Faculty of color in academic medicine face many barriers to career advancement.
With the recent national focus on racism, justice, diversity, equity, and inclusion and calls for the examination of systemic racism at the individual and structural levels, we must question how healthcare delivery and healthcare education contribute to the perpetuation of systemic racism. This is particularly important now, as we have witnessed glaring health disparities within the African American community across the United States over the past few years.
One method of combatting and overcoming these disparities is to train more minoritized healthcare professionals who are equipped to provide culturally competent care and bridge cultural gaps through cross cultural communication during patient education and clinical practice (Hamilton & Haozous, 2017). Minoritized health professionals can bring the knowledge needed to address health disparities that exist in their communities, yet one of the challenges of graduating healthcare professionals from minoritized populations lies in the disparities that also exist in the educational system, including the lack of minoritized educators (Mkandawire-Valhmu, 2010).
The Future of Nursing report from the National Academies of Sciences, Engineering, and Medicine acknowledges that to better meet the future health needs of the public and to provide more culturally relevant care, the current nursing workforce will need to grow more diverse (National Academies of Sciences, Engineering, and Medicine, 2021). Cottingham, et al, (2017) argues that although the American healthcare and educational systems assert themselves as “color-blind” institutions that promote environments of diversity, equity, and inclusion, the presence of racism and sexism throughout American history remains germane to today. In nursing academic institutions, both locally and nationally, there is a distinct imbalance of diversity amongst faculty, especially faculty of color (FOC), which will be the topic of this perspective piece.
What does the literature say about the experience of FOC in nursing?
We often encounter enthusiastic minoritized nurse clinicians who decide to embark upon a new role in nursing academia at predominantly white institutions (PWI). These institutions have few senior FOC, and their academic responsibilities, teaching workloads, and own pursuit of promotion leaves little to no time to actively engage with nor to mentor new faculty. Literature reveals that FOC in nursing academia have feelings of isolation, invisibility, underappreciation, and marginalization (DeWitty & Murray, 2020). Also, experiencing micro-aggressions, tokenism, lack of belonging, poor support, and unwelcoming climates have all been identified as barriers to retention of FOC (Hamilton & Haozous, 2017). Personal reflections from FOC in the literature also include the observation that their white counterparts advance more quickly through the ranks of academia (Hamilton & Haozous, 2017).
These common themes create an environment of internal conflict and confusion that paves the way for most FOC to return to the clinical arena and relinquish the pursuit of their involvement in nursing education. These compounded feelings have contributed to the finding that less than 15% of full time and tenure track faculty in nursing are FOC (NLN, 20201). To increase the presence of FOC in nursing academia, it is crucial to understand their lived experiences as minoritized professionals in the field and identify support mechanisms that need to be in place to retain them (Ro et al., 2021).
Racism in nursing education
Institutionalized and systemic racism is seldom addressed in nursing education, as the topic is likely difficult for nursing faculty to acknowledge as an issue in their own academic environment (Nairn, Hardy, Harling, Parumal & Narayanasamy, 2012). Nursing is widely seen as a caring and trusted profession which makes it more challenging to accept that racial prejudice is ever present (Nairn, Hardy, Harling, Parumal & Narayanasamy, 2012). In an attempt for white nursing faculty to not see themselves as racial or to “see color” in their colleagues and students, they often ignore the racial inequalities that inherently exist within our institutions (Holland. 2014).
Having to outperform their white counterparts, most FOC refrain from sharing their lived experiences as it may show signs of weakness, inability to perform, or untoward judgment. White faculty are often oblivious to the lived experiences of FOC due to either lack of concern, fear of resentment, or the inability to initiate the conversation without being perceived as condescending and demeaning (Durbin, 2020). As a result, white faculty can make assumptions that FOC have fair and equitable opportunities.
Implementing policies and procedures based on faulty assumptions will largely benefit white faculty only, without considering the real barriers that FOC face (Durbin, 2020). This is in part due to white faculty convincing themselves that their assumptions are true when they are false. The best way to combat these assumptions and to identify the barriers to advancement in nursing education for FOC is to ask the people who have overcome these barriers about their experiences. Through their experiences, these individuals are uniquely qualified to describe the individual and systemic issues that are barriers to the development, academic advancement, recruitment, and retention of FOC.
Brief personal reflections from the authors
As junior FOC in nursing academia, our experience in many ways has mirrored the themes identified in the literature. There has been a sense of imposter ship when transitioning from being experts in our respective clinical fields to becoming novices in an unfamiliar academic arena. We have shared similar sentiments of frustration, isolation, tokenism, feelings of invisibility, and microaggressions from students and faculty alike. As Black women in academia, we are keenly aware of the need to outperform our white counterparts, only to be marginally acknowledged and rewarded for our efforts. A common thread in our experiences has been our search for a relatable community within our environment and the need for formal and informal mentorship to not only help navigate the written and unwritten rules of nursing academia, but to also foster our development as junior faculty. Despite some of the challenges faced, we find solace in the personal connections we have made amongst ourselves and other FOC. We are also aware that representation matters, and our presence has encouraged, supported, and provided a safe space for students of color to discuss their own experiences of racism and discrimination along their academic journey.
Recommendation and Conclusion
Faculty of color in nursing academia have been recognized for their contributions to increasing diversity in the nursing workforce, decreasing health disparities, and promoting mentoring for nursing students and future educators of color (Ro et al., 2021). There is limited research on the lived experiences of nursing FOC, which further illustrates that this topic is under-investigated. Further research is needed on minoritized nurses of color transitioning to academia to identify the barriers, shortcomings, and requirements as junior faculty.
With heightened awareness of these common themes emerging from FOC lived experiences, institutions could identify ways to implement changes which would welcome, support, and include FOC in the academic nursing community. This would include creating a climate and culture where diversity, equity, and inclusion (DEI) initiatives are important to all faculty and not just minoritized faculty, the intentional recruitment and retention of FOC, and the implementation of structures that promote the inclusion and career development of FOC.
These efforts start with the mindset of leadership. By hearing about the experiences of FOC and becoming aware of the inequities they face, leaders of PWIs have an opportunity to facilitate strategic plans that support, advance, and transform performative diversity efforts into transformational diversity efforts. Building an environment of diversity and inclusion requires more than meeting usual quota benchmarks; it requires leaders who create a value-driven environment. This can only be constructed by leaders who are committed to inclusivity and value and recognize the contributions of FOC. As the world is evolving and becoming more aware of issues of diversity, equity, and inclusion, it would benefit institutions to create substantial support mechanisms for FOC which will create an environment of inclusion, effortless recruitment, and retention.
The authors would like to acknowledge Linda Lewin, MD and Laura Kimble, PhD, RN, FNP-C. The authors had no financial support for this work and do not have any financial conflicts of interest.
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Camille Brockett-Walker, DNP, APRN, AGACNP-BC, FNP-BC
Assistant Professor, Nell Hodgson School of Nursing, Emory University, email@example.com
Erica Moore, DNP, CRNA
Assistant Professor, Nell Hodgson School of Nursing, Emory University, firstname.lastname@example.org