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How changing the narrative in nursing schools could be an important step towards decolonizing the workplace

Traditional and historical beliefs hinder diversity in the curriculum

By Omarie Miller Hynds
February 26, 2024
Courtesy of Omarie Miller Hynds
“Nursing students are taught the importance of developing cultural competence to serve the needs of patients. However, it is equally important to apply cultural competence to meet the needs of our co-workers and peers,” says Omarie Miller Hynds.

Throughout the course of my nursing education, the need to promote further diversity and inclusion within the profession became increasingly evident. This change is necessary because current nursing culture is centred on traditional and historical beliefs that hinder the application of contemporary inclusion and diversity initiatives. This culture coincides with internalized beliefs and biases established by colonialism, which can negatively shape ways of thinking and give rise to implicit biases that make their way into the health-care system.

Nursing students are taught the importance of developing cultural competence to serve the needs of patients. However, it is equally important to apply cultural competence to meet the needs of our co-workers and peers. By applying this principle to our professional and daily relationships, we are best able to establish meaningful interactions, understand others’ beliefs, and learn from their experiences. This would serve to further decolonize the culture of nursing.

Florence Nightingale as symbol

Within the current nursing curriculum, there has been limited effort to promote a racially diverse nursing practice. I believe this lack of diversity is related to the historical depiction of Florence Nightingale, the central icon for all nurses, that has an excluding effect on students of colour. This simplification of the origin of nursing practice omits the contributions of other historical nurses of colour and their achievements, and limits the advancement of nursing practice.

As a Black female student, I have largely felt excluded from my peers because there is little discussion regarding the contributions made by Black and Indigenous people and people of colour (often abbreviated as BIPOC*) within historical or current nursing practice. This exclusion can negatively affect the desire to engage in advocacy that would address disparities because, as BIPOC students, our efforts are neither recognized nor encouraged.

The traditional white nursing uniform

A notable experience from my own nursing education was my decision to refrain from wearing the traditional white nursing uniform in my graduation pictures. The white nursing uniform is customary for graduating students in their pictures and even in clinical practice. This tradition evoked a sense of curiosity and discomfort within me — curiosity as to the meaning of such a uniform and discomfort because it seemed wrong. Initially, I was unsure why these feelings arose.

Through further research, I discovered the history of the uniform and those it sought to include, with significant influence from Florence Nightingale. I saw many photographs that showcased nurses in white uniforms; however, none of these nurses were a racial representation of me.

For whom, then, were these uniforms created, and who were allowed to wear them? And what about the BIPOC patients who may have received poor care from those wearing that uniform?

Colonial impact of nursing

Although there has been intentional efforts made within institutions and regulatory bodies to address racism and discrimination, to my knowledge, there remains a critical gap in discussion and literature to address the colonial impact of nursing and the exclusion of BIPOC nurses. I also continue to wonder about further discussing and acknowledging the impact of race within past inclusion criteria for the nursing profession to improve the culture of nursing.

Possibly, this topic has not been explored, or perhaps there is a historical preference to accept a narrower view of nursing, one that demonstrates only positivity. But neither explanation acknowledges the challenges and barriers created by the culture within nursing schools, thereby suppressing the true experiences of BIPOC nurses.

I ultimately chose not to wear the white uniform in my graduation pictures because it was not created for people like me; therefore, it would not be honourable to showcase such a uniform. Rather, I chose to shift the narrative and embody a modern reflection of nursing practice by wearing scrubs, which do not impose on BIPOC nurses and are inclusive of all individuals.

Creating an avenue for BIPOC students to share their experiences within nursing school, and to express their cultural and learning needs, can help support an appreciation of diversity and reshape the culture that is found in nursing schools. That being said, race is often an uncomfortable topic for students, regardless of their background. However, ignoring this topic effectively silences students’ needs and does not support positive change. For this reason, we need to establish an environment where students are encouraged to be curious and, in a respectful manner, to learn about the privileges, barriers, and biases of their peers.

Ultimately, this collaborative approach to learning ensures commitment to deepening understanding and acceptance of one another, a skill that will benefit nurses in their practice and in daily life.

Charting a path forward

  • Given the current disconnection between BIPOC students and nursing culture, it is important to implement activities that encourage all students to share their traditional practices and culture. This approach would generate understanding and inclusivity among peers and improve self-awareness regarding patients’ needs and preferences.
  • It would also be meaningful for students to engage in self-reflection to deepen their understanding of personal privileges, biases, and educational needs. This would provide an opportunity to absolve harmful biases, develop empathy, and express their needs, all of which support character development, furthering their success as future nurses.
  • Nursing schools must make an effort to understand the limitations within their curriculum. This might best be achieved through anonymous surveys that give students an opportunity to share their experiences and perceived barriers to learning.
  • However, BIPOC students do not bear the responsibility of educating others on well-known racial issues. Each of us knows only our own preferences and experiences; it would be a serious burden for BIPOC students to feel they must educate others.

In summary, the need for diversification of the nursing culture is a present concern that requires active efforts to ensure positive change and dismantle colonizing perspectives. Commitment to such change can support the recognition of BIPOC nurses within historical and current nursing practice. This can provide an avenue to discover ongoing disparities within the nursing profession and their impact on BIPOC students.

*The phrase Black and Indigenous people and people of colour (often abbreviated as BIPOC) is used in this article to represent and acknowledge the differences within the lived experience of non-White people compared to those of White people. This term in no way seeks to categorize a person’s unique identity, but rather to emphasize differences among experiences.

Omarie Miller Hynds, RN, is a recent graduate of the Red Deer Polytechnic nursing program collaborative with the University of Alberta, from where she graduated with distinction. Omarie was born and raised in Roatán, Honduras, and moved to Canada in 2014 as an international student. She currently works in acute care.