Diversity (or lack thereof) in nursing and healthcare: I remember it being a one-hour lecture in nursing school. We didn't go into much detail. Instead, we talked about how to navigate cultural differences. For example, we were told to ignore racial epithets from patients and "focus on the person, not their words."

I remember one of my non-black classmates stating, "It's 2010. No one is racist anymore. Why are we even going over this? Some people are so dramatic." At that moment, I should have stood up and shouted, "You're wrong! It still exists. Until you experience it, you can't speak about it!" But I was still a seed. I hadn't yet blossomed into a nursing flower. I just prayed I never experienced it; if I did, I'd have the strength to confront it and educate the offender.

I remember the first time it happened in my nursing career. It took me by surprise. I was shocked and shaken to my core. I couldn't believe what I had just witnessed, what I'd just heard. I didn't know how to address it. I wasn't going to fall into the stereotypes. Nope, I wasn't going to give anyone the satisfaction of labeling me "the angry Black woman." I didn't want to seem aggressive. Yet here I was. Being called the one thing I'd feared my entire life… 

"I don't want that 'n-word' gal taking care of me."

Those were the words that pierced my heart. Hit me like a ton of bricks. But the words of the patient didn't anger me. Instead, what angered me was the response of my managerial team. A team where no one looked like me, shared my experiences, or could even understand the psychological, mental, and emotional damage that generations of racism and lack of diversity have caused people like me.

They said things like, "Brush it off." "Patients have the right to refuse you." "This won't be the last time you hear it." Oh, and my favorite: "Get used to it. This is just a part of nursing."

I've been mistaken as an aid or housekeeper more times than I can count. And years later, these experiences stick with me. It's not only patients that project racism, discrimination, and biases onto Black nurses, but our coworkers, as well. As a result, I've often felt I had to become a shell of myself to function at work.

I couldn't express pride in being a Black woman. Something as simple as wearing my natural hair would often place me in uncomfortable positions. People would touch my hair without permission and pet it as if I were a Chia Pet. "Is it real?" they'd ask. And if I asked them not to invade my personal space, I was told I was standoffish and didn't want to be part of the team. I'd mention my son, and the stereotypical comments would follow, asking if his dad was around or if I was a single mom. Being assertive and standing up or advocating for patients meant I was "aggressive" and "abrasive." Code-switching became a part of my daily life because I didn't want to be seen as "too Black."

Once, I walked into the nurses' station, and a non-black nurse told me, "You don't talk Black." When asked what she meant, she proudly said, "You know, you're not 'ghetto' or 'hood.'" While non-black nurses spoke freely on politics or current events, I was careful not to assert myself in conversations because I didn't want to give anyone a reason to report me to HR.

Other Black nurses have similar experiences.

Nola, RN, recalled a time when she disagreed with her nursing manager about a professional football game. She told me, "A few weeks later, I was made aware of a conversation that happened in the break room while I was off. In that conversation, I was called racial slurs. I was called a typical angry Black woman who should just be thankful. It was insinuated that I was ungrateful and aggressive. Long story short, suddenly, my work was being combed through with a fine-tooth comb, and people were actively trying to get me written up."

She, too, experienced a patient refusing her care. "I had a patient throw a tray at me and scream, 'I'm not having no "n-word" touch me,'" she explained. "Management gave in to these demands, and I was reassigned. The rest of the night, I had to deal with racist comments coming from that room anytime I passed by, and it was never addressed. Other times, if we had patients of color, they were given to me or the one other nurse of color on the floor."

Does Diversity in Healthcare Really Exist?

Only 4% of doctors and 9.9% of nurses are Black, so it's clear the number of Black nurses and doctors doesn't represent the diverse US population. Not only are Black healthcare professionals suffering, but Black patients are, as well.

With the history of the inhuman, unethical, and illegal treatment of Black men and women, many have strong feelings of mistrust regarding healthcare. According to a survey, "Discrimination in America," more than one-third of African Americans have reported feeling discriminated against when receiving medical treatment and care. In addition, studies show African Americans are less likely to receive the same standard of care as their white counterparts. According to the Centers for Disease Control and Prevention, African American, Native American, and Alaska Native women die of pregnancy-related causes at a rate about three times higher than white women. I've often had to advocate for my black patients and encourage other nurses and physicians to check their biases and stereotypes at the door.

Shantay, BSN, RN, has a similar point of view. "I believe that patients of color are not treated equally or fairly in today's healthcare system," she tells me. "For example, look at the disparities in black maternal health. Too often, we hear patients of color describing experiences where their healthcare providers did not listen to their concerns or complaints, and patients end up dying."

Leaders in Diversity and Inclusion

A few nurses are taking a stance and using their platforms to educate on diversity and inclusion (D&I). I spoke with Tiffany Gibson, Ph.D., APRN-BC, WHNP-BC, MSN, RN, (TG) and Dr. Sharrica Miller, Ph.D., RN, (SM), about their take on D&I. This is what they had to say.

Why does healthcare lack racial diversity? What are some of the biggest barriers to creating a more diverse healthcare workforce that you've noticed?

TG: The lack of racial diversity in healthcare is a "systems" problem. People of color are more likely to have socioeconomic and mindset barriers that inhibit them from wanting to be in healthcare.

SM: To get into nursing school is pretty difficult. Often individuals who come from disadvantaged backgrounds may not have had the same preparation, resources, and opportunities as other applicants who are not minorities. Additionally, we have a lack of representation among African American, Black, and diverse faculty. That's definitely one of the biggest barriers to attracting, recruiting, and retaining a more diverse student population.

How does the lack of diversity affect health professionals of color?

TG: Representation matters as much for the professional as it does for patients. For employees to be the most productive, they need to be and feel accepted and respected so that they can be their authentic selves. If my appearance, culture, and spiritual beliefs are judged or misunderstood, I'm not going to like my job, peers, and position. I won't be my best self. This leads to stress and burnout, which in turn leads to turnover.

SM: We have a lack of people that we can relate to. There may not be a lot of people willing to mentor or guide us. There may not be individuals at work we feel we can trust, which can slow us down in terms of meeting professional goals. When I started my Ph.D. program, I really didn't know the difference between a Ph.D., DNP, and EdD. I just assumed that was the next step in the degree, and I don't regret it at all. I made the right decision, but I just got lucky.

How can the industry do a better job of including more people of color, especially in leadership roles?

TG: Succession planning is key for getting more people of color into better jobs and leadership roles. Also, the intention has to be sincere, not just a checklist to complete to say a diversity quota has been met. It doesn't make sense to have "diversity" at the table if diverse people aren't included. Don't have me on your team as the "token Black girl" if you don't value anything I say.

SM: There definitely needs to be more mentorship and professional development to encourage diverse working and student nurses to join professional organizations, such as the National Black Nurses Association. By doing so, they get to see other individuals in leadership roles who look like them.

Some research shows healthcare is starting to become more racially diverse, little by little. Is this something you've started to feel in your own professional life?

TG: People in healthcare are starting to recognize and slowly understand the importance of a workforce that reflects the patients and clients they serve. However, I don't think healthcare understands the significance of diversity in administrative and leadership roles. You can't have succession planning if the person I'm supposed to replace doesn't believe I'm capable of doing the job. 

SM: No, I have not noticed healthcare becoming more racially diverse. I have mostly been in academia. I work in an area where the city is only 4% Black, and my school is only 2% Black. And I've seen maybe five to seven Black students since I've been there for three years. So, no, I have not started to feel that.

How You Can be an Ally

I've had to explain privilege to many people outside my community. So how can you be an ally? Here are some strategies I've gathered from fellow health professionals.

• Amplify the voices of people of color. Don't speak about or for them, says Amanda Guarniere, MSN, NP-C.
• Speak up when you see problems relating to diversity and inclusion, even if you're uncomfortable, says Nola: "It's not the job of a person of color to dismantle a system designed against us. We need more voices."
• Lead with empathy and compassion, advises Shantay, and treat every patient as if they're your family member.
• Learn about other cultures, whether that's through professional networking or volunteering with a local community organization where you'll encounter more diverse perspectives, Shantay adds.
• "Approach each patient and colleague as a whole [person]," says Dr. Estacy Colòn Porter, DNP, MSN-Ed, FNP-C, PHNA-BC. "Remaining in this profession, we must continue to be lifelong learners. That also means educating yourself and being culturally competent with various backgrounds, beliefs, and practices. Approach all with respect and dignity."

Portia Wofford is a nurse, content healthcare writer, and strategist consultant. Chosen as a brand ambassador or collaborative partner by various organizations offering nurses development resources, she helps healthcare organizations and entrepreneurs create binge-worthy content. Follow her on Instagram and Twitter for her latest.