What is diversity? According to the Oxford English Dictionary, it is “the condition of being diverse, different, or varied; difference, unlikeness.” This simplistic definition of diversity does not assign any judgment or negative connotation to any of the words used to define it. However, the word “diversity” evokes multidimensional judgements, reactions, ideas, emotions, and actions, some of which could have adverse social and health consequences for generations of individuals in the United States.

Nursing, as the largest health care workforce in the United States with over 3 million nurses, is well positioned to champion diversity efforts. In 2010, the Institute of Medicine (IOM) published a landmark report, The Future of Nursing: Leading Change, Advancing Health. In this report, the IOM indicated that the nursing profession was not diverse to care for diverse populations across the lifespan. The IOM recommended that a diversity agenda be promoted, especially with increasing the diversity of nursing students. In partnership with AARP, the Robert Wood Johnson Foundation (RWJF) launched a campaign to implement the IOM recommendations from its 2010 report. Subsequently, commissioned by the RWJF, the IOM evaluated the state of affairs regarding these recommendations. In 2015, another report, Assessing Progress on the Institute of Medicine Report The Future of Nursing, was published. In this report, the IOM specified that nursing has improved on the recommendation to diverse the nursing workforce. Nonetheless, there remain gaps that must be addressed to meet the diversity goal for the nursing profession. Consequently, the new recommendation for nursing is that diversity must continue to be a priority that is paralleled with a series of actions to promote it. Before nursing can accomplish this noble goal, there should be a well-vetted strategic plan on diversity and inclusion in all nursing programs, schools, and colleges in the United States. Students, faculty, and staff must be an integral part of the dialogue to promote diversity within the nursing profession.

At the University of Florida College of Nursing (CON), we held our inaugural “Diversity and Inclusive Excellence” workshop in December 2015. This two-day workshop was designed for staff and faculty. As a member of the Diversity taskforce, I collaborated with the other taskforce members to invite G. Rumay Alexander, EdD, RN, FAAN, to lead the CON on this discussion. Alexander is director of the Office of Inclusive Excellence in the School of Nursing at the University of North Carolina at Chapel Hill, a nationally known expert with vast knowledge and expertise on diversity and inclusive excellence, and president-elect of the National League for Nursing.

During the early morning hours of December 3, 2015, my individual lesson on the topic began with Alexander as I had breakfast with her. My antenna on the topic sharpened following our conversation. After introducing her to my fellow Diversity Taskforce members, I hurried to pack my car and return to the CON to proceed with the plans of the day. I noticed the dean, Anna McDaniel, PhD, RN, FAAN, from a distance. I hurried up to keep her pace. “Good morning, Dean,” I greeted in my usual manner. McDaniel responded with a broad smile and a twinkle in her eyes that I perfectly understood. I surmised that McDaniel had finally accepted the fact that I love referring to her as the “Dean.” We conversed as we headed to the CON and into the elevator. I noticed the necklace McDaniel wore. The costume necklace had different shapes, colors, sizes, lengths, and mosaic designs. They were

  •  audaciously woven, yet unintimidating;
  • different, yet complementary;
  • individually, unassuming — yet, together, a paragon of beauty, inviting;
  • all held by a perfectly thin strand, yet unbreakable.

“That’s a beautiful necklace,” I uttered. “It belonged to my mother, who died twelve years ago,” McDaniel shared. “Each bead came from a different country. I have a brochure that provides a description of each bead, including the country of origin and its material composition.” Then, McDaniel voiced the word that gladdened my heart. “I wore this necklace today because it’s appropriate to celebrate diversity, the topic of the CON workshop.”

McDaniel had appointed the Diversity Taskforce and provided us with her full support. But, the fact that she actually thought of and adorned herself with a necklace that I now coined as a “diversity necklace” to celebrate the CON inaugural diversity workshop was admirable to me.

Someone not sensitive to the current diversity concerns around the United States, and the racial unrest related to such matters, may not appreciate my exhilaration upon hearing the history of the necklace. At issue is that, in several communities around the United States, numerous individuals are thoughtless about the devastating effects of antidiversity rhetorics and actions on the lives of its victims. Many may not realize that any action, whether good or evil, begins in the mind. Conversely, any work to combat uncelebrated diversity and exclusivity must begin in the mind. When people think about and proactively perform small acts, such as expressing recognition of diversity through a piece of jewelry or other special actions to celebrate diversity, it goes a long way. It could change the thought process from exclusion to inclusion. When people are attentive to their behaviors and understand the detrimental effects their actions could have on other human beings, things might change for the better. I believe that, as a nation, we must check the poisonous thoughts that percolate in our minds and subsequently manifest in forms of antidiversity rhetorics and behaviors, unacceptance, and racism. Confronting monstrous suggestions in the mind is the first step that many of us need to take to begin to challenge the subtle and insidious systemic diversity-aversion and exclusion in the United States.

As I thought about this issue of diversity and the role that nursing can play to eliminate it, I reminisced about how the imperfections of people categorized within the social construction of race stimulate antidiversity and anti-inclusive sentiments and movements. I wondered how nursing can care for these individuals, many of whom are marred with scars of history. My poem, “The Color of Justice,” captures my perceptions of the undeniable genesis of these historical blemishes that shockingly remain, overtly or covertly, as status quo in various parts of this country.

The Color of Justice

What color is justice?
Absorbing pain, insults, and lashes
Ancestors packed shoulder-to-shoulder, hip-to-hip,
chained like fire woods
Bones of the feeble lie un-mourned in ocean deep
across the Atlantic
Their sweat built the wealth in the new world, but
crumps have become their portions
This name sound like them, we have filled the position,
they need to go away
Low-hanging pants, cove-hopping birds,
gun-brandishing bunch
We cannot deal with the anger, we are better off
with the accent, intra-color battle ignited
Round them up, throw away the key, population control
Babes on the breast, mama and grandmamma, sitting
on the front porch pondering about the next check
Hair tightly woven, fried, or twisted, nails freshly manicured, next bun in the oven
The fortunate may triumph at the end, treacherous roads treaded, stress claims the wounded body after all
That they survive is still a mystery that ought to win
them a trophy
Who are they?
What color is justice?
Reflecting heat, demanding respect, crushing heads
Rolled into the new world in Mayflower boasting of
prostitutes, thieves, and prodigal sons
Raised arms against raised tea taxes, won freedom
but deny it to another
Melanin deficient hue suggest superiority
Blood by blood, noose on hand, destroyed a generation,
eye un-batting
Deeds done in the name of God, He must be weeping
Damages proudly scattered in museums, we pay to
relive the tragedy
Privileges left and right on the backs of the poor
Man in bow tie, lady in heels, rear the children, your lavatory in the rear
Own your history, mend your ways, teach your babes right
Who are they?
What color is justice?
Broad face, warm hue, and welcoming gesture
Land is supreme and cares for the offspring
Infected with strange diseases, killed with gun powder, survivors kept in special places devoid of opportunities
Culture deconstructed, the sacred used as mascots
Surviving by balancing mind, body, and spirit, harmony
in the land is their mantra
Not many left but their spirit is strong
The land beckons for their touch, to purge its roots of deadened souls
What does the Unites States’ constitution say about them?
Who are they?
What color is justice?
Messiah has come, awaiting messiah, there is no messiah
We profess peace, spiritual path is the way
Whose belief is superior?
When six feet under, belief quenches, but tainted
souls still suffer
Where are their senses?
Who are they?
What color is justice?
Light? Energy? God?
Penetrates Black, White, Red hue, religious, non-religious
Building block of things created
Revitalizes without questioning, unites all things created
Shines for Black, White, and Red hue, religious and
non-religious
Knows no foolishness but shines for fools
Knows no discrimination but supports the life of discriminators
Invites reconciliation until judgement day
Come unto me Black, White, and Red hue, religious,
non-religious
My light is your strength, unity, and peace

One may wonder how a nurse who is an advocate for a diverse, inclusive, and just world could pen “The Color of Justice.” This poem reflects my dual perceptions as a black woman and a nurse, of how the historical racial unrest that has plagued the United States for centuries has been subtly perpetuated even today. But, they ought not have continued, had the United States paid real attention and reconciled both the apparent and undercurrent narratives of this poem after the abolition of Jim Crow laws. As a black woman, I think that the first relevant question ought to be: How do individuals from diverse backgrounds interpret their historical or lived experiences in the United States? I encourage each one of us to answer this question individually or as a family, church, academic institution, or financial organization. I assert that there must be a recognition and acceptance of the different dimensions of diversity of thoughts, ideas, and experiences. This recognition must be matched with “courageous dialogue” on diversity and inclusion. In addition, there have to be concrete and measurable action plans for allocating resources to implement iterative strategies to address identified diversity concerns. This exercise could be so powerful that diversity and inclusion become strengths and not detriments to our collective humanity.

As a nurse, I think the second pertinent question must be: What role can nursing play to mitigate the adverse generational effects of antidiversity and anti-inclusivity experiences on marginalized and excluded individuals? I contend that, in order for nursing to be professionally and culturally relevant in the future and to continue to have the public trust as a caring discipline, we must identify ways to champion the diversity and inclusive excellence agenda. There should be constant and mandated training on diversity for university staff and faculty, with measurable outcomes. Nursing as a profession should develop a curriculum with a diversity and inclusion plan threaded throughout it. One approach to operationalize this suggestion is to equip nursing students with skills necessary to be culturally competent, diversity-savvy, and inclusive-perceptive in order to encourage these values in their work settings. Patients and clients at the receiving end of compassionate, culturally competent care infused with the spirit of diversity and inclusiveness should remember the feelings associated with that care, and hopefully pay it forward. Slowly, the culture of superiority and nontolerance directed toward individuals from diverse backgrounds could dissipate and a new world facilitated by nursing and inhabited by truly compassionate and empathetic humans would emerge.

Nursing students are the future of the nursing profession. Therefore, nursing must constantly remind students that antidiversity and anti-inclusion rhetorics and behaviors, historically and contemporary, breed racism in the United States. They should also learn to celebrate how much improvement we have made as a profession. But, recognize that diversity work is lifelong. The juxtaposition of the history of racism in the United States with the improvements made toward eliminating it is useful for at least two reasons: The contrast provides the space for constructive discourses and opportunities to develop positive avenues for endorsing diversity, and it allows for future and ongoing actions to completely obliterate racism heralded by antidiversity and anti-inclusive beliefs in the United States. Consequently, bead by bead—though diverse in shapes, colors, sizes, lengths, mosaic designs, and historical origins—we can hang unbreakably strong on the perfect strand of humanity, which unites us as “one Nation under God.”

Miriam O. Ezenwa, PhD, RN

Miriam O. Ezenwa, PhD, RN, is an associate professor in the Department of Biobehavioral Nursing Science at the University of Florida, College of Nursing.
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