How Nurse Leaders Can Address Discrimination in Nursing

February 22, 2021

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A nurse is measuring a man’s blood pressure. Discrimination in nursing manifests in various ways and at different levels. Patients may reject nurses of color and request white nurses. At the institutional level, healthcare organizations may fail to hire diverse nursing staffs that reflect the communities they serve, or pass over nurses of color for leadership positions. And nurses — who aren’t immune to implicit bias — may make treatment decisions rooted in cultural, racial and gender stereotypes that can leave patients with inadequate pain management, inaccurate diagnoses and poor health outcomes.

Just how prevalent is the problem? In a recent PLOS One study, 40 percent of nurses who responded reported experiencing discrimination in healthcare settings.

Discrimination in nursing not only affects the ability of healthcare facilities to provide optimal patient care. It also perpetuates health disparities. For this reason, nurse leaders need to develop and promote strategies that combat discrimination in healthcare settings. Programs, such as online post-master’s nursing certificates, offer nurse leaders opportunities to build the expertise needed to tackle discrimination and other issues that exacerbate inequalities in healthcare.

What Are Examples of Discrimination in Nursing?

Discrimination in nursing involves unfair or unjustified treatment that can harm individuals’ careers and their health. It can occur at the institutional level, when a healthcare organization’s policies curtail opportunities or adversely impact the well-being of certain groups. It can also occur among individuals, such as when negative interactions between nurses and patients are based on gender or racial stereotypes.

Regardless of intention, and whether perceived or not by individuals, discrimination in nursing carries a host of unwelcome consequences. Nurse leaders may observe several types of discrimination in health settings, including the following:

Racism
Ageism
Gender discrimination
LGBTQIA discrimination.

Discrimination Among Nurses

Discrimination exists among nursing peers. Nurses may experience acts of discrimination from other nurses who hold ignorant or prejudiced attitudes and beliefs about one or several of their personal characteristics. They may make injurious assumptions about their skill level or knowledge as a nurse based on factors such as their age, country of origin, or gender.

Discrimination between nurses can manifest in the form of overt bigoted behavior, such as the use of racial slurs, or it can be expressed more subtly through microaggressions. Microaggressions — actions and comments that communicate a bias against a marginalized group — demean, invalidate and slight their targets. Examples of microaggressions include a nurse telling a nonwhite, U.S.-born colleague, “You speak English very well,” or a nurse ignoring the opinions and comments of nurses from particular backgrounds.

Discrimination creates a hostile environment that jeopardizes cooperation between healthcare professionals and diminishes trust and communication among the staff. Such things interfere with the delivery of quality patient care. For example, nurses with biases may ignore or fail to effectively communicate with other nurses, leading to preventable and sometimes critical errors in care.

Discrimination Involving Nurses and Patients

Discrimination also occurs between nurses and patients. Nurses may hold stereotypes about patients that impact the care they deliver, while patients may hold prejudicial views about nurses that cause them to mistreat those charged with their care.

The Impact of Implicit Bias on Patient Care

Implicit biases in nursing can lead to a host of unfortunate outcomes for patients such as the following:

Insufficient patient assessments
Incorrect diagnoses
Inappropriate treatment decisions
Decreased time spent inpatient care
Inadequate patient follow-up after discharge

Additionally, numerous studies have found that patients who perceive discrimination in their treatment often disengage from healthcare and treatment in some of the following ways:

They delay getting prescriptions or medical care.
They are less likely to adhere to medical recommendations.
They use preventive services less.
They miss more appointments.

Patient Discrimination Against Nurses

Nurses can experience overt discrimination by patients such as an outright refusal of any care from them because of their backgrounds. More subtle discriminatory experiences might involve patients assuming registered nurses are medical technicians because of their ethnicity, race, religion or other characteristics.

These experiences do emotional harm to nurses and add stress to an already challenging job. Excessive stress can lead to health issues including hypertension and depression. Such experiences also create ethical conflicts for nurses who have a responsibility to care for patients but also have a duty to not give treatment against a patient’s will.

Racism in Nursing

Racism has a profound effect on nursing care. While nurses have a history of advocating to redress inequities in practice, teaching and research, racism nevertheless persists and demands attention on both an individual and systemic level.

Systemic Racism in Nursing

Many ingrained policies and practices in healthcare organizations put people of color at a disadvantage. Some norms and ways of conducting business perpetuate inequalities between racial groups and give privileges and access based on race to some individuals while denying them to others.

A recent study published in the journal Science found racial bias in an algorithm widely used by healthcare systems. The algorithm, which is used to make decisions about patient care, significantly underestimates the needs of sick and chronically ill Black patients, while giving preferential treatment to the needs of white patients.

Dismantling structural biases first requires identifying them. This demands critically evaluating the ways in which healthcare organizations operate, and initiating inclusive conversations throughout an organization to weed out practices that perpetuate racial bias.

Discussions should explore the many ways healthcare professionals are prevented from delivering equitable care to patients of color. They also need to address the structures in place that act as barriers to nurses of color trying to advance their careers.

The Impact of Systemic Racism in Nursing and Healthcare

The health disparities between white and nonwhite patients speak to the profound impact of systemic racism in healthcare. One notable example involves infant mortality. According to the Office of Minority Health, Black babies die at twice the rate of white babies.

Moreover, adjusting for socioeconomic factors does not eliminate this gap in infant mortality. Numerous studies have shown that the infant mortality rate of Black babies born to educated black mothers from middle-class backgrounds is markedly higher than that of white babies born to white mothers who haven’t graduated from high school.

Historically, Black patients have received inequitable medical care and lacked access to the best healthcare facilities. This problem persists. A recent study in the International Journal of Health Services found that healthcare facilities serving mostly people of color receive about half the funding for new equipment and updates compared to hospitals mostly serving white patients. As a result, patients of color often have limited access to the latest technologies and treatment methods.

The Impact of Systemic Racism on Nurses of Color

The dearth of people of color in leadership roles in nursing attests to ongoing systemic racism in nursing.

According to the most recent study by the American Hospital Association’s Institute for Diversity and Health Equity, people of color hold only a small percentage of healthcare leadership positions:

9 percent of healthcare CEO positions
11 percent of executive healthcare positions
19 percent of first level and midlevel healthcare management positions

The study also found that Black and Latinx individuals earned less than their white counterparts.

Clearly, structural racism significantly impacts the earning power and career opportunities of nurses of color.

Racist Attitudes from Nurses and Patients

Beyond dealing with structures that exclude them from advancing in their careers, nurses of color routinely confront racism from their peers and patients.

Colleagues and patients doubt their competency, devalue their opinions and actively mistreat them. Experiencing such treatment can chip away at a person’s well-being and harm patient care.

Ageism in Nursing

According to a 2018 national survey conducted by the Health Resources and Services Administration almost half of nurses are over age 50. Despite making up a critical part of the workforce, however, these nurses often face discrimination based on their age.

Unfounded assumptions about their cognitive abilities and stamina have led many to undervalue and underestimate the contributions of older nurses. Additionally, as healthcare facilities try to maximize profits and cut costs, they often view older nurses as an unnecessary expense. As such, many older nurses are unwillingly pushed into early retirement.

Conversely, recent graduates from nursing programs may also face age discrimination, with peers and supervisors holding biased views about their readiness and ability to confront the job’s challenges.

Whether directed at the young or old, ageism has no place in nursing. Not only does it harm individual nurses, it also damages the nursing profession as a whole. Undervaluing and underestimating nurses because of their age undermines the healthcare delivery process and compromises patient care.

Examples of ageism in nursing include the following:

Pay discrimination
Assumptions that older nurses cannot keep up with changes in technology or medications
Perceptions that older nurses are too frail to safely handle patients

The Impact of Ageism on Nurses

Ageism has serious consequences for nurses as it affects their financial security, career growth and self-esteem.

Age discrimination in nursing often results in the denial of job opportunities to qualified candidates. Though it’s illegal, proving ageism is difficult and may occur before nurses are hired. When reviewing résumés, healthcare organizations can use graduation dates to decide who gets interviewed. This prevents both younger and older nurses from securing work and higher pay. It also creates career stagnation.

The discriminatory practice of pushing older nurses into early retirement can hurt them financially. It may leave them with no other choice but to draw on their Social Security early if they have no other means of income. However, collecting Social Security before full retirement age means permanently reduced benefits, up to 30 percent less.

Finally, for nurses who have devoted their lives to caring for patients, age discrimination is a painful blow. Being cast aside can leave older nurses feeling depressed and abused. Additionally, treating nurses with a lifetime of experience as mere financial burdens or second-guessing their professional competency robs them of their dignity and disrespects their contributions.

The Impact of Ageism on Nursing Care

Age discrimination not only hurts nurses. It hurts patients. Ageism against nurses impedes a healthcare organization’s ability to deliver quality care, while ageism against older patients can easily interfere with the ability to deliver proper patient care and assessments.

Ageism Against Older Nurses Compromises Patient Care

Older nurses play a vital role in healthcare delivery. In fact, their knowledge and experience often mean they have superior judgment when it comes to patient care.

Having nurses of diverse ages allows for the formation of critical mentoring relationships. Older nurses help teach less experienced nurses the ins and outs of the job and train them invaluable skills that benefit patients.

Too much responsibility on the shoulders of novice nurses not only creates burnout; it results in preventable mistakes. The collective knowledge and support of older nurses helps provide invaluable guidance. It also maintains balance in the work environment.

Ageist Attitudes Impede Quality Care

Ageist attitudes and stereotypes can affect both the quality and quantity of care older patients receive, which can negatively impact their health.

Evidence suggests that many clinical decisions made about older patients are biased. For example, studies have found older patients are less likely to get the same care as younger patients in areas that include the following:

Getting referred for surgery (even in cases when recovery outcomes aren’t age-dependent)
Being treated according to treatment guidelines
Receiving standard diagnostics

Ageist attitudes not only affect treatment decisions, they also influence how nurses communicate with older patients. When nurses hold ageist attitudes, they tend to do the following:

Relate to patients with more detachment
Use a patronizing tone with patients
Forego patient consultations
Have low expectations for patient rehabilitation

Gender Discrimination in Nursing

Society has ingrained gender stereotypes that have affected and continue to affect the professions people enter. Attributing self-confidence, strength and rational thinking to males has pushed men into leadership positions. Perceptions of females as nurturers and caretakers has relegated women to less prestigious work.

Since modern nursing began, women have dominated the profession. That’s partly because historically people have thought of nursing as almost an extension of domestic work, viewing nurses as little more than doctors’ assistants. To many, these implied women were best suited for the job.

Gender bias and other stereotypes — including the notions that men don’t possess caring or nurturing traits and women belong in subservient positions — have distorted perceptions of the profession and who can be a nurse.

Today’s nurses are a far cry from doctors’ helpers. With specialized knowledge based on extensive training, nurses have many duties independent of physicians and perform tasks that require advanced medical expertise. Nevertheless, gender stereotypes and misconceptions about the nature of nursing persist, perpetuating the problem of gender discrimination in nursing.

The Impact of Gender Discrimination in Nursing

Gender discrimination in nursing manifests in several ways. First, it unfairly excludes and marginalizes people. Though the number of nurses who are male has increased significantly in recent years, women still greatly outnumber men in the profession.

According to the U.S. Bureau of Labor Statistics, in 2019 men accounted for a small percentage of nurses:

11 percent of registered nurses
12 percent of nurse practitioners

Men who enter nursing training programs and secure nursing jobs may experience gender-biased comments or find their sexuality or masculinity questioned. Additionally, nurses who are male may feel discouraged from pursuing subspecialties in nursing that are thought of as less technical, and therefore less masculine.

Such gender biases have consequences for nurses who are female as well. They can easily result in supervisors overlooking women for leadership positions and assigning women to positions less likely to result in promotions.

Among the most unfortunate consequences of gender bias is the compromise of the nursing profession as a whole. By associating nursing with femininity, it wrongly links gender to the work. This perpetuates misconceptions regarding the level of professionalism among nurses and diminishes its value.

Historically, professions dominated by women have received less respect, lower salaries, and less authority than other professions. Perpetuating gender biases in nursing fuels outdated perceptions that nursing is little more than a subservient role, requiring only soft skills and compassionate nature. In fact, nurses are highly skilled professionals with in-depth clinical knowledge who perform vital, lifesaving work.

Ultimately, preconceptions about nursing roles and duties undermine the authority of nurses and inhibit their ability to pursue leadership and autonomous roles.

How to Combat Gender Discrimination in Nursing

Nurse leaders have a responsibility to combat gender discrimination in nursing. By exercising their leadership and interpersonal skills, they can help minimize gender discrimination among nursing staff.

First, nurse leaders need to learn to recognize their own potential gender biases. They can do this by reflecting on the experiences of nurses who are male, transgender and binary to become more sensitized to the incidents of gender bias they may encounter. They can also analyze their expectations of nurses who are female. Perhaps they will discover they expect more caring and collaborative behavior from them compared to nurses who are male.

Beyond increasing their own awareness, nurse leaders should initiate conversations with their staff about gender discrimination in nursing, discussing how it presents in both subtle and overt ways and using specific examples. This makes identifying bias, a first step to eliminating it, easier for nurses.

Strategies to Tackle Gender Discrimination in Nursing

Nurse leaders must set the right tone to tackle gender discrimination in nursing. This requires prioritizing gender equality and acting decisively in response to gender discrimination when it appears.

For example, nurse leaders need to address microaggressions, ignored opinions and inappropriate comments when they happen. Though such conversations can be uncomfortable, they offer everyone a chance to develop awareness and learn. They also make it cear that gender discrimination will not be tolerated.

Because words have power, careful use of language is an important tool for dismantling gender discrimination. By eliminating gender-biased terms, such as “male nurse,” nurse leaders help discourage people from associating gender with the profession.

Rebranding nursing as gender-neutral lends legitimacy to the profession and discourages discrimination by expelling gender-driven assumptions about nurses.

The Importance of Diversity in Nursing Leadership

Patient populations represent a wide assortment of ethnicities, nationalities, sexual orientations and religions. Having nurse leaders who reflect that diversity plays an important role in combating discrimination in nursing and providing the highest quality care to every patient.

The contributions of nurse leaders enrich discussions and lead to more deliberate strategies and thoughtful decisions. With a diverse spectrum of races, ages and genders in nurse leadership professions, a healthcare facility broadens its perspective on patient care, clinical operations and community outreach.

Diversity in Nursing Leadership Promotes Cultural Competence

To meet the needs of diverse patients, healthcare facilities must build cultural competence — the ability to interact respectfully and effectively with people from different backgrounds. Cultivating competence improves the quality of care nurses deliver and helps to alleviate health disparities.

Diverse nurse leaders are well-positioned to promote cultural competence within their staff. They have deeper insights into the beliefs, values and perceptions of diverse patient populations. This enhanced understanding equips them to provide valuable guidance and understanding to other nurses, allowing them to develop their cultural competence.

Acknowledging and appreciating the differences between patients regarding their priorities in healthcare helps eliminate miscommunications and heightens the collaborative effort with patients. While improving patient care, this also helps prepare nurses to respond to potentially hostile situations with patients who discriminate against them because of their race or gender.

Additionally, the improved communication that diversity in nursing leadership fosters offers a more welcoming environment to patients. Approaches to care that take into account the differences between patients allow for smoother interactions between patients and providers. For example, having practices in place that deal with diversity in language or religion helps patients feel more comfortable and gives them a greater sense of belonging.

Diversity in Nursing Leadership Breaks Down Stereotypes

Promoting diversity in nursing leadership can play an important role in breaking down barriers such as gender biases and discrimination in nursing.

Nurse leaders from diverse backgrounds can help their staff identify their biases and change bad behaviors. They can also help their staff become more attuned to the needs of various populations, more effectively listen to their concerns and make better suggestions about their care as a result.

Additionally, patients from diverse backgrounds with histories of discrimination in healthcare may feel reassured when they see people who look like them in leadership positions. Improved trust between patients and providers can have a meaningful impact on health outcomes and help lessen health disparities.

Unified Care for the Future

Nurse leaders strive to meet the needs of all patients. Cultivating diverse nursing staffs and minimizing biases and discrimination in nursing play an instrumental role in meeting patients’ needs. With the right education and expertise, nurse leaders can strategically tackle one of healthcare’s greatest obstacles.

Discover how Duquesne University’s online post-master’s nursing certificates prepare nurse leaders to reach their professional goals and combat health disparities.