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.”
Gina S. Brown, dean for the College of Nursing and Allied Health Sciences at Howard University (left) and Eileen Sullivan-Marx, dean of NYU Meyers (right)
Howard University’s College of Nursing and Allied Health Sciences and New York University’s Rory Meyers College of Nursing have formed an educational and research partnership to work together to have a greater impact on improving health and health equity in urban areas and global communities.
“We are ecstatic to be in partnership with such a prestigious educational institution as NYU Meyers at such a critical time within our nation’s health care cataclysm,” said Gina S. Brown, PhD, MSA, RN, FAAN, dean for the College of Nursing and Allied Health Sciences at Howard University. “The potential collaborations are endless.”
The new partnership will enable nursing researchers at Howard and NYU to collaborate on existing research projects and jointly apply for grant funding for new projects. The schools are in the process of applying for funding to develop a mentoring and education program to encourage African-American nurses to obtain specialty nursing certifications. In addition, faculty will be invited to attend research seminars and professional development opportunities at both schools.
“We are thrilled to build new ties to Howard University, one of the country’s top HBCUs, and to work closely with its expert nursing faculty,” said Eileen Sullivan-Marx, PhD, RN, FAAN, dean and Erline Perkins McGriff professor at NYU Rory Meyers College of Nursing. “By formally establishing this partnership, we can develop unique opportunities for cross-school collaborations that address health inequities and increase our impact on improving care for the patients and communities we serve.”
In addition to fostering faculty and research collaborations, nursing students at Howard and NYU Meyers will have the opportunity to attend new and established programming through educational exchanges. For instance, Howard nursing students will be encouraged to participate in NYU Meyers’ 10-week summer research program, designed to engage undergraduate and graduate students from underrepresented backgrounds in mentored research. The NIH-funded program aims to develop the next generation of cardiovascular disease researchers, and NYU and Howard hope that participation will encourage more nursing students of color to pursue research doctorates in nursing or related fields.
The Howard-NYU partnership was catalyzed by Brown and NYU Meyers’ Audrey Lyndon, PhD, FAAN, RNC, professor and assistant dean for clinical research. While on faculty at the University of California, San Francisco, Lyndon worked closely with Brown on educational exchanges; they look forward to building upon this collaboration to change the future of nursing.
About NYU Rory Meyers College of Nursing (@NYUNursing) NYU Rory Meyers College of Nursing is a global leader in nursing and health. Founded in 1932, the College offers B.S., M.S., DNP and Ph.D. degree programs providing the educational foundation to prepare the next generation of nursing leaders and researchers. NYU Meyers has several programs that are highly ranked by U.S. News & World Report and is among the top 10 nursing schools receiving NIH funding, thanks to its research mission and commitment to innovative approaches to health care worldwide.
About the Howard University College of Nursing and Allied Health Sciences
The College of Nursing and Allied Health Sciences is comprised of top-ranked educational programs that prepare health care professionals to be leaders and innovators in practice, education, research and service. Graduates are prepared to deliver patient-centered, interprofessional care and utilize cutting-edge technology and evidence-based practice to improve the health of all people with an emphasis on promoting health equity toward eliminating health disparities. Currently, the college offers degrees in the following accredited programs: bachelor’s degrees in clinical laboratory science, health management sciences, nursing, nutritional sciences and radiation therapy; master’s degrees in nursing, occupational therapy and physician assistant; a post-master’s certificate in nursing; a doctoral degree in physical therapy; and a master’s and doctoral degree in nutritional science in conjunction with the Howard University Graduate School. To learn more, visit cnahs.howard.edu/
Unfortunately, racism and gender inequality still exist not only in our country at large, but also in the nursing field. Because she saw this in anesthesia, Wallena Gould, EdD, CRNA, FAAN, founded and is the CEO of Diversity in Nurse Anesthesia Mentorship Program.
Gould took time to answer our questions. What follows is our interview, edited for clarity and length.
Fred Reed, DNP, CRNA, who has mentored many nurses of color interested in Nurse Anesthesia.
The homepage of the Diversity in Nurse Anesthesia Mentorship Program (DNAMP) states that only 11% of nurse anesthetists are people of color. Why is that? Why hasn’t there been more diversity in these positions?
Honestly, it stems back from decades of graduate nurse anesthesia programs accepting all white cohorts with only one or two nurses of color in each cohort. Also, contributing to the lack of diversity in the nurse anesthesia profession is the historical treatment of Black nurses at the turn of the century. In the early 1900s, until late 1940s, professional nursing associations did not include members of color just based on race. The American Association of Nurse Anesthetists (AANA), founded in 1931, included Black CRNAs into the membership in 1944.
In addition, nursing schools including nurse anesthesia programs were segregated until the late 1940s. One of the historical nurse anesthesia programs that consistently accepted diverse cohorts with faculty that mirrored the community since the Jim Crow Era was the Harlem School of Anesthesia founded by Goldie Brangman, CRNA, MEd, MBA. Founded in New York City in 1951, it lasted for 36 years. Brangman would later become the first and only Black Nurse Anesthetists who was elected as President of the AANA in 1973.
The emergence of diverse nurse anesthesia faculty started in the 1990s and has increased in small increments in the 124 graduate programs. In addition, contributing to the 11% of Nurse Anesthetists of color, is the lack of exposure or encouragement for nursing students of color to pursue Nurse Anesthesia at Historical Black Colleges & Universities, Hispanic Serving Institutions, and Tribunal American Indian Nursing Schools.
There is also gender inequality in nurse anesthetists. Does this mean that more nurse anesthetists are male than female? If so, why does this disparity exist? What has caused it?
According to the American Association of Nurse Anesthetists 2018 Profile Survey of Nurse Anesthetists, there were 52,000 CRNAs in the country with 59% of female and 41% male providers. Male nurse anesthetists were accepted into the membership in the 1950s, into what was a predominantly female profession. There was a stigma of male nurses in the profession from 1950s—2000s.
Today, more men are entering the profession, but still have a majority of female nursing school cohorts. Also, men are pursuing more specialized careers such as nurse anesthesia with the addition of military male nurses entering the profession.
Why did you establish DNAMP? What did you want to accomplish?
As a nurse anesthesia student enrolled in La Salle University in Philadelphia, I had an individual class assignment in the form of a poster project. My focus was to find out the racial and ethnic composition of the nurse anesthesia profession. In addition, I noticed that the six nurse anesthesia programs in the Philadelphia area did not have one full-time faculty teaching in the programs and only a few students of color in each program.
I was able to retrieve demographic statistics from the AANA and polled the Philadelphia nurse anesthesia students from each program. The data from the national statistics mirrored the Philadelphia programs, which demonstrated a severe lack of diversity in nurse anesthesia.
I approached one of our faculty members who taught regional anesthesia, the late Dr. Arthur Zwerling, DNP, CRNA, DAAPM, about my poster and my urge to do something about it. Dr. Zwerling encouraged me to attend the American Association of Nurse Anesthetists Annual Conference in Boston. As a senior nurse anesthesia student, I attended the conference as suggested.
On the first day of the conference, I met Goldie Brangman, CRNA, MEd, MBA (retired), spoke with her for a moment, and knew my purpose was going to make attempts to achieve diversity and equity in the profession.
Today, the non-profit organization, Diversity in Nurse Anesthesia Mentorship Program has mentored more than 510 nurses of color to successfully matriculate into 74 graduate nurse anesthesia programs. We are able to extend the pipeline to diversify the nurse anesthesia profession with a second initiative of a Diversity CRNA HBCU and Hispanic Serving Institution School of Nursing Tour. Lastly, we started our newest initiative with a Diversity Advanced Practice Doctorate Symposium with a collaborative effort of doctorate prepared CRNAs, Nurse Practitioners, Nurse Researchers, and Nurse Midwives to encourage nurses of color to pursue a doctorate and build a body of work.
How can the nursing community at large be an ally or offer support to BIPOC nurses who want to get into anesthesia?
Deans of Nursing serving at predominantly white institutions, HBCUs, Hispanic Serving Institutions, and Tribunal American Indian Nursing Schools can intentionally hire CRNAs of color as full-time, part-time or adjunct faculty. They can also invite CRNAs of color to classrooms to speak to nursing students about nurse anesthesia or teach didactic courses. This includes hiring CRNAs in doctorate-prepared nurse anesthesia programs and affording opportunity to be promoted in rank and publish in nursing peer-review journals. This need to be a national effort to make a profound impact in the trajectory of a diverse profession with accountability.
How does mentoring help assist and encourage more BIPOC to get into this facet of nursing?
For many nurses of color, myself included as a first-generation college graduate, we have been motivated, but just need proper direction in career trajectory. I was a registered nurse for eight years before enrolling in a graduate nurse anesthesia program. So, if CRNAs of color can mentor diverse nurses and nursing students prior to their enrollment into a graduate nurse anesthesia program, students will have the support needed to complete the graduate program successfully.
Is there anything else that nurses need to know regarding racism and gender inequality in anesthesia?
In many nurse anesthesia programs, nurse anesthesia students of color experience social isolation, microaggressions, and in some cases, racism as one of the few in their own program in clinical and or in the classrooms. Nurse Anesthesia students need to be very familiar with student policies and in certain cases, should direct any inequities to the Director of Diversity and Equity Officer for any concerns.
Bankert, M. (1989). Watchful care: A history of America’s nurse anesthetists. New York
Carnegie, M. E. (2000). The path we tread: Blacks in nursing worldwide, 1854-1994. 3rd (eds.). Sudbury, MA: Jones and Bartlett Publishers, and National League for Nursing.
American Association of Nurse Anesthetists (2018). AANA 2018 Member Profile Survey. Park Ridge: IL.
The Foundation of the National Student Nurses’ Association (FNSNA) is delighted to announce a new diversity scholarship award sponsored by Johnson & Johnson. Funding may be used for tuition, fees, and books. Use the same application to apply for all FNSNA scholarships. Students must complete the race/ethnicity question to qualify. There is $225,000 available. Awards up to $7,500.
The deadline to apply is February 15, 2021.
Pre-nursing students taking courses to prepare for matriculation into a nursing program
Attending classes and taking no less than six (6) credits per semester
Involvement in student nursing organizations and/or community health activities
Document academic achievement
Establish financial need
U.S. Citizen or Alien with U.S. Permanent Resident Status/Alien Registration Number
High school students are not eligible to apply
Funds are not available for graduate study unless it is for a first degree in nursing
FNSNA Scholarship Application Instructions
Read carefully. Failure to follow all instructions may result in disqualification.
Complete all sections on the online application.
Eligibility:Undergraduate scholarships are available to students currently enrolled in a state-approved nursing program leading to an associate degree, baccalaureate, diploma, direct-entry master’s degree, RN to BSN/MSN completion, LPN/LVN to RN, or accelerated programs. Funds are not available for graduate study unless it is for a first degree in nursing
Action Item: Submission Fee: a non-refundable $10 submission fee must be paid via Stripe (Link to Stripe is within the online scholarship application)
Action Item: An unofficial transcript must be uploaded prior to submitting your application. In addition, grade reports for the fall semester are acceptable if not reported on the transcript.
Possible Action Item: Members of the National Student Nurses’ Association who wish to be considered for scholarships open only to NSNA members, must include membership number. NSNA Board of Directors and Nominating and Elections Committee are ineligible.
Possible Action Item: Students entering LPN/LVN to RN; or RN to BSN/MSN completion programs immediately upon graduation from associate degree or diploma programs must submit a letter of acceptance with the application or official confirmation that the application has been received by the new school. Proof of licensure and enrollment must be provided at the time the scholarship award check is issued.
Eligibility:Applicants must be a U.S. Citizen or Alien with U.S. Permanent Resident Status or hold an Alien Registration Number.
Possible Action Item: If you have been employed as an RN, attach a copy of your resume and license.
All checks are made payable to the school towards the account of the scholarship recipient. Scholarship money will be used to offset the cost of tuition, academic fees and books only.
Funds not used by the end of the scholarship-funding period are to be returned to FNSNA.
Do not include information that is not requested. Do not include photos.
Only complete applications will be considered. The Selection Committee does not accept separate documents after the application has been received.
All applicants will be notified of a decision in March.
As if nursing wasn’t already tough enough, male nurses have to contend with a lot of negative, gender-based stereotypes whenever they don their cotton scrubs. These stereotypes make it more difficult for male nurses to do their jobs well, especially if patients are suspicious of their competence just because they’re male. Here are six male nursing stereotypes that need to be shattered.
1. All nurses are women.
While it’s true that women make up a very high proportion of active nurses, there are some men who work as nurses, too. Approximately 89 percent of nurses are women, and 11 percent are men. While this isn’t a high number, it does prove that not all nurses are women. Other numbers make it clear why nursing is an attractive profession regardless of your gender. The 2019 median pay for registered nurses was $73,300 per year, much higher than the median annual wage for all workers, which was $39,810. If you’re a man looking for a well-paying and fast-growing career in health care, nursing might be the ticket.
2. Nursing is an inherently female role.
Men are expected to be ambitious and career-driven, while women are expected to be caring and nurturing. As a result, caregiving activities are often associated with women’s roles. This includes child care, cooking, household chores, and tending to the sick. Some patients may assume that men lack the nature and bedside manner to be good nurses simply because of their gender, which just isn’t true. This stereotype is most apparent in OB-GYN specialties, since many female patients are uncomfortable with having a male nurse and don’t believe they can provide the care that they need.
3. Male nurses are failed doctors…
Since most nurses are female and most doctors are male, some people make the leap to conclude that any male nurses must have tried to make it as doctors, but couldn’t cut it. This stereotype is harmful because it treats nursing as inferior to being a physician, when, in fact, both roles are necessary to patient care. Without nurses to actually take care of patients and execute the day to day duties, doctors would be able to heal a lot fewer patients. Maybe a few people decided to enroll in nursing school because they couldn’t get into medical school, but the vast majority of nurses—both male and female—have deliberately chosen nursing.
4. …or studying to become doctors.
Some patients will also assume that any men wearing stretch scrubs must be doctors in training, a corollary to the above stereotype. They may ask male nurses how long they’re planning to work as a nurse before they become a doctor, or ask when they will be going to medical school. Again, this stereotype is fueled by the belief that nursing is inferior to practicing medicine. If patients make these kinds of statements, try to use it as a teaching moment to educate them about how nursing is not a gender-specific field and explain why nursing is just as legitimate as being a physician.
5. Men become nurses because it’s easier.
This stereotype is also related to the idea that being a doctor is superior to being a nurse. In this case, people believe that being a nurse is easier than becoming a physician and, therefore, assume that any male nurse was too lazy to try for a more rigorous health care career. Of course, as all nurses know, nursing is a physically, mentally and emotionally demanding career. No matter your gender, it takes resilience and toughness to make it as a nurse—and it is not automatically easier than any other health care profession.
6. Male nurses are a joke.
Media is to blame for this stereotype. Male nurses are either not shown at all, or they’re portrayed to be the butt of the joke. For instance, in the 2000 comedy Meet the Parents, Greg Focker (played by Ben Stiller) is a male nurse, and there are running gags throughout the movie that center on making fun of Greg precisely because he is a male nurse and doesn’t work in a more “masculine” profession. Treating male nurses as a joke, rather than taking them seriously, further contributes to stereotypes and undermines the serious work that nurses of all genders do.
These male nursing stereotypes harm male nurses and the patients they’re trying to treat. Help to do your part to dispel these myths by working to educate people whenever they express these stereotypes.
While enrolled in the Doctor of Nursing Practice program at my PWI (predominantly white institution), I expected to be in the minority. It’s not uncommon to see less minorities in PWIs, especially in graduate level education. My hope was that the workforce would be a little different. Why? In the workforce there are many people from all over who are transplanted in Greenville, North Carolina, my small college town. I live in a place that would not be exactly be hailed as a black Mecca, but it is still somewhat diverse. The population of my county is roughly 55% White, 34% Black , and 6% Hispanic. I was mistaken. It seems the few minorities that were in my town moved away shortly after graduating from the university, or garnering a few years experience in their field.
I cannot even begin to tell you how many people actually assumed that once I graduated I would move to somewhere like Charlotte, or Atlanta. So, as I set out for employment I accepted that there may not be many colleagues that looked like me. What I did not expect was for there to be none.
I happen to work within an organization that I feel supports diversity, and I have a supervisor who is very inclusive and appreciative of all cultures. What I could not help but wonder was “Am I the ‘twofer’?”
A few years ago, I was watching a spinoff movie called ‘What Women Want’ starring the amazing Taraji P. Henson. She plays a spunky black female sports agent. In this particular scene, she was discussing her value to the team with her boss, when he hinted that she was only employed at the company because of her ethnicity and gender. I remember her proclaiming “I am not your twofer!” That struck a chord with me. ‘Twofer’ would imply that you check the box for racial inclusion and gender inclusion in a predominantly homologous role.
Fast forward to today’s newly overt recognition of what many minorities already knew, that inclusivity matters. Duh?! One can’t help to wonder whether we are being offered new roles based off merit and education or off the sudden need for companies to show that they support diversity. Am I more likely to get a job now because I am a black Nurse Practitioner or because I am the right fit? For years, the running joke in the Black community used to be name your kid something simple so that when they submit a job application, someone will not overlook them due to their ‘ethnic’ name. This may be reverse now. Are we sought after because our names indicate clues into our race when we submit applications?
Here is the kicker, being the ‘twofer’ isn’t always a bad thing. Why? Well, a seat at the table allows you to pave the way for more chairs later. This is how we change the narrative. This changes the work place from being a secondary ‘PWI’. This means we don’t all flock to the placers that are more culturally diverse, we create that space where we are so that our whole nation becomes culturally diverse.
So, if the only way to get in the door is to be let in from checking the boxes, it is our responsibility to ensure that we remain at the table because we actually have the education, experience, and expertise to stay there and make it a better place because of us. Or better yet, remember the words relayed to Tara Jaye Frank by the late Dr. Maya Angelou, “You don’t have to give up your seat to anyone. You are just as worthy of that seat as he is, and you have every right to sit proudly in it.”