Great Leaps, Step by Step
Despite lingering discrimination, African Americans continue to make inroads and significant contributions to nursing

By Janet Wells
December 16, 2003

When Joyce Newman Giger went back to her hometown in South Bend, Ind., after graduating from nursing school in the 1970s, she stopped at the city hospital and asked for a job application. She was told that the facility "didn't need anybody else to work in the kitchen."

Undaunted, she replied, "That's great, I don't want to work in the kitchen. I'm a nurse."

Giger, Ed.D., RN, FAAN, a professor of graduate studies at the University of Alabama at Birmingham School of Nursing, got the job. But, as one of five African-American nurses in a hospital with a staff of several hundred RNs, it would not be the last time she would run into prejudice.

One night, not long after she started working the 11 p.m.-to-7 a.m. shift at the same hospital, a patient on Giger's floor needed pain medication. He was Caucasian, and had been admitted that night after being severely beaten by several African Americans.

When Giger went into his room, the patient told her he didn't want to be treated by her. "I said, 'Fine,' knowing that the only other nurse on duty was also African American, as was the unit administrator," Giger recalled. "I went and got them, and said to the patient, 'It's either her, or her, or me or pain. What's your choice?' He said, 'OK, you.' "

Giger said she didn't take the patient's attitude personally. "It wasn't me, it was him," she said. "Racism is somewhere, everywhere. But you don't let it run you. You run it. You try to make a difference."

Giger succeeded that night. By the time her patient left the hospital, they were friends. "Every year at Christmas, we send cards. We have been doing that for over 30 years," she said. "That one experience that night changed his attitude. He told me he could have left that hospital not liking anyone who was African American."

Although working conditions and attitudes have improved in recent decades, lingering racism and discrimination present a continuing challenge-for nurses, patients and administrators of all backgrounds.

"When you go into the hospital, you're not going to have all black, all white, all Chinese. Cultural diversity, cultural sensitivity is the key," said Veronica Clarke-Tasker, Ph.D., MBA, MPH, RN, associate professor of nursing at Howard University in Washington, D.C.

African Americans have made significant strides in the nursing profession: The number of African-American nurses increased 119 percent between 1980 and 2000, and almost half have at least a BSN degree, according to the 2000 National Sample Survey of Registered Nurses.

The impressive growth rate is tempered, however, by the relatively small number of African-American nurses overall: Just 5 percent of the nation's 1.3 million nurses are African American-compared to 12 percent of the general population.

"We need more African-American nurses, more minority nurses period, since America is changing color," said Bettye Davis-Lewis, Ed.D., RN, FAAN, president of the National Black Nurses Association and CEO of Diversified Health Care in Houston.

African Americans have been involved in nursing in the United States for almost as long as the country has been independent from the British. In 1783, James Derham, a slave from New Orleans, bought his freedom while working as a nurse, and later became the first African-American physician in America, according to a history of African-American Nurses compiled by Aetna, a health insurance company.

In 1854, Mary Grant Seacole was a nurse alongside Florence Nightingale as a volunteer during the Crimean War. Beginning in 1861, Harriet Tubman served as an unpaid nurse to wounded civilians and soldiers during the Civil War. In 1879, Mary Eliza Mahoney became the first African American to graduate from an American nursing school.

Trailblazing is not a thing of the past: The list of firsts for African Americans in nursing continues through 1999, when Elnora Daniel became the first African-American nurse elected president of a major university, Chicago State University. Many African-American nurses practicing today remember well the years of feeling as though they were forging a path by themselves.

"My experiences as a student were very difficult, extremely hard," said Betty Adams, Ed.D., RN, FAAN, professor and dean of nursing at Prairie View A&M University in Texas and a member of the National League for Nursing Board of Governors.

Adams, who received her nursing degree in 1967, was in a segregated setting in school in southwestern Louisiana. "There was the opportunity for me to attend classes, but basically I had no other interaction or opportunity to become totally immersed as a student in the university. There was no place to live on campus, I couldn't take physical education classes because there was no place for me to change [clothes]."

Adams lived at home while she earned her nursing degree, had stalwart family support and didn't let the racial barriers deflect her focus.

"At that period of time, what I saw each day was a progressive movement toward change," she said. "The overall goal that I had was to pass all my courses, graduate and get my degree. I was not distracted by things I could not be a participant in."

Although not as widespread today, discrimination and racism still are "alive and well in the U.S.," said Clarke-Tasker, who advises her nursing students not to take it personally. "Don't get angry. Just do your job."

Educational opportunity

For Angela Anderson, RN, running into prejudice was an educational opportunity. The 27-year-old, a recent graduate of the nursing program at the University of the District of Columbia, said she wears African-style head wraps on a daily basis "as an expression of culture." While still in school, Anderson went to her externship job at a nearby hospital and an older woman at the hospital security office told her to take her "hat" off.

"I said, 'Excuse me? My hat?' She said, 'Well, whatever that is on your head.' It was a white head wrap, was neat, it matched my scrubs. It was not flagrant."

Anderson talked to the woman's supervisor, who apologized and told the woman that her actions were inappropriate and disrespectful. Anderson continues to wear a head wrap to the hospital. "Nurses are always in a position to educate," Anderson said. "It doesn't always have to be about health."

For Anderson, the barriers of racism and prejudice are more of a motivation than a deterrent. "No one's going to put my fire out," she said. "I'm going to be an emergency room nurse, and I intend to go and get my master's degree to be an acute care nurse practitioner so I can run that emergency room."

Anderson's enthusiasm and dedication are just what nursing needs to adequately care for America's multicultural society, said Giger, who co-authored the widely used textbook Transcultural Nursing: Assessment and Intervention.

"Health care teams need to reflect the demographics of the U.S., with all racial and cultural groups," Giger said. "It's important for African-American patients to be cared for by African-American nurses. It is so much better to be given care by someone who looks like you."

When it comes to offering health care advice-such as diet or lifestyle choices-Giger thinks the "patient is more likely to believe that what is being offered has been experienced by a person who looks like them. Whether it's true or not, it's a comfort zone," she said. "When you're black, it makes it easier to say [to an African-American patient], 'I understand what you're going through.' "

The crux comes in trying to recruit more African Americans into nursing. "Obviously, you go after them with a vengeance to get them into schools of nursing," Giger said. "But it's not all that attractive to 18-year-old graduates. The lack of salary and recognition, the long hours. You have got to want to do it."

Clarke-Tasker agreed, adding that African Americans-particularly women-have more options entering the workforce today. "When I went to school, women could be a nun, a teacher, a secretary, a housewife or a nurse," she said. "That was it. Now, you can do anything."

In addition, for those African Americans who do choose nursing, the plum jobs-especially in the upper echelons-can be tough to land, Davis-Lewis said. "We do not always have the same opportunities other nurses have," she said. "We go to the same training, to the same schools, have the same experience. The playing field should be leveled.

"Everyone should have the same opportunity to move in their career," Davis-Lewis added. "It would certainly help with recruitment and retention. Others can see that someone made it to the top, and that they could do the same thing."

Although nursing can sometimes be a challenging career choice for African Americans, the rewards can be significant. Anderson said she was headed for a career as a trauma surgeon when she decided to switch to nursing. Pregnant with her second child, she did not want to sacrifice family for medicine.

"I thought, 'How can I have my cake and eat it, too? Nursing.' I can be in the medical field and have the flexibility to be a full-time wife and mother."

One of Anderson's role models was her mother, who has been a nurse for 20 years."She gets up, smiles and puts on her scrubs every day," she said. "That's what I want. That's why I went into nursing. Because I can go home and say, 'I made a difference in somebody's life today.' "

Giger called her 33 years in the profession a "wonderful odyssey."

"It makes me shiver to think about what nurses can actually do," she said. "I don't know any other occupation where you either save someone or let them die with dignity."

Contact Janet Wells at janetawells@hotmail.com