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Bolstering our commitment to equity and anti-oppression

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        Kenneth White, PhD, AGACNP, ACHPN, FACHE, FAAN
        I agree with the Academy's Diversity and Inclusivity (D&I) Committee: equity, diversity, and inclusivity must live not only within our organization and across our Fellowship but also be reflected in our work. Our newly adopted Equity, Diversity, and Inclusivity (EDI) Statement (

        American Academy of Nursing. (2021). Equity, diversity, and inclusion statement. https://www.aannet.org/about/about-the-academy/edi.

        ), coupled with our strategic plan, will serve as our North Star, advancing our vision of healthy lives for all people. This is hard work, and we must do it: taking an active stance every day to dismantle oppressive and racist practices, wherever they occur in our professional environments, our communities, or globally.
        Many of our colleagues, including members of our D&I Committee, have been generous in sharing stories that are difficult and essential, to hear–how they have experienced incidents of bias, discriminatory statements or actions, and practices that are not inclusive. Some have faced discrimination throughout their careers. In January, the National Commission to Address Racism in Nursing released results from their national survey of more than 5,600 nurses, which found that 63% of respondents have personally experienced racism in the workplace (

        National Commission to Address Racism in Nursing (2022, January). Survey Shows Substantial Racism in Nursing. https://www.nursingworld.org/survey-on-racism.

        ). These are acts of oppression, where power is used to unfairly treat a population because they are different from others. Racist interactions, imposed stereotypes, and microaggressions have besieged nurses, even within the Academy. I have heard from Black Fellows that year after year, they were “welcomed” to the Academy even though they have been Fellows for several years. Those who have these experiences are courageous colleagues, working to promote an inclusive culture in their workplaces and organizations. What has happened to them demands that we examine, challenge, and change policies and practices that marginalize or exclude individuals and deepen the impact of systemic oppression in our nation—and in our profession.
        It is up to us to do the work needed to create a culture of equity within our organization where we all feel a strong sense of belonging. In 2021, the D&I Committee updated the Academy's Diversity and Inclusivity statement to ensure that it reflects the values of our organization, has appropriate language and definitions, and can be a living document embraced by the full Fellowship. The committee not only included “equity” in the title of the statement but also placed it first, aligning it with our vision for equitable health care for all people. The statement commits the Academy to dismantling structural and institutional racism to promote social justice; in September 2021, the Board of Directors adopted the revised statement and a Principles of Engagement document.

        Actions of the Academy

        It is deceptively easy to count all the things we, as a membership association, have done to be more inclusive in our thoughts, words, and actions. Incorporating EDI principles in our meetings and actions, having D&I receptions, hosting policy dialogues, partnering with the Institute for Nursing Leadership on the “Critical Conversation on Health Equity and Racism,” holding a bystander training workshop, and incorporating land acknowledgments when we open our conferences. For the past two years, the Fellow Selection Committee has participated in unconscious bias training to help ensure that our processes for cultivating future cohorts of Fellows are equitable. This fall, the Academy's Health Policy Conference and Institute for Nursing Leadership signature event will bring nursing leaders to share how they have had to stand up to the biases and inequities that pervade our healthcare system and professional environments. The Council for the Advancement of Nursing Science's State of the Science conference, Social and Structural Determinants of Health, will explore relationships between determinants of health, nursing science, and health equity. All of these are important steps—but continuing reports of oppression show they are not enough.
        Within my own organization, the MGH Institute of Health Professions, we “…acknowledge systemic oppression in our society and strive to confront power imbalances where none ought to exist within our organization and the communities we serve” (
        MGH Institute of Health Professions
        Our commitment to equity and anti-oppression.
        ). Other organizations that are Academy counterparts, such as the American Nurses Association (ANA), have been actively working to address racism in nursing. But still, oppression persists and equity is challenged every day. The Academy must reaffirm its commitment to anti-oppression in all its forms. We must address all aspects of EDI as we move forward to meet our mission and vision.

        The Policy Promise

        We must continue to use the expertise of our Fellows to fight oppression and elevate equity. Our Expert Panels have helped inform the public when abuse, acts of violence, discrimination, and unjust policies have hurt people and populations. The Academy published an article in Nursing Outlook that called for equitable access to culturally sensitive health services for vulnerable populations, including immigrant children who had escaped abuse and poverty only to experience new trauma because of inhumane U.S. immigration policies and practices. The authors made key recommendations, including engaging psychiatric/mental health nursing specialists as drivers of mental health services integrated into primary care and the adoption of local, state, and federal policies that respond to the needs of these children (
        American Academy of Nursing
        Support for humanitarian aid to refugee children.
        ).
        In 2018, the Expert Panel on Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ) Health released the policy brief, “Protecting Vulnerable LGBTQ Youth and Advocating for Ethical Health Care” (
        • Hein L.C.
        • Stokes F.
        • Greenberg C.S.
        • Saewyc E.M.
        Policy brief: Protecting vulnerable LGBTQ youth and advocating for ethical health care.
        ), which powerfully expressed the support of the Academy for the rights of LGBTQ youth to be safe at school, at home, in places of worship, in the community, and while seeking and obtaining access to health care (p. 505). Today, we see state governments releasing and enacting inhumane and discriminatory legislation that endangers the health and well-being of LGBTQ youth; as I noted above, our work is not done—we, as nurses out loud, must confront and work to reverse these harmful policies at every level.

        Allyship to Combat Oppression and Racism

        Madhukar Pai, the Canada Research Chair in Translational Epidemiology & Global Health and Associate Director at McGill International TB Centre, has written persuasively about the need to stop oppression; he notes that patterns of funding, access and distribution of vaccines, the membership of boards, participation in conferences, and authorship are all important considerations in assessing social oppression (). He argues that allyship—defined by the Anti-Oppression Network as “an active, consistent, and arduous practice of unlearning and re-evaluating, in which a person in a position of privilege and power seeks to operate in solidarity with a marginalized group” (

        Anti-oppression Network (n.d.) Allyship. The Anti-Oppression Network. https://theantioppressionnetwork.com/allyship/.

        )—is an essential strategy to reverse oppression. The times call on us, as leaders, to actively practice allyship. The work to end oppression and racism requires the active, passionate, and ongoing contributions of the nursing profession. I am honored to serve an organization whose members want to do that work and create a safe, inclusive, anti-oppressive, and anti-racist global community.

        References

        1. American Academy of Nursing. (2021). Equity, diversity, and inclusion statement. https://www.aannet.org/about/about-the-academy/edi.

        2. National Commission to Address Racism in Nursing (2022, January). Survey Shows Substantial Racism in Nursing. https://www.nursingworld.org/survey-on-racism.

          • MGH Institute of Health Professions
          Our commitment to equity and anti-oppression.
          (n.d.)2022
          • American Academy of Nursing
          Support for humanitarian aid to refugee children.
          Nursing Outlook. 2016; 64: 94-97https://doi.org/10.1016/j.outlook.2015.12.003
          • Hein L.C.
          • Stokes F.
          • Greenberg C.S.
          • Saewyc E.M.
          Policy brief: Protecting vulnerable LGBTQ youth and advocating for ethical health care.
          Nursing Outlook. 2018; 66https://doi.org/10.1016/j.outlook.2018.08.006
          • Pai M.
          Disrupting global health: From allyship to leadership.
          (15 March) Forbes, 2022
        3. Anti-oppression Network (n.d.) Allyship. The Anti-Oppression Network. https://theantioppressionnetwork.com/allyship/.