Lesson 3: Historically Black Healthcare Institutions
Standards (AACN entry and advanced)
Domain 1 - Knowledge for Nursing Practice
1.1c Understand the historical foundation of nursing as the relationship developed between the individual and nurse. (Entry-Level)
1.1g Integrate an understanding of nursing history in advancing nursing’s influence in health care. (Advanced-Level)
Domain 3 - Population Health
3.3a Describe access and equity implications of proposed intervention(s). (Entry-Level)
3.4k Evaluate the ability of policy to address disparities and inequities within segments of the population. (Advanced)
Domain 7- Systems-based Practice
7.2b Recognize the impact of health disparities and social determinants of health on care outcomes. (Entry-Level)
7.3d Recognize internal and external system processes and structures that perpetuate racism and other forms of discrimination within health care. (Entry-Level)
Associated Nursing History Framework
- Evidence - Bears witness to early nurses who exercised clinical judgment and created change
- Explanation - Explains present-day community health structures and provides a new lens for future structures
- Pedagogy - Provides space for discussion of racism/discrimination in healthcare
Essential Questions
- What were the advantages and disadvantages of historically Black institutions like Provident as a path toward equity for the Black community?
- What lessons can we learn from the successes and failures of Provident about proposed contemporary health equity interventions?
- What were the advantages and disadvantages of historically Black institutions like Provident as a path toward personal and professional advancement for Black nurses?
- What challenges and opportunities did Black nurses face as a result of their intersecting identities as Black women?
Learning Objectives
- Analyzing historical interventions to the problems of structural racism in healthcare and the limits of those interventions: Students will analyze the challenges and opportunities in the healthcare model of historically Black hospitals like Provident and consider how this history can inform the approaches of contemporary healthcare institutions that serve marginalized communities (AACN 1.1c, 1.1g, 3.3a, 3.4k)
- Examining intersectionality of race, gender, and occupation in the experiences of Black nurses: Students will compare and contrast the experiences of Black nurses at Provident Hospital and the contemporary experiences of nurses of color and/or nurses serving marginalized communities (AACN 7.2b, 7.3d).
Introduction (Faculty)
In this lesson, students will explore the history of the Black hospitals and nursing schools that the Black community and white philanthropists created during the Jim Crow period, in response to rampant employment and healthcare discrimination.This lesson asks students to consider Provident Hospital, one of the most famous of these institutions, located in the Bronzeville neighborhood of Chicago, largely through the voices of the Black nurses who passed through the hospital and nursing school. As a Black-founded, primarily Black healthcare institution, Provident provides a useful lens through which to analyze both the lasting legacy of historical racism, as well as the challenges and opportunities faced by contemporary healthcare institutions that serve historically marginalized communities. Provident also provides a case study through which students can consider the experiences of Black nurses in such institutions. This lesson centers the voices of these nurses, who have historically served as background players in the histories of these Black hospitals, despite providing much of the labor that allowed them to function.
This lesson includes two activities, each meeting one of the learning objectives. Faculty can teach the first or second half of the lesson, in any order, to best meet their needs. Ideally, this lesson follows Lesson 1 in the Teaching Care sequence, which extensively explores how Jim Crow-era discrimination and segregation impacted health and healthcare. If the faculty chooses not to use Lesson 1, we recommend providing a short lecture on the topic or have students read this overview of nursing education history up until the section titled “World War II and the Fight for Integration,” and this overview about the realities of health and healthcare access for Black people in this era.
Historical Context (for Faculty) (adapted from “Nursing Education in the United States: An Historical Overview”)
The first nursing schools in the U.S. emerged in the 1870’s after the widespread death and illness of the Civil War made clear the importance of nursing. Wealthy white women nurses founded these schools based on the model of Florence Nightingale, who saw nursing as a profession for white middle and upper-class unmarried women.By the 1890’s, scientific medical advances led to a massive expansion of hospitals. Hospital administrators and physicians (most of whom were male) realized that student nurses provided a source of cheap skilled labor. They created nurse training programs based in hospitals, which soon became the primary nursing education model until the 1960-1970’s.
Student nurses in hospital programs worked long hours running most of the hospitals’ operations, with little classroom instruction or teaching. These new hospital-based programs emerged during the beginnings of the Jim Crow era and they practiced racial discrimination like many other institutions at the time, denying admission to Black students.
Racism in the healthcare system also affected Black patients. Black Americans were rejected from public hospitals or were sent to segregated wards. They were often treated by racist white medical staff, creating a deep distrust of the healthcare system. Historical data indicate that medical advances were improving white Americans’ health outcomes at the beginning of the 1900’s, but the health of Black Americans was deteriorating.
Black physicians, their communities, and white philanthropists responded to these realities by creating a network of Black hospitals and nurse training schools. Some Black physicians founded these institutions because they cared about training Black nurses, and some because they needed a place to treat patients and build their own careers. Many were concerned about racial healthcare disparities. Black communities, particularly Black women, played a critical role in forming and sustaining these institutions. Black women’s clubs recruited nursing students, organized collections of hospital supplies, and raised funds to pay salaries and improve facilities.
These Black hospitals and nursing schools filled a crucial gap. They provided healthcare access for Black communities while creating paths into the middle class for young Black women in a time of rampant employment discrimination. Yet these schools, like all-white hospital training programs, required that students work long, unpaid hours as part of their training. The labor of Black nurses and nursing students was crucial for the survival of the hospitals that served as the cornerstone of African American healthcare during the Jim Crow years.
Some of the earliest Black hospital and nurse training programs included: Mercy Hospital (Philadelphia), Lincoln School for Nurses (New York), Harlem Hospital (New York), Freedman’s Hospital (Washington D.C.), Flint-Goodridge Hospital (New Orleans), John A. Andrew Hospital (Tuskegee, Alabama), and Provident Hospital in Chicago.
Dr. Daniel Hale Williams founded Provident Hospital and Training School in 1891 in response to the reality that Chicago had no schools of nursing that admitted Black nurses, no hospitals where Black doctors could practice, and few hospitals that admitted Black patients.
For more resources on this subject, see:
- Darlene Clark Hine, Black Women in White: Racial Conflict and Cooperation in the Nursing Profession, 1890-1950 (Indiana University Press, 1989).
- Provident Hospital: A Living Legacy - International Museum of Surgical Science
Preparation: Read/Watch/Listen
- Prior to the class session, the following articles will provide students with a crucial historical context for analyzing the oral histories they encounter in this lesson.
Provident Hospital, 1930-1966 (~3,000 words)
Activities Summary: The following is a brief summary of activities included in this lesson. Faculty are encouraged to pick and choose the activities that work best for their students and course. Faculty may also modify activities through adding readings or changing learning modalities, instructions, or evaluation criteria as they see fit.
Activities:
- The Impact of Structural Racism on Healthcare: Students will engage in a discussion on structural racism in healthcare, starting with an analysis of a historical quote about Provident Hospital. They will explore the legacy of structural inequities in healthcare through class discussion and video resources, examining why historically underserved areas remain at-risk.
- Exploring the Role of Black Healthcare Institutions: Students will analyze sources on Provident Hospital and similar institutions, focusing on their contributions as community-led responses to structural racism. Working in groups, students will present findings on Provident’s role in supporting Black health and addressing structural challenges.
Activity Plan 1: The Impact of Structural Racism on Healthcare
Introductory Quotes about the Reality of Structural Racism in Healthcare (class discussion or online discussion forum)
Show students this quote and ask them to guess what place and time the quote is describing:
“Doctors and nurses, forgetful of themselves, underpaid, and careless of sleep, work day and night to ease pain, mend broken bodies and wipe out disease…
Twenty-four hour duty - seven day week - lack of money for expansion, for research, for wages and for training. These are the common elements. Yet the work of healing goes on, 24 hours a day, seven days a week, despite lack of funds…
[The hospital] treats more non-paying patients than other private hospitals its size…Its patients cannot afford to pay full operating costs…”
Lead students in discussion to the ways this quote could easily be describing a modern hospital operating in the present in an underserved, historically marginalized community.
Explain that this is a quote from a 1949 article by Chuck Davis in The Chicago Defender about Provident Hospital. This lesson will challenge students to explore what the history of institutions like Provident Hospital can teach us about the challenges of addressing structural racism in healthcare - in the past and today.
Show students this video clip of Dr. Barbara Norman discussing the ongoing realities of structural inequities in healthcare in Chicago. Note that you may need to explain to students what Dr. Norman means by Chicago’s “wards” (geographic designations within a city, similar to neighborhoods or census tracts) as well as what she means by a “transparency.” (The clear sheet teachers would use with an overhead projector prior to projecting computer screens for a presentation)
Ask students for reactions and discuss: (synchronously or through discussion forum)
- Why would the same wards that were “at-risk” 70 years ago still be at-risk today?
- What does it mean for Dr. Norman, a now-retired nurse and activist, to be reflecting that the same areas of the city are still at-risk? What does that mean for you as someone just entering this field?
Explain that in this activity students will be exploring the story of Provident and other historically Black healthcare institutions. Remind students about the historical context that led to the creation of Provident Hospital from their required reading. Explain that institutions like Provident were an intervention that the Black community implemented in response to the realities of structural racism in healthcare. While we no longer see blatant legalized discrimination in the way we had during Jim Crow, Dr. Norman’s argument in her oral history challenges us to consider what parallels there are between the pre-integration era and today.
Students will be examining a set of sources about Provident and thinking about the essential questions and sub-questions outlined in the attached student guide.
Options for student analysis of sources:
- Split the class into groups of five, with each group member analyzing one source and presenting their findings to the rest of the group. You can also divide the class into five groups and have each group work on one source to present to the class.
- Individual asynchronous written/oral response to essential questions that references a specified number of sources.
- Small group and/or whole class discussion of sources with/without written component
- Big Paper strategy: sources are posted around the room and students circulate and ask and answer each other’s questions.
Optional Extension: Comparing Provident to other Black Healthcare Institutions
If you have more time to dedicate to the Black hospital and nursing school movement, students or student groups could do a short research project comparing Provident to other prominent Black hospitals and nursing schools.
For the case study analysis, students should use at least two secondary sources and 1-2 primary sources and then compare with Provident and how each institution impacted the local Black community - its successes and struggles.
Students can then present to each other about the different nursing schools, giving students an opportunity to learn about how different local contexts impacted different institutions.
Important questions for students to consider:
- How did the local context shape how the institution developed?
- What was the role of white philanthropists or leaders in the institution?
- What was the role of the government in the institution?
- Why do many of these institutions no longer exist? If the institution does still exist, how did it adapt to survive?
- What does it mean for the Black community in each city that these institutions no longer exist? For those that may still exist, what is their role within their community today?
Resources
- Chapters 1-3 of Black Women in White, though the book can be hard to access. Hine’s footnotes are also an incredibly rich place to start research about any of these institutions.
- Darlene Clark Hine, ed. Black Women in the Nursing Profession: A Documentary History. New York & London: Garland Publishing, Inc., 1985.
- See Mapping Care bibliography page
Possible Institutions to Research
- St. Louis City Hospital #2
- Hampton Institute (Virginia)
- Tuskegee Institute (Alabama)
- Lincoln Hospital (New York)
- Syndenham Hospital (New York)
- Mercy-Douglass Hospital (Philadelphia)
- Harlem Hospital (New York)
- Freedman’s Hospital (Washington D.C.)
- Flint-Goodridge Hospital (New Orleans)
- John A. Andrew Hospital (Tuskegee, Alabama)
Activity Plan 2: Exploring intersectionality within healthcare institutions
Introduction: Show students the following quote and explain that a scholar, Georgia Burnette, wrote this to describe the situation that Black nurses face:
“They [are] Black, female, and in a profession still striving for equality and respect within the medical community.”
Ask students to write down 1 reaction and 1 question. Have students share their responses - with the whole class, in small groups, or on an online platform.
Check for students’ familiarity with the idea of “intersectionality” & discuss how the concept relates to Burnette’s quote.
Optional resources (for use asynchronously or during class):
- Kimberlé Crenshaw: What is Intersectionality? (1:54)
- Professor Kimberlé Crenshaw Defines Intersectionality (6:42)
- Intersectionality Graphic
Possible discussion prompts:
- Gather students’ questions or ask them to share and have students work collectively to discuss their questions and reactions
- Ask students: What is the identity of being a nurse? How does that intersect with other identities?
- Ask students to draw their own identity chart and consider their different intersecting identities (including nursing students).
- Ask students to return to the history of Provident Hospital that they have explored so far and to find examples of the intersectional reality that Burnette describes in that history.
Present students with the essential questions for this section of the lesson:
- What were the advantages and disadvantages of historically Black institutions like Provident as a path toward personal and professional advancement for Black nurses?
- What challenges and opportunities did and do Black nurses experience as a result of their intersecting identities as Black women?
- How do nurses working at healthcare institutions that serve marginalized communities strike a balance between dedication to their patients and their own material well-being?
Explain to students that they will examine the stories of a few of the Black nurses who worked at Provident Hospital. Note that often these nurses have been in the backdrop of the story about Provident, so this lesson intentionally centers these nurses’ voices and stories.
Read/Listen to stories in one of the following ways:
- Students go through stories individually before class or in-class (requires that students have headphones).
- Students go through stories in small groups.
- Class goes through stories together, with Faculty playing audio/video clips, and students taking turns reading the written stories aloud or on their own.
As students go through these oral histories, they should complete this worksheet, in preparation for the final assignment.
Once students have completed the worksheet, they can use that to write a written response or oral response to answer some or all of the following questions: Provident Final Reflection_ Nursing
And the Faculty can evaluate using this rubric: Provident Hospital: Reflections & Takeaways Evaluation Rubric