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Increasing Racial/Ethnic Diversity in Nursing to Reduce Health Disparities and Achieve Health Equity
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.
... It is important to examine the education process of child life, as research supports that education can play a significant role in increasing workforce diversity in healthcare fields (Glazer et al., 2018). In turn, increased workforce diversity may reduce racial and ethnic health disparities (Phillips & Malone, 2014). However, it is also known that healthcare providers and students with marginalized identities may experience various barriers that harm their wellbeing (Filut et al., 2020;Iheduru-Anderson & Wahi, 2021). ...
... This necessitated a review of other healthcare professions and academic programs. In response to insufficient diversity in the nursing workforce to match the increasing diversity of the U.S. population and the significant health disparities resulting from this, Phillips and Malone (2014) outlined ways to increase nursing workforce diversity in order to eliminate health disparities. Their recommendations include creating fellowships and other training opportunities to support health equity, requiring opportunities for underrepresented nurse leadership and involvement, and expanding service learning in nursing schools that focus on health equity (Phillips & Malone, 2014). ...
... In response to insufficient diversity in the nursing workforce to match the increasing diversity of the U.S. population and the significant health disparities resulting from this, Phillips and Malone (2014) outlined ways to increase nursing workforce diversity in order to eliminate health disparities. Their recommendations include creating fellowships and other training opportunities to support health equity, requiring opportunities for underrepresented nurse leadership and involvement, and expanding service learning in nursing schools that focus on health equity (Phillips & Malone, 2014). ...
The child life profession is predominantly White. To date, there is no research on the experiences of child life students of color navigating child life academic programs and internships. The purpose of this exploratory study was to analyze the experiences of child life students of color. Twelve child life students of color took part in in-depth interviews with the authors. Qualitative thematic analysis produced five themes: barriers to progress, protective factors, fitting one’s marginalized identity into child life, connecting with patients and families, and the social landscape of child life. Research and professional implications are addressed.
... 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) . ...
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) . ...
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. ...
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.
... A lack of racial and ethnic diversity exists among nurses in faculty and leadership. The lack of diversity in higher-level leadership positions could continue to encumber access for Black nurses into the nursing profession's higher ranks and access to resources for individuals from diverse racial and ethnic backgrounds in nursing education (Phillips & Malone, 2014). One of the three central themes to the future success of the nursing campaign for action was "the need to continue to make promoting diversity in the nursing workforce a priority" (National Academies of Sciences, 2021, p. x). ...
... We must question who stands to gain and who continues to lose with the continued underrepresentation of Black nurses in academic leadership. Several studies and reports highlight the need for more Black nurses and other nurses of color at the leadership table as crucial for the recruitment, retention, and continued diversification of the nursing workforce at all levels (Iheduru-Anderson, 2020; National Academies of Sciences, 2021; Phillips & Malone, 2014). Whitfield- Harris et al. (2017) participants reported not receiving the same support as their white colleagues from their institutions, so they sought mentors outside their institutions or learned from their mistakes. ...
Mentoring is critical for career advancement in all professions. It is especially crucial for leadership development and succession planning. Studies suggest that increasing the racial minority representation in higher-level leadership will provide diverse skill sets, promote innovation, and yield positive outcomes. The study aimed to examine how Black women academic nurse leaders perceive mentoring in academic nursing using critical race theory as the guiding framework and explore the crucial role of mentorship in promoting and advancing Black women academic nurse leaders. The study used a narrative qualitative research design, purposive sampling, and unstructured interviews to collect and thematically analyze data. Findings fall under two major themes; being mentored and mentoring others. The findings highlight perceived significant differences in the allocation of resources and mentoring for career advancement in academic nursing for Black nurses compared to those classified as white. Increasing diversity in nursing requires deliberate effort from majority white leadership.
... in recognition of minority status being a social construct. Further, there is unequal gender and minority representation in the workforce, especially in higher management positions (Cohen, Gabriel, and Terell 2002;Frusti, Niesen, and Campion 2003;Gathers 2003;LaVeist and Pierre 2014;Phillips and Malone 2014;Williams et al. 2014). Additionally, organizational constraints, like scarcity of time and resources, can negatively affect the way healthcare organizations acknowledge, address, and accommodate diversity in both practice and policy (Celik et al. 2008). ...
... Developing a diversity statement or policy is such a practice; it can be an important starting point from which to promote diversity-responsive strategies, awareness, and equitable care practices within healthcare organizations (see for instance Carnes and Sheridan 2019;Leyerzapf et al. 2019;Phillips and Malone 2014;Seeleman et al. 2014Seeleman et al. , 2015Yearwood et al. 2006). Diversity statements describe normative ideas and moral values regarding how diversity is defined and act as a formal "moral compass" or declaration of intent concerning an organizations' diversity approach. ...
In pluralist societies, stakeholders in healthcare may have different experiences of and moral perspectives on health, well-being, and good care. Increasing cultural, religious, sexual, and gender diversity among both patients and healthcare professionals requires healthcare organizations to address these differences. Addressing diversity, however, comes with inherent moral challenges; for example, regarding how to deal with healthcare disparities between minoritized and majoritized patients or how to accommodate different healthcare needs and values. Diversity statements are an important strategy for healthcare organizations to define their normative ideas with respect to diversity and to establish a point of departure for concrete diversity approaches. We argue that healthcare organizations ought to develop diversity statements in a participatory and inclusive way in order to promote social justice. Furthermore, we maintain that clinical ethicists can support healthcare organizations in developing diversity statements in a more participatory way by fostering reflective dialogues through clinical ethics support. We will use a case example from our own practice to explore what such a developmental process may look like. We will critically reflect on the procedural strengths and challenges as well as on the role of the clinical ethicist in this example.
... 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." ...
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). ...
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.
... Hence, one remedy that is suggested (but cannot be proven or causally situated) by the study is to increase representation of gender among authors to achieve better parity. Recent studies have highlighted the importance of representation and diversity for increasing participation and equity in various fields (although a clear study in art and literature has been lacking, possibly due to lack of data availability) (Hoekstra, 2010;Nielsen et al., 2018), and along various dimensions, including both race and gender (Stathoulopoulos and Mateos-Garcia, 2019;Richard, 2000;Greider et al., 2019;Phillips and Malone, 2014). ...
Research has continued to shed light on the extent and significance of gender disparity in social, cultural and economic spheres. More recently, computational tools from the data science and Natural Language Processing (NLP) communities have been proposed for measuring such disparity at scale using empirically rigorous methodologies. In this article, we contribute to this line of research by studying gender disparity in 2,443 copyright-expired literary texts published in the pre-modern period, defined in this work as the period ranging from the beginning of the nineteenth through the early twentieth century. Using a replicable data science methodology relying on publicly available and established NLP components, we extract three different gendered character prevalence measures within these texts. We use an extensive set of statistical tests to robustly demonstrate a significant disparity between the prevalence of female characters and male characters in pre-modern literature. We also show that the proportion of female characters in literary texts significantly increases in female-authored texts compared to the same proportion in male-authored texts. However, regression-based analysis shows that, over the 120 year period covered by the corpus, female character prevalence does not change significantly over time, and remains below the parity level of 50%, regardless of the gender of the author. Qualitative analyses further show that descriptions associated with female characters across the corpus are markedly different (and stereotypical) from the descriptions associated with male characters.
... For decades, nurses have discussed the importance of developing a diverse nursing workforce, and many nurses and professional nursing organizations have acknowledged that increasing diversity is necessary to achieve health equity ( Phillips & Malone, 2014). Despite these longstanding calls to action, the current nursing workforce in the United States continues not to reflect population demographics. ...
The nursing workforce in America continues to experience significant challenges. Namely, the lack of student and faculty diversity in nursing programs leaves workforce diversity in a gridlock. Well documented in the literature, the nursing workforce does not match the current demographics in the United States. This poses significant obstacles with far-reaching implications, from student and faculty trauma and violence to adverse patient outcomes. Improving inclusion and reducing barriers for historically and intentionally marginalized people involves self-awareness and appropriate expressions of empathy. This study used a quantitative exploratory method with a cross-sectional design to survey nurse faculty (n = 318) empathy nationwide utilizing the scale of ethnocultural empathy. The findings indicate that, overall, nurse faculty report moderate levels of ethnocultural empathy (15.25 § 1.87). However, when the data were stratified by participant-reported racialized groups, non-white participants had statistically significant higher empathy scores F (25, 257) = 4.35, p < .001. These findings are consistent with research reporting the adverse experiences of under-represented students and faculty in nursing programs and the persistent racism, oppression, and violence they face. Increasing empathy through ongoing self-awareness, perspective-taking, and training with a full review of institutional policies can mitigate exclusionary harm. Institutional commitment to diversity alone will not rectify contemporary challenges. Intentional actions to create inclusive spaces, remove barriers, and improve empathy are critical implications for nursing programs nationwide.
... Another one of the proposals suggested to improve communication during the health care-related visit was the addition of migrant professionals. This proposal is not confined to our study, but it is also found in other studies [58], with special emphasis on the hiring of international nursing personnel [59,60]. These studies argue that the incorporation of nurses from other cultures is a key aspect for providing culturally competent care to patients and populations that are ever more diverse, and this strategy could improve the access to health care services and decrease health inequalities [61,62]. ...
Nurses have faced during the COVID-19 pandemic a tough professional situation in which they have had to work in a resource-limited context and with a high probability of COVID-19 transmission. In today's multicultural societies, care for immigrant patients is also included. In our study, we have delved into the perception of hospital nurses towards migrant people in the context of the COVID-19 pandemic. We used a qualitative methodology with a phenomenological approach. Semi-structured interviews were conducted with 16 nurses. Seven categories emerged and were distributed in the three blocks of the interviews: (a) perception before the pandemic: prejudices make a mark and communication problems; (b) perception after the pandemic: prejudices weaken and communication worsens; and (c) how to improve care: improve communication, more nurses, and no need for training. The approach in the interpersonal relationship between nurses and patients during the pandemic has improved health care. Proposals arise to overcome the language barrier such as the incorporation of intercultural translators-mediators and professionals of foreign origin. There is a lack of awareness of the need for training in cultural competence on the part of the nurses in the study.
... Nursing is at a critical point of self-reflection and change. Health disparities and the lack of diversity in nursing have been recognized as a healthcare concern for several decades (Cole & Stutte, 1998;Fontenot & McMurray, 2020; National Academies of Sciences, Engineering, and Medicine, 2021;Phillips & Malone, 2014). However, despite hundreds of publications and calls to action addressing the need to increase diversity in nursing, many populations remain underrepresented (Aragon et al., 2020). ...
Achieving health equity is a critical healthcare priority. Addressing health inequities will require that the nursing profession becomes more diverse, equitable, and inclusive. Nursing educators must be prepared to provide unbiased, inclusive, and accurate information about structural and social determinants of health. This cross-sectional exploratory study was conducted to evaluate the knowledge, skills, and attitudes of nurse educators related to diversity, equity, and inclusion. A researcher-designed survey was distributed to Associate Degree in Nursing programs across the United States. Study participants (n = 318) were primarily white, cisgender, heterosexual females, which is representative of the nursing profession. Findings from this study indicate that there is significant work to be done to address diversity, equity, and inclusion in both nursing education practice and curricular content. Nurse educators play a critical role in shaping the future of health care. Nursing faculty should use the findings of this study to examine their personal biases, institutional policies and procedures, and nursing program curricular content.
... 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). ...
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. ...
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.
America is more varied than ever. As cultural heterogeneity grows in America, religion, faith, and health habits show their effects. However, Latinx and African-American nurses, doctors, and healthcare professionals must represent the exponential expansion in population diversity. Black nurses may not reflect the variety of the U.S. population, but they are essential for culturally competent treatment and trust-building with communities of color. Many individuals believe health inequalities are caused by fundamental differences between populations and ignore their societal factors. Healthcare workers of color realize that social and political systems cause health inequities. We can then find structural gaps-closing solutions. Intervention research in an organizational case study addresses several of these complicated concerns. This chapter points to the critical importance of leadership, cultural change, employee engagement, and cultural change as essential for organizations to transform to make them more diverse and inclusive.
Currently, medical students frequently learn about race without the crucially important context of systemic and historical racism. As a result, these aspiring healthcare professionals learn to attribute racial disparities in health outcomes and populational health to perceived genetic differences between races, rather than being a result of persistent and pervasive oppression. In medical education, this manifests as racist associations between race and physiology, pathology, and treatment. In this chapter, the history of race and medicine will be addressed, providing clear examples that illuminate the ways in which the medical community has a consistent history of abusing communities of color. The authors will describe how these problems compound in a clinical setting, resulting in positive outcomes for patient health being much harder to achieve. In addition to the deleterious effects in clinical settings, the misuse of race in medicine also impacts student performance and mental health in the classroom setting. Readers will be presented with research that demonstrates the direct correlation of a student’s mental state to their academic success. This section will address the specific roles of microaggressions and its subsets – microinsults, microassaults and microinvalidations – particularly in shaping and maintaining barriers to learning and academic success for students of color. Strategies to reduce the gap in educational disparities will be discussed, including the need to provide equitable performance assessment measures. The guidance provided in this chapter will help medical educators train physicians who are prepared to acknowledge and address racial and ethnic health disparities in their future practice.KeywordsRaceImplicit biasBiasHistoryOppressionMicroaggressionMicroinsultsMicroassaultsMicroinvalidationsPerformanceMedical education
Throughout the world, health disparities among racial and ethnic minority groups have existed and continue to persist despite advances in medicine and technology. There is evidence that racial and ethnic health disparities (REHD) are being upheld in current pedagogical practice in undergraduate medical education (UME). Therefore, intentional changes to pedagogy during UME could progressively affect medical practice, potentially reducing REHDs. By creating an understanding of race as a social construct rather than a biological one, this manual was written to serve as a guide to anyone wanting to use their classroom as an agent for change to make our world a safer and healthier place for people of all races and ethnicities.This manual consists of several chapters providing background information and historical context for why REHDs exist and persist throughout our global history. The nuances of race-based medicine versus race-conscious medicine are described in detail throughout this manual and the mechanisms through which these practices can either contribute to or dismantle REHDs are described. Chapters 4–6 of this manual serve as “how-to” guides for educators, curriculum managers, and university leaders to implement evidence-based strategies to address REHDs in educational materials and curricula. Finally, tools and checklists are offered throughout the manual to provide guidance to readers as they implement the strategies described.KeywordsHealth equityMedical educationDisparitiesRacismAntiracismHealth disparities
Nurse educators share a major responsibility in shaping the future of nursing by preparing nurses to better understand and address health equity. In this chapter, we will share the experience of the School of Nursing of The University of Hong Kong in preparing the students to understand, recognize, and address social determinants of health and health equity through various teaching and learning strategies.KeywordsNursing educationExperiential learningAgingPovertyEthnic minorities
Among the U.S. health care workforce, the COVID-19 pandemic appeared to greatly impact employment levels in 2020. However, no research has examined how the pandemic's impact on employment varied by racial/ethnic group or beyond the initial emergency year. Our study aimed to quantitatively evaluate workforce trends by race/ethnicity before, during, and after the COVID-19 pandemic. This study analyzed each March supplement of the Current Population Survey over a 5-year span (2018-2022). We restricted the sample to nurses, physician assistants, and other non-physician health care workers (HCW), per specific census occupation codes, and constructed an event-history study to test for differential effects from each year, as compared to 2019, on the proportion of employment between non-Hispanic White, non-Hispanic Black, Hispanic, non-Hispanic Native (American Indian, Alaska Native, Hawaiian Islander), and non-Hispanic Asian HCW. Results suggest that the pandemic's negative impact on the health care workforce disproportionately reduced employment for HCW self-identifying as Black or Indigenous. Rates for other groups increased 2-3 percentage points in 2020 but returned to prepandemic levels by 2022. However, for Black and Native HCW, the change was twice as large in 2021 and remained significantly higher in 2022 for Black HCW, providing more evidence that the burden of the COVID-19 pandemic disproportionately fell on people of color. Future research investigating how employment disruptions impacted the health care workforce and, potentially, health equity remains warranted.
Background:
Indigenous nurses are underrepresented in the nursing workforce. Important strategies have been developed to increase the diversity of the future nursing workforce; however, unique cultural needs of Indigenous students must be addressed to provide holistic support while maintaining and strengthening cultural identity.
Method:
The Niganawenimaanaanig (We Take Care of Them) Indigenous Nursing Education Model was developed based on the Medicine Wheel and previous diverse nursing education models. This model supports the cultural, social, academic, and financial needs of Indigenous nursing students throughout recruitment, enrollment, retention, graduation, and licensure and specifies eight essential resources necessary for success.
Results:
Lessons learned from implementing the Niganawenimaanaanig Model are shared.
Conclusion:
The Niganawenimaanaanig Model may be employed in nursing schools to guide educators and universities in promoting the success of Indigenous nursing students. [J Nurs Educ. 2023;62(X):XXX-XXX.].
Background:
The profession of nursing has recognized the lack of diversity in nursing leadership. Nurses of color represent fewer than 20% of leadership roles in nursing administration, education, and professional organizations. Efforts are needed to identify and implement strategies to increase the representation of nurses of color in positions of high influence.
Purpose:
To review the literature to uncover the factors that may impact Black nurses in their pursuit of leadership roles in nursing administration, education, and professional organizations.
Methods:
The authors conducted a scoping review, searching CINAHL and PubMed databases in November 2022 for peer-reviewed English-language studies of leadership among U.S. nurses. They excluded studies that did not include a research method, did not have participants, a minimum of baccalaureate preparation as an inclusion criterion for participants, or were published before January 1, 2012.
Discussion:
Of 331 articles identified, a total of 12 met the inclusion criteria. Evaluation of the studies revealed three concepts related to mentorship, racism, and hiring practices. Of the 12 studies, 9 addressed issues related to mentorship, 5 addressed issues related to racism, and 2 addressed issues related to hiring practices. Some studies address more than one of the concepts. Ten were qualitative studies, and two were quantitative studies.
Conclusion:
Findings suggest that Black nurse leaders are faced with obstacles and challenges when considering entering and/or staying in leadership roles. The limited amount of research on Black nurses in leadership roles remains inadequate.
As we were thinking about how to approach the introduction to this chapter, we asked the “Why?,” “What?,” and “How?” questions; about how a section focused on mentoring racially and ethnically diverse nurses of color while mindful of diversity, inclusion, and equity would inform and enhance the overall project. Concurrently, we were reading S. R. Toliver’s Recovering Black Storytelling in Qualitative Research: Endarkened Storywork (2022). Toliver defines “Afrofuturism” as “a cultural aesthetic in which Black authors create speculative texts that center Black characters in an effort to reclaim and recover the past, counter negative and elevate positive realities that exist in the present and create new possibilities” ([1], p. xxi). In her qualitative research approach informed by Afrofuturism, Tolliver was not interested in traditional qualitative methods where themes would be identified across girls’ stories. Rather, she was interested in discovering how each Black girl’s experiences were connected to the experiences of other Black girls, to her own experiences as a Black woman, as well as to the experiences of Black women nationally. The method she used to gather data was storytelling and listening in order to understand the history, the current world, and what the future might look like for her research partners (known in traditional qualitative research as “informants” or “subjects”). Toliver’s approach, unlike traditional qualitative research, allows her to knit together the threads of the girls’ stories to produce solutions in their voices. Thus, possibilities for their futures are generated by them, not from an analysis of their stories by others.
Canadian Schools of Nursing rest upon white, colonial legacies that have shaped and defined what is valued as nursing knowledge and pedagogy. The diversity that exists in clinical nursing and is emerging within the graduate student population is not currently reflected within nursing faculty and academic leadership. Black, Indigenous, and People of Color (BIPOC) nurse leaders, historically and presently, are repeatedly left unacknowledged as knowers and keepers of nursing knowledge. This lack of diversity persists across nursing knowledge generation, research, and healthcare practices that ultimately aim to serve the increasingly diverse Canadian population. This narrative inquiry study examined the experiences of eight BIPOC graduate nursing students as they navigated white academic nursing spaces. The findings are presented to reflect their experiences of entrenched in whiteness, erasure of identity, and navigating belonging. These study findings highlight the importance of surfacing academic nursing history shaped by colonialism and racism, the need to diversify nursing faculty and the graduate nursing student population, and implementing nursing curricular and syllabi audits to ensure that they reflect the multitude of ways of knowing to expand dominant Eurocentric and Western knowledge in nursing education.
Introduction:
Midwifery leadership is vital for improving maternal health outcomes, yet limited leadership training opportunities exist. This study evaluated acceptability and preliminary outcomes of Leadership Link, a scalable online learning program that aims to increase midwives' leadership competencies.
Methods:
The program evaluation study enrolled early-career midwives (<10 years since certification) into an online leadership curriculum using the LinkedIn Learning platform. The curriculum consisted of 10 courses (approximately 11 hours) of self-paced, non-health care-specific leadership content supplemented with brief midwifery-specific introductions from midwifery leaders. A preprogram, postprogram, and follow-up study design was used to evaluate changes in 16 self-assessed leadership abilities, self-perception as a leader, and resilience. Data were also collected on the application of leadership skills acquired through, and career advancements attributed to, program participation.
Results:
A total of 186 individuals activated LinkedIn Learning accounts. Almost half (41.9%) completed the full curriculum. Satisfaction was high, with 83.3% of postprogram survey respondents reporting the program was "probably" or "definitely" worth the time invested. Seventy-six participants (40.9%) provided matched pre- and immediate postprogram survey data on at least some of the 16 self-assessed leadership abilities. All 16 abilities showed statistically significant increases in pre- to postprogram mean scores, ranging from 6.4% to 32.5%. Both self-perception as a leader and resilience scores significantly increased from baseline. More than 87% of postprogram and follow-up survey respondents reported having applied new or improved leadership abilities to at least a small degree. Fifty-eight percent of follow-up survey respondents reported at least one midwifery career advancement, of whom 43.6% attributed the advancement, at least in part, to Leadership Link.
Discussion:
The findings suggest that the online Leadership Link curriculum is acceptable and may be effective in improving midwives' leadership capacity, potentially enhancing career opportunities and engagement in system change.
Background:
Health inequities have enhanced efforts to diversify the nursing workforce. Despite recruitment strategies, the percentage of Black nurse practitioners (NPs) lags in comparison with the populous.
Problem:
Barriers to improving workforce diversity can be traced to academic nursing's lack of diversity in faculty, under-resourced education opportunities for students from underrepresented backgrounds, and historical hurdles.
Approach:
One systems-level approach to increasing NP workforce diversity is developing pathway programs aimed at preparing, recruiting, and supporting Black students into advanced practice nursing education. Current undergraduate RN students from 2 historically Black colleges and universities (HBCUs) attended a 1-week summer immersion program at a graduate school of nursing at a predominately White institution.
Conclusion:
Pathway programs for Black undergraduate RN students show promise for increasing awareness of graduate nursing, offering race and ethnicity concordant mentorship, and cultivating deep awareness for health equity.
A qualitative descriptive approach examined African American nurse scientists' (AANSs') experiences with African American research participants despite obstacles of structural racism. Fourteen nurse scientists participated in semistructured interviews that provided data for the thematic analysis. Major themes included barriers to overcome as doctoral students, cultural experiences with structural racism, designers of culturally sensitive research, and humanitarian respect and relationship depth. This is the first research study to illuminate the contributions of AANSs who lead research in health disparities. Therefore, nursing leadership needs to illuminate AANSs' contributions, increase nurse diversification, and dismantle structural racism that creates obstacles that ultimately impact population health.
Background
In 2005, Mountain Area Health Education Center (MAHEC) collaborated with community partners to establish the Minority Medical Mentoring Program (MMMP), a semester-long health care pathway internship for high school seniors of color. This evaluation aimed to assess program participants’ perceptions of program components, identify areas for improvement, and broaden the evidence base of pathway programs.
Methods
Seventy-three MMMP alumni were invited to participate in an online survey. Closed- and open-ended questions aimed to assess respondents’ perceptions of program components and MMMP’s impact on their personal and professional lives.
Results
Forty-six alumni responded to the survey. The MMMP was perceived as universally valuable. Clinical shadowing, mentors of color, and exposure to a variety of health professionals were viewed as the most valuable program components. The MMMP strengthened participants’ awareness of health disciplines, improved their self-confidence, and increased their professional skill sets. Surprisingly, the MMMP enabled some participants to recognize health career interests outside of clinical care.
Limitations
Selection, social desirability, and recall bias may limit interpretation of findings.
Conclusion
The MMMP is highly valued by participants. A high majority of respondents (40/46; 87%) plan to have a health career in the future. Pathway programs can shape career paths, increase self-awareness, and build self-confidence for success. It is important to note that systemic racism and discrimination must be addressed to fully ensure recruitment and retention of health care providers of color.
Background:
The United States continues to be plagued with pervasive health disparities. Leading health and professional organizations acknowledge structural racism as a contributing factor for the lack of a racially diverse nursing workforce particularly those serving in leadership roles which could help to mitigate health disparities among historically stigmatized populations.
Purpose:
Purpose Lack of funding for Historically Black Colleges and Universities (HBCUs) and lack of meaningful partnerships, stymie efforts that can be made by nursing programs at HBCUs.
Discussion:
Discussion This position paper examines collaborative actions that can address upstream factors that perpetuate healthcare disparities through deep engagement between the policymakers, professional associations, industry, and educational institutions.
Methods:
Faculty representing HBCU's and predominately White institutions, professional organizations, and staff met via videoconference to refine the focus of the paper, determine topic areas for writing teams, and refine details which occurred during weekly meetings.
Conclusion:
To disengage from structural racism, three critical recommendations are amplified with associated examples.
Background:
Despite calls to increase the proportion of men in nursing, little change has occurred, and anecdotal accounts suggest poor retention of men in nursing programs. This study explored the role that gender role conflict (GRC) may play in men's academic success.
Method:
Men in a large nursing program (n = 123) in the United States were surveyed to explore their GRC upon entry to their nursing program and then again 1 and 2 years later. GRC results, academic test scores, and indicators of program success were analyzed to explore GRC patterns over time and the influence of GRC on academic and program outcomes.
Results:
GRC did not significantly influence most measures of academic success, program completion, or NCLEX-RN results.
Conclusion:
GRC does not appear to influence academic or program success; however, additional research is needed. [J Nurs Educ. 2023;62(1):42-46.].
Purpose:
The increasing diversity among workforces - as well as the increasing diversity among patient populations served - offers a variety of opportunities and potential pitfalls for healthcare organizations and leaders. To unravel this complexity, the authors aim to holistically understand how to maximize provider and patient experiences regardless of (1) the degree to which diversity is present or lacking, and (2) the type(s) of diversity under consideration.
Design/methodology/approach:
This conceptual paper develops a framework that combines three organizational behavior theories - emotional labor theory, similarity-attraction theory and climate theory - with evidence from the broader healthcare literature.
Findings:
Authentic interactions yield positive outcomes for providers (i.e. improved job attitudes and work-related well-being) and patients (i.e. patient satisfaction) and acts as a mediator between demographic diversity and positive outcomes. Demographic similarity facilitates authentic interactions, whereas demographic diversity creates an initial barrier to engaging authentically with others. However, the presence of a positive diversity climate eliminates this barrier.
Originality/value:
The authors offer a conceptual model to unlock positive outcomes - including reduced absenteeism, better morale and improved patient satisfaction - regardless of the level and types of diversity present within the workforce. In addition to deriving an agenda for future research, the authors offer practical applications regarding how diversity can be more effectively managed and promoted within healthcare organizations.
Background:
Neonatal nurse practitioners have a strong presence in the neonatal intensive care unit and are primed to lead efforts to induce change related to health disparities. Underrepresented minority nurse practitioners offer valuable perspectives in the care of underrepresented minority patients. However, there remains a current racial and ethnic discordance between neonatal providers and patients. Efforts to eliminate health disparities must begin before nursing school. The current racial and ethnic composition of neonatal nurse practitioner faculty in comparison to students in the United States is unknown.
Purpose:
The purpose of this study was to determine the racial and ethnic composition of neonatal nurse practitioner faculty and students in the United States and contrast this data with available data for the racial and ethnic composition of the neonatal intensive care unit patient population.
Methods:
This cross-sectional study used a nonexperimental survey to describe the racial and ethnic composition of neonatal nurse practitioner faculty and students in the United States.
Results:
There was no significant difference in the racial and ethnic composition between neonatal nurse practitioner faculty and students. There were significant differences for all race distributions between neonatal nurse practitioner students and neonatal intensive care unit admissions.
Implications for practice and research:
The discordance between neonatal nurse practitioner students and neonates in the neonatal intensive care unit is important in addressing disparities and begins before nursing school. Identification of barriers and strategies for recruitment and retention of underrepresented minority nursing students and faculty is needed.
Video abstract available at:
https://journals.lww.com/advancesinneonatalcare/pages/video.aspx?v=62.
The United States organ transplantation system has recently reached a historic milestone of a cumulative 1 million transplants. Despite this considerable success in providing life-saving organ transplants to patients with end organ failure, there are ample opportunities for improvement, particularly with regard to achieving equity. Recognizing this, Congress directed the National Institutes of Health to fund the National Academies of Sciences, Engineering, and Medicine in conducting a study on deceased donor organ procurement, allocation, and distribution, recommending ways to improve equity and accountability. The National Academies of Sciences, Engineering, and Medicine study committee's report, Realizing the Promise of Equity in the Organ Transplantation System, reached multiple conclusions and agreed on 14 recommendations for action that can be grouped into 3 areas: (1) achieving equity, (2) improving system performance, and (3) increasing the utilization of available organs. Here, we review overarching areas for improvement, highlighting key recommendations, and suggest implementing actions.
Background:
Schools of nursing must produce nurses able to address the care needs of diverse populations. Within schools of nursing, faculty should intentionally construct syllabi to establish an environment of inclusivity where diversity is embraced.
Method:
Content analysis of 81 undergraduate and graduate course syllabi from four university campuses was performed to determine explicit evidence of content on diverse populations, inclusive andragogy, and policies related to diversity, equity, and inclusion (DEI).
Results:
Three quarters of terms indicative of diverse populations were found in course syllabi; all terms that provided evidence of inclusive andragogy and all DEI-related policies were identified at least once in course syllabi.
Conclusion:
Strengths and weaknesses were identified in communicating DEI content, policies, and inclusive andragogy to students. Faculty development on best practices related to inclusion of DEI in the classroom beginning with the syllabus is the first step to ensure a more inclusive nursing workforce. [J Nurs Educ. 2022;61(12):665-671.].
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.].
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.
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.
Background
The National Institutes of Health supports professional development of diverse researchers through diversity supplements. Limited awareness and understanding of the application process have hindered utilization of this funding mechanism.
Purpose
We describe perspectives and recommendations of mentee and mentor recipients of diversity supplements.
Methods
Our working group, comprised of faculty from an Historically Black College and University and an R1 research university, conducted stakeholder interviews with three mentees and four mentors from various institutions. We used content analysis to derive categories of experiences and recommendations.
Discussion
Interviewees reported on advantages of diversity supplements, ensuring institutional support, identifying a good mentee-mentor match, developing grantsmanship specific to diversity supplements, and increasing numbers of these applications.
Conclusion
We identify opportunities for stakeholders to increase awareness of diversity supplements. Our data support greater understanding of this mechanism, establishing strong mentoring relationships, and submitting robust applications. Findings can enhance diversity among the scientific community.
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.
Literature suggests the pediatric critical care (PCC) workforce includes limited providers from groups underrepresented in medicine (URiM; African American/Black, Hispanic/Latinx, American Indian/Alaska Native, Native Hawaiian/Pacific Islander). Additionally, women and providers URiM hold fewer leadership positions regardless of health-care discipline or specialty. Data on sexual and gender minority representation and persons with different physical abilities within the PCC workforce are incomplete or unknown. More data are needed to understand the true landscape of the PCC workforce across disciplines. Efforts to increase representation, promote mentorship/sponsorship, and cultivate inclusivity must be prioritized to foster diversity and inclusion in PCC.
Background:
People of African Nova Scotian (ANS) ancestry are a culturally distinct group who experience numerous socioeconomic inequities and health disparities, secondary to structural and social determinants of health. Understanding the experiences of ANS health practitioners is important in addressing anti-Black racism in health care. We sought to critically examine the leadership experiences of ANS nurses in health care practice.
Methods:
We used Black feminist theory to guide this qualitative study. We conducted 1-on-1 semistructured telephone interviews with ANS nurses and analyzed interview transcripts using Critical Discourse Analysis.
Results:
We interviewed 18 nurses of ANS ancestry. We conceptualized study findings in 3 overarching areas: People of ANS ancestry as a distinct people, institution of care, and leadership philosophy and practice. Each area, and its corresponding themes and subthemes, illustrated an emergent understanding of factors that influence leadership among ANS nurses, such as socialization, early exposure to care and diversity in health care. Participants perceived and practised leadership in a manner that transcended formal titles or designations.
Interpretation:
African Nova Scotian ancestry is implicated in the perception and practice of leadership among ANS nurses, who considered leadership to be a fundamental component of nursing practice that was grounded in community-oriented care. This study provides new insights that could inform recruitment, retention and representation of ANS people in nursing and other health professions.
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.
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.
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.
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.
It is widely accepted that diversifying the nation's health-care workforce is a necessary strategy to increase access to quality health care for all populations, reduce health disparities, and achieve health equity. In this article, we present a conceptual model that utilizes the social determinants of health framework to link nursing workforce diversity and care quality and access to two critical population health indicators-health disparities and health equity. Our proposed model suggests that a diverse nursing workforce can provide increased access to quality health care and health resources for all populations, and is a necessary precursor to reduce health disparities and achieve health equity. With this conceptual model as a foundation, we aim to stimulate the conceptual and analytical work-both within and outside the nursing field-that is necessary to answer these important but largely unanswered questions.
The objective of this paper was to identify barriers to successful program completion faced by underrepresented minority nursing students. This paper reveals that minority nursing student's face multiple barriers to success including lack of financial support, inadequate emotional and moral support, as well as insufficient academic advising, program mentoring, technical support, and professional socialization. An additional theme-a resolve to succeed in spite of the identified barriers-was identified. This body of literature focuses solely on successful minority students' experiences, revealing a significant gap in the research. The findings of this paper highlight the need to create and maintain nursing programs capable of aggressively supporting minority student needs. Recommendations for future research are included.
Health policy makers, providers, clinicians, and social scientists are among those who have identified racial and ethnic diversification of the health care workforce as one strategy for solving the seemingly intractable problem of health disparities in the U.S. population. But evidence supporting the impact of such diversification on narrowing health disparities is lacking, thus making it unclear if the push for workforce diversification is empirically or politically driven. Moreover, data are largely derived from the study of physicians, making it difficult to generalize findings to nursing and other health professions. This article reviews the evidence that supports the impact of a diverse workforce on patient outcomes and delivery services. Assuming a positive social value in the absence of the data, the authors review the approaches that have been successful in diversifying the nursing workforce. The authors conclude with recommendations for research and policies, including best practices, for enhancing recruitment and retention of a diverse nursing workforce.
Background: Recruiting, retaining, and graduating more minorities to diversify the nursing workforce is a national priority, which can lead to a decrease in healthcare disparities. The purpose of this review of literature is to highlight models developed and implemented in nursing education that focus on recruiting, retaining, and graduating minorities, and the degree of success obtained. Methodology: Electronic database searches of Cumulative Index of Nursing and Allied Health Literature (CINAHL), EBSCOhost, ProQuest, and ScienceDirect were conducted using specific keywords: minority, recruitment, retention, graduation, nursing students, models. The search yielded seven articles published in peer-reviewed journals that described each schools model, strategies, and the implementation process used to recruit, retain, and graduate minority nursing students. A tool was developed by the researcher for this review then used to analyze articles for inclusion. Results: Findings revealed that successful models included various combinations of academic support, mentoring, student financial support, and community partnerships that were effective in recruiting, retaining, and graduating minority students in nursing education. Conclusions/: The articles reviewed highlighted that when combinations of multiple strategies that includes; academic support, mentoring, student financial support, and community partnerships were used in minority nursing student populations there was increased minority retention. All articles included in this review reported minority nursing students who were given support prior to entrance and during nursing school, recruitment, retention and graduation increased.
Recent census data highlight the ongoing shift toward greater levels of racial and ethnic diversity in the US population. In 2000, non-Hispanic whites accounted for 69% of the population. By 2010, this decreased to 64%. The Census Bureau predicts that minorities will become the majority over the upcoming decades. In nursing and other healthcare professions, however, a different picture emerges, with minorities consistently underrepresented. The authors describe the development, outcomes, and benefits of the clinical leadership collaborative for diversity in nursing. Strategies for overcoming barriers to increasing diversity in the nursing profession are addressed.
This article reports on findings from a Nursing Diversity Workforce grant, BEST (Becoming Excellent Students in Transition to Nursing), designed to assist students from minority and educationally disadvantaged backgrounds to become culturally competent registered nurses. A program of retention strategies that included peer and faculty tutoring, counseling, and financial support helped to remove barriers to success in nursing. All but 3 of the enrolled students either have graduated or are on track to doing so. Most graduates are practicing in the city where they are helping to reduce health disparities through their contributions to improved health care for vulnerable populations.
The literature on increasing the diversity of individuals who enter and practice the nursing profession comes with sound argument, yet we have seen only modest gains in diversification over the past 10 years. This article addresses how to develop a sustainable program to increase the recruitment and retention of underrepresented students. The diversity pyramid is suggested as a conceptual planning model for increasing diversity that is matched to an institution and its resources. The foundation of the pyramid is an organizational commitment to attracting and retaining diverse students. The middle level addresses financial support for underrepresented students. From the top of the pyramid, one chooses appropriate media and relational tactics necessary to attract the underrepresented students a program seeks. All three elements of the pyramid-organizational commitment to diversity, significant financial support, and a targeted use of resources-play important and sequential roles in building a sustainable diversity initiative.
Underrepresentation of minority faculty in schools of nursing is well reported. Recently, there have been multiple initiatives from both public and private sectors to alleviate the shortage of minority faculty. This article describes how the University of Tennessee Health Science Center (UTHSC) College of Nursing took advantage of one such initiative: the Health Resources and Services Administration (HRSA) Minority Faculty Fellowship Program (MFFP) grant. This program grant provides stipends to enable health professions educational programs to increase the number of faculty who are racial and ethnic minorities underrepresented in the health professions. It enabled the college to recruit a Hispanic nurse and to assist her in preparing for a successful academic career. HRSA provided a stipend in an amount not exceeding 50% of regular faculty salary of the institution for 3 years, to be matched by the institution. Expert faculty mentored the nurse's development in the areas of pedagogy, administration and leadership, design and conduct of research, grant writing and scientific writing for publication in peer-reviewed journals, and cultural competence. Dr. Susan Jacob was the project director of the MFFP grant received by the College of Nursing at UTHSC, and Zoila Sanchez, a Cuban American, was the minority faculty fellow supported by an HRSA MFFP grant. Dr. Sanchez was the first minority faculty fellow selected from the nursing profession. Past fellows represented the other health professions such as medicine and dentistry.
In order to decrease health disparities, nursing needs to promote opportunities for minority nursing students to incorporate the conduct, as well as the utilization, of research into their professional careers. This article describes a model program to facilitate minority research career development, the Research Enrichment and Apprenticeship Program (REAP). REAP was developed and implemented by a federally funded partnership between 2 historically Black universities and a research-intensive university. Fifty-five (N = 55) baccalaureate and master's nursing students and 35 faculty members from the 3 schools participated in an intensive research mentorship program guided by learner-centered pedagogical approaches that culminated in the public presentation of students' research projects at a scientific poster session. Student, faculty, and institutional achievements, as well as challenges, were identified and addressed as the partnership evolved. Recognizing and building upon the strengths of both minority-serving and research-intensive institutions allowed the development of an exemplar program. While process measures provided many indicators of success, long-term evaluation of research career-related outcomes are needed.
The percentage of minority heath professionals is a serious problem in the United States. Of special concern is the small number of minority nurses in leadership positions. Affirmative action is proposed along with recommendations for various top-level national nursing organizations and governmental agencies.
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.
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.
The excessive burden of disease experienced by African-Americans has long been described by authorities in the public, private, and professional sector as a national health concern. Several reports have been published in the peer-reviewed literature that describe the outcomes of nurse-directed studies aimed at addressing the factors associated with the disparities experienced by African-Americans and these reports were also aimed toward the design of interventions to reduce and/or eliminate them. However, little is known about the scope, quality, and impact of these efforts relative to the promotion of health and the prevention of disease among African-American population groups. This report presents the results of a review, analysis, and critique of reports of outcomes of nursing research aimed toward reducing health-related disparities among African-Americans. These reports were described in a selected group of African-American nursing organizations and journals dedicated to providing a forum for the discussion of issues focused on cultural diversity, transcultural nursing, and multicultural health care issues. Included among the journals were the Journal of the National Black Nurses Association, the Journal of the Association of Black Nursing Faculty, the Journal of Chi Eta Phi Sorority, the Journal of Cultural Diversity, the Journal of Transcultural Nursing, and the Journal of Multicultural Nursing and Health. Results of the review will be reported in three parts. The first part was reported in an earlier edition (Journal of National Black Nurses Association, Volume 15, No. 1), the second part was reported in Volume 16, No 1, of the Journal of National Black Nurses Association, and the third part is reported here. The results of this critique revealed that this body of nursing research provides the profession with a broad base of knowledge and insights. This knowledge is relative to the individual and familial impact of cardiovascular disease, cancer, diabetes, HIV/AIDS, mental health and mental illness, and sickle cell disease within the African-American community. Knowledge and insights relative to the concerns and needs of childbearing, parenting, the elderly caregivers and care giving in African-American population groups is essential if health care disparities are to be truly eliminated. This review, analysis, and critique also revealed several gaps and limitations within this body of nursing research.
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.
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