Words Matter: An Integrative Review of Institutionalized Racism in Nursing Literature

Do no harm: A call to action by nurses to dismantle structural violence against LGBTQ+ youth

This commentary addresses structural violence - an overlooked and unrecognized harm within nursing. Structural violence within nursing practice refers to the violent impacts of racism, classism, homophobia, and transphobia as well as other biases on vulnerable and underprivileged groups. As one of the largest and most trusted health professions, collectively nursing has the power to leverage their influence to mitigate the harmful effects of structural violence when caring for LGBTQ+ youth.

Addressing diversity, equity, and inclusion: A response of professional nursing organizations to the future of nursing: 2020-2030 recommendations

One way in which professional nursing organizations have chosen to address the social determinants of health (SDoH) is through policy work focused on diversity, health equity and anti-racism activities. The recent report, Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity (FON 2020-2030), calls on professional nursing organizations and/or nursing coalitions to focus on addressing the SDoH to mitigate health inequities, including a focus on addressing racism and promoting practices to ensure the diversity of the nursing workforce. While these recommendations highlight issues of high importance to nursing and the broader society, they assume that professional nursing organizations or coalitions have not been sufficiently engaged in this work to date. Our goal was to better understand the current and/or ongoing activities of professional nursing organizations around their anti-racism work of diversity, health equity, and inclusion (DEI) activities recommended in the FON 2020-2030 report. To address this goal, we conducted a needs assessment of professional nursing organizations to document their DEI activities and the timing of these activities relevant to the recommendations in the report. The 26 responding organizations indicated they had been engaged in work addressing DEI issues for periods ranging from 4 months to 51 years. Minimal funding was the major barrier to advancing this work. Creating a vigorous shared DEI agenda across the profession, as suggested in the FON 2020-2030 report, will require input from nurses across the profession, as well as identification of resources to support this critical endeavor.

Lefebvre's production of space: Implications for nursing

In this paper, we argue that nurses need to be aware of how the production of space in specific contexts - including health care systems and research institutions - perpetuates marginalized populations' state of social otherness. Lefebvre's idea regarding spatial triad is mobilized in this paper, as it pertains to two-spirited, lesbian, gay, bisexual, trans and queer populations (2SLGBTQ*). We believe that nurses can create counter-spaces within health care systems and research institutions that challenge normative discourses. Lefebvre's work provides us the necessary tools to understand how various places or environments produce identities. In understanding Lefebvre's principles, we believe that nurses can play an essential role in creating counter-spaces, thereby instigating counter-institutional practices, for those who experience otherness.

Intersectional Examination of Gender-Inclusive Care and Women's Health

Transgender and gender-nonconforming people remain excluded from women's health spaces, and nurses with expertise in women's health best serve their needs when they seek sexual, reproductive, gynecologic, or obstetric care. However, commentary regarding the term "women" and exclusionary policies and behaviors in health care marginalize gender-nonconforming patients and contribute to health disparities. Therefore, the purpose of this article is twofold. First, we review terminology related to gender-nonconforming populations and their known health care needs; provide a brief historical overview of gender and health care; and describe the influence of White supremacist, misogynist, and heteronormative influences in women's health care. Second, we generate a call to action and specifically discuss the responsibilities of nurses and nursing organizations to ensure the provision of gender-equitable and respectful care and generate clinical recommendations for the specialty.

Illuminating the Contributions of African American Nurse Scientists Despite Structural Racism Barriers: A Qualitative Descriptive Study

A qualitative descriptive approach examined African American nurse scientists' (AANSs') experiences with African American research participants despite obstacles of structural racism. Fourteen nurse scientists participated in semistructured interviews that provided data for the thematic analysis. Major themes included barriers to overcome as doctoral students, cultural experiences with structural racism, designers of culturally sensitive research, and humanitarian respect and relationship depth. This is the first research study to illuminate the contributions of AANSs who lead research in health disparities. Therefore, nursing leadership needs to illuminate AANSs' contributions, increase nurse diversification, and dismantle structural racism that creates obstacles that ultimately impact population health.

Original Research: 'Do I See Myself?' Exploring the Potential for Online Images to Attract a Diverse Nursing Workforce

BACKGROUND

The current nursing shortage is expected to worsen in the coming years. While this shortage has in part been attributed to challenging working conditions, which were exacerbated during the COVID-19 pandemic, there are other factors. Although recruiting a more diverse health care workforce might help to reduce this shortage, little is known about how to do so effectively. This study explored how online images of health care workers vary by gender and skin tone and considered how those representations might impact recruitment.

METHODS

This was a prospective pragmatic study. Using a popular image search engine, we obtained and evaluated images (photographs, drawings, and cartoons) of people representing different genders and a range of skin tones. The search terms used were student, nurse, and physician. The search took place during a single day and stopped once 50 images for each term had been retrieved. Images were included if they depicted at least one human. Each image was evaluated independently by two raters regarding gender (male or female) and skin tone (using a version of the 10-point Monk Skin Tone Scale).

RESULTS

The final sample comprised 150 images that depicted 259 faces. Compared with the general population, nurses were overrepresented as being female (84.1%) and having lighter skin tones (85.2%). Physicians were overrepresented as being male (58.7%) and having lighter skin tones (63.5%). Compared with physicians or students, nurses were more likely to be represented as female and as having lighter skin tones.

CONCLUSIONS

The findings show a significant lack of diversity in gender and skin tone regarding how nurses are depicted in online images found via a popular image search engine. This lack of diversity may discourage people in some population groups from entering the health care field and could further contribute to the nursing shortage.

Racism, colonialism and the implications for nursing scholarship: A discussion paper

AIM

A critical discussion of the intersections between racism and colonialism as social determinants of health and explore how these discriminatory ideologies shape nursing inquiry.

DESIGN

Discussion paper.

DATA SOURCES

A review of pertinent discourse on racism and colonialism in nursing from 2000 to 2022.

IMPLICATIONS FOR NURSING

The failure to address health inequity plaguing racialized and marginalized populations locally and globally affects all groups, as illustrated in the COVID-19 pandemic. Racism and colonialism are inextricably linked, creating potent forces that influence nursing scholarship and adversely affect the health of a culturally and racially diverse society. Power differentials exist within and between countries creating structural challenges that lead to inequitable distribution of resources and othering. Nursing cannot be abstracted from the sociopolitical context in which it exists. There have been calls to address the social drivers that influence the health of the communities. More still needs to be done to support an antiracist agenda and decolonize nursing.

CONCLUSION

Nurses, as the largest healthcare workforce, can be critical in addressing health disparities. However, nurses have failed to eliminate racism within their ranks, and essentialism ideology has been normalized. A multidimensional approach that includes interventions aimed at nursing education, direct patient care, community health, nursing organizations and policy is needed to address problematic nursing discourse rooted in colonialism and racism ideologies. Since knowledge generated from scholarship informs nursing education, practice and policy, it is imperative to implement antiracist policies that eliminate racist assumptions and practices from nursing scholarship.

NO PATIENT OR PUBLIC CONTRIBUTION

The paper is a discursive paper using pertinent nursing literature.

IMPACT

For nursing to attain its potential as a leader in healthcare, standards of scientific vigour should be embedded within history, culture and politics. Recommendations are provided on possible strategies to identify, confront and abolish racism and colonialism in nursing scholarship.

The Experiences of United States Emergency Nurses Related to Witnessed and Experienced Bias: A Mixed-Methods Study

INTRODUCTION

The purpose of this study was to obtain a broad view of the knowledge, attitudes, beliefs, and lived experiences of emergency nurses regarding implicit and explicit bias.

METHODS

An exploratory, descriptive, sequential mixed-methods approach using online surveys and focus groups to generate study data. Two validated instruments were incorporated into the survey to evaluate experiences of microaggression in the workplace and ethnocultural empathy. Focus group data were collected using Zoom meetings.

RESULTS

The final sample comprised 1140 participants in the survey arm and 23 focus group participants. Significant differences were found in reported experiences of institutional, structural, and personal microaggressions for non-white vs white participants. Respondents who identified Christianity as their religious group had lower mean scores on items representing empathetic awareness. Respondents who identified as nonheterosexual had significantly higher mean total Scale of Ethnocultural Empathy scores, empathetic awareness subscale scores, and empathetic feeling and expression subscale scores. Thematic categories that arose from the focus group data included witnessed bias, experienced bias, responses to bias, impact of bias on care, and solutions.

DISCUSSION

In both our survey and focus group data, we see evidence that racism and other forms of bias are threats to safe patient care. We challenge all emergency nurses and institutions to reflect on the implicit and explicit biases they hold and to engage in purposeful learning about the effects of individual and structural bias on patients and colleagues. We suggest an approach that favors structural analysis, intervention, and accountability.

"Ally Theater Is a Problem": LGBTQI+ Migrants' Experiences With Nurses in Canada

In a 2021 research study, exploring the experiences of lesbian, gay, bisexual, two-spirit, trans, queer, intersex, and the "+" (LGBTQI+) migrants in health care in Canada, participants referred to the term "ally theater" in relation to their encounters with nurses. That is, the participants asserted that some nurses publicly demonstrate performative, or superficial, allyship regarding their identities. Using participants' experiences in health care as a metaphorical theater, this article presents a theoretical exploration of ally theater, and raises questions about professional practice claims of inclusivity and antiracism. The participants felt like deviant performers for not abiding by institutionalized centering of White hetero-cis-normative norms and thereby positioning racialized, LGBTQI+, and migrant as other.

Experiences of LGBTQIA+ migrants with nurses and other healthcare professionals in Canada

BACKGROUND

LGBTQIA+ migrants may have experienced discrimination and victimization related to ethnicity, culture, and race over the course of their migration journey, as well as in relation to their sexual orientation, gender identity and expression. Despite the work of some nurses in education, practice, policy, and research, there is a scarcity of literature investigating the experiences of LGBTQIA+ migrants with nurses and healthcare professionals in Canada.

METHODS

By utilizing Gadamerian hermeneutics research methodology with intersectional analysis, this study draws on 16 semi-structured individual interviews with LGBTQIA+ migrants who received care from nurses and other healthcare professionals (NHCPs) in Canada.

RESULTS

Two overarching areas of intersecting experiences were identified: (a) challenges and (b) supports. Four interwoven interpretations emerged from experiences of challenges: (a) unwanted visibility, (b) hearing a dead name and being misgendered, (c) cultural stigma, and (d) being asked intrusive hetero-cis-normative questions. Supportive experiences were evident when NHCPs accepted the unique needs of LGBTQIA+ migrants and acted as advocates.

CONCLUSIONS

Nursing interactions should not be traumatic for LGBTQIA+ migrants, but rather should be encounters where care providers ask relevant nonhetero-cis-normative questions, offer inclusive safe sex education for people's diverse identities, avoid dead naming and misgendering, and provide supportive and affirming care. To support the provision of safe care and mitigate trauma, systemic changes in nursing practice must include the experiences of LGBTQIA+ migrants.

Attending to our conceptualisations of race and racism in the pursuit of antiracism: A critical interpretative synthesis of the nursing literature

Race and racism are matters of urgent concern for the international nursing community. Recent global events have presented the discipline with an opportunity to generate and sustain long overdue discussions. However, with this opportunity comes a need to consciously attend to what we mean by race and racism, especially in the context of the nursing literature. Indeed, the development of antiracism depends on how we conceptualise race and racism; it is these conceptualisations that actively shape the scope and priorities of antiracist organising and action. The aim of this critical interpretative synthesis (CIS) is to examine conceptualisations of race and racism in the nursing literature by drawing on contemporary race scholarship. The synthesis of diverse literature is enabled through the explorative and expansive process of the CIS method. This review generates three synthesising arguments-a problem 'of' not 'for'; conceptual inconsistencies and drift; and reliance on the lens of experience-that both critique and contribute to the nursing literature. In the pursuit of antiracism, this article urges us to pay close attention to our conceptualisations of race and racism by illuminating the pitfalls that occur when our conceptualisations are inconsistent, contradictory, or simply neglected.

Reiterating a Need for Antiracism Praxis in Nursing and Psychiatric Nursing Education

BACKGROUND

The reemergence of the Black Lives Matter movement in 2020 reinforced the need for antiracist and decolonizing praxis in all areas, including nursing education, the burden for which has fallen predominantly on visible minorities. To enact the needed change within health care systems and nursing education, White nurses must recognize their privilege and become active participants in the conversations and change.

METHOD

This two-phase qualitative study explored nursing and psychiatric nursing students' experiences of racism and antiracism education at a small western Canadian university.

RESULTS

Anonymous qualitative surveys (n = 24) and structured interviews (n = 9) with nursing and psychiatric nursing students highlighted the difficulties and complexities of recognizing racism and a present lack of antiracism praxis in educational and health care settings.

CONCLUSION

Nursing educators must reevaluate structural and behavioral aspects of nursing education to support genuine antiracism praxis. [J Nurs Educ. 2022;61(8):439-446.].

Having Hard Conversations About Racism Within Nursing Education: A Collaborative Process of Developing an Antiracism Action Plan

BACKGROUND

Multiple events that occurred in the United States in early 2020 prompted a widespread response to address racism that exists within systemic and social structures. Third-year psychiatric nursing students at a small Western Canadian university answered the call to action by initiating a process to address racism within clinical and educational settings in their faculty.

METHODS

The researchers used collaborative autoethnography to examine the experience of students and faculty working collaboratively to create a Faculty of Health Studies antiracism action plan.

RESULTS

The reflections of the student and faculty researchers highlighted three major themes: what inspired the work of creating an antiracism action plan, doing the work, and lessons learned.

CONCLUSION

Engaging in this research provided an opportunity to critically reflect on the process of students and faculty working together in establishing an antiracism action plan. [J Nurs Educ. 2022;61(8):461-468.].

Defusing Land Mines: Keywords About Race in Nursing Education

BACKGROUND

The call for nurse educators to facilitate conversations about racism with learners has become inescapable. Yet, nurse educators in the United States indicate they feel unprepared or uncomfortable leading classroom conversations about race.

METHOD

Keyword analysis maps the multiple meanings of vocabulary, creating a common foundation for productive dialogue. Selection of keywords is subjective, but each keyword must meet three criteria: a term that is in common use, definitions that change according to time and perspective, and use that illuminates larger phenomena.

RESULTS

Five keywords when teaching about racism are Caucasian, colorblind, diversity, reverse racism, and underrepresented minority. Each keyword carries connotations that may be perceived as upholding egalitarian ideals without acknowledging the pernicious mechanisms of racism itself.

CONCLUSION

Familiarity with keywords provides educators with solid ground for engaging in often ambiguous and troubling dialogues about racism. [J Nurs Educ. 2022;61(7):408-412.].

Structural Racism in America: A Summative Content Analysis of National Nursing Organization Statements

The public and brutal death of Black American George Floyd was a tragedy that had the potential to push the profession of nursing toward a perspective transformation. A summative content analysis of 49 professional nursing organization statements served as a pilot to explore the research question: Did the nursing profession experience a perspective transformation relating to racial justice and health equity following the death of George Floyd? Texts from the statements were analyzed for the presence of an equity lens, which is necessary for a perspective transformation. Each statement was assigned a rating score to determine the organization's readiness for a perspective transformation based on equity competencies adapted from CommonHealth Action. Findings demonstrated that the nursing profession is beginning to articulate the issue of racism in health care and is committed to advocating for patients of color; however, further understanding of the historical context of structural racism and the development of meaningful policy remains necessary for the profession to experience a perspective transformation.

How to Support the Nursing Informatics Leadership Pipeline: Recommendations for Nurse Leaders and Professional Organizations

There is a need for nursing informatics leaders. However, there are not enough people educated and trained in informatics and leadership to fill that need. Therefore, the purpose of this study was to understand how professional organizations and nurse leaders support nursing informatics leadership development. This cross-sectional, descriptive study collected data via a scan of Web sites for eight nursing, informatics, and/or leadership professional organizations; interviews and surveys with nursing informatics leaders within the eight organizations; and a review of Web site, interview, and survey findings by nursing informatics leaders involved in leadership development. We found that nursing informatics leaders and professional organizations can support the nursing informatics leadership pipeline several ways. Examples included mentoring, education/training, and providing opportunities for networking and engagement in leadership roles. To help meet the need for nursing informatics leaders, professional organizations and current leaders can engage in various activities that provide training, education, and experiences for emerging leaders.

Institutional procedural discrimination, institutional racism, and other institutional discrimination: A nursing research example

Institutional discrimination matters. The purpose of this longitudinal community‐based participatory research study was to examine institutional procedural discrimination, institutional racism, and other institutional discrimination, and their relationships with participants' health during a maternal and child health program in a municipal initiative. Twenty participants from nine multilingual, multicultural community‐based organizations were included. Overall reported incidences of institutional procedural discrimination decreased from April 2019 (18.6%) to November 2019 (11.8%) although changes were not statistically significant and participants reporting incidences remained high (n = 15 in April and n = 14 in November). Participants reported experiencing significantly less “[when] different cultural ways of doing things were shared, the project did not support my way” from April 2019 (23.5%, n = 4) to November 2019 (0%, n = 0), Wilcoxon signed‐rank test Z = −2.00, p < 0.05. Some participants reported experiencing institutional racism (29.4%, n = 5) and other institutional discrimination (5.9%, n = 1). Participants experiencing institutional racism, compared to those who did not, reported a higher impact of the Initiative's program on their quality of life (t = 3.62, p < 0.01). Participatory survey designs enable nurse researchers to identify hidden pathways of institutional procedural discrimination, describe the impacts experienced, and examine types of institutional discrimination in health systems.

Reflections on whiteness: Racialised identities in nursing

In this article, I discuss the structural domination of whiteness as it intersects with the potential of individual critique and reflexivity. I reflect on my positioning as a white nurse researcher while researching international nurse migration. I draw on two large qualitative studies and one small focus group study to discuss my reactions as a white researcher to evidence of institutional racism in the British health services and my growing awareness of how racism is reproduced in the British nursing profession.

A critical exploration of nurses' perceptions of access to oncology care among Indigenous peoples: Results of a national survey

Inequities in access to oncology care among Indigenous peoples in Canada are well documented. Access to oncology care is mediated by a range of factors; however, emerging evidence suggests that healthcare providers, including nurses, play a significant role in shaping healthcare access. The purpose of this study was to critically examine access to oncology care among Indigenous peoples in Canada from the perspective of oncology nurses. Guided by postcolonial theoretical perspectives, interpretive descriptive and critical discourse analysis methodologies informed study design and data analysis. Oncology nurses were recruited from across Canada to complete an online survey (n = 78). Nurses identified a range of barriers experienced by Indigenous peoples when accessing oncology care, yet located these barriers primarily at the individual and systems levels. Nurses perceived themselves as mediators of access to oncology care; however, their efforts to facilitate access to care were constrained by the dominance of biomedicine within healthcare. Nurses' constructions of access to oncology care highlight the embedded narrative of individualism within nursing practice and the relative invisibility of racism as a determinant of equitable access to care among Indigenous peoples. This suggests a need for oncology nurses to better understand and incorporate structural determinants of health perspectives.

A Canadian perspective of pharmacy education for students belonging to diverse groups

BACKGROUND

Attention to equity, diversity, and inclusion (EDI) is on the rise in Canada, the United States, and the world. While there are evolving efforts across various sectors, post-secondary institutions, in particular, are growing in EDI efforts. For health professional programs, including pharmacy, health disparities are addressed and improvements in health care are realized when faculty are committed to EDI in hiring, admissions, and teaching and learning. To inform the direction and highlight the importance of further EDI research, programming, and evaluation, this paper analyzes the existing literature in pharmacy education and the education of diverse groups.

METHODS

Several databases were searched, resulting in 17 articles of varying scopes (e.g., reviews, commentaries, reports) that capture principles of pharmacy education for diverse or marginalized students. While other articles were screened for inclusion, the concepts of culture, equity, diversity, and inclusion were presented as part of classroom and curricular topics (e.g., learning about the topics) and did not contain mention or evaluation of the education of diverse or marginalized students in pharmacy.

RESULTS

Pharmacy education literature for diverse and/or marginalized student groups is limited. While significant publications exist regarding pharmacy education about EDI, little attention has been given to how pharmacy programs and educators may adapt their teaching and learning practices, policies, procedures, and admission processes to move beyond the status quo.

IMPLICATIONS

Findings from this review will better inform pharmacy education programs to engage in the research and practice of conscious continuous improvement of safe spaces for diverse pharmacy students.

Assessing Differences in Concussion Symptom Knowledge and Sources of Information Among Black and White Collegiate-Athletes

OBJECTIVE

Basic concussion symptom knowledge is fundamental to concussion identification; however, racial disparities in concussion knowledge exist in high school and youth sports. It is unknown whether similar differences exist in collegiate-athletes. Identifying racial disparities in concussion knowledge and sources of concussion information is essential to inform equitable approaches to knowledge translation and educational interventions. This study examined how Black and White collegiate-athletes differed in their knowledge of concussion symptoms and use of concussion information sources.

SETTING

National Collegiate Athletic Association (NCAA) institutions.

PARTICIPANTS

Collegiate-athletes.

DESIGN

Cross-sectional.

MAIN MEASURES

Collegiate-athletes completed a questionnaire that assessed personal and sports demographics, concussion symptom knowledge, and use of concussion information sources. Fisher's exact tests and Wilcoxon rank-sum tests examined differences in outcome measures between Black and White collegiate-athletes. A multivariable Poisson regression model examined the association between race and concussion symptom knowledge scores while accounting for sex, sports contact level, NCAA division, concussion history, and specific concussion information sources. Incidence rate ratios (IRRs) with 95% CIs excluding 1.00 were deemed significant.

RESULTS

A total of 768 (82.6% White, 17.4% Black) collegiate-athletes completed the questionnaire. Black athletes were more likely to have lower concussion symptom knowledge scores than White athletes (P < .001). In the multivariable Poisson regression model controlling for covariates, this finding was retained (IRR = 0.97; 95% CI, 0.94-0.997). White athletes were more likely to report school-based professional (P < .001), online medical sources (P = .02), and the NCAA (P = .008) as sources of concussion information. Black athletes were more likely to report referees (P = .03) as a source of concussion knowledge.

CONCLUSION

Despite NCAA concussion education requirements for athletes, Black collegiate-athletes were found to have lower concussion knowledge than White collegiate-athletes. The findings highlight the need for equitable strategies to disseminate concussion information to diverse populations by improving the physician-patient relationship and investing in culturally appropriate educational materials.

A Historical Analysis of the Impact of Hegemonic Masculinities on Sexual Assault in the Lives of Ethnic Minority Women: Informing Nursing Interventions and Health Policy

Women's experiences of sexual assault are rooted in and informed by a history that nurses need to understand in order to provide meaningful and effective care. In this article, we present a comprehensive literature review guided by intersectionality theory to deepen our understanding of the historical role that hegemonic masculinity plays in shaping ethnic minority women's experiences of sexual assault. Final sources included were analyzed using thematic analysis. On the basis of our analyses, we identified 4 themes: social order hierarchies, "othering" dynamics, economic labor divisions, and negative media/mass communication depiction. Our findings contribute to our understanding of these important histories that speak to the trauma of sexual violence inflicted upon the bodies of ethnic minority women, which we can incorporate into nursing education curricula. Incorporating this knowledge would equip nurses and allied health professionals with the necessary knowledge and skills that would enable them to help patients navigate multiple systems of oppression as they engage in help seeking following a sexual assault experience. This knowledge also acknowledges rather than dismisses the historically acceptable use of sexual violence against ethnic minority women. In addition, acknowledging these histories enables us to move forward as a society in engaging in an urgently needed cultural shift to address the hegemonic masculinities that perpetuate violence against women in the United States.

Nurses as agents of disruption: Operationalizing a framework to redress inequities in healthcare access among Indigenous Peoples

Health equity is a global concern. Although health equity extends far beyond the equitable distribution of healthcare, equitable access to healthcare is essential to the achievement of health equity. In Canada, Indigenous Peoples experience inequities in health and healthcare access. Cultural safety and trauma- and violence-informed care have been proposed as models of care to improve healthcare access, yet practitioners lack guidance on how to implement these models. In this paper, we build upon an existing framework of equity-oriented care for primary healthcare settings by proposing strategies to guide nurses in operationalizing cultural safety and trauma- and violence-informed care into nursing practice at the individual level. This component is one strategy to redress inequitable access to care among Indigenous Peoples in Canada. We conceptualize barriers to accessing healthcare as intrapersonal, interpersonal, and structural. We then define three domains for nursing action: practicing reflexivity, prioritizing relationships, and considering the context. We have applied this expanded framework within the context of Indigenous Peoples in Canada as a way of illustrating specific concepts and focusing our argument; however, this framework is relevant to other groups experiencing marginalizing conditions and inequitable access to healthcare, and thus is applicable to many areas of nursing practice.

Discourse of race and racism in nursing: An integrative review of literature

BACKGROUND

Race is a barrier and source of inequality affecting ethnic minorities in nursing practice and education.

PURPOSE

This integrative review study aimed to determine whether racism and institutionalized racism are explicitly named in the titles and abstracts of peer-reviewed publications on nursing education, leadership, and the nursing profession, and to explore the depth of discussion of racialized concepts in peer-reviewed nursing literature.

METHOD

Whittemore and Knafl's integrative review approach was used to review 23 studies published in nursing journals published from 2008 to 2020.

FINDINGS

Four themes were extracted: the context of racism discussions in the literature; consequences of experiences of racism; emotional and physical effects of racism on nurses and students of color; and scholars' recommendations.

DISCUSSION

Nursing must start to openly acknowledge the issue of racism within the profession, and to address it by providing safe spaces for authentic dialogue in academic and practice settings.

Achieving Health Equity Through Eradicating Structural Racism in the United States: A Call to Action for Nursing Leadership

PURPOSE

To advocate for strategic actions by U.S. nursing leadership that denote the presence, customs, and implications of racism that has been institutionalized within the structures of U.S. nursing leadership and the profession.

ORGANIZING CONSTRUCTS

A racial equity framework is used to examine the barriers to quality health care and equitable health outcomes and to present evidence-based actions to dismantle structural inequities embedded in the nursing profession.

METHODS

This article was developed through a comprehensive literature review and synthesis of relevant research, data, peer-reviewed literature, government reports, and organizational guidelines.

FINDINGS

A commitment by U.S. nursing leadership to eradicate structural racism in nursing must be made in order to effect sustainable transformative change toward more equitable systems of health care.

CONCLUSIONS

This article presents recommendations for nursing leadership in the United States to renew its commitment to quality health care through dismantling structural racism at all levels of direct and systems nursing practice and education, at the bedside, and in the boardrooms.

CLINICAL RELEVANCE

Structural racism in nursing and health care also persists globally as a key social determinant of health. Its elimination aligns with international health care and nursing's policy priorities, yet change can only occur when senior leaders clearly understand it as a key barrier to health, and commit to transformative change in how their "systems" work. These recommendations can also be culturally adapted by global nursing for use in antiracism work.