Mapping Care Project: The History of Black Nurses in Chicago

Lesson 5: Inequity & Pathbreakers in Education

 

Standards (AACN entry and advanced)

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). 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 Impact of Desegregation on Nursing Education Students will critically assess the impact of school desegregation on Black nursing students, nurses, patients and communities, using and analyzing historical evidence. (AACN Essentials 1.1c)
  2. Examine the Experiences of Black Students in Nursing Education Students will explore and compare the experiences of Black nursing students in predominantly white and historically Black institutions, identifying common challenges and strategies employed to navigate these environments successfully. (AACN Essentials 3.3a)
  3. Evaluate the Significance of Being a Trailblazer in Nursing Students will evaluate the implications of challenging racial barriers in nursing, considering both the challenges and achievements associated with challenging social norms in a predominantly white profession. (AACN Essentials 7.3d)
  4. Explore Inclusivity in Nursing Education Students will debate the feasibility and methods of creating fully welcoming environments for students of color in contemporary majority-white nursing schools, using modern and historical case studies and research findings as a basis. (AACN Essential 6.2c)

Introduction (Faculty)
Addressing racial equity and inclusion in nursing education is critical to preparing future nurses who are culturally humble and capable of providing equitable care in diverse healthcare environments. This lesson plan will illuminate the historical context of racial inequities in nursing education, challenge students to reflect on their own experiences and biases, and inspire actionable strategies for fostering an inclusive learning environment. 
This lesson plan is designed to engage nursing students in a reflective and analytical exploration of racial equity within the nursing education landscape. By aligning with AACN standards, students will explore the historical progression of desegregation within nursing education, focusing on pivotal events that have shaped the present-day educational environment. Students will examine the persistent challenges encountered by Black nursing students across various eras and settings and recognize the impacts made by pioneers who broke racial barriers in the nursing profession. 
Through historical explorations, class discussions, reflection, and collaborative projects, students will identify and propose strategies to foster more inclusive and supportive environments for students of color in nursing education. This exploration aims to deepen students' understanding of historical inequities and inspire proactive steps toward equity in nursing education today.
Connections to Practice This lesson ties historical and theoretical knowledge to practical applications, encouraging students to consider how they can contribute to equity and inclusion in their future nursing practice. By connecting historical insights with contemporary experiences and future roles, the lesson will equip students with the tools they need to be proactive agents of change in nursing, promoting a more inclusive and equitable healthcare environment for all.

Historical Context (for faculty)
Beginning and Early Contributions Black women have historically played a crucial role in nursing in the United States. During the European colonization of the Americas (1607 - 1861) and importation of enslaved Africans, Black women often provided medical and herbal care within their communities, including care to white slave-owners and their families. During the U.S. Civil War (1861 - 1865), figures like Harriet Tubman and Susie King Taylor served as nurses, caring for Union soldiers and the newly freed Black Americans. Despite facing racial barriers, hundreds of Black men and women served crucial roles during this period.
Post-Civil War Challenges The widespread illness and injury of the Civil War helped to raise awareness about the importance of nursing in the United States. White women and nurse leaders began establishing nursing schools soon after the war in the 1870’s. Blacks were largely excluded from early nursing schools, and those that were allowed to matriculate were often alone due to strict quota systems limiting the number of opportunities for Black students. African Americans, including those in nursing, struggled against persistent racism and exclusion from formal nursing education.
Early U.S. nursing schools were based on the Nightingale model. Florence Nightingale was a prominent British nurse who gained fame by nursing the sick and preventing disease during the Crimean War. The Nightingale model stressed the importance of etiquette, morals, and education by nurses rather than physicians, helping to establish nursing as a respectable profession. The early U.S. nurse training schools established based on Nightingale’s model created strict admission requirements, favoring white, middle- and upper-class unmarried women who adhered to Victorian etiquette. In reality, these programs admitted many working-class white women, but largely excluded Black women, other women of color, and all men.
Yet in the early years after the Civil War and Reconstruction, racial color lines existed; however, they had not been legislated in the way they would under the Jim Crow Era, allowing for pioneers like Mary Eliza Mahoney, who broke racial barriers by becoming the first professionally trained Black nurse in the U.S. in 1879. 
Hospital-Based Apprenticeship Programs and the Rise of Jim Crow Advances in medical science in the late 19th century shifted nurse training towards hospital-based apprenticeship programs, which exploited student nurses as cheap labor. This model valued the labor of the nurse over her education. This shift occurred alongside the increasing racial discrimination of Jim Crow laws, further segregating and disadvantaged Black Americans in healthcare settings. As the Jim Crow laws took effect, segregation became the norm in educational and professional spaces, including nursing. Black applicants were barred from entering most of the newly created hospital-based programs. 
Black Nursing Schools & Hospitals Black communities, however, supported their nurses who became pivotal in providing healthcare access and equity advocacy for Black Americans. During this era, Black nurses were often the primary healthcare providers in their communities, and were trusted and relied upon extensively.
Beginning in the 1890’s, Black doctors, nurses, their communities, and their white allies created a network of hospitals and nurse training schools. These institutions provided critical healthcare to the African American community and trained thousands of Black nurses who became leaders in their communities. Institutions like Provident Hospital’s Nursing School in Chicago provided Black women with opportunities to advance in a field that consistently set barriers against them.
Persistence and Leadership in Black Nursing Education The establishment of the National Association of Colored Graduate Nurses (NACGN) in 1908 was a response to the exclusion of Black nurses from the American Nurses Association (ANA), which maintained policies that limited membership to white nurses. This exclusion led Black nurses to create their own organization to support professional growth, advocacy, and education. The integration of nursing schools in the 1950s and 1960s (thanks to the efforts of the National Association of Colored Graduate Nurses) posed new challenges as Black students encountered racism in predominantly white institutions. Despite systemic racism, Black leaders in nursing continued to establish and support professional training for Black Americans. 
Modern Contributions and Continuing Challenges Today, Black nurses and educators continue to face challenges but also lead in advocating for equitable treatment and inclusive practices in nursing education and practice. Alongside allies from all racial backgrounds, their enduring contributions are crucial in addressing ongoing disparities in healthcare and education.

For more resources on this subject, see:
“Nursing Education in the United States: An Historical Overview”, Schools of Nursing from Mapping Care Project: The History of Black Nurses in Chicago
 “American Nursing: An Introduction to the Past.”, “To Degree or not to Degree” from the University of Pennsylvania Nursing, History, and Health Care 

Read/Watch/Listen (Resources from The History of Black Nurses in Chicago website)
Primary Source Library Selection(s)
Supplemental ResourcesGetting Started with Primary Sources | Teachers | Programs | Library of Congress (for faculty)
Introduction to Historical Study I: Analyzing Primary Sources(for students)American Nursing: An Introduction to the Past
To Degree or not to DegreeBurnette, Georgia. "Looking Back: Black Nurses Struggle for Admission to Professional
Schools." Afro-Americans in New York Life and History 28, no. 2 (July 2004): 85. Looking Back: Black Nurses Struggle for Admission to Professional Schools

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. Reflecting on racial equity in nursing education: Students will reflect on nursing education history based on the Mapping Care resources, and respond to prompts guiding reflection on the history of racial equity in nursing education, their personal experiences or observations related to this issue, and their role in promoting equity in nursing.
  2. Analyzing a primary source: Students will complete the instructions on each of the analysis guides for the primary source provided and choose a photo from the Mapping Care: Black Nurses in Chicago digital exhibit about the Schools of Nursing.
  3. Presenting on trailblazers’ challenges: Students will critically listen to one oral history case on the experiences of trailblazing Black nurses and discuss the impact of these individuals on nursing education and practice today. 
  4. Creating your own nursing school: Students will design an inclusive nursing school and compare it to historic schools and/or current schools. 


Activity Plan 1: Reflecting on racial equity in nursing education (Individual, in-class, reflective journaling, or small group discussion/Time 1-2 hrs)

PreparationProvide students with the article Nursing Education in the United States: An Historical Overview before the session to prepare students for in-depth reflection. This reading will help students understand the historical context of nursing education and its evolution, setting the stage for deeper reflection.
 Show students this resource (Schools of Nursing) and explain the major historical changes and pivotal events of racial equity in nursing education. This introduction will equip students with a detailed backdrop against which they can reflect racial equity in nursing education.
(Asynchronous option: students choose one school of nursing from Schools of Nursing page to read about)

Main activity: Reflective JournalingProvide students with the Reflective journal prompts and encourage students deep and critical thinking about the history and their personal experiences or roles in shaping a more equitable future.
 Conduct the activity in a quiet, reflective classroom setting and allow students sufficient time to think and write their responses to the journal prompts. 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 Offer to discuss students' reflections in one-on-one or small group sessions after the journaling activity, 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 takeaways about the historical and current issues of racial equity in nursing education. Ensure that all students can articulate the main points discussed and reflect on their learning journey.

EvaluationEvaluate the reflective journaling by assessing depth of reflection, understanding of historical context, personal engagement with the topic, and articulation of future actions or changes in perspective using the Rubric.

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


Activity Plan 2 Analyzing a primary source (Individual, online, self directed primary source analysis/ Time 1-2 hrs)

PreparationEncourage students watch this resource “ Introduction to Historical Study I: Analyzing Primary Sources" to gain foundational skills necessary for engaging critically with historical artifacts.
 * Note: Faculty can read these supplemental resources to understand Primary Source Analysis.  Getting Started with Primary Sources | Teachers | Programs | Library of Congress
 Present the selected picture and a brief context about this image to the students like below, ensuring it is clearly visible for all through online or blackboard. And ask them “How would you analyze this historical photo?” Depending on the amount of time, faculty can ask the class the questions from the analysis guide and practice analyzing the photo together. 
Photo of cadet nurses in capping ceremony at Provident Training School, 1945, the Provident Phalanx, January-February-March 1945 issue, University of Chicago Special Collections, Harold Swift Papers, Box 131, Folders 1-2.
Underneath the photo: "This photo doesn't fully show how great these future nurses are... They're the first bunch of U.S. Cadet Nurses to get their caps from Provident School of Nursing... At this moment, twenty student nurses, after finishing their preclinical training, got their school caps."
 Ensure all students are able to access the digital exhibit "Mapping Care: Black Nurses in Chicago" through an online platform. This session will focus on the following segments: 
Provident Hospital and Training School, 1891-1929
Provident Hospital and Training School, 1930-1966
Cook County School of Nursing
Michael Reese Hospital School of Nursing 

Main activity: Primary source analysis: PhotographThe following can be provided to students digitally, explaining the assignment instructions:

The purpose of this assignment is to prepare you to be able to read, analyze, and appropriately interpret a historical photo. Please complete the instructions on the primary source analysis photo guide for the primary source provided. The assignment will be graded on effort, completion, and accuracy. 

Please choose a photo from the Mapping Care: Black Nurses in Chicago digital exhibit about the Schools of Nursing. There are four pages to choose photos from: You will likely need to do some additional reading from these pages to be able to properly contextualize the photo you select. Be sure to read the caption, page and other related pages/information to get the needed historical context for interpreting the photo and completing the worksheet. 

After you have selected your photo, complete the photo primary source analysis based on the information found in your photo and the related pages. You may also do your own external research to help contextualize what you see in the photo and answer the questions on the worksheet.

Discussion and FeedbackGo over the worksheet as a class, asking students to share their various discoveries and observations from their selected photos.Set up and oversee an online forum for discussion, creating opportunities for students to post their analyses and respond to their peers. Stimulate dialogue that helps students to exchange insights, challenge views, and deepen their understanding of historical and current issues in racial equity in nursing education. Be sure to have the students include a link to the original photo they analyzed in their post, in addition to posting their analyses.

EvaluationGrade student’s worksheet with each part of the analysis guide weighted accordingly to the rubric. Rubric for Primary Source Analysis - photo.docx


Activity Plan 3 Presenting on trailblazers’ challenges (Small group, in class, group presentation)

Preparation Assign interviews of pioneering black nurses to give students understanding of the historical challenges and resilience of Black nurses in the face of racial discrimination and professional isolation. Students will be pre-assigned to review the interview of Barbara Norman, Tamara Bland, or Annie Lawrence from the Mapping Care Oral histories before this small group session. 
(option to give students List of Oral History Excerpts if you do not want to assign them the full oral histories)
 Provide students with a worksheet containing specific questions and topics to guide their review about key contributions and achievements of the trailblazer, major challenges faced, strategies used to overcome obstacles and foster resilience, and impact on nursing and healthcare policy using the worksheet. 

Introduction to the sessionBegin the session by spotlighting key Black nurses who acted as trailblazers in the profession. Discuss their significant contributions and the adversities they faced due to racial discrimination and professional isolation. Ask students to discuss examples of how Dr. Bland, Dr. Norman, or Dr. Lawrence were trailblazers in their professional career.
Dr. Tamara Bland currently serves as the Interim Dean of the Borra College of Health Sciences at Dominican University, River Forest, overseeing an array of programs including nursing, dietetics, and a physician assistant program. Her professional journey began at the bedside, transitioning to academia after earning her MSN from Resurrection University. She furthered her education with an EdD from the University of St. Francis, Joliet, IL. The interview with Dr. Bland addresses key issues such as overcoming educational barriers, acknowledging structural determinants of health, addressing the impact of racism within the nursing field, ongoing initiatives to support BIPOC nursing students and efforts to diversify the profession. It also discusses the challenges encountered by black women in leadership roles within nursing and underscores the significance of her upbringing in Chicago’s south side.

Dr. Barbara Norman, a graduate of the Grant Hospital School of Nursing, has had a distinguished career, including her role as a former Captain in the U.S. Army and Deputy Commissioner of Health for Chicago under the late Mayor Harold Washington. Her extensive experience spans hospital leadership roles across the Chicago metro area and academic positions as a nursing instructor. The interview explores various topics including her religious influences, upbringing on the south side of Chicago at Dunbar Academy, and her student experiences at Grant Hospital School of Nursing, where she confronted racial challenges. 

Dr. Annie Lawrence is a graduate of the Freedman’s Hospital Training School in Washington, D.C. During her five-decade-long career Dr. Lawrence served among other positions, as the Director of Nursing Education at the Provident Hospital School of Nursing, as a Nursing Education Coordinator for the State of Illinois, and as Nursing Chair for Governors State University. Dr Lawrence served as a trailblazer for black women in Nursing, having served as the first black President for the Illinois Nurses Association, and as an advisory committee member for several Chicago-area nursing programs both public and private. Interview includes discussion on public health nursing, racial adversity, hospital and ward administration, and educational leadership.

Main Activity: Group PresentationsProvide students with a set of questions and topics that direct their research and analysis of the trailblazers' experiences and challenges and instruct students to form small groups to research, discuss, and prepare a presentation on a chosen Black nursing pioneer, highlighting their impact on the profession.

Discussion and FeedbackAfter the presentations, lead a class discussion allowing students to reflect on the impact of these trailblazers on current nursing education and practice.Encourage students to consider how the legacy of these trailblazers affects their own understanding of and role in promoting racial equity in nursing.Ask each group to articulate the main insights from their research and discussions, emphasizing what they learned about historical and contemporary issues of racial equity in nursing.

Questions samples: 
EvaluationAssess the group presentations using this rubric that evaluates the quality of analysis, understanding of historical context, and the ability to draw connections between past experiences and present-day nursing practices.

Note: This 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. If you use all activities in this lesson plan, it is recommended that students complete activities 1 and 2 first.


Activity Plan 4: Creating your own nursing school (Class-wide, individual, silent discussion, and project presentation, online or in class/ Times 4-6 hrs)

Preparation Encourage students to read or review the historical timeline and events from
 the articles Nursing Education in the United States: An Historical Overview, Schools of Nursing before the session if teaching within this lesson plan. If this activity is a standalone lesson, introduce the historical context of nursing education from Nursing Education in the United States: An Historical Overview, Schools of Nursing. 
 Create a discussion board in the Learning Management System (LMS) for students to reflect on the experiences of Black nurses and relate these to their own past educational experiences. Ask students to propose three methods to enhance inclusivity in nursing education on the discussion board. Students will post their reflections and discuss how their views have evolved throughout the lesson and/or their nursing experience.

Discussion and reflection questions
EvaluationAssess the individual discussion board post using the rubric that evaluates their understanding of historical context, personal reflection on experiences of Black nurses, and suggestions for enhancing inclusivity in nursing education. 

Main ActivityGuide students through the design process, encouraging them to address past inequities while maintaining high educational standards. Students will search and review historic data about early nurse training programs.

Resource lists Provide a guideline for designing inclusive educational programs, highlighting key considerations for supporting students from diverse backgrounds. Facilitate comparisons between students’ designs and historical/current models and lead discussions on potential improvements and challenges. 
The guideline is based on these essential questions: Form groups to finalize their designs and have students present their school's design, addressing inclusivity, educational standards, and student support mechanisms. Student groups will present their final design project to the class, with the option of  an in-class presentation or a narrated presentation/video for online/asynchronous students.

Discussion and FeedbackAllow time for students to discuss and critique each other’s proposed models. Teachers
can opt to have students review the rubric criteria to help shape and guide the discussion. After the design phase, create a feedback post where students can discuss their proposed models using the course LMS. Encourage them to critique each other’s designs based on inclusivity, feasibility, and alignment with professional standards using an evaluation rubric.
 Post/provide your feedback on key insights and the creative processes involved in designing an inclusive school from each group design project presentation.

Evaluation

Assess the design's inclusivity, innovation, and feasibility, with a focus on how well it supports the well-being and success of all students, especially those from marginalized groups using a rubric. 

Note: This activity can be a standalone lesson and applied within any course that has learning objectives related to diversity, social justice, healthcare equity, nursing education or historical studies. If you apply for all activities in this lesson plan, students should complete the earlier activities first. 
 

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