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.”
Despite roots stretching far back into history, nursing has only been a recognized profession for a little more than a century. While the nursing industry has made great strides since that time, it primarily remains the realm of white females. Just over 9% of registered nurses (RNs) are male, and minorities only make up about 20% of the nation’s total number of RNs.
Nursing’s lack of diversity is problematic on its own, and minority nurses may find that the diversity issue is compounded when the time comes for a career change. So what happens when seasoned nurses are ready to expand their employment horizons? Some LPNs and RNs may choose to tread the path of primary care, re-enrolling in medical school and working towards a doctorate. For others, the realm of human resources may be an attractive option.
Individuals from historically underrepresented groups are a great choice for roles within health care-related human resources management and administration. That’s because minorities are more likely to bring the topics of diversity and inclusion to center stage. And when the importance of diversity is emphasized at the managerial level, everyone benefits, from patients to providers and educators.
Discrimination in the Health Care Industry
As most people of color are well aware, discrimination is still a major social issue in 2020. And this discrimination can happen everywhere, from social settings to the workplace and beyond. Although federal law prohibits workplace discrimination on the basis of age, gender, race, religion, and disability, more diversity is needed within the health care industry, especially in the field of nursing.
That’s because nurses are essentially the foundation of quality care and healing. Further, they act as liaisons to primary care physicians and specialists, often serving as the voices of their patients. Patients from all walks of life deserve to feel as though they’re represented within the field of nursing.
By fostering a more inclusive environment, human resource managers in hospitals and clinics may be able to bridge the gaps, at least where health care for minority groups is concerned. And make no mistake, there is a glaring disparity among minority populations. According to a 2014 study published in Public Health Reports, “diabetes care, maternal and child health care, adverse events, cancer screening, and access to care are just a few examples in which persistent disparities exist for minority and low-income populations.”
Human Resources, Inclusion, and Diversity
So how does human resources fit into the equation? At their core, nursing and human resource management have a lot in common. After all, providing compassionate interactions with a diverse group of individuals is a major component of both career paths. Yet where nurses typically only deal with patients and their immediate colleagues on a daily basis, HR managers must also deal with the business side of health care as well.
For example, health care HR managers must address industry trends and set the standards for ethical practices within their facility. They may oversee digital recruitment and hiring, while also keeping patient needs at the forefront of their mind and even addressing legal situations that may arise. It’s a multifaceted job that requires knowledge, patience, and discipline as well as compassion.
A nurse who is interested in becoming an HR manager in health care should prepare to be challenged. You’ll need plenty of experience under your belt, as well as strong communication, organization, and computer skills. To get an edge over the competition, you may also want to consider pursuing an advanced degree in health administration.
Prospective HR professionals should also take note that speed and accuracy are paramount to the job, as they are in the field of nursing. Computer skills are a vital component of the job, and HR managers should have a strong grasp of technology and tools such as open-source software that allows you to quickly sign forms online, from invoices to payroll and hiring documents. Even in our digital age, most health care facilities leave a significant paper trail.
Workplace Discrimination
Unfortunately, sometimes that paperwork can stem from an unpleasant situation, such as legal action against your health care facility. Even when great care is taken to ensure that the most vigilant professionals are employed at a facility, that fact doesn’t always guarantee a safe and inclusive work environment. Thus, even the best HR managers may end up on the receiving end of a workers’ compensation claim.
While most workers’ compensation claims involve physical injuries, a hostile work environment could indeed be grounds for a lawsuit, especially if management was aware of the problem. And although workplace stress isn’t grounds for a workers’ comp claim, work-related trauma injuries may be. If the discrimination was serious enough to be deemed traumatic, the injured worker may indeed be entitled to compensation. As an HR manager, it’s your duty to help foster a more inclusive work environment where discrimination has no place.
This becomes even more important when you yourself are one of the very minorities who is often overlooked for leadership positions such as HR management. Nursing leadership means making connections with your staff, one of the best ways to prevent discriminatory practices is by modeling inclusion and diversity in your workplace. Do this in your hiring practices, in your relationships with your employees, in your interactions with clients; it will trickle down.
Final Thoughts
Advocating for diversity is extremely important when it comes to social justice, but it can be a fine line to tread in the workplace. Within the health care industry, minorities should try to take on leadership roles, such as in management and HR, in order to help build a more inclusive environment where patients and providers alike can feel safe, respected, and represented.
There is a growing demand for more nurses in general and that the demand for male nurses is currently on the rise. Male nurses are increasing their presence at the bedside, hospital, clinic, and nursing home. The American Association for Men in Nursing (AAMN) profiles the progress of its campaign for a 20% increase in the number of male nurses in the workforce by 2020. We all know that the nursing profession would benefit from a more diverse representation of gender, age, and cultures within the workforce.
Male nurses are bringing balance to the profession, which benefits patients as a whole. Having male nurses ensures that male patients are well cared and represented. Sometimes patients prefer a nurse of a certain sex, particularly for procedures like inserting a catheter, serving a bedpan, or administering EKG. Male nurses have skills and care-giving strengths that can make nursing an excellent career for them. Importantly, the benefits of being a male nurse are the same benefits of being a nurse.
If you are male and thinking about becoming a nurse, don’t hesitate to explore the career and most importantly look into yourself to ensure that this is the right career for you. Nursing is a challenging job and one that requires hard work, integrity, and dedication. Nurses can treat every patient regardless of gender, but dealing with human sickness and patients who may be crabby and cranky is simply a fact of life for nurses. As nurse, you are able to help patients and give them a level of comfort and put them at ease. The world of nursing holds many possibilities. There are over 100 different nursing specialties available and there are plenty of ways to advance your career if you are willing to work hard. Since not everyone has what it takes to be a nurse, there are a lot of considerations when it comes to nursing and what your personality needs to be like in order to be a good nurse.
Here are four key questions to ask yourself.
1. How well do you cope with stress and emergency situations?
Nursing jobs can be stressful at times. If you are someone who can work well under pressure and copes well with stress, you will do well as a nurse.
2. Are you easily offended?
Nurses sometimes come in contact with patients who are hostile or unfriendly. Being easily offended can make your nursing job difficult and stressful quickly.
3. Do you consider yourself to never stop learning?
The field of health care is continuously changing, whether it is a new disease or recently discovered new treatment, nurses learn something new every day. Therefore, a good nurse is always ready to learn more.
4. Are you a team player?
Teamwork is essential in nursing to getting the job done right and improving the patient’s health. Nurses, who enjoy their job, work well with other team members.
As increasing numbers of patients don’t speak English as their first language—or at all—the health care field is taking action. Here’s what’s happening and how you can become involved.
Imagine if you were in a hospital in a country where no one spoke English. Being in a strange hospital or other health care facility can be scary enough, but if you had no idea what was going on, it would make you more stressed—possibly making your health worse. You would feel incredibly vulnerable, as not knowing what was happening to you or if the workers could help you would be terrifying.
There was a time in the United States when that
could happen. Although it shouldn’t happen, legally, anymore, as Allison Squires, PhD, RN, FAAN, explains, there is still a need for more bilingual nurses. “All health care facilities are required by law—including the Civil Rights Act and updated regulations in the Affordable Care Act—to provide patients who do not speak English with an interpreter,” says Squires, an associate professor at the New York University Rory Meyers College of Nursing. “The interpreter can be an in-person interpreter or a telephone or video interpreter to meet the requirements of the law.”
According to Squires, the increase in patients who haven’t developed English skills comes from two situations: the post-WWII legacy in which U.S. citizens came here as immigrants, and the most recent wave of immigration, which has matched or surpassed the immigration numbers of the early 20th century. “According to the Pew Research Center, one in five households in the U.S. speaks a language other than English at home. More communities are also becoming refugee resettlement cities across the U.S., which means increasing linguistic diversity in places that have historically only had English speakers,” says Squires. “The demand for nurses who speak another language is at an all-time high.”
Location, Location, Location
While all the sources whom we interviewed agree that Spanish is the most prevalent second language needed for patients, they also say that other languages are vital as well, depending on your region of the country. “Spanish is the priority language nationally. Other languages depend on where you live and who is migrating there,” says Squires. “For example, in the New York City and New England regions, there are now large numbers of Russian speakers. These individuals often come from former Soviet Union states where Russian was the official language. Other parts of the country, like Texas and Louisiana, have large numbers of Vietnamese speakers who came to the U.S. as refugees or immigrants. Other than Spanish, language demand is often specific to a local health care service area.”
“Spanish is the language in highest demand, particularly in Texas, California, Florida, and Illinois. In California, bilingual skills are needed for Spanish, Chinese, Vietnamese, and Russian,” says Terry Mort, who is manager of talent acquisition for VITAS Healthcare, the nation’s leading provider of end-of-life care. In the 14 states and the District of Columbia in which they provide care, VITAS Healthcare has also found the need for Mandarin, Cantonese, Tagalog, Hmong, Korean, and Creole.
“We constantly have to look at demographics of the communities we serve and pay attention to how they’re changing over time,” explains Mort. “Take California as an example. At one time, South Central Los Angeles was primarily an African American community, whereas today it’s predominately Hispanic. And as our services move into outlying areas of Los Angeles County, our needs change again because we encounter more families that are Filipino, Asian American, or Hispanic American.”
Currently, in South Florida, several VITAS hospice teams are solely Spanish speaking to appropriately serve their patients’ and community’s needs. “In California, a trilingual nurse—someone who speaks English, Spanish, and other language—would be in high demand,” says Mort.
Although particular languages may be needed to serve certain populations, there are also instances in which unexpected languages may also be required. For example, when there was a recent influx of patients from Puerto Rico at the University of Maryland Baltimore Washington Medical Center who needed health care after Hurricane Maria, there were more Spanish-speaking patients, says Edith Lopez Dobbins, RN. Dobbins is a JET Nurse, which stands for Just Excellent Timing and means that she is a full-time nurse who serves as supplemental staff for different nursing units throughout the hospital. As a result, she has noticed an overall increase in patients who speak Hindi and Korean as their first language.
“In the hospice profession particularly, we also have the challenge of end-stage dementia patients, who may revert to their language of origin as their disease progresses. We had a Russian patient who reverted to speaking Russian, but the family indicated he had not conversed in that language for more than 20 years. If that happens, it requires us to update our care plan so that our nurses and staff members can communicate effectively with these patients in a language they understand,” explains Karen Peterson, senior vice president and chief nursing officer for VITAS Healthcare. “The more languages our staff members can speak, the easier our job is.”
Benefits to Being Bilingual
Bilingual nurses on staff help open everyone up to another world as well as another set of patients to care for, says Vivian Carta Sanchez, DNP, ARNP, from Tenet Florida Physician Services. “Nurses who are bilingual can also serve as translators to communicate very important information from physicians who do not speak the language,” says Sanchez.
Squires says that if you work in a hospital, home care, long-term care, or rehabilitation, there are four key times when interpreters are needed—admission, patient education, consent, and discharge. “Using an interpreter during these times can help reduce your patient’s risk for readmission and complications,” explains Squires.
Having a nurse who is bilingual, rather than using a family member to translate, can be crucial. “Let’s say that I take five minutes to explain something in detail to a patient, and the family member who translates what I said to the patient takes about 30 seconds. I can tell that my patient isn’t hearing the same thing that I said—and that’s a risk to the patient, because they’re not getting complete information,” says Peterson. “It’s one of the reasons we prefer not to use family members as translators because they are part of the unit of care and also dealing with psychosocial issues associated with end of life.”
Another advantage to staffing or being a bilingual nurse is that when you are speaking the same language as a patient, the work you are doing will take the same amount of time that it does as when you are talking with an English-speaking patient, says Squires. There’s no need to be concerned about waiting for an interpreter to arrive or to have to deal with any issues that can occur when using an interpreter by phone. In addition, communicating with family members may also be easier. “That being said, as a bilingual nurse, if you are the first language nurse to work with the patient when they access health services—be they in the hospital, home care, or primary care—sometimes you spend more time with them initially because the patient is so happy to have someone who speaks their own language,” states Squires. “You find out all this other stuff that the patient held back because of the language barrier or issues with interpreter services. Another advantage of being a bilingual nurse is that you can quality check video or phone interpretation.”
Culture Comfort
Speaking to patients in their native language isn’t only about the words; it’s also about their culture. Dobbins says that while they use “language phone-lines” to keep at patients’ bedsides so that they, their families, and the health care workers can communicate—which is certainly helpful—the phones can also make talking more impersonal. “It makes patients and their families uncomfortable—possibly because it’s not just about language, it’s about culture. Most of the time, we use peers in the health care team who speak the same language as the patient for better communication and overall quality of care,” says Dobbins.
“Bilingualism is even more imperative in the hospice profession because there’s a lot of emotion and psychosocial aspects of language surrounding the dying process. Each person might have a different opinion or thought process around the issues related to dying. It’s unique in that people may have difficulty conveying their thoughts and feelings, even in the same language, simply because it’s about death,” explains Peterson. “Some patients or family members can’t even say the word ‘hospice,’ so they find a way not to say it. But when our nurses, families and patients understand each other’s language and cultural nuances, we’re more confident that patients are making the right decisions and receiving the best possible care because everyone understands each other.”
Knowing about patients’ culture has become so important that the Chamberlain University College of Nursing began offering a Hispanic concentration on its Phoenix, AZ campus in May 2016. Pam Fuller, EdD, MN, RN, the Phoenix campus president, states that this concentration doesn’t aim to attract Hispanic nurses, but rather to appeal to nurses who want to care specifically for this culturally diverse group. This concentration is offered to anyone who is enrolled in the university’s pre-licensure BSN program. Because of its ability to logistically provide clinical experiences for students who are enrolled in the Hispanic concentration, the Phoenix campus volunteered to pilot it. “The local hospitals and health care centers currently serve Hispanic patients and families every day, and Chamberlain helps provide nurses and care to these local communities,” says Fuller.
“Providing nursing care requires not just an appropriate educational degree and a license, but also crosses boundaries of human dignity and respect. Many, if not all, hospitals and care centers are challenged to communicate more effectively with their patients, regardless of cultural background. Chamberlain specifically launched the Hispanic concentration based on information from hospitals in our local markets,” explains Fuller. “When a patient is in pain or in need of health care, they tend to revert to what is comfortable to them, culturally. If you are culturally more comfortable with your own language and traditions, if there is someone who can speak—at least a little bit—the language you speak, it makes the care that much more effective and personal.”
“Chamberlain’s Hispanic concentration is not a language program. This concentration exposes students to the Hispanic language and culture and allows for 25% of their clinical experience to be placed with a Hispanic patient. This gives them real-time experience in serving the Hispanic population,” says Fuller. “Any student—regardless of their personal cultural background—may enter this concentration…The goal of the Hispanic concentration is to educate students and expose them to the culture and language of the Hispanic community to provide an improved level of care to this population.”
Attracting Appropriate Personnel
How can facilities go about recruiting bilingual nurses? Squires believes that a combination of actions could help. Nursing schools need to recognize local demand for bilingual services and restructure curricula to help ensure the success of English as a Foreign Language (EFL) students, says Squires. “Even now, EFL students have lower pass rates on the NCLEX-RN exam, and that’s not helping to meet our need for more bilingual nurses. Schools need to change how they teach and support EFL students so they have the same success rates as English speakers,” Squires says.
“Organizations should give bonuses to people who are bilingual to encourage better communication,” says Sanchez.
As for becoming bilingual, Squires says that to achieve the level of fluency to be able to effectively and safely communicate with patients about health issues, nurses would be required to undergo years of study or at least a six-month immersion in a country where the language that they want to learn is spoken. “Having just a few words or phrases can be helpful for recognizing when a patient is in pain or [has] toileting needs, but when it comes to the complex communication needs that go with admission for services, patient education, consent, and discharge, you really need to have what’s called sociolinguistic competence in a language. That’s something that your employer should help you certify or do it on your own to make yourself more marketable,” says Squires.
At the end of the day, being bilingual or having bilingual nurses on staff is all about patients’ safety and comfort. “As a nurse, many of my most rewarding moments have to do with going the extra mile to help a Spanish-speaking family during their hospital stay,” says Dobbins.
The nursing program at MidAmerica Nazarene University, with the help of Digital Third Coast, created an infographic depicting data on the perceived stigma of male nurses. Through their research, they gleaned quite a lot of interesting information.
For example, while it’s well-known that mainly men served as nurses in the past, their research indicates that “Due to associations with the military and religious orders, there was significant male representation in the nursing profession through the late 1800s.” The visual even shows a photo of famed poet Walt Whitman with his male nurse, Fritzenger.
When did this all change? According to the graphic, legal barriers in the early 1900s contributed to the scarcity of male nurses. In fact, many nursing schools would not even admit men. This didn’t officially change, though, until 1981 when the U.S. Supreme Court ruled that not admitting men to nursing schools was unconstitutional.
As a result, during the 1930s and 1940s, the percentage of nurses who were male decreased to its lowest point, which according to the U.S. Bureau of Labor was 1%. Not surprisingly, that percentage has risen over the years. As stated in the 2013 Census, out of the 3.5 million employed nurses, 78% are Registered Nurses (9.6% of these are male); 19% are Licensed Practical and Vocational Nurses; 3% are Nurse Practitioners; and 1% are Nurse Anesthetists (41% of these are male).
From these statistics, it can be concluded that men are more likely to become nurse anesthetists—which is the highest paid role in the nursing field. With women making up the majority of the nursing field, one would assume that they tend to make more in terms of salary, right?
Wrong. Female nurses make only 91 cents per every dollar that male nurses make.
For more fascinating facts about the perceived stigma of male nurses, check out the infographic here.
