Systemic racism creates the fear of not belonging and feelings of imposter syndrome among nurses of color, according to speakers at the recent public forum on racism in nursing held by DNPs of Color. The forum was held to raise awareness about the 2022 National Commission to Address Racism in Nursing Foundational Report and offer space for discussion to encourage participation in the call for public comment on the report issued by the American Nurses Association.

“The alarming statistic is that 92% of Black nurses have recently experienced racism in their workplaces in 2021,” said Yvette Conyers, DNP, MS, RN, FNP-C, CTN-B, CFCN, CFCS, in reference to the National Commission’s 2022 survey results. Black nurses said they experienced racist acts from leaders (70%), patients (68%), and peers (66%). Hispanic and Asian nurses also reported racism in the workplace at high levels.

The data also show that 76% of respondents attested to witnessing racism in the workplace, “which makes me think of allyship. Ok you witnessed it, now what are we now doing? What is the action behind it to create change?,” Dr Conyers said.

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The need for improved verbiage to describe being overlooked for promotions and/or raises as well as when a nurse’s skill set is not being fully utilized was discussed by Alicia McMillan Senegal, LPN, who is currently in a DNP program. She said that nurses and staff members have trouble putting into words their experiences with systemic racism.

A DNP-prepared nurse echoed that sentiment saying that she is 1 of 2 Black nurse practitioners (NPs) practicing in cardiology at her institution and the only one with her doctorate degree but her institution has failed to recognize her skill set. She said she doesn’t feel supported at her institution and is not brought on to research projects despite volunteering. This experience affected her mood for almost a year after completing her doctorate degree. “I don’t know if it is just my department because I have a colleague who completed the same doctorate program and was thoroughly celebrated by everyone in her department,” she said.

“Systemic racism creates the fear of not belonging and discouragement by pressure of MDs and DOs, making you feel like an imposter or not appreciated by administration,” said Cassandra Alexandre, APRN, who is currently a DNP student. “In my graduate APRN program in New Jersey, I was 1 of 2 Black students in a class of 45 students. Where are WE?”

Janet A. Williams, DNP, MSM, CNM, said that she briefly felt imposter syndrome upon graduation from a DNP program in 2018, but then began to step into her role and sit in leadership roles. She works as a certified nurse midwife and also is founder and chief executive officer for Transitions Women’s Health Consulting.

“I realized that my imposter syndrome came from realizing how much information is available and that, although I knew so much, there was still much to be learned,” Dr Williams said. She accepted that she knew how to access information and that she will continue life-long learning.

Implicit Bias Training and Policy Changes

Dr Williams called for implicit bias training as many times behaviors are unconscious and not recognized by those in positions of authority. “We are all biased, but it leads to racism also. We must continually educate people about their biases,” she said. 

Vivienne Pierce McDaniel, DNP, MSN, RN

Hand in hand with this training should be changes in policy to hold people accountable, said Vivienne Pierce McDaniel, DNP, MSN, RN, who is professor of nursing at Aspen University where she serves as the chair of the Aspen University School of Nursing Diversity, Equity, Inclusion, Belonging, Accessibility, and Accountability Advisory Committee.

Other clinicians called for having delineated roles for DNPs because executive leadership often does not recognize roles for nurses that are outside of those traditional “at the bedside.”

Furthermore, many attendees said they do not feel that they can be their authentic selves at work. One attendee said she had to tame her passion in meetings so as not to be considered an angry woman. Dr Pierce McDaniel said she is “very unapologetic at the table. I expect to be heard. I bring every bit of my passion to the table and I challenge anyone who considers me an angry Black woman.”

Are Holistic Admission Processes the Answer?

Feelings of imposter syndrome may also stem from institutional racism in the application process to DNP programs at traditionally all-White institutions.

“It’s so important for us to be on … holistic nursing admission committees,” said Sherena Samuel, DNP, APRN, FNP-BC. Another attendee stated that the undergraduate program where she teaches is not diversified and that the institution is trying to fix that through holistic admissions processes. While she has heard rumblings of negativity among faculty about the process as more minority students are accepted, the attendee said she mentors students of color, telling them that this is not their final stop and that they should elevate their degree beyond a BSN.

A single Black woman with an infant may be discredited from a program for not having a 3.5 or 3.75 grade point average, without considering that the obstacles faced by that person can make them excel as a student and those life experiences can be an asset in nursing practice, said Dr Conyers. Holistic admissions can counteract implicit bias by assessing an applicant’s unique experiences alongside traditional measures of academic achievement such as grades and test scores. 

Dr Conyers stressed the importance of creating awareness of who is on the search committees for new faculty, who is interviewing the staff, and are they looking at questions that filter out bias. “All those things can have an impact on the continued structural racism that is embedded in organizations,” she said.

Encourage Nurse of Color to Seek Higher Degrees

Dr Conyers spoke of encouraging people of color to pursue higher degrees than LPN or RN. The goal is to have more people of color in board rooms and C-suites so they can begin making decisions that will trickle down.

She added that the discrepancy in people of color in leadership roles in clinical settings or academia as well as in specialty areas can make nurses feel like they are not worthy or capable of those roles, particularly those who didn’t attend a historically Black college or university or who live in predominantly White areas. “We need to be more intentional in displaying people of color who practice in those areas. I think seeing is believing,” she said.

Danielle McCamey, DNP, APRN, ACNP-BC, FCCP

Madeline Feliciano-Weiser, MSN, RN, said she encourages her mentees to bypass the LPN degree and aim for an RN. “We have to elevate our younger nurses into realizing that they can expect more of themselves than what society has programmed us to expect of ourselves and there will be strength in numbers,” she said. Ms Feliciano-Weiser is an oncology clinical nurse coordinator at Penn State Health Milton S. Hershey Medical Center and a DNP candidate. She is also on the DEI Committee of the National Association of Hispanic Nurses

“I’m always an advocate for the seat at the table and even taking over the table, which is the essence of DNPs of Color’s mission,” said Danielle McCamey, DNP, APRN, ACNP-BC, FCCP, who is President of DNPs of Color. “Our focus is on elevating nurses of color to the doctorate level… because, as we all know, in order to be faculty or to have a tenured professorship and to have certain leadership levels within nursing you have to have your doctorate.”