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Increasing Racial/Ethnic Diversity in Nursing to Reduce Health Disparities and Achieve Health Equity

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Abstract

As nursing continues to advance health care in the 21st century, the current shift in demographics, coupled with the ongoing disparities in health care and health outcomes, will warrant our ongoing attention and action. As within all health professions, concerted efforts are needed to diversify the nation's health-care workforce. The nursing profession in particular will be challenged to recruit and retain a culturally diverse workforce that mirrors the nation's change in demographics. This increased need to enhance diversity in nursing is not new to the profession; however, the need to successfully address this issue has never been greater. This article discusses increasing the diversity in nursing and its importance in reducing health disparities. We highlight characteristics of successful recruitment and retention efforts targeting racial/ethnic minority nurses and conclude with recommendations to strengthen the development and evaluation of their contributions to eliminating health disparities.

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... Las tendencias demográficas predicen un rápido crecimiento de las poblaciones de minorías raciales y étnicas en todo el mundo (2) . Se prevé que la población de la UE aumente de 446,8 millones en 2019 a 449,3 millones en 2026 (3) . ...
... Específicamente, entre los países de la Organización para la Cooperación y el Desarrollo Económicos (OCDE), el número de enfermeros capacitados en el extranjero aumentó en un 20% durante el período de cinco años, de 2011 a 2016 (hasta llegar a casi 550.000) (8) . Sin embargo, aunque la población de enfermeros está creciendo en diversidad, los enfermeros migrantes y de minorías étnicas (MME) siguen estando subrepresentados (2) . ...
... Los líderes de enfermería, las principales organizaciones de enfermería y otras partes interesadas han expresado la necesidad de una mayor diversidad en la enfermería (2) . La evidencia sugiere que una fuerza laboral de enfermería culturalmente diversa es crucial para satisfacer las necesidades de poblaciones cada vez más diversas y ofrecer atención de enfermería culturalmente competente y centrada en el paciente, mejorar el acceso a los servicios de salud y reducir las disparidades de salud (11) . ...
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Objective To analyze the perception of culture and experience of working in European health services of a purposive sample of qualified migrant and ethnic minority nurses currently living in Belgium, Portugal, Spain and Turkey. Method A qualitative phenomenological method was chosen. Individual interviews took place with 8 qualified migrant and ethnic minority nurses currently living in four European countries. Thematic analysis was conducted using Braun and Clark’s stages after qualitative data had been verbatim transcribed, translated into English, and analyzed Results Four themes and 4 subthemes emerged from thematic analysis of the transcripts. Conclusion Migrant and ethnic minority nurses working in the European Union experience and witness discrimination and prejudice from patients and colleagues due to cultural differences. European health services should closely monitor and address discrimination and prejudice towards migrant and ethnic minority staff and patients, and take initiatives to reduce and, eventually, eradicate them. DESCRIPTORS Cultural Competency; Cultural Diversity; Europe; Health Equity; Health Services; Cultural Diversity; Nursing; Qualitative Research
... Demographic trends predict a rapid growth in racial and ethnic minority populations worldwide (2) . The EU population is projected to increase from 446.8 million in 2019 to 449.3 million in 2026 (3) . ...
... Specifically, within the Organisation for Economic Co-operation and Development (OECD) countries, the number of foreign-trained nurses increased by 20% over the five-year period from 2011 to 2016 (to reach nearly 550.000) (8) . Yet, although the population of registered nurses is growing in diversity, migrant and ethnic minority (MEM) nurses remain underrepresented (2) . ...
... Nurse leaders, leading nursing organizations and other stakeholders have articulated the need for more diversity in nursing (2) . Evidence suggests that a culturally diverse nursing workforce is crucial to meet the needs of increasingly diverse populations and provide patient-centered, culturally competent nursing care, improves access to health services, and reduces health disparities (11) . ...
Article
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Objective: To analyze the perception of culture and experience of working in European health services of a purposive sample of qualified migrant and ethnic minority nurses currently living in Belgium, Portugal, Spain and Turkey. Method: A qualitative phenomenological method was chosen. Individual interviews took place with 8 qualified migrant and ethnic minority nurses currently living in four European countries. Thematic analysis was conducted using Braun and Clark's stages after qualitative data had been verbatim transcribed, translated into English, and analyzed. Results: Four themes and 4 subthemes emerged from thematic analysis of the transcripts. Conclusion: Migrant and ethnic minority nurses working in the European Union experience and witness discrimination and prejudice from patients and colleagues due to cultural differences. European health services should closely monitor and address discrimination and prejudice towards migrant and ethnic minority staff and patients, and take initiatives to reduce and, eventually, eradicate them.
... Further,these professionals be representative of the diverse Canadian population. Additionally, Phillips and Malone [6] argue that minority nurses have an important role in the healthcare system since they contribute to the recruitment and retention efforts of a diverse workforce. Finally, to truly diversify the nursing workforce, address intra-professional tensions and improve health outcomes for populations, it is essential to both eliminate barriers to accessibility that reinforce exclusion and marginalization, in addition to enhancing the sense of belonging for groups who have historically been marginalized and excluded from nursing [8,26,28]. ...
... Specifically, sources were screened first according to the context, the next level of screening was based on participants and the final level of screening was the concept. Reasons for exclusion of full text studies not meeting the inclusion criteria were recorded and are reported in Appendix 2. Lastly, in accordance with the a priori protocol [6], any disagreements that arose between the reviewers at each stage of the study selection process were resolved through a third reviewer or through discussion with the review team. The results of the search are reported in Fig. 1, in the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) flow diagram [31]. ...
... Duncan [87] suggests that it is imperative that nursing leadership in Canada begin from a place where social justice is used as a framework to guide decision-making, policies, and political advocacy, to ensure health equity on a global scale. Increased diversity in clinical nursing can mitigate health disparities, such as health care access for minority populations, by increasing community-oriented delivery models of health care and nurse-managed primary care [6,88]. Importantly, transitioning into leadership roles requires a level of readiness from both a personal and organizational perspective. ...
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Background With migration occurring over a series of centuries, dating back to the 1600’s, the circumstance regarding Black people in Canada is a complex account. A plethora of social issues and the failure to adequately acknowledge and reconcile historical issues, has resulted in health inequity, disparities and knowledge gaps, related to the Black population in Canada. In nursing, historical records indicate a legacy of discrimination that continues to impact Black nurses. The profession has begun reckoning with anti-Black racism and the residual effects. This scoping review sought to chart the existing evidence on Black nurses in the nursing profession in Canada. Methods JBI methodology was used to search peer-reviewed evidence and unpublished gray literature. Sources were considered for inclusion based on criteria outlined in an a priori protocol focusing on: 1) Canada 2) Black nurses and 3) nursing practice. No restrictions were placed on date of publication and language was limited to English and French. All screening and extractions were completed by two independent reviewers. Results The database search yielded 688 records. After removing duplicates, 600 titles and abstracts were screened for eligibility and 127 advanced to full-text screening. Eighty-two full-text articles were excluded, for a total of 44 sources meeting the inclusion criteria. Seven sources were identified through gray literature search. Subsequently, 31 sources underwent data extraction. Of the 31 sources, 18 are research ( n = 18), six are commentaries ( n = 6); one report ( n = 1) and six are classified as announcements, memoranda or policy statements ( n = 6). The review findings are categorized into five conceptual categories: racism ( n = 12); historical situatedness ( n = 2); leadership and career progression ( n = 7); immigration ( n = 4); and diversity in the workforce ( n = 4). Conclusions This review reveals the interconnectedness of the five conceptual categories. Racism was a prominent issue woven throughout the majority of the sources. Additionally, this review captures how racism is exacerbated by intersectional factors such as gender, class and nationality. The findings herein offer insight regarding anti-Black racism and discrimination in nursing as well as suggestions for future research including the use of diverse methodologies in different jurisdictions across the country. Lastly, the implications extend to the nursing workforce in relation to enhancing diversity and addressing the ongoing nursing shortage.
... 9,19,26 Black nurse mentors can give students a sense of belonging and often have first-hand experience of a Black student's challenges. 9,19,26 As mentors, they can be effective recruiters and can provide one-one support not only to the student but also to the student's family. 19,26 These nurses, who are working professionals, can provide students with the appropriate intellectual stimulation, challenge, and academic rigor to create meaningful learning opportunities. ...
... 9,19,26 As mentors, they can be effective recruiters and can provide one-one support not only to the student but also to the student's family. 19,26 These nurses, who are working professionals, can provide students with the appropriate intellectual stimulation, challenge, and academic rigor to create meaningful learning opportunities. 6,22,27 Peer mentors are just as important as a professional mentor because students can identify with them and there are fewer power differences in their relationship as mentor and mentee. ...
... Peer mentors can help socialize the student to the prenursing environment so that students can be successful. 10,26 Another advantage is that some mentors can double as role models. ...
Article
Disparities in the quality of health care for the black population have been apparent for many decades, evidenced by the high mortality and morbidity rates for the black/African American community. Major health care organizations have recognized that a culturally diverse nursing workforce is essential to improve the health of this community. Recruitment of prenursing students from the black population is vital to building a diversified workforce sensitive to the community's needs. In recent years, innovative projects have evolved to increase nurse workforce's diversity by recruiting black/African American students. This article provides background, identifies challenges, recommends solutions, and showcases successful programs.
... Racial concordance between health care providers and patients promotes optimal health care outcomes as health care quality and access for underrepresented racial and ethnic groups continues to lag behind those who are non-Hispanic White. 10 Although the quality of care delivered by health care systems has slowly improved over decades of racial discordance between providers and patients, evidence still supports the urgent need to reduce and, ultimately, eliminate health disparities. 10 The goal is to develop a health care workforce that mirrors the population and will lead to heightened health care outcomes across all ethnic-racial populations. ...
... 10 Although the quality of care delivered by health care systems has slowly improved over decades of racial discordance between providers and patients, evidence still supports the urgent need to reduce and, ultimately, eliminate health disparities. 10 The goal is to develop a health care workforce that mirrors the population and will lead to heightened health care outcomes across all ethnic-racial populations. 10 Strategies for Recruitment and Retainment of Black Nursing Students Many barriers have been documented in the literature to explain the lack of diversity among nursing students. ...
... 10 The goal is to develop a health care workforce that mirrors the population and will lead to heightened health care outcomes across all ethnic-racial populations. 10 Strategies for Recruitment and Retainment of Black Nursing Students Many barriers have been documented in the literature to explain the lack of diversity among nursing students. These barriers include personal, social, and institutional challenges that impede efforts to recruit and retain Black students. ...
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Background: The lack of a diverse nursing workforce and inclusive nursing student pipeline initiatives can impact existing health disparities in the United States. Problem: Gaps in the representation of future Black nurses in schools of nursing provide missed opportunities for cultural congruence and awareness. Approach: Developing collaborative relationships with historically Black colleges and universities (HBCUs) for recruitment is a mutually beneficial strategy. Undergraduate interns from 3 HBCUs attended a 6-week summer nursing immersion program at a graduate school of nursing on the campus of a predominately White institution. The aim was to provide awareness of the nursing profession and mentorship for further exploration into the profession. Conclusions: The program managed by Black nurse faculty provides a recruitment strategy that serves as a framework to support the financial, emotional, and social needs of prospective Black nursing students.
... Less has been published about the experiences of child life specialists with marginalized racial, ethnic, sexual orientation, age, and disability identities. The extant literature indicates that while increased workforce diversity may reduce racial and ethnic health disparities (Phillips & Malone, 2014), a significant barrier to this diversity is the discriminatory experiences of health care providers with marginalized identities (Sim et al., 2021;Woodhead et al., 2021). Retention of diverse providers depends on a hospital system's ability to provide a safe environment. ...
... Many participants suggested that more diversity within the child life profession would improve their own experience in the workplace and potentially mitigate their experiences of microaggressions, othering, tokenism, and discrimination. Other health care fields have made significant efforts to increase their workforce diversity (LaVeist & Pierre, 2014;Phillips & Malone, 2014) that may be applied to the child life profession. However, as one participant noted about being a person of color in the field, "Along with that comes a lot of burden." ...
Article
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The child life profession in the United States primarily comprises White females. Little is known about the experiences of child life specialists with marginalized identities. This exploratory qualitative study examines the experiences of child life students and specialists with marginalized racial, ethnic, sexual orientation, age, and disability identities. Eighteen participants with self-identified marginalized identities took part in a study on navigating the field of child life. The authors used thematic analysis to find themes and subthemes in the data. In this manuscript, themes surrounding microaggressions, the perception of being othered, tokenism, and discrimination experienced in the workplace are described. These findings have implications for research and practice.
... A well-established factor that contributes to the sustenance of racial/ethnic disparities in MCH health indices is the disproportionate representation of underrepresented and underserved groups in the MCH workforce (Bozlak et al., 2022;Mishkin et al., 2021;National Research Council, 2003). The current inadequate representation of underrepresented groups in the MCH workforce poses significant cultural and linguistic barriers in the course of patient-provider interactions, providers' intentional and unintentional biases towards patients of different backgrounds, and providers' clinical uncertainty when treating diverse populations (Bouye et al., 2016;Phillips and Malone, 2014;Oh et al., 2015). Therefore, it is key that academic institutions recruit, engage and train students belonging to racial/ethnic underrepresented populations, and those from disadvantaged backgrounds in order to have a more effective MCH workforce capable of addressing contemporary challenges of health equity and racial/ethnic health disparities (Bouye et al., 2016;Bozlak et al., 2022). ...
... For example, it was found that up to 75% of Pacific Islanders are unable to convert the antiplatelet drug clopidogrel into its active form and are therefore, at higher risk for adverse outcomes following angioplasty; and without recruiting candidates from varied backgrounds, such nuances can be missed (Oh et al., 2015). When researchers and health care providers identify with and understand the population sub-group they are working with, the health outcomes for the target community tend to improve (Bouye et al., 2016;Phillips & Malone, 2014). When there are culturally representative researchers tending to the diverse MCH population, barriers such as fears of exploitation in medical research, financial constraints, competing demands of time, lack of access to information and comprehension about research, unique cultural and linguistic differences, fears of unintended outcomes, stigmatization, and health care discrimination that prevent minority population from participating in research could be overcome (Oh et al., 2015). ...
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Purpose Presently, there are six undergraduate HRSA-funded MCH pipeline training programs (MCHPTP) in the nation and they have gained significant momentum since inception by recruiting, training and mentoring undergraduate students in a comprehensive MCH-focused approach. This article describes the outcomes from the 6 training programs; and primarily Baylor College of Medicine–Texas Southern University (BCM–TSU’s) collaborative strategy focusing on the MCH research training and outcomes, which align with HRSA’s MCH bureau’s missions. Description Each MCHPTP offers trainees interdisciplinary MCH research experiences through intra/inter-institutional collaborations and partnerships, but BCM–TSU’s MCHPTP was the only one with the primary focus to be research. As a case study, the BCM–TSU Program developed an innovative research curriculum integrated with MCH Foundations Course that comprised 2 hour weekly meetings. Students were split into collaborative research groups of 4–5 students, with multidisciplinary peer-mentors, clinical fellows and MCH research faculty from institutions at the world—renowned Texas Medical Center. Assessment Since the inception of the MCH mentorship programs, all six MCHPTPs have enrolled up to 1890 trainees and/or interns. BCM–TSU Program trainees are defined as undergraduate students in their 1st or 2nd year of college while research interns are upper classmen in their 3rd or 4th year of college. The case study showed that BCM–TSU Program trainees demonstrated outstanding accomplishments in the area of research through primary and co-authorships of 13 peer-reviewed journal publications by 78 trainees, over a period of 3 years, in addition to dozens of presentations at local, regional and national conferences. Conclusions The research productivity of students in the six MCHPTPs is strongly indicative of the success of integrating MCH research mentoring into MCH didactic training. The development of a diverse and robust MCH mentorship program promotes and strengthens research activities in areas of high priority such as addressing health disparities in MCH morbidity and mortality in the U.S.
... Increasing equity in healthcare education, therefore, creates opportunities for men and people of color to start on and climb the healthcare occupational ladder and achieve better economic outcomes. Moreover, a diverse healthcare workforce holds the promise to reduce healthcare discrimination and foster better health among underrepresented populations (Phillips & Malone, 2014;Wilbur et al., 2020). ...
... Moreover, colleges' retention practices impact equity within the healthcare field. Increasing skills and opportunities for people of color not only provides a path out of the lowest-paying healthcare professions (Snyder et al., 2015), but may also benefit communities of color by reducing healthcare discrimination and improving public health (Phillips & Malone, 2014;Wilbur et al., 2020). Moreover, better support for men, who face numerous barriers to entry into nursing and allied health professions (Hodges et al., 2017), will help to further reduce workforce gaps. ...
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Addressing labor shortages within nursing and allied health professions, which have been exacerbated by the COVID-19 pandemic, requires increasing persistence and equity among community college students pursuing these fields. In this study, we adapted and combined three values-based interventions (values affirmation, goal congruence, and utility values) into one treatment, delivered via interactive text messages, with the goal to support reenrollment­ among pre-allied health students during the pandemic. Using institutional data from a statewide community college system, we randomized pre-allied health students who were enrolled in Fall 2019 and/or Spring 2020, and who had a valid mobile number on file, into treatment (n = 1,649) or control (n = 1,650) groups. Fully treated students received an average of 17 text messages over 8 weeks of Summer 2020; control students received business as usual support from the college. After adjusting for baseline differences in prior enrollment, the treatment significantly increased reenrollment by 3 percentage points (74% vs. 71%). Examination of individual differences revealed that effects were concentrated among men (+11 percentage points), Black/African American students (+7 percentage points), and students who were not enrolled in Spring 2020 (+13 percentage points). Values-based interventions, therefore, can be an important tool for addressing shortages and inequities in healthcare education and the labor force, an important step toward improving public health. Moreover, community colleges seeking to engage students who withdrew before or during the COVID-19 pandemic should leverage evidence-based practices to boost reenrollment.
... i. to eliminate the oppressive structural and social barriers which prevent people from marginalised groups to become dietitians if they so choose, because the choice to pursue the career that is self-determined is a privilege not afforded to all (Autin & Allan, 2019;Boak, 2021;Lassemillante & Delbridge, 2021); ii. to pursue an agenda of explorative innovation, where diverse peoples bring ways of knowing that broaden and enable better organisational and professional outcomes (Boak, 2021;Diversity Council Australia, 2019;Elia et al., 2019;Herring, 2009); iii. for the demographics of people in dietetics would mirror the Australian population, that is, to reach parity with the population (Hickson et al., 2018; Indigenous Allied Health Australia, 2019); iv. to actively contribute to the Australian and international agenda for diverse and inclusive health workforces as part of improving healthcare and reducing differential access to power and privilege in health systems (Dune et al., 2021;Mayes et al., 2021;Phillips et al., 2014;Stanford, 2020); and v. to better meet the needs of the ever increasingly diverse communities that dietitians serve, in the pursuit of health equity (Mahajan, 2021;Phillips et al., 2014;Warren, 2017). ...
... i. to eliminate the oppressive structural and social barriers which prevent people from marginalised groups to become dietitians if they so choose, because the choice to pursue the career that is self-determined is a privilege not afforded to all (Autin & Allan, 2019;Boak, 2021;Lassemillante & Delbridge, 2021); ii. to pursue an agenda of explorative innovation, where diverse peoples bring ways of knowing that broaden and enable better organisational and professional outcomes (Boak, 2021;Diversity Council Australia, 2019;Elia et al., 2019;Herring, 2009); iii. for the demographics of people in dietetics would mirror the Australian population, that is, to reach parity with the population (Hickson et al., 2018; Indigenous Allied Health Australia, 2019); iv. to actively contribute to the Australian and international agenda for diverse and inclusive health workforces as part of improving healthcare and reducing differential access to power and privilege in health systems (Dune et al., 2021;Mayes et al., 2021;Phillips et al., 2014;Stanford, 2020); and v. to better meet the needs of the ever increasingly diverse communities that dietitians serve, in the pursuit of health equity (Mahajan, 2021;Phillips et al., 2014;Warren, 2017). ...
Article
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Through an exploration of the origins of dietetics in the West, and specifically in Australia, we problematise the lack of diversity within the profession through the lens of intersectionality. Dietetics in Australia continues to be dominated by Australian‐born women, and ideologies about dietitians perpetuate narratives of white, young, slim, women. Intersectional approaches to critiquing diversity in dietetics provides a useful framework to extend critical studies of health disparities into disparities in the dietetics professional workforce, which is advanced through structural, political and representational intersectionality guided critique. Through the analysis, a dialog is prompted in order to chart paths forward to find ‘how differences will find expression’ within the professional group. To do this, dietetics as a profession must reckon with its historical roots and step forward, out of a perceived position of objective neutrality regarding people and diversity, and into a position that can recognise that professional institutions have the power to exclude and marginalise, along with the power to include and transform.
... 69 Beyond this, URM nurses make up only 16.8% of the registered nurse workforce, with the lack of diversity even more apparent in nursing faculty. 70 These stark disparities between the US population and America's health care workforce are particularly troubling, given that, even after adjusting for income, communities with high proportions of minorities have over 4 times the likelihood of other communities to suffer from physician shortages, whereas URM pediatricians and other physicians are significantly more likely than their non-URM counterparts to care for minority, publicly insured, and uninsured patients. 71 A recent study also revealed that Black men seen by Black physicians are much more likely to select every preventive service, particularly invasive services, once meeting with a racially concordant physician, and suggested that Black physicians could reduce the Black-White male gap in cardiovascular mortality by 19%. ...
... It is hugely beneficial for parents of patients with limited English proficiency to have a competent bedside nurse who speaks their language, both in terms of quality care and parent satisfaction. 70 It is important to consider that the entire health care staff be diverse, and that efforts be made to encourage and support those from URMs who want to further their education in other health care areas. ...
Article
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Despite the overall improvement in life expectancy of patients living with congenital heart disease (congenital HD), disparities in morbidity and mortality remain throughout the lifespan. Longstanding systemic inequities, disparities in the social determinants of health, and the inability to obtain quality lifelong care contribute to poorer outcomes. To work toward health equity in populations with congenital HD, we must recognize the existence and strategize the elimination of inequities in overall congenital HD morbidity and mortality, disparate health care access, and overall quality of health services in the context of varying social determinants of health, systemic inequities, and structural racism. This requires critically examining multilevel contributions that continue to facilitate health inequities in the natural history and consequences of congenital HD. In this scientific statement, we focus on population, systemic, institutional, and individual‐level contributions to health inequities from prenatal to adult congenital HD care. We review opportunities and strategies for improvement in lifelong congenital HD care based on current public health and scientific evidence, surgical data, experiences from other patient populations, and recognition of implicit bias and microaggressions. Furthermore, we review directions and goals for both quantitative and qualitative research approaches to understanding and mitigating health inequities in congenital HD care. Finally, we assess ways to improve the diversity of the congenital HD workforce as well as ethical guidance on addressing social determinants of health in the context of clinical care and research.
... A racially diverse nursing workforce is crucial to the care of racially diverse patient populations, and understanding the potentially harmful effects of exposure to COVID-19 and racialized experiences in the workplace on nurses' emotional distress is a priority. 1,23 Theoretical framework Socioecological perspectives about work and health provide a basis for understanding the complex interrelationships among nurses' experiences of racism in hospital workplaces, their worries about COVID-19 exposures, and their emotional distress. Social ecology frameworks postulate that workplaces are complex systems comprised of multiple social and environmental conditions that jointly influence the physical, emotional, and social well-being of their employees. ...
... The scale was modified for this study with the addition of a sixth item, "A patient or patient's family member treated me differently than my coworkers of other racial groups", based on previous research that revealed differential treatment of healthcare workers by patients based on race. 13,14,23 For each item, participants are presented with a checklist (0 = I did not experience this in the last six months; 1 = I did experience this in the last six months). The checklist item ratings (yes/no) are summed, and a higher score reflects a higher number of workplace racial microaggression types experienced. ...
Article
Persons of color in the US experience the worst COVID-related outcomes and account for the majority of COVID-19 cases and hospitalizations among healthcare workers. In a pandemic where minority populations and healthcare workers are among the hardest hit, nurses of color are undoubtedly taxed. Moreover, their workplace racism experiences represent a dual pandemic in that the effects of COVID-19 worries and workplace racism may synergize to the detriment of their emotional well-being. The purpose of this study was to examine the direct, indirect, and interactive effects of individual (race, COVID worry), interpersonal (workplace racial microaggressions), and institutional (racial climate) factors on hospital-based nurses' emotional well-being. A sample of 788 registered nurses who worked in New Jersey hospitals completed an electronic survey. Compared to White nurses, nonwhite nurses reported higher emotional distress, more negative racial climates, more racial microaggressions, and higher levels of COVID worry. Nurses' worry about getting sick from COVID and multiple racial microaggression experiences had the largest effects on the likelihood of high emotional distress. Racism variables and worry about COVID mediated indirect effects of nonwhite race on emotional distress. Racial microaggressions mediated an indirect effect of racial climate on this outcome. Nurses who were worried about getting sick from COVID and experienced multiple microaggressions and/or the most negative racial climates had severe emotional distress. There is a need for sustained investment in a racially diverse nursing workforce. Mitigating workplace racism in hospitals is crucial, particularly during public health crises that disproportionately threaten minority populations and healthcare workers.
... Research also shows that healthcare professionals from diverse backgrounds are more likely to serve disadvantaged populations, thus increasing access to quality medical services for the underserved (Camacho et al., 2017). In addition, diversifying the healthcare workforce by supporting minority nurse researchers and scientists may contribute to broadening the research agenda to include specific intention on studying health disparities within minority groups and subgroups (Phillips & Malone, 2014;Underwood et al., 2004). Furthermore, there is evidence that improving workforce diversity would increase the pipeline for faculty from minority groups in health professional schools and universities and would expand the leadership in academic institutions and healthcare organizations (Phillips & Malone, 2014;Sullivan, 2004, Underwood et al., 2004. ...
... In addition, diversifying the healthcare workforce by supporting minority nurse researchers and scientists may contribute to broadening the research agenda to include specific intention on studying health disparities within minority groups and subgroups (Phillips & Malone, 2014;Underwood et al., 2004). Furthermore, there is evidence that improving workforce diversity would increase the pipeline for faculty from minority groups in health professional schools and universities and would expand the leadership in academic institutions and healthcare organizations (Phillips & Malone, 2014;Sullivan, 2004, Underwood et al., 2004. ...
Article
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Background: Filipino American nurses represent an impressive share of the nursing workforce; however, they are not well represented in advanced practice, faculty, and executive leadership positions. Obtaining a graduate degree in nursing has the potential to open a wider range of opportunities to meet the healthcare demands of a population that is becoming more diverse. Objective: The purpose of this study was to examine the factors affecting graduate degree pursuit for BSN-prepared Filipino American nurses working in the United States. Methods: Ricoeur's hermeneutical phenomenology was utilized as an interpretive approach to analyzing the data and the theoretical underpinnings of career construction theory served as a conceptual framework to make sense and meaning of the rich stories that the participants shared about their educational aspirations and professional lives. Results: This study provides an in-depth examination into intergenerational perspectives of 33 BSN-prepared Filipino American nurses working in 14 different states in the U.S. that revealed that the push and pull of family responsibilities and the influence of culture were the main factors that affected the pursuit of a graduate degree. The participants' career construction was deeply influenced by the Filipino American cultural values they espoused: "pakikipagkapwa", the sharing of one's self with one's fellow being and "utang na loob", a deep commitment to debt reciprocity, towards their nuclear family and the extended family and community that they left behind in the Philippines. Conclusion: The decision to pursue an advanced nursing degree depended upon the nurse's determination that the return on investment of a graduate degree outweighed the sum of all their responsibilities and obligations towards their family in the United States and the extended family they left behind in the Philippines, and deep commitment to their patients and community.
... Students in programs with a diverse student body reported an increased ability to work with members of other ethnic groups, increased acceptance of individuals from other cultural backgrounds, and increased participation in community-based activities after graduation (Rogers & Molina, 2006). In addition to enhancing the learning environment, minoritized students are needed as researchers and leaders whose perspectives can promote research, policies, and resource allocation that reflect the needs of underserved communities (Phillips & Malone, 2014). ...
Article
The rising racially and ethnically minoritized population in the U.S. challenges counselor educators to train racially and ethnically diverse counselors; therefore, there is a need to better understand the factors that affect persistence and retention of diverse students in counseling programs. The researchers examined the role of motivation (Academic Motivation Scale), sense of belonging (Campus Connectedness Scale), and social support (Student Academic Support Scale) on the persistence (3-item persistence measure) of 396 master’s level counseling students, including investigating differences between White and minoritized students. Pearson’s correlations results revealed intention to persist was positively correlated with motivation (r(394) = .44, p < .01), belonging (r(394) = .39, p < .01), and social support (r(394) = .01, p < .05) and ANOVA results showed no significant differences were found between White and minoritized students. Counselor educators can improve student experiences by implementing strategies to create a diverse and inclusive community.
... On average, half of the participants reported affirmatively to inclusion measures at their institution/organization ( Furthermore, this is consistent with workforces in other closely related fields, such as medicine, 25 nursing, 26 epidemiology, 14 and economics. 16 The persistent lack of diversity may partly inform why more than one-third of our participants believed that DEI initiatives at their institutions/organizations are symbolic rather than substantive. ...
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Objective: To describe the perception of professional climate in health services and policy research (HSPR) and efforts to advance diversity, equity, and inclusion (DEI) in the HSPR workforce and workplaces. Data source: We administered the HSPR Workplace Culture Survey online to health services and policy researchers. Study design: Our survey examined participants' sociodemographic, educational, and professional backgrounds, their perception on DEI in HSPR, experience with DEI initiatives, feeling of inclusion, and direct and witnessed experiences of discrimination at their institutions/organizations. We calculated sample proportions of responses by gender identity, sexual orientation, race/ethnicity, and disability status and compared them with Fisher's exact test. Data collection: We administered the survey online from July 28 to September 4, 2020. HSPR professionals and trainees aged 18 and older were eligible to participate. Analyses used complete cases only (n=906; 70.6% completion rate). Principal findings: 53.4% of the participants did not believe that the current workforce reflects the diversity of communities impacted by HSPR. While most participants have witnessed various DEI initiatives at their institutions/organizations, nearly 40% characterized these initiatives as "tokenistic." Larger proportions of participants who identified as female, LGBQI+, underrepresented racial/ethnic groups, and those with a disability held this perception than their male, heterosexual, White, and non-disabled peers. Current DEI initiatives focused on "planning" activities (e.g., convening task forces) rather than "implementation" activities (e.g., establishing mentoring or network programs). 43.7% of the participants felt supported on their career development, while female, Black, Hispanic/Latino, LGBQI+ participants and those with a disability experienced discrimination at their workplace. Conclusions: Despite an increasing commitment to increasing the diversity of the HSPR workforce and improving equity and inclusion in the HSPR workplace, our results suggest that there is more work to be done to achieve such goals. This article is protected by copyright. All rights reserved.
... Baccalaureate Nursing (BSN) programs are responsible for recruiting, enrolling, and retaining a large and diverse group of students (Phillips & Malone, 2014). However, the average nursing programs experience attrition rates up to 50% (Salamonson et al., 2014), with higher rates reported among underrepresented minority (URM) students (Harris, Rosenberg, & Grace O'Rourke, 2014). ...
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The COVID-19 pandemic and the significant disparities experienced by Black, Indigenous, and people of color (BIPOC) in infections, hospitalizations, and deaths associated with the Coronavirus have underscored the imperative to increase the size and diversity of the healthcare workforce, including nursing. Academically focused pipeline development programs have led to some advances in minority recruitment and retention; however, emerging research highlights the importance of extra-academic factors that reduce the sense of belonging and persistence among underrepresented and minority students. The purpose of this manuscript is to describe the diversity, equity, and inclusion goals and activities of a college of nursing located in a minority-serving institution. Here, we emphasize the description of a range of activities aimed at meeting our diversity goals. Further, we highlight the actions initiated in response to emergent “extra-academic” student needs over the past year related to the COVID-19 pandemic and police brutality. The strategies described have implications for improving diversity, equity, and inclusion among higher education institutions in nursing.
... Increasing workforce diversity expands healthcare access and experiences for underserved communities and minority groups, in addition to improving a workforce's organisational climate (Cohen et al., 2002;Jansen et al., 2016;Mitchell and Lassiter, 2006;Snipes et al., 2011). Advancing heterogeneity within the workforce, mirrors the culture and diversity present in local groups and communities, where increasing diversity advances behaviours and healthcare attitudes that are dominant within a group (Brown et al., 2016;Jongen et al., 2018;Lorenz et al., 2017;Phillips and Malone, 2014). Shortfalls in diversity climate investigations have primarily focused on; fairness and inclusion as sources of inquiry McKay and Avery, 2015), focusing on the ways of equipping the workforce with inter-cultural knowledge, and developing self-awareness skills and sentiments to service patients and customers of divergent cultures. ...
Article
The healthcare supply chain plays a fundamental role in addressing the healthcare needs of local and global communities. The composition of the healthcare sector, particularly regarding cultural and gender diversity, is an antecedent to effective medical healthcare management, and achieving organisational performance. Following an appraisal of the selected literature, six themes emerged in the research area of diversity in healthcare. These were cultural diversity management, gender diversity management, governance and leadership, board management, Indigenous healthcare, and healthcare workers and teamwork. Findings from the study suggest the advancement of critical elements of organisational diversity research in the agile medical supply chain, including aspects of the influences of workforce heterogeneity on board governance practices, organisational culture and climate-specific studies, organisational performance and non-performance outcomes, and diversity disparities in senior and executive-level leadership roles. This study can influence regulatory decision-making, strategic policy origination, and operational diversity management programs
... Increasing workforce diversity expands healthcare access and experiences for underserved communities and minority groups, in addition to improving a workforce's organisational climate (Cohen et al., 2002;Jansen et al., 2016;Mitchell and Lassiter, 2006;Snipes et al., 2011). Advancing heterogeneity within the workforce, mirrors the culture and diversity present in local groups and communities, where increasing diversity advances behaviours and healthcare attitudes that are dominant within a group (Brown et al., 2016;Jongen et al., 2018;Lorenz et al., 2017;Phillips and Malone, 2014). Shortfalls in diversity climate investigations have primarily focused on; fairness and inclusion as sources of inquiry McKay and Avery, 2015), focusing on the ways of equipping the workforce with inter-cultural knowledge, and developing self-awareness skills and sentiments to service patients and customers of divergent cultures. ...
Article
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The healthcare supply chain plays a fundamental role in addressing the healthcare needs of local and global communities. The composition of the healthcare sector, particularly regarding cultural and gender diversity, is an antecedent to effective medical healthcare management, and achieving organisational performance. Following an appraisal of the selected literature, six themes emerged in the research area of diversity in healthcare. These were cultural diversity management, gender diversity management, governance and leadership, board management, Indigenous healthcare, and healthcare workers and teamwork. Findings from the study suggest the advancement of critical elements of organisational diversity research in the agile medical supply chain, including aspects of the influences of workforce heterogeneity on board governance practices, organisational culture and climate-specific studies, organisational performance and non-performance outcomes, and diversity disparities in senior and executive-level leadership roles. This study can influence regulatory decision-making, strategic policy origination, and operational diversity management programs.
... We must be careful not to lose the rich body of evidence, personal stories, and information that will support nursing leaders in the future. Two of our Academy Fellows, Dr. Janice Phillips and Dr. Beverly Malone (a Living Legend), noted in their work that "diverse leadership can serve as particularly important role models, provide guidance and mentoring for other nurses, influence the allocation of resources, and shape policies aimed at eliminating inequities" (Phillips and Malone, 2014). This year, the Academy's Institute for Nursing Leadership Signature Event, "Moving Conversation to Action: Championing Health Equity" will feature Living Legend General Clara Adams-Ender and Fellow Dr. Ronald Hickman during the opening session for a candid and inspirational discussion on the challenges and successes they have faced on their leadership journeys; guiding takeaway points for the audience on authentic leadership, and how they are wielding their leadership to create opportunities for diversity in education, research, and practice. ...
... It is estimated that African Americans/Black individuals comprised 13.7% of the population in 2020 (US Census Bureau, 2020), but only 6.7% comprised the workforce of registered nurses (Smiley et al., 2021). Phillips and Malone (2014) argue that efforts to reduce health disparities cannot be fully achieved without successfully addressing the underrepresentation of minority nurse leaders in health care. Among nurses in positions of greater influence, Black nurses are only 8.8% of full-time nursing faculty (National League of Nursing, 2017), <10% are deans or directors (National League for Nursing, 2015), and <1% are nurse scientists (Smiley et al., 2021). ...
Article
The pandemics of COVID-19 and systemic racism highlighted health inequities that have existed for decades among Black communities. Nurses are positioned to address these health inequities through innovative ideas and research. More specifically, Black nurses, because of their shared lived experience, understand sociostructural factors underpinning health inequities and how to best engage with Black communities. However, only 8% of Black nurses make up the overall nursing workforce and far fewer are nurse scientists. Historically Black Colleges and Universities (HBCUs) can offer critically important options for success in addressing the dearth of Black nurse scientists working across sectors and contributing to rich academic milieu, informing innovative national policy, and creating impactful practice. We discuss challenges and strategies to promoting research careers at HBCUs to attract Black nurse scientists as the next leaders in health inequities research.
... This highlights the well acknowledged, yet unaddressed critical need for increased racial and ethnic representation in both the nursing profession and nursing research (Morone, 2021), as only 19.9% of Registered Nurses self-identify as members of underrepresented racial/ethnic groups (Smiley et al., 2018). A lack of racial and ethnic diversity in the nursing profession contributes to poorer outcomes for patients of color (Phillips & Malone, 2014) and relates to the SDoH as the racial and ethnic make-up of environments contributes to social and community contexts. ...
Article
Background: Nurses develop meaningful and deep connections with patients, making them particularly skilled to consider how social determinants of health (SDOH) affect patients. SDOH include one's neighborhood and built environment, health and health care, social and community context, education, and economic stability. Consideration of SDOH, in addition to individual factors, allows nurses to better support patient engagement in health behaviors. Objectives: This article aims to explore how nurses consider SDOH when talking about health behaviors with patients and to provide case exemplars of how incorporation of the SDOH can be increased in holistic, patient-centered nursing care. Methods: A secondary data analysis was conducted to identify how practicing oncology nurses (N = 75) take SDOH into account when talking about physical activity with patients. Findings: Of the 124 considerations that nurses made when talking about physical activity with patients, most did not relate to SDOH.
... Successes gained from other fields including offering research funding, promotion of physicians of color to leadership roles, and incorporation of underrepresented organizations may help recruit and retain a more diverse and equitable workforce. [17][18][19] ...
Article
Racial health disparities persist despite increased public awareness of systemic racism. Due to the inherent subjectivity of pain perception, assessment and management, physician-patient bias in pain medicine remains widespread. It is broadly accepted that increasing racial diversity in the field of medicine is a critical step towards addressing persistent inequities in patient care. To assess the current racial demographics of the pain medicine pipeline, we conducted a cross-sectional analysis of medical school matriculants and graduates, residents, and pain fellows in 2018. Our results show that the 2018 anesthesiology residency ERAS applicant pool consisted of 46.2% non-Hispanic White, 7.0% non-Hispanic Black and 5.8% Hispanic students. The population of 2018 anesthesiology residents included 63% non-Hispanic White, 6.8% non-Hispanic Black and 5.4% Hispanic persons. Of the total eligible resident pool for pain fellowships (n = 30,415) drawn from core specialties, 44% were non-Hispanic White, 4.9% non-Hispanic Black and 5.1% Hispanic. Similar proportions were observed for pain medicine and regional anesthesia fellows. We briefly discuss the implications of the shortage of non-Hispanic Black and Hispanic representation in pain medicine as it relates to the COVID-19 pandemic and suggest approaches to improving these disparities.
... Similar to other sectors, racial inequalities in employment are present in healthcare systems (WRES, 2019a). Due to significant nurse and midwifery shortages and corresponding international recruitment strategies (WHO, 2014), recent years have seen a growing interest regarding these groups in particular (Phillips & Malone, 2014;West & Nayar, 2016). Empirical studies have reported concerning findings, suggesting that Black, Asian, Minority Ethnic and migrant nurses perceive fewer career development opportunities in their work (Likupe et al., 2014) and receive lower pay (Pittman et al., 2014). ...
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Background Black, Asian and Minority Ethnic (BAME) nurses and midwives are under-represented in higher and managerial roles. Aims This study aimed to explore the presence and nature of career progression delays for BAME nurses and midwives and to identify where the barriers to progression were. Design A secondary analysis of data from a wider cross-sectional survey investigating workplace experiences, burnout and patient safety in nurses and midwives. Methods : 538 nurses and midwives were recruited from four UK hospitals between February and March 2017. A career progression delay was viewed as being present if BAME nurses and midwives had spent longer on the entry level nursing grade and less time on higher grades in the previous 10 years. The analysis included items pertaining to: receipt of professional training, perceived managerial support for progression, likelihood of submitting applications and application success rates. Data were analysed using linear regression, odds ratios and t-tests. Results were reported using the STROBE Checklist. Results : BAME nurses and midwives (n=104; 19.4%) had spent more months working at the entry-level grade (M=75.75, SD=44.90) than White nurses and midwives (n=428; 79.7%; M=41.85, SD=44.02, p<0.001) and fewer months working at higher grades (M=15.29, SD=30.94 v 29.33, SD=39.78, p=0.006 at Band 6; M=6.54, SD=22.59 v M=19.68, SD=37.83, p=0.001 at Band 7) over the previous 10 years. BAME nurses and midwives were less likely to have received professional training in the previous year (N=53; 53.0% v N=274; 66.0%, p=0.015) and had to apply for a significantly higher number of posts than White nurses and midwives before gaining their first post on their current band (M=1.22, SD=1.51 v M=0.81, SD=1.55, p=0.26). Conclusions Interventions are needed to improve racial equality regarding career progression in nurses and midwives. Increasing access to professional training and reducing discriminatory practice in job recruitment procedures may be beneficial. Impact statement BAME nurses and midwives experience career progression inequalities. Interventions should improve transparency in recruitment procedures and enhance training opportunities.
... Internationally educated nurses (IENs) can play an important role in the provision of care for the changing population. The literature demonstrates that health inequities for newcomers are reduced when health workforce diversity is increased [6,7]. In 2019, IENs accounted for 9% of the regulated nursing supply in Canada [8]. ...
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Background Historically, immigration has been a significant population driver in Canada. In October 2020, immigration targets were raised to an unprecedented level to support economic recovery in response to COVID-19. In addition to the economic impact on Canada, the pandemic has created extraordinary challenges for the health sector and heightened the demand for healthcare professionals. It is therefore imperative to accelerate commensurate employment of internationally educated nurses (IENs) to strengthen and sustain the health workforce and provide care for an increasingly diverse population. This study aimed to determine the effectiveness of a project to help job-ready IENs in Ontario, Canada, overcome the hurdle of employment by matching them with healthcare employers that had available nursing positions. Methods A mixed methods design was used. Interviews were held with IENs seeking employment in the health sector. Secondary analysis was conducted of a job bank database between September 1 and November 30, 2019 to identify healthcare employers with the highest number of postings. Data obtained from the 2016 Canadian Census were used to create demographic profiles mapping the number and proportion of immigrants living in the communities served by these employers. The project team met with senior executives responsible for hiring and managing nurses for these employers. The executives were given the appropriate community immigrant demographic profile, a manual of strategic practices for hiring and integrating IENs, and the résumés and bios of IENs whose skills and experience matched the jobs posted. Results In total, 112 IENs were assessed for eligibility and 95 met the inclusion criteria. Twenty-one healthcare employers were identified, and the project team met with 54 senior executives representing these employers. Ninety-five IENs were subsequently matched with an employer. Conclusions The project was successful in matching job-ready IENs with healthcare employers and increasing employer awareness of IENs' abilities and competencies, changing demographics, and the benefits of workforce diversity. The targeted activities implemented to support the project goal are applicable to sectors beyond healthcare. Future research should explore the long-term impact of accelerated employment integration of internationally educated professionals and approaches used by other countries.
... Second, debate about whether to focus on workforce diversity as an independent goal or as a means toward the goal of health equity can complicate policy decisions. That is, some experts question whether diversity and inclusion-in itself-can help achieve health equity (Gilliss et al., 2010;Phillips & Malone, 2014). Data indicate that a lack of diversity among clinicians is associated with poor outcomes for minority patients (Johnson et al., 2004;Laveist & Nuru-Jeter, 2002;LaVeist et al., 2003;Saha et al., 1999;Schoenthaler et al., 2012), but it is not known whether the relationship holds in reverse or if it is possible in all settings. ...
Article
Racial and ethnic inequities in health are a national crisis requiring engagement across a range of factors, including the health care workforce. Racial inequities in maternal and infant health are an increasing focus of attention in the wake of rising rates of maternal morbidity and mortality in the United States. Efforts to achieve racial equity in childbirth should include attention to the nurses who provide care before and during pregnancy, at childbirth, and postpartum.
Article
Stigma is a key driver of inequity and affects myriad health behaviors and outcomes, especially those related to substance use disorder, HIV, and mental illness. Intersectionality, theorized by Black feminist scholars, emphasizes the intersecting, structural processes that place people at risk for harm. As people's multiple identities are inseparable and non-additive, their experiences of stigma are complex and multifaceted. Nurse educators, scholars, and clinicians form the foundation of patient care and scientific advancements to improve the health and well-being of diverse patient populations. The nursing profession must contend with the underlying drivers of intersectional stigma, including systemic racism and White supremacy, classism, and gender inequality. Centering equity, strengthening recruitment/retention of minoritized nursing students, implementing stigma training in curricula, improving the nursing leadership pipeline, moving beyond implicit bias training and deficit models, and incorporating intersectional and implementation science approaches in research can help advance equity for clinicians and patient populations. [Journal of Psychosocial Nursing and Mental Health Services, 60(12), 9-15.].
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An associate degree in nursing program was established six years ago at the tribal college of the Fort Belknap Indian Reservation, home of the Aaniiih and Nakoda people. As this program continues to evolve and grow, it offers a successful example of how to increase diversity in nursing and potentially improve the health outcomes of Native Americans living on and nearby reservation communities.
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Despite a compelling body of evidence and decades of policy recommendations, deep inequities in health persist with historically marginalized groups. Operationalizing strategies to achieve equity in health and health care continues to remain elusive to health systems. We propose several focus areas; attention to semantics and concepts, building knowledge of health inequities, redesigning care and transforming cultures, to advance health equity work by health system nurse leaders and clinical nurses. Health equity frameworks, traditionally applied in population and public health, are also discussed to tackle health equity issues and formulate, implement and evaluate solutions to inequities. Examples illustrate ongoing work in our health system in targeted areas and challenges in advancing health equity work. Future efforts by health system nurse leaders should concentrate on technology for point of care health screening and data acquisition, data-driven decisions, and organizational performance measures to narrow health equity gaps.
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Background The NIH Diversity Administrative Supplement is a funding mechanism that provides support for diverse early-stage researchers. There is limited guidance on how to apply for these awards. Purpose We describe perspectives of NIH program/diversity officers and university research administrators offering recommendations for diversity supplement submission. Methods This article is the product of a working group exploring diversity in research. Nursing faculty from an R2 Historically Black College and University and an R1 research intensive university conducted stakeholder interviews with NIH program/diversity officers and university research administrators. We used content analysis to categorize respondents’ recommendations. Findings Recommendations centered on harmonizing the applicant with the program announcement, communication with program/diversity officers, mentor/mentee relationship, scientific plan, and systematic institutional approaches to the diversity supplement. Discussion Successful strategies in submitting diversity supplements will facilitate inclusion of diverse researchers in NIH-sponsored programs. Systematic approaches are needed to support development of diverse voices to enhance the scientific community.
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A larger and more diverse registered nurse (RN) workforce in the U.S. is needed to meet growing demand and address social determinants of health and improve health equity. To improve understanding of pathways and barriers to becoming an RN, this study examined prior health care employment and financial assistance factors associated with completion of pre-licensure RN education programs, by initial entry degree (associate degree or bachelor of science in nursing) and across racial and ethnic groups, using the 2018 National Sample Survey of Registered Nurses. The study found higher percentages of associate degree-entry RNs held a health-related job prior to completing their initial RN program than did bachelor’s degree entrants. Employer support for education financing as well as reliance on loans and scholarships increased among RNs graduating in 2000 and later, and reliance on self-financing was reported less frequently. Hispanic associate degree-entry RNs reported education financing from only federal loans more frequently compared with White RNs, and higher percentages of Black, multiracial, and “some other race” baccalaureate degree entry RNs accessed federal loans compared with White baccalaureate degree-entry RNs. These findings indicate diversifying the RN workforce should remain a priority to increase representation by underrepresented racial and ethnic groups. Equitable pathways into the RN profession will be facilitated and expedited through policies that overcome financial and social barriers that enable individuals from population groups underrepresented in the nursing workforce to identify with the RN role and route to the profession.
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High-stakes, standardized testing has historically impeded education/career attainment for members of underrepresented minority groups and people needing testing accommodations. This study was to understand how high-stakes, standardized testing, particularly the NCLEX-RN, impacts diversity, equity, and inclusion (DEI) in nursing. This study explored the history, context, perspectives surrounding standardized testing, with a focus on the NCLEX-RN. The authors consider content, form, and delivery of testing, including accommodations. They identify available data and data collection gaps relevant to DEI and the NCLEX-RN. No nursing organization published the national data necessary to evaluate/refine the NCLEX-RN from a DEI perspective. Preliminary nursing studies and data from other professions indicated disparities in testing outcomes. Nursing must determine if prospective nurses are experiencing disparities in testing outcomes. The authors highlight opportunities to advance DEI through improved data collection, reformed licensure processes, and the reframing of standardized testing as one of many tools to determine competency.
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This study examined the impact of an out-of-school science, technology, engineering, and mathematics-medicine (STEM-M) program in a large U.S. metropolitan area designed to support the learning, development, and educational resilience of high-achieving high school students of color. Students highlighted that a key aspect of the program was the cultivation of what we termed a “culture of transformation.” Using a multi-year study (2016–2019), we completed 72 interviews and conducted in-depth qualitative analysis across six cohorts of students ( n = 37). In this article, we propose an expanded conceptual model of college socialization for students of color that leverages their engagement with (1) equitable resources, (2) relevant opportunities, (3) diverse knowledge, and (4) meaningful relationships. The relationship between early STEM-M career interest and youth socialization in related out-of-school activities that address larger societal inequities in school success and life and career outcomes warrants further study.
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Background: The 2021 Future of Nursing Report 2020-2030: Charting a Path to Achieve Health Equity recognizes increasing racial and ethnic diversity in nursing as an imperative to achieving health equity. Practice initiatives: Over a 3-year period, nursing and human resource leaders at Boston Children's Hospital, a tertiary care, 415-bed pediatric academic medical center in Massachusetts, developed, implemented, and evaluated specific strategies to increase racial and ethnic diversity in recruitment and hiring of the nursing workforce. These specific strategies focused on cultivating partnerships, building relationships with candidates, and supporting transition into practice. Results: Significant increases in racial and ethnic diversity recruitment and hiring were achieved over the 3-year period. In 2019, strategies yielded a 6% overall increase in total registered nurse diversity hiring with an 18% increase in new graduate diversity hires over 2018. In total, 16.2% of registered nurse hires for 2019 were racially and ethnically diverse. Subsequent years yielded similar success in the recruitment of diverse registered nurses. Clinical implications: With the projected growth of racial and ethnic minority populations, nursing and health care leaders must prioritize intentional strategic diversity recruitment and retention actions to address this imperative to advance health equity through the creation of a racially and ethnically diverse nursing workforce.
Article
Background Historically, in the United States, nursing programs reflected practices that systematically discriminated against Black students and nurses. Objectives The authors investigated historical nursing school admission policies to determine if racist practices existed that impeded Black students' ability to access formal nurse training programs. This study further examined whether those historical discriminating practices continue to exist in schools of nursing today and if admission policies in a Southern School of Nursing contributed to inequitable admission of students. Current recommendations for increasing diversity, equity and inclusion in nursing schools will be addressed. Methods This study combines social-historical archival research with a case study of the racial breakdown of applied versus admitted nursing students at a Southern university. Results School of Nursing admission data (2019–2021) demonstrate discrepancies in the distribution of admitted students by race, reflecting the ongoing effects of systematic discrimination. Conclusions In the United States, the nursing profession is pursuing strategies to promote diversity, equity, and inclusion. However, the lingering effects of policies that systematically built barriers keeping underrepresented groups from earning a nursing education persist. Holistic admission is one way that nursing programs can address this inequity.
Article
Background There is scant evidence of quantifiable effects of workplace racism on nurses’ job-related outcomes. Purpose The study aimed to examine associations among race, workplace racism, emotional distress, job dissatisfaction, and intent to leave among hospital-based nurses. Methods This study used a correlational design with six measures in a statewide sample of 788 hospital-based nurses. Findings Non-White nurses intended to leave the job at a higher rate than White nurses. Non-White nurses reported negative racial climates, multiple racial microaggression experiences, and high job dissatisfaction and emotional distress. Non-white race and workplace racism had significant individual effects on intent to leave. Job dissatisfaction and emotional distress significantly mediated indirect effects of non-White race, negative racial climates, and racial microaggressions on nurses’ intent to leave. Discussion In efforts to retain nurses of color in hospitals, there is an urgent need to mitigate workplace racism in these settings.
Article
Black and Latinx adolescents in urban schools can derive numerous benefits from tailored career and health education. However, many factors may prevent schools and teachers from offering such programing. To address the need for career and health education, we prototyped Caduceus Quest, a theory-based, digital role-playing game designed to provide information on health and biomedical science careers and sexual health (specifically HIV) for Black and Latinx adolescents. Forty high-school-aged adolescents participated in small group sessions to playtest the prototype. Post-intervention, adolescents reported increased interest in health and biomedical science careers, as well as HIV knowledge and PrEP awareness.
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The representation of nursing faculty of color is disproportionate to that in the general population, despite recruitment and retention strategies. Boosting the presence of nursing faculty of color requires an understanding of factors that undermine diversity initiatives and calls for the adoption of innovative practices. This article addresses the importance of racial and ethnic diversity within nursing education. Furthermore, it examines the factors that prevent the recruitment and retention of a racially and ethnically diverse nursing faculty workforce and provides evidence-based recommendations for increasing diversity among nursing faculty and nursing organizations.
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ABSTRACT Background: As nursing continues to promote healthcare in the 21st century, the current shift in demographics, combined with diversity in healthcare and continuing inequalities, will require our continued attention and action. Aim: Measuring the diversity of nurses in the work environment based on three fundamental axes (origin, gender, sexual orientation) and how these dimensions can adversely affect patient health as well as staff relationships. Material and Method: The sample (N=106) consisted of nurses working in clinics, care units and public and private health centers, while a research tool was a non-standard questionnaire according to the needs of the study with influences from the English version of the Transcultural Self-Efficacy Tool (TSET). Results: The research questions were answered by men where they constituted 17.9% of the respondents while women by 82.1%. 45.3% of the respondents stated that in the hospital / clinic where they work, the differences in ethnicity are supported, followed by disability with a percentage of 29.2% and gender (17.9%), while sexual orientation is the least supported difference with a percentage of 7.5 %. Also, 58.5% of the respondents stated that they have never felt criticized because of their gender, while 25.5% answered that this has happened. At the same time, 92.5% of them stated that equal opportunities should be given between the sexes in the workplace. When asked about collaboration, 89.6% of respondents said they do not feel embarrassed about working with people of different backgrounds than their own. Regarding sexual orientation, 80.2% stated that their sexuality does not affect to any extent his daily life as a health professional. Finally, the internal consistency coefficient of Cronbach's alpha questionnaires was 0.859. Conclusions: Diversity brings new ideas and experiences and people can learn from each other. Attracting different ideas and perspectives leads to better problem solving, opens dialogue and promotes creativity. This increased need to enhance diversity in nursing is not new to the profession. The value of diversity also applies to our culture. Key Wοrds: Diversity, nurses, equality, healthcare, workplace.
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Racism against Black people, Indigenous and other racialized people continues to exist in healthcare and academic settings. Racism produces profound harm to racialized people. Strategies to address systemic racism must be implemented to bring about sustainable changes in healthcare and academic settings. This quality improvement initiative provides strategies to address systemic racism and discrimination against Black nurses and nursing students in Ontario, Canada. It is part of a broader initiative showcasing Black nurses in action to end racism and discrimination. We have found that people who have experienced racism need healing, support and protection including trauma-related services to facilitate their healing. Implementing multi-level, multi-pronged interventions in workplaces will create healthy work environments for all members of society, especially Black nurses who are both clients/patients and providers of healthcare.
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Diversity in the nursing workforce is an important driver of patient satisfaction, adherence to care, and quality outcomes. Systemic barriers exist that prevent individuals from underrepresented minority groups entering and advancing in the nursing workforce. To advance the health of the community we serve and with grant support from the Health Resources and Services Administration, we developed a postgraduate advanced practice registered nurse (APRN) fellowship in community health. This program is a partnership between a federally qualified health center and a college of nursing. We developed a deliberate plan to recruit and admit diverse applicants who would continue to practice in our community at the conclusion of their fellowship year. Using targeted recruitment outreach, we identified new-graduate APRNs who were representative of the community we serve. Using holistic review methodology, we interviewed applicants with explicit efforts to mitigate the effects of bias towards race, ethnicity, gender, and academic affiliation. We embraced a quality-improvement ethos that enabled evolution and growth with each iteration of the program. Understanding that intention does not translate to outcomes, we undertook ongoing critique of our methods and engaged diverse resources to improve our processes. Over two admission cycles, our fellowship in community health for new graduate APRNs has demonstrated improvements in strategies to diversify the community health workforce. We will describe our process of nonjudgmental self-critique and a quality-improvement framework that can serve as a strategy to promote diversity, equity, and inclusion in the community health workforce.
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The decade ahead will test the nation's nearly 4 million nurses in new and complex ways. Nurses live and work at the intersection of health, education, and communities. Nurses work in a wide array of settings and practice at a range of professional levels. They are often the first and most frequent line of contact with people of all backgrounds and experiences seeking care and they represent the largest of the health care professions. A nation cannot fully thrive until everyone - no matter who they are, where they live, or how much money they make - can live their healthiest possible life, and helping people live their healthiest life is and has always been the essential role of nurses. Nurses have a critical role to play in achieving the goal of health equity, but they need robust education, supportive work environments, and autonomy. Accordingly, at the request of the Robert Wood Johnson Foundation, on behalf of the National Academy of Medicine, an ad hoc committee under the auspices of the National Academies of Sciences, Engineering, and Medicine conducted a study aimed at envisioning and charting a path forward for the nursing profession to help reduce inequities in people's ability to achieve their full health potential. The ultimate goal is the achievement of health equity in the United States built on strengthened nursing capacity and expertise. By leveraging these attributes, nursing will help to create and contribute comprehensively to equitable public health and health care systems that are designed to work for everyone. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity explores how nurses can work to reduce health disparities and promote equity, while keeping costs at bay, utilizing technology, and maintaining patient and family-focused care into 2030. This work builds on the foundation set out by The Future of Nursing: Leading Change, Advancing Health (2011) report. © 2021 by the National Academy of Sciences. All rights reserved.
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PhD-prepared nurses are integral to the delivery of cost-effective, safe, and high-quality care to the increasingly diverse population in the U.S. Nurses with a PhD are needed to develop knowledge that informs and directs nursing care, promote positive health outcomes, and train the next generation of nurses and nurse scientists. Unfortunately, less than one percent of nurses have their PhD in nursing and there is an ongoing shortage of nurses in the U.S. that has not been effectively addressed. The PhD in nursing pipeline needs to be bolstered to address the escalating nursing shortage. This is especially important considering the importance of having an adequate number of well-prepared nurses to address the increasing complexities of health conditions and patient populations in the U.S. This paper presents strategies to promote and sustain interest in PhD in nursing among baccalaureate nursing students and discusses the importance of meaningful engagement in research and engaged faculty mentorship. It is important to incorporate research into undergraduate experiences, promote engaged mentorship during undergraduate level and beyond, and provide a conducive environment for undergraduate students to address their fears, misconceptions, and myths about PhD in nursing.
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Minority nurses are underrepresented in leadership roles in the Canadian healthcare system. The purpose of this study was to explore MNs’ perceptions and experiences with regards to career development and MNs in leadership positions. Twelve nurses, four Caucasian and eight from the Caribbean and Africa in a tertiary care setting were recruited through purposive sampling. Face-to-face semi-structured interviews were conducted, transcribed, coded, and analyzed using critical ethnography. Findings revealed lack of social support, of equal opportunities, of recognition and of trust. Despite negative experiences, minority nurses recognized the value of their work experience at the hospital where they were employed. Committing to a diverse workforce in leadership roles can ultimately have an effect on patient care. Minority nurses’ leadership is needed to provide role models and to ensure the delivery of competent care to diverse populations.
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This contextual statement is focussed on nursing in clinical practice and higher education encapsulated in a selected body of published work, illustrating a career of over thirty years. This journey spans a political and policy context that includes the expansion of higher education in the 1970s, the closure of the Victorian psychiatric hospitals in the 1990’s, the move of nursing from apprentice-style training into higher education in 1995, and the partial decoupling of nurse education from the NHS. Drawing on theories of liminality and Michael Lipsky’s Street Level Bureaucracy, the statement proposes innovative approaches to raising the profile of nursing, beyond a liminal position. The public works are produced from liminal spaces in clinical practice to the liminal space occupied by nursing in higher education. Whilst accepting the essence of nursing as a caring profession, the statement suggests how societal views about nursing are stereotyped and heavily influenced by the position of women generally. This is compounded by the reluctance of feminism to embrace nursing, and nostalgic views about the profession portrayed in the media and articulated at all levels, including in government. The works indicate how this has contributed to nursing occupying a liminal space in higher education. Focussing on nursing at the margins of society, early papers cover the period of deinstitutionalisation from the large psychiatric hospitals. Further papers focus on influencing the education, identity, and values of nurses, including how the rise of service user involvement can transform curricula. Later papers consider the views and experiences of nurse academics and students about professional identity and how this is expressed in learning and teaching; with insight into how identity and values are shaped by both clinical and educational experiences. The liminal experience of nursing in higher education is explored, alongside the dual identity experienced by nurses who move from clinical practice to the academy. The final group of papers examine the place of work-based learning in higher education, with the paradoxical discovery that although learning in healthcare is abundant, identifying learning opportunities can be elusive. Produced on the margins of clinical and academic practice, the works illuminate hidden areas that are not sufficiently valued. The statement and works provide a platform to raise the position and profile of nursing overall.
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Healthcare organizations must be intentional and purposeful in creating diversity programs. A nursing leader mentorship program for racial and ethnic minority nurse managers was introduced at a large academic medical center to meet this need. The program design was based on the successful Leadership Institute for Black Nurses, first conducted at a university school of nursing. The participants in the 4-month program were 16 nurse managers from 2 city hospitals and their mentors.
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This article highlights selected components of the National Institute of Nursing Research's (NINR) Strategic Plan on Reducing Health Disparities. Building on its long history of supporting research devoted to improving minority health, NINR has expanded its opportunities and efforts related to health disparities and enhancing the research career development of minority investigators. Given the increased emphasis on reducing and, ultimately, eliminating health disparities, nurse researchers are encouraged to explore the various opportunities provided by NINR when addressing health inequalities.
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This article describes the development of a model designed to enhance and develop minority nurses. Select literature on leadership and diversity are highlighted. Background information that was pertinent to the development of the model is provided, as well as some brief information on how the model is being used in an ongoing project.
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This chapter focuses on promoting cultural competence in research and the care of vulnerable populations by establishing inter-university nursing partnership centers for health disparities research between historically Black universities and minority-serving institutions and research-intensive majority institutions. The Hampton-Penn Center to Reduce Health Disparities (HPC), an inter-university collaborative center funded through the National Institutes of Health (NIH) National Institute of Nursing Research (NINR) P20 funding mechanism, is discussed as the exemplar. The mission of the Hampton-Penn Center is to promote culturally competent research on health promotion and disease prevention and the examination of how culture, race and ethnicity and their interactions with the health care system and the larger society influence health outcomes and the occurrence of health disparities. The history, goals, and conceptual model underlying this collaborative effort between the University of Pennsylvania and Hampton University Schools of Nursing are described as are the accomplishments and lessons learned to date. Based upon the Hampton-Penn experience, recommendations for similar collaborations to reduce health disparities among vulnerable populations are made in three major areas: (a) increasing the study of the multi-system level factors that contribute to health disparities among vulnerable populations, (b) promoting the development of culturally competent research on health disparities, and (c) promoting the recruitment and training of health researchers who are themselves members of vulnerable populations.
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Health disparities are a major public health problem in the United States. Doctorally prepared nurse scholars, who understand factors contributing to these disparities, possess research competence to study these factors, and pose strategies to be tested are essential to improve the health of these vulnerable populations. This article describes how a PhD curriculum was designed to prepare teacher-scholars to assume leadership roles in reducing health disparities.
Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Board on Health Sciences Policy. Unequal treatment: Confronting racial and ethnic disparities in health care
  • Smedley BD
  • Stith AY
  • Nelson AR