Yesterday, Today, & Tomorrow

Article excerpt

Transitioning Through Time with the Cleveland Council of Black Nurses

Children, I come back today To tell you a story of the long dark way That I had to climb, That I had to know In order that the race might live and grow.

From "The Negro Mother," Langston Hughes

THE STORY OF THE CLEVELAND COUNCIL OF BLACK NURSES, as for black nurses throughout the United States, is one of isolation, stigmatism, and injustice. Time is an important element in the development of professional organizations. This article chronicles the history of the CCBN from the events of three separate points in time -- the advent of segregation, the dissolution of the National Association of Colored Graduate Nurses (NACGN), and the programmatic thrust of the American Nurses Association (ANA). * We discuss political and social issues in terms of "windows of opportunity" -- openings to pursue alternatives for changing the status quo. The experiences of African-American nurses in the United States are inextricably bound to significant social and professional events that were intended to provide windows of opportunity for professional nursing and the assurance of equity for all nurses. However, that was not to be the case for African-American nurses.

Yesterday, Our Heritage

THE CLEVELAND COUNCIL OF BLACK NURSES, INC. was chartered as a chapter of the National Black Nurses Association in 1972 and incorporated as a not-for-profit organization in the state of Ohio in 1981. Its existence is inextricably linked to the experience of African-Americans in the Unites States and the history of the major nursing organizations we know today.

Lost in time, space, and archival collections are the stories of such "colored" women as Mary Seacole, a Jamaican, who nursed British, French, Russian, and Sardinian soldiers during the Crimean War; Sojourner Truth, Harriet Tubman, and Susie Taylor, who nursed soldiers during the Civil War; and Namahyoke Sockum Curtis, who served as a contract nurse during the Spanish-American War. A review of nursing history texts will show that "Negro" nurses are rarely mentioned as contributors to the development of the profession. (The term Negro is used in this article to reflect the attitudes of the historical period under discussion.)

Mary Eliza Mahoney is usually identified as the first "black trained nurse" to graduate from the New England Hospital for Women and Children. She was one of 40 students admitted in her class and one of three to graduate, on August 1, 1879. Before that school closed in 1951, only six other known blacks completed the program -- Josephine Braxton, Kittie Toliver, Ann Dillit, Roxie Dentz Smith, Lavinia Holloway, and Laura Morrison Bayne (1). The school had a policy of admitting only one Negro and one Jew in each class. The low graduation rate is attributed to several factors, including the exclusionary policies of hospitals with which the school affiliated (2). With few exceptions (1-5), most authors of nursing history texts provide a minimal amount of information about Mahoney (6-10).

Prior to the 20th century, black women attended integrated nursing schools in the North. However, the institutionalization of segregation led many aspiring nurses, in both the North and the South, to attend nursing programs specifically organized for Negroes. These schools followed the pattern of nursing programs for whites and were founded by, or affiliated with, hospitals. The first such schools were Atlanta Baptist Female Seminary (Spelman College), 1891; Provident Hospital School of Nursing in Chicago, 1891; Tuskegee Institute in Alabama, 1892; Howard University in Washington, DC, 1893; Freedmens Hospital in Washington, DC, 1894; and Lincoln School for Nurses in New York City, 1898. Between 1886 and 1977, 77 schools for Negroes were established in 20 states and Washington, DC (1).

Many of these schools were characterized as substandard by nursing leaders of the era because they did not have adequate resources to provide quality educational programs. However, in the early 1900s, many schools for white students also had limited resources, inadequately prepared faculty, substandard facilities, and poorly designed or nonexistent curricula. These conditions were of major concern for nursing leaders such as Isabel Hampton Robb, who, in 1893, established the American Society of Superintendents of Training Schools of Nurses (forerunner of the National League for Nursing) to improve nursing curricula and develop standards of admission to schools of nursing (6,8,9,10). The Goldmark Report of 1923 detailed the weaknesses of nursing education programs of the era and proposed several recommendations to correct the problems (12).

Professional Organization Throughout the country, schools of nursing for both blacks and whites established alumnae associations to afford graduates the opportunity for professional, social, and financial support. These were major socializing agents and gatekeepers for nursing. In 1896, the Nurses' Associated Alumnae Association of the United States and Canada was formed to provide a voice for nursing and to establish standards for the profession. Membership was open to the "alumnae associations of schools of nursing connected with general hospitals offering not less than two years of hospital training" (13, p. 90). Graduates of affiliated schools were allowed to join, but alumnae associations of Negro training schools considered to be substandard were denied membership (4,5,13).

Discrimination Within the ANA For reasons of sovereignty, Canada withdrew from the Nurses' Associated Alumnae Association of the United States and Canada in 1911, and it became the American Nurses Association (14). Prior to 1916, membership in ANA was open to all qualified registered nurses regardless of race, creed, color, or national origin. While Negro nurses joined the association, "little was done to encourage their participation" (4, p. 15) in programs and activities. Through pressure from Negro leaders, the ANA instituted new membership policies in 1916 to assure access of all Negro nurses to its membership. The new criteria provided for membership through state associations.

When ANA asked affiliated alumnae associations to draw up membership rules to comply with these changes in 1918, this was considered a window of opportunity for Negro nurses to gain membership. However, discriminatory practices in 16 states and the District of Columbia that resulted in the denial of access provided the incentive for black nurses to organize to form an organization to address their plight (1,4,15). Lavinia Dock's comments in 1912 provide insight into this period of nursing: "These women have all the usual problems of the nurse to meet, with an additional one -- the cruel handicap of race prejudice, springing, it must be, in the white race, from a sense of guilt. While the nursing community was small, it was free from this antisocial feeling, but as it grows, here and there barriers are put up (8, p. 198).

In 1908, employment for black nurses in the South was limited to hospitals for Negroes (2,4,15). While black codes limited access to practice opportunities and entry into educational institutions in the South, de facto segregation in the North had a similar effect. Throughout the country, Negro students desirous of entering schools of nursing experienced these typical exclusionary policies: learning experiences only in hospitals that cared for Negro patients, separate state board licensing examinations, admission quotas, separate and unequal training facilities with few qualified faculty, and the attitude that black nurses were inferior.

This attitude is reflected in the report of proceedings at the ANA Convention in 1912: "`The soul of improvement is the improvement of the soul,' and that the soul of a training school is embodied in the make-up of the pupils and the teachers, and exemplified by their habits and standards of living, improvements must extend back to the home environment and be more sweeping and radical than those with which state boards deal, if the Negro pupil is to embody our ideals of morality, refinement, and culture" (15, p. 103).

An excerpt from the proceedings of the 15th Annual Convention of the ANA in 1912 provides further insight: "The graduate Negro nurse, as we know her, fills a valuable place in the nursing scheme; she is well-trained, practical nurse, and a salary of $15 to $20 per week is to be found on obstetrical cases, as the second nurse in acute cases, and on long chronic cases, in the home of the small wage earner. Her position in the household is essentially different from that of the white nurse -- not necessarily because of inferior qualifications, but because, belonging as she does to the servant class, conventional society draws a dead line, beyond which no magical power of an R.N. title could enable her to pass.... There will always be people who, from necessity or from choice, select the cheaper article, just as there will always be doctors who prefer the `under-' educated to the `over-educated' nurse, and as the correspondence school graduate is unknown with us, we believe that our exemption from that fraudulent class of nurse is due to the presence of our trained practical Negro nurse, who fills the need of the community for a good second-class article" (15, p. 106).

Racial attitudes of the era limited the opportunities of black nurses in both education and practice. White nursing leaders accepted no responsibility for these problems and continuously blamed the "deficiencies" of the beneficiaries for exclusionary practices. As late as 1932, Margaret E. Conrad, principal of the New England Hospital Training School, attributed the low number of Negro graduates to segregation and the policies of affiliating hospitals (2).

The Role of the NACGN Throughout the United States, black nurses encountered barriers to educational, professional, and economic progress. August 26, 1908, 52 nurses, led by Martha Franklin, met at St. Marks Methodist Church in New York City to respond to problems relating to education and employment. This historic three-day meeting led to the establishment of the National Association of Colored Graduate Nurses (NACGN), with Franklin as the first president (16), to champion the cause of black nurses and fight against discrimination within health care. Three goals that have become the hallmark of most African-American nursing organizations were delineated:

* To advance the standards and best interest of trained nurses.

* To break down discrimination in the nursing profession.

* To develop leadership within the ranks of black nurses.

Members of NACGN believed that segregation could only be removed if there was close cooperation between local groups and the national organization. Thus, chapters were developed across the country. Black nurses finally had a voice and the ability to influence the structure of nursing from within and without.

Over the years, NACGN worked to increase employment opportunities for nurses by lobbying against exclusionary state board of nursing policies, for workplace issues such as pay equity and scheduling, and for the improvement of nursing education in Negro schools (4,5). With the assistance of the National Medical Association, NACGN addressed discrimination in the workplace by establishing, in 1918, a national nursing registry to assist black nurses to find employment. Adah B. Thoms pointed out that the registry "will be a means of aiding doctors and the public in securing the best nurses with the least exertion, and will likewise be a means of helping the nurses to secure desirable positions. Our objective in establishing the registry is to raise the standard of nursing, for if doctors will employ only the best nurses, then only those who are determined to be the best will enter the profession" (5, p. 214).

NACGN addressed the quality of nursing schools by campaigning for high school graduation to be a criterion for admission. The association encouraged nursing programs to improve standards to be in compliance with national requirements and urged substandard nursing programs to close. Members worked with the ANA and the National League for Nursing Education to improve educational standards nationwide and to elevate the status of the black nurse. Concerned about prospective nursing students, leaders directed students to schools that met national criteria and provided guidance to high school students regarding the courses required for entry into nursing programs.

With the support of philanthropic, political, and social associations, NACGN advocated for the welfare of black nurses and students. Its leaders worked with nursing organizations to secure the inclusion of black nurses in all aspects of the profession. Through its efforts, the ANA House of Delegates voted in 1946 to remove all barriers to full participation of black nurses in that organization at the state and local levels. After much lobbying and political pressure at the national level, black nurses were allowed to become direct members in ANA, bypassing local associations.

With the belief that black nurses would have complete participation in ANA at the national, state, and local levels, NACGN voted to dissolve in 1949. The formal dissolution of NACGN took place in 1951, with its merger into ANA.

Isolation and Despair in Cleveland The dissolution of NACGN heralded a dark period for local members in Cleveland, who felt as if they had been abandoned because they were not welcomed in the local nursing association. Consistent with national policy, the State Nurses Association of Ohio allowed black nurses to join the ANA, but the Greater Cleveland Nurses Association (GCNA) did not accept black members until 1952 (17). The Cleveland chapter of NACGN had worked to gain entry into this local chapter by forming coalitions with other civil rights organizations and with the National Medical Association. It took pressure from civil rights groups, a local black newspaper, the Call and Post, NACGN, and two councilmen to bring about the change. Rose Peebles was the first black nurse accepted as a member, followed by Clairetta Jones, the last president of the local chapter of NACGN. During this time period, four other states barred black nurses; it was not until 1964 that black nurses in every state were accepted as members of local chapters of the ANA.

Following the dissolution of NACGN, Clairetta Jones worked with other black nurses to form the Cleveland Nurses' Association. They met regularly at Cory United Methodist Church to address the needs of members, who became the nucleus of the Cleveland Council of Black Nurses when it was chartered in 1972.

Educational Discrimination The nursing scene in Cleveland reflected the national scene relative to both the education and employment of black nurses. Early on, black women interested in attending schools of nursing in the Cleveland area were often told to apply to Carnegie Institute's Practical Nursing program, which was nonaccredited. Cleveland City Hospital (now MetroHealth Medical Center) admitted blacks into its school of nursing in 1929, but success in this program did not open the door to others in the area. Continuing political pressure from the Urban League, the Call and Post, NACGN, and local politicians was needed to convince the Medical Council of University Hospitals of Cleveland to admit blacks into the basic nursing program at Western Reserve University in 1945.

With the establishment of the Cadet Nurse Corps in 1943 and its emphasis on the recruitment of blacks, men, and practical nurses, the opportunity to enroll in formerly segregated nursing schools increased in Cleveland and other areas. Its mandates for service in the armed forces and in civilian hospitals facilitated the employment of black nurses in the United States Army and Navy as well as in hospitals across the country.

Discrimination in Employment Staffing patterns used by hospitals contributed to the difficulty experienced by black nurses in finding employment. These patterns included the use of student nurses to staff hospitals, the use of private duty nurses to care for patients, and the limited number of RNs hired for supervisory positions. Prior to World War II, most nurses were employed as private duty nurses and assigned to patients by nursing registries owned and operated by private individuals as well as local chapters of the ANA. Some registries in Cleveland that hired black nurses charged them higher fees than their white counterparts for the privilege of being employed -- 10 percent of their earnings rather than an annual fee. In addition, black nurses hired by hospitals or registries were often assigned to work the evening or night shift only. Since registries controlled hiring, access to patients, and economic status, relief was needed. In 1950, Rose Peebles opened the first black-owned nursing registry in Cleveland to meet the needs of black nurses; in 1953, she sold the agency to Mildred Maze, who continued to operate it until 1964.

At the closing dinner of NACGN in New York City in 1951, Judge William H. Hastie stated: "What a grand thing that there is no longer need for a separate organization of Negro nurses. It is also a grand thing that these ladies have recognized that fact, and have cheerfully embraced the opportunity to give up an organization of which they are deservedly proud" (15, p. 108). Little did the attendees at the gathering know that segregation and discrimination would continue to cause problems.

Taking Control It was against a backdrop of prejudice, discrimination, and segregation that more than 200 black nurses from across the United States convened in 1970 at the ANA Convention in Miami, Florida. At the urging of friends, Dr. Lauranne Sams, a faculty member from Indiana University, called a special meeting of black nurses to discuss their situation in ANA and in nursing in general. Attending the caucus were 150 nurses, who shared experiences and discussed strategies to actively control their professional destinies. The meeting concluded with the decision to study the feasibility of forming an association. The group adopted the name Action Oriented Black Nurses Council and developed plans for the steering committee to meet in Cleveland at the home of Dr. Mary Harper (18).

The steering committee met twice, in December 1971 and March 1972, and drafted plans for the establishment of the National Black Nurses Association (NBNA). Spurred on by the caucus in Miami, nurses in Cleveland began to talk about joining forces at the local level to develop strategies to address their need for visibility within the profession, equal employment opportunity, and economic security. To that end, the Greater Cleveland Association of Colored Nurses was formed. Registered nurses, licensed practical nurses, and nursing students met on a regular basis at Cory United Methodist Church in two groups, Friday evenings and Saturday mornings, because shift schedules precluded meeting in one session.

This group evolved into the Cleveland Council of Black Nurses (CCBN) that we know today. The first officers were Gladys Moon, RN, president; Beulah Carroll, LPN, vice president; E. Ruth Taylor, LPN, second vice president; Florrie Jefferson, RN, treasurer; Levolia Calloway, LPN, and Pauline Baker, LPN, secretary; and Mattie Kelley, RN, coordinator.

A total of 67 nurses attended meetings during the first year. The programmatic thrust of the group broadened from the professional development of members to concern for the health of black people, and the motto "Committed to Nursing and Health Care of the Black Community" was adopted.

When the National Black Nurses Association (NBNA) was incorporated in Ohio in 1971, CCBN sought membership. It was chartered in 1972 as the first chapter of the NBNA and incorporated in 1972 as the first chapter of the NBNA and incorporated as a not-for-profit organization in Ohio in 1981. Its constitution, from 1981, and its bylaws outline the philosophy and major goals that guide its functioning (19). (See box below.)

The CCBN Today

MEMBERS OF CCBN have been active participants in the NBNA since its inception, interacting with colleagues from across the United States at the Annual Institute and Conference. Three members, Jane B. Gray, Valerie D. George, and Tangela Spearman, have served on the NBNA Board of Directors, and Daisy Alford-Smith has served as second vice president.

The major agenda items for CCBN are educational programs for members and health promotion and disease prevention programs for the black community. The Council also works collaboratively with other nursing organizations, health care agencies, and health-related community groups. Since 1995, it has received three Community Service Awards from the NBNA for the variety and scope of programs that it has conducted on behalf of greater Cleveland.

Members of CCBN have served as officers and on committees of GCNA and have been active in various nursing organizations such as the Ohio Nurses Association and the Northeast Ohio League. Dorothy E. Bradford has served as president of the Ohio League for Nursing, and Fay A. Miller has served as president of the Ohio Board of Nursing. Members have worked collaboratively to address such professional issues as entry into practice, prescriptive authority for nurse practitioners, recruitment of minorities and men in nursing, leadership development of minority nurses, and legislative programs. The Council also serves as an advocate and support for black nurses experiencing stress on the job.

The Council fulfills its goals to improve the health care of the black community through the efforts of various committees. For example, the Health Education and Community Service Committee sponsors continuing education programs for the nursing community. Programs address the issue of culturally sensitive care and topics of particular importance to the health and nursing care of the African-American community. The organization has received grant awards from the Ohio Commission on Minority Health, the Ohio Department of Health, and the National Eye Institute of the National Institutes of Health to conduct health education programs, and it has been in the forefront of hypertension screening since 1971, when members developed a community hypertension program at Cory United Methodist Church. This screening program continues today in various locations.

Members have been acknowledged for their efforts by the International Society for Hypertension in Blacks and by the American Sickle Cell Anemia Association. The programmatic thrust of NBNA has resulted in funding for depression screening, smoking cessation, and AIDS awareness. The Council has also been a member of Mayor Michael White's Violence Task Force for the City of Cleveland.

Members fulfill the organization's mission to "act as a change agent in restructuring existing institutions and/or helping to establish institutions to address unmet needs" by providing expert testimony at the state and local levels regarding the status of minority health, serving on the Ohio Commission on Minority Health, and testifying on the impact of Ohiocare on nursing and the health of the black community. In addition, members participate in the Congressional Black Caucus' "Health Braintrust."

Tomorrow anal Its Challenges

"BLACK AMERICA IS YOUNG AMERICA.... There is a wide and deep gulf between those young people standing at the door of the 21st century and the Civil Rights generation, those who fought the hard battles to get them there. But the battles are far from over, and if Black America is to win, it must find a way to build bridges of communication. Our future depends on it" (20, p. 33). African-Americans are born into history, with no memory of what transpired before, and find themselves as characters in a play without remembering the past. They are expected to have knowledge of the past, and use it to guide their path. "They need and deserve to know that they, like all living beings, are rooted, webbed, woven, and wound throughout the infinite fabric of existence" (21, p. 2). This knowledge is essential for perceiving one's connectedness to the past, for dwelling in the present and envisioning the future. Thus, our tomorrow rests in the minds and hearts of African-American nurses and nursing students as they successfully meet the challenges in education and practice and transform the face of professional nursing as their ancestors did before.

As an organization, CCBN has identified several strategies to ensure the continued inclusion and empowerment of blacks in the profession: recruitment; fostering academic success through tutoring, advising, and mentoring; fostering and promoting the empowerment of students and nurses in various practice settings; serving as role models; supporting participation in professional organizations; publicizing the history of African-American nurses; and collaborating with individuals, professional organizations, and other stakeholders.

Recruitment and Retention Recruitment of competent blacks into nursing is essential to the development of a multicultural nursing workforce. The current disparity (22) is derived from lack of effective recruitment strategies (23), attrition related to academic performance and personal-social problems (24,25), lack of social support and campus culture (26), marginalization of black students (27,28), and dissatisfaction with the work environment or relationships with co-workers and administrators (10,29). Recruitment efforts by CCBN focus on promoting enrollment, retention, and graduation from undergraduate and graduate nursing programs.

Where does one recruit potential nurses? While traditional efforts take place in high schools and community colleges, other disciplines are competing for students in those environments. Thus, recruitment attempts must be broader, beginning in elementary schools, when parents and others are invited to speak about their careers. They can take place at black churches, where nurses often offer prevention programs and speak about nursing and health; on the campuses of four-year colleges and universities, where students are involved in career decision making; at health care centers, where the public sees the nursing professional interact with clients; and in fraternal organizations.

For CCBN, recruitment begins in schools in the greater Cleveland area. Members talk about what nurses do, career options that are available, the types of courses that are required, and how a student's abilities and talents can be used in the care of others. The power of nursing's visibility for recruiting young people is evident in this quotation by Retired Lt. Nancy Leftenant-Colon: "I saw a picture of an Army nurse with her cape.... She looked so good -- straight and tall. I wanted to do my part" (30, p. 26). Student members serve as role models, visiting schools to talk about nursing. One reported that black elementary students were "amazed" that she was pursuing nursing. "It's as if they couldn't conceive that I (or they) could be a nurse."

During elementary and secondary school, the learning and behavioral development of students of color are negatively affected by racism, which may diminish self-esteem and cause decreased interest in school or the desire to persist in school, resentment about unequal treatment, or a feeling of being less good in the eyes of the teacher (31). The student whose self-esteem is suppressed may not believe that he or she has the necessary skills, attitudes, or abilities to succeed in nursing. Therefore, the recruitment and mentoring process includes helping children develop and recite affirmations that acknowledge their self-worth and celebrate their potential for success.

The educational mobility of adults in all phases of nursing (nursing assistants, LPNs, RNs) is fostered by encouraging them to use available staff development and tuition reimbursement programs to enhance their professional stature. The city of Cleveland is fortunate to have an ACCESS in Nursing program that facilitates educational mobility. (See Nursing and Health Care Perspectives, July/August 2000, for information about this program.) Several African-American LPNs and RNs have used it to obtain their associate and baccalaureate degrees. The Recruitment and Retention and Scholarship committees provide mentoring, social support, peer counseling, tutoring, and financial support to students at local colleges, universities, diploma, and practical nursing programs.

Retention of black students is a local as well as a national problem (32-35). Of particular concern to the membership is the "revolving door syndrome" noted at several nursing schools in the area. After being actively recruited and awarded scholarships, loans, and grants, students fail one or more subjects during the senior year and are prevented from graduating. Whether this pattern is intentional cannot be readily documented. However, the frequency with which it occurs causes us to reflect back to the experiences of black nursing students of "yesterday," when white nurse educators and administrators took no responsibility for negative attitudes, and discriminatory practices excluded "Negroes" from admission into nursing programs and limited employment opportunities. Today, affirmative action policies and federal funding guidelines prohibit discrimination in employment but do not protect students from practices of individual faculty, or the silence that surrounds admission, progression, dismissal, and graduation practices. We provide social support and advocacy for students who are experiencing stressors related to grade disputes, financial aid, probation, and dismissal.

For many nursing students, the climate of a nursing program is the major socializing agent for the profession (32). The faculty, staff, and the curriculum transmit values, beliefs, knowledge, and skills that impact the student's learning about self and others. Positive and negative attitudes of faculty affect the self-esteem of all students. However, for African-American students who have experienced acts of adult racism in previous educational or power relationships, and who may carry these negative feelings into post-secondary educational settings, negative feedback is tantamount to rejection (31). Some students may become overwhelmed, unable to deal with racism, and drop out of the program, while others may persist, determined to excel. Some may cope by taking steps to remove or circumvent the problem, seeking support or advice, or sympathy or emotional support, from peers or others (36). Several factors facilitate retention: availability of social support and strong family ties (31); on-campus housing and the presence of African-American counselors and faculty (37); personal and academic development and retention programs (33,38,39); and academic support, cultural activities, and career exploration (34,40).

One strategy that CCBN uses to promote the progression of students and colleagues is mentoring (41). Our mentoring practices reflect the values described by Wright, namely, "enabling and empowering young professionals, fostering growth and development, recognizing individual worth, directing toward goal achievement, facilitating learning, focusing on strengths rather than weakness" (42, p. 50). Emphasis is on providing social support that empowers, enhances self-esteem, validates experiences as real, promotes problem-focused coping, and strengthens our collective resolve to work toward a preferred future in nursing.

Both student and institutional factors contribute to attrition. Student factors such as academic preparation, work or family stressors, financial hardship, motivation, and coping skills are well documented. A variety of academic and social support programs have had a significant impact on reducing attrition (36,38,43-45).

Institutional factors such as faculty attitudes, relevance of the curriculum, marginalization of students, social support, and the campus' cultural climate are also powerful contributors to attrition as evidenced by findings from a study by Ancis and colleagues (26). They report that among their heterogeneous sample of undergraduate students, African-Americans report significantly more racial-ethnic conflict and racial-ethnic separation than Asian-Americans and white students. Blacks felt more pressure to conform to stereotypes, less equitable treatment by faculty, staff, and teaching assistants, and more faculty racism than other students of color. A consistent finding was that white students had limited perceptions of racial-ethnic tensions.

It is understood that students will have different perceptions of the academic environment as a function of their worldview, historical background, and adjustment experience. For black students, these perceptions are real, and, as such, will influence their achievement, adjustment, and ability to take advantage of the opportunities that exist. These findings indicate that to be effective, institutional interventions for retention must address the social milieu (26).

Working Toward Diversity CCBN actively encourages the pursuit of graduate education to address the disparity of African-Americans in leadership positions in nursing education, research, and practice. Research data continue to chronicle the decline of minorities in the profession. During 1991 and 1995, enrollment of minority students in master's and doctoral programs was 10 percent to 12 percent and 9 percent to 11 percent, respectively. The percentage for graduates of those programs ranged from 8 percent and 12 percent to 7 percent and 12 percent, respectively. Blacks comprised 6.3 percent of students enrolled in master's programs and 5 percent of doctoral program enrollees. Graduation rates from these programs were 5 percent and 4 percent, respectively (22,46,47).

Since only 4.9 percent of nursing faculty are black (22,46), few opportunities exist for nursing students of color to have mentoring relationships with them. Black students need a mentoring relationship with a nurse educator whom they can emulate and with whom they feel comfortable (41,44). With low enrollment and graduation rates of people of color from BSN and graduate programs, increasing the diversity of the profession is a worthy goal (28,48-50).

Marla Salmon proposed five values critical for the future of nursing education: caring, courage, inclusion, reflective thinking, and social responsibility (51). These provide an excellent framework for addressing the status of African-Americans in nursing. Salmon questions the impact of nursing's history of being marginalized on its willingness to accept differences. "Whether one considers differences in race and ethnicity, qualitative or quantitative research methodologies, nursing theories, ... we struggle with ideas that do not quite fit our mold.... What is it that allows us to promote cultural competence in our students and fail to make significant strides in the ethnic makeup of our ranks and leadership?" (51, p. 23). As CCBN plans for tomorrow, the value of assuring inclusion, that is, "the ability to truly appreciate and incorporate diversity" (51, p. 23), and the presence of African-American nurses at all levels of nursing, becomes paramount.

To increase the cadre of black nurses who will assume positions of leadership in the 21st century, black nursing students need support and encouragement to complete master's and doctoral programs and compete for predoctoral and postdoctoral fellowships. This problem will be resolved only when all nurses become engaged in finding solutions.

The gains of the past are but a backdrop for the potential of the future. Nursing and health care of the 21st century will become more politicized, and other players will enter the health care arena. Thus, CCBN must be diligent in preventing erosion of the gains of the past. The challenges of the decades ahead will require building coalitions to achieve our goals, monitoring legislation regarding nursing practice, and enacting legislation that protects and promotes the health of the black community and ensures the health of vulnerable populations. A steady flow of blacks into nursing, with black nurses participating in all aspects of the profession, must be assured.

Periodically it is important for us to look back and reflect on the world of professional nursing and the institutions that regulate and influence our profession and the larger society (48-51). As an organization, members guide its destiny. We recognize that attitudes and values related to those who are "different" will continue to exist. However, it is through building and using the strength and talents of members that we can create and maintain a path for personal and professional viability.

Our "tomorrow" rests in the minds, hearts, commitment, motivation, and achievements of African-American nursing students and nurses, and the commitment of all nurses, to the values and ideals of the nursing profession. Each of us must accept our social responsibility to remove artificial barriers that limit access to the profession, or mobility within its ranks, for competent African-Americans, if we are to achieve a multicultural nursing workforce and a preferred future that enables us to meet our collective commitment to nursing and the health care of our communities. "We must create our preferred future from a commitment to `us.' We must unite, as if in a single garment. To do less will diminish us all" (49).

Philosophy of the National Black Nurses Association

Provision for the enjoyment of optimal health is the birthright of every American. Major health interest groups and governmental agencies believe this and act upon it. Yet, Black Americans, along with other minority groups in our society, are by design or neglect excluded from the means to achieve access to the health care that is available to the mainstream of America. Therefore, we, as Black nurses, have established a national organization to investigate, define, and determine what the health care needs of Black Americans are, and to implement change to make available to Black Americans and other minorities health care commensurate to that of the larger society. Black nurses have the understanding, knowledge, interest, concern, and experience to make a significant difference in the health care status of the Black community.


1. Define and determine optimum quality of health care for the Black consumer by acting as their advocates.

2. Act as a change agent in restructuring existing institutions and/or helping to establish institutions to address unmet needs.

3. Serve as local nursing body to improve health care for the Black community and to work cooperatively and collaboratively with other health care workers to this end.

4. Conduct, analyze, and publish research to increase the body of knowledge about health needs of Blacks.

5. Compile and maintain a local directory of Black nurses to assist with the dissemination of information regarding Black nurses and nursing on national and local levels by the use of all media.

6. Utilize standards and guidelines for quality education of Black nurses established by the NBNA by providing consultation to nursing faculties and monitoring for proper utilization and placement of Black nurses.

7. Recruit, counsel, and assist Black persons interested in nursing to insure a constant progression of Blacks into the profession.

8. Act as a vehicle for unification of Black nurses of various age groups, educational levels and geographic locations to insure continuity and flow of our common heritage.

9. Collaborate with other Black groups to compile archives to the historical, current, and future activities of Black nurses.

10. Provide information and encourage Black nurses to write and publish on an individual or collaborative basis.

11. Provide educational programs for the membership and other nurses throughout the community (19).


(1.) Carnegie, M. E. (1986). The path we tread: Blacks in nursing 1854-1984. New York: NLN Press.

(2.) Miller, H. S. (1986). America's first Black professional nurse: A historical perspective. Atlanta, GA: Chi Eta Phi Sorority.

(3.) Hine, D. C. (Ed.). (1985). Black women in the nursing profession: A documentary history, New York: Garland Publishing.

(4.) Staupers, M. K, (1961). No time for prejudice: A history of the integration of Negro nursing in the United States. New York: Macmillan.

(5.) Thoms, A. B. (1985). Pathfinders: A history of the progress of Colored graduate nurses. New York: Garland Publishing.

(6.) Bullough, V. L., & Bullough, B. (1978). The emergence of modern nursing. New York: Macmillan.

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Valerie D. George, PhD, RN, is associate professor, Department of Nursing, Cleveland State University, Cleveland, Ohio. Dorothy M. Bradford, PhD, RN, is former division head, Eastern Campus, Cuyahoga Community College, Cleveland. Alice Battle, BSN, RN, is corresponding secretary, and Drs. George and Bradford are past presidents, Cleveland Council of Black Nurses. An earlier version of this article was the script for the award-winning video "Yesterday, Today and Tomorrow: A History of Cleveland Council of Black Nurses," produced in 1995 to celebrate the 25th anniversary of the organization. A version of the article was also presented at the International Council of Nursing, Centennial Conference, London, England, June 27-July 1, 1999. Information was obtained from personal recollections of founding members of CCBN, documents from the organization's files, and historical accounts.


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