History of Black Nurses

Black Americans make up about 13% of the population but only 7.8% of nurses, according to the Health Resources and Services Administration. The gap has narrowed over time, but the need for more Black nurses is still real, and it matters for patient care.

"There are benefits for both the health system and consumer side when you have a diverse population of people who are providing health to the community," says Tiffany M. Montgomery, an assistant professor of nursing at Temple University.

The beginnings of Black nursing

Black nurses run throughout U.S. history, but earning an education and recognition took perseverance against long odds. They faced racism on multiple fronts: few schools would admit them, professional organizations rejected them, and the Army and Navy barred them from service. They fought for ground anyway and opened the door for the nurses of color who followed, though broad acceptance took decades.

Historic figures

Mary Eliza Mahoney became the first Black American to earn a professional nursing license in 1879. She spent much of her life expanding access to nursing education for people of color and fighting discrimination in the field.

Estelle Massey Osbourne became the first Black American to earn a master's degree in nursing in 1931. During World War II, she worked to overturn discriminatory policies, and her efforts helped push more nursing schools to admit Black students and led the Army and Navy to drop their bans.

Hazel Johnson-Brown became the first Black female brigadier general in the U.S. Army. When she took her post in 1979, she commanded the 7,000 nurses of the Army Nurse Corps, and she later directed the Walter Reed Army Institute of Nursing.

Black nursing today

Black Americans' relationship with healthcare is complicated. A history of discrimination and unethical experimentation, including the Tuskegee Syphilis Study, has bred deep mistrust, Montgomery says. More than a third of Black people reported feeling discriminated against while receiving medical care in a 2017 poll by the Robert Wood Johnson Foundation.

"We finally are just getting around to receiving an apology, but people have long memories," Montgomery says. "Our community doesn't trust healthcare providers, and so we must have healthcare professionals who are a part of the communities that distrust the healthcare system."

The evidence supports her point. Research from the nonprofit Families USA found that patients who share a racial or ethnic background with their provider are more likely to report being satisfied with their care. The benefit runs both ways. "You learn that some of the biases that you have against people in these communities have no basis," Montgomery says. "So, you become a better practitioner yourself."

Getting there is hard. Cultural alienation and discrimination can keep Black students from finishing their degrees. As a student and an educator, Montgomery says she's "seen white students treated with privilege and Black or other students of color discriminated against."

The future of Black nursing

So what keeps Black nursing students enrolled through graduation? Montgomery points first to faculty. "One of the biggest challenges for Black nursing students is the lack of Black faculty," she says. Today, 11% of students pursuing a BSN are Black, and 8.7% of nursing faculty are Black, according to the American Association of Colleges of Nursing.

Black faculty serve as role models and help all students understand the health disparities Black communities face. But hiring and keeping them is tough. Teaching often pays less than clinical work and carries a heavier load, and low retention can stem from cultural bias among white faculty and the isolation Black faculty feel.

"As we can increase diversity, I think that students will feel more comfortable," Montgomery says. "We can recruit more students to nursing, and we can retain them." The key, she says, is making students feel part of a community. She advises prospective students to weigh more than a school's pass rates and look at its Black faculty and staff, Black student unions, Black nursing groups, and organizations aligned with their interests.

"Nursing school is hard enough on its own," she says. "We don't need to do anything to make it more difficult than it already is, and so creating an environment where people can just be themselves is the best way to get successful students."

Resources for Black nurses

Organizations: National Black Nurses Association, Black Nurses Rock, and the National Coalition of Ethnic Minority Nurse Associations.

Scholarships:

• NBNA scholarships, ranging from $1,000 to $15,000
• M. Elizabeth Carnegie African American Scholarship, for Black nurses in doctoral programs
• Black Nurses Rock Scholarship, for current Black nursing students, in varying amounts