11.3 Nursing and healthcare professions
11 min read•august 21, 2024
Black women have long played a crucial role in healthcare, from traditional healing practices during slavery to formal nursing education. Their involvement reflects broader struggles for equality, mirroring the fight for civil rights and women's empowerment in American society.
Despite facing dual barriers of racism and sexism, pioneering black nurses paved the way for future generations. They challenged discriminatory practices, advocated for equality, and made significant contributions to public health, shaping the nursing profession and healthcare landscape we see today.
Origins of black nursing
- Black women's involvement in healthcare predates formal nursing education, rooted in traditional healing practices and midwifery within enslaved communities
- The evolution of black nursing reflects broader struggles for equality and recognition in American society, paralleling the fight for civil rights and women's empowerment
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- Enslaved women served as healers and midwives on plantations, utilizing traditional African medical knowledge
- "Mammy" figures often cared for both black and white children, including health-related duties
- Some free black women worked as nurses or healers in urban areas, facing racial discrimination and limited opportunities
- Herbal remedies and folk medicine played a crucial role in maintaining community health
Civil War nursing efforts
- Black women, both free and enslaved, provided nursing care to Union and Confederate soldiers
- Susie King Taylor, a former slave, became one of the first black Army nurses, serving with the 33rd U.S. Colored Troops
- Harriet Tubman worked as a nurse and spy for the Union Army, using her medical skills to treat soldiers and refugees
- Many black women gained valuable medical experience during the war, laying groundwork for future healthcare careers
Post-emancipation healthcare challenges
- Newly freed black Americans faced severe health disparities and limited access to medical care
- Discriminatory policies in hospitals and medical schools restricted opportunities for black healthcare workers
- established hospitals and clinics to serve black communities, employing some black nurses
- Black women continued to provide informal healthcare services within their communities, filling gaps left by the formal medical system
Pioneering black nurses
- Early black nurses faced dual barriers of racism and sexism in their pursuit of professional recognition and education
- These trailblazers paved the way for future generations of black healthcare professionals, challenging discriminatory practices and advocating for equality
Mary Eliza Mahoney
- First African American to graduate from a nursing school in the United States (New England Hospital for Women and Children, 1879)
- Advocated for equality in nursing education and professional opportunities for black nurses
- Co-founded the National Association of Colored Graduate Nurses (NACGN) in 1908
- Served as one of the first black members of the American Nurses Association (ANA)
- Her legacy inspired the Mary Mahoney Award, recognizing nurses who promote integration in nursing
Adah Belle Thoms
- Director of nursing at Lincoln Hospital in New York City, one of the few hospitals that trained black nurses
- Fought against racial discrimination in nursing and advocated for the integration of black nurses into the American Red Cross during World War I
- Served as president of the National Association of Colored Graduate Nurses from 1916 to 1923
- Instrumental in securing commissioned officer status for black nurses in the U.S. Army Nurse Corps
- Co-founded the National Association for the Advancement of Colored People's (NAACP) health committee
Mabel Keaton Staupers
- Executive secretary of the National Association of Colored Graduate Nurses from 1934 to 1949
- Led successful efforts to integrate black nurses into the American Nurses Association and U.S. military nursing corps
- Advocated for desegregation of nursing schools and equal employment opportunities for black nurses
- Published "No Time for Prejudice," detailing the struggles and achievements of black nurses
- Received the Spingarn Medal from the NAACP for her contributions to racial integration in nursing
Nursing education barriers
- in education and healthcare created significant obstacles for aspiring black nurses
- Overcoming these barriers required persistence, community support, and strategic advocacy efforts
Segregated training programs
- Many nursing schools refused to admit black students, citing "separate but equal" policies
- Black nursing students often received inferior training and resources in segregated programs
- Some hospitals maintained separate wards and training facilities for black nurses and patients
- Limited clinical experience opportunities due to segregation impacted the quality of education
- Graduates of segregated programs faced challenges in gaining recognition and employment
Discrimination in admissions
- Quota systems limited the number of black students admitted to integrated nursing programs
- Entrance exams and interviews were often used to exclude black applicants unfairly
- Financial barriers, including higher tuition and lack of scholarships, disproportionately affected black students
- Some schools required recommendations from white physicians or nurses, creating additional hurdles
- Black applicants often faced stricter academic and personal conduct standards than their white counterparts
Historically black nursing schools
- Established to provide educational opportunities denied elsewhere (Meharry Medical College, Tuskegee Institute)
- Faced chronic underfunding and limited resources compared to predominantly white institutions
- Played crucial role in training the majority of black nurses in the early to mid-20th century
- Fostered a sense of community and empowerment among black nursing students
- Graduates often returned to serve as faculty, creating a pipeline for future black nursing leaders
Professional organizations
- Black nurses formed their own professional associations to address unique challenges and advocate for equality
- These organizations provided networking, mentorship, and professional development opportunities
National Association of Colored Graduate Nurses
- Founded in 1908 to promote higher professional standards and combat racial discrimination
- Advocated for integration of black nurses into mainstream nursing organizations and military service
- Published the "National News Bulletin" to share information and unite black nurses across the country
- Merged with the American Nurses Association in 1951, marking a significant step towards integration
- Key leaders included Mary Mahoney, Martha Franklin, and
Chi Eta Phi Sorority
- Professional nursing sorority established in 1932 at Freedmen's Hospital in Washington, D.C.
- Focused on scholarship, professional development, and community service
- Provided support and mentorship for black nursing students and early-career professionals
- Organized health education programs in underserved communities
- Continues to promote excellence in nursing and address health disparities today
Black Nurses Association
- Founded in 1971 to address ongoing racial disparities in healthcare and nursing education
- Advocates for increased representation of black nurses in leadership and policymaking roles
- Provides scholarships and mentorship programs to support aspiring black nurses
- Organizes annual conferences and professional development opportunities
- Collaborates with other organizations to address health disparities in black communities
Integration of healthcare professions
- The Civil Rights Movement catalyzed significant changes in healthcare, including the gradual integration of nursing
- Progress towards equality in healthcare professions reflected broader societal shifts and legal reforms
Civil Rights Movement impact
- (1954) set legal precedent for desegregation in education, including nursing schools
- prohibited discrimination in healthcare facilities receiving federal funds
- Increased activism and awareness led to more opportunities for black healthcare professionals
- Black nurses played active roles in civil rights demonstrations and advocacy efforts
- Integration efforts faced resistance and often progressed slowly, requiring ongoing vigilance and activism
Desegregation of hospitals
- of 1946 mandated hospital desegregation as a condition for federal funding
- Many hospitals maintained de facto segregation through the 1960s despite legal requirements
- Medicare implementation in 1966 accelerated integration by withholding funds from segregated facilities
- Black nurses often served as bridges between white medical staff and black patients during integration
- Desegregation improved access to quality healthcare for black communities but also disrupted some black-owned healthcare institutions
Equal employment opportunities
- (1965) required affirmative action in federal employment, including healthcare
- Increased recruitment of black nurses in previously all-white hospitals and healthcare facilities
- Persistent wage gaps and promotion disparities despite legal protections against discrimination
- Growth of diversity and inclusion initiatives in healthcare organizations
- Ongoing challenges in achieving equitable representation in leadership and specialized nursing roles
Contributions to public health
- Black nurses have been at the forefront of addressing health disparities and improving community health
- Their work often extends beyond clinical settings to tackle broader social determinants of health
Community health initiatives
- Establishment of community health clinics in underserved urban and rural areas
- Development of culturally competent health education programs (diabetes management, maternal health)
- Organization of health fairs and screening events to promote preventive care
- Collaboration with churches and community organizations to reach vulnerable populations
- Implementation of home visiting programs to support new mothers and infants in high-risk communities
Addressing health disparities
- Research and data collection on racial health disparities to inform policy and interventions
- Advocacy for increased funding and resources to address conditions disproportionately affecting black communities (hypertension, sickle cell disease)
- Development of culturally tailored interventions to improve health outcomes
- Promotion of diversity in clinical trials and medical research
- Education of healthcare providers on the impact of racism on health and healthcare delivery
Advocacy for underserved populations
- Lobbying for expanded healthcare access and coverage for low-income individuals and families
- Participation in policy discussions on healthcare reform and health equity
- Raising awareness about environmental health issues affecting minority communities
- Addressing social determinants of health through partnerships with housing, education, and social service organizations
- Providing testimony and expert guidance to lawmakers on health-related legislation
Modern black nursing leaders
- Contemporary black nurses continue to break barriers and shape the future of healthcare
- Their diverse roles reflect the expanding influence of nursing in healthcare policy, research, and administration
Influential administrators
- , CEO of the National League for Nursing, advocates for nursing education reform
- , former U.S. Deputy Surgeon General, leads public health initiatives
- , first woman and first Hispanic U.S. Surgeon General, focused on minority health issues
- These leaders drive organizational change and promote diversity in healthcare leadership
Researchers and educators
- , pioneered evidence-based nursing practice and quality improvement methodologies
- , conducts groundbreaking research on cancer prevention in minority communities
- , founding dean of Western Michigan University's School of Nursing, emphasizes community health
- Their work advances nursing science and prepares future generations of culturally competent nurses
Policy advocates
- , former chief of staff to Senate Majority Leader Bob Dole, shaped healthcare legislation
- , first black president of the American Nurses Association, champions global nursing issues
- C. , past president of the , advocates for health equity
- These nurses leverage their expertise to influence healthcare policy at local, national, and international levels
Challenges in contemporary healthcare
- Despite progress, black nurses continue to face unique challenges in the modern healthcare landscape
- Addressing these issues requires ongoing efforts to promote equity and inclusion in nursing
Representation in leadership roles
- Underrepresentation of black nurses in executive positions and hospital administration
- Limited visibility of black nurses on hospital boards and in healthcare policymaking roles
- Barriers to advancement include lack of mentorship, unconscious bias, and systemic racism
- Initiatives to promote leadership development and create pathways to senior positions
- Importance of representation in shaping organizational culture and decision-making processes
Cultural competence in patient care
- Need for increased cultural competence training in nursing education and professional development
- Addressing implicit bias and its impact on patient care and health outcomes
- Development of culturally tailored interventions and communication strategies
- Importance of linguistic diversity and interpretation services in healthcare settings
- Challenges in navigating cultural beliefs and practices that may conflict with Western medical approaches
Mentorship and career advancement
- Limited access to formal mentorship programs for black nurses, particularly in specialized fields
- Importance of peer support networks and professional organizations in career development
- Challenges in finding mentors who understand the unique experiences of black nurses
- Need for increased sponsorship to promote black nurses for leadership positions and advanced training
- Strategies for building resilience and navigating microaggressions in the workplace
Impact on healthcare policy
- Black nurses have played crucial roles in shaping healthcare policy to promote equity and access
- Their advocacy efforts have led to significant reforms and increased attention to minority health issues
Legislative contributions
- Involvement in drafting and advocating for the Nurse Training Act of 1964, expanding nursing education
- Participation in developing policies to increase diversity in healthcare workforce (National Health Service Corps)
- Contributions to maternal and child health legislation, addressing disparities in infant mortality
- Advocacy for increased funding for research on diseases disproportionately affecting black communities (sickle cell anemia)
- Involvement in crafting language for cultural competence requirements in healthcare legislation
Healthcare reform advocacy
- Active participation in debates surrounding the Affordable Care Act and its implementation
- Advocacy for expansion of Medicaid and increased access to preventive care services
- Promotion of programs to bridge gaps in healthcare access
- Support for policies addressing social determinants of health (housing, nutrition, education)
- Efforts to strengthen primary care and increase funding for community health centers
Addressing systemic inequalities
- Work to highlight and address racial disparities in healthcare quality and outcomes
- Advocacy for increased data collection and reporting on health equity measures
- Promotion of diversity, equity, and inclusion initiatives in healthcare organizations and education
- Efforts to address environmental justice issues affecting minority communities' health
- Involvement in developing and implementing cultural competence standards for healthcare providers
Legacy and future outlook
- The contributions of black nurses have left an indelible mark on American healthcare
- Their ongoing efforts continue to shape the nursing profession and healthcare landscape
Inspiring new generations
- Establishment of scholarship programs and mentorship initiatives to support aspiring black nurses
- Increased visibility of black nurse role models in media and professional literature
- Development of pipeline programs to introduce nursing careers to black youth
- Creation of leadership academies and professional development opportunities for early-career black nurses
- Celebration and documentation of black nursing history to provide context and inspiration
Ongoing struggles vs progress
- Persistent underrepresentation in certain nursing specialties and leadership positions
- Continued wage gaps and disparities in promotion rates compared to white counterparts
- Improvements in diversity of nursing school faculty and student bodies
- Increased recognition of the value of diversity in improving patient care and health outcomes
- Ongoing efforts to address systemic racism and bias in healthcare education and practice
Shaping the future of healthcare
- Leadership in developing patient-centered care models that address cultural and social factors
- Pioneering research on health disparities and interventions to improve minority health outcomes
- Advocacy for integration of technology and data analytics to address health inequities
- Promotion of interdisciplinary approaches to healthcare delivery and education
- Influence on global health initiatives, bringing perspectives on health equity to international forums
Key Terms to Review (33)
Adah Belle Thoms: Adah Belle Thoms was a pioneering African American nurse and advocate for the rights of Black women in the nursing profession during the early 20th century. She played a critical role in elevating the status of Black nurses and addressing racial discrimination within healthcare, significantly contributing to the nursing profession's development and the fight for equality in medical settings.
Affordable Care Act's Impact on Minority Health: The Affordable Care Act (ACA) is a comprehensive healthcare reform law enacted in 2010, aimed at expanding access to health insurance, reducing healthcare costs, and improving healthcare quality. Its impact on minority health is significant as it addresses disparities in access to care, insurance coverage, and health outcomes among various racial and ethnic groups, ultimately promoting greater health equity.
African American women's health: the impact of racism on health: African American women's health refers to the unique healthcare challenges and disparities faced by Black women in the United States, heavily influenced by systemic racism. This impacts their access to quality healthcare, experiences with medical professionals, and overall health outcomes, which are often worsened by socioeconomic factors, stressors associated with racism, and a history of discrimination in healthcare settings.
Alicia Georges: Alicia Georges is a prominent African American nurse and healthcare advocate known for her significant contributions to nursing education and community health. She has played a vital role in addressing healthcare disparities, particularly among marginalized communities, emphasizing the importance of culturally competent care and the empowerment of Black nurses in the healthcare system.
Antonia Novello: Antonia Novello is a prominent Puerto Rican physician and public health administrator who served as the 14th Surgeon General of the United States from 1990 to 1993. She is known for her advocacy on health issues affecting women and children, and she made history as the first woman and first Latina to hold this position. Novello's work emphasizes the importance of addressing health disparities and improving healthcare access for underserved communities.
Barbara Nichols: Barbara Nichols was an influential African American nurse and leader in the nursing profession, known for her advocacy for racial equality and her significant contributions to nursing education and policy. Her work helped pave the way for greater representation of Black nurses in healthcare, highlighting issues of access and equity within the profession.
Bernardine Lacey: Bernardine Lacey is a pioneering African American nurse and educator known for her significant contributions to nursing and healthcare, particularly in addressing the needs of Black women and communities. She advocated for the inclusion of cultural competence in nursing education, recognizing the unique challenges faced by African American patients and the necessity of understanding their cultural backgrounds in healthcare settings.
Beverly Malone: Beverly Malone is a prominent African American nurse and healthcare leader known for her significant contributions to nursing education and advocacy for diversity within the healthcare profession. She has served as the Chief Executive Officer of the National League for Nursing, where she worked to advance the quality of nursing education and promote inclusivity in nursing practice.
Black women’s health imperative: The black women’s health imperative refers to the critical need to address the unique health challenges and disparities faced by Black women in America. This concept emphasizes the importance of integrating culturally relevant healthcare practices and addressing systemic barriers in healthcare access, ensuring that Black women's voices and experiences are prioritized in health policy and practice. It highlights the intersection of race, gender, and socio-economic factors affecting health outcomes.
Brown v. Board of Education: Brown v. Board of Education was a landmark 1954 Supreme Court case that declared racial segregation in public schools unconstitutional, effectively overturning the 'separate but equal' doctrine established by Plessy v. Ferguson in 1896. This ruling became a pivotal moment in the civil rights movement, challenging the systemic inequalities faced by Black Americans in educational institutions and beyond.
Chi Eta Phi Sorority: Chi Eta Phi Sorority, Incorporated is a professional organization founded in 1932 by a group of Black registered nurses and allied health professionals. It was established to promote the professional development of its members and to provide community service and education focused on health issues, particularly in underserved populations. This sorority also aims to foster unity and promote the importance of nursing as a vital profession within healthcare.
Civil Rights Act of 1964: The Civil Rights Act of 1964 is landmark legislation in the United States that outlawed discrimination based on race, color, religion, sex, or national origin. This act aimed to end segregation in public places and banned employment discrimination, providing a critical legal foundation for the civil rights movement and addressing various social injustices prevalent at the time.
Civil Rights Movement Impact on Healthcare Access: The civil rights movement significantly influenced healthcare access by advocating for equal treatment and resources for all individuals, regardless of race. It exposed systemic inequalities and discrimination in healthcare settings, which led to policy changes aimed at reducing barriers for marginalized communities. The movement not only highlighted disparities but also propelled reforms that improved the quality and accessibility of healthcare for African Americans and other minorities.
Community health worker: A community health worker is a frontline public health professional who is a trusted member of the community they serve, often bridging the gap between healthcare providers and the community. They play a vital role in providing culturally appropriate health education, promoting access to healthcare services, and facilitating communication between patients and healthcare systems. This role is essential for improving health outcomes, particularly in underserved populations.
Cultural competency: Cultural competency refers to the ability of individuals, especially professionals, to understand, communicate with, and effectively interact with people from different cultures and backgrounds. This includes recognizing one's own cultural biases, understanding the cultural context of others, and adapting practices to meet the diverse needs of those they serve.
Discrimination in medical education: Discrimination in medical education refers to the unequal treatment and biases that affect students based on race, gender, socioeconomic status, and other characteristics within medical training programs. This discrimination can manifest in various forms, including unequal access to resources, biased evaluations, and systemic barriers that hinder the academic and professional success of marginalized groups. Addressing this issue is critical to ensuring a more equitable healthcare system.
Executive Order 11246: Executive Order 11246 is a directive signed by President Lyndon B. Johnson in 1965, aimed at promoting affirmative action in the workforce and ensuring equal employment opportunities for all individuals, regardless of race, color, religion, sex, or national origin. This order specifically mandates that federal contractors take affirmative steps to eliminate discrimination and to actively recruit women and minority groups within their hiring practices.
Freedmen's Bureau: The Freedmen's Bureau was a federal agency established in 1865, aimed at assisting newly freed African Americans in the South during the Reconstruction era. It provided various forms of support, including food, housing, education, and legal assistance, helping to transition formerly enslaved people into society as free citizens. The Bureau played a crucial role in addressing the immediate needs of freedmen and their families while also advocating for their civil rights.
Hill-Burton Act: The Hill-Burton Act, officially known as the Hospital Survey and Construction Act of 1946, was a U.S. law aimed at providing federal funding for the construction and modernization of hospitals and healthcare facilities across the country. This act played a crucial role in expanding access to healthcare services, particularly in underserved areas, by allocating grants and loans to build or improve hospitals, thus shaping the landscape of nursing and healthcare professions in America.
Holistic care practices: Holistic care practices refer to a comprehensive approach to healthcare that considers the whole person, including their physical, emotional, social, and spiritual needs. This method emphasizes the importance of understanding how these various aspects of a person's life can influence their health and well-being, promoting overall wellness rather than just treating specific symptoms or conditions.
Integration of nursing schools: The integration of nursing schools refers to the process of allowing individuals from diverse racial and ethnic backgrounds to access nursing education and training within the same institutions, breaking down barriers that historically separated white students from Black students and other minorities. This movement not only aimed to improve educational equity but also sought to enhance the quality of healthcare by promoting a more diverse workforce that reflects the populations served.
Linda Burnes Bolton: Linda Burnes Bolton is a prominent nurse and healthcare leader known for her contributions to nursing practice, education, and healthcare policy. She has played a critical role in advocating for diversity within the nursing profession and improving healthcare access for underserved communities, making her a significant figure in the nursing and healthcare sectors.
Mabel Keaton Staupers: Mabel Keaton Staupers was a pioneering African American nurse and healthcare advocate who played a crucial role in increasing the participation of Black nurses in the nursing profession. She is best known for her work in the early 20th century, where she fought against racial discrimination and promoted equal opportunities for Black nurses within the American Nurses Association (ANA). Staupers’ contributions were vital in shaping the nursing profession to be more inclusive and equitable.
Mary Eliza Mahoney: Mary Eliza Mahoney was the first African American registered nurse in the United States, making significant contributions to the nursing profession and advocating for equality in healthcare. Her pioneering efforts not only helped to pave the way for other Black women in nursing but also highlighted the need for better training and recognition within medical institutions.
National Black Nurses Association: The National Black Nurses Association (NBNA) is a professional organization founded in 1971 to advocate for the interests of Black nurses and to promote the health of Black communities. The NBNA focuses on addressing disparities in healthcare, enhancing the professional development of Black nurses, and increasing their representation in nursing leadership roles. This organization plays a crucial role in both medical research contributions and the broader field of nursing and healthcare professions by highlighting issues specific to Black health and advocating for policy changes.
Nursing Reinvestment Act: The Nursing Reinvestment Act is a piece of legislation enacted in 2002 aimed at addressing the nursing shortage in the United States by increasing funding for nursing education, recruitment, and retention programs. It seeks to improve the quality of healthcare by ensuring that there are enough qualified nurses to meet the demands of the healthcare system, particularly as the population ages and healthcare needs grow.
Patient advocacy: Patient advocacy refers to the support and actions taken on behalf of patients to ensure they receive the necessary care, respect, and understanding from healthcare providers. This concept emphasizes the importance of patient rights, informed consent, and effective communication between patients and medical professionals, especially in the nursing and healthcare fields.
Rear Admiral Sylvia Trent-Adams: Rear Admiral Sylvia Trent-Adams is a prominent figure in nursing and healthcare professions, known for her leadership roles within the U.S. Public Health Service and her advocacy for public health issues. As a nurse, she has significantly contributed to the fields of healthcare policy and health promotion, emphasizing the importance of nursing in addressing health disparities and improving community health outcomes.
Rebecca Lee Crumpler: Rebecca Lee Crumpler was the first African American woman to earn a medical degree in the United States, graduating from the New England Female Medical College in 1864. Her groundbreaking achievements not only contributed significantly to medical research but also paved the way for future generations of black women in nursing and healthcare professions, as she faced and overcame substantial barriers in the scientific fields during a time of racial and gender discrimination.
Sandra Millon Underwood: Sandra Millon Underwood is a prominent African American nurse and educator known for her contributions to nursing, public health, and health equity. Her work has been particularly focused on addressing health disparities affecting minority populations and advocating for the inclusion of diverse voices in healthcare policy and education.
Sheila Burke: Sheila Burke is a prominent figure in the nursing and healthcare profession, known for her influential role in health policy and management. She has been instrumental in advocating for the advancement of nursing as a vital component of the healthcare system, emphasizing the importance of nurses in leadership positions. Her work reflects the growing recognition of nursing as a key player in improving patient care and health outcomes across various settings.
Systemic racism: Systemic racism refers to the institutional policies and practices that perpetuate racial inequalities and discrimination across various aspects of society. It is embedded in laws, education systems, healthcare, and economic structures, affecting the opportunities and quality of life for marginalized racial groups. This form of racism is often subtle and ingrained, making it challenging to identify and combat.
The health of black women: a report: The health of black women: a report refers to a comprehensive examination and analysis of the health disparities and challenges faced by black women in America. This report highlights the intersectionality of race, gender, and socioeconomic status, revealing how systemic inequalities contribute to poorer health outcomes for this demographic group compared to their white counterparts. It underscores the importance of culturally competent healthcare practices and the need for targeted interventions to improve access to healthcare services for black women.