During the coronavirus pandemic, nurses have been recognized as being among the nation’s frontline workers. However, to this day, the contributions of Black nurses continue to be hard-fought, unrecognized, and under-appreciated.
Nurses are essential in care delivery and policy directives that shape the health-care system. The year 2020 is the Year of the Nurse and Midwife. Yet, Canada’s history of racism and segregation has contributed to residual anti-Black racism that remains present in Canadian nursing.
Nursing, as a profession, was established on Victorian ideals of “true womanhood”, including notions of dignity, purity, morality and virtue. Think white caps and pristine white smocks.
Historically, people who did not meet these “ideals” were prevented from practising nursing. It was believed that Black women did not possess these attributes of “true womanhood” and in turn, were prevented from pursuing nursing as a career. Many of these subconscious biases and stereotypes about nursing are still believed today, with evidence showing that the exclusion of Black folks and anti-Black practices persist.
Beginning with oppression
In Canada, the first nursing training facility opened in 1874 in Ontario. The first baccalaureate nursing program started in 1919 at the University of British Columbia.
Moving Beyond Borders, Karen Flynn’s 2011 account of the racial segregation in Canadian nursing, vividly describes the experiences of Canada’s earliest Black nurses. As Flynn notes, Black folks were not permitted to attend nursing programs. Instead, prospective Black nurses in Canada were told to go to the United States. American schools began allowing Black folks into nursing in the 1870s while Canada continued to restrict admissions to Black folks until the 1940s, granting admission only after pressure from community groups and organizations.
Ruth Bailey and Gwennyth Barton were the first Black nurses to earn nursing diplomas in Canada from the Grace Maternity School of Nursing in Halifax, graduating in 1948. This was almost three-quarters of a century after the first nursing school opened.
Black nurses in Canada
Overall, Black nurses are largely absent from leadership positions and specialty practice areas such as intensive care. Instead, Black nurses are often streamlined into areas that are more physically demanding and strenuous. At the same time, Black people are concentrated in entry-level positions, non-specialty roles or in non-licensed clinical roles such as personal care workers. Beyond physical challenges and visibility, Black nurses are subjected to micro-aggressions and racism from patients, colleagues, and superiors.
Gender and class have a substantial impact on Black women nurses with the nursing profession having successfully racialized gender and class discrimination. Men who enter nursing usually ride the glass escalator: leadership, higher wages and other substantial advantages.
It’s a marked contrast to Black women who do not encounter a glass ceiling but a concrete wall from simultaneous racism and sexism. Their existence is invisible, yet their mistakes and flaws are amplified.
Racism reinforced through nursing education
In 2013, I proudly graduated from a nursing program with more than 10 Black soon-to-be nurses. At that time, there were designated seats for qualified Black applicants resulting in a 100 per cent increase in enrolment for Black students.
After the removal of these designated seats, the program now graduates far fewer Black nurses each year. I hear similar findings from nursing graduates at other universities. Yet, despite evidence regarding inequity amongst faculty appointments in universities, most Canadian institutions do not collect nor publish race-disaggregated data related to the student population.
Multiple barriers limit access to post-secondary education for Black students. However, issues within nursing education go beyond admissions.
Considering what is taught in nursing school, we see stark examples of anti-Black racism embedded within a curriculum that not only reinforces the invisibility of Black nurses but also exacerbates health inequities.
What is taught is largely void of the contributions to nursing made by Black pioneers. For example, nurses are not taught about Bernice Redmon, who was refused admissions to Canadian nursing programs and trained in Virginia before returning to Canada in 1945. Redmon became the first Black nurse appointed to the Victorian Order of Nurses in Canada.
The nursing curriculum continues to be riddled with colonial, anti-Black, heteronormative, and hegemonic content. For most of nursing’s history, aspiring nurses have been taught how to care for white, straight, and gender-binary patients.
If this is not you, even a routine hair, skin, or health history assessment can pose a challenge.
Anti-Black racism in nursing is detrimental to Black nurses and to the health of all Canadians, especially since Black folks suffer from high rates of chronic illnesses including diabetes, high blood pressure, and mental illness. These health inequities are worsened by an undertone of mistrust towards a health-care system that does not have health-care workers who look like you nor who understand your health needs — leading to misdiagnosed or undertreated conditions.
Towards an anti-racist profession
There are successful initiatives in place. The Faculty of Medicine at the University of Toronto has made great strides in combating anti-Black racism through the Black applicant stream and the collection of race-disaggregated data.
At the Dalhousie Schulich School of Law, a successful program established in 1989 has increased the representation of indigenous Black and Mi’kmaq students in the legal profession. Select universities, like Dalhousie, offer entrance scholarships for Black students as a means to alleviate financial barriers.
Nursing can learn from these bold, innovative ideas and work towards adopting anti-racist frameworks in education and practice. This begins by actively recognizing, appreciating and celebrating Black nurses and their contributions in nursing. Despite the persistence of anti-Blackness in society, nursing education, and health care, Black nurses continue to provide care. Now, more than ever, we must recognize and celebrate their contributions.
The Role of the RPN/LPN
Nurses are an integral component of our healthcare system. Whether at the RPN/LPN, RN or APN level, nurses have a resounding impact on patients, communities, and society as a whole. Canadian literature shows that Black nurses are well represented and arguably, overrepresented at the RPN/ LPN level. Moreover, Black, Indigenous, and People of Color (BIPOC) tend to be concentrated at the RPN/LPN level.
This is a major win in one respect, since representation is vitally important to cultural inclusive and equitable care at all levels. However, concern arises upon examination of the RN and APN level, where there is much less representation of Black nurses. Across the profession, the scope of practice shifts. However, the patient population – and their inherent health needs of equitable care – remain the same.
As described above, there are multiple reasons that point to variability in representation throughout nursing, including but not limited to challenges encountered by internationally educated nurses, anti-Black racist practices in education, as well as the glaring problem of implicit bias.
Without actively striving towards and maintaining representation throughout nursing, the profession has few safeguards against perpetuating harmful stereotypes and, in turn, providing assumption-based care. Extensive research in both Canada and the United States describe the harmful (and sometimes fatal) health outcomes that are directly linked to implicit bias, relying on stereotypes or providing assumption-based care. Beyond patient care, there is a growing body of literature that unveils the lived realities of Black nurses in Canada. These are stories of both despair and triumph.
Committing to the representation of BIPOC folks in nursing is a way to ensure that the historically supressed voices and knowledge of the Canadian population are not only valued but also included and integrated into nursing in order to continue the advancement of the profession.
One important aspect, or takeaway if you will, is the need to leverage the profound leadership displayed by nurses. This would require nurses to challenge the current understanding of what is meant by representation and extend it beyond a proportion or particular number of healthcare providers. Rather, as BIPOC scholars are suggesting, achieving true representation requires addressing the systemic and institutional barriers that exist throughout nursing – inclusive of practice, education, research, and policy.
Having achieved a recognizable level of representation, RPNs/ LPNs are in a prime position to lead by example and cause a ripple effect across other levels of the profession. As nurses, it is our duty to advocate for health and address injustice. Beginning with ourselves is a great place to start this work.
This article was originally published on The Conversation at theconversation.com and has been adapted for this publication by the author.
About Keisha Jefferies
Keisha Jefferies is a Toronto-based African Nova Scotian woman, born and raised in New Glasgow, Nova Scotia. She is a registered nurse and PhD candidate in the School of Nursing at Dalhousie University. Her research examines the leadership experiences of African Nova Scotian nurses and the implications for nursing practice and education. Her scholarly and advocacy work focus on addressing anti-Black racism in nursing, equitable admissions in post-secondary institutions and social justice at-large.
Keisha has clinical and policy experience in the areas of neonatal intensive care and breastfeeding. She is a Junior Fellow with the MacEachen Institute of Public Policy and Governance at Dalhousie. Lastly, her research is funded and supported by Vanier Canada Graduate Scholarships (Vanier-CGS), Killam Trust, Research Nova Scotia, Johnson Scholarship Foundation, BRIC NS and the Faculty of Graduate Studies and School of Nursing at Dalhousie.