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When I was asked to contribute to the Afterword for Taking Action: Top 10 Priorities to Promote Health Equity and Well-Being in Nursing, the most recent edition of The Power of Ten, with a specific focus on the history of health equity and structural racism in nursing and how the nursing profession has addressed these things in the past, I was torn. After all, the nursing profession’s history of addressing structural racism is admittedly complex, and there are debates about the degree to which nursing has been actively involved in efforts to address structural racism. Some have called out the seeming passivity of nursing when discussing structural racism. Others have pointed to examples where the nursing profession has been at the forefront of advocacy, activism, health promotion, and efforts to address health inequities.

To be fair, there are legitimate points on both sides of this argument. The American nursing profession is plagued by a legacy of racism. At the same time, the ugliness that racism represents in both society and nursing stands in contrast to many superlatives attributed to nurses such as “caring,” “nurturing,” “healers,” “trusted,” “advocates,” and “activists.” However, if structural racism is defined by the way our systems’ resources and services are structured to advantage and disadvantage one group over the other, then the history of the nursing profession provides an exemplar case study of its presence at every level of practice, education, regulation, and research.

Indeed, just as structural (and interpersonal) racism impacts the lives of millions of historically marginalized people, through segregated living conditions, limited access to high-quality healthcare, and opportunities for employment and education, its pernicious effects are also evident in professional nursing. By taking the time to identify, interrogate, and reflect on the ways that nursing has been complicit in perpetuating disparities, while highlighting those who resisted and prevailed against these injustices, we stand to uncover viable solutions rooted in our past.

No, history is not a blueprint for addressing structural racism, but it can be a teacher, illuminating our individual and collective power to dismantle, redesign, and rebuild health and professional systems that are rooted in justice and equity.

The Past as Prologue

As a discipline, professional nursing emerged within the late 19th century and in most ways reflected the deeply rooted racial animus echoed in many quarters of society at the time. Black nurses were barred from admission to nurse training schools in the US South, and in the North, quotas were introduced to reduce the number of racial and ethnic minoritized trainees (Hine, 1989). Professional nursing organizations, including the American Nursing Association, required nurses to join via state nurses’ associations, effectively excluding minoritized nurses given that most state nurses’ associations denied them membership (Bennett et al., 2019). Advanced training opportunities were also limited for minoritized nurses. The education of nurses in midwifery, for example, reveals ...

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