The Importance of Diversity, Equity, and Inclusion in Nursing

The Importance of Diversity, Equity, and Inclusion in Nursing

Diversity, equity, and inclusion (DEI) are hot topics in the healthcare world, but including a DEI module in our yearly education isn’t enough to address these issues. Policy is a valuable tool, but actual change needs to come from a more personal level, from each and every staff member.

Before we can have a meaningful conversation about DEI that might lead us toward significant change, we need to understand the meaning of diversity, equity, and inclusion and why it is important in healthcare.

First, the issues often relate to our biases, especially those so deeply ingrained in our life circumstances that we aren’t aware of them. We can’t advocate for what we don’t understand, and if we don’t advocate for change, we will stay in our “safe” silos, which only strengthens the idea that we are separate and different.

Understanding that we are separate and different and what that means is the first step in making diversity, equity, and inclusion a part of our workspace and nurse recruitment.

Diversity

Diversity is simply including people with different backgrounds. For example, when healthcare systems conduct nurse staffing while considering different cultural, gender, religious, sexual orientation, and socioeconomic backgrounds, the staff benefits from exposure to differences among coworkers, and patients feel more comfortable knowing they aren’t alone.

Our healthcare system has been lacking in diversity from the beginning, and although we’ve seen a lot of progress since the days when only white males could practice medicine, we are far from diverse.

In one study, over 56% of physicians identified as White and 64% as male, according to the Association of American Medical Colleges (AAMC). According to Minority Nurse, about 75% of RNs identify as White, and 91% are female. So if most doctors and nurses are white, most doctors are male, and most nurses are female, who are we really serving?

When we don’t have a common background, it’s easy to make the mistake of seeing the patient through our own lens instead of their reality. Our lenses place them where we want them to be—fully able and capable of taking the steps we want them to take for their health. The outcomes we desire assume the tools, processes, and understanding are within their reach and that they have the same goals we do.

Textbook knowledge can never make up for the lack of diversity in our own lives. And our lack of understanding of our patients’ reality can lead to misunderstanding or errors in care, creating inequity. Hiring a diverse workforce promotes understanding and creates a more comfortable environment for patients and coworkers alike.

Equity

Equity is a concept that often gets confused with equality. In healthcare, equality means giving everybody the same resource or opportunity to achieve their health goals. Equity is recognizing that each person has different circumstances and honoring that by allocating opportunities and resources to allow them to reach an equal outcome.

Simply giving someone an opportunity isn’t enough if they don’t have the means to use it. Equity can only be achieved when nobody is allowed to be disadvantaged due to age, race, ethnicity, nationality, gender identity, sexual orientation, geographical background, or socioeconomic status.

Access to life-saving medication is an example of inequity we see every day. A medication that costs hundreds of dollars every month may not be out of reach for someone with superb insurance coverage and a large bank account. For someone whose job doesn’t offer prescription coverage or who doesn’t make a living wage, that life-saving medication is technically available but far out of their reach. Far too many patients fail to fill the prescriptions they need for this reason.

Healthcare policy can promote equity, but we can also change how we treat and educate patients. In our medication example, we could address a patient’s ability to obtain a prescription before they leave the office or hospital. No patient should walk out the door with a prescription they can’t fill.

Inclusion

Inclusion is about deliberately creating a respectful and safe environment for all staff and patients. Inclusion means giving patients and staff a voice in giving and receiving care and encouraging diversity. Healthcare isn’t the place for a one-size-fits-all approach. We must all strive to embrace diversity and promote equity.

Nurses Are Uniquely Positioned to Champion DEI

Nurses may have little say in enacting policy within their healthcare systems but are very likely the first and last staff member a patient sees and the role they interact with most frequently. That close relationship with our patients makes nurses the most important role to champion diversity, equity, and inclusion with our patients, in nursing education, and within our own workspaces.

One of the most essential directives we learned in nursing school may have been to meet patients where they’re at. Let’s add and coworkers to that and, together, we can create a more effective healthcare system that serves all people.

 

Nurse Researcher: Pandemic Had Heavy Impact on Black Girls’ Health

Nurse Researcher: Pandemic Had Heavy Impact on Black Girls’ Health

The physical, psychological and sexual development of Black adolescent girls has been “heavily impacted” by the COVID-19 pandemic, says Natasha Crooks, PhD, RN, an assistant professor at the University of Illinois Chicago (UIC) College of Nursing.

Natasha Crooks, PhD, RN.Crooks has published a paper, titled “The Impact of COVID-19 Among Black Girls: A Social-Ecological Perspective,” in the Journal of Pediatric Psychology, reporting on the findings of a qualitative study that featured interviews with 25 Black girls—ages 9 to 18—from December 2020 to April 2021. Most participants reported significant psychological and physical consequences, including depression and anxiety, disrupted eating, distorted body image, and changes in self-esteem.

“Black girls are a very vulnerable and unprotected population, especially within the context of COVID,” Crooks says. “I thought it was a really critical question to be asking youth: How has this impacted their perceptions of self?”

Black girls are particularly vulnerable because they enter puberty and develop secondary sex characteristics earlier than their non-Black peers, according to the paper, causing them to suffer from “adultification” and “sexualization by society.” This can lead to elevated sexual and mental health risks.

Crooks found that only two of the girls in the study received any formal sexual education during the pandemic, as schools opted to delay teaching sex education during online learning due to the sensitive nature of the topic.

“Missing such a critical component of education was alarming to me,” she says. “This is a critical period in their life. Just because the world stops, doesn’t mean their bodies stop growing and evolving.”

Social media also played an outsized role in the girls’ lives as they found themselves isolated from peers during quarantine. Some girls struggled with body image issues and eating disorders, Crooks says.

“They were sitting in their houses watching TV, or they were on social media sites like Instagram or Tik Tok, so they were constantly exposed to overly-sexualized, unrealistic expectations for what their bodies are supposed to look like,” Crooks says.

Conversely, a majority of the participants said the isolation and reduction in peer interactions allowed them to engage in emotional healing and self-discovery, independent from peer pressure.

The pandemic also intersected with the Black Lives Matters movement. As the participants increasingly turned to media in lieu of social interactions, they saw mistreatment of Black people by police, including the murders of Breonna Taylor and George Floyd, nationally broadcasted. These messages led to mixed feelings among the participants.

“A lot of what the girls talked about was feeling empowered to be Black and having a sense of pride within their identities,” Crooks says. “On the other hand, there was fear that came with color of their skin – fear of being harmed themselves, or their fathers, brothers or other family members being hurt. There was this constant fear and threat to Black families.”

Crooks says her research shows the need for more school-based programming to bridge the gap in sexual health education in schools, as well as the need for family interventions to instill protective strategies in Black girls to help them be prepared to handle threatening situations.

Teaching Healthcare Staff to Lose Their Weight Bias

Teaching Healthcare Staff to Lose Their Weight Bias

After showering, applying deodorant twice, and cranking up her car’s air conditioning against the summer heat (“I will not be the sweaty, smelly fat girl,” she thinks), Eva arrives at the doctor’s office ready to get to the bottom of what ails her: a newly swollen, tender abdomen, growing breathlessness, and debilitating fatigue.

Given her previous interactions with healthcare providers, Eva practices what she’ll say when she reaches the clinic: “I know I am fat. But this is not because I am fat.”

But clinic staff presume she has diabetes and hypertension. They raise their eyebrows when she steps on the scale. And the waiting room chairs are as tight as the nurse practitioner’s smile and her degrading use of the word we.

As in, “Have we maybe been eating our feelings? Your BMI is 39.6. We don’t get to that size on accident.”

“I speak about weight bias as an actual factor that furthers these patients’ disease processes. Healthcare providers need to recognize that their weight bias actually hurts their patients.”

Habibah Williams, NP.“We often talk about contributors to someone’s obesity—genetic factors, emotional factors, and personal factors,” explained University of Virginia DNP student Habibah Williams, NP, MSN, AGACNP-BC, the lead clinician at Virginia State University’s Student Health and a nurse practitioner who often treats patients with weight issues, “but I speak about weight bias as an actual factor that furthers these patients’ disease processes. Healthcare providers need to recognize that their weight bias actually hurts their patients.”

For her doctoral scholarly project, Williams created a seven-week intervention to educate healthcare staff—”from the physicians to nurses to receptionists”—to affect awareness and change. She’s deployed and is currently testing “We Matter” among 20 clinic staff to determine its impact. In addition to the intervention’s educational and self-assessment components, Williams, with University of Central Florida nurse and PhD student Aislinn Woody, also created a unique fictional narrative—Eva’s story, told in the first person—to build consciousness of the experiences obese and overweight patients face.

“Bias is slick and sneaky.”

After the seven-week intervention is administered, Williams will assess participants’ knowledge and weight biases. Her ultimate hope is to scale the intervention up so that, like other routinely certified healthcare competencies, such awareness is repeatedly built among those whose job it is to provide compassionate, non-discriminatory health care without regard to a patient’s weight status.

In mid-November, Williams and Woody earned the American Association of Colleges of Nursing’s 2021 “PhD-DNP Collaboration Excellence Award” for their work. The two will present the intervention—“Evaluation of an Educational Intervention to Effect Obesity Bias”—and their findings at AACN Doctoral Education Conference in Naples, Fla., in January 2022.

Williams is the first UVA student to earn the competitive national AACN collaboration award, which is bestowed annually and comes with a cash prize.

“DNPs are charged with identifying the best evidence, folding it into practice change, and improving outcomes,” said Beth Quatrara, assistant professor and DNP program director, “and Habibah is following the DNP path. We are incredibly proud of her work to trial strategies to reduce obesity bias with the goal of removing roadblocks so that all obese patients can receive compassionate care that enhances their health.”

Williams hopes to build healthcare staffers’ awareness and ownership of weight bias—and to affirm that living with obesity doesn’t reflect a personal moral failing. She also firmly believes biases can be intentionally unlearned.

“Bias is slick and sneaky,” she said. “Many of us say we don’t have weight bias, but in many cases, we’re not aware that it’s going on. And non-overweight people don’t understand just how much the person with obesity internalizes the behaviors, which has a snowball effect on their weight journey.”

UVA school of nursing.

 

Alabama Trailblazer Constance Smith Hendricks Extends Helping Hand to the Next Generation of Nurses

Alabama Trailblazer Constance Smith Hendricks Extends Helping Hand to the Next Generation of Nurses

The famous biblical verse, “To whom much is given, much will be required” (Luke 12:48) is more than a quote for Constance Smith Hendricks, PhD, RN, FAAN. For the influential University of Alabama at Birmingham School of Nursing alumna (BSN 1974, MSN 1981), it is a mantra to live by.

With more than 40 years of trailblazing experience educating, mentoring and inspiring students who want to fulfill their dreams and become leaders in nursing and health care, Hendricks has blazed a trail on another front as the first African American to establish an endowed scholarship in the UAB School of Nursing.

“I had the privilege of doors being open for me growing up,” Hendricks said. “I want to give students a chance to reach their full potential and have access to higher education, much like I have.”

Constance Smith Hendricks, PhD, RN, FAAN with her first two scholarship recipients.In 2016, Hendricks accomplished her goal and established the Dr. Constance Smith Hendricks Endowed Scholarship in Nursing in the hopes that it inspires students to give back to their communities and strengthens the bond between the community and minority-run community hospitals.

Hendricks has been a “first” and “only” at almost every step of her career. After earning her BSN and MSN from the UAB School of Nursing, she was hired by Auburn University’s School of Nursing as an instructor in community health nursing, where she was the only African American faculty member. She then followed that up with a milestone only she can say she’s accomplished.

“Going to Boston College in 1989 and being the first African American to graduate from their prestigious PhD program in 1992 was a tremendous honor and a life-changing event for me,” Hendricks said. “I hope my continued efforts have inspired the next generation of students and show them that with hard work and dedication, anything is possible.”

Hendricks has devoted her career to developing quality nursing programs at universities across the southeast and even in her hometown of Selma, Alabama. She was dean of the School of Nursing and Allied Health at Tuskegee University, a professor (now emerita) and the Charles W. Barkley Endowed Professor at Auburn University, dean of the Hampton University School of Nursing, developed the DNP Program at Kentucky State University, implemented the first Doctor of Philosophy nursing program in the state of Louisiana at Southern University and A&M College and founding dean of Nursing and Allied Health at Concordia College Alabama in Selma.

Recently Hendricks, along with her friends, have been working on a book, “Alabama’s Notable Nurses,” that recognizes notable nurses in the state of Alabama.

“We are shining a light on nurses who have been in the field for at least 35 years or more and may not necessarily get the recognition they deserve because they are in a smaller county in Alabama,” said Hendricks.

Polly Sheppard Delivers Some Home Truths About Hate in Video Address

Polly Sheppard Delivers Some Home Truths About Hate in Video Address

Polly Sheppard has been on a mission since surviving the 2015 Emmanuel AME church massacre in South Carolina. If the killer spared the retired prison nurse in the hope that she would spread his message of gun-toting white supremacy, though, he must be grievously disappointed.In fact, the indefatigable septuagenarian has been delivering her own messages – and like many nurses, she is a very good communicator.

Former nurse Polly Sheppard addresses the S Carolina senate.In the years following the notorious shooting, Sheppard crisscrossed the country to speak against gun violence. Then, once she accumulated enough speaker fees she poured her earnings into another passion and established her own Scholarship Foundation to support nursing students in Charleston. Now, as the seventh anniversary of the chilling church murders approaches, Sheppard is focusing on another initiative to reduce future bloodshed: this week she sent an eloquent appeal to South Carolina’s senate urging them to finally pass a hate crimes law.

“Being there, laying under the table with this gun to my head couldn’t be anything but hate.”

Like most hate crime laws, the proposed SC bill would add up to five years to prison sentences for any homicide or assault motivated by hatred of the victim’s race, sexual orientation, gender, religion, or disability. Aside from Wyoming, South Carolina is the only state that has failed to pass some form of law against hate crimes, but the current bill has faced a steep uphill battle. At present eight SC senators are determined to see it expire… which is a painful irony as Emmanuel pastor Clementa Pinckney, a victim of the massacre, had been a senator himself.  If the bill ends up on the table as a code blue, though, it won’t be due to inactivity on Sheppard’s part.

In a powerful two-minute video viewed by the senate on April 27, Sheppard addressed the recalcitrant senators. She mused on other ironies, asking some acute questions: “I really can’t understand them standing against a [hate] law, but they can pass a law to kill somebody a firing squad. They can take that to the floor, but they can’t bring the hate crime law to the floor… What’s the problem?” Sheppard also wondered “why South Carolina has to be the last, almost the last to get a hate crime law?  Because we didn’t have it. We had to go to the federal government for (the AME killer) to be charged with a hate crime. It makes no sense.”

Sheppard reminded her audience: “Eight members of the South Carolina Senate are giving a safe haven to hate. Every time you look at senator Pinckney’s photograph, you should be reminded that hate killed him.”

Community Health Pioneer Gloria McNeal Tapped for AACN Award

Community Health Pioneer Gloria McNeal Tapped for AACN Award

Having spent her career “truly on the front lines making a difference,” Gloria McNeal, PhD, MSN, ACNS-BC, FAAN, will receive an AACN Pioneering Spirit Award at the American Association of Critical-Care Nurses (AACN) 2022 National Teaching Institute & Critical Care Exposition in Houston, May 16-18.

McNeal’s award recognizes her efforts to bring healthcare directly to those most in need and introduce telehealth and remote monitoring to critical care. The AACN Pioneering Spirit Award, one of AACN’s Visionary Leadership awards, recognizes significant contributions that influence progressive and critical care nursing and relate to the association’s mission, vision and values.

Gloria McNeal, PhD, MSN, ACNS-BC, FAANThe health equity trailblazer is associate vice president for community affairs in health at National University headquartered in San Diego, the flagship institution of the National University System, which comprises three nonprofit universities serving more than 45,000 students nationwide, both on-site and online. In this role, she leads the university’s comprehensive community and global outreach strategies efforts related to healthcare services and education. She previously served as dean for the university’s School of Health and Human Services for six years.

“Dr. McNeal has a passion for healthcare and serving those who are underserved,” said AACN President Beth Wathen. “Her community service efforts and nurse-led clinic model sponsored by the university bring healthcare directly to those most in need. She is truly on the front lines making a difference.”

At National University, McNeal has worked with community-based organizations to establish nurse-managed clinics at churches, community centers and shelters in South Los Angeles. The initiative was expanded to offer telehealth services for patient-provider interactions that do not require in-person visits.

Among her academic appointments, she has held the administrative positions of director, assistant dean, associate dean, dean and founding dean at various research-intensive public and private universities. As dean, McNeal has led several academic nursing programs on their journey to acquire national accreditation for both graduate and undergraduate curricula of study.

Her interprofessional, nurse-led and other projects, totaling more than $12 million in extramural funding, have been continuously funded for over 20 years. She currently serves as project director for the Health Resources and Services Administration Nurse Education, Practice, Quality and Retention (NEPQR) Simulation Education Training (SET) Program, a highly competitive grant-funded project initially awarded to a cohort of only five nursing programs nationwide. With this latest project, she is spearheading the use of virtual reality and immersive technologies to better prepare nursing students to practice in real-world settings through simulation.

Developing the protocols of care, she helped lead the transition of critical care nursing practice beyond the traditional walls of the intensive care unit, and was among the first to publish work on the remote monitoring and electronic transmission of ambulatory electrocardiographic data, revolutionizing the manner by which critical care nurses could remotely monitor their patients.

As a result of her work, she was invited to author “AACN Guide to Acute Care Procedures in the Home,” which describes over 100 complex nursing home-care procedures written in collaboration with 20 nursing expert contributors.

Her nursing career began as a critical care nurse in the U.S. Navy Nurse Corps at Philadelphia Naval Hospital, where she received two medals of commendation and three promotions leading to the rank of Lieutenant.

She obtained her bachelor’s degree from Villanova University Fitzpatrick College of Nursing, where she currently sits on the Board of Consultors, and her master’s degree at University of Pennsylvania (Penn) School of Nursing, later receiving the Outstanding Alumna Award. She returned to Penn for doctoral studies in the Graduate School of Education. For her PhD, which was awarded with meritorious distinction, she investigated the scholarly productivity of minority nurse academicians.

The American Academy of Nursing awarded her the coveted Media Award in 1994, inducted her into the Academy in 2006, and most recently named her a 2020 Edge Runner Award recipient.

She served as an invited co-contributor for the IOM (now National Academy of Medicine [NAM]) text on “The Future of Nursing: Leading Change Advancing Health” and is a featured speaker for the current NAM podcast on “The Future of Nursing 2020-2030,” Episode 2 – Health Equity.

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