Inclusion, Part 1: Your Role in an Inclusive Work Environment

Inclusion, Part 1: Your Role in an Inclusive Work Environment

Inclusion tops the list of many workplace must-haves. But what exactly does inclusion mean?

According to G. Rumay Alexander, EdD, RN, FAAN, clinical professor and director of the Office of Multicultural Affairs at the University of North Carolina at Chapel Hill, when people talk about inclusion they can’t ignore one very important fact – inclusion means something different for each person.

“You have to define terms and explore it and explain it a little more carefully,” says Alexander, who recently moderated the American Nurses Association webinar Diversity Matters: Create an Inclusive Nursing Culture that Leads to Better Outcomes. “A prime example is that people talk about respect. The fact of the matter is that ten different people have ten different definitions of respect.”

How can you begin talking about inclusion?

1. Define It

Nurses excel at critical thinking skills, says Alexander, so sitting down to talk about what inclusion means in your workplace should be the first step.

2. Think About What Inclusion Means to You

Self-awareness is so key to the work of an inclusive space,” says Alexander. “Understanding and knowing yourself is important. Know what pushes and doesn’t push your buttons.” Use honest self examination of your biases and prejudices so you become aware of them and realize how they could impact your work. Everyone has had different experiences, says Alexander, and each of those can change your outlook. The important work is understanding how that happens and making sure it doesn’t invade your work.

3. Be Willing to Change

When you do some honest reflection, you might realize where you need to make changes. That’s not a bad thing. Almost everyone needs to do something better, so having an open mind and understanding that you are part of a team trying to change takes the personal sting out. Be willing to learn. “Understand that your private decisions have public ramifications,” says Alexander. “You can’t talk your way out of what you behaved your way into.”

4. Change Your Culture

Culture will trump strategy every time,” says Alexander. If everyone isn’t on board, any changes and any strategies put in place won’t hold. Understanding workplace culture means understanding who shapes the culture and how they interact. “You have to understand culture,” says Alexander. “Culture is the way you approach your work.”

5. Be Patient

You have to understand when you are changing culture you are dealing with a process and that takes time,” says Alexander. A new environment won’t happen overnight, but it will happen with self reflection, new approaches, and honest and open communication.

Sexual Orientation and Gender Identity in Nursing

Sexual Orientation and Gender Identity in Nursing

It’s been said that lesbian, gay, bisexual, and transgender (LGBT) nurses form one of the largest minorities within the profession, and yet they are hardly recognized as a subgroup. To date, limited data are available to determine just how many nurses identify as LGBT (or some variation of those letters, such as LGBTQ, in which the “Q” stands for questioning or queer). But according to a 2013 Gallup poll, approximately 3.5% of the US general population identifies as LGBT; so whether or not you identify as LGBT, it’s likely that you will have to treat patients who do at some point during your nursing career. As patient advocates first and foremost, nurses must strive to provide culturally competent care for all, regardless of gender or sexual orientation.

LGBT nurses and patients alike face a unique set of challenges in the health care system: hostile personnel, lack of insurance, and higher rates of certain disorders, such as substance abuse. Yet both seek to make the health care system more supportive and equitable through changes in policy, education, and advocacy. Their aim: to raise cultural competence of health care professionals and lower the health disparities and barriers to care affecting LGBT individuals, families, and couples. Here are the profiles of five professionals committed to leading the charge for an open and accepting health care environment.


Austin Nation, RN, PHN, MSN 

PhD Student at University of California – San Francisco (UCSF)

Veteran nurse Austin Nation has over 30 years of nursing experience to his credit, including stints in hospital supervision and providing AIDS services, before heading back for a PhD program. His aim is to teach nursing, which he is now undertaking as an adjunct professor at San Francisco State University.

He says he’s faced a “triple-whammy” of discrimination—surprising in a city like San Francisco, where he expected more cultural competency around these issues.

“I thought this was the gay mecca, with open, liberal thinkers, but that hasn’t been the case,” he says. “I’ve experienced racism, sexism, and homophobia. I’m a black male in nursing. I’ve been blatantly subjected to all this stress while embarking on a PhD journey, which is already stressful enough.”

Nation wonders why the UCSF system, which dominates the city and cares for a larger LGBT population than any other, is “so provincial when it comes to addressing issues closest to the heart of that community.”

“We have beautiful diversity banners, photos of different kinds of people together all getting along, but it isn’t like that,” he says. “In an academic setting, change happens so slow—it’s like turning the Titanic.”

Nation takes every opportunity to raise consciousness in class. “I’m trying to provide education in real time as it happens.” For example, if a nurse refers to gay patients in a distant or disrespectful way, he’ll step in: “Hey, that’s us you’re talking about—we’re not those people.” In addition, Nation leads a Men in Nursing group and is spearheading an LGBT Cultural Competency for Healthcare Providers workshop that has generated overwhelming interest.

One part of the problem, Nation suggests, is that “the health care community tends to be conservative. We come from a paradigm of heterosexuality.” It wasn’t too long ago that homosexuality was considered a psychological aberration, he adds.

Nurses are often uncomfortable with the subject of sexuality and reluctant to talk to patients about sexual health, Nation has observed. He suggests that discomfort first crops up during physical assessment class as undergraduates.

“We learn about the human sexual reproduction system. Then, during a head-to-toe assessment of a patient, you pull the covers up and look. But what are you looking for?” What happens if a nurse pulls up the gown of a male and sees female sexual organs, say? “That’s a good opportunity to have a conversation about gender variances,” he says.

“There have been many people that didn’t accept me,” explains Nation. “I’m the kid from the ghetto who made good. For me, the saving grace is that I’ve had women who’ve taken me under their wings. They watched over me and protected me in difficult or sensitive situations. I try to create that same sense of belonging for my students.”


Riikka Salonen, MA

Manager, Workforce Equity and Inclusion, Oregon Health & Science University (OHSU)

A bi-national native of Finland, Riikka Salonen leads diversity and inclusion strategy efforts at OHSU in Portland, Oregon. “Our intention is to provide an environment of care which is welcoming and inclusive,” she says, “as well as protective of patient and employee rights and benefits. For instance, we’ve had same-sex partner benefits since 1998, and offered transgender health-specific benefits for employees for over a year.”

Family inclusion is one topic that OHSU focuses on—and for patients, that means visitation is a given for everyone, including same-sex couples or a child who has two mothers. “Family inclusion also means that if a gay employee wants to put out family photos, they feel they can without there being whispering about it.”

OHSU Pride, an employee resource group for LGBTQ employees and allies, was started in 2007 to ensure an inclusive environment. “OHSU Pride has created a significant difference in our campus, which has become very LGBTQ-affirming,” says Salonen.

LGBTQ education and consciousness-raising at OHSU is an ongoing effort, Salonen notes, starting with new employee orientation. From there, it proceeds on an as-needed basis, depending on a nurse’s specialty. For example, Salonen says, OHSU provides “a specific session for pediatric nurses that focuses on providing care for transgender or gender-nonconforming youth.”

Parents worried about a 5-year-old boy who insists he’s a girl, for example, can be referred to TransActive Gender Center (, a national nonprofit with low-cost services for youth and families. (For those living outside Portland, Skype counseling sessions are an option.)


Mary Bylone, RN, MSM, CNML

Regional Vice President, Patient Care Services, Hartford HealthCare, East Region, and Director, American Association of Critical-Care Nurses National Board of Directors 

“I’m 58 and didn’t figure out my lesbian orientation until later in life,” says Mary Bylone. “My brother is gay and so is my son. I didn’t come out at first because of the prejudice and abuse my brother experienced. As a manager, I’m now out; [but] as a staff nurse, I wasn’t.”

Bylone says her sexual orientation doesn’t totally define her: “It’s part of me, not all of me.” She has noticed that fellow employees and patients gravitate toward her to talk about gay issues. Possibly, she suspects, they do it “because I’m an out person in a responsible position. One day, a mother started crying when she told me her son was gay. I was able to comfort her as the mother of a gay son.”

Bylone has experienced situations where patients have discriminated against gay nurses. “I remember a patient who asked to see me when I was a head nurse,” Bylone recalls. “She didn’t want to see her nurse that day. ‘Why? Is it because he’s a man?’ ‘No, that’s just the problem. He’s no man,’ is what she answered. Unfortunately, the nurse was standing outside the door and heard her cruel complaint.”

Bylone adds that managers sometimes treat out nurses differently. “You may be assigned a gay patient when people know you’re gay, misunderstanding that someone’s sexual orientation does not define her or his entire person,” she explains. “I’m a nurse who happens to be lesbian, not a lesbian nurse.”


Emily Pittman Newberry

Trans Woman and Recent Surgical Patient in Portland, Oregon

Emily Pittman Newberry says she lived life for 55 years “pretending to be a man,” before embracing her gender identity as woman and transitioning over a period of five years. “People often ask me, ‘When did you decide you were a woman?’ The question should be: ‘When did you acknowledge it to yourself and choose to live openly?’” Every transgender person Newberry has met or read about says they always knew.

Newberry maintains that health care personnel have been universally professional and even kind to her during this process, though she had trouble with her insurance company. They wouldn’t cover the cost of surgical gender-confirming surgery.

She has some advice for nurses, such as not taking it for granted that you know a patient’s gender. “Ask them to self-identify and tell you what gender pronoun they prefer you use in referring to them,” says Newberry, though she understands that “asking is a tender place for a nurse and a transgender person.”

“Sometimes I see someone who is clearly struggling with it—getting pronouns wrong, getting uptight [such as the time she asked a clerk to change her gender in the clinic patient record system],” says Newberry. “I want to say, ‘This is new for everybody.’ It’s my job to educate people, be kind and humane even when I feel angry. It’s a dance, and we’re all learning the steps.”

Another piece of advice is to not get thrown if a transsexual patient has a health condition that doesn’t match their gender as your records show it. “If you see a prostate problem in a woman, for instance, act like it’s no big deal,” Newberry suggests.

Many health care IT systems only offer “male” or “female” as gender choices, which is limiting and potentially hazardous. Binary options are also being challenged by popular culture. Facebook now allows users to self-select from 56 gender options, such as “transgender” and “intersex” and “Female to Male/FTM.”

There are bound to be many uncertainties and uncomfortable moments for Trans patients and their nurses as we travel this unmarked path. “Do your best to carry on in a professional way,” says Newberry. “Ask yourself: ‘Am I being tender or am I being rational?’ You can be both at all times, of course, but sometimes more on the compassionate side and other times the scientific. Both are a part of every health care professional—you can emphasize one or the other, depending on the situation.”


Desiray Bailey, MD

Hospital Chief of Staff, Central Hospital, Group Health Cooperative, Seattle, WA, and immediate past president of GLMA: Health Professionals Advancing LGBT Equality (formerly known as the Gay and Lesbian Medical Association)

“GLMA was a physician-oriented organization originally, but we decided to be more inclusive and include the whole health care team,” says Desiray Bailey. “We work to provide opportunities to practice openly and more compassionately.”

Nurses are now an active part of the group, as evidenced by GLMA’s annual conference and nursing summit, scheduled for September 10-13, 2014, in Baltimore, Maryland.

One of the aims of GLMA is to improve education and awareness of gay and transgender issues among health care personnel. “It’s a very rare nursing program that provides LGBT education,” says Bailey. “We’d like to see it as part of the curriculum for all health professionals—physicians, nurses, physician assistants, and people in behavioral health training.”

At Group Health, Bailey has been an advocate for equal treatment of LGBT staff and patients for many years, facilitating changes in policy, employee benefits, patient and family visitation, consumer rights, and community outreach.

Additionally, she advocates for equal treatment so that “any professional in a hospital or medical center who is gay, lesbian, bisexual, or transgender won’t experience discrimination as an employee because they can’t be out, or their organization doesn’t provide benefits that are equitable with straight employees.”

In many states where LGBT employees aren’t a protected class, it’s possible to be discriminated against or fired for being gay. Even worse, a few states have “anti-gay laws—where certain sexual acts are illegal—or there aren’t specific protections,” Bailey says. “I’m fortunate to live in Washington State—we’ve had domestic partnerships for a few years and now marriage equality.”

According to Bailey, the Affordable Care Act has benefited the LGBT community. “Insurance plans can’t discriminate based on sexual orientation or gender identity. Legally married couples are still recognized, even if they live in a state that doesn’t recognize their union, and there aren’t lifetime limits for AIDS patients,” she adds.

Among the tools available to improve LGBT equality in a health care setting is the Healthcare Equality Index of the Human Rights Campaign, a civil rights organization. “This is a tool that really changes the atmosphere for employees and patients,” says Bailey. Once a decision has been made to participate, “there’s an organizational will to want to score well. They want to put in place the right policies and training for staff,” she adds.

Seeking out legitimate information about LGBT issues is very important “if you want to take care of all your patients,” Bailey says.


Jebra Turner is a freelance health and business writer based in Portland, Oregon. She frequently contributes to the Minority Nurse magazine and website. Visit her online at 


2014 Annual  Salary Survey

2014 Annual Salary Survey

Depending on where they work and their specialties, nurses can earn a range of salaries. Salaries continue to appear to vary by ethnic background as well, but overall, nurses reported in the second annual Minority Nurse salary survey making more this year than they did last year—and more than they did five years ago.

Although nurses reported making higher salaries this year than they reported last year, there are wage gaps by ethnicity that remain to be closed.

In 2013, nurses reported making a median salary of $67,000; this year, they reported earning a bit more, a median $68,000. Still, African American nurses earned a median $60,200 and Hispanic nurses received a median $60,000, while white nurses took home a median $72,000.

To gather all this data, Minority Nurse and Springer Publishing e-mailed a link to an online survey that asked respondents about their jobs, educational backgrounds, and more to better understand their roles as nurses and to determine their current and past salaries.

Some 4,850 nurses from all over the United States responded to the survey questions. The respondents also hailed from a number of specialties, including nurses working in critical care, as certified nurse educators, and in pediatrics, as well as nurses employed at public hospitals, private hospitals, and at colleges or universities.

Some stark differences, though, were noticeable when survey data were broken down by ethnicity. For instance, nurses belonging to different ethnic groups working at similar institutions reported earning different amounts of money. African American nurses working at a public hospital reported earning a median $65,000, as did Asian nurses. Hispanic nurses reported making less, taking home a median $60,000. White nurses, though, said they earned $79,500.

Additionally, nurses belonging to different ethnic groups with similar educational backgrounds also reported salary differences. African American nurses with a bachelor’s degree reported making a median $62,000—similar to the median $60,000 reported by Hispanic nurses—though higher than the median $50,000 received by Asian nurses, but lower than the median $70,000 that white nurses said they made.

At the master’s degree level, the picture is a little different. Asian nurses with master’s degrees commanded the highest salary, a median $80,000, followed by African American nurses, who received a median $76,000. Hispanic nurses, meanwhile, earned a median $74,940, and white nurses with a master’s degree reported making a median $73,000.

Overall, respondents reported earning a higher salary this year than they took home last year and a bit more than they reported earning five years ago. For example, nurses working primarily in patient care reported earning $60,000 this year, $55,000 last year, and $47,000 five years ago, and advanced practice nurses reported making $89,000 this year, $84,000 last year, and $78,000 five years ago.

Though there are still wage gaps to be bridged, nurses reported earning more now than they did just a few years ago.



17.6% of respondents have a PhD or other doctoral-level degree

33.3% work at a college or university

56.2% have been at their current job for five years or longer

65.8% received a raise within the last year

53.5% left their prior job to pursue a better opportunity

41.1% do not expect a raise this year

48.9% are looking to leave their current job in coming years


Top Two Degrees Held by Respondents

MSN, or other master’s-level degree

BSN, or other bachelor’s-level degree


Five Most Common Specialties

Critical care (NICU, PICU, SICU, MICU)

Certified Nurse Educator

Advanced practice nursing




Highest Paid by Employer Type

Private practice

Private hospital

Health insurance company

Public hospital

College or university


Most Common Benefits Provided

Health insurance

Retirement plan (401(k), 403(b), pension, etc.)

Dental insurance

Paid time off

Life insurance


The 2013 Take Pride Campaign

The 2013 Take Pride Campaign

Each year, we call for nominations for our Take Pride Campaign in an effort to recognize those places of employment that went above and beyond regarding encouraging diversity; recruiting and retaining minorities; and creating a cooperative, inclusive work environment. We hope all of the nominated facilities continue to lead by example, and we are proud to recognize this year’s winners here. 

Office of Multicultural Affairs, The University of North Carolina at Chapel Hill, School of Nursing

Nominated by Debra J. Barksdale, Director, Doctor of Nursing Practice Program

As Director of the Office of Multicultural Affairs (OMA) in the School of Nursing (SON) at the University of North Carolina at Chapel Hill, Dr. G. Rumay Alexander has worked tirelessly over the past 10 years to improve the SON’s climate in regards to diversity and multiculturalism. OMA serves as a school-wide resource for the proper understanding and judicious application of equity and multicultural concepts. She facilitates system-wide efforts for retaining students, faculty, and staff of underrepresented racial and ethnic populations and for enhancing their development as members of the nursing profession and the UNC community. Dr. Alexander ascribes to the principles of human flourishing. Not only does she have programming and activities that help faculty staff and students to open the eyes of their understanding, but she also provides many forms of consultation: individual, curricular, admissions, and organizational process and procedure. Through OMA, she implemented a program called cultural coaches. Dedicated faculty are assigned to work with specific diverse students to ensure that they are “cared for”. Currently there are 4 groups based on race and/or sexual orientation. Dr. Alexander has guided many health professions students, faculties, and executive leaders in educational, service organizations and health care settings, nationally and internationally, to explore together marginalizing processes, causality, and the vicissitudes of lived experiences of difference for those for whom we have promised to provide care, healing, and hope in our global world.

Dr. Alexander’s work retains an important place in designing and shaping continued support for culturally sensitive practices in education and health care. In addition to lectures, advisement, and consultations at UNC, she also has national and international influence. For example, in 2010, she received the AONE Prism Award in recognition of her diversity work. As a champion for transforming organizational cultures, she was featured in three National Student Nurses Association’s award winning videos distributed to thousands of nursing schools and high schools nationally. Appointed as a commissioner on the landmark Commission of Workforce for Hospitals and Health Systems of the American Hospital Association, she assisted in setting national conversations and directions regarding the recruitment and retention of all nurses and participated in the development
of the document, In Our Hands. Over 2 million copies of the report have been distributed nationally and internationally. She has consulted with 87 hospitals, seven externally funded grants and 12 schools of nursing. Her work has impacted nurses and nursing practice in England, Scotland, Wales, and Northern Ireland. She has authored four books and seven book chapters and participated on expert panels, advisory committees and professional bodies such as Sigma Theta Tau’s International Nursing Alliance, the Robert Wood Johnson Foundation, and the National Quality Forum’s steering committee for the first national voluntary consensus standards for nursing-sensitive care. An integral part of her work these past 25 years has been her leadership in advocating for the elimination of entrenched patterns of systems of inequality.

Creedmoor Psychiatric Center

Nominated by Renee Anderson, Chief Nursing Officer

Creedmoor Psychiatric Center’s approach to diversity and cultural planning is in line with the Office of Mental Health’s Office of Diversity Management, which includes the Bureau of Diversity Planning and Compliance, and the Bureau of Cultural Competence. 

Diversity Management is responsible for implementing and monitoring all programs and initiatives related to equal employment opportunity, reasonable accommodations for employees with disabilities, affirmative action, diversity and cultural competence in service delivery. Recruitment and retention efforts are focused on maintaining an equitable work environment and a diverse workforce. Additionally, through assertive cultural competence programming, reducing and/or eliminating disparities in the delivery of mental health services is accomplished by infusing cultural and linguistic competence within all facility operations and supporting the goal of providing person centered care to all consumers.

Our Vision Statement “Mental Health for all, disparities for none”   is demonstrated each and every day by how the facility provides services and programming both inpatient and in the community.  For example, from the moment a consumer walks through our front door, a language assessment is conducted.  Any language and/or linguistic needs that are identified are quickly put in place.  Because the facility is located in one of the most diverse counties, we have more than 47 spoken languages under one roof readily available for translation services.  

As part of our Educational and Training program, all ward staff attend in-service training and are culturally sensitive in providing a full range of diverse treatment services.  These diverse services not only increase the level of understanding for our staff, it also provides a multi-cultural education and comfort zone for our patients.

In addition to the overall cultural sensitivity throughout the facility, Creedmoor has two inpatient wards for monolingual patients: one ward for Asian speaking and one ward for Spanish speaking patients.  Bi-lingual staff are assigned to the respective wards, culturally appropriate cuisine is offered, traditional holidays are celebrated and ESL services are provided.   On the Asian cohort ward, religious services are offered to those who practice Buddhism.  When inpatients are ready to return to the community, referrals are made to culturally sensitive recovery programs where staff speak the native language.  

I am very proud of the work we do here at Creedmoor. The Facility is making every effort to meet the needs of the culturally diverse population we serve in the Queens community.

Putting Culturally Competent Communication into Hospital Accreditation

Putting Culturally Competent Communication into Hospital Accreditation

Last summer, The Joint Commission’s culturally and linguistically competent patient-centered communication standards became part of the hospital accreditation process. One year later, what difference are they making?

In 2009, Minority Nurse published a Vital Signs story that asked: “Have you ever wished that hospitals had more of an incentive to provide culturally and linguistically competent patient care?” What prompted that question was The Joint Commission’s announcement that it was developing a set of standards that would incorporate the provision of culturally competent patient-centered care into the national requirements for hospital accreditation.

            They’ve been a long time coming, but on July 1, 2012, these new and revised standards for patient-centered communication officially became part of the overall accreditation decision. The standards—which are published in a free downloadable implementation guide, Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals—require health care organizations to, among other things:

  • Identify and effectively meet the oral and written communication needs of all patients, including those with limited English proficiency, hearing or visual impairments, and low health literacy;
  • Use highly qualified interpreters and translators, rather than untrained individuals, family members, or bilingual staff;
  • Document patients’ language and communication needs in their medical records.

            Plus, the standards include two provisions designed to create a more equitable environment for lesbian, gay, bisexual, and transgender (LGBT) patients and their loved ones. One requires hospitals to prohibit discrimination based on sexual orientation and expression of gender identity. The other provides equal hospital visitation rights for same-sex domestic partners by allowing “a family member, friend, or other individual to be present with the patient for emotional support during the course of stay.”

            As all nurses know, Joint Commission accreditation reviews are something hospitals take seriously. One year later (or two years in the case of the LGBT standards, which took effect in July 2011 to align with the Centers for Medicare & Medicaid Services’ 2011 visitation rights regulations1), what effect have the patient-centered communication standards had? Are they helping hospitals do a better job of serving culturally diverse patients’ needs? And more importantly, are they starting to make any difference in improving minority health outcomes?


Too Soon to Know

The answer is: It’s still too early to tell.

            “We’ve been trying to do some analysis of the scoring data and the requirements for improvement that we’ve seen since last July,” says Christina Cordero, PhD, MPH, associate project director, Department of Standards and Survey Methods, at The Joint Commission. “These data have been somewhat limited because of the time frame. But we’re planning to [look at] that information to see how frequently these issues are being scored, what kinds of situations and comments are coming up on survey, and what our surveyors are seeing on-site.”

            In the meantime, anecdotal evidence suggests that most hospitals are at least trying to make sure they’re implementing the standards correctly. For instance, says Cordero, who helped develop the patient-centered communication standards and the Roadmap for Hospitals, The Joint Commission has been fielding many questions about how to implement standard RC.02.01.01, EP 28, which requires hospitals to include patients’ race and ethnicity in their medical records.

            “Most of these inquiries have focused on what categories and question formats hospitals should use to collect that information from patients,” she explains. “For example, should they ask about race and ethnicity together in one question or in two separate questions? We responded by publishing FAQ documents on our website to help hospitals implement a data collection system that works for them.”

            As for identifying areas where improvement may be needed, The Joint Commission’s initial analysis of data from surveyor site visits seems to indicate that hospitals are finding some of the standards harder to comply with than others.

            “The one standard that has been coming up most frequently on-site over the last few months is PC.02.01.21, identification of patients’ language and communication needs during the provision of care, treatment, and services,” Cordero reports. “This may mean that hospitals are struggling more with that issue. Our surveyors are looking at not just the documentation of communication needs but what hospitals are doing to identify and address those needs.”


Is It Enough?

Minority health advocates are also keeping an eye on what The Joint Commission’s evaluation of the standards’ early years will reveal.

            “I hope there will be a systematic examination of the outcomes and the impact on the quality of patient care,” says Cora Muñoz, PhD, RN, co-author of the book Transcultural Communication in Nursing. “But the fact that there are now two external bodies that require this—the Office of Minority Health [which developed the Culturally and Linguistically Appropriate Services (CLAS) standards in 20002] and now The Joint Commission—is a step in the right direction.”

            Hector Vargas, JD, Executive Director of GLMA: Health Professionals Advancing LGBT Equality (formerly the Gay & Lesbian Medical Association) feels that the patient-centered communication standards are “just one piece of a larger picture of progress we’ve seen over the last few years. These standards, the CMS hospital visitation rules, the [2011] Institute of Medicine report [The Health of LGBT People: Building a Foundation for Better Understanding], Healthy People 2020—which for the first time includes specific LGBT health goals—and the Affordable Care Act have all made a difference in how hospitals are addressing the needs of LGBT patients.”

            But some transcultural nursing leaders, such as Josepha Campinha-Bacote, PhD, MAR, PMHCNS-BC, CNS, CTN-A, FAAN, President and Founder of Transcultural C.A.R.E. Associates in Cincinnati, argue that simply having culturally sensitive accreditation standards—or even federal government mandates—in place is not enough. Unless these requirements are vigorously enforced, she believes, there’s no guarantee that hospitals will act on them.

            Vargas agrees. “The policies are there at the macro level,” he says, “but we really have to rely on the professionals in the hospitals—nurses in particular, but all members of the health care team—to make sure those policies are enforced.”


Nurses as Communication Champions

What can nurses do to help ensure that their institutions are complying with the standards on an ongoing basis—not just when Joint Commission surveyors show up? Muñoz, who is professor emeritus and an adjunct professor at Capital University School of Nursing, asserts that nurses must be leaders in a constant dialogue about the crucial role culturally competent communication plays in planning and delivering the best possible care for every patient.

            “When nurses have a patient who needs language assistance, they must demand that the patient gets those [interpretation] services,” Muñoz adds. “As patient advocates, they should not settle for just getting by, or using family members [as interpreters] when it is convenient. That is not acceptable.”

            Laura Hein, PhD, RN, an assistant professor at the University of South Carolina College of Nursing and a member of GLMA’s board of directors, gives two reasons why it’s important for nurses to be involved in championing the standards’ LGBT-inclusive provisions. “One is patient protection and advocacy. The other is to protect the rights of their [LGBT] colleagues, whether they themselves are LGBT-identified or not.” However, she cautions, “If they’re working in a state, or a hospital, that is not accepting of LGBT people, it’s a little trickier for them to be an advocate without endangering their own employment.”

            Even though the impact of the patient-centered communication standards is still a work in progress, Muñoz emphasizes that progress is the key word. “At least we have the standards now; we didn’t have them before,” she says. “We’re moving forward. I wish we could move faster. But we’re moving.” MN



  1. U.S. Department of Health and Human Services, “Medicare Finalizes New Rules to Require Equal Visitation Rights for All Hospital Patients,” November 17, 2010,, accessed March 26, 2013.
  2. U.S. Department of Health and Human Services, Office of Minority Health, “National Standards on Culturally and Linguistically Appropriate Services (CLAS),”, accessed March 25, 2013.

Spotlight on the Diversity in Nurse Anesthesia Mentorship Program

We always thought the Diversity in Nurse Anesthesia Mentorship Program was a great initiative, and now it’s clear that industry heavyweight Johnson & Johnson thinks so too.

Johnson & Johnson featured the Diversity in Nurse Anesthesia Mentorship Program and its founder Wallena M. Gould, C.R.N.A., M.S.N., in its May 2011 Campaign for Nursing Nursing Notes e-newsletter, and we’re happy to share the link with you here!

For more info on the Mentorship Program, visit