American Nurses Association confronts history of racism

The ANA acknowledges it has failed nurses of color in the past. ANA Enterprise CEO Loressa Cole talks about the organization’s efforts to make amends and vows ‘actions that matter.’

The American Nurses Association is working toward atonement and striving to do better for nurses of color.

The ANA released a “Racial Reckoning Statement” last month acknowledging the organization’s role in perpetuating systemic racism. The statement included specific examples of where the group had failed Black nurses and nurses from other minority groups. The ANA also outlined steps to promote equity and inclusion within the organization and in the nursing profession as a whole.

Loressa Cole, ANA Enterprise CEO, talked to Chief Healthcare Executive about the statement and the ANA’s efforts to become a more powerful voice for all nurses. So far, she said the ANA’s statement on confronting its own history of racism has generated “very positive feedback.”

“This is a very bold statement, a very needed statement,” Cole said.

In releasing the statement last month, the ANA called it “a meaningful first step for the association to acknowledge its own past actions that have negatively impacted nurses of color and perpetuated systemic racism.”

The effort comes months after a blunt report from the National Commission to Address Racism in Nursing, which concluded that the nursing profession is “steeped in racism.” Almost two-thirds (63%) of nurses said they have experienced an act of racism in the workplace. ​​

Cole said it’s critical to address racism in nursing for the well-being of nurses and also to provide better healthcare. “Racism in nursing is impacting health,” Cole said.

“As we listen to nurses who have been subjected to years and years of racism in their work settings, they clearly said to us this has absolutely impacted their emotional and even physical well-being,” Cole said.

It would be impossible for nurses to suffer exclusion and unfair treatment and not have it affect them, she said.

“We heard literally from our nurses across the country, this has played out in such a way that this has impacted their health,” Cole said.

The ANA, and the healthcare industry, must address the racism nurses are experiencing for the sake of nurses and their patients. “The better the nurse is, the better she’s able to care for patients,” Cole said.

Acknowledging painful history

In the Racial Reckoning Statement, the ANA apologized to all nurses of color, conceding the group's failings with specific examples stretching back decades.

The ANA acknowledges that “from 1916 until 1964, ANA purposefully, systemically and systematically excluded Black nurses.” Even in 1964, when no rules explicitly barred membership for nurses of color, “it was evident that exclusionary practices and a failure to represent all nurses remained,” the ANA said in its statement.

The statement recounts the organization’s poor treatment of Estelle Massey Riddle Osborne, president of the National Association of Colored Graduate Nurses, in 1939. Osborne was invited to speak at an ANA event in Louisiana but was told she’d have to use the service entrance of a Louisiana hotel. Osborne urged the ANA to protest. The ANA’s president, Julia C. Stimson, offered to walk in the service entrance with Osborne. Ultimately, Osborne didn't attend.

In its reconciliation statement, the ANA acknowledged it “failed to step into a space of advocacy and support.”

Cole said the statement doesn’t offer a complete list of the ANA’s missteps with nurses of color. But she said it was important to include some examples to admit where the organization fell short, even for some incidents and practices occurring many years ago.

“Despite being decades ago, it’s history. And history matters,” Cole said. “There are still practicing nurses who were impacted by those decisions.”

“We thought it was very important to state what we know, what we learned and issue an apology,” she said. “There are nurses who have been impacted by that.”

Moving forward

The ANA has also set clear goals toward reconciliation and improving diversity in the association and beyond.

“We will move forward with actions that matter,” Cole said.

In its statement, the ANA said it will improve diversity, equity and inclusion within the organization, including its governance structure, and would disclose the racial and ethnic makeup of its board of directors. The ANA’s board vowed to engage in reconciliation efforts with organizations representing nurses from minority groups.

The ANA said diversity and equity would be considered in all policy decisions. And the association will promote the reporting of race and ethnicity in professional journals and publications, among other steps.

Many of those goals can be measured, Cole noted. She also said the ANA is going to get feedback from nurses to evaluate progress. Cole said the ANA “reached this point by listening.”

“We will know by listening to those same audiences,” Cole said. “Nurses of color will tell us.”

The ANA will continue to work with the National Commission to Address Racism in Nursing, and its work will be informed by the commission, she said.

‘Have the difficult conversations’

The vast majority of nurses of color say they have personally experienced racism, according to the national commission’s report.

Almost all Black nurses surveyed (92%) said they have personally experienced racism at work, and 70% said it came from leaders. More than two-thirds of Hispanic nurses (69%) and nearly 3 out of 4 Asian nurses (73%) say they have suffered from racism at work.

Healthcare leaders must act to produce a better workplace for nurses of color, Cole said.

“Have the difficult conversations,” Cole said. “Convene nurses of color. And ask them, as we did. Is this a problem? And develop policies and structures that eliminate the bias, and take a hard look as ANA is doing, of policies that exist.”

Hospital and health system leaders must examine their hiring practices and the way they are compensating nurses from minority groups, Cole said. Health systems must examine structural bias and deal with biases that go beyond race and ethnicity.

“Bias exists in many other shapes and forms,” Cole said. “We need to be raising awareness.”

Nurses that encounter racism must speak up, even if it’s not easy, Cole said. And nurses say it is very difficult to coax leaders to change when confronted about discrimination.

More than half of nurses surveyed (57%) said they challenged racist treatment in the workplace, but 64% said it made no difference, according to the national commission report on racism in nursing.

Nurses must be persistent, Cole said.

“Don’t give up,” she said. “Find the right audience for that conversation.”

“If not the immediate supervisor, go to their supervisor, or human resources, or someone leading the DEI work,” Cole said.

As for the ANA’s own efforts to reconcile and build bridges, Cole said she is optimistic about those efforts, and knows nurses are watching. “Our membership body is holding us accountable for this work,” Cole said.

At the same time, she recognizes it will be a long road.

“I’m not underestimating what a large body of work this will be,” Cole said. “It took us years to get here, and it’s going to take us years.”