Critical Lessons & Educational Change

A letter to my colleagues about educating future nurses

Ellen Smith

December 2010

Dear Friends and Colleagues,

We are professional nurse educators and reflect a long, storied history of modern nursing that began with Florence Nightingale. As you know, Nightingale was a well-to-do English lady, cultured and sincere, with high ideals and intelligence. She was a brilliant statistician, educated by her father in the mid-1800s when most women learned only domestic skills and social etiquette. She defied her family in the 1850’s by going to the Crimean War, where her legacy as a nurse and epidemiologist saved countless lives. She was a non-conformist and forward–thinker, rejecting her parent’s push toward marriage in favor of nursing service. Nightingale was zealous about her calling, and her family was wealthy and influential. Her societal position and political connections enabled her nontraditional work and popularity. She became an icon, re-defining nursing world-wide, and by her example also narrowly defined the modern nurse by gender, ethnicity, and class. Americans modeled the nursing profession in her image and thus largely excluded racial minorities and men for more than 100 hundred years.

My friends, we have come to professional nursing under Nightingale’s ideological influence, and we still exist in her likeness. We, like her, are all white women of comfortable means. We reflect the profession’s social order that continues to benefit nurses who look like us. We are representative of the majority demographic, both products and producers of social injustice, knowingly or not. We fit the stereotype of “nurse” in the most traditional sense, physically mirroring Nightingale’s legacy. We are socially perceived and positioned daughters of our white, privileged nursing mothers.

“Reproduction theory concludes that schooling reproduces hierarchical class relations in American society and culture” (Conchas, 2006, p.8). American society is built upon this tradition and premise of inequality, and even our department is guilty of actions that perpetuate inequalities based on race, gender, and sexual preference.

I’ll explain what I mean. Our students don’t fit the Victorian image of “nurse”; they are demographically different than our founder, and from us. For that I am grateful and excited about the future of our profession. A multitude of lenses and experiences will strengthen our profession through improving quality of patient care and research. Most of our students are not white, privileged women. They are breaking new ground, changing the face of nursing for the better. They will soon succeed us as nurse educators to break the cycle of social reproduction and advance our profession. It is already beginning, as many nursing leaders are people – women and men – of color. Yet the number of minorities and men in our profession do not match the national demographics. We, fellow nursing professors, are unwitting obstacles to diversifying the nursing profession.

Because education at its best creates public spaces for people to come together with their own hopes and dreams and aspirations and experiences, education is essentially a process that opens doors and opens minds – anything that constrains or limits or closes is an enemy of education. Racism, sexism, homophobia, and other forms of organized oppression are anti-education (Ayers, p. 165 in Jelloun, 1999).

As William Ayers explains, we need to fight all forms of oppression, and consciously approach all students as true equals and learners of distinction. A mix of races and genders and religions in a class does not equal an integrated class. We must actively affirm student identities, deliberately disrupt biases, orchestrate challenging conversations, and intentionally diversify work groups.

Racism, sexism and homophobia in schools are born out of stereotypes. Research shows that teachers and students form judgments of others based on appearances and preconceived ideas, not just actual behavior (Conchas, 2006). This affects who feels empowered to participate in class and who is most anxious regarding test-taking. Colleges, even ours, perpetuate structural discrimination in this way, reproducing educational and economic inequalities. Students for which we have high expectations become most academically and financially successful, and meet our expectations. Those with lower assigned expectations also fulfill them, and often do not finish college. Which students do you expect to succeed? Do they share your demographic?

Tests are especially stressful for students affected by low expectations, seeing themselves as poor test-takers. We need to affirm identities and academic confidence, so that students can face finals and the State Registration Exam for Nurses without undue stress which affects test performance. Test-taking practice may decrease this anxiety, but likely it will not be as helpful as actively learning from several perspectives and applying concepts in practice. Enthusiastically engage all students to improve learning, minimize anxiety and maximize performance.

My dear friends, we cannot change the past. We can recognize that we physically represent a historically exclusionary profession. We can stop our silent support for institutional discrimination. If you accept these points, you must be wondering what to do. How do we counter stereotypes and systemic discrimination? How can we best educate and encourage future nurses?

First, remember our appearance and our actions are perceived by our students as threatening, even scary. Students detect racism (or sexism, or homophobia) through micro-inequities – teaching methods, small actions, and differences in attention. Our threat to our students is compounded by our position of power as teachers, responsible for validating good work and correcting substandard work. We are required to not only educate and evaluate skills and knowledge needed to provide competent care. It is also our job to validate students as unique individuals that make our workspaces interesting and vibrant. Please, be critically reflective of your own actions. Assess who you involve in class discussions, how you orchestrate group work, and how you empower all of your students.

Second, be aware of actions and words, both yours and your students’, which can be deleterious to the already marginalized. Never allow even vague disparaging remarks regarding welfare, gang members, or recent immigrants without your immediate correction and clarification. Hepatitis B, HIV, gun violence and teenage pregnancy are never the fault of the victim, but a result of larger societal ills. Thoughtless comments are taken very personally by anyone ever in need of public assistance, or who has lost a family member to violence or has suffered from inequities. Students, especially those most vulnerable, will be silenced by unthinking remarks like these. Instead, model positive acknowledgement and affirmation of student perspectives and views, and insist on professional respect of all persons. Set ground rules regarding courteous communication. It is easy to repeat negative patterns of behavior, so be watchful and intervene to prevent student silencing.

Third, reverse the norm. Center those often left on the margins. Students will self-segregate, as you have no doubt noticed in your classes, just as students segregate themselves along racial lines throughout American schools. This can be remedied through simple seat assignments and work-groups. Intentional team-building and get-to-know- you activities are vital for interaction between groups of students in the classroom and lab, and require your leadership. Purposeful groupings of diverse students will help overcome the structural racism experienced (though not acknowledged) by everyone in our schools. Direct discussions and problem-solving pedagogy will place high value on each student contribution. This is good for all our students, both personally and professionally.

Learning environments and pedagogy can be richer if we spend more time early in student careers affirming and sharing differences and verbally valuing various identities and perspectives. This change in attitude and approach will affirm differences, enhance learning and improve professionalism in nursing. We can make our classroom an oasis for students; a place where anxiety is reduced, and eagerness to learn is increased.

Friends and Colleagues, I love working with you! I respect your abilities and intentions, and therefore want to partake in self- reflection of how we do what we do. Let us critically review our actions, as well as those of our students. To ignore or avoid differences of appearance, culture, and opportunity among our students is to perpetuate the societal norm in nursing that favors those that look like us, over those who do not. Please read to increase your awareness (suggested references attached), as this is not just my crazy idea, though you may think so. Then, let’s talk, confronting changes needed in attitude and pedagogy that will enhance us personally and professionally. As Ayers states, we must “look unblinkingly at our history, face our construed reality, confront the tears of the wounded, the consequences of wickedness; we must harness ourselves, then, to a great collective effort toward justice” (p. 167, in Jelloun, 1999).

I’ll chill the wine, and I look forward to hearing from you!




Ayers, W. (1999). To the bone: Reflections in black and white. In T. B. Jelloun, Racism explained to my daughter. New York: New Press.

Conchas, G. Q. (2005). Introduction; Chapter 1: The racial dichotomy and challenges confronting students in American schools: Toward a conceptual framework of urban school success. In The color of success: Race and high-achieving urban youth (pp. 1-6; 7-19). New York: Teachers College Press.

Jelloun, T. B. (1999). Racism explained to my daughter. New York: New Press.

Markus, H.R., & Moya P.M.L ( 2010). Doing race: 21 essays for the 21st century New York: Norton.