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What Keeps Black Women Nurses Out of Leadership Roles?

Analysis  |  By Jennifer Thew RN  
   October 04, 2019

After noticing black women were not well-represented in academic leadership, one researcher was prompted to study what influences can impact black women from securing leadership roles.

Does your healthcare organization's leadership team represent the diversity of your organization and surrounding community? Not likely.

According to the Institute for Diversity and Health Equity's 2015 benchmarking study, Diversity and Disparities: A Benchmarking Study of U.S. Hospitals in 2015, "minorities comprise only 14% of hospital board members, 11% of executive leadership positions, and 19% of first- and mid-level managers."

The same report found that "minorities represent 32% of patients in hospitals that responded to the survey."

Tamara Bland, EdD, MSN, RN, director of the RN-BSN program at Dominican University in River Forest, Illinois, has noticed this disparity firsthand.   

"When I started [working] in higher education, I was at an institution where I was the only person of color," Bland says.

The lack of black women in leadership roles in higher education inspired Bland's doctoral research, Factors that Impact Black Nurses’ Leadership Opportunities in Higher-education, she says.

"As I went to conferences and talked with others, [I noticed] there weren't many black women in positions of leadership. I thought it would be good to look at what variables were impacting women of color to be in such roles," she says.

In 2017, Bland undertook a mixed method, explanatory correlational study "to determine any correlation between Black nurses and the influence of racism, leadership attributes, mentors, institutional support, self-efficacy and financial barriers and the participants’ achievement and success in their professional role."

Through a Likert scale survey distributed to nursing faculty from 88 nursing schools in Illinois, Bland collected data on nurse’s beliefs about "leadership roles within higher-education and the impact of racism, leadership attributes, mentoring, institutional support, self-efficacy and financial disparity" that affected attainment of leadership roles among black nurses in the state. Data from 28 participants was collected that included an open-ended qualitative question.

For purposes of the study, the variables were defined as follows:

  • Racism: prejudice, discrimination, or antagonism directed against someone of a different race based on such a belief.
  • Leadership attributes: social influence process where leaders use interpersonal behaviors to motivate followers.
  • Mentoring: an experienced person in a company, college, or school who trains and counsels new employees or students.
  • Institutional support: refers to the support received from the institution in which the participant is employed.
  • Self-efficacy: refers to an individual’s belief in his or her capacity to execute behaviors necessary to produce specific performance attainments
  • Financial disparity: relates to the difference between financial statuses among other ethnic/minority groups

Following are insights Bland shared with HealthLeaders about her research and advice about how to create a more diverse and inclusive group of nurse leaders both in academia and at healthcare organizations.

The transcript has been lightly edited for brevity and clarity.


The State of Black Women in Healthcare Leadership

"The 'a-ha' moment for me [after doing the study] was how little things have changed. We've made very little progress in the past 20 years to diversify faculty roles and leadership roles within higher education and within organizations. We haven't done much to address and change that, and I thought, 'Wow, that's kind of sad.' "

Factors Affecting Leadership

"The variables that showed the most statistical significance were self-efficacy, financial disparity, institutional support, and mentoring. One of the other variables that I listed and asked questions about was racism. However, that showed no statistical significance."  

"In order to rectify the barriers, leaders of all backgrounds and ethnicities must first understand and accept that these barriers exist. It's important that healthcare providers are representing the racial or ethnic minorities that they are caring for. We need to understand the ways to overcome the barriers and increase the representation of black women in leadership within healthcare. Then [these leaders] could take that knowledge and their personal cultural insights to effectively address disparities within their own communities."

"[In the survey findings,] black women wanted to pursue higher degrees, but financially either [they] couldn't or didn't want to get into debt. When it comes to the mentoring piece, I think a good mentor can help you find funding or find something that you're passionate about and then help you overcome the obstacle of, 'I can't do this because of finances.'"

Finding a Mentor Is Critical

"I think organizations are starting to put those mentoring programs in place, but if we want more people of color or racially diverse backgrounds, we have to fund this somehow."

"Black nurses are looking for leaders that can help inspire them and achieve that higher aspiration of being in leadership roles, whether it's within academia to be an assistant dean, a dean, a president or provost, or in the healthcare setting to be a CNO. Representation of women of color within both settings could bring a different perspective to healthcare."

Institutional Support Is Essential

"One of the things that came up [during the research was], black nurses didn't necessarily feel valued as leaders, and black nurses also had fewer opportunities to participate in funded research and less opportunity to be published."

Diversity Can Affect the Future Workforce

"In my opinion, the implications of empowerment of black women into the field of education and leadership would help to extinguish stereotypes, break the minority stigma, and further diversify colleges and universities."

"One outcome [of more black nurse leaders] would be enrollment of more [black] students. What I've found in the research was that everyone wants to be represented. If institutions don't have diversity and inclusion, what they do is they inadvertently contribute to a system that marginalizes women of color, whether it's faculty or students. If we could increase inclusion and diversity and foster the role of black nursing faculty or administrators as an integral part of any institution, I think that would increase the value of the organization. I think you would also improve or increase retention and attainment of students or faculty within those settings."

"To be represented shows that, 'I could achieve that goal because this person did it.' "

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.


The variables of self-efficacy, financial disparity, institutional support, and mentoring affect whether black nurses obtain leadership positions.

Representation of black women in academia can help encourage diversity and inclusion among nursing students.

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