A study by the Boston University School of Public Health has found a need to create health programs specifically promoting the well-being of lesbian, gay, and bisexual cancer survivors. The research was lead by Ulrike Boehmer, associate professor of community health sciences.
The results found that gay men were 1.9 times more likely to report a cancer diagnosis than heterosexual men. Though there were no significant differences in cancer prevalence among women with varied sexual orientation, the study showed that lesbian and bisexual cancer survivors were respectively two and 2.3 times more likely to report fair or poor health than heterosexual cancer survivors.
In a BU Today article, Boehmer says the differences in the prevalence of cancer survivorship raises questions about possible differences in the cancer rates by sexual orientation. She also says they can only speculate that HIV status may have contributed to the higher cancer prevalence in gay men, but they were unable to address this in the study since they didn’t have data on the participants’ HIV status.
The significance of the study, according to Boehmer, is the finding that sexual orientation may be a factor in cancer incidence and outcomes. The study concludes saying lesbian and bisexual cancer survivors need to be targeted by programs and services to better assist them in improving their health perceptions. The study also suggests health care providers and public health agencies need to be made aware of the higher prevalence of cancer in gay men through increased screening and primary prevention.
The study was published online in Cancer, a peer-reviewed journal of the American Cancer Society, and included data from the California Health Interview Survey.
With America’s severe nursing shortage predicted to reach emergency levels by 2010, a national coalition of nursing leaders has united to launch a sweeping strategic action plan for ensuring the profession’s future health. Unveiled this summer at the 2002 American Nurses Association (ANA) convention in Philadelphia, Nursing’s Agenda for the Future focuses on addressing the complex, interrelated factors that are the root causes of the RN staffing crisis.
Collectively developed by leaders from more than 60 major nursing organizations–including the National Black Nurses Association, the Philippine Nurses Association of America and the Association of Black Nursing Faculty in Higher Education–the plan is organized into 10 key action areas. Among them are leadership and planning, delivery systems/nursing models, work environment, legislation/policy, education, recruitment/retention and diversity.
Some of the plan’s specific strategies for increasing diversity in nursing and recruiting more people of color into the profession are:
- Establish national professional development models for mentoring, leadership and diversity for nurses across their career trajectory.
- Address diversity issues by obtaining funding to support an increase in minority enrollment [in nursing schools], identifying a mobility track for nurses of diverse cultures throughout their careers and creating a specific curriculum to address diversity.
- Recruit retired nurses to form the foundation of a professional mentoring corps.
- Develop recommendations for regulatory, accrediting and credentialing bodies to address and incorporate diversity issues into regulations, standards and examinations.
- Create diversity and cultural competence through educational programs and standards in the workplace.
- Target legislation and funding for diversity initiatives.
The nursing brain trust that created Nursing’s Agenda for the Future plans to present its recommendations to health care institutions, policy-makers and consumers at a special Call to the Nation meeting to be held in late 2002 or early ’03. For more information, contact ANA at (800) 274-4ANA.
In recent years, nursing schools throughout the country have gone to great lengths to recruit more students from populations that have been traditionally underrepresented in the profession: racial and ethnic minorities, men, people with disabilities and older, “nontraditional” students. But despite this growing emphasis on diversity, that doesn’t mean these students always find a welcoming environment in the classroom where, ironically, they are taught one of the most nurturing of professions.
Today, of course, it is illegal to intentionally deny anyone admission to a college or university on the basis of race, religion, gender, disability or similar factors. And in our politically correct society, minority nursing students rarely hear racial or ethnic slurs from instructors, staff or fellow students. But even though such blatant forms of discrimination are pretty much a thing of the past, students whose race, gender, disability, etc. causes them to be perceived as different from the majority student population may still find themselves feeling acutely aware of their “differentness.”
G. Rumay Alexander, EdD, RN
For instance, they may have feelings of isolation, of being “shut out” by other students or of being “tolerated” rather than accepted. (See “What Students Say.”)
In some cases, they may feel they are being treated differently than other students, or even that they are being singled out or picked on by an instructor for no apparent reason. At its worst, this situation can result in complaints–whether real or perceived–of minority students being held to different standards than their majority counterparts–e.g., given more or different assignments, undeservedly low grades on tests, less opportunity to rewrite a paper or harsher treatment when it comes to absences and make-up work.
“Some students just feel targeted. They don’t fit the image of what the faculty think a nurse should be,” says Sheldon Fields, PhD, RN, APRN, BC, FNP, AACRN, assistant professor at the University of Rochester School of Nursing in Rochester, N.Y. “Maybe you have a different cultural background, language, skin color or gender; maybe you’re a little older or younger, or maybe you’re out about being lesbian or gay. [Whatever it is, it makes you stand out and] it can make you a [potential] target.”
A Subtler Form of Bias
“Discrimination in nursing schools is becoming less of a problem, that’s the good news,” says Chad O’Lynn, PhD, RN, an instructor at the University of Portland School of Nursing in Oregon and author of the forthcoming book Men in Nursing: History, Challenges and Opportunities. “But when it is present, it’s more covert.”
While he still hears stories of overt discrimination from male nursing students–like the one about a professor who said, “I’ve never passed a male student and you aren’t going to pass either”–O’Lynn believes these situations are happening less frequently these days. They are being replaced, however, by a more subtle bias that manifests itself in a learning environment that doesn’t recognize the strengths and talents that ethnic minority and male students bring to the profession, he says.
“The nursing profession is still teaching students how to care for patients in one way,” O’Lynn argues. “The underlying message [to male students] is that if you want to be a nurse, you have to behave like a woman. Although that message isn’t stated explicitly, it is often implicit.” For example, he says, men communicate differently than women and the male style of communication is not valued in nursing schools.
Furthermore, O’Lynn feels there is an overall lack of sensitivity to the issues and concerns that male nursing students face–or even to the fact that male students are present at all. There is the constant referral to nurses as “she,” not only in lectures but in textbooks, he points out. There is the lack of curriculum content concerning men’s health issues, although numerous courses are taught on women’s health.
As a board member of the American Assembly for Men in Nursing, O’Lynn says he hears from many male students who are nervous about examining female patients, particularly in sensitive areas, because they’re afraid of being accused of sexually inappropriate touching. Here, too, he feels that nursing educators are not acknowledging the needs of male students, let alone addressing them.
“It’s the elephant in the living room that nobody talks about,” O’Lynn maintains, adding that nursing programs must do more to help male students learn to work through these issues.
Susan Fleming, MN, RN, a nursing clinical instructor/lecturer at Washington State University’s Intercollegiate College of Nursing in Spokane and a board member of ExceptionalNurse.com, an online resource for nurses with disabilities, agrees that there is less discrimination nowadays than when she first started her nursing studies, but that it does still exist. Fleming was born without a left hand and was denied admission to the first nursing school she applied to because of her disability. She was subsequently accepted at a different school and completed the program successfully.
“[Today] it’s usually an instructor or group of instructors who can’t see past a student’s disability,” she says. “They usually have a problem with [the student’s ability to perform] one skill and they focus [all their attention] on that.”
Fields believes that one reason why bias still occurs in nursing schools today is that even though the students have become more diverse, the nursing faculty has remained virtually unchanged. They are still predominantly white and female. “The nursing faculty hasn’t changed, they’ve just gotten older,” he says. “They’re not adding enough diversity to the workforce to make a difference.”
Some diversity experts argue that it’s unfair to place all of the blame on a few insensitive faculty. “It’s not so much individual acts that people do,” says G. Rumay Alexander, EdD, RN, director of the Office of Multicultural Affairs at the University of North Carolina at Chapel Hill School of Nursing. “It’s systemic. Any ‘ism,’ whether it be racism, sexism, or ageism, can only operate if the system perpetuates it.”
Take admissions policies, for example. Alexander believes many nursing schools have admissions criteria that, while not deliberately exclusionary, may unintentionally be creating an unequal playing field for applicants from underrepresented populations.
“Admissions committees struggle with how to meet mandates in the [institution’s] vision and mission statements to meet the demand of a demographically changed world,” notes Alexander, who also is an associate clinical professor in the School of Nursing. Although nursing schools are incorporating these ideas into their public statements, they aren’t necessarily living them out, she believes. While the intent in many nursing schools today is to be inclusive and have a diverse student body, admissions committees are often operating from outdated guidelines that can actually achieve the opposite effect.
What the schools value or give credit for in their admissions policies can inadvertently keep certain students out, and even perpetuate past discrimination without the school being fully aware of it. For instance, says Alexander, the purpose of promoting legacy is to reward the alumni, but an unintended consequence is excluding students from populations that weren’t accepted in the past. “You can’t have a legacy if [your parents were denied admission],” she points out. Rather than doing away with legacy, she suggests that schools can add an admissions policy that rewards individuals who are the first generation in their family to attend nursing school.
Another issue is how nursing schools define leadership for admissions purposes. Typically, schools value individuals who have demonstrated leadership roles, such as serving as president of the class or a sorority. Many students of color may not have had those opportunities, but they may have served as president of their church choir. “Cultures can have their own ways of crafting a leader,” says Alexander. “To be fair, you need to expand the definition.”
Admissions essays can be still another source of unintended bias. Writing styles may be influenced by a student’s culture, Alexander explains. For example, if the faculty is subconsciously biased toward essays that display emotion about why the student wants to enter the nursing profession, a minority student from a culture that is stoic about expressing emotion would be at a disadvantage.
Conversely, if the admissions committee looks for how knowledgeable about the profession the applicant is and he or she comes from a culture that emphasizes story- telling, that student may be penalized on the essay, says Maria Warda, PhD, RN, dean of nursing at Georgia Southwestern State University.
Admissions criteria that don’t give applicants credit for being multicultural or bilingual also can be inadvertently exclusionary, adds Warda, who is vice president of the National Association of Hispanic Nurses. She notes that current admissions standards are predominantly qualitative, focusing on measurements such as grade point averages and SAT scores. She recommends using admissions criteria that focus on a combination of quantitative and qualitative measures.
Problem or Perception?
Antiquated admissions policies that fail to acknowledge cultural differences can result in bias against minority students before they even get into a nursing program. But what if you are a current nursing student and you feel that you’re experiencing unequal treatment because of your race, ethnicity, gender, religion, disability, sexual orientation, age, etc.? Should you turn the other cheek and just try to focus all your attention on your studies? Or should you speak up about it?
Obviously, it’s hard to just ignore the situation if you feel it is jeopardizing your chances of passing the course, getting a good grade or graduating from the program. Most of the experts interviewed for this article agree that students who believe they have been discriminated against–whether by a faculty member, administrator, clinical instructor or another student–should discuss the situation with the individual involved.
But before you initiate that discussion, you must do what psychotherapists refer to as “reality testing.” In other words, is it really discrimination or is it just your perception? Is there a possibility that you’re being oversensitive? Could you have misinterpreted or overpersonalized the individual’s comments or actions?
Alexander recommends writing down the incident as soon as it happens. “Record it immediately while the details are still fresh,” she says. Then you should process it past someone you trust to get another perspective.
Minority or male students may feel more comfortable checking their perceptions by talking to a student or faculty member of their same race, ethnicity or gender. If that is not possible within the nursing department, O’Lynn suggests seeking out a minority or male professor from another academic department.
He also offers this rule of thumb for assessing whether or not a male student is really experiencing gender bias: If the roles were reversed and the situation happened to a female student in medical school and it would be considered a problem, then it’s a problem for the male nursing student and he is not being overly sensitive.
Taking Action. . .
If a student’s perception of bias is validated, it’s time to proceed with what Alexander refers to as a “courageous dialogue.” As her nursing school’s chief diversity officer, helping to resolve such conflicts is part of her job. “I help people work through it, rather than walk away and make assumptions or judgments and operate out of those for the remainder of their time together,” she says.
If students feel that they can’t approach the faculty member because of the power inequity, they come to her. If the student feels threatened or vulnerable, Alexander suggests having a third party sit in on the discussion, as these types of situations can escalate rapidly. Over the years, she has served as that third party on behalf of students as well as faculty and staff members. “I’m there to support that person who has experienced the inequity, unfairness or injustice,” she says. In certain situations, she has even interviewed other students who were present during the incident.
Susan Fleming, MN, RN
Alexander not only encourages students to pursue this dialogue, she also offers tips on how to communicate their position more effectively. For example, she says, always use “I” statements, as in “I felt this way. . . .” Using “you” statements, such as “you make me feel. . .,” puts the other person on the defensive.
If talking one-on-one doesn’t solve the problem, then the student should learn the school’s policies and procedures for filing a grievance. “The more you adhere to the process, the better the chance of having your voice heard,” Warda advises.
Following the chain of command may involve talking to the school’s diversity officer, the student’s advisor or the associate dean. At most schools, the academic dean or the director of the Office of Admissions are helpful when trying to work through these types of situations, says Alexander. Talking with a representative of your school’s student nursing organization or minority student association who can share the encounter with leadership may also be beneficial.
Additionally, most schools have an Equal Opportunity office to mediate conflicts regarding discrimination and harassment. Fields encourages students to seek out an ombudsman, a process that he has found to be helpful because it gives access to an outside person who is unbiased.
Students who feel they have not gotten satisfaction from their school’s grievance process can seek outside legal counsel, provided that they have ample documentation to prove their case. Asking national organizations, such as the National Black Nurses Association, the National Association of Hispanic Nurses or the American Assembly for Men in Nursing, to intercede on your behalf may also be an option. However, the decision to take action at this level should be weighed heavily because it does come with potentially steep consequences.
“The problem is that nursing courses are not transferred between schools, so the student could be throwing away an entire academic year or two,” Warda cautions. Or worse, you could be jeopardizing your future career in nursing.
. . .Or Not
Sometimes you really can fight City Hall. Other times the battle may just not be winnable and it’s better to drop it and move on. Ultimately, minority nursing students who feel they are victims of bias must decide which option is right for them.
Alexander notes that not all schools jump to embrace diversity. Some talk about it, but don’t actually do it. “You have to decide ultimately if this school is the right place for you,” she says. “If you’re under physical and mental distress, getting sick all the time, then these are signals that it’s not the best place for you.”
If the situation is so egregious that it’s threatening your ability to progress, then you must stand up for yourself and take action, says Fields. If, on the other hand, the situation is not that bad and you have some support to help you handle it, then “suck it up, graduate and move on with your life,” he advises.
“At some point in your career, you will be able to express how you feel by, for example, never giving back to your alma mater,” Fields continues. “You live to fight another day. You don’t jeopardize your goals, especially if you’re outnumbered or outgunned. Nursing school is hard enough without having to deal with that burden.”
Fleming’s case is a perfect example. When she first applied to nursing school she was given a “skills test” that involved spiking IV bottles. Because she had some difficulty performing the task–which was not surprising, since she had never been taught how to do it–she was told that she would endanger patients’ lives and she was not accepted into the program. Continuing to work as a nurses’ aide and encouraged by a doctor to re-apply to other nursing schools, Fleming found a school that welcomed her. When she asked about the “skills test,” she was told that giving her such a test would be illegal. In hindsight, Fleming realizes that half of her current students wouldn’t have been able to pass the test.
“I realized that I could expend my energy fighting the system,” she says. “But because I found another school that did accept me, I thought it was more important to turn my energy to my education.
“There are no stop signs,” she adds. “They’re just roadblocks. You have to go around them.”
Above all, says Fields, “Never give up your dream of being a nurse just because one particular school doesn’t think you fit its mold for the kind of nurse it wants to produce.”
“As nurses, we’re expected to provide quality health care to people from a variety of cultural and socioeconomic backgrounds. Without diversity among our ranks, it’s almost impossible to do that.”
That’s how May Wykle, RN, PhD, FAAN, explains her decision to make diversity the focus of her term as the 24th president of Sigma Theta Tau International (STTI), the Honor Society of Nursing.
The society, whose mission is to provide leadership and scholarship in nursing practice, education and research in order to enhance the health of all people and improve nursing care worldwide, has 120,000 active members in 90 countries. Yet, like the nursing profession itself, STTI remains predominately white and female. When Wykle, who is African American, began her two-year term as president in 2001, its membership was 96% female and 93% white.
“Since we are the international honor society of the profession, we should take the lead in defining diversity and making a commitment to achieving it,” asserts Wykle, a distinguished scholar, researcher and geriatric health specialist who is currently dean and Florence Cellar Professor of Nursing at Case Western Reserve University’s Frances Payne Bolton School of Nursing in Cleveland. “The diversity in nursing should mirror that of the general population. My definition of diversity is a broad one that includes cultural diversity, but also diversity of gender, backgrounds, resources and talents.”
To achieve these goals, the honor society has launched an ambitious initiative designed to increase and celebrate all forms of diversity within its membership ranks and in the nursing profession as a whole. The push began last year with the creation of a Diversity Task Force, whose responsibilities included drafting the organization’s official position statement on the subject, “Community Through Diversity: A Diversity Statement for Sigma Theta Tau International.”
In stating STTI’s overall motivation in pursuing diversity, the position paper notes that “diversity creates an opportunity to support a mosaic of cultural distinctiveness and nursing excellence through inclusivity, personal and professional development and the stimulation to think in different ways.”
Diversity at the Top
Sigma Theta Tau’s commitment to “the value and active engagement of diversity in achieving the society’s vision” encompasses 10 points, beginning with encouraging dialogue at the both the individual and chapter levels. The society’s more than 400 local chapters and their members are charged with finding ways to enhance diversity, such as developing educational programs that promote diversity, cultural competence and community building.
The initiative also stresses the importance of reflecting diversity in the society’s leadership by seeking officers and committee members from culturally diverse backgrounds. This “starting at the top” approach is vital to any organization’s efforts to build diversity, according to STTI Vice President Carol Picard, RN, PhD.
“You diversify an organization from the top to the bottom and horizontally,” explains Picard, associate director of the Graduate Program in Nursing at MGH Institute of Health Professions in Boston. “Having a diverse leadership makes a difference in [attracting more minority nurses and men] into the organization and in how we present Sigma Theta Tau to the world.”
This year, in addition to Wykle, the organization’s board of directors includes one other African-American woman and three men, including one European. And for the first time, the organization has elected a man, Daniel Pesut, RN, PhD, CS, FAAN, to the position of president-elect. Pesut has been involved in Sigma Theta Tau since his 1976 induction as a nursing student.
“For STTI, diversity is a means to building a community,” he says. “We want a diverse membership so that we can attract the best of the creative minds and backgrounds to build a stronger community within the organization.”
Pesut, who is professor and chair of the Department of Environments for Health at the Indiana University School of Nursing in Indianapolis, feels that attracting more minority and male nurses into the organization can best be accomplished on a one-on-one basis backed by national media coverage.
“We need more coverage of the different kinds of things that men are doing in nursing,” he adds. “The reason I am a nurse is that it gives me creativity and flexibility in career roles. You can be a consultant, you can practice, you can teach. You can do a variety of things with the same fundamental education.”
While the honor society’s national leaders are spearheading the diversity initiative, much of the responsibility for actually changing the demographics of the organization will rest with its local chapters. At the chapter level, diversity doesn’t just mean attracting more male and minority members, but also providing education programs on cultural competence to help all local nurses better meet the needs of the diverse patient bases they serve.
Many STTI chapters have found success in attracting more nurses from underrepresented populations into their membership by jointly sponsoring educational and networking events with other local and regional nursing organizations.
“In Boston, our chapter has partnered with the New England Black Nurses Association to hold a luncheon with a guest speaker,” says Picard. “From those types of events, nurses learn about us and we can establish relationships with [minority] nurses who might be interested in joining Sigma Theta Tau. In turn, these new members take our message back to their nursing colleagues.
“I hope to see more such partnerships engaged in dialogues at the local level,” she adds. “That will give us the broadest impact across the world.”
The honor society will learn more about how well its chapters are implementing the diversity plan at the local level when chapter annual reports are submitted in July.
Encouraging Diversity Today–and Tomorrow
Attracting more men and nurses of color into its current membership is just one aspect of Sigma Theta Tau’s diversity goals. The honor society is also exploring ways to increase the racial, cultural and gender diversity of the nursing profession in the future. One local chapter, for example, is sponsoring a Girl Scout troop.
“We have to talk about the importance of nursing [careers] in the early grades,” Wykle explains. “Nursing has always been held in the highest esteem among racial and ethnic minority groups. We need to build on that.”
One barrier she hopes to challenge is the career advice many minority students interested in nursing careers receive from guidance counselors. “So many of them are counseled to go into two-year [nursing] programs,” she says. “These programs are fine, but students need to be encouraged to keep going and earn a higher degree.”
Wykle believes the low number of associate-degree and diploma students who choose to continue their nursing education at four-year universities can be blamed on the misconception that “a nurse is a nurse is a nurse.” Disproving that myth by demonstrating the career advantages a BSN degree brings would play a key role in drawing more minorities into nursing leadership roles, she adds.
“Once we have attracted a diverse group of students into nursing programs, we want to make sure they have access to faculty and practicing nurses who can provide mentorship and other types of support that help retain minority students,” the STTI president continues. “It’s one thing to bring in people [from diverse backgrounds], but we also have to ensure that they’ll stay in the profession.”
Still another key item on the Honor Society of Nursing’s diversity agenda is to address the disparities in health outcomes and quality of care between Caucasian populations and persons of color. As Wykle puts it, “We want it to be an even playing field.”
To meet this challenge, Sigma Theta Tau hopes to influence the nursing research community so that more members of underrepresented minority groups will be included in research studies.
“To change [health care] practice, you have to have the evidence,” Wykle points out. “Nursing needs research not only to discover improvements in patient care but also to contribute to the growth of the profession. STTI envisions research being conducted not just by nurse scientists with PhDs, but by nurses at all levels who value research and want to solve clinical problems. If nurses don’t do the research, who will?”
Diversity on a Global Scale
Because Sigma Theta Tau is an international society, efforts to promoting diversity within its membership must take a global approach. The organization has chapters in Canada, Brazil, The Netherlands, Hong Kong, Korea, Pakistan and several other countries. This can sometimes cause STTI’s leaders to reexamine membership policies that work well in North America but may not be effective in other parts of the world.
The society’s traditional chapter model is one such structure currently under examination. In the past, STTI chapters have always been affiliated with a university. Now, several nurses in Africa have expressed an interest in forming a Pan-Africa chapter. The nurses involved are national leaders in the profession and members of an association that meets regularly but is not affiliated with a university.
“They came forward to the eligibility committee and said, ‘this is how we connect [professionally] and we would like our association to be the way we bring Sigma Theta Tau to our nurses,’” Picard explains. “So we’re working with them to establish a new chapter model that will fit their needs.”
Being able to interact with international nurses from a diverse range of countries and cultures is a big draw for STTI members, according to Richard Smith, RN, MSN, who has held various local and national positions in Sigma Theta Tau and now serves on its national Public Relations Committee. “You have the opportunity to work very closely with people throughout the world who are working toward a common goal of promoting professional aspects of nursing, whether it’s research or another objective,” he says. “You benefit from gaining their [international] insights and perspectives.”
To Be Continued
Wykle knows that all of her goals won’t be accomplished before her term as president expires next spring. She’s hoping, however, that her two years at the helm have laid the foundation for Sigma Theta Tau International to not only increase its own racial, ethnic and gender diversity but also change the way nursing care is delivered to people of color.
“I think this initiative will eventually impact nursing significantly,” she explains. “Having an international honor organization step up and call for more diversity in nursing is going to improve the image of the profession. It’s going to attract a more diverse group of people into nursing and also attract more young people. We can’t do all of this in two years, but we can have people become more aware of the differences in care [available to white versus minority populations] and work toward a goal of erasing those disparities. We can help people understand that nursing is a wonderful, open profession.”
Becoming a Member
The opportunity to help increase the racial, cultural and gender diversity of one of nursing’s most respected professional organizations isn’t the only reason why nurses of color and male nurses should think about joining Sigma Theta Tau International. Membership in this prestigious international honor society, whose name is synonymous with excellence, leadership and scholarship in nursing, offers many benefits that can help advance your career and foster the achievement of your personal goals, whether your interest lies in clinical practice, education or research.
Adding STTI membership to a resume or vita sets a nurse apart as someone who is interested in playing a leadership role in the profession, says Richard Smith, RN, MSN, who serves on the society’s national Public Relations Committee. “The organization stands behind research and supports evidence-based practices,” he explains. “STTI’s emphasis on scholarship and professionalism is its most outstanding feature.”
Smith, an assistant professor at the University of Arkansas for Medical Sciences College of Nursing in Little Rock, notes that his involvement with STTI has benefited him in every stage of his career: as a student, a clinical nurse and now as a faculty member.
“Sigma Theta Tau has opportunities for you no matter what your particular career focus is–whether you’re a clinician who works in a hospital or even a self-employed nurse entrepreneur,” he states. “There’s a heavy emphasis on research, which is necessary for good evidence-based practices. If you’re a faculty member, you want to prepare your students with the latest information for achieving better patient outcomes. Sigma Theta Tau is a good vehicle for that.”
Currently, more than 60% of the organization’s active members are clinicians, 23% are administrators or supervisors and 17% are educators or researchers. Sixty percent of STTI members hold advanced degrees.
How does the honor society recruit new members? Most of them are invited to join while still in nursing school. Undergraduate students must have completed at least half of the nursing curriculum, have a GPA of 3.0 on a 4.0 scale, rank in the upper 35 percentile of their class and meet the society’s expectation of academic integrity. Graduate students must have completed 25% of their curriculum and have a GPA of at least 3.5.
“Student members have access to the same benefits [of STTI membership] that are available to nurses who have been working in the field for many years,” says Smith. “Plus, students have the added advantage of being able to develop a mentor relationship with more experienced STTI members. For graduate students, it’s an opportunity to be involved with faculty as a peer member of the same organization, not just as a student.”
Membership in Sigma Theta Tau isn’t just open to students–practicing nurses are often invited to join as well. They must be RNs, be legally recognized to practice in their country, hold at least a baccalaureate degree in nursing and have demonstrated achievement in the profession.
For these nurses, there is less emphasis on the grade point average they may have earned years ago, emphasizes STTI Vice President Carol Picard, RN, PhD. “We’re looking for people who are community leaders. I can remember having someone come to me and say, ‘my GPA was only 2.9 but I’d like to join.’ This person happened to be running the HIV action committee for a large city,” Picard says, adding that the nurse’s professional accomplishments and contributions to health care outweighed her lack of a 3.0 average.
Even though membership in STTI is invitational, Daniel Pesut, RN, PhD, CS, FAAN, who next year will become the honor society’s first male president, encourages qualified nurses to be proactive about becoming involved in the organization, rather than waiting for an invitation to join. “Visit our Web site and find a chapter near you,” he recommends. “If someone is actively making a contribution to the nursing profession, he or she can certainly seek membership by getting connected with the local chapter.”
For more information, contact:
Sigma Theta Tau International
550 West North Street
Indianapolis, IN 46202
Fax (317) 634-8188
Photo by Daquella manera
For most people, an emergency room visit or a extended stay in a hospital’s intensive care unit is a trying, perhaps even frightening experience. So imagine going through the same ordeal while looking up into the faces of health care providers who look nothing like you, don’t speak your language and know nothing about your culture.
That’s what a growing number of hospital patients encounter these days as the nation’s population becomes increasingly diverse and the shortage of emergency department and critical care nurses–especially minority nurses–continues.
A January 2002 report by the American Organization of Nurse Executives states that the average nurse vacancy rate in critical care fields is 14.6% compared with 10.2% overall, and nurse executives surveyed said staffing shortages are contributing to emergency department overcrowding. According to the American Association of Critical-Care Nurses, the number of requests for temporary and traveling critical care nurses to fill staffing gaps has skyrocketed in every part of the U.S., with an especially pronounced demand in the areas of adult critical care units, pediatric and neonatal ICUs and emergency departments.
Given the severe underrepresentation of minority nurses in the nation’s overall RN workforce, it’s easy to understand why the nursing staffs in emergency departments and critical care units don’t reflect the racial and ethnic diversity of the patients they serve. The National Association of Hispanic Nurses estimates that Hispanics make up only 2% of RNs in the United States, even though they account for 12.5% of the nation’s population. African Americans, meanwhile, account for 12.1% of the population but only 4.9% of RNs. On the other hand, Caucasians make up 69.1% of the population, yet they account for an overwhelming 86.6% of the RN workforce.
Training RNs to become emergency department and critical care specialists is the goal behind an innovative collaboration between HCA (Hospital Corporation of America) Affiliated East Florida Hospitals and Broward Community College (BCC) in Miami. The program, which is open to HCA nurses only, is funded by a $4 million Specialty Nurse Training Grant awarded under the President’s High Growth Job Training Initiative and implemented by the U.S. Department of Labor’s Employment and Training Administration. The award is divided between the Florida and Texas divisions of HCA.
“We are focusing on these two specialties because we saw the most vacancies in these areas,” explains Broward Community College’s Alicia Hinton, BSN, RN, MBA, emergency department project manager for the grant.
One reason for those vacancies, says Kathy King, ARNP, MSN, CCRN, the college’s director for the specialty grant, is that because more patients are now able to be treated without hospitalization, the patients who do end up in the hospital are sicker than they were in the past and therefore require more care. At the same time, the nursing population is getting older and is less inclined, as a whole, to work in these specialties.
“We are seeing nursing shortages really impacting those areas of the ICU and the [ED] the most,” King says. “The literature suggests that cardiovascular ICUs are also having a large percentage of shortages. [These jobs are] very physically demanding, so [RNs are] trying to transfer into a less acute area of nursing.”
The BCC/HCA Specialty Nurse Training Program, which began training students in January 2005, isn’t designed specifically to increase the number of minority nurses in critical care and emergency nursing. But because the training is offered in the culturally diverse Miami area, a large percentage of the program’s students and graduates are nurses of color.
“The cultural diversity in this program has been unbelievable,” says Charlene Ingwell, MSN, RN, project manager for HCA.
Of the 130 nurses who have either completed or are currently enrolled in the program, 37 are African American, 37 are Hispanic, 28 are Caucasian, 15 are Asian and 13 are classified as “other.”
“I think every cohort has had at least one male student,” adds King. “In this last group we had three, and it averages between one to three per class, so we’ve probably had close to 20 male students.” To be exact, the breakdown by gender is 108 females and 22 males.
The project’s goal was to enroll at least 80 RNs into the training program over the two-year grant period. Of the 130 nurses who have participated in the program, 79 chose training as a critical care specialist while 51 chose emergency department training, which builds on the critical care component. Graduates from the program receive college credit from BCC, in the form of an Advanced Technical Certificate that can transfer to other colleges and universities.
Pedro Valdes, Jr., RN-CEN, was in the second cohort of nurses who completed the specialty training. He chose to become an emergency department specialist and now works as an ED nurse at HCA’s Kendall Regional Medical Center.
“We were a very eclectic group, ” says Valdes, who has been a nurse for three years. “We had someone from everywhere.”
Having such diverse classmates not only made him feel comfortable, he says, it also provided unique learning opportunities as students shared their experiences treating patients from different cultures. That sort of knowledge is beneficial in a hospital like Kendall Regional, where the patient population is becoming increasingly diverse, Valdes adds.
Disparities between the quality of health care received by Americans of color compared to the majority Caucasian population are well documented. The National Healthcare Disparities Report, published annually by the Agency for Healthcare Research and Quality (AHRQ), reported in 2003 that “racial, ethnic and socioeconomic disparities are national problems that affect health care at all points in the process, at all sites of care and for all medical conditions.” The Institute of Medicine, the Sullivan Commission on Diversity in the Healthcare Workforce and other groups recommend increasing the number of culturally diverse minority nurses in order to help eliminate these inequities. And health care providers like HCA have taken notice.
“To bridge the gap between caring and cultural competency, many health care organizations are looking to hire minorities who represent their patient population,” says Hinton. “They have found that this has been effective in reducing patient complaints, and I would venture to say it reduces the potential for lawsuits, because many lawsuits start out as misunderstandings or miscommunications.”
Learning While Earning
HCA nurses who are selected to enroll in the specialty training program–which is open to both current employees and newly hired RN grads–first complete a two-week basic arrhythmia course (or pass a challenge exam) before moving on to a two-week clinical on a telemetry unit. Experienced nurses then move on to the four-week critical care course, while graduate nurses continue to gain experience by working on a telemetry unit for three to four months before starting the critical care program.
Students who are not planning to advance to emergency department training go through clinicals on a critical care unit for six to eight weeks. Those who do desire the ED specialty complete a two-week critical care rotation, followed by a two-week emergency department course and six to eight weeks of clinicals in the ED. After three months, all students return for a three-day, 12-lead EKG course.
The training includes a mix of didactic courses, skills lab and a clinical internship. Courses are taught at Broward Community College and simulcast to HCA’s JFK Medical Center. Students must attend class daily, with both online learning and face-to-face classroom activities. This intensive learning environment is designed to accelerate the time typically needed for nurses to become familiar, comfortable and confident with their new specialized skills.
Nurses who work in any of the 13 HCA Affiliated East Florida Hospitals are eligible to apply for the Specialty Nurse Training Program. During the training period, participants are considered both employees and enrolled students of Broward Community College, remaining on HCA’s payroll while earning college credits.
One of the most beneficial aspects of the program is the one-on-one pairing of students with preceptors experienced in emergency department or critical care nursing. Students make rounds with their preceptors, who are given a normal patient load so they can spend the time needed to train their preceptees. The student and preceptor develop a trusting relationship, King says, and as the student’s skills increase, assignments become more complex and the student’s independence grows.
In addition, placing nurses together who are seeking training in separate specialties helps bridge the gap between emergency department and critical care nurses, Hinton says.
“There has been a long history of a little disconnect between critical care nurses and ED nurses,” she explains. “We feel we are planting a seed of empathy, if you will, amongst the two areas, so ultimately the patients will get the greatest care possible. I believe the way our program is set up helps foster and enhance that collegial relationship that is so important in facilitating a good patient outcome.”
Keeping It Going
Ultimately, one of the key benefits of having such an ethnically diverse group of students in the BCC/HCA Specialty Nurse Training Program is the education of more nurse specialists who can help increase the overall cultural competency among the nursing staff at their respective HCA hospitals.
“Culturally competent nurses can contribute to positive patient outcomes,” Hinton emphasizes. “Patients feel more comfortable if they feel their culture is being accepted, and they also communicate more to that nurse.”
Culturally competent nurses are often able to detect various illnesses based on their comfort level with patients, Hinton says, and that makes it easier for them to ask the right questions and guide the patient toward the proper treatment.
The training program addresses the need for cultural competency by requiring students to interview someone from a culture other than their own and to develop a 15-minute slide presentation on communication style, space preference and social organization. The students are required to incorporate into the presentation three things that can be implemented to promote cultural harmony.
Students are encouraged to pay attention, Hinton says, by the inclusion of questions on the final exam that are drawn from the presentations. King, who has sat in on some of the slide shows, says she has found them enlightening: “As a faculty member, I have learned numerous points about care and management of not only different cultures but different religions.”
HCA employees who enroll in the training program must commit to remaining with the company for at least two years. HCA is gauging response to the program, King says, by surveying nurses and nurse managers. So far, comments have been overwhelmingly positive, and the retention rate among the program’s graduates is 88%, which King says is above the national average. Nurses who have left have generally been those who were forced to move because a spouse was being relocated, while a few have decided that emergency department or critical care nursing is not for them.
“If a nurse is not [psychologically] prepared to be in those [highly intense critical care areas]–and even if he/she is prepared–[the stress] can take its toll,” says Hinton, adding that burnout contributes to the shortage in critical care and emergency department nursing.
Prior to implementation of the program, HCA hospitals trained nurses to work in these two crucial specialty areas on their own. There was concern that training was inconsistent in these specialties where consistency, skill and knowledge are indispensable. Now, Ingwell says, nurses receive the theory behind what they’re being taught combined with the hands-on clinical component. “The program is absolutely amazing because they get the training, the knowledge and the resources they need to really shine in these two specialties,” she explains.
With the grant scheduled to expire in May 2007, the project managers are looking toward future sustainability for this successful initiative. “The idea is that [once the grant ends] HCA will step up and say, ‘How can we continue with this program without the presence of the grant,’” says Ingwell.
Diversity directors appear to be a small but dedicated niche among nursing schools that are making an effort to better include and serve people of varying racial, ethnic and cultural backgrounds. While campus-wide diversity and multicultural affairs offices are fairly common at major U.S. universities, it’s rarer for nursing schools—or other individual colleges and professional schools, for that matter—to have a diversity department of their own.
“There have been pockets, but it hasn’t been done consistently, and there hasn’t been a big vision ,” says Mary Lou de Leon Siantz, PhD, RN, FAAN, assistant dean for diversity and cultural affairs at the University of Pennsylvania School of Nursing in Philadelphia.
There’s at least one reason, however, why the idea of establishing an office dedicated to enhancing the recruitment, retention and teaching of a diverse population may soon catch on at more nursing schools. “Now more than ever, because of the changing demographics of the United States, [a greater focus on multiculturalism in nursing education and practice] is very badly needed,” notes Siantz, who is a past president of the National Association of Hispanic Nurses.
By having their own formalized diversity departments and appointing diversity directors, nursing schools are in a position not only to create a more inclusive profession but also to prepare future nurses to meet the health care needs of an increasingly multicultural patient population. But what exactly do diversity directors do? And is this an emerging career opportunity that more minority nurses should consider pursuing?
The Mission and the Vision
One of the first tasks that Lillian Stokes, PhD, RN, FAAN, took on when she took the helm of the Office of Diversity and Enrichment at Indiana University School of Nursing in Indianapolis was to help fashion a diversity mission statement. Today, she sees that message displayed on a bronze plaque each time she walks through the front entrance of the school.
“Our overall vision is to try to promote an environment that values respect and reflects a global view of diversity,” says Stokes, who is also an associate professor at Indiana and the national president of Chi Eta Phi, a sorority for minority nurses.
Clarifying the vision of a diversity department usually starts with determining what diversity means. “We define diversity here as ‘holding multiple perspectives without judgment,’” says G. Rumay Alexander, EdD, RN, director of the Office of Multicultural Affairs and associate clinical professor at the University of North Carolina-Chapel Hill School of Nursing.
Nursing school diversity directors say they want to expand the definition of diversity beyond the familiar parameters of race, ethnicity and gender. “One of the things I always talk to our first-year students about is the need to think about diversity in broader terms, not just [in terms of] ethnicity,” says Jana Lauderdale, PhD, RN, assistant dean for cultural diversity at Vanderbilt University School of Nursing in Nashville. “That’s something I kind of preach all the way through the program.”
The term can apply to any subculture or underrepresented group, she explains–for example, homeless persons, people with disabilities or people with chronic illnesses.
In Alexander’s view, achieving diversity means more than simply admitting more students from diverse backgrounds. These students need to find a supportive environment that will help them succeed.
“If you’re inviting people into an environment that for whatever reasons does not feel welcoming to them, or treats some [members] of its community in an inequitable way, then you may be bringing in many people through the door, and your numbers may be going up in terms of admissions,” she says. “But if these students are not successful in matriculating through the program and graduating, then it’s kind of like coming in the front door of a house and going out the back door.”
At Penn, Siantz says a key element of the school’s vision is that the commitment to diversity must be top-down. “That means that at the top there is recognition of the need to diversify the administration and the faculty, as well as the student body, to better promote the mission of the school,” she explains. “Diversity is the number one strategic goal of the School of Nursing. Globalization is the second.”
The Scope of the Job
A common thread in the job descriptions of nursing school diversity directors is a major focus on assisting students. Some are also involved in faculty programs and curriculum development.
At Indiana University School of Nursing, Stokes’ Office of Diversity and Enrichment is part of the Center for Academic Affairs. The enrichment part of her job title is broad in scope.
“This position calls for working with all students, not just minority students or underrepresented students,” she says. “Although the faculty and my office are committed to supporting underrepresented students as much as possible, I probably see just as many or more majority students.”
Diversity-related programs at Indiana’s nursing school include “empowerment sessions” to aid students with test taking, stress management, time management, organization and other skills; peer-led tutorial reviews of specific classroom subjects; a Diversity Forum series featuring presentations by faculty members and local and national leaders; and workshops for faculty on teaching students from diverse cultures.
Recruitment of minority and international students is another aspect of Stokes’ job, although she says it’s not her primary role. “We have a marketing and recruitment person [who is in charge of that],” she explains. “I work very closely with that office, and also with our graduate offices.”
Stokes and some of the senior nurse researchers on the faculty have established a program called Connections that targets students who might be good candidates for the PhD program in nursing. “We meet with students—it may be one student or ten—who express an interest or who I see have potential,” she says. “We take them through the admissions process [and] get them to start thinking about their research area, so we can think about a faculty member who might work with them.”
Two students–one African American and one Nigerian–who participated in Connections have since begun their doctoral studies in the School of Nursing. “They are doing very well,” Stokes reports.
She is also a founding member of the nursing school’s Minority Advisory Council, now called the Diversity and Enrichment Council. The group includes faculty, students, staff and community partners, such as practicing nurses, politicians and leaders of local organizations.
Lauderdale, who is president-elect of the Transcultural Nursing Society, says the range of her job at Vanderbilt “seems to be a moving target. Almost every day, there seems to be another layer added to it, which tells you something about the scope of the need for a position of this type.”
Lauderdale’s initial focus was on ensuring a “cultural diversity content thread” throughout the curriculum, “so that by the time students graduate, they feel comfortable working with patients from different cultures and are able to provide culturally competent care.”
Today, in its expanded role, the cultural diversity office at the School of Nursing offers an Academic Enrichment Program in which a group of students meet about once a month for brown bag lunch discussions on a wide range of topics–from critical thinking skills and time management to working with culturally diverse patients. Lauderdale also coordinates a Pre-Nursing Society for freshmen and sophomores who are considering nursing as a career.
For faculty, the nursing school’s summer institute on teaching strategies includes discussions of how to celebrate cultural diversity in the classroom. In addition, Lauderdale works closely with the faculty member who directs the cultural diversity program in the School of Medicine.
Diversity Is a Full-Time Job
When Alexander came aboard at UNC, she turned what had previously been a part-time role into a full-time focus. “Prior to my [being hired], the issues relating to diversity and inclusion were part of an assignment [given to] someone else on the faculty,” she explains. For her predecessors, this function took up a relatively small percentage of their responsibilities.
“I came into the interview with a clear understanding, because of [my] past work experience in diversity, that if it wasn’t getting the full attention of someone and it was kind of the job of ‘everybody,’ it was not going to get the traction that it needed to get,” Alexander says.
Specific diversity enhancement strategies at her school include a continuing education requirement for faculty and staff that is linked to their performance evaluations and compensation; the Kindred Spirits Award for Excellence in Multicultural Scholarship, given each year at commencement to a student who exemplifies respect for diversity; and an Ethnic Minority Visiting Scholars Program.
All of these elements, Alexander says, make her days on the job “unpredictable and lots of fun.”
At Penn, Siantz works closely with the nursing school’s Master’s Curriculum Committee and Diversity Committee. She also partners with other groups within the school and throughout the campus that are interested in promoting diversity.
For example, Siantz has partnered with the university’s medical school to develop a Leadership Education and Policy Development program to promote leadership skills among nurses and physicians of color. Supported by the university vice provost’s Office for Diversity, this program also teaches them how to use their research and clinical practice to help shape public health policies to eliminate disparities.
Another key strategy for Siantz has been to become a faculty member of minority nursing student organizations on campus, holding leadership retreats with the groups’ outgoing and incoming boards.
Challenges and Rewards
All of the nursing school diversity directors interviewed for this article admit that the work they do has its share of challenges. Yet they also find it extremely rewarding, especially when they see that their efforts to promote diversity and inclusiveness are producing measurable results and making a real difference at their institutions.
Siantz says one of the biggest challenges in diversifying the nursing profession is that nursing schools need to extend their outreach beyond the college campus.
“We need to partner with the [elementary and secondary] school systems, because despite the fact that the numbers [of people of color] are growing, they’re not going to college,” she emphasizes. “That’s something that the schools in individual communities need to wrestle with in terms of how they’re going to change that picture over time.”
Stokes sums up the main barrier multicultural students face in advancing their nursing studies with one word: “Money.” For example, she says, “I’ve been in communication [recently] with a young lady who graduated from another university here in [Indianapolis]. She has attended several of [our] Connections programs, but right now it’s [the lack of] money that’s keeping her away [from pursuing doctoral studies here].”
On the plus side, the school has been successful in obtaining a National Institutes of Health grant that provides some scholarships and stipends for qualified nursing students. About 36 nursing students at Indiana have participated in the university-wide Summer Research Opportunities Program, and several have gone on to pursue graduate studies. “I think we have had more students in the program than any other unit [of the university],” Stokes comments.
Another success story for Stokes has been seeing the nursing school’s learning environment change for the better when it comes to faculty interaction with students from diverse backgrounds. “They just have a better understanding of students who are different from them,” she says.
At UNC, one of Alexander’s proudest accomplishments has been to have the School of Nursing become a national role model for promoting and achieving diversity.
“We are called on frequently to consult with other schools about how to walk the talk of inclusion,” she says.
Is This a Career for You?
Because nursing school diversity directors represent a newly emerging specialty, there is little data available about their current employment statistics, salary levels or the career outlook for the field. However, the U.S. Bureau of Labor Statistics reports that the mean annual wage for all education administrators in colleges, universities and professional schools was $86,480 in 2006.
What kind of background and experience would be prerequisites for this career? The BLS notes that top student affairs positions usually require an EdD or PhD, along with good interpersonal, leadership and decision-making skills.
The directors interviewed for this article all have credentials that fit that profile. Alexander has an MSN from Vanderbilt University, training as a family nurse practitioner and an EdD in educational administration and supervision from Tennessee State University. She also has work experience in both hospital and corporate settings. Just prior to arriving at UNC, she was the head of her own diversity consulting business in Nashville.
Lauderdale has an MSN with a major in maternal-child health from Texas Women’s University and a PhD in transcultural nursing from the University of Utah.
Stokes has an MSN from Indiana University School of Nursing and a PhD in instructional psychology with a minor in gerontology from Indiana University-Bloomington. She says her instructional psychology background, with its focus on teaching behaviors, is an asset in her current job.
Siantz has a master’s in child psychiatric nursing and community mental health from UCLA and a PhD in human development from the University of Maryland. Before accepting her position at the University of Pennsylvania, she was an associate dean and director of the Center for Excellence in Hispanic Health at Georgetown University.
Siantz believes the successful nursing school diversity director will be someone who is a visionary leader with excellent communication skills and strong relationship-building skills. “The person who is recruited to this position must be a senior-level person who not only walks the talk but also understands, and has a vision for, how to pull it forward,” she says.