Diversity in the nursing faculty has been an ongoing topic of discussion. Over the last year, there has been a degree of discourse in the United States. Many universities created or are in the process of creating position statements for diversity, equity, and inclusion. The question is, why did we have to wait? Why not be proactive instead of being reactive?
At my alma mater, Norfolk State University, a historically Black university, I was welcomed with open arms, not just from the nursing faculty but all faculty. It resonates with the student and self-efficacy when they can see people who look like them, who have reached the goals they are attempting to achieve.
As an African-American nursing faculty member for RN, MSN, Nurse Practitioner, and DNP students, my goal is to help my students reach their goals. It is a bonus to help inspire a person of color that may not have felt the encouragement of their counterparts.
While I am here to make a difference, there still are challenges that I face as a doctorate-prepared professor, where I am not treated equitably. Researchers Christine Salvucci and Carolyn A. Lawless reported in the Journal of Cultural Diversity in 2016 that minority faculty of color have unique experiences, which has an impact on interpersonal relationships and the professional components of their career compared with White colleagues. In some of the articles that were reviewed, there was a review of topics that included “Insincerity and Putting You in Your Place,” “Invalidation of Sense of Self,” and “Unequal Standards.” As some of my colleagues of color and I have discussed and experienced these topics, the aforementioned topics resonate with me. There is increasing diversity in the students that are presenting to advance their education. How can we begin to retrospectively attempt to address diversity, equity, and inclusion for the students, and we have not properly addressed for the faculty? We have to do better. More research is required, and change is necessary.
With a recent and horrifying uptick in hate crimes against Asian Americans, May’s Asian Pacific American Heritage Month is especially timely to help educate people and find another opportunity to eliminate the systemic racism that leads to such harmful incidents.
According to the Center for Study of Hate & Extremism, the rate of anti-Asian hate crimes rose 149 percent in 2020 alone and continues to rise in 2021. The long-lasting implications for being a target of a hate crime or even part of a larger group that is being targeted are troublesome. Whether you’ve experienced AAPI racism personally or seen it happen to colleagues, family, or friends, the impact to mental health and personal security is only the beginning of the potential detrimental effects.
As a nurse, you may treat patients who have been hurt or threatened in a hate crime. You may treat people who direct hate and threats at you or someone in your care. The concern and fear can be paralyzing, and making sure your colleagues and supervisors are aware of incidents can help your organization track them.
And it’s helpful to have the government recognize the problem and take active steps to mitigate hate crimes. The COVID-19 Hate Crimes Act, recently signed into law by President Joe Biden, is designed to make reporting hate crimes easier through more extensive public outreach, straightforward reporting and resources available in multiple languages, and community education opportunities to reduce crime.
AAPI nurses can find a professional organization such as the Asian American/Pacific Islander Nurses Association, Inc., that offers resources and support as well. You can check out their past newsletters to find out about what nurses across the country are working on, topics of concern or interest, and news about conferences or professional development opportunities. As many minority nurses find excellent networking opportunities though professional organizations dedicated to their identity, belonging to AAPINA can also help you learn methods to combat racism that other nurses around the country have had success with.
Throughout the healthcare industry, organizations are collaborating to help fight racism and hate crimes. The National Commission to Address Racism in Nursing will tackle the issue in a broad approach with multiple organizations. With large and small efforts, progress will be made and honoring Asian Pacific American Heritage Month offers more opportunities for action.
Nursing strives to exceed the boundaries when it comes to providing patient care in the United States, and nursing leaders have long understood the importance of diversity in the workplace to obtain quality outcomes for their patients.
Over the last decade, the American Association of Colleges of Nursing (AACN) has dedicated efforts to diversify the workforce. The aim is to have adequate representation from all groups—including men and individuals from the African American, Alaskan Native, Asian, Hispanic, Native American, Native Hawaiian, and those of other backgrounds.
Improving nurse workforce diversity will help decrease health disparities and increase health equity so all people of all groups can be as healthy as possible. Because different populations often present symptoms dissimilarly or are predisposed to distinct conditions, it’s important for nursing schools and staff to gain a wider perspective on the patients they serve. In parallel, when nursing staff mirrors the population they serve, it’s common for patients to feel more trusting and comfortable discussing their personal concerns and symptoms.
The National Council of State Boards of Nursing (NCSBN) and The Forum of State Nursing Workforce Centers were surveyed in 2017 to look at the cultural makeup of the nursing pool. Registered Nurses (RN) from minority backgrounds represented 19.2% of the workforce.
The survey identified the RN ethnic backgrounds comprised of 80.8% white/Caucasian; 7.5% Asian; 6.2% African American; 5.3% Hispanic; 0.4% Native American/Alaskan Native; 0.5% Native Hawaiian/Pacific Islander; 1.7% Two or more races; and 2.9% other nurses. Of the total nursing workforce, men accounted for 9.9% of the workforce, up from 1.1% from 2015.
Elmhurst University, located just outside of Chicago, is committed to successfully recruiting and retaining their nursing students to meet the growing need in their communities. Elmhurst’s mission is to prepare nurses for professional practice and exceed leadership roles to meet the needs of a diverse society.
If you are looking for a new career path in high demand, a degree in nursing can launch you into a highly respected, satisfying, and financially stable profession. Elmhurst University understands the importance of providing high-quality nursing degrees in a timeframe that matches the workforce demand.
Find the Right Program for You
Elmhurst University offers a distance accelerated BSN nursing program for those who are ready to begin their nursing career today. Students complete all course requirements in less than 2 years. An online distance learning structure allows those living in remote areas to gain access to a high-quality nursing education. Furthermore, there are just two on-campus visits during the program, limiting the number of travel disruptions to students.
Elmhurst University nursing students.
The 16-month fast-track program prepares students to sit for the National Council Licensure Examination for Registered Nurses (NCLEX-RN) exam. Elmhurst University is consistently above the national and state scoring averages on the NCLEX exam. In 2020, 90% of their BSN students passed the exam.
Elmhurst University’s application process is easy to access online. Apply today and take the first step to a rewarding career.
International Nurses Day on May 12 honors nurses worldwide with a day of celebration for all the work they do to care for patients, people in their communities, and those they know and love.
The past year has been one of tumult and exhaustion for nurses as the COVID-19 pandemic brought challenges and conditions that today’s nurses never worked through before. As Minority Nurse honors nurses around the world today, we thought hearing from a student nurse—one on the brink of starting a career path that has seen so much pain and joy in the past year—would give a perspective of the next generation of nurses on International Nurses Day 2021.
Twenty-year-old Bisola Ariyo is this year’s valedictorian for Howard University’s College of Nursing Class of 2021. Her work as a nursing student took on new meaning in the past year, she says, and only amplified the determination she’s always had to excel as a nurse.
As a student in Lagos, Nigeria, Ariyo earned a full scholarship to Howard University—where she dreamed of going. Originally, she (and her parents) thought she was going to pursue a med school track, but she realized her love of biology was suited for a different path.
“I did my first internship and my first clinical and I experienced that bedside, hands-on work,” she says. “Doctors don’t do that. Nurses build relationships and it’s a big responsibility when you think you’re the only advocate for this patient. They look to you for all sorts of things. It made me admire nurses, and I wanted to be just like them.”
Throughout her college years, her dedication never wavered and her scholarship was something she used as a guiding light. “I wanted to come here and be everything I was expected to be,” she says, noting that she’s a recent an inductee of the Sigma Theta Tau International Honor Society of Nursing. “It drives everything I do. I wanted to make my parents proud and make myself proud.”
As the pandemic swept through the world during her junior year, Ariyo says everything changed. During those early days, her father became ill and while his illness was not related to COVID, it put her in a deeply empathetic place. “It gave me an idea of what people were going through in the pandemic,” she says. Her parents were far away and the feeling deeply unsettled her.
When her family saw the work she was doing thorough the pandemic, it changed their perspective. Hearing about Ariyo’s 12-hours shifts, her parents were concerned about her safety and if she had enough PPE. They understood the gravity of her work. “Now my mom tells everyone her daughter is a nurse,” Ariyo says. “Before that, she thought doctors were the most prestigious. She has the most respect for nurses now.”
This spring, when she found herself working at a vaccine clinic and giving so many shots every day, she says she was grateful. “I was vaccinating people who were so thankful to get the vaccine and who would now get to see their grandmothers or their friends,” she says. “I never envisioned giving vaccines all day was something I would ever be doing, but I hope to take that experience with me.”
Ariyo decided on her specialty path after a summer externship at Duke University Hospital Pediatric Cardiac Intensive Care Unit where she shadowed a nurse and performed pre-op and post-op care of children with congenital heart defects. She’s decided to become a pediatric nurse practitioner. “Every day was a joy,” she says of the experience. Whether she was seeing children get better or enduring the sadness when they didn’t, Ariyo says working with children was profoundly moving. “They are so resilient,” she says of children. “Being part of that every day made me realize that is what I want to do. And that is the patient population I want to serve.”
As Ariyo gained additional work, she also saw how crucial it is for the nursing industry to attract more minority nurses. “Nursing is definitely impacted by how representation matters to patient care,” she says. While on a post-Hurricane Maria alternative spring break program with Howard University in Puerto Rico, Ariyo says she noticed how a language barrier or residents’ general mistrust of the healthcare system influenced care. “The Black or brown people or people of color who don’t trust the healthcare system are looking for the Black person in the room because that’s the person that looks like them,” she says. “There’s a responsibility for me and a trust they have in me because I look like them.” The experience even gave rise to new goal—learning Spanish. “I felt bad when there was no interpreter in the room,” Ariyo says. “Minority nurses are so important.”
Being part of Howard University’s nursing school gives Ariyo deep pride. She has taken advantage of every opportunity and has worked as a mentor at an afterschool program; was a HU Geriatrics Lab student researcher on the Alzheimer’s research team; and is a member of the Comprehensive Medical Mentoring Program (CMMP) and the National Society of Collegiate Scholars (NSCS).
Although she knows the work has been challenging, she sees herself reflected in her fellow graduates on this International Nurses Day. “My class is 42 strong incredible Black women,” preparing for a nursing career, she says. “I feel brave because I see all the other people in my class as brave as I am. And despite how much social unrest there has been, we can take solace in this future generation. It is a time for hope.”
Changes have occurred since the Civil Rights Movement of the 1960s to improve the treatment of Black people; however, the underpinnings of systemic and structural racism are alive and well in the United States. Through the inequitable outcomes of the COVID-19 Pandemic, 2020 bestowed upon us an undeniable reality check on the national impact of systemic and structural racism in our healthcare delivery system. As of March 17, 2021, the Centers for Disease Control (CDC) (2021) reported 533,057 COVID deaths in the U.S., 289,119 of which were reported by race. Of those 289,119 deaths in which the race was known, 14% of the victims were identified as Black, non-Hispanic. Although underrepresented in the U.S., Black people disproportionately led the death toll rates as they suffer from existing socioeconomic hardships in addition to the adversities brought on by the pandemic.
The COVID-19 Pandemic has shone a light on the health disparities and inequalities that people of color suffer from daily. The lack of trust for the COVID-19 vaccine embodied within the Black community due to historical and current medical negligence and bias provided by a vastly white population of healthcare professionals compounds this problem. In November 2020, a survey conducted by the National Association for the Advancement of Colored People (NAACP) revealed that only 14 percent of Black respondents trusted the vaccine and only 18 percent indicated that they would definitely get vaccinated.
Health care disparities extend beyond the pandemic, however. For example, according to 2017 data from the CDC, Black women are three to four times more likely to die of pregnancy complications than white women. Contributing factors to these disparities are financial, bureaucratic, transportation, language barriers, and care that is not consistently culturally appropriate or respectful.
To abate these tragic, disproportionate outcomes and build trust within the U.S. health care delivery system, the healthcare workforce must become more diverse. Our nation’s population is continuously changing and becoming more diverse. The healthcare workforce must change to match. The United States Census Bureau predicts that by 2045, over half of the U.S. population will consist of minority populations. The American Association of Colleges of Nursing (AACN) stated, “with projections pointing to minority populations becoming the majority, professional nurses must demonstrate a sensitivity to and understanding of a variety of cultures to provide high-quality care across settings.”
Culturally congruent health care providers representing racial, ethnic minority populations improve trust in the health care delivery system, quality of care, and outcomes of minority populations. A 2017 report by the National Institutes of Health determined that cultural respect was an essential factor in reducing healthcare disparities and improving access to quality health care for diverse patients. According to data from the National League of Nursing and the U.S. Census Bureau, approximately 80% of registered nurses, nurse practitioners, and nurse-midwives are white. Schools of nursing must also develop strategies for increasing diversity within the nursing workforce.
An example of this shift can be found at Frontier Nursing University, which, over the past decade, has placed an emphasis on diversity, equity, and inclusion (DEI), with a particular focus on increasing the enrollment and graduation rates of students of color. FNU included DEI in its strategic plan to address issues surrounding access to health care, health outcomes, health disparities, health inequities, and to increase diversity in nursing. These efforts will play a significant role in ameliorating health disparities and inequities. FNU’s SOC enrollment has grown from 9% in 2010 to over 25% in 2020. FNU is continuing on the trajectory of integrating DEI and antiracism throughout the university to support racial, ethnic underrepresented students. Resilience during the COVID-19 Pandemic permitted FNU to graduate 841 students, including 208 students of color, yielding an increased workforce diversity to care for diverse, rural, underserved populations. Additionally, FNU’s current retention rate for SOC is 84%, exceeding the university’s goal of 80%, and the number of faculty of color is on the rise, currently standing at 14%.
FNU is an example of the intentional focus required to begin building a more diverse, culturally competent health care system. We have known and understood for a while now that the lack of diversity among primary health care providers was a contributing factor to the glaring disparities in health care outcomes among diverse populations. The past year only acted to exacerbate the problem and heighten our awareness of the need for immediate change and action. If we have learned anything from the pandemic, it is that diversity, equity, and inclusion are the keys to the future success of our nation’s health care delivery system.
As the nation continues to grapple with the wide-ranging effects of racism, the nursing industry continues to take steps to address disparities, inequalities, and racism. Last summer, the Academy of Medical-Surgical Nurses (AMSN) ramped up the AMSN DEI Campaign, motivated by the killing of George Floyd.
Terri Hinkley, EdD, MBA, BSN, RN, and chief executive officer of the Academy of Medical-Surgical Nurses (AMSN) and Medical-Surgical Nursing Certification Board (MSNCB), says Floyd’s killing troubled her deeply, leading her to question if she had done everything she could to make the world as safe and inclusive as possible. Hinkley spoke with the presidents of AMSN and MSNCB and with her family and then wrote, My Reckoning, an op-ed expressing her commitment to actively working to combat racism.
While the program helps nurses learn about DEI, it’s also a way for them to build competence, says Hinkley, especially in areas they may not be familiar with or have a deeper understanding of. “We do not understand the norms, practices, and requirements of cultures we did not grow up with or in,” she says. “By focusing on building competency, we are striving to take away the ‘blame and shame’ that often surrounds these issues and discussions. Let us start with the basic principle that everyone wants to be respectful of others and build on that to help them understand and be able to take action to make that happen.”
75% of the nurses that completed the survey reported that they wished to have a better understanding of topics related to diversity, equity, and inclusion.
92% reported that it is important for their national professional association to take action regarding diversity, equity, and inclusion and lead efforts for its members.
46% reported experiencing harassment or discrimination because of issues of race, class, gender, age, religion, culture, sexuality, or ability.
63% witnessed harassment or discrimination.
DEI work is sometimes uncomfortable, as Hinkley noted, and that’s why it’s important to give nurses the tools to have discussions around difficult topics. “We genuinely believe that we, as nurses, start from a position of caring and compassion,” she says. “We believe that every nurse wants the best possible outcome for their patient, and for their teammates to be respected and supported as an integral part of the team.”
As nurses learn more and become more intentional with their DEI work, they can more effectively advocate for those around them—whether teammates or patients. “DEI isn’t a one and done initiative,” says Hinkley. “It is a journey that will only have its beginning in the first 18 to 24 months. This is a lifelong learning initiative, one that AMSN is embracing and committing to.”
Hinkley says AMSN is committed to making this process inclusive and developed several different activities intended to help nurses be able to identify their own biases, or those within their institutions, and develop solutions to combat them.
Members can participate in a six-module educational certificate program in which the first module (the first module is offered at no cost to members) will focus on why the program is important. The remaining modules will allow deep dives into the areas of greatest discrimination, such as race, sexual orientation and gender identity, disabilities, age, and culture and religion, says Hinkley.
As nurses begin to move through the process and gain a new understanding, Hinkley says stepping back for the big picture is essential. “AMSN wants to build a culture of inquiry, where our nurses can start to question why we do things the way we do, or why I believe the things I believe,” she says. “Is there a different perspective that might shape how I approach a situation, or patient, or problem? Am I intentional in my actions, or am I just doing what I was taught and the way it has always been done? It is all about opening conversations, with yourself and others.”
Gaining competence and new perspectives will transfer into better nursing practice, higher nursing standards, and patient care in very specific ways, she says, including
as individual employees who remain competitive and effective in a changing workforce
as employees of organizations who will be DEI ambassadors to their organizations after completing the certificate program
as members of the largest segment of the healthcare workforce who will increase DEI competence across the healthcare sector
as primary providers of patient care in the nation whocan address the inequities in patient care
Hinkley noted that even with a DEI focus, real-life experiences can be uncomfortable. “I would like to share an example I experienced recently,” she says. “Someone I know came out as non-binary, changed their name (I will call them Storm), and their pronouns. Another friend (I will call Alice) was so distressed she would not be able to remember Storm’s pronouns because we have spent a lifetime of only having binary choices: he/him or she/her. ‘They’ sounds odd and feels odd, and we have a lifetime of using ‘they’ for more than one person. That results in dissonance and is incredibly challenging from a cognitive perspective. Alice is doing her best to be supportive and respectful and was so worried that she was going to forget and say the wrong pronoun. I tried to help Alice understand that if it were an honest mistake, Storm would understand, and they would not be offended. I tried to stress that Storm understands that we are all doing our best to be supportive and, in turn, have new things to learn as a result.”
As Hinkley notes, overnight change isn’t expected, but there are things nurses can do to help themselves move forward. “I think it is important to understand that no one expects perfection, they just expect the same respect and value that everyone else is given. What helped me was practicing. I practice using inclusive pronouns at every opportunity. I also challenge myself not to use binary pronouns, but rather to collectively refer to individuals I do not know as ‘they’ until I learn their preferred pronouns. I am not always successful, and just the other day I said ‘he or she’ when referring to a nurse in an example to a point I was making. I was gently corrected to ‘they’ and the conversation continued. Life-long learning is a hallmark of the nursing profession, and we embrace that in every other area of our lives, so why not this one?”
As nurses’ DEI work grows stronger, Hinkley says it will have a pervasive effect on nurses’ work, patient care, and the workplace in general. “Having the opportunity to improve health for all individuals would be the best possible outcome of this initiative and would bring me personal and professional joy,” says Hinkley. “I also feel very strongly about doing my part to contribute to the work environment for all nurses. I am keenly interested in issues regarding the work environment, and the human cost of caring to nurses and healthcare providers. There are so many wonderful aspects to nursing and being in the caring profession, but we do not all have the same experience at work, and I am excited to be able to improve the work experience for all nurses.”