In June 2020, when millions took to the streets in the midst of a pandemic to protest police attacks on Black lives, public statements began to trickle out of major nursing organizations. The American Nurses Association (ANA) called racism “a public health crisis,” while the American Association of Colleges of Nursing declared that “racism will no longer be tolerated.” In fact, since its inception, organized nursing has not only tolerated racism but also actively practiced it, while those who have provided the field with both evidence and opportunity to make antiracist change have found themselves facing the weaponized inertia of the institutions which claim to represent them.
In the 1970s, buoyed by the momentum of the Civil Rights and Black Power movements, Black nurse and activist Marie Branch took on the challenge of implementing antiracist philosophy and practice in nursing education. Branch, an assistant professor of nursing at the University of California, Los Angeles, co-founded the Black Panther Party’s Free Clinic in Los Angeles at the end of 1969 and traveled to China as part of a Black Panther Party delegation in 1972.2 This affiliation alone placed her at the vanguard of a field whose major professional organization, the aforementioned ANA, was declared “obstructionist” by the Black Panther Party–associated Medical Committee for Human Rights in 1971.3
Branch nonetheless believed that nursing had the power to effect radical change in ways other health professions could not. She saw nursing as singularly “free to innovate and improve practice,” unencumbered by either elitism or payment models which prioritized quantity over quality.4 In order to fulfill its revolutionary potential, however, the field would need to adopt a philosophy she named “ethnic humanism,” which she described in terms of its component concepts:
“Ethnic inclusion” for any purpose was a distant dream: in 1972, the U.S. Division of Nursing estimated that only 5 percent of registered nurses were Black, while 93 percent were white, and 2 percent were identified simply as “other.”6 Even at the Alprentice Bunchy Carter Clinic that she had helped to found, Branch was one of few Black healthcare professionals, reflecting the broader underrepresentation of those she termed “ethnic people of color” in her field.7
In 1971, Branch took the helm of a three-year project designed to provide nursing faculty with the tools they lacked to attract and support students of color, who were entering nursing schools at lower rates and dropping out at higher rates than their white counterparts.8 This problem was particularly acute in baccalaureate programs, which were being heralded as the new standard for entry to practice and would put students on the most likely path to professional advancement.9
The project consisted of workshops and follow-up consultations with faculty from forty-five nursing schools across the western United States.10 Results were largely positive: among participating programs, most increased their enrollment of students of color over the workshop period, and many reported an increase in resources directed toward tutoring and support services. However, faculty participation was repeatedly cited as a barrier; Branch’s final report noted that some white faculty (who comprised the majority of participants) exhibited defensiveness and denial, and expressed feelings of powerlessness to make change. Using an anti-Black epithet to drive her point home, Branch observed that for many white participants, “this was their first experience as a … nonentity without power or identity.”11
In a second three-year project targeted at curriculum reform, she rebuked nursing’s usual practice of exploiting both nurses of color and cultural information as tools to achieve patient compliance.12 Cultural diversity, Branch held, “should be a means of improving the condition of ethnic group peoples . . . Culturally specific information should be used as a means of preparing nurses who will become advocates for the ethnic groups under discussion.”13 Having aimed for institutional and policy change, Branch concluded with some disappointment that this project seemed to have had more effect on individual participants than on educational systems.14
To extend her work’s reach and impact, in 1976 Branch co-edited a textbook called Providing Safe Nursing Care for Ethnic People of Color with Phyllis Perry Paxton. The book contained chapters written by nurses who had participated in the California Nursing Association’s Minority Group Task Force as well as subsequent workshops and projects. It expanded on the ethnic humanism framework, outlined guidelines for safe nursing care for people of color, and explicitly critiqued organized nursing both past and present, including a scathing analysis of the American Nurses Association. In perhaps its most prescient moment, the “Epidemiology” chapter stated frankly: “racism must be addressed as a factor in disease causation.”15
Providing Safe Nursing Care for Ethnic People of Color was reviewed on the American Journal of Nursing‘s “Books of the Year” list for 1977, perhaps somewhat surprisingly, given that the AJN was the official publication of the American Nurses Association.16 Despite this promising start, it was not widely adopted into nursing school curricula, nor was it extensively cited.17 Evelyn Barbee, an anthropologist and contemporary of Branch who has written about racism in the nursing profession, recalled, “Marie was way ahead of her time . . . . [The reaction to her work] was very dismissive. There was a level of frustration.”18
By the mid-1980s, Branch’s view of nursing’s trajectory was grim: “nursing has jumped on the bandwagon of reactionary, conservative attitudes toward ethnic inclusion much more quickly than we moved toward equal opportunity for people of color.”19 Branch herself had become a chiropractor several years earlier; her reasons for this career shift are a matter of speculation, but one can imagine her work within nursing felt Sisyphean.20 Her assessment appears to have been correct: as of 2017, Black nurses still made up only 6.2 percent of the RN workforce, which remains 81 percent white. There are still no formal accountability processes for nursing programs that fail students of color, and “culture” in nursing is still taught primarily through the “deficit-deficiency” lens that Branch deplored.21 And almost a half-century after her textbook’s publication, racism is only just beginning to be taken seriously as a factor in disease causation.
“Ethically and morally, we are headed toward ‘business as usual’. … This mood in nursing echoes the mood in the nation as a whole, and it is a dismal prospect for both.”22 Branch’s 1985 warning rings eerily apropos today. Statements issued by nursing organizations condemning racism and calling for “liberty and justice for all” may seem appropriate and reassuring at this moment, but the history of organized nursing’s failure to embrace anti-racist interventions – to change when given every opportunity to change – will require more than words to demonstrate their sincerity.
- Marie Branch and Phyllis Perry Paxton, Providing Safe Nursing Care for Ethnic People of Color (Appleton-Century-Crofts, 1976), xvi. Return to text.
- Marie Branch, “A Black American Nurse Visits the People’s Republic of China,” Nursing Forum (October 1973): 403–11; Marie Branch, “Models for Introducing Cultural Diversity in Nursing Curricula,” Journal of Nursing Education 15, no. 2 (1976): 7–13; Marie Branch, “Catch up or Keep up? Ethnic Minorities in Nursing,” Urban Health, 1977, 49–52; Alondra Nelson, Body & Soul: The Black Panther Party and the Fight against Medical Discrimination (University of Minnesota Press, 2011), 62. Return to text.
- Medical Committee for Human Rights, Letter from Medical Committee for Human Rights to Margaret F. Carroll, January 19, 1971. From American Nurses Association Collection, Howard Gotlieb Archival Research Center at Boston University; “ Mildred Pitts Walter oral history interview conducted by David P. Cline in San Mateo, California, 2013 March 01,” From Library of Congress, Civil Rights Oral History Project. Film. Accessed June 27, 2020. Return to text.
- Branch and Paxton, Providing Safe Nursing Care for Ethnic People of Color, 3. Return to text.
- Branch and Paxton, 5. Return to text.
- “Source Book Nursing Personnel: Health Manpower References.” DHEW Publication No. (HRA) 75-43, (US Department of Health, Education and Welfare, December 1974), 31. This estimate represents a revision of 1970 federal census numbers based on later data collected by the National League for Nursing, and the estimators expressed some uncertainty in their tabulation. Return to text.
- Nelson, Body & Soul, 87; Mildred Pitts Walter, a staff consultant on the WICHE Projects, stated in her 2013 oral history that Branch and her cohort were the first to use the term “people of color.” While the term had been used in the 1960s, they were certainly among its earlier promoters. Return to text.
- Marie Branch, “Faculty Development to Meet Minority Group Needs: Recruitment., Retention, and Curriculum Change, 1971–1974” (Western Interstate Commission for Higher Education, 1975), 6. Return to text.
- Branch argued that the push for the BSN as the standard for entry to practice represented “one of the greatest threats to ethnic inclusion in nursing.” Marie Branch, “Ethnicity and Cultural Diversity in the Nursing Profession,” in Current Issues in Nursing, eds. Joanne C. McCloskey and Helen K. Grace, 2nd ed. (Blackwell, 1985), 937. Return to text.
- Marie Branch, “Catch up or Keep up?” 51. Return to text.
- Marie Branch, “Faculty Development to Meet Minority Group Needs,” 2. Return to text.
- Originally funded for three years, from 1974–1977, the project was then extended for an additional six months. Return to text.
- Marie Branch, “Models for Cultural Diversity in Nursing: A Process for Change. Final Report.” (Western Interstate Commission for Higher Education, July 1978), 7. Return to text.
- Marie Branch, “Models for Cultural Diversity in Nursing: A Process for Change. Final Report,” 113. Return to text.
- Branch and Paxton, Providing Safe Nursing Care for Ethnic People of Color, 130. Return to text.
- Carolyn M. Hudak, “Providing Safe Nursing Care for Ethnic People of Color,” American Journal of Nursing 77, no. 1 (1977): 71. Return to text.
- Telephone Interview with Evelyn Barbee, April 15, 2019. Google Scholar results for search term Providing Safe Nursing Care for Ethnic People of Color returns 75 citations over 44 years; in contrast, a search for Madeleine Leininger’s 1970 Nursing and Anthropology: Two Worlds to Blend returns 458 citations over 50 years.Return to text.
- Telephone Interview with Evelyn Barbee, April 15, 2019. Return to text.
- Branch, “Ethnicity and Cultural Diversity in the Nursing Profession,” 936. Return to text.
- “Mildred Pitts Walter oral history interview conducted by David P. Cline in San Mateo, California, 2013 March 01,” From Library of Congress, Civil Rights Oral History Project. Film. Accessed June 27, 2020. Return to text.
- Branch and Paxton, Providing Safe Nursing Care for Ethnic People of Color, 8. Return to text.
- Branch, “Ethnicity and Cultural Diversity in the Nursing Profession,” 936. Return to text.
Terrific piece as are all of those in this special series in Nursing Clio. If I was still teaching I’d use them all in my classes.I only wish the ANA had taken the step of so many health provider and scientific groups and made an endorsement in this election.
Thank you Cory Ellen for this wonderful report! So important for all of us who are concerned that our efforts today do not suffer languishing in the annals of history – but instead make real change!