The Macy Foundation is proud to recognize and celebrate this year’s Black History Month—a time dedicated to both reflecting upon and commemorating the countless contributions of Black Americans to all aspects of society. With this edition of Macy Notes, I am honored to share the thoughts and experiences of two such individuals, Dr. Coretta Jenerette and Dr. Danica Fulbright Sumpter, both senior leaders in nursing and Macy Faculty Scholar alumnae. Through their tireless, thoughtful work, both are helping to ensure that the next generation of nurses has a strong understanding of the social determinants of health and feels empowered to implement that understanding through advocacy for those who are marginalized within the health care system. The following represents an excerpt of the insights they shared with me.
Holly Humphrey (HH): What is the role of nursing in achieving social justice as well as helping to bring about better health and well-being for Black communities both in the past and in the future?
Danica Fulbright Sumpter (DFS): Nurses are perfectly positioned in the quest for social justice—they have the quantity and the quality. In terms of quantity, nurses make up the largest of the health professions; if all of us can get on board, the sheer number of people who would be able to make some of these movements actionable would be tremendous.
In terms of quality, nurses have the proximity to patients and communities. Nurses have such intimate contact with patients such that we are perfectly positioned to know what their needs are, to have intimate conversations of what barriers are, and to brainstorm and think about what solutions might be.
Our code of ethics compels us to promote, advocate for, and protect the rights, health, and safety of our patients and families. Within that code of ethics, we are also called to integrate principles of social justice into nursing and health policy.
Coretta Jenerette (CJ): I am proud to be a nurse. I am also a first-generation African American nurse. Nursing is the most trusted health profession. If a nurse considers and understands social and structural determinants of health and the outcomes that occur because of the social and structural determinants of health, there is no question that the health and well-being of Black communities benefit from nurses who are intentional in serving as social justice advocates on behalf of these minoritized, marginalized, and often underrepresented populations. For some, if not all, Black humans, the past is the present. The historical impact of slavery and the persistent dehumanization of a group of people simply because of the color of their skin still impacts our everyday lives.
I recently participated in a panel with outstanding health professionals to discuss health disparities in the Black community. As a former oncology nurse and breast cancer survivor, I know about the disparities in breast cancer treatment equity and outcomes for Black women compared to White women. On the panel, a well-educated Black woman shared her story of breast cancer survivorship and how assertive she had to be to get the care she needed in a timely manner. It was no coincidence that I shared the same experience with having to advocate for myself amid a cancer diagnosis. Were the delays in our care because the provider did not empathize with us because we did not look like their sister or mother? My co-panelist talked about using the word “why” to insist that explanations be provided as it made the health care provider mindful of what they said and how they said it. Additionally, I shared that as Black humans, we have to be able to know when something is unacceptable and say so. As nurses, we should learn and be compelled to be social justice advocates for those groups of humans who are most likely to suffer disproportionately due to social and structural determinants of health and racism.
DFS: How does one, then, go about becoming an effective nurse advocate? I think the answer lies in three steps: for us to look inward; for us to look backwards; and for us to look outward.
Being introspective allows me to think deeply about the ways in which I am a gatekeeper. Where do I control access to knowledge and resources, and how can I potentially stand in the way of someone being able to gain those things? How do I continue to uphold the status quo of structural racism within my sphere of influence? We’ve all been socialized to believe negative stereotypes about marginalized groups, even the groups that we belong to. How do I become more cognizant of when this pops up so that I can interrupt it and not act upon it?
In looking backward, I am reminded of a colleague of mine, Margo Carthon, PhD, RN, FAAN, who used history as a lens for her dissertation by looking at Mary Elizabeth Tyler, a Black nurse whom I’d never heard of. Ms. Tyler was a nurse in 20th-century Philadelphia who was instrumental in health campaigns to address tuberculosis among the Black community. She resisted prevailing narratives of biologic determinism and instead focused on social determinants of health, looking at poverty and the lack of credible, accessible health care. She worked with the community to leverage their assets and to advance health justice. So much of our nursing history has overlooked many of these agents for social justice. We would do well to highlight these individuals and their efforts and to learn from them, because there are things they learned that we can utilize today.
And finally, one of the things that Mary Elizabeth Tyler did that we can and should do is to look outward. Our role is to listen to the communities that we care for—care for in practice but also in research. Communities know what they need; they just don’t always have access to the power and the resources to make it happen. And so that’s where nurses come in by utilizing our power, our privilege, and our knowledge. We must listen to, partner with, and co-create with communities to advance social justice and health justice.
HH: If you could identify one important change in nursing to support diversity, equity, and belonging in the profession and/or health equity in Black communities, what would it be?
CJ: Nurses must be held accountable for their contributions to the inhumanity experienced by underrepresented, minoritized, and marginalized Black patient populations. To enact accountability, nursing curricula and ongoing, required professional development should include content on bias, anti-racism, and cultural humility. Nursing must strive to understand and mitigate our nation’s history of systemic racism as it still permeates society and health care today. When society or nurses know better, they can be held accountable when they do not do better—accountability matters.
DFS: Accountability. The more and more I talk to individuals, I find that we have guiding documents, mission statements, vision statements, values, and accrediting standards that state the importance of diversity, equity, inclusion, and belonging to advance health, equity, and social justice. But many Black and Brown people’s experiences reflect a very different reality.
If we are going to make good on the stated promises that we have made to our students, our patients, our families, and to all the communities we serve, then we have to put our heads together and think long and hard about how we hold ourselves accountable. How do we empower those whom we serve to help in this endeavor? How do we privilege their feedback? How do we truly take it to heart and allow it to help us change and evolve into better organizations and better people? Will we have the humility to acknowledge that we don’t have all the answers? That will lead us to be able to co-create a better future that has everyone’s needs in mind.
There’s so much goodness happening in different places and spaces, but sometimes we don’t even know about it: for example, pioneers like Lucina Canty, PhD, CNM, FACNM, who played an integral role in launching the Overdue Reckoning on Racism in Nursing initiative, along with Peggy Chinn, MSN, PhD, DSc(Hon), FAAN, and Christina Nyirati, PhD, RN. We need to elevate these individuals—their work and their voices—so that people know what is taking place.