New Study Explores Nursing Students’ Grasp of Racism and Health Disparities

It is no secret that the U.S. has one of the highest rates of maternal mortality among the world’s developed countries and that the rates for Black women (69.9 deaths/100,000 live births) are nearly three times higher than for White (26.6).

Research continues to show that racism is a factor to be recognized and dealt with, and a recent study looks at this from the perspective of nurses in training. The qualitative study looked at the perceptions of 16 White, Black, Hispanic and Asian maternal-child nursing health students on the effects of bias and racism on health outcomes.

Five themes emerged from the findings:

  1. Why are we so afraid to talk about race?

It’s awkward; mistrust and fear of saying the wrong thing. There is a fear of being “shut down” if they bring up race, or of being called a racist. There is no provision for race discussion in the curriculum.

  1. Whiteness, racism, and bias are learned behaviors

We learn from observation; nursing curriculum could perpetuate White supremacy; separate realities. Respondents cited family generational behaviors, recent sociopolitical (e.g. Black Lives Matter) coverage on social media among influences. They also felt nursing curriculum tends to be “average White American” focused as the norm, with little information about racial disparities and how to address them.

Racism was largely understood to be hostility toward others based on their appearance, and bias as unintentional and not fully understood.

  1. I treat everyone the same.

Most felt that they could set aside any personal biases while caring for their patients, although they were aware that bias in general can affect patient outcomes.

  1. I am just a nursing student.

The power structure within the clinical environment puts students in vulnerable positions, and the they feel they need to gain experience and respect before challenging superiors on issues of race and bias.

  1. We see racism and bias around us.

All study respondents reported having had direct or indirect exposure to racism or bias, in some cases toward themselves or their families and friends, and in other instances noticing different behaviors from providers and nurses toward those of their own race.

In addition, study authors found that the participants saw racism and bias from a personal level, but did not discuss it on an institutionalized or structural level, where affects social determinants of health and policies.

Although small, the study shines a light on the gap between what is wanted and needed and what current realities seem to be. The American Association of Colleges of Nursing’s nursing education core competencies calls for “nurses who are equipped to address systemic racism and pervasive inequities in health care.”

This study and the further research it could spur might lead to steps to broaden students’ education around the effects of racism and bias on maternal health outcomes, and save lives.