Discrimination in nursing involves unfair or unjustified treatment that can harm individuals’ careers and their health. It can occur at the institutional level, when a healthcare organization’s policies curtail opportunities or adversely impact the well-being of certain groups. It can also occur among individuals, such as when negative interactions between nurses and patients are based on gender or racial stereotypes. Regardless of intention, and whether perceived or not by individuals, discrimination in nursing carries a host of unwelcome consequences. Nurse leaders may observe several types of discrimination in health settings, including the following:

• Racism
• Ageism
• Gender discrimination
• LGBTQIA discrimination.

Discrimination Among Nurses

Discrimination exists among nursing peers. Nurses may experience acts of discrimination from other nurses who hold ignorant or prejudiced attitudes and beliefs about one or several of their personal characteristics. They may make injurious assumptions about their skill level or knowledge as a nurse based on factors such as their age, country of origin, or gender. Discrimination between nurses can manifest in the form of overt bigoted behavior, such as the use of racial slurs, or it can be expressed more subtly through microaggressions. Microaggressions — actions and comments that communicate a bias against a marginalized group — demean, invalidate and slight their targets. Examples of microaggressions include a nurse telling a nonwhite, U.S.-born colleague, “You speak English very well,” or a nurse ignoring the opinions and comments of nurses from particular backgrounds. Discrimination creates a hostile environment that jeopardizes cooperation between healthcare professionals and diminishes trust and communication among the staff. Such things interfere with the delivery of quality patient care. For example, nurses with biases may ignore or fail to effectively communicate with other nurses, leading to preventable and sometimes critical errors in care.

Discrimination Involving Nurses and Patients

Discrimination also occurs between nurses and patients. Nurses may hold stereotypes about patients that impact the care they deliver, while patients may hold prejudicial views about nurses that cause them to mistreat those charged with their care.

The Impact of Implicit Bias on Patient Care

Implicit biases in nursing can lead to a host of unfortunate outcomes for patients such as the following:

• Insufficient patient assessments
• Incorrect diagnoses
• Inappropriate treatment decisions
• Decreased time spent inpatient care
• Inadequate patient follow-up after discharge

Additionally, numerous studies have found that patients who perceive discrimination in their treatment often disengage from healthcare and treatment in some of the following ways:

• They delay getting prescriptions or medical care.
• They are less likely to adhere to medical recommendations.
• They use preventive services less.
• They miss more appointments.

Patient Discrimination Against Nurses

Nurses can experience overt discrimination by patients such as an outright refusal of any care from them because of their backgrounds. More subtle discriminatory experiences might involve patients assuming registered nurses are medical technicians because of their ethnicity, race, religion or other characteristics. These experiences do emotional harm to nurses and add stress to an already challenging job. Excessive stress can lead to health issues including hypertension and depression. Such experiences also create ethical conflicts for nurses who have a responsibility to care for patients but also have a duty to not give treatment against a patient’s will.

Racism in Nursing

Racism has a profound effect on nursing care. While nurses have a history of advocating to redress inequities in practice, teaching and research, racism nevertheless persists and demands attention on both an individual and systemic level.

Systemic Racism in Nursing

Many ingrained policies and practices in healthcare organizations put people of color at a disadvantage. Some norms and ways of conducting business perpetuate inequalities between racial groups and give privileges and access based on race to some individuals while denying them to others. A recent study published in the journal Science found racial bias in an algorithm widely used by healthcare systems. The algorithm, which is used to make decisions about patient care, significantly underestimates the needs of sick and chronically ill Black patients, while giving preferential treatment to the needs of white patients. Dismantling structural biases first requires identifying them. This demands critically evaluating the ways in which healthcare organizations operate, and initiating inclusive conversations throughout an organization to weed out practices that perpetuate racial bias. Discussions should explore the many ways healthcare professionals are prevented from delivering equitable care to patients of color. They also need to address the structures in place that act as barriers to nurses of color trying to advance their careers.