An 'open wound': How nurses of color fight the rampant racism plaguing their field
Every day, Kechinyere Iheduru-Anderson walked into work at a Massachusetts hospital with her fingers crossed, holding her breath.
The Black, Nigerian-born nurse braced herself for the demeaning treatment.
Her supervisors brushed off patient taunts. Her white counterparts doubted the accuracy of her patient charts, looking for faults. She watched as more senior staff rudely bossed around Black nursing assistants.
She’d pray her caustic co-workers weren’t on the surgical unit schedule that day.
"Or you hope that when you go to work, that they get floated to another unit, just so you don't have to work with them," Iheduru-Anderson said.
For years, she said, higher-ups dismissed her complaints, citing the longtime careers of some of her co-workers.
“Are you sure you didn’t misunderstand?” they said.
Iheduru-Anderson stuck it out. A nurse of three decades, she lives in Mount Pleasant, Michigan, and directs Central Michigan University’s nursing program. She’s dedicated her career to researching racism within the nursing field and mentoring young nurses of color.
“The history of nursing is rooted in segregation and discrimination. It is a microcosm of what is happening in society,” she said. “For the most trusted profession, it is kind of ironic, isn't it? The profession that is supposed to care for people that cannot even care for its own constituents.”
A survey of more than 5,600 nurses by the National Commission to Address Racism in Nursing reported an overwhelming majority of nurses of color say they experienced or witnessed racism. Iheduru and others draw on their experiences to fight it.
Compared with less than a third of white nurses surveyed, more than 90% of Black nurses say they’ve experienced racism. More than 70% of Asian nurses report the same, along with 69% of Hispanic nurses.
About 3 of 4 nurses say they witnessed racism in the workplace, but efforts to counter or confront it were futile. More than half say they challenged racialized treatment in the workplace, and 64% said no changes resulted from their efforts.
More than three quarters of Black nurses surveyed say racism in the workplace affected their well-being. About 70% report experiencing discrimination directly from health care facility leaders, 68% from patients and 66% from their own peers.
Increasing awareness of racism in nursing was one of the main goals of the survey, said Ernest Grant, the commission's co-leader and president of the American Nurses Association.
“It's like an open wound that continues to fester, and it's not going to get better. If anything, it’s going to get worse,” he said. “By bringing this issue to the light, we can begin to address it as a profession.”
Nurses of color are underrepresented in the registered nurse workforce. A Health Resources and Services Administration survey found 73% of the nation’s registered nurses are white; 7.8% are Black, 5.2% are Asian, 10% are Hispanic or Latino, and less than are 1% Indigenous.
Grant said he hopes the findings encourage leaders within the field to face their biases and help cultivate a culture of respect for nurses of color. The nursing field needs to be welcoming, he said, so up-and-coming minority nurses know "no matter what color your skin is, that you have a voice and that you are respected.”
Colorism and coping
Nurse and University of San Francisco doctoral student Daniela Vargas, born to an Indigenous Oaxacan family of farmworkers, is a first-generation immigrant and Santa Clara Valley Medical Center prenatal nurse educator. A Spanish speaker, Vargas is proud of her identity and connects with her patients through it.
“You realize how much of an honor it is to be in the sphere when you're in it, because I've had patients look at me before and say, ‘I've never been taken care of by someone that looks like me,’” said commission co-chair Vargas.
Other times, she said, she gets dismissed because of how she looks. She is creating a workforce experience program to counter racism, focusing on underrepresented nurses of color.
In California, Black nurses are about 5.4% of the registered nurse workforce, and Hispanic or Latino nurses make up 9.6%, despite being almost 40% of the state's population, according to research from the University of California, San Francisco that looked at figures from 2018.
Over the years, Vargas has grappled with judgment, even from non-Indigenous Hispanic workplace peers. "Colorism occurs within the community," she said.
She recalled a Hispanic nursing student who took one look at Vargas and assumed she wasn't a nurse.
"We all work really hard as health care providers in the different roles that we play," she said. "But the fact that somebody went straight to identifying me as a medical assistant when I am not only a nurse but a master's-prepared nurse – it was kind of shocking."
Through her doctoral project, she hopes to create a model that helps nurses cope with similar experiences.
"If I can somehow address the issues that create trauma for nurses in their foundation or as they go on into practice ... (and) it helps one nurse, then that's made my entire project worth it," she said.
Paving a future toward equity
Haitian American health care worker Farah André said teachers such as Iheduru-Anderson – who looked like her, advocated for nursing students of color and knew what she'd face in the field – helped her be more resilient.
"If you look a certain type of way, and they really feel a certain type of way, you really have the odds against you," André, 39, said. "People don't know your worth and your value because of your color or your accent. And your knowledge – they undermine that."
Iheduru-Anderson’s mentorship, she said, helped prepare her. When a patient called her a racial slur, André said, she simply replied, “You don't have any other better adjectives?”
“You can still be strong and gain the respect without stepping out of character, and approaching every situation that comes with a type of peace, instead of feeding into the negative,” she said.
Iheduru-Anderson was one of few faculty members of color among many white professors when André was her student, she said.
“She was kind of like the lifesaver, being the voice or the advocate of the minority nurses,” André added, tears in her eyes. “A lot of the nursing students wouldn't be able to graduate if it wasn’t because of her.”
Iheduru-Anderson said she began her work to pave the way for nurses such as André.
"I just couldn't imagine another 20 years, or 30 years, for people coming into nursing ... to be experiencing the same thing," she said.
Her research ranges from reviews of perceptions and experiences of young nurses of color to coping strategies and analyses of systemic barriers to success.
She's interviewed dozens of U.S.-born and immigrant nurses of color, particularly Black and African nurses, and hopes her efforts will be a catalyst for change.
"I listen to them, I validate their feelings, and never dismiss it. That's the last thing I will ever do, because I was dismissed," she said. "I was silenced, silent for so long."