Racism and Discrimination in Nursing and Nursing School: A Look at the Startling Numbers

Chinese flower.

Foreign sports car.

Oriental.

These are just a few of the names that Jaime Yoo, RN, a recent University of Pittsburgh School of Nursing graduate, can recall from her time interning in hospitals.

Yoo, who is Asian American, is far from alone. A recent report from the Robert Wood Johnson Foundation found a startlingly high prevalence of racism and discrimination in nursing school and in practice.

In the workplace, roughly 8 of 10 nurses reported experiencing racism or discrimination from patients, with 6 of 10 experiencing the same from colleagues, according to the report.

Overall, 44% of survey respondents report that racism or discrimination was a part of their nursing school culture. Black nurses are almost twice as likely as white nurses to say that their nursing school had a culture of racism and/or discrimination (60% vs. 31%).

The report used survey and interview data from nearly 1,000 nurses to shed new light on the topic, with information on racism by demographic — and nurses' own ideas for improvement. For example, 68% of nurses, according to the survey, believe there is a need for more DEI training or education in both nursing education and the workplace.

This is a deep dive into the numbers uncovered by the report.

Racism and Discrimination in Nursing School

More Than Half of Nurses (53%) Say Microaggressions Were Part of Nursing School Culture

Over half of nurses (53%) say that microaggressions were a part of nursing school culture. Microaggressions are generally more indirect or subtle expressions of discrimination.

Some examples include being addressed unprofessionally, being associated with racial/ethnic stereotypes, or being discredited due to race/ethnicity.

Broken down by race, Asian (54%), Black (65%), and Hispanic and/or Latino/a (53%) nurses reported much higher rates of experiencing or witnessing microaggressions than white nurses did (43%).

Asian and Black Nurses Most Likely to Experience Discrimination in Nursing School

Asian and Black nurses are most likely to respond that they were discriminated against based on their race or ethnicity during nursing school. Examples of this included:

• Being held to a higher standard of performance
• Being subjected to racially/ethnically offensive remarks or name-calling
• Receiving lower evaluations or grades solely based on race
• Being denied opportunities or training based on race/ethnicity

White nurses have the lowest rate of those responding who say they were discriminated against based on race/ethnicity during nursing school.

In the example below, Black nurses accounted for the highest percentage of respondents who say they were held to a higher standard of performance based on race/ethnicity during nursing school.

In another example, nurses of Asian descent accounted for the highest percentage of respondents who say they were subjected to racially/ethnically offensive remarks during nursing school.

Racism and Discrimination in the Nursing Workplace

Similarly to nursing school, Asian and Black nurses are significantly more likely out of any other demographic:

• To experience racism/discrimination from patients
• To experience racism/discrimination from colleagues
• To experience racism/discrimination from workplace management, including nursing directors, supervisors, senior leaders/executives, and human resources staff
• To be called slurs or insulted by a supervisor or boss based on race/ethnicity
• To be called slurs or insulted by a co-worker based on race/ethnicity
• To be humiliated in front of others at work based on race/ethnicity
• To be threatened or harassed due to race/ethnicity
• To be treated with less courtesy/respect due to race/ethnicity
• To be treated as less qualified due to race/ethnicity

Asian and Black nurses make up the highest percentages of respondents to report having seen or experienced microaggressions from colleagues.

This was also true from patients and at even higher rates.

Workplace Setting Affects Prevalence of Racism and Discrimination

The workplace setting, whether a hospital or care facility, also affects the prevalence of racism and discrimination, according to the report.

• Nurses experience the highest rate of racism/discrimination from patients in residential care and home health care facilities.
• Nurses experience the highest rate of racism/discrimination from colleagues in hospitals.

Having workplace-specific policies that target the way racism and discrimination uniquely take place in these environments may also help reduce incidents.

Effects of Racism/Discrimination on a Nurse's Mental Health/Well-Being

A whopping 9 in 10 nurses who have encountered racism/discrimination in the workplace say the experience affected their mental health or well-being.

What's Being Taught in Nursing School to Improve DEI?

When it comes to how well nursing schools prepare nursing students to care for racially/ethnically diverse patients, 58% of nurses respond that nursing school did it to a great or moderate extent.

Nurses had relatively high marks for the training they received about understanding and incorporating people's cultures into their care (58%).

Nurses saw more glaring deficiencies in other kinds of DEI training.

However, when it comes to systemic racism in the healthcare system, nearly 70% of nurses answer that nursing school covered this to a slight or no extent.

Another 68% say that nursing did not have adequate lessons on unconscious bias or stereotypes.

Large Majorities of Nurses Want More DEI Training

Overall, a large majority — 79% — of nurses feel more DEI training is needed in nursing education.

Nearly 70% (68%) of nurses also believe that there is a need for more DEI training in the workplace.

The following are nurses' recommendations to enhance DEI in the workplace.

• 83% of nurses recommend establishing zero-tolerance workplace discrimination policies.
• 81% of nurses recommend outlining and implementing clear consequences for violators of the policies.
• 80% of nurses recommend encouraging staff to report incidents of discrimination with guaranteed anonymity.

Methodology

The Robert Wood Johnson Foundation survey report was based on nursing surveys conducted by the National Opinion Research Center (NORC) at the University of Chicago's survey partner. The sample size was 980 nurses and the survey was taken from March 23-April 7, 2022.