Black nurses are essential to improving health care access and outcomes. But, as new study findings show, they face significant racism that can impede their professional growth or discourage them from joining the profession altogether.

In recent Urban research, we conducted focus groups and interviews with Black nursing students and practicing nurses and interviews with labor and delivery nurses to understand the obstacles they face in the nursing, medicine, and maternal health fields and to identify the supports they need to thrive. Though we focused on California, these state-level findings illuminated a larger national problem: Black nurses face nearly insurmountable challenges related to racism, underrepresentation, and a lack of necessary supports.

Though little progress has been made in combating nursing’s long history of deeply entrenched racism, researchers, advocates, and others invested in the well-being of Black nurses and the health care system can take concrete, immediate steps to build and sustain a workforce of Black nurses.

What unique obstacles do Black nurses face?

Underrepresentation. Growing evidence suggests a diverse, representative health care workforce (PDF) can improve the quality of care patients receive. Black patients, especially, can often benefit from having providers who share the same racial or ethnic background. Nonetheless, nursing is just one of many clinical fields in which Black professionals continue to be underrepresented. In 2020, just 6.7 percent of registered nurses in the US were Black, although Black Americans made up 12.4 percent of the population.

Racism. In our research into strategies for increasing Black people’s participation in nursing and medicine and in the maternal health workforce, we heard repeatedly from nurses about challenges they face because of racism. It affects aspiring Black nurses' abilities to graduate from nursing school, be hired as nursing professionals, advance to professional leadership positions, and attain tenure in academia. In a recent survey of registered, vocational, and nurse practitioners, most Black nurses (60 percent) reported a culture of racism or discrimination in their nursing schools. In addition, 90 percent of Black nurses reported having seen or experienced racism or discrimination from patients, and 72 percent had seen or experienced it from colleagues. Many Black nurses told us they struggled with burnout because of the racism they faced from patients and colleagues.

Insufficient career support and guidance. Interviewees described encountering barriers throughout their professional journeys. They started with training, which involves high tuition costs and the risk of encountering racial bias in the nursing school admissions process. Black nurses, especially those who are first-generation health professionals, also cited a lack of career pathway information as an enormous hurdle. Many respondents described instances when advisers who were not Black actively tried to redirect them from their desired careers by withholding advice or information about pathways to careers in health professions, or told them they could not achieve their goals or should not be part of the nursing profession.

How to support the Black nursing workforce

Based on these insights, training programs and workplaces can consider making the following changes to increase the recruitment and retention of Black nurses.

1. Expand financial support available to Black nursing trainees and clinicians. Interviewees frequently described debt as a barrier to both entering and staying in the nursing profession. Programs like the federal government’s Nurse Corps Loan Repayment Program could provide loan repayment opportunities that address the disproportionate debt Black students take on to finance their educations.
    
2. Develop additional training and support programs and commit to sustaining them. Interviewees commonly highlighted the importance of having Black role models and formal and informal support from Black peers throughout students’ training and career journeys. Interviewees who had these support systems felt they contributed to their success in the field, whereas interviewees who lacked such support felt they were at a disadvantage.
    
3. Improve the diversity of hospital nursing staff, especially in leadership positions. Nurses of color who work in hospitals and nursing homes are the most likely to experience racism and discrimination. Leadership can change this, as many of the nurses we interviewed said. Interviewees noted that when managers and supervisors were people of color or had committed to equity and inclusion, they saw positive impacts in their work environments, such as the implementation of equity-focused care initiatives, greater diversity in staff hiring, and improved handling of reports of discrimination.
    
4. Value and support the contributions of Black nurses. Diversifying the nursing workforce is necessary, but this change alone won’t improve Black people’s health outcomes; leaders in training programs and workplaces must also value and support the contributions of their Black workers and ensure all staff members and students understand the importance of eliminating inequities.
    
5. Address workplace climate issues to retain diverse staff. Our discussions with interviewees highlighted the need for hospitals and other institutions to embrace diversity, equity, and inclusion and hold accountable any staff members who are racist or create hostile work environments. Too often, nurses of color face negative repercussions from reporting experiences of discrimination, whereas the perpetrators aren’t punished or held accountable.

Together these strategies could give Black nurses the support they need to thrive throughout their professional journeys and to do the critical work of improving health outcomes and advancing health equity.