History of Diversity and Inclusivity in Nursing

Diversity in nursing has come a long way—but it still has a long way to go, especially since the pandemic exacerbated health inequities. Efforts to promote diversity and inclusion in the field of nursing are still so important.

To learn more, check out the infographic below, created by Hawai‘i Pacific University’s Master of Science in Nursing.

The Early Days of Diversity in Nursing

Diversity has been present in nursing longer than the profession itself. Before the Civil War, enslaved Black women primarily did nursing on plantations. Prominent abolitionists had ties to nursing. Sojourner Truth, born into slavery in 1797, was a longtime nurse, and Harriet Tubman, born into slavery in 1822, served as a nurse and spy during the Civil War.

Nursing education was formalized in the late 1800s, in response to growing demand due to the Civil War and the Industrial Revolution. However, Black nurses were segregated, and whiteness was prioritized in hiring rather than experience and education.

Notable Nurses

Susie King Taylor was born in 1848. She was the first Black U.S. Army nurse, and she taught soldiers to read and write.

Mary Eliza Mahoney was the first Black nurse to graduate from a formal program in 1879. However, discrimination drove her out of the industry. Later, she was inducted into the American Nurses Association Hall of Fame and the National Women’s Hall of Fame.

Adah Belle Samuels Thoms was the first graduate of the Lincoln Training School for Black Nurses in 1905. She was also the co-founder of the National Association of Colored Graduate Nurses.

Martha Franklin, who produced one of the first national studies on Black nurses, was an early proponent of racial equality. She held the first meeting of the National Association of Colored Graduate Nurses in 1908.

The Nurses Who Diversified Their Field

Throughout history, American nurses have braved difficult conditions to transform their profession for the better. In 1916, the American Nurses Association refused membership to those who weren’t part of state nursing associations. Because most of those associations excluded Black nurses, they were kept out of leadership roles.

In the 1920s, nursing education continued to expand at universities, in part because of World War I, but nursing institutions remained segregated. The Hill-Burton Act, which provided funding for desegregated hospitals, wasn’t passed until 1946, and the U.S. Army Nurse Corps wasn’t desegregated until 1948.

The U.S. Supreme Court’s landmark decision in Brown v. Board of Education in 1954 paved the way for more widespread desegregation, and the Civil Rights Act of 1964 prohibited discrimination in any public facility, including hospitals. The civil rights movement sparked pride in Black identity and the urge to fight for equality and combat racism.

Black nursing leaders who met in California in 1968 and 1969 to discuss improving the health care system formed new advocacy organizations, led by Dr. Betty Smith Williams and Barbara Johnson. The National Black Nurses Association was officially formed in 1971. Its goals were to clearly define nursing care for Black people, influence legislation and policies, increase Black recruitment, and create mechanisms for Black nurses to publish more of their work. The National Association of Hispanic Nurses followed suit in 1975.

Spotlight on Betty Smith Williams

Smith Williams was born in 1929. She’s an educator and researcher who’s won more than 70 awards. Some of her notable achievements include becoming the first Black nurse to work in higher education in California in 1956 and cofounding the Council of Black Nurses-Los Angeles in 1968. Smith Williams also cofounded the National Black Nurses Association in 1971 and the National Coalition of Ethnic Minority Nurse Associations in 1998. In 2010, she received the Living Legend Award from the American Academy of Nursing.

Continuing the Conversation

The efforts of nurses like Smith Williams have helped bolster dialogue about diversity in nursing. By identifying persistent bias in nursing and demonstrating its negative effects on both health care providers and patients, nurses, researchers, and industry groups continue to recognize opportunities to make the nursing profession a more equitable environment.

Why Diversity in The Nursing Workforce Matters

The U.S. is increasingly diverse, and while the nursing profession is currently more diverse than at any other time in its history, some racial and ethnic groups are still underrepresented. For example, America’s population is 18.9% Hispanic/Latino, but only 5.6% of registered nurses are Hispanic/Latino. Similarly, people who identify as Black make up 13.6% of the U.S. population, but only 6.7% of registered nurses.

In 2021, the National Commission to Address Racism in Nursing surveyed 5,600+ nurses and found that more than 60% reported having personally experienced workplace racism perpetrated by a peer or supervisor. Racial discrimination takes many forms, including discouraging career goals, assuming incompetence or lack of knowledge, offering lower pay, perpetuating stereotypes, and denying opportunities.

How a Lack of Diversity Hurts Patients

In addition to being unfair, such discrimination has a negative effect on patient care. A diverse nursing staff is better able to provide care to a diverse patient population. Marginalized patients do worse than white patients when it comes to access to health care, use of health care, overall health status, health outcomes, and social determinants of health.

The COVID-19 pandemic has worsened these inequities, only increasing the need to diversify the nursing profession. How does diversifying the nursing workforce help? Different perspectives improve problem-solving, creativity, and collaborative outcomes. Diversity tends to increase flexibility, and diversity begets diversity, improving hiring outcomes.

Improving Diversity

There are many ways to promote greater diversity in nursing. You can empower students and staff to identify and act on racism and conduct workshops to address implicit bias. You can leave behind color-blind ideology and prioritize recruiting and retaining minority nurses. You can also pair training with a plan for measurable outcomes.

Changing Nursing for the Better

Today’s nurses are more diverse, more educated, and more experienced. Together, nurses have the ability to improve health outcomes for marginalized people and, in doing so, change nursing for the better.


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Health Affairs, "Structural Racism In Historical And Modern US Health Care Policy"

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Kaiser Family Foundation, "Key Facts on Health and Health Care by Race and Ethnicity"

National Association of Hispanic Nurses, "History"

National Black Nurses Association, "History"

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