1. Black, Terrie DNP, MBA, CRRN, FAHA, FAAN

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"Empathy, not sympathy." These words really struck a chord with me as I listened to a recent podcast by Brene Brown (2013). What exactly does that mean? As I think about the recent events occurring in our nation that have caused pain and grief (amidst a pandemic), it's an ideal time to reflect and to challenge what it is we think we know about race, racism, privilege, and empathy. Do we, as nurses, recognize the difference between empathy and sympathy?


In a recent webinar, "Antiracism: Move to Action-A Conversation with Dr. Camara Jones," Dr. Jones challenged viewers to consider three things (Jones, 2020):


1. Define or name racism.


2. Ask "How is racism operating here?"


3. Organize and strategize to act.



First, we must define or name racism and acknowledge it exists. Racism occurs when prejudices, negativity, or discrimination target a person or group of individuals, depending on their race, language, ethnicity, or culture. Racism can be discernable, or it can be subtle.


If we are white, we must acknowledge and overcome white fragility-those feelings of discomfort a white individual may experience when discussing racism or racial inequality (DiAngelo, 2018). This fragility may entice one to disengage and avoid situations or discussions where racism is discussed. This may then cause people of color to avoid discussing racism with that individual. We must provide and foster an environment in which open, honest, and safe dialogue can occur. Being silent about racism is complacent and, quite frankly, unacceptable.


One must determine how racism is operating within a facility, organization, or community. How we see an individual and how that individual identifies often differs. Black or Brown individuals from Africa may have very different cultures, beliefs, and traditions versus those from the Caribbean or North America. Beliefs and culture cannot be assumed based upon one's skin color, nor should we assume an individual identifies as a particular race based upon skin color. Put quite simply, race, culture, and ethnicity are not interchangeable terms.


As Keeton (2020) notes, when examining practices within nursing education, most notably through case studies, nursing students may be presented with information about a patient that inadvertently may form biases. For instance, is it necessary to indicate that the 50-year-old patient in respiratory distress is Black? Rather, it is important to provide individualized, person-centered care in a respectful manner within the context of the patient to avoid racism.


Jones (2000) describes a theoretical framework about the three levels of racism: institutionalized, personally mediated, and internalized. Institutionalized racism includes inherited disadvantage or inaction in time of need. Personally mediated racism includes prejudice (assumptions about others based on race) or discrimination (behavior toward others based on race). These acts of omission or commission may involve a lack of respect or service, suspicion, or hate crimes. Internalized racism is acceptance by marginalized individuals of the negative stereotypes portrayed of them. This results in devaluing oneself, resignation, and hopelessness.


To eliminate racism in this country, we each need to do our part. Systemic racism exists through various societal, political, and individual constructs. We must break the cycle of oppression and call out discrimination when we see it. What are the public policies that need changing? What are the larger system issues? What can be done to ensure public and health policies are created to ensure a system that is equitable, fair, and balanced for all? We have data that affirm that health disparities exist in certain populations and in certain health conditions. However, additional exploration and policy reform need to occur to ensure all individuals have access to healthy food; a safe environment for physical activity; and access to affordable, preventative care, regardless of race and not just for the privileged or wealthy. We must commit to providing health equity for all, which means everyone has an equal opportunity to live a long and healthy life regardless of race, ethnicity, or culture.


Commit to Action

As nurses, we abide by the Code of Ethics for Nurses. Provision 8 within the Code of Ethics explicitly addresses "social justice" as part of clinical practice. We need to advocate for health equity for all. Nurses must acknowledge, validate, respect, and be responsive to the different needs of the patients we care for. The American Nurses Association (ANA) has adopted a resolution on racial justice for communities of color that every nurse should become familiar with (ANA, 2020). We must pledge to end racism and the social injustices that occur within the human race; as nurses, we are obligated to do so (ANA, 2015).


We must act and not merely articulate changes to the system in which racism exists. Having difficult conversations and moving out of our comfort zone to allow dialogue to occur is necessary. Putting ourselves in the place of others so that we may empathize must be apparent. Asking "what can I do?" and acknowledging feelings, frustration, and, yes, even anger, amidst those populations experiencing prejudice and racism is a start. Acknowledging that white privilege exists is imperative.


We often hear there is no "I" in team; however, when it comes to inclusion, it does begin with "I." We must assess our personal values, perceptions, and any biases and be willing to set aside any preconceived prejudices and stereotypes as we provide competent care with an open mind. We must be objective and not become defensive when people of color or marginalized individuals share personal experiences and examples of racism. We must consider others' perspectives and commit to overcoming ignorance (or denial) of racism. The George Floyd story had a profound effect on me-how could this happen? I realize I can do better not only as a nurse, but as an individual. I am by no means an expert on this issue; however, I have committed to having conversations with family, friends, and colleagues on social justice to end racism. As nurses, we need to become better informed and not just be an ally but to create an "allyship." We must have empathy-that connection to others through understanding by putting ourselves in their place-not mere sympathy or pity.


I challenge each of you to identify actions you can take: perhaps become better informed on racism, advocate for a policy change to eliminate racism, have a conversation about these issues with others, or increase your awareness of the unique needs of each patient you care for. Commit to provide care without judgment, bias, or prejudice and do your part to eliminate racism.


Conflict of Interest

The author declares no conflict of interest.


Terrie Black, DNP, MBA, CRRN, FAHA, FAAN


ARN Past President, 2003-2004


RNJ Editorial Board Member




American Nurses Association. (2015). Code of ethics for nurses.[Context Link]


American Nurses Association. (2020). ANA's Membership Assembly adopts resolution on racial justice for communities of color.[Context Link]


Brown B. (2013). Brene Brown on empathy.[Context Link]


DiAngelo R. (2018). White fragility: Why it's so hard for White people to talk about racism. Boston, MA: Beacon Press. [Context Link]


Jones C. (2000). Levels of racism: A theoretic framework and a gardener's tale. American Journal of Public Health, 90(8), 1212-1215. [Context Link]


Jones C. (2020). Antiracism: Move to action-A conversation with Dr. Camara Jones. Webinar sponsored by Simmons College, July 7, 2020. [Context Link]


Keeton V. F. (2020). What's race got to do with it? A close look at the misuse of race in case-based nursing education. Nurse Educator, 45(3), 122-124. [Context Link]