Addressing anti-black racism - advancing equity and empowering black registered practical nurses: A multiple method research design

Abstract

Background

Nurses form the backbone of the Canadian healthcare system, with the largest workforce representation across various care settings (Health Canada, 2024). The purpose of this narrative review is to critically examine from the literature the structural and systemic challenges experienced by Black Registered Practical Nurses (RPNs), within the broader context of the ongoing national nursing crisis. While RPNs form a significant portion of the nursing workforce, Black RPNs encounter unique and compounding barriers due to anti-Black racism (ABR) and systemic inequities. RPNs, who are invaluable healthcare providers that work in various disciplines such as education, informatics, policy and leadership, are increasingly impacted by workforce shortages, burnout, and structural challenges issues especially intensified for Black RPNs (RNAO, n.d.; Registered Practical Nurses of Ontario (WeRPN), 2024).

Methods

Between January and March 2025, a literature search was conducted on the following databases: Emcare, Embase, Scopus, Medline (Ovid), CINAHL Complete, and APAPsychNET. Key search words such as “Black Canadians”, “Black Persons”, “Registered Practical Nurses”, “Social Discrimination”, “Prejudice”, “Job Satisfaction", “Professional Development” were used. Out of 795 papers reviewed, a narrative review of eight qualitative and quantitative studies was conducted to explore the experiences of Black nurses in Canada. Thematic analysis identified four core themes: (1) navigating racism and discrimination in the workforce, (2) leadership and career progression in nursing, (3) diversity and inclusion in the workforce, (4) and strain on personhood.

Results and discussion

Racism emerged as a key barrier at multiple levels. For example, historical exclusion limited early access to nursing education, while career progression remained hindered by structural inequities and lack of mentorship. Studies have also shown a pattern of internationally educated Black nurses facing systemic obstacles through immigration and credentialing processing, contributing to underemployment, and deskilling. Diversity initiatives also were often seen as symbolic rather than transformative.

Conclusion

This review’s findings highlight the intersecting factors such as unsafe working conditions, professional role conflicts, limited support for career advancement, and racial discrimination collectively impact the retention, well-being, and professional growth of Black RPNs. By highlighting these overlooked experiences, this review will contribute to further inform equity-oriented policies, education, and organizational change to promote the professional well being of Black RPNs.

What is already known.

• •Black nurses experience anti-Black racism through interpersonal discrimination, institutional exclusion, and systemic barriers within nursing education and healthcare workplaces.
• •Black nurses face inequities in hiring, career advancement, leadership representation, workload, compensation, mentorship access, and organizational support.
• •Evidence specifically examining the professional experiences, advancement, and retention of Black Registered Practical Nurses remains limited, with many studies combining multiple nursing designations.

Alt-text: Unlabelled box dummy alt text

What this paper adds.

• •This review found that anti-Black racism affects Black nurses across multiple stages of their careers and contributes to psychological distress, professional isolation, restricted advancement opportunities, and risks to workforce retention.
• •This review identified leadership as both a site of exclusion and a form of community-centred advocacy, with Black nurses frequently demonstrating leadership outside formally recognized organizational roles.
• •This review found that symbolic diversity initiatives, unequal workloads and compensation, and credentialing and immigration barriers, particularly for internationally educated Black nurses, reinforce structural inequities within the nursing workforce.

Alt-text: Unlabelled box dummy alt text

1. Introduction

Nurses are an integral component of the Canadian healthcare system, representing the largest proportion of the health workforce (Health Canada, 2024). Ontario recognizes three categories of nursing: Registered Practical Nurses (RPNs), Registered Nurses (RNs), and Nurse Practitioners (NPs) (College of Nurses of Ontario [CNO], 2025; RNAO, n.d.). All categories of nurse’s study from a shared body of nursing knowledge, although RPNs typically complete a two- to two-and-a-half-year college diploma. In Ontario alone, as of July 1st, 2025, the CNO reports 130,137 RNs, 60, 374 RPNs, 5497 NPs, and 2862 dual RPN/RNs registered in the general and extended classes (CNO, 2025). According to the Registered Practical Nurses Association of Ontario (2024), also known as WeRPN, Registered Practical Nurses are employed across a broad range of sectors, including acute care, long-term care, home and community care, public health, school care, and primary care.

Ontario's ongoing nursing crisis has placed unprecedented strain on the workforce. The impacts of the COVID-19 pandemic, rising workloads, and an aging population have amplified system-level challenges (Tomblin Murphy et al., 2022). In Ontario, RPNs particularly those working in long-term care and acute-care hospitals are experiencing heightened pressure as frontline care providers in the most heavily burdened sectors (Connelly et al., 2023). Data from longitudinal surveys conducted by WeRPN (Registered Practical Nurses of Ontario (WeRPN) 2024) further underscore the growing concerns related to burnout, job dissatisfaction, and attrition. Compounding these pressures are intraprofessional tensions and role ambiguity between RPNs and RNs, which have been shown to affect team dynamics and create barriers to collaboration (Nowrouzi-Kia et al., 2022). These challenges have direct implications for job retention, career progression, and overall mental well-being, prompting growing numbers of RPNs to leave the profession (Connelly et al., 2023).

These systemic challenges disproportionately affect racialized nurses, especially Black RPNs, who encounter additional layers of marginalization due to anti-Black racism (ABR) and systemic exclusion. Anti-Black Racism has been embedded and normalized in Canadian institutions, policies, and practices (Government of Canada, 2026). ABR manifests itself in various ways, ranging from harmful interpersonal communications to larger societal disparities and barriers (Government of Canada, 2026).While broader research has examined racial disparities in nursing, there is a notable gap in literature specific to the experiences of Black RPNs in Canada. This gap in empirical evidence and policy guidance results in the ongoing invisibility of their contributions and the absence of targeted support within healthcare institutions. Without a strong body of research to inform equity-driven strategies, Black RPNs continue to operate within systems that fail to address their unique needs. Critical Race Theory (CRT) offers an important framework for understanding how systemic racism is embedded within institutional structures and highlights the need for race-conscious approaches in nursing research and policy.

These inequities are rooted in long-standing social, political, and historical dynamics. A United Nations report in 2017 emphasized the persistence of ABR in Canada, affirming that individuals of African descent continue to experience systemic discrimination (Working Group of Experts on People of African Descent, 2017). In healthcare, this manifests through microaggressions, implicit bias, and exclusionary practices (Williams et al., 2022). The cumulative effects of racism have been linked to psychological distress, negative physical health outcomes, social isolation, and deepened structural inequities (Cénat et al., 2023). Given this context, there is an urgent need to understand from the literature and address the experiences of Black RPNS in policy, practice, and education.

1.1. Significance and purpose

The purpose of this narrative review is to examine the existing literature on Black RPNs’ professional experiences such as professional development, retention levels, job satisfaction, and opportunities for advancement particularly within the context of anti-Black racism (ABR). This review is guided by the following central question: How does anti-Black racism influence the professional advancement and retention within the experiences of Black Registered Practical Nurses (RPNs)? By synthesizing current evidence, this review aims to illuminate the systemic barriers that affect the professional lives of Black RPNs, identify critical gaps in policy and practice, and provide insights to inform equity-oriented strategies in nursing education, leadership, and workforce planning.

2. Methods

For this narrative review, the inclusion criteria were designed to ensure a comprehensive examination of the experiences of Black Registered Practical Nurses (RPNs) within Ontario. Due to the dearth of literature on this population, designations such as Licensed Practical Nurse, Enrolled Nurse, Auxiliary Nurse, Vocational Nurse were included into the study. A narrative review was chosen for this paper because it allows for a comprehensive, contextual, and interpretive synthesis of literature on the complex and underexplored experiences of Black Registered Practical Nurses (RPNs) in Ontario (Sukhera, 2022). This approach is particularly suited to exploring multifaceted issues such as anti-Black racism in healthcare, which has not been captured by current literature. Unlike systematic reviews, which rely on rigid inclusion criteria, a narrative review supports the exploration of broader themes allowing for a more nuanced understanding of how structural racism intersects with the nursing profession (Green et al., 2006; Sukhera, 2022). Additionally, this approach helps to identify critical gaps in literature and center the voices and experiences of Black RPNs' that have often been marginalized. Ultimately, the narrative review format aligns with the paper’s goal of raising awareness and informing equity-oriented policy and institutional change within the healthcare system.

2.1. Inclusion criteria

The review considered studies involving participants of any gender, including male, female, and non-binary individuals. The primary focus was on research that explored the experiences of Black RPNs, particularly in relation to anti-Black racism, professional development, career advancement, nursing retention, and workplace relationships. Given that this population is both underrepresented and understudied, there were no restrictions based on the publication years of the studies included in the review.

Only studies published in English or those available in English translation were considered. The review also did not impose geographical limitations, allowing for the inclusion of studies conducted internationally, thereby broadening the scope of insights gathered. The types of studies reviewed included full-text, peer-reviewed experimental studies, qualitative research, systematic reviews, meta-analyses, and descriptive studies. In addition, gray literature was included to capture valuable insights that may not be found in traditional peer-reviewed sources. Ultimately, this approach ensured a thorough and diverse range of studies, all aimed at understanding the unique experiences and challenges faced by Black RPNs.

2.2. Selection and screening process

A preliminary search and screening were conducted between January and March 2025 using the following databases: Emcare, Embase, Scopus, Medline (Ovid), CINAHL Complete, and APAPsychNET. A liaison librarian was consulted to aid in developing a more refined search strategy. The selection and screening process for this narrative review was structured to ensure that the studies included met predefined inclusion criteria, essential for gathering relevant and high-quality data to achieve the review’s objectives. The results from the search strategies were first imported into a Zotero library for efficient reference management. These results were then uploaded to Covidence to aid in the screening process. After importing the search results, a total of 795 papers were identified. Of these, 55 duplicates were automatically removed by Covidence, leaving 740 papers to be screened during Level 1 Screening. During this phase, 693 papers were excluded, and 47 papers proceeded to Level 2 Screening, where 12 papers were ultimately extracted for full text review. At the end of the full text review, 8 papers were included in the study by the screeners and remaining four papers were excluded due to limited data for retrieval, and wrong population.

2.3. Data extraction

Two independent screeners (A.B and E.A) under the supervision of the principal investigator and co-investigator (N.P and P.B) reviewed the titles and abstracts of the selected studies to assess their alignment with the predefined inclusion criteria. Any disagreements between the screeners were resolved through a discussion with one another to reach a consensus. Once an agreement was reached, the full texts of the potentially eligible studies were reviewed independently by both screeners. A Google Sheets spreadsheet was created to record detailed information for each study, including author, year of publication, country where the study was conducted, study aim and purpose, study design, population and sample size, ethnic group of participants, key findings and results (Fig. 1).

Fig. 1.

The PRISMA diagram outlines the study selection process for this narrative review. After careful consideration, the authors have included in this review 8 studies.

This comprehensive screening process ensured a thorough evaluation of each study's eligibility, enabling the identification of those that most effectively addressed the review's objectives. The screening adhered to the SANRA (the Scale for the Assessment of Narrative Review Articles) scale, providing a transparent methodology that minimized bias and strengthened the reliability of the narrative review's findings (Baethge et al., 2019). By systematically narrowing the studies, only the most relevant and robust evidence was included, ensuring that the review's synthesis would accurately and comprehensively address the research question.

A thematic analysis approach was used to organize the extracted data into four themes. We chose thematic analysis because it involves systematically reading data to closely identify common patterns and themes across the manuscripts (Ahmed et al., 2025).

3. Results

3.1. Study characteristics

The geographic distribution of the articles included in this study are the United States (Hurtado et al., 2012; Kaminski-Ozturk et al., 2024; Martin et al., 2024), Canada (Cooper Brathwaite et al., 2023; Jefferies et al., 2022a, 2022b, 2025) and South Africa (Cohen and Venter, 2020). The papers extracted are primarily qualitative design. Black RPNs are underrepresented in the literature which is reflected by the results of this study. Due to the limited information on this topic, the studies included in this review contain a mixed-sample of nursing classifications (e.g., LPN/RPNs, RNs, NPs), and races (e.g., Black, White, Asian). We have also included a scoping review, and a rapid review into this paper. This demonstrates the dearth of literature currently available on Black RPNs.

Theme 1: Navigating Racism and Discrimination in the Workforce

In five studies, racism emerged as a central and recurring theme throughout the literature, manifesting across interpersonal, institutional, and systemic levels (Cooper Brathwaite et al., 2023; Hurtado et al., 2012; Jefferies et al., 2022a, 2022b, 2025). Participants reported a range of racist experiences, including racial slurs, microaggressions, and exclusionary behaviors from colleagues and patients (Cooper Brathwaite et al., 2023; Jefferies et al., 2022a, 2022b, 2025). At the systemic level, racism was evident in discriminatory hiring practices, limited opportunities for promotion, and institutional inaction when racism was reported (Cooper Brathwaite et al., 2023; Jefferies et al., 2025). These experiences were further compounded by intersectional factors such as cultural norms, gender, immigration status, and class, which shaped the ways in which Black nurses experienced and responded to discrimination (Jefferies et al., 2022a, 2022b, 2025).

Importantly, the effects of racism extended beyond the workplace. In Cooper Brathwaite et al. (2023) article, 63% of respondents reported the negative impacts of racism on their mental health. Many Black nurses described feeling isolated and unsupported, and emphasized the need for mental health services, legal advocacy, mentorship programs, and allyship from both peers and leadership (Cooper Brathwaite et al., 2023; Jefferies et al., 2025). Across the literature, there was a consistent call for greater leadership accountability and institutional transparency, underscoring the urgent need for healthcare organizations to address and dismantle the structures that allow racism to persist (Cooper Brathwaite et al., 2023; Jefferies et al., 2022a, 2022b, 2025).

The literature also consistently identified the historical exclusion of Black nurses in Canada as a foundational barrier to equity within the profession (Cooper Brathwaite et al., 2023; Jefferies et al., 2022a, 2022b). Jefferies et al. (2022b) reported in their article that prior to the 1940s, Black Canadians were largely denied access to nursing education, effectively restricting their entry into the field. Even when access was eventually granted, the contributions of Black nurses were frequently overlooked or erased from dominant professional narratives (Jefferies et al., 2022b).

Theme 2: Leadership and Career Progression in Nursing

Black nurses remain significantly underrepresented in leadership roles and continue to face persistent structural barriers to career advancement. Out of the eight studies, seven studies have consistently described marginalization, excessive workloads, and a lack of access to mentorship and professional development opportunities as routine challenges that hinder upward mobility (Cooper Brathwaite et al., 2023; Hurtado et al., 2012; Jefferies et al., 2022a, 2022b, 2025; Kaminski-Ozturk et al., 2024; Martin et al., 2024). Many Black nurses reported that their career trajectories were directly shaped by experiences of racism, resulting in limited access to senior positions, decision-making roles, and influential professional networks (Cooper Brathwaite et al., 2023; Jefferies et al., 2022a, 2025).

Jefferies et al. (2022a) article reported that Among African Nova Scotian (ANS) nurses, the concept of leadership was viewed as a community-centered and advocacy-driven practice. Participants emphasized leadership as rooted in their care practices, resilience, and commitment to social justice, often enacted despite institutional barriers and limited visibility in formal leadership structures (Jefferies et al., 2022a). For ANS nurses, leadership was inseparable from their identity and collective responsibility to their communities, highlighting the need for broader definitions and recognitions of leadership within the nursing profession (Jefferies et al., 2022a).

Theme 3: Workforce Diversity and Inclusion Gaps

Although diversity initiatives were present across nursing education and healthcare institutions, six studies have consistently highlighted that many of these efforts lacked depth, accountability, and measurable long-term impact (Cooper Brathwaite et al., 2023; Jefferies et al., 2022a, 2022b, 2025; Kaminski-Ozturk et al., 2024; Martin et al., 2024). Black nurses frequently reported feeling excluded from leadership roles and marginalized in decision-making spaces, particularly in environments dominated by white leadership and Eurocentric norms (Cooper Brathwaite et al., 2023; Jefferies et al., 2022a, 2022b, 2025). Many expressed skepticism about the effectiveness of existing diversity strategies, especially those that did not incorporate meaningful structural change or ongoing evaluation mechanisms.

Theme 4: Strain on Personhood

Four papers have also reported that Black nurses face lower wages, heavier workloads and greater job strain in the profession, echoing racial inequalities present in society (Cohen and Venter, 2020; Hurtado et al., 2012; Kaminski-Ozturk et al., 2024; Martin et al., 2024). For instance, Hurtado et al. (2012) article on the racial disparities in job strain in nursing homes reported that Black workers on average worked longer hours and made approximately 2.58 dollars less than the White workers. Kaminski-Ozturk et al. (2024) article on LPN workforce in America also highlighted that a significant number of Black, Indigenous and People of Colour LPNs were more likely to hold multiple job positions compared to White LPNs.

Hurtado et al. (2012) article noted that compared to White Americans, Black nurses from the Caribbean reported 3.5 times higher risk of job strain. This is an example of distinguished experiences between Canadian-born Black nurses and internationally educated nurses, particularly those from the Caribbean who faced additional barriers related to credential recognition, restrictive immigration policies, occupational deskilling and underemployment, and racialized assumptions about their qualifications and competence (Jefferies et al., 2022b).

4. Discussion

The primary objective of this narrative review was to examine the existing literature on how anti-Black racism impacts the professional advancement and retention of Black Registered Practical Nurses (RPNs). This paper recognizes the various designated titles (e.g., Vocational Nurses, Licensed Practical Nurses, Auxiliary Nurses), and jurisdictional practice differences that practical nurses can have in the profession. However, since the study focuses on Ontario RPNs, we will continue to refer to them using the term RPN.

This paper aims to identify knowledge gaps and explore key themes surrounding the experiences of Black RPNs. While some literature on Black RPNs exists, it remains limited, highlighting a significant gap that calls for further research and targeted interventions to support this group in Canada. Through the selection and screening of relevant studies, this narrative review seeks to provide valuable insights to fill these gaps and inform strategies to better support Black RPNs.

This review underscores the profound and pervasive impact of systemic racism on the professional experiences of Black nurses in Canada (Cooper Brathwaite et al., 2023; Hurtado et al., 2012; Jefferies et al., 2022a, 2022b, 2025). Racism was found in this narrative review as not an isolated occurrence, but a structural reality embedded in the fabric of the nursing profession manifesting interpersonally, institutionally, and systemically. These findings echo broader conversations within healthcare about the need to move beyond diversity rhetoric toward concrete anti-racist reforms as it has many detrimental impacts.

The need for comprehensive support, including accessible mental health services, legal advocacy, and culturally responsive mentorship was consistently identified across the studies. However, these supports must be accompanied by systemic shifts in accountability and leadership responsiveness to meaningfully address the root causes of harm. Unaddressed, these inequities contribute not only to individual distress, but to workforce attrition, institutional distrust, and enduring racial disparities in health outcomes.

The historical exclusion and erasure of Black nurses particularly prior to the 1940s continue to shape present-day inequities in representation, recognition, and advancement (De Sousa et al., 2024; Flynn, 2009). The legacy of these exclusionary practices persists in the underrepresentation of Black nurses in leadership, the limited acknowledgment of their contributions, and the devaluation of informal leadership rooted in community care. Findings in this study demonstrate that more research is needed to better understand the professional experiences of Black nurses, including RPNs to guide nursing education, policy and practice for a stronger and more inclusive healthcare system and improved patient care.

Importantly, the review differentiated the unique challenges faced by Canadian-born Black nurses and IENs, particularly from the Caribbean (Flynn, 2009; Jefferies et al., 2022b). Jefferies et al. (2022b) touched upon the urgent need for systemic policy reform to facilitate equitable integration for immigrant Black nurses. This includes fairer credential assessment, streamlined licensure processes, and recognition of international experience to ensure that these nurses can fully contribute to the Canadian healthcare system. Additionally, these structural barriers were compounded by racism and discrimination, both during the immigration process and within the workplace, further hindering their ability to succeed professionally (Jefferies et al., 2022b).

Leadership emerged as both a site of exclusion and a space of resistance. While Black nurses remain underrepresented in formal leadership roles, many continue to lead through advocacy, care, and resilience often outside traditional structures (Jefferies et al., 2022a; Nelson et al., 2023). This was especially evident among African Nova Scotian nurses, who articulated leadership as a collective, community-driven practice (Jefferies et al., 2022a). Recognizing and validating these broader definitions of leadership can challenge dominant norms and expand pathways for Black nurses to influence institutional culture and policy (Philips et al., 2021). BFT provides a useful lens to understand this, foregrounding how Black women often engage in leadership through relational, rather than hierarchical, models rooted in historical traditions of mutual care and resistance.

Although diversity and inclusion initiatives are increasingly common within nursing and healthcare education, the review also revealed that many efforts lack depth, sustainability, and accountability (Cooper Brathwaite et al., 2023; Jefferies et al., 2022a, 2022b, 2025). The continued marginalization of Black nurses in leadership and decision-making roles along with skepticism about the efficacy of current diversity strategies suggests that symbolic representation alone is insufficient. Critical Race Theory (CRT) helps explain these limitations, particularly through the concept of interest convergence, where institutional reforms only advance when they align with dominant group interests. This reinforces the need for policies that are structurally transformative rather than merely performative.

These papers have also highlighted higher rates of lower salaries, heavier workloads, and increased job strain among Black nurses. Unaddressed, these types of workplace disparities may play a significant role in contributing to chronic stress, fatigue, and burnout within this population, and ultimately lead to their exit out of this field (Filipova, 2022; Thomas-Hawkins et al., 2022). This attrition not only limits the diversity of the nursing workforce but also diminishes culturally competent care, especially for Black patients. The economic and emotional burden borne by Black nurses is inseparable from broader systems of labor inequity and exploitation.

Ultimately, this review illustrates that improving equity for Black nurses in Canada demands more than recruitment or representation; it requires a sustained, systemic commitment to justice, accountability, and transformation. As healthcare institutions begin to grapple with the legacies of colonialism and racism in Canada, the insights and leadership of Black nurses must be central, not peripheral to any efforts toward reform.

5. Future implications

The findings of this review emphasize the urgent need for a targeted, multipronged approach to address the systemic inequities faced by Black Registered Practical Nurses (RPNs) across healthcare and nursing institutions in Canada. Moving forward, specific actions in policy, practice, education, and research must be prioritized to improve the professional advancement, retention, and well-being of Black RPNs.

5.1. Policy reform and institutional accountability

Healthcare organizations, regulatory bodies such as the College of Nurses of Ontario, and nursing employers must develop and enforce anti-Black racism-specific policies that directly address discriminatory hiring, inequitable promotion practices, and workplace racism affecting RPNs. Given the high proportion of internationally educated Black RPNs, particularly those from a Caribbean background, immigration and credentialing processes must be restructured to recognize international nursing education and experience, minimizing deskilling and employment delays (Prendergast et al., 2025). Regulatory bodies and employers must also establish clear, transparent accountability structures to track and report progress on racial equity goals, with mandatory anti-Black racism education for senior leadership and decision-makers responsible for RPN workforce management. Collecting race-based data is impertinent, allowing stakeholders, and organizations to identify, monitor, and address any racial-biases present in healthcare (Canadian Institute of Health Information, 2022).

5.2. Leadership development and redefinition

Healthcare institutions must integrate anti-Black racism frameworks directly into organizational leadership policies, recruitment, and promotion practices specifically for Registered Practical Nurses (RPNs), whose leadership contributions are often undervalued. This includes implementing mandatory, culturally responsive leadership training for all managers and supervisors overseeing RPNs, along with transparent and measurable career advancement pathways that explicitly address racial inequities.

Leadership development programs must also be tailored to the distinct needs of Black RPNs and should include access to formal mentorship, sponsorship by senior leaders, and financial support (e.g., paid time for leadership training and professional development courses). These initiatives should be designed not only to foster individual advancement but also to increase Black RPN representation in unit leadership, advisory roles, union leadership, and organizational decision-making bodies.

Institutions should also track leadership development outcomes disaggregated by race and nursing designation (RPN, RN, NP) to ensure accountability and measurable progress toward equity goals.

5.3. Mental health and workforce support

Given the well-documented psychological toll of anti-Black racism, healthcare institutions must provide culturally safe, trauma-informed, and accessible mental health support specifically for Black Registered Practical Nurses (RPNs). These services should be designed in consultation with Black RPNs and mental health professionals who specialize in racial trauma. Supports must go beyond generic employee assistance programs to include race-conscious counselling, group therapy spaces for Black nurses, and access to culturally competent care providers.

Interventions must also address the broader structural stressors disproportionately affecting Black RPNs, including caregiving responsibilities, immigration-related pressures, and financial strain, especially for immigrant and women-identifying RPNs who face intersecting vulnerabilities.

Additionally, healthcare organizations and employers should implement workforce supports that are essential for both retention and well-being, including:

• •Peer mentorship programs led by and for Black RPNs
• •Flexible scheduling policies that account for caregiving demands and burnout risks
• •Legal advocacy resources and supports to assist RPNs facing workplace discrimination or credentialing barriers.

These workforce supports should be sustained and monitored through regular evaluations that include race-based data collection, ensuring interventions effectively reduce psychological distress and improve job satisfaction for Black RPNs.

5.4. Educational transformation

Nursing education programs, particularly those preparing Registered Practical Nurses (RPNs) must undergo intentional reforms to address the erasure of Black histories, voices, and contributions within the profession. This requires the integration of a critical race theory using an anti-Black racism perspective, and content that explicitly examines the historical and ongoing exclusion of Black communities from nursing and healthcare leadership roles, including within the RPN profession.

Curricula for RPN programs should include:

• •Case studies, clinical scenarios, and readings that reflect the lived experiences of Black patients, nurses, and communities.
• •Training on recognizing and addressing anti-Black racism in clinical practice, professional relationships, and healthcare systems.
• •Education on the impacts of racial trauma, racialized health disparities, and systemic barriers specific to Black RPNs.

Additionally, increasing the recruitment, hiring, and retention of Black RPNs as faculty, clinical instructors, and academic mentors is critical for fostering inclusive learning environments. Nursing programs should also create formal mentorship initiatives connecting Black nursing students, particularly those in RPN streams with practicing Black RPNs to promote retention, reduce isolation, and support professional advancement from the earliest stages of nursing education.

These changes must be paired with accountability measures to evaluate the effectiveness of anti-racist education and to ensure long-term, systemic transformation within RPN education pathways.

5.5. Ongoing research and evaluation

There is a critical need for sustained, community-engaged, and longitudinal research that specifically centers the voices and experiences of Black Registered Practical Nurses (RPNs) across Canada. Future studies should focus on the long-term impacts of anti-Black racism in both clinical and non-clinical RPN roles, while also evaluating the outcomes of anti-racist policies, mentorship programs, leadership initiatives, and mental health supports designed for Black RPNs.

Research priorities should include:

• •Collection and analysis of race-based data disaggregated by nursing designation (RPN, RN, NP) to track disparities in hiring, retention, promotion, and well-being.
• •Comparative studies examining regional and institutional differences in workplace experiences and advancement opportunities for Black RPNs, particularly in underserved and rural areas.
• •Evaluation of the effectiveness of diversity, equity, and inclusion initiatives, with clear metrics beyond basic representation such as indicators of psychological safety, job satisfaction, mentorship access, and leadership progression among Black RPNs.
• •Research on how intersecting identities, such as gender, immigration status, and international education, shape the career trajectories and professional needs of Black RPNs.

To ensure relevance and accountability, future research should meaningfully engage Black RPNs in leadership roles throughout the research process including study design, data collection, analysis, and dissemination to prevent tokenism and to foster actionable, community-driven solutions.

6. Strengths and limitations

This narrative review presents several strengths. First, the review adhered to the Scale for the Assessment of Narrative Review Articles (SANRA), a widely recognized tool for evaluating the quality of narrative reviews. Given the limited research available on Black Registered Practical Nurses (RPNs), the review employed diverse search strategies to capture a broad range of studies and sources. Additionally, collaboration with the Registered Practical Nurses Association of Ontario (WeRPN) enriched the review by providing nuanced, practice-informed insights and ensuring the findings reflect the lived realities of Black RPNs in Ontario. To the best of the authors’ knowledge, this is the first narrative review to focus exclusively on the experiences of Black RPNs, offering a foundational contribution to the nursing literature and helping to fill an important gap in research.

Nonetheless, this review also has limitations that must be acknowledged. The inclusion criteria restricted the review to English-language publications, potentially excluding relevant studies published in other languages, particularly from regions with diverse nursing populations. This language limitation may have narrowed the cultural and global scope of the findings. Furthermore, the search strategy did not involve manual reference list checks or expanded searches on platforms such as Google Scholar, which may have resulted in the omission of grey literature or studies published in less prominent journals potentially limiting the comprehensiveness of the review.

Another limitation lies in the nature of the available literature itself. Many studies reviewed did not clearly differentiate among nursing designations such as Registered Practical Nurses (RPNs), Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and Advanced Practice Nurses which may obscure important distinctions in how anti-Black racism and systemic barriers manifest across different nursing roles. This lack of role-specific data highlights the need for future research that disaggregates findings by nursing designation to more precisely capture the unique challenges experienced by Black RPNs.

Finally, as a narrative review, this study is inherently subject to potential selection bias and does not employ the systematic, replicable methodologies required for meta-analyses or scoping reviews. While the narrative approach allows for in-depth thematic exploration and contextual analysis, it may limit the generalizability of the findings across broader contexts.

7. Conclusion

This review highlights the entrenched and multifaceted nature of racism within the nursing profession, particularly as experienced by Black Registered Practical Nurses across Canada, the United States, and South Africa. The findings reveal that racism is not only a persistent interpersonal issue but also a deeply embedded institutional and systemic problem that affects every stage of a Black nurse’s career from education and licensure to workplace conditions and leadership opportunities. In order to move forward, equity in nursing must be pursued not as an aspirational goal, but as a structural imperative. This includes addressing racism at all levels, reforming immigration and credentialing policies, reimagining leadership pathways, and embedding anti-racist frameworks within institutional practices, and nursing education. Equally important is the need to invest in mental health supports, mentorship programs, and legal advocacy that center the needs and voices of Black nurses. Future research should build on this foundation by exploring anti-racist interventions in practice, evaluating their long-term impacts, and examining the diverse experiences of Black nurses across geographic, cultural, and institutional contexts. Above all, Black nurses must be centered as agents of change not only as participants in the system but as leaders in transforming it.

Ethics approval statement

This narrative review did receive ethical approval (REB 2025–040).

Patient consent statement

Not applicable.

Permission to reproduce material from other sources

No material from other sources requiring permission is included in this manuscript.

Clinical trial registration

Not applicable.

Funding statement

This study is funded by the WeRPN and Social Sciences and Humanities Research Council (SSHRC) grant.

CRediT authorship contribution statement

Nadia Prendergast: Writing – review & editing, Writing – original draft, Supervision, Project administration, Methodology, Data curation, Conceptualization. Priscilla Boakye: Writing – review & editing, Writing – original draft, Resources, Methodology, Data curation, Conceptualization. Andrea Borges: Writing – review & editing, Writing – original draft, Methodology, Data curation, Conceptualization. Elwad Ahmed: Writing – review & editing, Writing – original draft, Methodology, Data curation, Conceptualization. Jen Calver: Writing – review & editing, Resources. Marilyn Oliver: Writing – review & editing. Kimberely Reid: Writing – review & editing.

Declaration of competing interest

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:

Nadia Prendergast reports writing assistance was provided by Registered Practical Nurses Association of Ontario. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Data availability

• The data supporting this study's findings are available from the corresponding author, Dr. Nadia Prendergast, RN, PhD upon request.