadelphia, PA. These schools educated, trained, and employed Black doctors and nurses, who could address the unmet health needs of Black people in rural and urban areas, often denied treatment at white hospitals or placed in segregated wards.
“The schools were often underfunded, had limited faculty, poor facilities, a lack of access to large numbers of patients,” according to the Journal of the National Medical Association. With limited access to funds (from government sources, private donors, or impoverished patients) Black training hospitals sought endowments from white philanthropic organizations, such as The Julius Rosenwald Fund and The General Education Board.du/cspcs-publication/general-education-board-1903-1960/ This support, however, often enabled white philanthropies to determine polices at Black hospitals. In addition, their motivations included preventing the spread of diseases in Black communities to white communities.
Conditions for nursing students in Black hospital-based training programs, however, were not optimal. A source of cheap labor, they worked 12-hour shifts, with little or no clinical supervision. Hospitals cancelled scheduled classes if they needed additional staffing on the wards. Their other duties might include changing linens, doing housekeeping, and preparing meals.
Having white administrators and instructors at the helm of training schools for Black nurses oftentimes led to conflicts between students and staff. During the 1930s, Salaria Kee, a nursing student at the Harlem Hospital Nurse Training School, organized a successful campaign to end the hospital’s practice of reserving dining room tables for white administrators and nurses.
Many Black nurse training schools struggled to cover operating costs. Consequently, they hired out Black nursing students to wealthy white families or poor, rural Black communities to generate income, Hine explained. “(Student nurses) had few options but to venture into unpredictable situations in communities with little support or pay.”
“In the 1910s, trained Black female nurses faced steep obstacles,” according to the Journal of Public Health. “Most Whites and some Black men … viewed them through a “triple index of inferiority”: as nurses (not doctors), women (not men), and Black (not White).” ls was substandard. At the same time, white university-based nursing programs prohibited Black nurses from getting advanced training. In addition, they could not join state nursing associations or take exams for state board certification.
Unwelcome in the American Nurses Association (ANA), in 1908, nurses Martha Minerva Franklin and Adah B. Samuels Thoms (who served 17 years as assistant superintendent at the Lincoln Hospital and Home School of Nursing, yet never received the official title of director), spearheaded the push to establish the National Association of Colored Graduate Nurses (NACGN) “… dedicated to promoting the standards and welfare of Black nurses and breaking down racial discrimination in the profession.”
As the push for integration gained momentum, more nursing schools accepted Black students. In 1949, the NACGN merged with the American Nurses Association, and members voted to end it in 1951.
In July 2022, the ANA adopted a “racial reckoning” statement acknowledging “… its own past actions that have negatively impacted nurses of color and perpetuated systemic racism … To begin, we must acknowledge that from 1916 until 1964, ANA purposefully, and systematically, excluded Black nurses.”
Notwithstanding this apology, the nursing profession lacks diversity. Minority Nurse’s latest statistics indicate that of 2, 824, 641 registered nurses in the United States, 9.9 percent (or 279, 600) of registered nurses self-identify as Black or African American.
In 2022, the Robert Wood Johnson Foundation surveyed 980 registered nurses, nurse practitioners, and licensed vocational nurses by about their experiences with racism on the job.
“While 80% of the respondents said they have seen or experienced racism from patients, and 60% from colleagues … fewer than 1 in 4 nurses reported the incidents ... nurses said they felt human resources employees, administrators, and even their union leaders would do little to help, and more than half of those who did report what happened said their relationships with supervisors and fellow nurses suffered as a result.”
According to the Washington Informer, “Black nurses (can) provide culturally sensitive and informed care, as well as provide representation to inspire and increase Black medical professional rates.”
A sisterhood of service—from NACGN’s inception to today’s National Black Nurses Association—has pushed to “influence health care services for Black people and to promote the inclusion of blacks in nursing education and nursing leadership positions.”
The struggle continues.
2024 Wista Johnson (Reprint by permission only.) Photo: courtesy of Smithsonian National Museum of African American History and Culture