1. Pickler, Rita H.

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Racism is a public health crisis affecting mental, spiritual, and physical health, as well as overall quality of life. The National Commission to Address Racism in Nursing, established in January 2021 by the American Nurses Association, the National Black Nurses Association, the National Coalition of Ethnic Minority Nurse Associations, and the National Association of Hispanic Nurses, will examine the issue of racism within nursing. The Commission's overall mission is to set as a standard of practice that nurses confront and mitigate systemic racism within nursing, including developing strategies to address racism within nursing education, practice, policy, and research (American Nurses Association, 2021).


Prior to the Commission being established, the American Academy of Nursing (the Academy) hosted an Institute for Nursing Leadership Critical Conversation on Health Equity and Racism in collaboration with its Diversity and Inclusivity Committee at the Academy's 2020 Virtual Policy Conference. The Institute for Nursing Leadership Critical Conversation on Health Equity and Racism focused on stimulating discussion and gathering diverse views on equity, inclusion, and social justice. One of the key points from the discussion was the need for nurses to examine how they relate to the populations they serve in practice, education, and research. Specifically, the Academy's proposed actions include support for antiracism in nursing scholarship, research, and grant funding to raise awareness of and consider many solutions to racism (American Academy of Nursing, 2021). One suggested course of action was to conduct research about the effects of racism on health inequities within multiple underrepresented populations. This includes examining the ways multiple communities affected by health inequity, a leading adverse outcome of racism, might be involved in research to increase trust and, perhaps, increase scientific work around problems of significant community interest.


The new Future of Nursing document, although mostly silent about the substantive nature of nursing science, also speaks to the need for nursing to address health equity and reduce health disparities, with a call for nurses to study interventions aimed at reducing health disparities. Notably, interventions that are effective at reducing disparities in the short term (e.g., interventions to improve rates of cancer screening) need longitudinal study of their sustainability and long-term effectiveness on improving health equity (National Academies of Sciences, Engineering, and Medicine, 2021). Most recently, the National Institute of Nursing Research (NINR) issued its Strategic Plan Working Group Draft Framework (NINR, 2021). The framework sets goals for the NINR, presumably linked to future funding, with the first goal being that nursing science will focus on dismantling structures that perpetuate racism and impede health equity.


To some extent, nurse scientists are already well engaged in the work called for by these national groups. On its website, the NINR notes that of the work it funds, over 75% supports clinical research, including that of 32% of its funded researchers who focus on research to eliminate health disparities. The NINR website also notes that over 75% of applications submitted to NINR focus on topics on which African American investigators apply, the second highest percentage at the National Institutes of Health. Furthermore, one hopes that the greater than 50% of NINR-funded prevention projects that include randomized trials testing interventions also focus on, at least in part, efforts to reduce racial disparities. Importantly, more than one third of NINR's budget supports research on preventing chronic conditions, which certainly incorporate diverse populations and those who have experienced health inequities. These numbers reflect only those research projects funded by the NINR. Clearly, many more nurse scientists have focused their studies, if not their careers, on examining health determinants, including those associated with racism, and developing and testing interventions to improve health outcomes in diverse populations.


The question now is what do these initiatives, reports, frameworks, and data reveal about the work of nursing science? On one hand, it is clear that nursing science, at least that supported by the NINR, has historically included diverse populations and been conducted by scientists from diverse backgrounds. In fact, in earlier editorials, we have noted that nursing science has a goal of studying the most important health concerns of diverse populations. That goal certainly includes careful study of differential effects of health determinants across diverse populations. It also includes deliberate study of the effects of biobehavioral and systemic interventions on health outcomes across the life span and across diverse peoples. On the other hand, we wonder if all scientific activity should be focused on confronting and dismantling racism. More specifically, should all nursing science focus on racism?


For at least a year, all sentient persons have been grappling with their own thoughts and behaviors around racism. Individually and collectively, we have engaged in renewed efforts to uncover our "hidden biases" and develop different, better ways of thinking and being. As an editor, I have tried to consider my own scientific and editorial biases, especially regarding papers about the effects of racism and discrimination on health and well-being. I have particularly searched for and tried to "recruit" papers reporting on tests of interventions designed to stop the long-standing adverse effects of a racially biased social world that clearly is reflected in long-standing health disparities. Regrettably, few authors submit these papers to the journal.


Nursing science has a well-known, respected focus on health promotion, disease prevention, and outcome improvement across acute and chronic conditions. Nursing science should and does include diverse persons, families, and communities, especially those who experience health inequities related to adverse health determinants. The foundations of nursing science-from phenomenological to mechanistic-are strongly rooted in a focus on improving health for all. That focus should continue to build on existing nursing science and extend the progress made in important areas of symptom science, palliative and end-of-life care, and wellness. We should additionally continue to employ omic strategies in our work and to study the effects of a multitude of factors (i.e., through the use of "big data") on health outcomes for all.


Very clearly, as a society, we must work on dismantling racism. We must be always aware of the effect that our words and actions have on people, no matter their background. However, nursing science alone cannot accomplish the work needed to dismantle racism. Moreover, the dismantling of racism cannot be the primary focus of nursing science; there is too much at stake scientifically and professionally. Although we must be firmly committed to health equity and we must test interventions to remove inequities and their ill effects, those important areas of focus cannot be the sole emphasis of our science. Rather, we need a balanced approach to the priorities of nursing science in order to provide evidence for safe and effective practice and better health outcomes for all. Let me be clear: I am not suggesting that nurse scientists ignore the importance of racism on the health of those we aim to serve through our science and practice. We must eliminate racism. However, racism cannot be the only determinant considered among the vast array of health determinants that are so critical to the health of humans.


In keeping with the spirit of our commitment to address important health concerns, we draw your attention to the supplement attached to this issue of Nursing Research entitled "Racism, Stress, and Health." All eight articles focus on the effects of racial or ethnic discrimination on stress responses and/or health outcomes. The populations of interest include African American women, youth, and children, as well as women from Southeast Asia. Collectively, the results of these descriptive studies reveal the effects of race and racism, experiences of discrimination, and exposure to health disparities on stress and other health outcomes. The study results also demonstrate that people at great risk for poor health through no fault of their own doing are also capable of mastering the challenges of racism and discrimination, given supportive environments. These enlightening results should be the focus of intervention work-to bring strength to people when, where, and how they need it.


At Nursing Research, we remain committed to reporting scientific findings that advance understanding of all aspects of health. We will continue to publish research across the spectrum of biological, behavioral, psychosocial, spiritual, and cultural factors in health. We remain particularly interested in nursing intervention and outcome research, and we will continue to publish basic, translational, and clinical research findings. We also will continue to seek papers where researchers present new or advanced research methods and analytic strategies; these papers are particularly important as we expand our scientific teams to greater inclusion of those to whom it really matters-the diverse populations our research aims to help.


Nursing science is surely moving forward, confronting the most important of human health concerns, including those on which our practice and discipline are based. At Nursing Research, we look forward to our scientific evolution and to the continued commitment to improve health for all.




American Academy of Nursing. (2021). A critical conversation on health equity and racism: Summary report.[Context Link]


American Nurses Association. (2021). The National Commission to Address Racism in Nursing reflects on nurses' vast contributions during nurses month.[Context Link]


National Academies of Sciences, Engineering, and Medicine (2021). The future of nursing 2020-2030: Charting a path to achieve health equity. The National Academies Press. 10.17226/25982 [Context Link]


National Institute of Nursing Research. (2021). NINR strategic plan (2022-2026)-Under development.[Context Link]