What Nurses Can Teach Us About Health Equity

I talked to a fellow nurse about inequities in healthcare settings, our own experiences with bias, and the importance of acknowledging and confronting the harms associated with structural racism.

In Manhattan’s financial district, the average resident can expect to live until the age of 85. In East Harlem, life expectancy is only 76 years. Ten stops on the subway and a nine-year drop. That’s what Jasmine Travers, a nurse and New York University assistant professor, told me when we talked about the importance of digging out the root causes of health disparities.

As Black women in the nursing profession, both of us understand the need to “get real” about structural racism because we’ve seen how it plays out at the patient’s bedside and in our own professional lives. In fact, Jasmine left hands-on nursing to pursue research into the policies, practices, and structures that impede good outcomes. Talking about the realities of racism isn’t easy, but being uncomfortable isn’t an excuse to avoid tough conversations. The goal is not to accuse or shame anyone, but rather to shine light on enduring inequities, the forces that perpetuate them, and the ways we can heal the damage they do.

As an example, Jasmine described differences in how hospital staff sometimes approach pain control. The immediate response to a White patient’s complaint tends to be “let’s see how we can ease the pain.” But patients of color face more scrutiny. Too often, the first question a healthcare provider asks is, “what’s really going on here?”—the assumption being that pill-seeking behavior needs to be ruled out before considering the use of pain meds.

Bias can also stall opportunities for career advancement. Medical/surgical hospital units may have a diverse staff, but Black nurses don’t seem to get the same offers of promotion as their White colleagues do. “There were just never people of color in leadership,” recalls Jasmine. “It just didn’t seem like those opportunities were achievable for specific racial and ethnic groups. It was kind of unspoken.”

As nurses, we pledge to respect our patients and provide them dignified care. We can’t do that if our leaders don’t reflect the people they serve. “It impedes the ability of nursing to achieve excellent care,” Jasmine says. “If we are all just one-minded, one background, all share the same thoughts, we’re not going to see the blind spots. We’re doing such harm.”

Here are some steps to change that:

Understand what perpetuates structural racism.

Too often, we don’t recognize our own advantages or the unconscious biases we hold. Jasmine has a personal take on this. As a Black nurse, she sometimes felt disadvantaged compared to her White peers. But she also realized she was benefiting from certain privileges that were denied nurse assistants and nursing home care workers, who are overwhelmingly people of color. Acknowledging that totality pushed her to say, “Hey, let me see how I may be part of the issues that we are seeing when it comes to structural inequities or structural racism.”

We all need that kind of awareness, even if takes an emotional toll. Let’s face it: Who wants to hear that their well-intentioned actions contributed to inequity? But it is only by listening respectfully, rather than turning away defensively, that hidden barriers reveal themselves and we gain the agency to break them down.

Serve as a mentor and encourage colleagues to pursue leadership roles.

Early in my nursing career, I started applying for positions as a charge nurse, even though my co-workers told me the job was out of reach. Management sent the same message—despite getting great reviews and salary raises, I kept hearing “that role doesn’t suit you” when I applied for supervisory positions. No one explained why I wasn’t a good fit, but it was easy to see that none of the leaders in my workplace looked like me.

The same not-so-subtle racism is reflected in the forces holding back highly-educated people of color, Jasmine told me. “Despite having these advanced degrees, we’re always needing to work 10 times, 15 times, a hundred times harder than the next person and we still struggle.”

We have to challenge the assumptions behind all that, raising our voices to say, as Jasmine does, “This is not how things should be.” Let’s find allies, become role models to peers who need our support, and make broad-based commitments to bring more people of color into leadership positions. That’s the only way we will transform culture.

Become an agent of change.

It didn’t surprise me that Jasmine wants us to walk the walk, not just talk the talk. “At some point, we need to move from discussion to actual institutional change,” she insists. It’s a matter of “being part of the table, being part of the decision-making.” Join the workplace committees and neighborhood community boards where choices are being made that affect the lives of people of color. Urge your institutions to offer in-service education about health disparities and inequities. Share knowledge about how long-standing systemic inequities can be unraveled. By acting on the belief that all of us can make a difference, we can confront structural racism together.

Listen to my entire discussion with Jasmine Travers about dismantling structural barriers on the SHIFT Talk podcast.

About the Author

Nacole Riccaboni is a board-certified RN and critical care nurse practitioner with a passion for professional advocacy and community building. She hosts SHIFT Talk, a podcast sponsored by the Robert Wood Johnson Foundation that brings together nurses to talk about the challenges they face both on and off the clock.