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Diversity And Discomfort: Nurses, Racism, and Bias

Bias nursing Getty Images 1385163662

By Gary Evans, Medical Writer

Nursing has a long history of racism and bias in training and practice, making it critical that the largest workforce in healthcare confront this issue, said Anna Valdez, PhD, MSN, a consultant on racism and equity in healthcare.

In addition to consulting, Valdez is a professor of nursing at Sonoma (CA) State University and the Editor-in-Chief of the Journal of Emergency Nursing. She served as a subject matter expert on the inaugural National Commission to Address Racism in Nursing. She recently spoke on racism and bias at a webinar held by the American Nurses Association.

Somewhat understandably, Valdez makes nurses uncomfortable addressing such subjects, in part because about 80% of nurses are white and the vast majority of them do not see themselves as racist or biased.

“I think we have an anchoring bias that we are empathetic which keeps us from being able to see evidence that we actually have a lot of work to do,” she said. “Even if you’re empathetic, it doesn’t mean that you are not perpetuating racism or causing harm by being biased in your care.”

This is a subtle, potentially volatile distinction to draw, but Valdez says these issues must be addressed to improve nursing education and practice.

“Health equity cannot be achieved without anti-racism,” she said. “So nurses have to adopt an anti-racist ideology and constantly be working to learn and grow.”

That means speaking up when you see racism or bias, even though it is uncomfortable.

Growth with humility

“I’ve been doing that for a very long time, and it is still hard because I often end up having to [speak up] in rooms with people who I work with or I like or I don’t want to have bad relationships with,” Valdez said. “It takes courage, and you have to develop the perspective of seeing it through the eyes of somebody else who is experiencing it and understand it. We have to have a growth and learning mindset for anti-racist work in nursing. We need to approach it with humility because you will make mistakes and I have made mistakes.”

There are historical roots of racism in nursing, like the long-held falsehood that Black people can tolerate more pain, an enduring perception that may be contributing to the higher maternal death rates in Black women compared to white women, she observed. Outright racist practices — as described in such texts as Medical Apartheid — have given way to more subtle, possibly unconscious bias reinforced by the silence of others who may not see themselves as complicit in some harm.1

“They don’t directly confront what’s happening. We have this interesting risk-harm tolerance when it comes to racism,” she said. “As a nurse none of you are going to let me walk into a patient room knowing that I’m carrying the wrong unit of blood to infuse. It doesn’t matter if I’m manager of the unit or the most seasoned nurse on the unit. Nobody’s going to let me do that because they understand that I’m going to cause harm.”

However, typically nothing will be said if a nurse expresses racist ideologies or bias.

“That also significantly harms people and can kill them,” she said. “We tolerate it because we don’t want to create conflict with our colleagues — rather than directly acting by being prepared to disrupt bias.”

Moreover, cultural competency as typically practiced actually reinforces racism because nursing has normalized white Eurocentric culture as what is right and normal.

“Everybody else is [the] other and different from that, so this perpetuates the ‘othering’ and racism,” Valdez says.

Yet most nurses see racism and bias as a personal flaw, not the result of some confluence of history cast upon them as a profession.

“Therefore if I have good intentions — I don’t look at my patient as being different and I don’t intend to treat them differently — and I don’t see my colleagues doing that too, then racism can’t exist in nursing,” she said.

Blind privilege

“People get the most uncomfortable when I talk about privilege,” Valdez said. “Often times that’s because people don’t understand privilege. When people hear privilege, they think that you have a lot of money and a lot of resources, and that’s not what we mean when we’re talking about racism.”

Those who don’t recognize it themselves may assume that all races have the “benefit of the doubt” and the ability to move freely in all spaces, she noted.

“I had somebody recently at an international talk say, ‘Why don’t you just call it inequity other than racism?” Valdez said. “’We’re really uncomfortable with this idea of racism because we think about people with tiki torches, white hoods, and burning crosses. We’re so anchored to this idea that we’re caring individuals that we can’t possibly explore that we might be causing harm.”

According to the Southern Poverty Law Center, what is commonly called “white privilege” includes being less likely less likely to be followed, interrogated, or searched by law enforcement because they look “suspicious.”2 Moreover, their skin tone will not cause financial institutions to distrust their credit and fiscal responsibility.

“The reality is we have plethora of research — just piles of it for decades — around health disparities and inequities and around bias and harm,” Valdez said. “So we know we don’t treat everybody the same. We say that we’re colorblind and by that we are saying we don’t see your full humanity, what you are experiencing. While race is made up, racism is not. We need to see each other.”


1. Washington HA. Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. 2008. Vintage Books. A division of Penguin Random House.

2. Collins C. What is white privilege, really? Recognizing white privilege begins with truly understanding the term itself. Southern Poverty Law Center. Learning from Justice.