Racism in Care: Speak Up to Save a Life

Racism in Care: Speak Up to Save a Life

By: Dr. Nicole Warren

Nurses prides themselves on being the “the last line of defense” to protect patients from errors in care. Similarly, they have the power to limit the damage of racism in healthcare by ensuring its presence in the care environment does not go unchecked.

How many times have you been part of an interaction with a colleague that left you wondering if you should have done it differently? If you kicked yourself later for not doing so — for not listening to yourself, believing what you know to be right, and speaking up — you’re not alone. What is it that keeps experienced, confident professionals from speaking up when we hear comments or see behavior that is inappropriate or disrespectful? Part of the answer may be the hierarchies that tend to dominate a nurse’s workplace.

These can stifle the “speaking up and speaking out” instincts burned into a nurse by years of education and on-the-job training. The odd byproduct of that fear of speaking up is that it also creates room for more of the inappropriate or disrespectful comments and actions that would normally drive us to address and end them. Too often it is too easy to simply go along, then go home.

But this is no way to live, much less to be a nurse. And it’s a horrible example to set.

I’ve been there. I was there as a new nurse who heard a senior resident make disparaging comments about women’s bodies. And as an experienced midwife when I overheard a nurse colleague respond to learning that a client wanted an ultrasound to clarify her gestational age: “She’s just trying to figure out who the father is.”

The nursing students I teach are there too. These rookies will one day be our colleagues, and they will follow our example. Think about it.

They hear when a laboring woman’s concerns are dismissed by nursing staff: “She just knows what to say to get induced.” (The woman was subsequently diagnosed with a life-threatening hypertensive disorder that her care team had difficulty stabilizing.) They see our moral distress when we don’t feel free to speak up to a colleague with seniority and allow harmful comments and actions—often motivated by racism—to go unchecked. And when such an environment puts patients at risk, we have a crisis on our hands.

Racism continues to have devastating impact on health outcomes, especially for women and babies of color. Black women are 3-4 times more likely to die from a childbearing-related cause than White women. Even when we control for income and education, the elevated risks persist.  These disparities have been attributed to the unique stressors experienced by Black women in the U.S. Simply put, living in the U.S. puts Black women at risk for the cardiovascular and metabolic complications that often lead to poor pregnancy outcomes.

Too often, the cases of African-American women who suffer death and/or illness related to their pregnancies (like Simone Landrum and even multimillionaire tennis star Serena Williams for example) tell a story with a familiar theme: They were not heard.

To not be heard is to be dehumanized. This how racism infiltrates our lives in insidious but dangerous ways. If a woman does not feel heard, patient advocacy was incomplete or inadequate. And this kind of advocacy falls squarely on nurses who are duty-bound to ensure patients’ are respected. Nurses’ behavior cannot undo the damage of a lifetime of discriminatory social norms experiences by a black woman. But we can limit its impact on care.

Nurses prides themselves on being the “the last line of defense” for patients, with the responsibility and power to detect and avoid lethal errors in medications and care procedures.  Similarly, nurses can limit the damage of racism by ensuring its presence in the care environment does not go unacknowledged or unchecked. Nurses can use the hierarchy of care teams to identify and create mechanisms to limit the influence of racism in our care. More than anything, they are going to need to be brave.

They need the guts to speak up in the moment. 

That moment starts now. With me. For my patients. For my students (and your future colleagues). When does yours begin?

This blog is a part of the “Dialogues in Health Equity” series by the Health Equity Faculty Interest Group. They are committed to decreasing health disparities experienced by local and global communities by promoting social justice and health equity through nursing practice, research, education, and service.

Dialogues in Health Equity:


Nicole Warren, PhD, MPH, CNM, is an assistant professor at Johns Hopkins School of Nursing and a certified nurse midwife at Johns Hopkins Hospital with over 15 years of experience in research, clinical practice, and teaching. Her work has focused on improving care for women affected by female genital cutting (FGC); currently she conducts research that aims to improve the quality of care and promote the Universal Rights of Childbearing Women.


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