Prejudice is belief (even if it's unacknowledged) in a preconceived opinion, one not based in reason but rather in pervasive and widely accepted systems of subtle acceptance (Collins, 1990; Crenshaw, 1989). Prejudice assumes the inadequacy of "others." It is expressed through racist, classist, sexist, and ethnic stereotyping behaviors. Expressions of prejudicial behaviors may be readily discernible, incorporating name-calling and rude affronts. Equally as frequent, prejudicial behaviors may be elusive, manifested through subtle unjust and dismissive acts: verbal microaggressions such as slights, snubs, and insults that communicate hostile or derogatory negative messages that serve to define the parameters of who has rights to resource access (Baptiste, 2015; Byers et al., 2021).

The 2003 publication of Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (Smedley et al., 2003) urged attention to healthcare inequities emerging as a consequence of prejudice. As consideration of these disparities has advanced across the last several decades, attention has been devoted not only to acknowledging health disparities, themselves, but also to the systems of belief through which those disparities are maintained, to the "culture of silence" (Iheduru-Anderson et al., 2021, p. 118) that promotes the institutionalization of prejudice. Prejudicial systems of belief are powerful and stable, and as Ricks et al. (2021) note, "nothing less than a seismic paradigm shift" (p. 1) will alter their influence on the quality of patient care.

As nurses in the United States, we must recognize that our profession has been developed and continues to operate within a context dominated by prejudice, characterized by issues of colonialism and structural racism (Waite & Nardi, 2017; Weitzel et al., 2020, p. 110). As a social practice, racism emerged in the 19th century through European colonization of much of the world. Racism supported the rise and development of Western, White capitalism as it advanced the slave trade in Europe and the United States (Dennis, 2004). Embedded as they are in much of the world's culture, racist behaviors have continued for several hundred years, largely unnamed and widely accepted as justified and justifiable. They constitute "America's original sin" (Ross, 2020, para. 8).

The stigma felt by those in a minority group, whether personally experienced, perceived as involving self or others, or just anticipated through subtle contextual cues, impacts their social and personal well-being (Valdiserri et al., 2019); its influence may hasten the onset and progression of chronic disease (Braveman et al., 2011). The May 2020 murder of George Floyd and the disproportionate impact of COVID-19 in communities of color, as inappropriate and immoral as both are, seem to have initiated the paradigm shift called for by Ricks et al. (2021). From the context generated by these atrocities, the inappropriateness of racism and other forms of prejudice are "yelling" loudly (Villaruel & Broome, 2020), belying the 200-year history of silence that has perpetuated networks of prejudicial policies, practices, and norms, extending calls for a research agenda that addresses the "minority stress" of those who are not of the dominant social group (Institute of Medicine, 2011).

In 1993, Barbee considered the impact of racism in nursing practice. She questioned the dichotomies posed in nursing when "caring" transpires in a culture of often-subtle racist practices, when values for tradition impede breaking free from racism, and when comfort in the familiarity of tradition challenges willingness to challenge racist practice. In nursing, racist traditions and practices, no matter how "subtle" they are, will powerfully marginalize nursing's core concepts and values, surreptitiously shifting focus away from caring toward efforts that foster disparity (Braveman, 2011) and act powerfully and invisibly to serve those who are "legitimate and deserving."

To practice nursing fully and honestly as professionals, we must confront racism and the beliefs and structures that support its institutionalization. To do less would actively defeat our efforts to "care." In this time of COVID-19 when nurses so badly need the support and colleagueship of each other, moving beyond the artificial margins constituting subtle acceptability is worthy of in-depth and focused consideration. There is and has been no time like the present, a time during which history and social trauma have inadvertently opened a door for truly seeing the vagaries of "unequal treatment" (Betancourt & Maina, 2004). Caring, in this complex, present time, is in short supply, even on the best days. There is no place for structures that foster prejudice when caring is so significantly needed. Knowing this, how can we remain silent?

Conflict of Interest

The authors declare no conflicts of interest.

Funding

There is no funding for this article.

Laura Dzurec, PhD, PMHCNS-BC, ANEF, FAAN

Editorial Board Member

Pamala D. Larsen, PhD, MS, RN

Editor-in-Chief

References