Racism: Dismantling the Threat for Health Equity and the Nursing Profession

Kenya V. Beard, EdD, AGACNP-BC, CNE, ANEF, FAAN; Carla D. Sanderson, PhD, RN, FAAN


Nurs Econ. 2022;40(1):11-18. 

In This Article

Abstract and Introduction


Racism is a public health crisis and is the ultimate threat to health equity. Recognizing and dismantling racism in nursing could yield a more racially and ethnically diverse nursing workforce, which remains a critical step to attaining health equity. Although nursing organizations have explicitly denounced racism, not all nursing school leaders recognize, confront, and dismantle racism. Two coordinated approaches to guide efforts in identifying and mitigating racism and advancing health equity are described: The Social Determinants of Learning™ and Social Mission Framework. Nursing leaders who seek to illuminate the road to health equity and respond to upstream factors that undermine diversifying the nursing workforce should consider these two frameworks.


Disparities connected to COVID-19 triggered a robust discourse that indicts racism as the ultimate threat to health equity (National Academies of Sciences, Engineering, and Medicine [NASEM], 2021). The Centers for Disease Control and Prevention (CDC, 2021) defined racism as

a system consisting of structures, policies, practices, and norms – that assigns value and determines opportunity based on the way people look or the color of their skin … and results in conditions that unfairly advantage some and disadvantage others throughout society. (para. 1)

More recently, racism has been declared a public health crisis (American Hospital Association, 2021; American Public Health Association, 2021; CDC, 2021). The CDC's response to racism is in harmony with President Biden's Executive Order, Advancing Racial Equity and Support for Underserved Communities (The White House, 2021). The Executive Order exposed the costs of racism, underscored the need to advance equity (defined as "the consistent and systematic fair, just, and impartial treatment of all individuals" [para. 4]), and called on federal agencies to conduct a comprehensive review to determine the extent to which policies, programs, and practices propagate inequities. To dismantle racism and co-create a healthier America where everyone can achieve their highest level of health, institutions should conduct a collective assessment of the systems and policies that have seeded generational injustices (CDC, 2021; NASEM, 2021; National League for Nursing [NLN], 2017).

Attempts to address and dismantle racism at the federal level have not been static, nor have efforts focused solely on healthcare institutions. Recently, the nursing profession has moved to examine and respond to racism more deeply. The American Nurses Association (ANA, 2021) launched a commission to address racism in nursing and convened national leaders to collectively confront policies and practices that contribute to inequities in nursing. Additionally, the recent report The Future of Nursing 2020–2030: Charting a Path to Achieve Health Equity (NASEM, 2021) noted "nurse leaders have a responsibility to address structural racism" and reconcile issues that derail efforts to promote health equity (p. 296).

The American Association of Colleges of Nursing (AACN, 2021) echoed in The Essentials: Core Competencies for Professional Nursing Education that "making nursing education equitable and inclusive requires actively combating structural racism, systemic inequity, exclusion, and bias" (p. 6) and called for a curriculum that recognizes and redresses the processes that perpetuate racism. Indeed, efforts to address and dismantle racism align well with NLN's (2021) bold agenda that provides faculty development to ensure nurse educators possess skills to address racism and advance diversity, equity, inclusion, and social justice.