Nursing schools are the gateway to the profession. But when racism is prevalent at the collegiate level

, the racial, structural, and institutional inequities entrenched in these programs have a profound impact. Workforce composition, the development of future educators and administrators, student success, and the overall health and well-being of society are at risk when racism in nursing education persists.

The impact of racism in nursing education is multifaceted, affecting both individuals and the broader institutional culture. Pedagogy, access, climate and culture, and progression are key concepts impacting education systems’ efforts to address racism in nursing sustainably.

Without inclusive pedagogy that integrates diverse perspectives and equitable teaching methods, minority students face educational disparities.
Limited access due to biased admissions processes hinders the diversity of the student body.
Inadequate climate and culture result in environments rife with microaggressions and discriminatory practices, with impacts lasting up to two decades.
A lack of robust reporting mechanisms undermines accountability and trust.
Poor planning and limited diversity among decision-makers restrict professional development, mentorship, and career advancement opportunities for minoritized communities, perpetuating systemic inequities.

Nursing schools must include these elements in their strategic plans and periodically assess their faculty, administrators, and students for progress to create learning environments grounded in diversity, equity, inclusion, accessibility, and anti-racism.

This article focuses on actionable steps universities and colleges can take to address and overcome barriers to racism within nursing education and an opportunity for nursing schools in California to participate in an Assessment to Eradicate Racism in Nursing Education case study by the American Nurses AssociationCalifornia.

Barriers to Sustainable Anti-Racism in Nursing Education

Nursing students, faculty, and administrators may be aware of racism’s impact on nursing and healthcare but lack clear, actionable steps to eradicate racism in nursing education. Four systemic barriers create complexities in successfully developing and adopting these strategic anti-racism plans in academic institutions:

A Lack of Sustainable Conversations: Nursing students, faculty, and administrators express a desire and need to dismantle racism in nursing education. However, they find that a lack of common understanding and ineffective communication skills create barriers to initiating sustainable and constructive action within educational settings. In many instances, attempts to discuss racism devolve into arguments about political ideology, proper terminology, and personal experiences rather than focusing on actionable plans for better outcomes.
A Lack of Accountability and Confidence in Reporting Systems: Nursing students and faculty often have little to no confidence in their institutions’ reporting systems for racism, discrimination, incivility, and other acts of prejudice due to a perceived lack of accountability, communication or follow-up after a report is submitted. It is not uncommon for reports of racism to be met with silence, leaving students and faculty unsure if any actions are taken. This lack of response leads to instances where individuals choose not to report racism at all.
A Lack of Awareness and Unified Standards Among Decision-Makers: Key decision-makers within academic institutions are often unaware or only partially aware of the severity of racial disparities within nursing education. Many existing initiatives are in their infancy and need more calls for system-wide standardization, essential for lasting change.
A Lack of Diversity Among Decision-Makers: Key decision-makers in nursing education, including faculty, school leadership, and academic officials, often do not adequately reflect the populations they serve. According to the Campaign for College Opportunity, 50% of California RN faculty were white in 2020-21 (down from 65% in 2011-12), while diversity among newly enrolled nursing students is increasingly diverse, with white nursing students representing only 30% of all students. This disparity highlights the need for greater diversity among those shaping nursing education policies and practices.

10 Strategic Steps to Eradicating Racism in Nursing Education

“Those in positions of power and privilege, the prevailing culture within an organization, and those who do not encounter racism are lucky enough to be able to wait for proof that racism is there. Bringing forth evidence of how prominent racism is in academics and students today can be the catalyst for making the necessary change in nursing academic culture.” – Derald Wing Sue, Professor, Columbia University

Racism exists, and it is important to hear the voices of those who are often marginalized, abused, and silenced.

While faculty and administrators may have concerns about negative feedback along their anti-racism journey, systematic reviews published in 2017 and 2020 have shown that bringing awareness and addressing racism may improve workplace satisfaction and retention, engagement, self-efficacy, and student learning environments. Raising awareness of racism might positively influence the lives of faculty and students of color by promoting career mobility.

Effectively addressing these issues requires nursing education leadership to understand the experiences of their faculty, administrators, and students. This involves conducting comprehensive assessments to gather data on the prevalence and impact of racism within their institutions. By understanding the specific challenges faced by their academic community, leadership can develop targeted interventions and strategies to foster a more inclusive and equitable environment. This approach ensures that all voices are heard and strengthens the institution’s commitment to dismantling systemic racism in nursing education.

We conducted two focus group sessions with nursing faculty and administration to ensure that the following ten steps are actionable and relevant. These sessions provided valuable insights into the entry points, processes, approvals, and other key factors within academic institutions that must be considered when implementing anti-racism initiatives. By incorporating feedback from those directly involved in nursing education, we’ve developed a comprehensive approach that is both practical and impactful.

Here are ten steps to addressing racism in nursing education:

Get Buy-in from Top Leadership: Secure commitment from top academic leadership. The president, provost, and deans must recognize the importance of diversity, equity, and inclusion and actively support anti-racism initiatives. Their endorsement is crucial for driving systemic change and ensuring these values are prioritized across the institution.
The Strategic Plan includes the integration of anti-racism and DEIAA initiatives into the institution’s strategic plan. This formal inclusion ensures these efforts are part of the institution’s long-term goals and receive the necessary resources and attention. It also signals to all stakeholders that the institution is committed to meaningful and sustained change.
Review Plan with a DEIAA Lead, Council, or Committee: Engage with a dedicated DEIAA lead, council, or committee to review the strategic plan. This group should provide expertise and guidance on best practices, help identify potential challenges, and ensure the plan is comprehensive and actionable. Their insights can help refine the approach and enhance its effectiveness.
Get Buy-in for Pilot Program: Secure buy-in for a pilot program before full-scale implementation. This involves engaging key stakeholders, including faculty, students, and administrative staff, to gather support and input. The pilot program serves as a testbed for new initiatives and allows for identifying any issues before a broader rollout.
Assess Students, Faculty, and Administrators: Conduct a thorough assessment of the academic community to identify current attitudes, behaviors, and practices related to racism and DEIAA. This assessment could include surveys, focus groups, and interviews to gather comprehensive data regarding pedagogy, access, climate and culture, and progression. Understanding the baseline state of the community is essential for measuring progress and identifying areas needing attention.
Analyze Data: Analyze the data collected from the community assessment to identify patterns, inequities, and areas for intervention. This evidence-based approach clearly explains the current state and helps prioritize actions. Data analysis is crucial for developing targeted strategies and measuring the impact of initiatives over time.
Build a Dashboard with KPIs: Develop a dashboard with key performance indicators (KPIs) to track the progress and outcomes of anti-racism and DEIAA initiatives. The dashboard should include but not be limited to metrics such as diversity of faculty and students, retention rates, and reported incidents of discrimination. Regularly updating and reviewing this dashboard ensures transparency and accountability.
Implement Evidence-Based Strategies: Develop, adopt, and implement evidence-based strategies to address identified deficiencies and promote DEIAA. These strategies should be informed by best practices and tailored to the institution’s specific needs and context.
Monitor and Adjust: Regularly monitor the implementation of initiatives and make adjustments as needed. This involves ongoing evaluation, feedback loops, and responsiveness to emerging challenges and opportunities. Flexibility and adaptability are key to maintaining momentum and achieving long-term success.
Change Policies for Sustainable Practices: Finally, institutionalize changes by updating policies and procedures to support sustainable DEIAA practices. This includes revising hiring practices, curriculum design, student support services, and clinical placements to ensure they align with anti-racism and DEIAA principles.

By following these steps, leaders can create a more inclusive and equitable environment that fosters a culture of diversity, equity, inclusion, accessibility, and anti-racism in nursing education.

Join ANACalifornia’s Assessment to Eradicate Racism in Nursing Education Case Study

This Fall, 2024, fourteen California Nursing Schools are slated to participate in ANACalifornia’s Assessment to Eradicate Racism in Nursing Education Case Study.

The goal of the Assessment to Eradicate Racism in Nursing Education™ Case Study is to create a future where nursing education reflects the principles of diversity, equity, inclusion, accessibility, and anti-racism. The study’s findings have the potential to catalyze positive change within the institution by identifying barriers and providing actionable recommendations for policy reform, professional development, organizational communications, etc.

The Assessments cover (14) concepts, including questions about:

Demographics
Microaggressions
Terminology
Conversations
Reporting
Individual DEIAA
Organizational DEIAA
Representation
Admissions
Student Support Services
Faculty Hiring
Nursing Curriculum
Teaching
Clinical Placements
Anti-Racist Institutions

To learn more about the case study, view our Participant Form here.

To learn more about our Racism in Nursing Campaign here.

ANACalifornia’s Taskforce and Contributors

Dr. Christina Kelley DNP, APRN, CNS, NE-BC, ANACalifornia Nursing Education Director 2023-2025, Associate Professor, Point Loma Nazarene University
Dr. Quanna Batiste-Brown, DNP, RN, NEA-BC, FAAN, Chief Nursing Officer Ambulatory Care at UCLA Health
Dr. Charlotte Gullap-Moore, DNP, MSN, APRN, ANP-BC, CEO and Adult Nurse Practitioner of Moore on Health, Santa Barbara City College Board Trustee
Aron King MS, RN
Shontaya Carrico MSN, APRN, ACNS-BC, CPHQ
Lourdes Moldre MSN, BSN, RN, ACNP-BC, Patient Care Director for UCSF Health
Jared Fesler, ANACalifornia Communications and Programs Manager

Contributors:

Dr. Loleater Gibson EdD, MSN, BSN, ANACalifornia Advocacy Institute Fellow 2024
Dr. Deborah Finn-Romero DNP, RN, PHN, PACT, Assistant Professor, California State University, Sacramento

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