Mapping Care Project: The History of Black Nurses in Chicago

Lesson 4: Political Advocacy in Nursing - NACGN & Integration

Standards (AACN entry and advanced)1.1c Understand the historical foundation of nursing as the relationship developed between the individual and nurse. (Entry-Level)3.3a Describe access and equity implications of proposed intervention(s). (Entry-Level)6.2c Engage in the work of the team as appropriate to one’s scope of practice and competency. (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
Essential Questions (student and teacher guide)

Learning Objectives 
  1. Analyze the Factors Leading to the Integration of Nursing in the U.S. Students will critically assess the most important factors that led to the integration of nursing in the U.S., using and analyzing historical evidence from at least two primary sources. (AACN Essentials 1.1c)
  2. Examine Strategies Used by Black Nurses to Achieve Equity Students will explore and compare the strategies Black nurses used to react to injustice and make gains towards equity, identifying common challenges and successful approaches, using evidence from two primary sources. (AACN Essentials 3.3a)
  3. Evaluate the Advancement of Justice in Healthcare Post-WWII  Students will evaluate how justice advances within healthcare systems in the context of the post-WWII era, creating the historical timeline (AACN Essentials 7.3d)
  4. Debate the Role of Government in Achieving Racial Equity in Healthcare Students will debate whether racial equity within healthcare depends on government action, making claims and using evidence from at least two primary sources. (AACN Essentials 6.2c)

Introduction (Faculty)
In this lesson, nursing students will delve into the history of racial integration within nursing schools and the broader nursing profession, focusing on the pivotal period following World War II. They will examine primary sources related to the National Association of Colored Graduate Nurses (NACGN), a significant yet lesser-known civil rights organization that played a crucial role in advocating for the integration of Black nurses into the mainstream nursing workforce. Through these sources, students will develop arguments about the key factors that facilitated the integration of nursing, thereby gaining a nuanced understanding of social justice activism and the complexities of historical documentation.
This lesson offers an opportunity for nursing students to engage with critical questions about the most effective forms of social justice activism and the strengths and limitations of primary sources. Positioned within the Teaching Care sequence, this lesson follows an exploration of Black nursing schools established in response to systemic racism and segregation.
Connections to Practice The lesson integrates historical and theoretical knowledge with practical applications, prompting students to reflect on their role in advancing equity and inclusion within nursing practice. By examining the strategies used by the NACGN and Black nurses to achieve integration and equity, students will gain insights into effective advocacy and activism that can be applied in their professional lives. Through activities such as developing diversity and inclusion proposals, role-playing scenarios to address racial injustices, and designing educational workshops, students will learn to translate historical lessons into actionable steps. This connection between past and present prepares them to be proactive agents of change, equipped to foster an inclusive and equitable healthcare environment. By understanding the historical context of racial integration in nursing, students will be better positioned to identify and implement practices that promote justice and equity in their future roles.

Historical Context (for faculty)
When the nursing profession emerged after the Civil War, its leaders and institutions reflected the common (racist) belief of the time that Black people were inferior to white people. In nursing, Black nurses were usually limited to training in Black nurse training schools, and treating Black patients in segregated hospitals, wards, and communities. In the early 1900’s, white nurse leaders pushed for state laws that required nurse licensing and registration. Many southern states forced Black nurses to take different licensing exams or refused to license them altogether, shutting them out of most job opportunities. When Black nurses could find work, they were usually paid less than white nurses for the same duties, and given the most undesirable assignments. Black nurses were also not allowed to join the American Nurses Association (ANA) due to racist policies regarding graduation from particular nurse training programs which excluded Black training programs. 
Black nurses would not accept this situation quietly. In 1908, Martha Minerva Franklin, a Black nurse leader, helped to organize the creation of the National Association for Colored Graduate Nurses (NACGN).
The NACGN tackled many injustices, fighting discriminatory licensing laws, working to improve the quality of Black nursing schools and hospitals, and operating a registry to help Black nurses find work. The NACGN also partnered with groups like the National Urban League, the NAACP, and the National Council of Negro Women on campaigns for Black voting rights and against Jim Crow segregation laws.
Among the NACGN’s greatest victories was the passage of the 1943 Bolton Act and the 1945 integration of military nursing under the leadership of Mabel Staupers and Estelle Massey Riddle Osborne. The Bolton Act infused nursing schools with millions of dollars to train Cadet Nurses in support of the war; however, in order to be eligible for funding schools could not discriminate based on race. The leaders of the NACGN decided to dissolve the organization in 1951 and merge with the American Association of Nursing, after finally fighting for and being allowed admission into the professional organization.

Read/Watch/Listen (Resources from The History of Black Nurses in Chicago website)
Supplemental Resources
Books/publications 
A Note for teachers regarding historical language: Many of these primary sources, written by both Black and white authors, use the term “Negro.” It is important for teachers to provide students with a content warning and with historical context for this term. In the period when these authors were writing, many Black people considered “Negro” to be a term of respect, as compared to “colored.” It had very different connotations than the n-word, which white people used as a slur. In the 1960’s civil rights activists pushed for a shift from “Negro,” to “Black,” making it no longer socially acceptable for non-Black people to use the term “Negro.” In later decades, some Black activists pushed for use of the term “African American.” Please take time to explain that although historically accurate and relevant, when talking or writing about Black Americans in the present time, it is unacceptable to use the terms “negro” or “colored.” Encourage them to use “Black” or “people/person of color” instead. Students may appropriately use these terms in their writing if quoting a source document and including [sic] following the term, to signify that the term is used to preserve historical accuracy. They may also need to use the term when citing or listing references, in which case they should follow standard practice for the chosen citation style. 

For more information regarding historical terminology:
“A Note on Historical Language: 'Negro,' 'Colored,' 'Black,' and 'African American'” from African American Poetry (1870-1928): A Digital Anthology, by Amardeep Singh.
When Did the Word Negro Become Socially Unacceptable?, Jim Crow Museum website.

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.
  1. Analyzing the Factors Leading to the Integration of Nursing in the U.S.: Students will analyze and discuss the historical context and key factors contributing to the integration of nursing in the U.S.
  2. Examining Strategies Used by Black Nurses to Achieve Equity: Students will analyze case studies of prominent Black nurses to understand the strategies they employed to overcome racial barriers and promote equity in nursing.
  3. Evaluating the Advancement of Justice in Healthcare Post-WWII: Students will create a timeline detailing significant post-WWII events that advanced justice in healthcare, highlighting the impact of these changes on racial equity.
  4. Debating the Role of Government in Achieving Racial Equity in Healthcare: Students will engage in a structured debate to examine whether government actions have been central to achieving racial equity in healthcare, using historical evidence and case studies.


Activity Plan 1: Analyzing the Factors Leading to the Integration of Nursing in the U.S. (Individual, in-class, reflective journaling, or small group discussion)

PreparationProvide students with the articles Fighting Healthcare & Racial Injustices, World War Two: The Fight to Integrate Military Nursing before the session to prepare students for in-depth analysis. This reading will help students understand the historical context of the integration of nursing and its factors. 

Main activity: Reflective JournalingProvide students with the Reflective Journal Prompts and encourage students to deeply and critically analyze the historical context and factors leading to the integration of nursing in the U.S. 
 Conduct the activity in a quiet, reflective classroom setting and allow students sufficient time to think and write their responses to the journal prompts. If teaching online, use the “journaling” feature in the LMS, or discussion board, if available. Due to the potentially sensitive nature of this topic, we recommend instructors use their discretion to decide whether or not to discuss the journals in groups or to submit privately to the instructor.

Discussion and Feedback Building on their journal reflections, ask students to discuss the following questions in small groups.

Small Group Discussion Prompts

 Conclude the session by asking each group to summarize their discussions and key historical factors they found. Ensure that student groups can articulate the main points discussed and reflect on their learning journey.

EvaluationEvaluate the reflective journaling by assessing on depth of reflection, understanding of historical context, engagement with key factors, and articulation of future actions or changes in perspective using the Reflective Journal Rubric

Note: This lesson plan activity can be a standalone lesson and applied within any course that has learning objectives related to diversity, social justice, healthcare equity, or historical studies.


Activity Plan 2: Examining Strategies Used by Black Nurses to Achieve Equity (Individual, in-class or online, Case study analysis, and Group debate)

PreparationIntroduce the historical background on two black nurses Mabel Staupers and Estelle Massey Riddle Osborne as key figures in the integration of nursing in the U.S. using these two resources from the mapping care site. 
Fighting Healthcare & Racial Injustices
World War Two: The Fight to Integrate Military Nursing

Provide students with two case studies detailing the actions and strategies of Mabel Staupers and Estelle Massey Riddle Osborne, and assign the listed readings below as preparation for the case study analysis
Main activity: Case study
Discussion and Feedback Facilitate a  summary of the class discussion based on comparative analysis encouraging students to share their findings and insights from the case studies. Provide feedback and guidance on their analysis, highlighting key points and areas for further exploration.

Evaluation

Activity Plan 3: Evaluate the Advancement of Justice in Healthcare Post-WWII (Group, in-class/online, Historical Timeline Creation, Group Presentations)

PreparationProvide students with the articles or resources before the session to prepare students for the timeline creation. This reading will help students understand the historical context of the advancement in healthcare post-WWII. Introduce the online history timeline creation guide to the students to visualize the historical timeline of the advancement of healthcare post-WWII.
Main activity: 
Discussion and Feedback:Offer to discuss students' reflections in one-on-one or small group sessions after the presentation, providing a supportive space where students can share their insights, challenge each other’s views and deepen their understanding and exploration of the topic. Conclude the session by asking each group to summarize their discussions and key historical factors they found. Ensure that all students can articulate the main points discussed and reflect on their learning journey.

Evaluation 

Activity Plan 4: Debate the Role of Government in Achieving Racial Equity in Healthcare (Group, in-class or synchronized online class, Group debate)

PreparationProvide students with the articles or resources before the session to prepare students for the debate. This reading will help students understand the historical context in achieving racial equity in Healthcare. Pro: Arguing that racial equity in healthcare depends primarily on government action.
Con: Arguing that government action is necessary but not sufficient, and other factors (e.g., community advocacy, professional organizations) play a critical role.Debate facilitation preparation resources for Faculty:
Main Activity:
Discussion and FeedbackAfter the debate, facilitate a class discussion where students reflect on the arguments presented and consider the complexities of achieving racial equity in healthcare, providing a supportive space where students can share their insights, challenge each other’s views and deepen their understanding and exploration of the topic. This can be accomplished during a live class or through online course discussion boards.
 Conclude the session by asking each group to summarize their discussions and key historical factors they found. Ensure that all students can articulate the main points discussed and reflect on their learning journey. Students will write a short essay summarizing their preferred position on the role of government in promoting racial equity, incorporating insights from the debate.

Evaluation 
Evaluate students based on content accuracy, depth of analysis, presentation skills, team collaboration, and use of resources using the Debating the Role of Government in Achieving Racial Equality Rubric

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