Joane Moceri, PhD, RN, racism researcher and associate dean of the University of Portland School of Nursing, recently wrote an introduction and overview for a nursing journal’s special issue on racism and nursing.¹ She recalled an incident about a decade ago when a peer reviewer objected to an article she authored because it used the word “racism.”

Hospital Employee Health asked Moceri about this and her other experiences and opinions on the complex and controversial topic of systemic racism in medicine. This interview was lightly edited for length and clarity.

HEH: In objecting to the wording in your paper, the reviewer said, “There is no racism in nursing because nurses care and therefore they cannot be racist.” This is an interesting example of how language and euphemisms mask structural racism. Can you comment on this?

Moceri: My first thought is the issue is not whether the medical community “treats” minority patients; rather, it is how patients of color are treated. It is a very clear example of the illusion that racism creates. Comments like that allow people to not think any further, and they also provide cover for just accepting statements like that without some critical analysis.

What is missing in that statement is cultural humility and the recognition that patients bring their histories and cultures with them. For optimal healing to occur, these must be addressed as part of care. A powerful aspect of structural racism is the privilege of not having to see racism, because white providers and people in general don’t have to confront it in the way BIPOC [Black, Indigenous, and people of color] members of our society do. Only when the illusion is torn away — such as in the case of the murder of George Floyd at the same time that people of color were dying at greater rates than whites from COVID-19 — is the public health crisis that is structural racism became noticed, yet it has been there all along.

HEH: What should bedside nurses, clinicians, and other healthcare workers do to join this fight? For example, should they be trained to recognize possible unconscious bias toward patients and colleagues of color?

Moceri: Recognizing unconscious bias is a good start. The next, and more important question is what to do about it. There have been studies showing that Black people received less pain medication in the ED than whites. Once that study was published, everybody got more pain medication, but Blacks still got less. The unconscious bias was not really addressed.

Another step toward ending racism is cultural humility training. Recognizing that I, as a nurse, do not know people’s individual stories, that I cannot stereotype, and that I must enter the nurse-client relationship with openness as a learner and a willingness to change. This can go far to mitigate the effects of racism as well as create better health outcomes. Along with humility, deep listening to gain perspective and understanding is critical.

HEH: Can you please elaborate on what you mean when you say, “Nurses, nursing students, and our patients and clients suffer as a result of racism?” It almost sounds like you are saying racism is toxic.

Moceri: It is. People who experience racism also experience physical and mental health issues related to the chronic stress racism causes. Hypertension, preterm birth, death in childbirth, death from COVID-19, are all harmful conditions or events that are experienced at greater rates for people of color, regardless of socioeconomic status or education in many cases.

When nurses of color encounter racism and/or are asked to bear the burden of explaining culture or speaking in their own language to a patient who does not speak English, that creates stress. When they are not recognized for the extra effort that requires, it exacerbates that stress, potentially causing them to leave the profession, which in turn affects patient care. This loss of nurses of color negatively affects health outcomes because we know those who are cared for by people of similar culture have better outcomes. Nursing students who are only exposed to white patient exemplars are disadvantaged in two ways: All nursing students miss out on important information, and BIPOC students feel they and their culture are invisible. This invisibility is opposite to a sense of belonging, which is important for nursing students to experience in a challenging educational setting.

HEH: Have you uncovered patterns of recurrent racism against minority healthcare workers by patients, and even their colleagues?

Moceri: The nurses in my research described three main themes. The first was being overlooked and undervalued, which they experienced by being [passed over] for promotions, given a greater patient load, and hearing negative comments by other nurses about patients of their same race or ethnicity. They felt they were invisible when it came time for promotions, but visible when there was a need for a scapegoat. The second was needing to prove competency, which was reflected in being viewed by providers and peers as less competent nurses because of [speaking with] an accent, facing greater scrutiny, or having their competency questioned.

The third theme of living with “only-ness” was experienced when they were the only one of their race or ethnicity on a nursing unit, or when they had to explain their culture on behalf of a patient of like culture. Nurses of color were frequently mistaken for housekeepers or aides — and in some cases, patients asked for a white nurse to replace them to provide their care.

This constant drip of interpersonal racism, which is structurally supported, was wearing, and so much so that there was a significant correlation between the amount of racism a nurse experienced and their intent to leave that job within the next six months. We cannot afford to lose a single nurse, let alone a BIPOC nurse.

HEH: Do you see any link between racism and violence, a longstanding problem in healthcare?

Moceri: My belief is that racism is violence. When a nurse or provider of color is viewed through a racist lens, I believe the chance of racist violence increases.

HEH: Given the cultural divide and rise of white supremacist groups, can meaningful change occur in medicine?

Moceri: Can meaningful change be made in healthcare with 400-plus years of racism at its back? I want to believe it can happen, but unfortunately, it will not happen overnight. Yet, that is not a reason to give up. For healthcare to change, I suggest we all first take a good look at our codes of ethics. At least in the ANA [American Nurses Association] Code of Ethics for Nurses, it is clearly spelled out that racism is unethical.

White nurses and providers need to educate ourselves as to our privilege, and more providers of color are essential. The structures that prevent people of color from entering the health professions need to be dismantled. Learning from those affected by racism about [tactics] that will increase health equity are necessary. Additional funding to address the social determinants of health, of which racism is one, is essential. Finally, I also believe this is spiritual (not religious) work, where we all need to examine our hearts and our motives, and seek respectful, open dialog that begins with deep listening.

REFERENCE

1. Moceri JT. Overview and summary: Racism and nursing: Diverse perspectives. Online J Issues Nurs 2022;27.