During this year’s CRNA Week (#crnaweek), there are many nurse anesthetists who are remembering why they got into the profession, and even more are reflecting on how the face of the profession is changing.
John Bing, BSN, CRNA, American Association of Nurse Anesthetists (AANA) Region 6 director, and national AANA board of directors member, says one of his steadfast missions is to make sure the field continues to attract top nurses, but that it is especially welcoming to aspiring minority nurse anesthetists.
Bing knows first-hand how hard it is being a minority in the field. When he first started out, he was often the only African American in the OR, he says. At times, people assumed he was part of the housekeeping staff. Although he laughs about it now, Bing has made it a direct part of his mission to attract more minorities into this field.
He even takes on leadership positions with the primary goal of making sure he is representing the minorities in the field. “You need to see that in leadership,” he says. “If others don’t see that, they won’t see a place for them. I make sure they see it.”
“Many times you would go in and you were it,” he says of when he started out. “Maybe you were the only one in the hospital or the department. Now you go in and you see a fair amount [of minorities].”
As a president of the Diversity in Nurse Anesthesia Mentoring Program, Bing also makes sure his students know why he enjoys this profession so much.
One of Bing’s specific approaches is to make sure he talks to patients as the anesthesia takes effect. He finds out what they like so they can chat about it—sports, cooking, books, kids—anything that helps them relax. “That’s like a sedative,” he says. “It calms them down and they remember that.”
And while he’s monitoring a patient, Bing does exactly what he teaches his students—he assesses his patient over and over and over. “You must rely on your instinct,” he says. During travels with students to countries like Nicaragua, Bing teaches students that not every machine is calibrated the same or even correctly.
“The machine is a guideline,” he says. “You are ultimately responsible for anything that happens. You can’t blame the machine for anything. Look at the patient.”
Bing says that while he’s checking blood pressure every five minutes or so, he is constantly “circling the block,” as he calls it. All the machines are incredibly helpful, but they should only confirm what a nurse anesthetist is seeing, hearing, smelling, and touching.
And getting stale in this profession is not an option, he says. “I say to my students, ‘Tell me how this patient could die today,’” he says. That forces students to look at the big picture and not just look for complications, but to look for other factors that could impact that patient on that day.
Bing clearly enjoys working with his students, but he understands first-hand how sometimes they are not the ones who chose the profession. “The last thing I thought I would be was a nurse,” he says with a laugh. As an African-American, there were few role models that looked like him.
A chance look at a jobs list that revealed six pages of nursing jobs, convinced Bing, an athlete in high school and college, to take a look. Bing says he turned to his buddy he was working out with and said, “We get to be around girls and have a great job!” But he still didn’t expect to land in this field. Eventually, nurses in the recovery room where he worked nudged him to give it a try.
Now, Bing’s mission is to attract minorities into nurse anesthesiology. He speaks to kids in schools, paying special attention to making the field appealing to boys and young men. As it is, 49 percent of nurse anesthetists are male, he says, which is a high number considering less than 10 percent of all nurses are male.
But Bing lets kids know that there are chances to be out on a helicopter go team or even in the midst of trauma situations. “Men like that kind of stuff,” he says and it certainly gets the attention of younger kids who don’t know those possibilities exist.
Add in the good salary, the camaraderie, and the fair amount of autonomy, says Bing, and a career as a CRNA shows kids who might not initially consider a nursing career that the path is open to more possibilities than they ever imagined.
What is diversity? According to the Oxford English Dictionary, it is “the condition of being diverse, different, or varied; difference, unlikeness.” This simplistic definition of diversity does not assign any judgment or negative connotation to any of the words used to define it. However, the word “diversity” evokes multidimensional judgements, reactions, ideas, emotions, and actions, some of which could have adverse social and health consequences for generations of individuals in the United States.
Nursing, as the largest health care workforce in the United States with over 3 million nurses, is well positioned to champion diversity efforts. In 2010, the Institute of Medicine (IOM) published a landmark report, The Future of Nursing: Leading Change, Advancing Health. In this report, the IOM indicated that the nursing profession was not diverse to care for diverse populations across the lifespan. The IOM recommended that a diversity agenda be promoted, especially with increasing the diversity of nursing students. In partnership with AARP, the Robert Wood Johnson Foundation (RWJF) launched a campaign to implement the IOM recommendations from its 2010 report. Subsequently, commissioned by the RWJF, the IOM evaluated the state of affairs regarding these recommendations. In 2015, another report, Assessing Progress on the Institute of Medicine Report The Future of Nursing, was published. In this report, the IOM specified that nursing has improved on the recommendation to diverse the nursing workforce. Nonetheless, there remain gaps that must be addressed to meet the diversity goal for the nursing profession. Consequently, the new recommendation for nursing is that diversity must continue to be a priority that is paralleled with a series of actions to promote it. Before nursing can accomplish this noble goal, there should be a well-vetted strategic plan on diversity and inclusion in all nursing programs, schools, and colleges in the United States. Students, faculty, and staff must be an integral part of the dialogue to promote diversity within the nursing profession.
At the University of Florida College of Nursing (CON), we held our inaugural “Diversity and Inclusive Excellence” workshop in December 2015. This two-day workshop was designed for staff and faculty. As a member of the Diversity taskforce, I collaborated with the other taskforce members to invite G. Rumay Alexander, EdD, RN, FAAN, to lead the CON on this discussion. Alexander is director of the Office of Inclusive Excellence in the School of Nursing at the University of North Carolina at Chapel Hill, a nationally known expert with vast knowledge and expertise on diversity and inclusive excellence, and president-elect of the National League for Nursing.
During the early morning hours of December 3, 2015, my individual lesson on the topic began with Alexander as I had breakfast with her. My antenna on the topic sharpened following our conversation. After introducing her to my fellow Diversity Taskforce members, I hurried to pack my car and return to the CON to proceed with the plans of the day. I noticed the dean, Anna McDaniel, PhD, RN, FAAN, from a distance. I hurried up to keep her pace. “Good morning, Dean,” I greeted in my usual manner. McDaniel responded with a broad smile and a twinkle in her eyes that I perfectly understood. I surmised that McDaniel had finally accepted the fact that I love referring to her as the “Dean.” We conversed as we headed to the CON and into the elevator. I noticed the necklace McDaniel wore. The costume necklace had different shapes, colors, sizes, lengths, and mosaic designs. They were
- audaciously woven, yet unintimidating;
- different, yet complementary;
- individually, unassuming — yet, together, a paragon of beauty, inviting;
- all held by a perfectly thin strand, yet unbreakable.
“That’s a beautiful necklace,” I uttered. “It belonged to my mother, who died twelve years ago,” McDaniel shared. “Each bead came from a different country. I have a brochure that provides a description of each bead, including the country of origin and its material composition.” Then, McDaniel voiced the word that gladdened my heart. “I wore this necklace today because it’s appropriate to celebrate diversity, the topic of the CON workshop.”
McDaniel had appointed the Diversity Taskforce and provided us with her full support. But, the fact that she actually thought of and adorned herself with a necklace that I now coined as a “diversity necklace” to celebrate the CON inaugural diversity workshop was admirable to me.
Someone not sensitive to the current diversity concerns around the United States, and the racial unrest related to such matters, may not appreciate my exhilaration upon hearing the history of the necklace. At issue is that, in several communities around the United States, numerous individuals are thoughtless about the devastating effects of antidiversity rhetorics and actions on the lives of its victims. Many may not realize that any action, whether good or evil, begins in the mind. Conversely, any work to combat uncelebrated diversity and exclusivity must begin in the mind. When people think about and proactively perform small acts, such as expressing recognition of diversity through a piece of jewelry or other special actions to celebrate diversity, it goes a long way. It could change the thought process from exclusion to inclusion. When people are attentive to their behaviors and understand the detrimental effects their actions could have on other human beings, things might change for the better. I believe that, as a nation, we must check the poisonous thoughts that percolate in our minds and subsequently manifest in forms of antidiversity rhetorics and behaviors, unacceptance, and racism. Confronting monstrous suggestions in the mind is the first step that many of us need to take to begin to challenge the subtle and insidious systemic diversity-aversion and exclusion in the United States.
As I thought about this issue of diversity and the role that nursing can play to eliminate it, I reminisced about how the imperfections of people categorized within the social construction of race stimulate antidiversity and anti-inclusive sentiments and movements. I wondered how nursing can care for these individuals, many of whom are marred with scars of history. My poem, “The Color of Justice,” captures my perceptions of the undeniable genesis of these historical blemishes that shockingly remain, overtly or covertly, as status quo in various parts of this country.
The Color of Justice
What color is justice?
Absorbing pain, insults, and lashes
Ancestors packed shoulder-to-shoulder, hip-to-hip,
chained like fire woods
Bones of the feeble lie un-mourned in ocean deep
across the Atlantic
Their sweat built the wealth in the new world, but
crumps have become their portions
This name sound like them, we have filled the position,
they need to go away
Low-hanging pants, cove-hopping birds,
We cannot deal with the anger, we are better off
with the accent, intra-color battle ignited
Round them up, throw away the key, population control
Babes on the breast, mama and grandmamma, sitting
on the front porch pondering about the next check
Hair tightly woven, fried, or twisted, nails freshly manicured, next bun in the oven
The fortunate may triumph at the end, treacherous roads treaded, stress claims the wounded body after all
That they survive is still a mystery that ought to win
them a trophy
Who are they?
What color is justice?
Reflecting heat, demanding respect, crushing heads
Rolled into the new world in Mayflower boasting of
prostitutes, thieves, and prodigal sons
Raised arms against raised tea taxes, won freedom
but deny it to another
Melanin deficient hue suggest superiority
Blood by blood, noose on hand, destroyed a generation,
Deeds done in the name of God, He must be weeping
Damages proudly scattered in museums, we pay to
relive the tragedy
Privileges left and right on the backs of the poor
Man in bow tie, lady in heels, rear the children, your lavatory in the rear
Own your history, mend your ways, teach your babes right
Who are they?
What color is justice?
Broad face, warm hue, and welcoming gesture
Land is supreme and cares for the offspring
Infected with strange diseases, killed with gun powder, survivors kept in special places devoid of opportunities
Culture deconstructed, the sacred used as mascots
Surviving by balancing mind, body, and spirit, harmony
in the land is their mantra
Not many left but their spirit is strong
The land beckons for their touch, to purge its roots of deadened souls
What does the Unites States’ constitution say about them?
Who are they?
What color is justice?
Messiah has come, awaiting messiah, there is no messiah
We profess peace, spiritual path is the way
Whose belief is superior?
When six feet under, belief quenches, but tainted
souls still suffer
Where are their senses?
Who are they?
What color is justice?
Light? Energy? God?
Penetrates Black, White, Red hue, religious, non-religious
Building block of things created
Revitalizes without questioning, unites all things created
Shines for Black, White, and Red hue, religious and
Knows no foolishness but shines for fools
Knows no discrimination but supports the life of discriminators
Invites reconciliation until judgement day
Come unto me Black, White, and Red hue, religious,
My light is your strength, unity, and peace
One may wonder how a nurse who is an advocate for a diverse, inclusive, and just world could pen “The Color of Justice.” This poem reflects my dual perceptions as a black woman and a nurse, of how the historical racial unrest that has plagued the United States for centuries has been subtly perpetuated even today. But, they ought not have continued, had the United States paid real attention and reconciled both the apparent and undercurrent narratives of this poem after the abolition of Jim Crow laws. As a black woman, I think that the first relevant question ought to be: How do individuals from diverse backgrounds interpret their historical or lived experiences in the United States? I encourage each one of us to answer this question individually or as a family, church, academic institution, or financial organization. I assert that there must be a recognition and acceptance of the different dimensions of diversity of thoughts, ideas, and experiences. This recognition must be matched with “courageous dialogue” on diversity and inclusion. In addition, there have to be concrete and measurable action plans for allocating resources to implement iterative strategies to address identified diversity concerns. This exercise could be so powerful that diversity and inclusion become strengths and not detriments to our collective humanity.
As a nurse, I think the second pertinent question must be: What role can nursing play to mitigate the adverse generational effects of antidiversity and anti-inclusivity experiences on marginalized and excluded individuals? I contend that, in order for nursing to be professionally and culturally relevant in the future and to continue to have the public trust as a caring discipline, we must identify ways to champion the diversity and inclusive excellence agenda. There should be constant and mandated training on diversity for university staff and faculty, with measurable outcomes. Nursing as a profession should develop a curriculum with a diversity and inclusion plan threaded throughout it. One approach to operationalize this suggestion is to equip nursing students with skills necessary to be culturally competent, diversity-savvy, and inclusive-perceptive in order to encourage these values in their work settings. Patients and clients at the receiving end of compassionate, culturally competent care infused with the spirit of diversity and inclusiveness should remember the feelings associated with that care, and hopefully pay it forward. Slowly, the culture of superiority and nontolerance directed toward individuals from diverse backgrounds could dissipate and a new world facilitated by nursing and inhabited by truly compassionate and empathetic humans would emerge.
Nursing students are the future of the nursing profession. Therefore, nursing must constantly remind students that antidiversity and anti-inclusion rhetorics and behaviors, historically and contemporary, breed racism in the United States. They should also learn to celebrate how much improvement we have made as a profession. But, recognize that diversity work is lifelong. The juxtaposition of the history of racism in the United States with the improvements made toward eliminating it is useful for at least two reasons: The contrast provides the space for constructive discourses and opportunities to develop positive avenues for endorsing diversity, and it allows for future and ongoing actions to completely obliterate racism heralded by antidiversity and anti-inclusive beliefs in the United States. Consequently, bead by bead—though diverse in shapes, colors, sizes, lengths, mosaic designs, and historical origins—we can hang unbreakably strong on the perfect strand of humanity, which unites us as “one Nation under God.”
When Dr. Scharmaine Baker started the Nola the Nurse book series, she knew kids needed information about advanced practice nurses and a role model to show them all about it. What Baker, DNP, didn’t expect was the impact the character and the Nola books would have on kids or the people who would help her get the word out.
On October 27, Baker told her story on The Harry Show, in which New Orleans-native, show host, and entertainer Harry Connick, Jr. gave her a chance to talk about Nola the Nurse on a show devoted to nursing. While the experience was thrilling (and included a vacation to Punta Cana that Connick gave to her family), Baker was especially excited at the thought of having more information about nursing and advanced practice nursing reach a national audience so quickly. “He said, ‘I really believe in Nola the Nurse and I hope this show helps you go far,’” recalls Baker of Connick’s support.
Nola has really taken off,” says Baker. She started the books when she couldn’t find any books that featured African American NPs or even many that talked about nursing as a career. Baker’s books take her Nola character into people’s homes, each of which exposes her to different cultures.
Over the summer, Baker said she thought a mascot would help the kids connect nursing to real life, so she added a life-size Nola doll to bring with her when she makes presentations and reads her books to groups. “She’s a tremendous hit,” says Baker about the Nola doll.
Kids get engaged with the story and it’s an opportunity for them to listen to her heart and to check her pulse,” says Baker.
As Baker continues to develop the Nola series (three more books are set to be published starting next year), she is developing a specific structure to help kids understand what NPs do. Using the Nola mascot, stickers, activity books, and the stories themselves, Baker connects with elementary school kids in schools, camps, and groups.
As the program is taken to teens in high school, Baker finds it just easy to talk to them about nursing as a career. “It’s engaging the next generation into the world of advanced practice nursing,” says Baker.
A new $50 million initiative to build on the excellence and diversity of the faculty at Yale University was announced last fall. The initiative, backed by the Provost’s Faculty Development Fund, will provide up to half of the salary for three years to support faculty who enrich diversity or an aspect of strategic importance at Yale.
Provost Ben Polak and Professor Richard Bribiescas, deputy provost for faculty development and diversity, have provided a recent update on the ongoing initiative. The inaugural year of the initiative supported 26 faculty members and a number of schools at Yale including Nursing and Public Health amongst several other fields of study.
Yale’s goal for the initiative is to recruit and retain the best faculty and several deans at the university have already said that the initiative significantly contributed to their recruiting efforts over the past year. Ann Kurth, Dean of the Yale School of Nursing (YSN), wants to develop a nursing faculty with a range of diversity and expertise. YSN believes that a diverse and inclusive faculty is the answer to a strong and productive culture in its school and a healthier society overall.
The Diversity and Excellence Initiative will also expand beyond faculty recruiting to support a diverse student body. A new Dean’s Emerging Scholars Program will select 15 incoming PhD students as Emerging Scholars Fellows and 10 PhD students to receive Emerging Scholars Research Awards. Yale will also be launching a new faculty program, Diversity & Education Series: Inclusive Pedagogy in Action, which promotes inclusive teaching.
In an effort funded by the US Department of Health and Human Services, St. Louis University (SLU) received over $2 million in federal funds to provide nursing scholarships to disadvantaged students over the next three and a half years. Similar scholarship programs at schools around the country are being put into effect to address issues facing the nursing profession as a whole (i.e. lack of diversity, nursing shortages).
The first year of the grant will provide 20 scholarships to SLU students – 10 to freshmen and 10 to sophomores. Mentoring is part of the award package, a huge benefit to students who are participating in a high pressure program and career. In the future, high school students will be recruited specifically from disadvantaged campuses.
A 2010 Institute of Medicine report titled Future of Nursing specifically addressed diversity as an issue. Compared to the general US population, nursing students show both gender and racial disparities. In 2015 men made up just 12% of the students in pre-licensure programs, and white students were 10% more prevalent in nursing programs compared to the general population, with fewer African American and Latino students being represented in nursing programs.
The current population of registered nurses has even higher racial disparities. Nursing populations now are overwhelmingly white at nearly 75%, but the rising generation has a more representative ratio at just 61% white students. Diversity in the nursing workforce has become such an important issue because of the diversity of those being cared for. Future of Nursing’s Campaign for Action explains, “A nursing workforce that reflects the diversity of the country’s communities and populations will lead to better understanding of the many elements that affect a person’s health and emotional well-being and, ultimately, to improved interactions and treatment.”
“A nursing workforce that reflects the diversity of the country’s communities and populations will lead to better understanding of the many elements that affect a person’s health and emotional well-being and, ultimately, to improved interactions and treatment.”
Scholarships also offer another important aspect in that they form a path that leads to jobs. Many popular degrees in college today do not match up with high demand jobs so incentives to get students into fields that offer high post-graduation success is beneficial to everyone involved. There are 3.6 million registered nurses in the US, but with an aging population, the demand for nurses continues to grow.
Nursing isn’t an easy profession, but for those talented in providing care for others, especially those who thought they wouldn’t be able to afford nursing school, scholarships like the ones being offered at St. Louis University could make a difference. The fact that these scholarships contribute to creating a more diverse nursing workforce in the US is an added bonus.
The University of Florida (UF) College of Nursing has named Dr. Jeanne-Marie Stacciarini, PhD, RN, FAAN, its first director of diversity and inclusion. Created to enhance awareness and dialogue about important issues in diversity, the newly established position was created based on recommendations from UF’s diversity and inclusion task force.
Stacciarini is an associate professor in the college and has been with UF since 2006. Her research focuses on mental health promotion among minorities and community-based participatory research for minority, rural, and international populations. Stacciarini has been recognized for her work with underserved populations with the 2012 Southern Nursing Research Society (SNRS) Award for Research in Minority Health and the 2014 APNA Award for Excellence in Research. Outside the College of Nursing, Stacciarini is a leader on campus as chair of the UF President’s Council on Diversity and she sits on President Fuchs’ leadership cabinet.
In her new position she aims to create better dialogue and educate others about the need for diversity. She will work on student and faculty recruitment to create a better working and learning environment. Leading a new initiative with undergraduate students in the College of Nursing, Stacciarini will be launching a program called Engaging Multiple-communities of BSN students in Research and Academic Curricular Experiences (EMBRACE).
UF College of Nursing Dean, Anna M. McDaniel, says she believes that Dr. Stacciarini’s diversity work will have a positive impact on the entire college and serve as a campus-wide model. Dr. Stacciarini is a tireless advocate for faculty, staff, students, and patients from diverse and underrepresented backgrounds, and as director of diversity and inclusion she will play a lead role in carrying out the College of Nursing’s commitment to diversity and inclusion for all members of the community.
Casey Dillon, a nursing graduate student in the college and former student of Stacciarini says she thinks more diversity in the college will prepare students for nursing careers. Nurses work with a wide variety of people every day, so diversity education is a necessary thing.
As nurses, Stacciarini says we need to be prepared to care for a more diverse patient body. She is honored to fill this important position and work to help more people understand diversity and inclusion to sustain that culture across the College. She hopes to bring ideas from the President’s Council on Diversity to new initiatives in the College of Nursing.