The nursing profession looks at race in the workplace.
On January 25, 2022, the National Commission to Address Racism in Nursing released the results from a survey of over 5,600 nurses provided by the American Nursing Association (ANA).
The survey findings reveal that racism can be found on all levels of nursing. Beginning in nursing school, students face unfair assumptions and barriers.
Some 63% of nurses surveyed say that they have personally experienced an act of racism in the workplace with the transgressors being either a peer (66%), patient (63%), or a manager or supervisor (60%).
As with all professions and workplaces, nursing will continue to uncover layers to a wide-ranging and complex issue. Here are three lenses into why the nursing profession is looking closely now.
Lens #1: Health outcomes depend upon greater representation.
According to the National Academy of Medicine, medical care is estimated to account for only 20% of a person’s health. The other 80% is known as Social Determinants of Health: life expectancy, infant mortality and maternal mortality, mental health, smoking, drug and opioid use, obesity, housing, lead poisoning, crime, literacy and other factors.
In 2021, the National Academy of Medicine published a lengthy report titled, Future of Nursing 2020-2030. Charting a Path to Achieve Health Equity. The report observes: “Today in the United States, the health of far too many individuals, families, entire neighborhoods, and communities is compromised by social determinants of health (SDOH), such as food insecurity and poverty, as well as by limited
access to health care services. The size, distribution, diversity, and educational preparation of the nursing workforce needed to assist in addressing these health challenges are therefore critically important. Even as the potential for nurses to help improve both SDOH and health outcomes has become clear, however, it has become increasingly apparent that a robust nursing workforce ready to meet these challenges does not yet exist.”
Also from 2021, a Journal of American Medicine study finds that nearly all of the 10 leading diagnosing and treating occupations are below parity in terms of Black, Hispanic and Native American representation, with some well below that of others. The persistently low representation of Black graduates in the educational pipeline predicts that the future health care workforce may be less diverse.
The New England Journal of Medicine has created a stand-alone website to cover the wide ranging issues of race in medicine, including disparity of outcomes across illnesses. According to the W.K. Kellogg Foundation, Health disparities costs America approximately $93 billion in excess medical care costs and $42 billion in lost productivity per year.
One glaring instance is diabetes can often be effectively managed — for example, with consistent blood glucose monitoring and proven medications — but is nonetheless associated with profound racial and ethnic disparities in outcomes. Black and American Indian/Alaska Native individuals are much more likely to die from diabetes-related complications than people of other races and ethnicities.
Racism in nursing and healthcare more broadly contributes to a longstanding public health crisis that impacts mental, spiritual, and physical health.
Lens #2: A Changing Patient Population Requires a Culturally Competent Workforce
America’s population continues to grow more diverse. In 2016, people of color made up 39% of the U.S. population. By 2050, people of color will make up 52% of the U.S. population, according to the US Census Bureau.
Six states have already reached majority-minority status: Hawaii, New Mexico, California, Texas, Nevada, and Maryland. Looking ahead, as of 2017, minority children comprise the majority among children in fourteen states: the six that are already majority-minority, plus the following eight: Arizona, Florida, Georgia, New Jersey, Delaware, Alaska, New York, and Mississippi.
At the same time, the demographics of the nursing population has not kept pace. Some 81% of all RNs report being White/Caucasian; 7.2% report being Asian; 6.7 % report being Black/African American and 5.6% report being Hispanic/Latinx, according to a 2020 National Workforce Survey.
The same survey puts the median age of RNs at 52 years, and finds that nurses aged 65 years or older account for 19.0% of the RN workforce. One in five expect to retire by 2025, a number that may have accelerated in response to the pandemic. Now is the time to address full representation in nursing and across healthcare.
Lens #3: Burnout impacts everyone, especially underrepresented nurses.
The American Nursing Association survey finds that 56% of nurses say racism in the workplace has negatively impacted their professional well-being. That’s just another data point in a growing body of evidence that nurses have been deluged by the pandemic and by economic forces within healthcare.
In January 2021, NSI Nursing Solutions, Inc. surveyed more than 3,000 hospitals, and found that the turnover rate for staff RNs increased by 2.8% to reach 18.7%. The average cost of a single turnover for a bedside RN is $40,038. That translates to an average hospital loss of between $3.6m – $6.5m/yr. Each percent change in RN turnover costs/saves the average hospital an additional $270,800/yr.
In the U.S., burnout is estimated to be responsible for about $4.6 billion in annual costs related to physician turnover and reduced clinical hours.
On average, it takes a hospital three months to recruit an experienced RN. Most replacements will come from a younger cohort — Generation Z graduates born between 1997-2000. Early data from a large study — Nurse Wellbeing at Risk — indicates that 57.3% of Generation Z nurses report that COVID-19 negatively impacted their overall well-being.
Gen Z nurses stand out from the older peers as the least likely (23.5%) to report effectively managing work-related stress and anxiety or to decompress after work (19.2%).
A group of researchers from AdventHealth, the largest not-for-profit Protestant health care provider and one of the largest non-profit health systems in the nation, looked at stress, compassion fatigue, grief management, and self-care. The study echoed the findings of the other reports as to the vulnerability of early career stage nurses to high burnout and low self-care. John Carroll has designed a curriculum that provides self-care and resiliency training from day one, and also allows BSN students to compete in athletics, the arts and other mind-body-spirit pursuits and passions.
Make an impact with a nursing degree from John Carroll University.