Journal of Nursing Education

Major Article 

Telling the Story of Role Conflict Among Black Nurses and Black Nursing Students: A Literature Review

Ora V. Robinson, PhD, RN, CNE

Abstract

Racism continues to affect minority nursing students and nurses in professional roles. A selective review of the literature published from 1992 to 2011 was conducted using the Cumulative Index of Literature in Nursing and Allied Health, ScienceDirect, and EBSCOhost. Keywords used included racism within nursing, minority nurses and role conflict, cultural diversity within nursing, racism, and diversity. The purpose of this review is to describe Black nurses’ and Black nursing students’ experiences of role conflict as an outcome of perceived racism within the nursing profession to gain an understanding of factors that contribute to perceived racism and role conflict. Noblit’s and Hare’s framework for metasynthesis of the data was used to identify and synthesize key concepts. The role perspectives of Hardy and Conway guided the review to develop a conceptual framework for minority role conflict and the nursing implications discussed herein. [J Nurs Educ. 2013;52(9):517–524.]

Dr. Robinson is Assistant Professor, Nursing Department, California State University, San Bernardino, San Bernardino, California.

The author has disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Ora V. Robinson, PhD, RN, CNE, Assistant Professor, Nursing Department, 5500 University Parkway, California State University, San Bernardino, San Bernardino, CA 92407-2393 e-mail: orobinso@csusb.edu or orarobins@aol.com.

Received: August 16, 2011
Accepted: July 25, 2012
Posted Online: August 19, 2013

Abstract

Racism continues to affect minority nursing students and nurses in professional roles. A selective review of the literature published from 1992 to 2011 was conducted using the Cumulative Index of Literature in Nursing and Allied Health, ScienceDirect, and EBSCOhost. Keywords used included racism within nursing, minority nurses and role conflict, cultural diversity within nursing, racism, and diversity. The purpose of this review is to describe Black nurses’ and Black nursing students’ experiences of role conflict as an outcome of perceived racism within the nursing profession to gain an understanding of factors that contribute to perceived racism and role conflict. Noblit’s and Hare’s framework for metasynthesis of the data was used to identify and synthesize key concepts. The role perspectives of Hardy and Conway guided the review to develop a conceptual framework for minority role conflict and the nursing implications discussed herein. [J Nurs Educ. 2013;52(9):517–524.]

Dr. Robinson is Assistant Professor, Nursing Department, California State University, San Bernardino, San Bernardino, California.

The author has disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Ora V. Robinson, PhD, RN, CNE, Assistant Professor, Nursing Department, 5500 University Parkway, California State University, San Bernardino, San Bernardino, CA 92407-2393 e-mail: orobinso@csusb.edu or orarobins@aol.com.

Received: August 16, 2011
Accepted: July 25, 2012
Posted Online: August 19, 2013

A recurring theme identified in the nursing literature during the past 19 years is lack of inclusion of Black nurses, nursing students, and faculty in clinical and academic settings (Carnegie, 2000; Hassouneh, 2006; Wilson, 2007). This sense of exclusion has caused some Black nurses to experience feelings of ambiguity when implementing their professional role responsibilities. Historic reviews reported that Black nurses were not included in the profession of nursing due to segregation (Carnegie, 2000; Hine, 1989). Many definitions of racism exist, but Hine’s (1989) definition, “a system of beliefs and practices promulgated by certain Whites to maintain unequal distribution of power and resources between themselves and Black Americans” (p. ix), provides an appropriate context for this review. For the purpose of this review, perceived racism is defined as the subjective experience of prejudice or discrimination (Clark, Anderson, Clark, & Williams, 1999).

Defining Role Conflict

Origins of role conflict in nursing have been identified as a blurring of self-image, nurse–physician conflict, nurse–supervisor conflict, and patterns of adjustment to conflict (Benne & Bennis, 1959). Role conflict relates to professional–bureaucratic work conflict, gender issues, and nurses’ own personal values, as well as those of the profession (Shead, 1991). Role conflict, as discussed in this article, is grounded in Hardy’s and Conway’s (1978) role perspectives. Role conflict is a subjective state that emerges when existing role expectations are contradictory or mutually exclusive. For example, role conflict can arise when the individual’s perception of his or her professional role conflicts with society’s role expectations. Or it can be inferred, based on anecdotal evidence, that Black nurses enter the profession with the belief that they can make a difference in their achieved role as nurse and that their colleagues will view them based on their achievement rather than on their race, ethnicity, or culture. Historical aspects of role socialization provide a background for discussing the dynamics of role socialization in relation to Black nurses and nursing students.

Key Questions Guiding The Review

The following basic key questions guided the review:

  • What does the nursing literature report about Black nurses and nursing students’ experiences of role conflict?
  • How do Black nurses and nursing students experience role conflict?

In this article, the term nurses includes both clinicians and faculty. Selected quotes from non-Black minority nurses portray a picture of experiences by some racial and ethnic minority nurses. This review is limited to the racial and ethnic minority category of Black.

The restrictions on or interference with the ability to fulfill role responsibilities owing to experiences with racism has been shown to directly affect the physical health and psychological well-being of Black nurses (Harrell, Sadiki, & Taliaferro, 2003; Krieger, Kosheleva, Waterman, Chen, & Koenen, 2011). In addition, Black nurses who have experienced inequalities or bias within the nursing profession resulting from perceived racism have exhibited physical and psychological health problems (Clark et al., 1999; Harrell et al., 2003; Krieger et al., 2011). Consequently, many Black nursing students and faculty continue to perceive the nursing education environment as hostile (Alspach, 2008; Barbee, 1993; Clark & Springer, 2010; Roy, 2007; Williams-Evans, 2004; Wilson, 2007). This perception may lead to experiences of role ambiguity and role strain, resulting in role conflict.

The purpose of this review is not to generalize and blame White nurses for their misconceptions or to encourage the victim mentality among Black nurses; rather, the purpose is to examine the experience of role conflict among Black nurses’ exposure to racism to develop new insights, gain an understanding of Black nurses’ experiences with racism, discover new ways of thinking about role conflict as a consequence of perceived racism, and provide useful information to all nurses that will lead to reduced role ambiguity, strain, and conflict.

Historically, some Black nurses have encountered barriers resulting from some White nurses’ negative opinions of the Black nurses’ professional competence when enacting their nursing roles, with White nurses exhibiting little or no insight into the barriers confronted by Black nurses (Hine, 1989). White nurses’ perceptions that Black nurses are inferior, of limited intelligence, lack stamina to fulfill the pressure of nursing, and lack professional competence may hinder Black nurses from fulfilling their role responsibilities as full-fledged members of the profession (Hine, 1989). Further, although racism in the nursing profession has recently been recognized and acknowledged (Allan, Cowie, & Smith, 2009; Gardner, 2005; Gupta, 2009; Hassouneh, 2006; Wilson, 2007), research continues to demonstrate that White nurses lack confidence and experience with race-related issues and are uncomfortable discussing these issues with their minority colleagues (Peckover & Chidlaw, 2007).

The concept of role theory as formulated by Hardy and Conway (1978) provides a social context for viewing individuals on the basis of societal expectations and cultural norms, which provides a framework for understanding role conflict experience by Black nurses. Metasynthesis of the literature identified current perspectives on Black nurses’ experiences of role conflict as they relate to racism within the nursing profession. Experiences perceived as racism are identified, and implications for the nursing profession are considered.

Background

During the era of segregation, the nursing profession excluded Black nurses as equal partners in the delivery of care, as evidenced by less than favorable views of Black nurses expressed by White colleagues (Carnegie, 2000; Hine, 1989). For example, many White nurses believed that Black nurses had inferior intelligence as evidenced by poor judgment, limited intellectual capacity, and irresponsibility (Carnegie, 2000; Hine, 1989). Consequently, White nurses believed that Black nurses were best employed to provide basic bedside care. Comments by White nurses reflected the belief that Black nurses were not prepared for nursing management roles, believing that Black nurses had received an inferior education, lacked executive skills, and could not withstand the organizational pressure of a hospital setting (Hine, 1989). In addition, they considered Black nurses to have weak character, limited intelligence, and no morals, and to be liars who quarreled constantly (Hine, 1989). These views, expressed more than 20 years ago, conflict with a view of nurses as caring and compassionate professionals who can work within a multicultural and racially diverse society. The question to ask in the second decade of the 21st century is “To what degree do Black nurses continue to experience racial conflict within the nursing profession?” Both Black and White nurses may experience residual effects of the history of racism and segregation in U.S. society and in the profession of nursing. Alleyne (2004) noted that problems related to the psychological wounds of Black history are reopened when Black nurses encounter acts of racial bullying, harassment, scapegoating, and other forms of oppression.

Nursing research has reported several instances of perceived racism among Blacks in the nursing profession (Chambers & Alexis, 2004; Cortis & Law, 2005; Hassouneh-Phillips & Beckett, 2003). Perceived racism results from perceived lack of inclusion by Black nurses and nursing students, ineffective or inappropriate communication by White students when interacting with racial and ethnic minority students and faculty, and horizontal abuse of Black nurses and nursing students by their White peer groups. Although all nursing students and nursing faculty are taught—and expected—to use effective, professional, and culturally sensitive communication when interacting with colleagues, peers, and patients of diverse backgrounds, Black faculty and students may not consistently experience this type of communication in their interactions with some White nursing faculty, staff, or students. Black nursing students may perceive that the discipline of nursing is not upholding its own professional values, which include a respect for human dignity and difference and an awareness of social justice, when interacting with minority faculty and students (Gardner, 2005; Wilby, 2009).

The phenomenon of perceived racism translates into costs to hospitals and academic institutions because of psychological, physiological, and behavioral manifestations of stress, such as low productivity, less than optimal work performance, and absenteeism (Mistry & Latoo, 2009). An additional consequence includes increased attrition rates among minority nurses and nursing students in both hospital and academic settings, which is costly for both the individuals affected and their organizations (Brinkert, 2010).

Theoretical Framework

Hardy and Conway (1978) defined role expectations as position-specific attitudes, behaviors, and cognitions that are required and expected from the role occupant, defined as “a person who holds a position within the social structure” (p. 76). Hardy and Conway distinguished among the following types of roles: (a) ascribed roles based on social class, ethnic group, and gender; (b) achieved roles based on educational or occupational background; and (c) age-related roles based on stage of life from infancy to old age. According to Hardy and Conway, role stress occurs when conflicting role expectations or obligations make role demands difficult or impossible to meet. Role stress is a precursor to role strain, in which the individual has difficulty fulfilling role obligations. Role strain is a precursor to role conflict, which is a subjective state that emerges when existing role expectations are contradictory or mutually exclusive (Hardy & Conway, 1978). Role occupants for the purpose of this review are Black nurses and nursing students.

Historically, Black women have been aware of the roles prescribed for them by society as they transitioned from the context of slavery through abolition to the civil rights acts and beyond. Although the U.S. Constitution affords certain rights to all American citizens, such as freedom of speech and the right to vote, societal norms did not allow all Americans to exercise the pursuit of happiness as described in the Declaration of Independence. After the abolition of slavery, over time, American society prescribed new role assignments and behaviors. Black individuals have had numerous labels applied to describe their racial category. For example, colored, Negro, Afro-American, Black, and, most recently, African American. Because African American women belong to two disenfranchised societal groups, Blacks and women, they face unique challenges that complicate their role expectations and society’s role expectations. Gender challenges are not a focus of this review, which instead focuses on the problem of role conflict that occurs when White individuals do not accept the new normalization of roles resulting from the civil rights acts and guaranteed by the Constitution. For example, a Black American who has fulfilled the educational and licensing requirements to hold the title of RN reasonably expects to be viewed and treated by colleagues based on this achieved role rather than on his or her ascribed role as Black. When colleagues, peers and supervisors view Black nurses and nursing students based on their race (ascribed role, first impression) rather than on their educational achievements (achieved role, second impression), role stress, role strain, and, subsequently, role conflict result.

Literature Review

The goal of this review was to locate articles relating to experiences of perceived racism and resulting role conflict among Black nurses. The focus of the review was Black nurses and Black nursing students as a cohort of a racial minority group. A literature search using the Cumulative Index to Nursing and Allied Health Literature, ScienceDirect, and EBSCOhost examined reports in across health disciplines. The vast quantity of literature on racism in general, role stress and role strain, role conflict, diversity, discrimination, and bias made it difficult to conduct a comprehensive review. Therefore, query terms used for the search included racism within nursing, minority nurses and role conflict, cultural diversity within nursing, racism, and diversity. Articles that included recurring themes and terms that reflected racism or role conflict among minority nurses, such as cultural diversity and discrimination, were included in the review. This limited sample seeks to provide a historic and contemporary perspective of Black nurses’ and nursing students’ experiences with racism.

Most of the included articles were cited in more than one database, resulting in many duplicate titles. Articles that did not address the theme of racism within nursing or role conflict among Black nurses or nursing students were excluded. The procedure of the literature review included a meta-ethnography synthesis to interpret the narrative data and offer an explanation. Meta-ethnography uses multiple peer-reviewed studies with a purposive sample. Given the purpose of this study to identify role conflict experienced by Black nurses and nursing students owing to perceived racism, the study offers an interpretative explanation rather than a prediction of actual racism (Thomas & Harden, 2008).

Method

Noblit and Hare (1988) outlined a seven-step framework for synthesizing qualitative studies (Table). These steps include identifying query words, reading the selected articles to identify a nursing practice issue, and organizing the data into categories for translation and synthesis.

Synthesizing Qualitative Studies With Use of Noblit’s and Hare’s (1988) Framework

Table: Synthesizing Qualitative Studies With Use of Noblit’s and Hare’s (1988) Framework

After reading the articles, a thematic framework was created that referenced discrimination, cultural diversity, racial inclusion, incivility, workplace violence, bullying, job stress, and minority nurses’ experiences of racism within the profession, leading to role stress, role strain, and resultant role conflict.

Step five of Noblit’s and Hare’s (1988) framework translates the studies into categories to facilitate comparison and contrast of the findings. Findings were then synthesized into a single document that grouped the findings into similar categories and reduced the grouped categories into a summation of all findings. Categorizing the findings revealed the phenomenon of role conflict as a holistic concept that Black nurses and students have experienced throughout the 19 years covered by this review. Experiences with role stress and resultant role strain based on their ascribed role, race, or ethnicity resulted in external stressors by the role sender (another nurse or faculty member), who demonstrated overt or covert behavioral acts of discrimination, bias, or racism. After the role sender moved past his or her initial impression of the role occupant (Black nurse), he or she could see the role occupant in his or her achieved role (as a professional RN). Although Black nurses are professionals in their achieved roles, their experiences differ from those of their peers while performing the role expectations for a nurse, which consist of caring behaviors.

Findings

Findings identify trends and gaps in the literature of role conflict among Black nursing students, Black staff nurses, and Black faculty in academia. Due to the lack of published articles on role conflict specific to Black nurses, published articles on the experiences of other minority nurses were included in the review. Published studies over a 19-year period (1992–2011) reflected key concepts of isolation, alienation, denial of advancement, a sense of minority nurses having to work harder than peers, and having to prove themselves in their professional roles. Findings revealed the impact of racism on health in terms of biopsychosocial stress, physical ailments, and behavioral and psychological manifestations. Conversely, findings also revealed the resilience of Black nurses and nursing students who use effective coping strategies to mitigate the effects of perceived racism and resultant role strain.

The review also showed themes consistent with marginalization (Barbee, 1993) and being invisible and voiceless (Wilson, 2007). The vast quantity of literature on racism in general, as well as role conflict, role stress and role strain, diversity, discrimination, and bias, precluded a more comprehensive review or one specific to Black nurses and nursing students. Instead, the sampling of literature was specific to the themes of racism within the nursing profession and role conflict within the nursing profession specific to race (Hassouneh-Phillips & Beckett, 2003; Wilson, 2007).

In several studies, Black nurses described feelings of invisibility (being “looked through”) loneliness, and isolation, as well as discriminatory treatment in their roles as practicing RNs, students, and faculty (Wilson, 2007). For example, one Black nurse stated, “When I worked at a private hospital setting, certain physicians didn’t like certain nurses, African American, Asian, or whatever, to take care of their patients” (Wilson, 2007, p. 146). Another Black nurse said, “I feel that as an African-American nurse, sometimes you get dumped on. I mean sometimes they [White peers] give you the worst of the worst patients” (Wilson, 2007 p. 147.). Another Black nurse stated, “They [physicians] tend to approach their Caucasian peer more readily than they would me. They assume that I am the LPN or the Psych tech. After a fire drill, the Fire Marshall referred to me as the housekeeper. I was the charge nurse” (Wilson, 2007 p. 147). One Black nurse stated, “My new manager (a non-nurse) has forbidden me from submitting professional abstracts and accepting opportunities for presentations and publications at professional nursing conferences” (Alspach, 2008, p. 18). The following statement summarizes the feelings of isolation: “Social isolation is a powerful tool. I believe it to be a form of punishment in the workplace” (Alspach, 2008, p. 19). Wilson (2007) cited examples of hostility experienced by Black nurses. As an example, one Black nurse stated, “hostility also includes unwarranted write-ups, twisting facts, ganging up on others” (Alspach, 2008, p. 19).

The relationship between perceived racism and the health of Black nurses and Black nursing students may be manifested as psychosomatic complaints, such as depression, anxiety, and increased blood pressure (Clark et al., 1999; Harrell et al., 2003). Internalized perception of racism may negatively affect racial identity development resulting from isolation from their peer group, which in turn can lead to adverse health consequences (Alleyne, 2004). Abuse of power by administrators and faculty and marginalization were cited as common experiences among Black nurses at all levels (nurses, nursing students, and faculty). Specific complaints included negative comments that affect self-esteem and self-confidence; lack of support from colleagues, peers, and faculty; acts of incivility among colleagues, peers, and faculty; character assassination; lack of access to equitable clinical learning experiences; and not being provided opportunities or support for career advancement (Amaro, Abriam-Yago, & Yoder, 2004; Barbee, 1993; Bennie, 2005; Bessent, 2009; Chambers & Alexis, 2004; Hassouneh-Phillips & Beckett, 2003; Williams-Evans, 2004).

Nursing Students. Regarding Black nursing students’ experiences with role conflict related to experiences of racism, the reviewed articles indicated the students felt a lack of support in the clinical environment. For example, Black nursing students claimed they were not allowed to observe certain procedures during their clinical experience and, in some cases, were not allowed to use the hospital library when other students were permitted access to these experiences (Gardner, 2005). Black students also expressed they at times perceived they were silenced. One Black nursing student stated, ” I was trying to say something, she [the lecturer] was doing this [rolls eyes up to heaven and sighs heavily]” (Markey & Tilki, 2007, p. 392). In contrast, Amaro et al. (2004) found that ethnically diverse nursing students did not perceive faculty members to be discriminatory but encountered discrimination in the clinical setting from staff and from their peers. Additional challenges relate to lack of support from teachers and colleagues who ignore or fail to address insensitivity and instances of discrimination (Gardner, 2005; Markey & Tilki, 2007).

Staff Nurses.Cortis and Law (2005) recounted discriminatory treatment experienced by Black nurses in the United Kingdom. Similarly, Black nurses in the United States experienced perceived racism in the work environment emanating from patients and peers, resulting in an uncomfortable work environment that hindered Black nurses’ professional opportunities and career advancement (Markey & Tilki, 2007; Williams-Evans, 2004). Black nurses may experience not only barriers to their full professional potential imposed by others, including institutional racism, but also may experience self-imposed barriers (Barbee, 1993; Cortis & Law, 2005). An example of the latter is resentment related to the legacy of slavery and disenfranchisement, which can further hamper the development of a strong identity as an equally qualified professional nurse entitled to the respect, recognition, and rewards available to their White peers.

Nursing Faculty.Chambers and Alexis (2004) identified faculty incivility as a significant barrier for Black nurse educators. Other institutional barriers include the lack of educational opportunities that promote confidence and self-esteem and knowing where to turn for help. Yoder (1996) suggested that ethnically diverse students’ perceptions that nursing faculty lack cultural awareness can be a barrier to learning and socialization. This finding is consistent with those of Amaro et al. (2004), who identified similar barriers, as well as barriers in the areas of communication and assertiveness, compounded by the lack of ethnic role models. Black nursing faculty experiencing role conflict often mentioned the feeling of being someone other than themselves (Gardner, 2005).

Additional challenges faced by faculty of color include the lack of integration on anti-racist pedagogy framed under the context of culture that engages in open dialogue on issues of race and resultant health disparities in minority groups that is neglected under the framework of culture. Black nursing faculty who seek to engage students in discourse about racial issues that affect health and health care may have a backlash in their student evaluations based on the demographic characteristics of students (Hassouneh, 2006). A profound example was an evaluation comment by a student accusing a faculty member of being anti-White, anti-Christian, and a “sand nigger,” a racial slur directed toward Arabs and Arab Americans (Hassouneh, 2006, p. 258). Over time, such experiences may inhibit the voices of Black faculty in addressing racial, ethnic, and cultural issues as part of their teaching. Further, overt or covert racism may derail the success of Black faculty by denying them opportunities to participate in activities that lead to promotion and tenure (Gerrish & Papadopoulos, 1999; Williams-Evans, 2004).

Discussion

These findings raise several important questions:

  • Why do Black nurses and Black nursing students encounter role conflict in the form of perceived racism from their colleagues and peers?
  • Why are Black nursing students hindered from opportunities to access resources to meet their learning objectives in the clinical and academic setting, compared with their White peers?
  • Why do administrators hinder Black professional nurses from progressing in their careers?

It is plausible that first impressions are based on outward physical characteristics that allow the role sender (White nurse, faculty member, student, or administrator) to place a Black colleague into a racial or ethnic category rather than a professional category. Black nurses may encounter role stress, and their response may or may not lead to role strain. The results of this study suggest that when role stress initiates the stress response, the outcome depends on the amount of pre-exposure to the stimulus (racism), the degree of skill used to cope with role stress, and the type of defense mechanisms used by Black nurses experiencing role stress and role strain. As a result of historical societal role expectations, research shows that Black nurses experience multiple role expectations grounded in their racial and ethnic identity, gender, and professional roles. The inter-connectedness of these roles may expose them to additional role stress by their White colleagues. Role conflict emerges when Black nurses or nursing students experience devaluing of their achieved professional roles by their peers. Such devaluing may result when Blacks internalize residual remnants of oppression (Alleyne, 2004). Doing so may lead to role conflict, given that Black nurses experience multiple and simultaneous oppressions (Wilson, 2007). Black nurses at times may be confronted with White nurses whose intrinsic motivation stems from unconscious bias and the residual effects of a legacy of racism, resulting in barriers or obstacles to the successful progression of their Black colleagues and peers and their full integration as members of the professional nursing community (Wilson, 2007, p. 148).

Possible solutions to address these problems include promising interventions at professional, organizational, policy, and individual levels. Previous research has identified the need for curriculum changes that confront the persistence of racism (Bednarz, Schim, & Doorenbos, 2010; Gardner, 2005; Mobily, 1991; Terhune, 2006). Organizational changes may include using survey tools to assess levels of diversity, instances of discrimination, or institutional racism followed by measures to address these issues and change the organizational culture. White nurses can be catalysts for change by looking inward to identify biases that may lead to acts of discrimination and racist behaviors toward Black nurses. Black nurses, too, must look inward to identify self-imposed oppressive behaviors and liberate themselves from internalized oppressive thoughts related to race and ethnicity (Roberts, 2000) and develop a positive professional identity. Feminist theory, which may be applicable in relation to race as well as gender, supports the use of storytelling and autobiographic accounts to identify experiences of different forms of oppression, such as racism, classism, sexism and power (Chinn, 2003; Collins, 2000; Frankenberg, 1993; Friedman, 1998; Maher & Tetreault, 2001; Tisdell, 2002).

A conceptual framework of role conflict among Black nurses emerges with the proposition that Black nurses are viewed within the context of their ascribed rather than their achieved role. Wilson (2007) examined the lived experiences of Black nurses and found that it was not ensured that Black nurses would be accepted by their peers or patients based on their credentials, abilities, and expertise. Wilson (2007) noted that Black nurses had to continuously prove themselves, even when their credentials were at a higher level than those of their White peers. For example, one nurse stated, “The color of your skin should never affect the reason for you getting a job. But it has. And I know that for a fact. Because when you consider the credential, mine outweighed the other applicants. But I did not get the job. What other reason besides, I am Black?” (Wilson, 2007, p. 146). Participants in Wilson’s (2007) study used words such as racism, prejudice, and discrimination to describe what they encountered in the work environment. Further, participants verbalized they encountered racial stereotypes, unfair and unequal treatment, and harassment in the workplace (Wilson, 2007).

Figure 1 depicts a process of impressions. The first block depicts the initial encounter (first impression) of the role occupant (Black nurse) by the role sender (another nurse). The role sender initially views the Black nurse based on racial attributes and places him or her into a racial category, which may lead to role stress for the Black nurse. The second block depicts the Black nurse’s experiences that lead to role strain while engaged in his or her achieved role (licensed and credentialed nurse, or nursing student), where role obligations are mutually exclusive and conflicting. The third block depicts the role conflict resulting from the combination of role stress and role strain.

Emerging graphic depiction of minority nurse role conflict.

Figure 1. Emerging graphic depiction of minority nurse role conflict.

Figure 2 depicts Black nurses’ struggle to balance ascribed roles and achieved roles. As illustrated by Figures 12, role conflict results from mutually exclusive role sets. Ascribed roles and achieved roles intersect, and first impressions are usually based on the ascribed role set rather than on the achieved role set. The perception that others view him or her within the context of the ascribed role leads to role strain when the Black nurse encounters horizontal abuse from colleagues or fellow students. Black nurses feel scrutinized and held to a higher standard than White colleagues, and they feel their achieved role is delegitimized as they strive to be accepted in their achieved role (Sims & Napholz, 1995).

Black nurses balancing ascribed and achieved roles.

Figure 2. Black nurses balancing ascribed and achieved roles.

Research regarding strategies that promote engagement of racial conflict holds promise for nursing education. Curriculum changes might include antiracist pedagogy to engage stakeholders (nurses, faculty, clinical staff, and students) in open and candid discourse and collaboratively developed race-based simulation scenarios to encourage dialogue in a safe environment. Class assignments to build cultural competence could include conversations and role-playing related to the challenges experienced by Black nurses in the workplace and academic environment.

Future research could focus on variables and strategies that mitigate the physical and psychosocial effects of role conflict, using both qualitative and quantitative approaches. Qualitative inquiry using narrative analysis and storytelling by White and racially diverse researchers could be used to explore the characteristics White nurses observe when first meeting minority nurses, as well as Black nurses’ perceptions of being devalued and delegitimized in their achieved roles.

The findings of this review are consistent with those of earlier research that the experiences of perceived racism and discrimination are stressors that create role stress, role strain, and role conflict and, in turn, affect the physical health and psychological well-being of Black individuals (Clark et al., 1999; Harrell et al., 2003). For example, exposure to racism has been shown to result in depression and increased blood pressure (Fernando, 1984; Harrell et al., 2003), providing evidence that Black nurses’ and nursing students’ treatment by their White colleagues, peers, and faculty can lead to adverse health consequences.

This review supports the phenomenon of Black nurses and nursing students experiencing role conflict in their professional roles, specifically when their ascribed role (race) adversely affects how they are perceived in their achieved role (professional nurse). Although these findings provide preliminary insight into Black nurses’ experiences with role stress, role strain, and resultant role conflict, it is imperative that both nurses and nursing students of all races continue to reflect on their personal experiences with and views about racism, including addressing ways to uncover unconscious biases and, in turn, build equitable, collegial, and supportive work and professional environments.

Limitations

One limitation of this review was the scarcity of research articles that specifically examined the phenomenon of racism within the nursing profession and minority nurse role conflict, specifically among Black nurses. The research based on the published literature infers that role stress and role strain contributed to feelings of role conflict related to perceived racism among minority nurses, and not necessarily only Black nurses. The review also does not cover age-related roles in depth, as years of exposure to racism, role stress, and role strain may alter Black nurses’ perspective or experience with role conflict in their roles as providers of care, managers of care, and members of the nursing profession.

Conclusion

To begin the dialogue of racism, its accompanying behaviors, and its potential psychological, social, and physiological consequences, the nursing profession must first acknowledge that racism is endemic within its culture. Specifically pertaining to this review, Black nurses and Black nursing students must be allowed to be visible, encouraged to speak in their own voice, and supported in their efforts to contribute to the profession consistent with their achieved roles and without hindrance. The status of nursing as a caring profession is at risk if White nurses continue to devalue Black nurses and nursing students. A lingering question is whether nursing’s commitment to a culture of caring and compassion applies to peers and colleagues as well as patients, and whether the profession’s espoused commitments are reflected in interactions with Black nurses and nursing students .

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Synthesizing Qualitative Studies With Use of Noblit’s and Hare’s (1988) Framework

StepDescription
1Getting started: Identification of query words.
2Deciding on what is relevant: Themes not directly related are excluded.
3Reading the studies: Framework of the identification of a practice issue.
4Determining the relationship of studies: Development of a table to provide an overview.
5Translating the studies: Tables created for each category to develop a profile.
6Synthesizing the translation: Reduce the findings into similar categories to summarize.
7Expressing the synthesis: Tables with supportive illustrations.

10.3928/01484834-20130819-04

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