Mapping Care Project: The History of Black Nurses in Chicago

Lesson 6: Modern Challenges in Nursing

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)
3.4b Describe the impact of policies on population outcomes, including social justice and health equity.  (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 COVID-19 on the Nursing Profession: Students will evaluate the unique challenges faced by Black nurses during the COVID-19 pandemic, including their effects on nurses' physical and mental health, using case studies and oral histories like those of Joan Bundley, Askale Facey-Phillips, Fred Brown, and Angelique Richard.
  2. Examine the Effects of Stigma and Discrimination on Patient Care and Nursing Practice During COVID-19: Students will investigate the effects of stigma and discrimination on patients with COVID-19 and develop strategies for nurses to address and mitigate these issues in their practice.
  3. Evaluate the Role of Nurses in Public Health Advocacy During the COVID-19 Pandemic: Students will explore the role of nurses in advocating for public health measures and policies during the COVID-19 pandemic and develop strategies to influence public health policy and improve healthcare outcomes.
 

Introduction (Faculty)

As the facilitator of these activities, introduce each session by providing context and relevance to the learning objectives. Emphasize the importance of understanding the impact of pandemics on the nursing profession and the critical role nurses play in patient care, public health response, and advocacy. Understanding the historical and contemporary experiences of Black nurses during the COVID-19 pandemic provides essential insights into the broader challenges and contributions of the nursing profession. By examining these experiences, students can develop a deeper appreciation for the critical role of nurses in addressing public health crises, combating stigma and discrimination, and advocating for equitable healthcare policies.

Historical/Conceptual Background (for teachers) (adapted from Mapping Care website)
The COVID-19 pandemic exposed significant flaws and exacerbated ongoing crises within the U.S. healthcare system, disproportionately impacting communities of color and highlighting the essential role of Black nurses. These nurses have historically faced systemic racism and structural barriers while providing crucial care to marginalized populations. The following background provides a conceptual framework to understand the challenges and contributions of Black nurses during the COVID-19 pandemic, aligning with the learning objectives of analyzing, comparing, examining, and evaluating various aspects of nursing during this period.

Impact on Nursing Profession

The pandemic placed nurses in extremely challenging conditions, often without adequate support or resources. Joan Bundley highlighted the critical issue of insufficient personal protective equipment (PPE) and overwhelming nurse-to-patient ratios, emphasizing how nurses' concerns were frequently ignored, leading to dangerous working environments. Askale Facey-Phillips' experience in an ICU during the Omicron surge illustrates the emotional toll and physical dangers nurses faced daily, often caring for patients their own age, which intensified the personal impact of the pandemic.

Public Health Responses and Advocacy

Fred Brown and Angelique Richard's leadership roles during the pandemic at Rush Hospital underscore the complexities of managing healthcare facilities amid crisis conditions. Their experiences reveal the intense pressures of ensuring adequate staffing, securing supplies, and providing emotional support to frontline workers. Brown's account of the daily emotional toll on staff and the need for PPE reflects the broader systemic challenges faced by healthcare leaders.
Karelle Webb's role in community health clinics highlights the significant challenges in accessing testing supplies and organizing efficient responses outside hospital settings. Webb's efforts to develop telehealth check-ins and care packages for high-risk patients demonstrate innovative approaches to public health during the pandemic.

Stigma and Discrimination

Black nurses like Karelle Webb faced additional burdens of combating stigma and discrimination within the healthcare system. Webb's experiences educating both staff and patients about the COVID-19 vaccine reveal deep-seated distrust in medical institutions among Black communities, rooted in historical medical racism. 

Role in Public Health Advocacy

The pandemic highlighted the crucial role of nurses in public health advocacy. Black nurses have been at the forefront of advocating for equitable healthcare policies and practices. The strikes by healthcare workers in the University of Illinois healthcare system, led by the Illinois Nurses Association (INA) and Service Employees International Union (SEIU), Local 73, underscore the collective efforts of nurses to push for better working conditions, fair pay, and access to PPE. These actions reflect the broader struggle for justice and equity within the healthcare system, emphasizing the importance of nurses in driving systemic change.

For more resources on this subject, see:
COVID-19
Black Nurses & Healthcare Equity

Read/Watch/Listen (Resources from The History of Black Nurses in Chicago website)
Supplemental Resources (version with hyperlinks, version for print)
Books/publications 
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. Analyze the Impact of COVID-19 on the Nursing Profession: Students will examine the challenges faced by nurses during the COVID-19 pandemic, analyze oral histories, and present group discussions on improving nurse support in future health crises.
  2. Examine the Effects of Stigma and Discrimination on Patient Care and Nursing Practice During COVID-19: Students will analyze data and images to understand the impact of stigma and discrimination on nursing practice during the pandemic, culminating in a group presentation on strategies to address these issues.
  3. Evaluate the Role of Nurses in Public Health Advocacy During the COVID-19 Pandemic: Students will analyze a passage on nurse advocacy during COVID-19, participate in group discussions on the role of nurses in public health, and write a reflection on strategies for influencing healthcare policy.


Activity Plan 1 Analyze the Impact of COVID-19 on the Nursing Profession (Individual and Group, in-class or online, oral history analysis, small group discussion, presentation)

PreparationProvide students with the main article COVID-19 from the Mapping Care website and additional resources articles before the session to prepare students for understanding the contextual background. Consider adding some of the additional scholarly resources to supplement the Mapping Care content, which is primarily based on the oral history collection.

Additional resources: Impacts of COVID-19 on Essential/Healthcare Workers- Assign students to read/listen to one of the following oral histories that discuss the impact of COVID-19 on nurses' physical/mental health or any challenges. Students can use the transcripts to navigate to relevant sections/timestamps that discuss COVID-19 and other key elements specifically. Provide students with a template for analyzing oral histories and encourage them to complete the individual analysis before the group discussion. Students should upload their oral histories analysis into LMS or bring the copy to class and submit for grading using the Rubric for Individual Oral History Analysis. 
 
Main activity: Oral History Analysis and Group Discussion/PresentationRecommended Discussion Questions
Online modification: Students can complete presentations in groups over a week-long period and upload their presentations to a discussion board. Each student should review 1-2 other groups’ presentations and answer the discussion questions above based on what they learned from their presentation and other groups’ presentations.

Evaluation

Activity Plan 2 Examine the Effects of Stigma and Discrimination on Patient Care and Nursing Practice During COVID-19 (Individual, in-class or online, data/image analysis, and group presentation)

PreparationProvide the student with additional articles related to the stigma and discrimiation in nursing practice during COVID-19 to understand COVID-19, economic mobility, racial justice, and the middle class Note: Faculty can use the Faculty guide version Data/Image Analysis and Group Presentation Worksheet (Faculty guide) of the worksheet which includes the main key for every question. 

Main activity: Data/Image Analysis and Group Presentation Students will divide into small groups and analyze provided articles, highlighting examples of stigma and discrimination in nursing during COVID-19, including case studies from the readings.
 Student groups will conduct an analysis of two images. From their analysis they should be able to address: 
  1. Who do you see in these images? Do the people in these images share or differ in appearance?  
  2. What are people in these images doing?
  3. What symbols or words do you see in these images? Do they have similar or different messages? What do you think they mean?  How do they relate to the COVID-19 pandemic? How do they relate to healthcare more broadly? 
  4. How do these images give you ideas to answer the essential questions of this lesson?


Courtesy of SEIU Local 73 Facebook page, Source: , https://www.facebook.com/SEIULocal73/photos/pb.100064511061742.-2207520000./10158582559577381/?...Each group presents their findings on stigma and discrimination using data and image analysis to support their conclusions.

Discussion and FeedbackOnline Option: Ask student group members to submit their group worksheet for grading. Separately, ask group members to summarize their findings in 2-3 paragraphs and post to the course discussion board. Ask students to comment and reflect on the lesson’s essential questions, shared findings, and strategies to combat discrimination in healthcare. 

Evaluation

Activity Plan 3 Evaluate the Role of Nurses in Public Health Advocacy During the COVID-19 Pandemic (Individual, in-class/online, passage analysis, group discussion, and short writing exercise)

Preparation
Main activity: Passage Analysis
“On Strike For Our Lives”: COVID-19 & Black Nurses in Unions”            
“As the COVID-19 pandemic surged, many healthcare staff on the frontlines felt upset to be called “essential workers” without getting the pay or benefits that would truly recognize their work. Unlicensed Black nursing staff, such as certified nursing assistants, have faced unique problems, getting low pay and little protection while often being the most exposed to COVID-19 because of the close care they have to provide. Nurses and other healthcare staff have used unions and labor organizing to pressure bosses who they believe often care more about profits than patients.
In September 2020, around 800 nurses (represented by the Illinois Nurses Association (INA)) and 3,700 hospital staff (represented by Service Employees International Union (SEIU), Local 73) in the University of Illinois healthcare system went on strike during a breakdown in contract talks.
The nurses were focused on pushing the hospital to promise in their contract about limits on nurse-to-patient ratios and better access to personal protective equipment (PPE). Other hospital staff were demanding higher pay, better PPE, and better staffing ratios in their own contracts so that staff would not have too much work. The striking workers believed these improvements would help their patients, who deserved better.
The teamwork between the INA and SEIU Local 73 to pursue collective ways of pushing for better working conditions and better pay was a big step towards nurses joining with other healthcare workers like nursing assistants, medical technicians, and maintenance and dining staff, who are mostly Black and Latinx workers. These workers play a key role in the day-to-day operations of healthcare facilities but are often at the bottom of the healthcare ladder and are poorly paid for their work.
The hospital’s management tried to block the strike with a court order and then brought in workers from other states to replace the striking workers. Despite this, the nurses stayed on strike for a week, while other hospital staff continued to strike for ten days.
The strikes ended with the hospital system agreeing to increase pay, hire more nurses, and provide a continuous supply of PPE.
Dian Palmer, president of SEIU Local 73, a Black woman who began her career as a registered nurse, declared at the end of the strike that:
“I am so proud of the Black and Brown women who led this strike, who convinced their co-workers striking was worth the risk. They never gave up. They were out there at dawn every day demanding justice for essential workers. UIC called them heroes but their pay and benefits didn’t reflect that, but UIC now understands what it means to be essential.”
 
  1. What were healthcare workers' jobs like in the first year of the pandemic (2020)?
  2. Why did the INA and SEIU go on strike? What were they asking for?
  3. Which types of healthcare workers usually get low pay? What groups of people often have these low-paying jobs? Are there reasons why these groups might get paid less?
  4. Who tried to stop the strike? How did they try to do it?
  5. What happened to end the strike?
  6. Do you think nurses and other healthcare workers got what they deserved from the strike?
These questions should be answered based on both the passage and the required preparatory readings. Students should summarize the discussion as part of their worksheet
  1. What were the biggest challenges faced by healthcare workers during the pandemic?
  2. How did nurses and other healthcare workers use advocacy to fight for better working conditions?
  3. What are some lessons we can learn about healthcare equity from this strike?
  4. Do you think strikes are an effective form of public health advocacy? Why or why not?
 After the group discussion, students will individually write a brief reflection (300-500 words) on the role of nurses in public health advocacy during the COVID-19 pandemic, using the passage, discussions, and supplemental readings as references.

Evaluation 

This page has paths:

This page has tags:

Contents of this tag: