I previously posted part of an interview with Dr. Shelley Burke, author of, The Unsung Heroes. Here is the rest of the interview.
Why is it especially important to learn about diverse voices in nursing?
As is, the understanding of nursing pioneers through history and modernity has been largely Eurocentric. Very rarely do we hear about the African American, Asian American, Native American, Latin American, immigrant, (and male) nurses who have helped shape this industry. The contributions of diverse, multicultural nurses are just as valuable and deserve to be honored. For example, did you know Harriet Tubman was not just an Underground Railroad Conductor, but also a Civil War nurse? Or that Susie Walking Bear Yellowtail, a Native American nurse, brought modern healthcare to her people? Or that many Japanese American nurses were incarcerated in internment camps during World War II?
For the most part, the nurse who is most heralded in history is Florence Nightingale. Of course, her achievements are iconic -- but they are not the only achievements in nursing that are worth knowing about. I think it is very important for readers to be aware of the many significant achievements of diverse pioneers, leaders, and legends in nursing. If we don't include the broad spectrum of all the nurses who contributed to our noble profession, then we are not getting the full picture of all the legends who have done this remarkable work throughout the centuries.
How diverse is the nursing field?
Right now, the registered nursing population is predominantly white and female, with approximately 75% of nurses being white and approximately 9% being male. African American, Asian American, and Native American are all significantly lower percentages. So, the field still has a ways to go to becoming truly multicultural in reflecting the kaleidoscopic populations it serves, but we are on our way.
Additionally, from a medical perspective, diversity, inclusion, and equity are critically important because they create a cultural competence in caregiving. Cultural competence benefits both the caregiver and the one being cared for. For example, if a patient speaks a different language, the caregiver can provide more comprehensive care if linguistic translation is offered as a part of that care. Bridging this language barrier allows caregivers to be more effective because the patient receives a better understanding of the doctor's and nurse's expectations of them.
Do nurses face discrimination because of their diverse backgrounds from patients and doctors?
I would say yes, both historically and in modern times. The discrimination is packaged in the form of having to constantly "prove" one's capabilities. Especially in positions of leadership, you have to achieve enough accolades before you can climb the ladder. Patients can also be challenging. One of the nurses we interviewed in the book, Dr. Ernest J. Grant, who was the former President of the American Nurses Association, shared a story of how he grew up in Jim Crow Segregated North Carolina. His experience in a segregated doctor's office informed his career choice of becoming a nurse. Even with an esteemed career, Dr. Grant still had to face down direct bigotry as a nurse. He recalled being called the N-word by patients, and having to take care of a patient who was a member of the KKK. With authority, kindness, and diplomacy, he navigated those waters. In my own life as a nurse, I have also faced discrimination from a patient. I remember serving a bedridden white patient lunch, when she threw the plate of food at me saying, 'I don't take anything from you people!'. I was a new immigrant to America at that time, so I did not have the full context of the historical racism in this country to fully understand her behavior. But my awareness of the underlying undercurrent of racism in American healthcare was growing.
Any other ways nurses face discrimination?
One of the ways that nurses face discrimination today is through microaggressions. For example, a nurse of color might receive a back-handed compliment from a colleague to the tune of, "Wow, you're doing so well!" The underlying subtext is "You're doing well for a Black person." Or, "We notice a lot of Black people in leadership positions now...!" Followed by shock and awe. Subtext: "You shouldn't be in those positions." The supposing compliment comes across to the receiver as a slight because the expectation of minorities --especially Black nurses-- is so low. When we excel, it is seen as a big surprise! Sometimes these microaggressions can come from the patients themselves, especially when a nurse of color is in a top leadership position, such as a charge nurse. A patient might say, "Can I have the real charge nurse?" when a nurse of color is running the show. Or it could be a staff nurse, and the patient has a problem with receiving care from a person of a different skin color. They might ask, "Can I have a different nurse?" These are a few discriminatory challenges nurses of color have to navigate in the medical field. As for discrimination from doctors, I don't think it is as blatant as it was in the past.
Why did you seek to become a nurse?
It was a childhood desire that never left me. I saw the caring side of my mom at an early age. When I got my first nurse doll kit, it set everything in motion. I continued with that thought process until it happened.
What changes in nursing have you seen?
There are so many changes and advancements in nursing today especially in education, separate and distinct from the medical profession. We are now more science-based and evidence-based driven. This is a development from earlier times in history when nursing practice was not necessarily based on true proven science. Nurses are now educated with advanced degrees as doctoral-prepared healthcare professionals. Moreover, our profession has expanded into various specialties, such as nurse anesthetists, nurse informatics, or nurse practitioners. These positions were not there when I was growing up, but thankfully they are there now. As nurses, we seek the highest degrees in our profession and education is highly prioritized.
What advice would you give to someone wanting to be a nurse?
I would say to a new nurse, pursue this career with all zeal and gusto because there are so many opportunities to make an impact in the lives of so many people. In addition, there is a stability to the profession. A nurse is always needed. The professional contribution you bring to society and to the lives of people makes it all worthwhile.
Do doctors value the importance and experience of nurses?
This issue was actually brought up in a controversial lawsuit regarding the moniker of "doctor" being used with Doctor of Nursing Practice (DNP) professionals. I am a Doctor of Nursing Practice, myself. This title and that of Doctor of Philosophy in Nursing (PhD) are bestowed on nurses with an advanced specialty in nursing practice, university teaching, or healthcare leadership. But the use of "doctor" caused controversy with Medical Doctors (MDs). In a 2023 California court case, three nurse practitioners with a doctorate brought a lawsuit challenging the legislative ruling about the use of this prefix. Having earned their degrees, they fought for their right to use doctor in their DNP title. The powers that be overruled the nurses, citing that their use of the word "doctor" would confuse patients when working with both Doctors of Nursing Practice and Medical Doctors. Personally, I believe this legislative ruling was unfair and speaks to the underlying fear, jealousy, and competitiveness regarding that sacred title. I prefer to use my title of doctor because I have earned it. So, to answer the question, I believe some doctors still have a two-tiered view of healthcare professionals, which includes nurses. Not openly, but subtly, those doctors may see nurses in a lower tier in terms of medical knowledge and experience. So, there are some doctors who value nurses... only as long as those nurses "stay in their place."
Why are skills like resilience and leadership important to the nursing profession, at all points in history?
Nursing is a difficult career at times. You have to take care of the sick and experience loss and death, whether it be a new baby born prematurely or a teenager suddenly struck with cancer. The beautiful thing is you can comfort and transform lives, but the downside is you also have to witness the pain that comes along with loss through illness or death. That takes resilience.
These things impact your work as a nurse and cause you to think about the brevity of life, but yet you have to be strong for the people that need you in those critical hours -- especially the patients and their family members. Remember, it is you the nurse that has to give them hope during the crises of their loved ones. That takes leadership. Throughout the history of nursing, this type of leading in love, in comfort, and in strength constituted the core values of what it meant to be a nurse. From Civil War nurse Sojourner Truth to Dr. Beverly Malone, the President of the National League of Nursing, the pioneers featured in my book all demonstrated resilience and leadership.
In what ways are nurses advocates?
Nurses advocate for the betterment of healthcare in the lives of people, especially vulnerable populations such as the elderly or children, by becoming the voice of the voiceless. We champion better health, food, and financial support, and even now, vaccines to save lives from diseases. Currently in this country, the government is taking away Children's Health Insurance Program (CHIP), Supplemental Nutrition Assistance Program (SNAP), and Medicare. I never thought I would see the day. When these types of programs are removed, it is like pulling the rug out from under our most vulnerable populations, effectively putting patients out to die. Most people cannot afford to pay out of pocket for the cost of private health insurance. For those in even lower socioeconomic circumstances, food and vaccines are also unaffordable. These critical programs truly help to sustain lives. Thus, we need nurses to become advocates to champion social causes that improve the better health of our overall society.
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