Last December, the FDA reported on both the Pfizer-BioNTech and Moderna Covid-19 vaccine and the respective race and ethnicity of their research participants in the Phases 2 and 3 research trials. The Pfizer trial included ages 16 or older and the Moderna trial included those 18 and older. Of 285 million in the United States population, over 40 thousand participated in the Pfizer trials and over 27 thousand in the Moderna trial. When looking at the combined totals of subjects compared to the general population, whites were found to be over represented. Whereas 73.6% of the U.S. population are white, 79.4% to 81.9% of the subjects reported their race as white. American Indian/Alaska Native and Native Hawaiian or Other Pacific Islanders had the exact percentage of research participants to those of the U.S. population; 0.8% and 0.2%, respectively. The second largest contrast in proportion of participants to the U.S. population was seen in comparing those of Asian race. Only 9.7-9.8% of research subjects reported themselves as Asian, whereas the total U.S. population percentage is 5.9%. The biggest discrepancy can be seen in research participants who reported their race as Black. Only 9.7-9.8% of research subjects were Black, whereas Blacks make up 12.3% the current total U.S. population. Regarding ethnicity, 17.6% of the U.S. population reports themselves as being Hispanic and 20-26% of participants identified themselves of Hispanic ethnicity. However, 82.4% of Americans report themselves as non-Hispanic and 73.2% to 79.1% of research subjects identified themselves as that ethnicity.
Despite these Covid-19 vaccine trials demonstrating greater diversity than previous trials of other pharmaceuticals, these statistics still represent a disparity in the representation of people of color as research participants in a vaccine designed to boost the immunity of a virus that is disproportionately affecting people of color in the United States.
The good news is that despite this disparity in the diversity of representation in the clinical trials, the findings did show that the safety and efficiency of the Pfizer-BioNTech and Moderna vaccines were similar across groups despite race. The question many pose in reaction to such statistics is why minorities are underrepresented in clinical trials. The main four reasons include: barriers to access, lack of information, and historical and continuous racism and discrimination. Barriers to access come in the form of few clinical trials being offered through under-resourced hospital systems that minorities use for health care. Also, minorities are less likely to have eligibility to participate in such trials due to having co-morbid conditions or not having health insurance. These attributes can exclude them from participation in such research studies.
Other challenges to access may be their limited or lack of transportation resources, being unable to request off of work, caregiving schedules, or not having access to technologies for monitoring during a research study. Some research studies have reported that physicians are less likely to offer clinical trial participation to minority patients. Enrollment efforts of research studies often may not reach the minority population if they are not culturally sensitive to address language or health literacy barriers. The history of medicine in the United States also has seen the abuse and mistreatment of minorities such as the Tuskegee syphilis experiment. As a result of such abuse and ongoing racism and discrimination, minorities are less willing to participate in clinical trials.
The racial and ethnic diversity of clinical trials in the further development of Covid-19 vaccines is imperative. This pandemic has impacted those of Black adults and minorities the most, so more trials should effectively recruit and maintain the participation of minorities. Minorities already historically have had lower vaccination rates and express more concerns about receiving the Covid-19 vaccine and perhaps their concerns are valid based on the data presented in this essay. Therefore, it is important that Covid-19 vaccine researchers ensure the safety and efficiency of the vaccine across all of the United States to increase the trust and confidence of minorities that they should get the vaccine.
International Nurses Day on May 12 honors nurses worldwide with a day of celebration for all the work they do to care for patients, people in their communities, and those they know and love.
The past year has been one of tumult and exhaustion for nurses as the COVID-19 pandemic brought challenges and conditions that today’s nurses never worked through before. As Minority Nurse honors nurses around the world today, we thought hearing from a student nurse—one on the brink of starting a career path that has seen so much pain and joy in the past year—would give a perspective of the next generation of nurses on International Nurses Day 2021.
Twenty-year-old Bisola Ariyo is this year’s valedictorian for Howard University’s College of Nursing Class of 2021. Her work as a nursing student took on new meaning in the past year, she says, and only amplified the determination she’s always had to excel as a nurse.
As a student in Lagos, Nigeria, Ariyo earned a full scholarship to Howard University—where she dreamed of going. Originally, she (and her parents) thought she was going to pursue a med school track, but she realized her love of biology was suited for a different path.
“I did my first internship and my first clinical and I experienced that bedside, hands-on work,” she says. “Doctors don’t do that. Nurses build relationships and it’s a big responsibility when you think you’re the only advocate for this patient. They look to you for all sorts of things. It made me admire nurses, and I wanted to be just like them.”
Throughout her college years, her dedication never wavered and her scholarship was something she used as a guiding light. “I wanted to come here and be everything I was expected to be,” she says, noting that she’s a recent an inductee of the Sigma Theta Tau International Honor Society of Nursing. “It drives everything I do. I wanted to make my parents proud and make myself proud.”
As the pandemic swept through the world during her junior year, Ariyo says everything changed. During those early days, her father became ill and while his illness was not related to COVID, it put her in a deeply empathetic place. “It gave me an idea of what people were going through in the pandemic,” she says. Her parents were far away and the feeling deeply unsettled her.
When her family saw the work she was doing thorough the pandemic, it changed their perspective. Hearing about Ariyo’s 12-hours shifts, her parents were concerned about her safety and if she had enough PPE. They understood the gravity of her work. “Now my mom tells everyone her daughter is a nurse,” Ariyo says. “Before that, she thought doctors were the most prestigious. She has the most respect for nurses now.”
This spring, when she found herself working at a vaccine clinic and giving so many shots every day, she says she was grateful. “I was vaccinating people who were so thankful to get the vaccine and who would now get to see their grandmothers or their friends,” she says. “I never envisioned giving vaccines all day was something I would ever be doing, but I hope to take that experience with me.”
Ariyo decided on her specialty path after a summer externship at Duke University Hospital Pediatric Cardiac Intensive Care Unit where she shadowed a nurse and performed pre-op and post-op care of children with congenital heart defects. She’s decided to become a pediatric nurse practitioner. “Every day was a joy,” she says of the experience. Whether she was seeing children get better or enduring the sadness when they didn’t, Ariyo says working with children was profoundly moving. “They are so resilient,” she says of children. “Being part of that every day made me realize that is what I want to do. And that is the patient population I want to serve.”
As Ariyo gained additional work, she also saw how crucial it is for the nursing industry to attract more minority nurses. “Nursing is definitely impacted by how representation matters to patient care,” she says. While on a post-Hurricane Maria alternative spring break program with Howard University in Puerto Rico, Ariyo says she noticed how a language barrier or residents’ general mistrust of the healthcare system influenced care. “The Black or brown people or people of color who don’t trust the healthcare system are looking for the Black person in the room because that’s the person that looks like them,” she says. “There’s a responsibility for me and a trust they have in me because I look like them.” The experience even gave rise to new goal—learning Spanish. “I felt bad when there was no interpreter in the room,” Ariyo says. “Minority nurses are so important.”
Being part of Howard University’s nursing school gives Ariyo deep pride. She has taken advantage of every opportunity and has worked as a mentor at an afterschool program; was a HU Geriatrics Lab student researcher on the Alzheimer’s research team; and is a member of the Comprehensive Medical Mentoring Program (CMMP) and the National Society of Collegiate Scholars (NSCS).
Although she knows the work has been challenging, she sees herself reflected in her fellow graduates on this International Nurses Day. “My class is 42 strong incredible Black women,” preparing for a nursing career, she says. “I feel brave because I see all the other people in my class as brave as I am. And despite how much social unrest there has been, we can take solace in this future generation. It is a time for hope.”
Changes have occurred since the Civil Rights Movement of the 1960s to improve the treatment of Black people; however, the underpinnings of systemic and structural racism are alive and well in the United States. Through the inequitable outcomes of the COVID-19 Pandemic, 2020 bestowed upon us an undeniable reality check on the national impact of systemic and structural racism in our healthcare delivery system. As of March 17, 2021, the Centers for Disease Control (CDC) (2021) reported 533,057 COVID deaths in the U.S., 289,119 of which were reported by race. Of those 289,119 deaths in which the race was known, 14% of the victims were identified as Black, non-Hispanic. Although underrepresented in the U.S., Black people disproportionately led the death toll rates as they suffer from existing socioeconomic hardships in addition to the adversities brought on by the pandemic.
The COVID-19 Pandemic has shone a light on the health disparities and inequalities that people of color suffer from daily. The lack of trust for the COVID-19 vaccine embodied within the Black community due to historical and current medical negligence and bias provided by a vastly white population of healthcare professionals compounds this problem. In November 2020, a survey conducted by the National Association for the Advancement of Colored People (NAACP) revealed that only 14 percent of Black respondents trusted the vaccine and only 18 percent indicated that they would definitely get vaccinated.
Health care disparities extend beyond the pandemic, however. For example, according to 2017 data from the CDC, Black women are three to four times more likely to die of pregnancy complications than white women. Contributing factors to these disparities are financial, bureaucratic, transportation, language barriers, and care that is not consistently culturally appropriate or respectful.
To abate these tragic, disproportionate outcomes and build trust within the U.S. health care delivery system, the healthcare workforce must become more diverse. Our nation’s population is continuously changing and becoming more diverse. The healthcare workforce must change to match. The United States Census Bureau predicts that by 2045, over half of the U.S. population will consist of minority populations. The American Association of Colleges of Nursing (AACN) stated, “with projections pointing to minority populations becoming the majority, professional nurses must demonstrate a sensitivity to and understanding of a variety of cultures to provide high-quality care across settings.”
Culturally congruent health care providers representing racial, ethnic minority populations improve trust in the health care delivery system, quality of care, and outcomes of minority populations. A 2017 report by the National Institutes of Health determined that cultural respect was an essential factor in reducing healthcare disparities and improving access to quality health care for diverse patients. According to data from the National League of Nursing and the U.S. Census Bureau, approximately 80% of registered nurses, nurse practitioners, and nurse-midwives are white. Schools of nursing must also develop strategies for increasing diversity within the nursing workforce.
An example of this shift can be found at Frontier Nursing University, which, over the past decade, has placed an emphasis on diversity, equity, and inclusion (DEI), with a particular focus on increasing the enrollment and graduation rates of students of color. FNU included DEI in its strategic plan to address issues surrounding access to health care, health outcomes, health disparities, health inequities, and to increase diversity in nursing. These efforts will play a significant role in ameliorating health disparities and inequities. FNU’s SOC enrollment has grown from 9% in 2010 to over 25% in 2020. FNU is continuing on the trajectory of integrating DEI and antiracism throughout the university to support racial, ethnic underrepresented students. Resilience during the COVID-19 Pandemic permitted FNU to graduate 841 students, including 208 students of color, yielding an increased workforce diversity to care for diverse, rural, underserved populations. Additionally, FNU’s current retention rate for SOC is 84%, exceeding the university’s goal of 80%, and the number of faculty of color is on the rise, currently standing at 14%.
FNU is an example of the intentional focus required to begin building a more diverse, culturally competent health care system. We have known and understood for a while now that the lack of diversity among primary health care providers was a contributing factor to the glaring disparities in health care outcomes among diverse populations. The past year only acted to exacerbate the problem and heighten our awareness of the need for immediate change and action. If we have learned anything from the pandemic, it is that diversity, equity, and inclusion are the keys to the future success of our nation’s health care delivery system.
This week’s National School Nurse Day (May 12) honors the tireless and complex work of school nurses—all of whom cared for students thorough a constantly changing year that veered between in-person, remote, and a hybrid of both.
I had a wonderful community health nursing rotation within my undergraduate nursing coursework that always stuck with me. I worked on a trauma unit after earning my BSN, and often thought back to that course and the role of a public health nurse. I remember calling my high school nurse on one of my days off and asking her “what do I have to do to become a school nurse?” I made the decision to follow my passion after that phone call and haven’t looked back since.
How has your job changed in the last year and with all the ramifications from the pandemic?
School nurses have always answered the call to serve during times of crisis. What I know for sure about school nursing is that we are each demonstrating how essential the role of a school nurse is to the health, safety, and well-being of students, staff, and the communities across the state of Illinois.
School nurses were at the frontlines before stay-at-home orders went into effect last year; over the summer many of us answered the call to action and donated PPE to our colleagues, volunteered at COVID testing sites, donated blood, served on various state taskforces, and supported our students by delivering meals. We are now serving in the tremendous role as frontline healthcare providers mitigating the impact of COVID-19 in our schools by isolating, contact tracing, ensuring IDPH COVID-19 Exclusion Guidelines, and case management amongst many other things.
We continue to amplify our voices at the local, state, and national level, all the while working together to address the health inequities faced by so many of our students and families that have only magnified over these past several months.
What do you enjoy most about your job?
What I enjoy most about my career in school nursing is the continuity of care that I’m able to offer my students throughout their high school experience. I love being a school nurse, and I encourage everyone reading this to follow their passion and find your place to thrive. I also enjoy being an advocate for my profession and teaching. I’ve been teaching for over seven years now, and it fulfills my other passion of educating the next generation of nurse leaders.
School nurses’ jobs are incredibly complex and you care for kids with many health conditions. What do you wish people knew about your role?
I wish people knew how vital our role is and that we are public health experts. I have a vision that every child in the U.S. will one day have access to a full-time certified school nurse. Every child deserves that access and it should not be determined by their zip code.
Can you give us an example of your work in educating the public on issues that are relevant right now?
In partnership with the COVID Collaborative, the Ad Council launched a historic public communications effort to educate the public about the COVID-19 vaccines. I was chosen to participate in these messages for healthcare professionals nationwide! The videos featured Dr. Anthony Fauci and other healthcare experts. We explained the rollout and administration of COVID-19 vaccinations and discussed how to navigate questions and conversations with patients.
At the local level, I am leading a science-first public health campaign through IASN by calling all Illinois school nurses to share their COVID-19 vaccine photos and videos by and using the hashtag #VaxUpIL and #IASNVaxUp to show how safe and important it is to get vaccinated. This campaign will also cover topics like masking, testing, vaccinations, and will address vaccine hesitancy. I’m designing the messages with diversity and inclusion in mind to maximize their reach and effectiveness.
To ensure equitable access to COVID-19 vaccines we must consider the social determinants of health that have increased the prevalence of COVID-19 within BIPOC communities. The national vaccination effort is one of the greatest operational challenges America has ever faced, and this is with existing underfunded public health programs across the country. I’m proud to be doing my part in this effort.
Barrera serves on the legislative committee and most recently as an expert panel member of the Diversity, Equity, and Inclusion Committee of the American Nurses Association-Illinois. She holds a chair elect position within the American Public Health Association’s (APHA) Nursing Section, is an active representative of Hispanic nurses on the Nursing Coalition on Climate Change and Health, and is an active member of the Alliance of Nurses for Healthy Environments (ANHE). Barrera has been recognized for her leadership and community work by several organizations, both locally and nationally and most recently was named a 2020 Pinnacle Nurse Leader in Illinois. She is committed to being a lifelong learner and continues her efforts in improving child health outcomes in our most vulnerable populations through her current practice, advocacy, and teaching.
As student nurses celebrate the May 8 designation of National Student Nurses Day, they have a lot to be proud of. This year, student nurses navigated through a tumultuous time while continuing to pursue their nursing education despite a global pandemic. The task was, and continues to be, enormous.
To mark National Student Nurses Day, Minority Nurse went right to the source. We asked Aisha Zalwango, who is currently finishing up her senior year at Regis College in Weston, Mass., what it’s like to be a student nurse in 2021. Her answers reflect the challenges of the past year and the hope many nursing students feel going forward.
Please tell me about what led you to go to nursing school.
Ever since I was a young girl in Uganda, I knew that I wanted to become a nurse because I love taking care of the sick, the disabled, and those who need my help. I am majoring in nursing because I want to become a great nurse who will give the best care to my patients. I believe that good care is the best gift one can ever give to someone who is sick and away from their family and friends.
What is your intended specialty?
My intended specialty is Intensive Care nursing (ICU). As a novice nurse, I want to start in medical-surgical nursing so that I can improve my nursing skills and get more experience working as a bedside nurse. After a year or two, I will transfer to Intensive Care nursing.
What has surprised you about being a nursing student?
The things that have surprised me about being a nursing student are the things that I have found out about the nursing profession. They include the following:
Nurses’ roles are not limited to patient care. After a few years of experience, some nurses take on administrative roles, while others become teachers to the next generation of nurses. There are those who become researchers and consultants in the healthcare field.
Nurses have a chance to specialize in a particular area of healthcare. The only requirement to specialize is to fulfill an additional education requirement which in some cases involves completing a master’s degree program.
Have you had a mentor or someone who has influenced you?
A lady whose mother I took care of when I had just come to America has greatly influenced my journey of becoming a nurse. Ever since she found out that I was in school for nursing, she has been encouraging me to keep going. She has always made me feel cared for even if I do not have family here in America. She always calls to check on me so that I do not feel alone. Her caring attitude has really made me feel that I matter.
Have the events of the past year and the pandemic influenced your studies or the way you see your future career at all?
Yes, the events in the past year and the pandemic have influenced my studies and the way I see my future career. When the pandemic was at its peak last year, school and classes were remote, and I could not get in touch with my study group. Some of my friends got sick from COVID-19, and we could not even meet or hang out for a long time. I felt very lonely and so sad because I spent most of my time by myself.
This pandemic taught me to stand strong through challenges and to keep going regardless of the situation, because accomplishing my goals requires such skill. Living in a pandemic so early on in my career, has assured me that I am where I need to be. It has influenced my future career in that I know how challenging this field can get and has assured me that I can handle it.
Through this pandemic, I have learned several essential nursing skills required to become a great nurse. From experience, working as a patient care associate in a community hospital, I have also learned that nurses should use the required precautions the right way in order to protect themselves and take good care of very sick patients without spreading infections. I now know what it takes to be a nurse and to be in this amazing field.
What has helped you succeed as a nursing student?
I am goal oriented. I set goals for myself which include small goals that I believe help me achieve my major goals. This type of skill has really helped me to focus on important tasks, with understanding expectations, and by giving me motivation to get my work done on time. I also organize my time well. I have time to study, time to work, and time to relax.
Being organized has helped me avoid being burned out. I am optimistic as well. Nursing school can be very challenging because preparing for exams, completing clinical hours, going to class, and managing other responsibilities can be overwhelming. However, I look at the bright side of it all. Instead of dwelling on challenging situations, I look for solutions, and I keep going because I am sure and I believe that there is a bright light ahead—in the end, I will be successful.
What are your next steps after graduation?
My major goal for after graduation is to get a nursing job so that I can start taking care of the sick and improve my nursing skills. Since learning in healthcare is ongoing, I will take on any opportunity that will come my way to further my education so that I can improve my professional experience in nursing practice. I also want to take part in various community healthcare projects. That way, I will be able to give back to my community through improving people’s health.
Unfortunately, some issues or diseases are more prone to affect people in certain communities—case in point, colorectal cancer has been known to disproportionately affect the Black community as compared with white communities. In fact, according to the American Cancer Society, Black people are up to 20% more likely to get colorectal cancer and are also about 40% more likely to die from it.
We interviewed Phyllis Morgan, PhD, FNP-BC, CNE, FAANP, academic coordinator for Walden University’s MSN-FNP program, as she has conducted research on colorectal cancer in men as well as Black men and women’s health issues, including disparity in health and health care.
Phyllis Morgan, PhD, FNP-BC, CNE, FAANP
Why does colorectal cancer disproportionately affect the Black community?
There are several reasons why colorectal cancer disproportionately affects the Black community. First, there is a general lack of knowledge about screening for colorectal cancer, which contributes to inadequate prevention and screening behaviors. There are also various fears that come into play, such as fear of cancer and of a cancer diagnosis, and fatalistic views about cancer.
A recent study showed that in Black Americans, the right side of the colon ages much faster than the left side, which could contribute to this population’s increased risk for colorectal cancer, particularly on the right side of the colon, and at a younger age.
Other factors may include delayed treatment and the fact that Black individuals have a higher incidence of obesity and more often consume a high fat, low fiber diet, which increases risk.
Why are Black people who get colorectal cancer about 40% more likely to die of it than other groups?
In addition to factors such as inadequate prevention and screening behaviors as well as delayed treatment, racial inequities in care also contribute to the fact that Black people who get colorectal cancer are more likely to die of it than other groups. There is a widespread lack of access to care for many people in this population, and some have no health insurance or inadequate health insurance for treatment.
Additionally, lifestyle factors such as diet and exercise can contribute to this.
What are the challenges facing the Black community regarding colorectal cancer?
Some challenges facing the Black community regarding colorectal cancer include inequities in health care, lack of access to quality care, and a lack of adequate resources to educate about the importance of colorectal cancer screening. It is crucial that we increase screening by providing better education for the Black community regarding screening and the importance of polyps being removed from the colon.
Additionally, we need more diverse health care providers, so patients can have providers who look like them and with whom they can connect and relate. Black health care providers can play an important role in helping patients to understand the seriousness of colorectal cancer in their community.
What can nurses do in order to get people in minority communities to go for tests, pay attention to symptoms, etc.?
First, nurses can help by providing more colorectal cancer resources for their communities. In addition, culturally appropriate educational programs and community or faith-based educational programs can be helpful in encouraging people in minority communities to undergo screening.
As an African American woman and advanced practice nurse, I have participated in many projects and studies to identify ways to increase awareness, prevention, and treatment of health issues that impact the Black community. Specifically, I worked on a community and faith-based education program to increase awareness of prostate cancer among Black men, which resulted in an increase in participants’ general knowledge of prostate cancer and treatment by over 40%. I have also implemented successful community and faith-based education programs in North Carolina and Virginia to help educate Black people about colorectal cancer and increase screening behaviors. These types of programs are proven to make a difference.
Nurses can play a vital role in helping community and faith-based organizations develop and execute programs to address health disparities. It’s critically important for research to be conducted, especially in developing culturally appropriate models for diverse communities, so more contributions toward reducing health disparities can be made available to effect positive social change.
Last but not least, Walden University and the National League for Nursing are excited to launch the Institute for Social Determinants of Health and Social Change, where nurse educators and inter-professional colleagues will play an instrumental role in achieving health equity across various demographics. The institute is designed to cultivate these health care professionals into leaders who address the impact of structural racism, socioeconomic status, environment, education, adequate housing, and food insecurity on health and well-being.