Nursing our way to health care freedom
Juneteenth reminds us how far we need to go to achieve equity in our workplaces and communities.
“Juneteenth for me, is our true Independence Day,” said Astria Johnson, a registered nurse in the emergency department at the University of Chicago Medical Center (UCMC). “It honors our ancestors. My ancestors weren’t free on July fourth.”
The word Juneteenth, a merging of June and 19, marks the date when Union Maj. Gen. Gordon Granger and his troops arrived in Texas and told the enslaved people in the Lone Star State that they were free — two months after the Civil War had ended on April 9, 1865 and two-and-a-half years after President Abraham Lincoln issued the Emancipation Proclamation. To take this date and transform it into a celebration is emblematic of Black people’s extraordinary strength and uncompromising resilience in the face of tremendous adversity and crushing oppression.
Juneteenth is a fitting time to recognize what union nurses are doing to fight racism in their workplaces and to ensure that all patients are getting the care they need. Nurses have a duty to care for all of their patients and that duty goes beyond the bedside. It means building a just and inclusive democratic society in which all people can be healthy and free. It means advocating for equity for our patients as well as ourselves by demanding safe and respectful workplace environments free from discrimination, harassment, and other policies that compromise nurses’ well-being and dignity.
Johnson, whose grandmother was a nurse, noted that many patients at her hospital are low-income, under-insured or uninsured people, despite the facility’s location in affluent Hyde Park. “To have a diverse nursing workforce is so important,” said Johnson, who grew up in Rhode Island, has childhood memories of white doctors being cruel to her mother when she took her children to the ER when they had a fever or got hurt at school. “They yelled at her,” said Johnson, whose mother worked three jobs to support her three children. “For me, it would have made such a huge difference to see a Black doctor or a Black nurse.”
Workplace justice includes fighting for opportunities, resources, and support for nurses who have been historically marginalized, disenfranchised, and oppressed. Social justice at work also means organizing, winning contracts, and advancing campaigns that change oppressive institutional policies and practices.
Last fall, thousands of union nurses at Dignity Health facilities in California and Nevada took a historic step to making a more just workplace a reality: For the first time ever, RNs bargained for and won equity and inclusion provisions in their collective bargaining contracts with their employers. The contracts include the agreement to fight racial injustice and health care disparities within the community, a commitment to a workplace free from racism and unlawful discrimination, and the expansion of implicit and unconscious bias training.
“Having this language gives nurses the ability to engage on a level we were not able to before,” said Karen Boxley, an RN who has worked for 32 years at Mercy San Juan Medical Center, a Dignity facility in Carmichael, Calif. “It’s important because now we can say, ‘You agreed to talk about these things,’” said Boxley. “If it’s not written, administrators will find a way to ignore it.”
“I am elated to have this language in our contracts,” said Cathy Kennedy, RN and a vice president of National Nurses United. “I applaud that this is what we’re doing throughout our organization. With this language, we are finally recognizing that racism is an ongoing issue that has been swept under the rug. It is a problem for nurses and patients and now it’s up to us to hold our employer’s feet to the fire.”
Boxley also noted that the nurses fought hard to maintain the hiring of associate degree nurses, which has a big impact on the diversity of nurses, especially with the high cost of education. Some hospitals are making it more difficult for nurses of color to enter the workforce by requiring a Bachelor of Science in Nursing degree, which is more costly and time-intensive. Black and Latinx nursing graduates are more likely to earn an ADN than a BSN degree. “Many of the people I currently work with are associate degree nurses,” said Boxley who also has an ADN. “They represent an outstanding team. We have the experience. You don’t need a bachelor’s degree to be effective.”
As National Nurses United (NNU) stated in its November 2021 staffing report, both ADN and BSN nursing programs require a similar number of clinical hours, state boards of nursing that specified a minimum number of clinical hours for ADN and BSN degrees nearly always specified an identical number of hours for both programs, and the first-time passage rates of the NCLEX exam, the final licensure requirement for all U.S. nurses, are similar for graduates of both programs. NNU’s staffing report also noted that among the RN workforce, Latinx and Black nurses are most underrepresented compared to the general population, “with the gap between the percentage working as RNs compared to their percentage of the population at approximately 8.1 percent for Latinx RNs and 4.7 percent for Black RNs.”
Having nurses who represent the patient population is critical. Nurses at UChicago Medicine Ingalls fought for and won union representation and their first contract, including a significant and historic commitment from hospital management to hire associate degree nurses. That commitment will ensure that nurse graduates from the local community colleges will have the opportunity to care for patients in their communities. “I believe our patients need that representation and that advocacy,” said Boxley. “We need to speak up for our patients who are having trouble getting the health care they need.”
Representation matters, as we noted in NNU’s May blog post during Asian Pacific American Heritage Month, about the RNs at Chinese Hospital in San Francisco who also fought for and won union representation and their first contract.
Johnson, who has been an RN for 18 years, including 13 years at UCMC, agrees. A few years ago, Black nurses at her facility sent a letter to UChicago leadership and executive management stating that 89 percent of their patients were African American yet only 11 percent of the staff is African American. “The union backed us 100 percent on it, and we have definitely had some significant changes,” said Johnson.
Earlier this month, Johnson had a memorable experience illustrating the importance of representation. She was working in the ER with a Black charge nurse in EMS triage — handling the ambulance flow, when an older Black nurse brought a patient down from a clinic. When the older nurse saw that the staff — the charge nurse, Johnson, and the trauma director — were all Black, she exclaimed, “This is beautiful! I’ve never seen this many black people.”
She was so excited, Johnson recalled, because if she had not come down that day, she would not have seen us. “She hugged us and everything,” said Johnson. “It was a beautiful moment.”