Why Gender Diversity in the Workforce Matters

Why Gender Diversity in the Workforce Matters

At Charles R. Drew University of Medicine and Science, the number of male nursing students seeking a master’s degree is reason to celebrate.
“At the beginning of this semester, a faculty member said, ‘I just did an assessment of our new cohort and 15% of the incoming class are men, and it’s the most we’ve had in a cohort,’” says Sheldon D. Fields, PhD, RN, FNP-BC, AACRN, FNAP, FAANP, dean of the Mervyn M. Dymally School of Nursing.
But gender diversity is just part of the story at the historically black and Hispanic graduate institution based in South Central Los Angeles. “Not only is our male student population up, I also only have minority male students in my program,” says Fields, who previously served as an assistant dean and codirector of the Doctor of Nursing Practice Program in the Nicole Wertheim College of Nursing and Health Sciences at Florida International University. At that Miami school—a historically Hispanic institution—the male nursing enrollment is much higher at 30%.
Such historically diverse schools of nursing are key to getting more men of color into the nursing pipeline, says Fields. “Minority-serving institutions, I think, stand a better chance of attracting men because we are more flexible and we don’t have those historically traditional ways of looking at who should and who could be a nurse.”

Increasing Gender Diversity
Today, one out of 10 nurses is a male. And while more men are resisting stereotypes and increasingly pursuing a career in the most trusted health profession, many more are needed not only to achieve gender parity, but also to reflect the nation’s demographics, says William T. Lecher, RN, DNP, MBA, NE-BC, immediate past president of the American Assembly for Men in Nursing (AAMN).

AAMN has aligned its goals to improve gender diversity with the recommendations of the Institute of Medicine nursing report, which stated that to improve the quality of patient care, more efforts are needed to increase the diversity of the nursing workforce, especially in the areas of gender, race, and ethnicity.
“Our patients and families know the important role men in nursing play in meeting their nursing and health care needs. For example, The DAISY Award is provided by almost 2,000 health care facilities and celebrates and honors the extraordinary compassion and direct care nurses provide to patients and families every day,” says Lecher, senior clinical director at Cincinnati Children’s Hospital Medical Center.
“The DAISY Foundation has found that men are recognized by patients, families, and health team members two to three times the rate they are employed. Or, in other words, the patient and family experience benefits by having men in the nursing workforce. As such, our patients, families, and health care administrators should demand our nursing schools do a better job recruiting and retaining more men in nursing school. It is hard to believe that, in this day and age, men in nursing school only account for 12% of students [as of 2012] and their attrition continues about twice the rate of women in nursing programs,” says Lecher.
According to a report by the American Association of Colleges of Nursing, 2014-2015 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, men comprised 11.7% of students in baccalaureate programs, 10.8% of master’s students, 9.6% of research-focused doctoral students, and 11.7% of practice-focused doctoral students. One of AAMN’s goals is to have men make up 20% of nursing student enrollment by 2020.
To encourage schools of nursing to support its male students, AAMN has created the Excellence in Nursing Education Environments Supportive of Men program, a recognition designed to provide evidence to stakeholders that a specific program is gender-inclusive. Recognition symbolizes excellence in providing male students a positive and equitable educational environment as determined by AAMN.
The program’s goals include increasing awareness of issues that may challenge the success of male student nurses, fostering the recruitment and retention of men as nursing students, and recognizing nursing education programs that have achieved excellence in supporting male students. Recognition is valid for eight years. Schools interested in applying can do so at AAMN.org.
Increasing the gender diversity of students to create a workforce prepared to meet the demands of diverse populations requires schools of nursing to do a better job of recruiting and retaining male students, says Marianne Baernholdt, PhD, MPH, RN, FAAN, professor and director of the Langston Center for Quality, Safety, and Innovation at Virginia Commonwealth University (VCU).
“You won’t find a school of nursing today… that wouldn’t say we do everything we can to increase minorities in nursing and that includes men. If you are not going to put money or specific actions behind [these goals] well, you will just keep doing what you are doing,” Baernholdt says. At VCU, men are 12.5% of the undergraduate nursing school enrollment, she adds.
VCU offers several entryways into nursing, including the RN-to-BSN program, and an accelerated bachelor’s degree program. “Because we have that mix, I think we have a higher proportion of male students. But VCU is known for its diversity, so that’s another reason we also have as many African Americans as we have males. Does that mean we could do better? Of course, we need to do even better,” says Baernholdt.

Growing Numbers
From 2010 to 2013, the number of male RNs increased from 8% to 10.7%. During that three-year period, an additional 70,000 male nurses entered the workforce, increasing their number to over 300,000. Since the 1970s, the percentage of male nurses has more than tripled.
The profession’s low unemployment, a desire to make a difference, and a shift in how male nurses are viewed are among the reasons men are entering nursing, experts say.
“The increased visibility of AAMN and men in other nursing organizations make it easier for men to see themselves as nurses,” says Lecher. “Furthermore, the recent recession has helped men choose nursing as a way to help others, have purpose and meaning in their work, and earn good income for their families.”
Alexandra Robbins, author of The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital, agrees. “I think they are increasingly drawn to the profession as the stigma and stereotypes wane and as more men realize just how hands-on a nursing career can be,” she says.
Fueling the growth of male nurses are innovative initiatives, including programs that train foreign-educated physicians—who cannot practice in this country—to become nurses, says Fields. The number of returning military veterans is another factor. “There are several medic-to-RN programs around the country, and the VA has put money into continuing education for vets, and a large number of them are coming into nursing,” says Fields, noting that the military is disproportionately higher in men.

Pay Disparity
While male nurses are the minority, they still earn more money than women in the same role.
A report published earlier this year in JAMA: The Journal of the American Medical Association, found that the average female nurse earns about $5,100 less than her male counterpart—even when researchers controlled for factors such as race, age, marital status, and specialty. The uneven wages also varied significantly by specialty. The highest salary gap was for nurse anesthetists, a role held by many men.
“I don’t think what we’re seeing should surprise anybody because we live in a country that has a pay disparity between men and women, with men making more money,” says Fields. “In nursing, there is a slightly larger number of men who pursue an administrative role, and they tend to work in critical care roles, which requires more credentials and pay more money,” he adds. Men seemed to be promoted quicker, too.
The bottom line? “In America, we have a patriarchal society that says men are worth more,’’ says Fields.
The salary gaps are dismaying but may not be as widespread as the study suggests, says Peter McMenamin, PhD, senior policy fellow and health economist at the American Nurses Association.
The challenge is in the data, which included information that stretched back more than 10 years, when there were fewer male nurses. Also, the wage differences are not explained but may include women who took time off to have children and, so, lost their place in the labor force and never caught up. Or, the data could include male nurses who worked two or more jobs, which meant their total compensation increased, explains McMenamin.
“So there are all these little things that suggest it’s not as simple as taking the average wage for men and women in the same category” because of other issues, including training and experience, says McMenamin. Still, he is dismayed that the differentials exist. “We’d like to live in a world where experience and education were the primary determinant of compensation…but gender alone should not.”
Gender diversity may help to resolve the uneven wages, says Lecher. “Gender occupational segregation does not promote wage advancement in nursing or any other occupation. A more gender-diverse workforce will benefit the wage potential for all nurses.”
While that remains to be seen, gender diversity improves culture competence and outcome for patients, says Elliot Brooks, senior vice president of human resources at MJHS, one of the largest health systems in the greater New York area.
“New York is one of the most diverse cities in the world. At MJHS, we believe that our employee population should reflect, understand, and respect the diversity of this great city. That doesn’t just extend to gender; it also means culture, faith, tradition, ethnicity, sexual orientation, et cetera. Our anecdotal qualitative research shows that our patients, of any background, appreciate receiving care from nurses who are culturally sensitive. This enhances care management, goal setting, and having difficult conversations. But, the benefits go beyond those important things,” Brooks says.

Amplifying Voices
Patients are more likely to open up “about their personal lives, dreams, hopes, and challenges,” Brooks continues. “By extending compassion, dignity, and respect to our patients, we are able to help provide care to the whole person—physically, socially, emotionally, psychologically, and, of course, culturally.”
The nursing community, health care stakeholders, and the public must work together to improve gender opportunity in nursing. “There’s been a huge cultural expectation and assumption shift in the past 40 to 50 years,” says Brooks. “It used to be that most people assumed all nurses were women. Today, fewer people make that assumption. I think the Millennials and future generations will help continue to push for greater gender opportunity in all professions, not just nursing.”
Lecher agrees that more vocal support is needed, particularly from fellow nurses. More men and women nurses need to demand that the profession become more gender diverse and inclusive, he says. “It would be a mistake to think that men can solve gender recruitment and retention by themselves when women dominate the profession,” he adds.
“We have many women in nursing advocates for gender diversity. There are presently five women serving in the role of AAMN chapter presidents. A lot of nurses believe our membership is limited to men, but that is not the case,” says Lecher. “The truth is our women in nursing colleagues need to take a leadership role for such change, or our progress will continue to be glacial.”
Robin Farmer covers health, business, and education as a freelance journalist. Based in Virginia, she contributes frequently to Minority Nurse magazine and website. Visit her at www.RobinFarmerWrites.com.

Bullying in a Least Expected Place

Bullying in a Least Expected Place

It was an intentionally simple question the clinical nurse in the examining room heard. “Lynn,” I said, “Have you ever been bullied?” There came a pause. Then, she responded with a torrent of emotions reflecting anger and disappointment that took her back to the start of her career 23 years ago. I posed the question as she prepped me for the ECG my doctor ordered.

After completing her nursing degree, Lynn went to work as a registered nurse in the emergency department at a suburban hospital in North Carolina. For the next two years, she was abused, intimidated, openly berated, and humiliated by staff nurses with more seniority and the nurse manager.

“What was that like?”

She said it was just how you were treated. “You were made to feel stupid when you sought clarification of a physician’s charted instructions, for example, or asked for input to correctly respond to a patient’s request. Eventually, I left.”

What happened to Lynn is not a rare occurrence among nurses, unfortunately. On July 9, 2008, The Joint Commission, which provides oversight to over 20,000 hospitals and other care facilities, issued a policy directive to its membership called a Sentinel Event Alert. Its instruction was to have procedures in place to deal with “behaviors that undermine a culture of safety” by January 1, 2009. It described “intimidating and disruptive behaviors” in great detail, which is the most widely accepted definition of bullying. Its rationale was clearly embedded within the body of the policy: “There is a history of tolerance and indifference to intimidating and disruptive behaviors in health care.”

With mounting evidence that bullying was surprisingly prevalent within the health care sector, the intended purpose of the Sentinel Event Alert was to amend its leadership standards. Accredited health care organizations would be required to create codes of conduct that define disruptive and inappropriate workplace behaviors as well as establish and implement procedures for managing such behaviors. Additionally, the institutions The Joint Commission accredits were expected to make their data available for review, according to Gerard M. Castro, PhD, The Joint Commission’s project director for patient safety initiatives.

Nursing’s Dirty Little Secret 

“Nurses eat their young,” wrote Theresa Brown, a registered nurse, in an article in The New York Times in February 2010. “The expression is standard lore among nurses, and it means bullying, harassment, whatever you want to call it. It’s that harsh, sometimes abusive treatment of new nurses that is entrenched on some hospital floors and schools of nursing. It’s the dirty little secret of nursing.”

Her story is not exceptional, and it prompted me to contact Gina, a clinical nurse in Worcester, Massachusetts, with a master of science degree in nursing education and 35 years of experience—15 of which were on a nursing school’s faculty.

“There are nurses that I do not assign a new-to-nursing nurse to because of what I know would be their experience,” Gina tells me. Then, she describes her very recent experience where she accepted a per diem assignment in the operating room (OR) of a local hospital with which she is very familiar: “I almost never survived a month because of the bullying that went on. I had never seen anything like it and never experienced anything like it in my years in nursing.”

It seems that there had not been an assignment of someone new to the OR in 10 years, so Gina was treated as an outsider and not part of the clique. So targeted was the hostility that after three months of enduring the treatment, she says, “I began to feel myself spiraling down, losing my self-confidence. I endured badgering criticism; I couldn’t do anything right; there was an absence of kindness.”

Fortunately, there was a change of supervisor who observed the climate in the OR and stepped in to end the intimidation by referring the preceptor for retraining.

An Occupational Hazard

Scenarios similar to the one Gina describes must have been alarmingly common to have prompted The Joint Commission to issue a specific directive regarding workplace bullying, or lateral violence, as it is technically referenced. Diverse studies identify nursing as a risk group for workplace bullying; further, they confirm that the problem of hostility in the workplace is very common in the health care sector.

Indeed, health systems are aware of this hostility and responding to the Commission’s directive. Duke University and the University of North Carolina, for instance, have policies and procedures to deal with workplace behavior. Duke shies away from describing intimidating and disruptive behaviors as bullying per se—and perhaps may have tacitly not reinforced the implications that bullying is specific and disruptive conduct that impacts the delivery of care.

Carole Akerly, BSN, director of accreditation and regulatory affairs at Duke University Hospital, responded to my inquiry. “Duke,” she says, “has identified behaviors that are appropriate and has not specifically described intimidating and disruptive behaviors, and I don’t know whether we have identified it as that close.” But if bullying is as prevalent as the research and reports indicate—and there are many—it is unlikely that Duke and other health care providers have an incident pattern less than the norm.

The University of North Carolina Health Care System, on the other hand, provides a detailed description of intimidating and disruptive behavior and a very specific description of what constitutes appropriate behavior, so the employee has no room to allege ambiguity. The rationale for its disruptive and inappropriate behavior policy admits that disruptive behavior “intimidates others and affects morale or staff turnover [and] can be harmful to patient care and satisfaction as well as employee satisfaction and safety.” Further, the policy acknowledges the possible presence of such behavior: “While this kind of conduct is not pervasive in our facilities, no hospital or clinic is immune.”

Carol F. Rocker, PhD, RN, the lead investigator of a study of nurse-to-nurse bullying and its impact on retention in Canada, reported in OJIN: The Online Journal of Issues in Nursing in September 2008 that Canadian nurses are not alone when it comes to workplace bullying and emphasized that workplace bullying among nurses is now recognized as a major occupational health problem in the United Kingdom, Europe, and Australia. Why did The Joint Commission go to the trouble of defining bullying if it was not to delineate behaviors that threatened patient safety and care quality? The answer is embedded in what led the Commission to do this in the first place. It’s found in the promulgation of the Universal Protocol (UP).

In addressing the need to create a climate of safety related to wrong site, wrong patient, and wrong procedure within a health care facility, the Commission became aware that one of the contributing factors was the failure to speak up. What stops a clinician from speaking up? Oftentimes, it’s the deference to the physician and other clinicians.

“We have heard of abusive behavior by physicians when clinicians in the operating room, for example, have corrected the physician. Not speaking up is the result of deference to the physician,” says Castro. The UP team became aware at that time that this harmful behavior within care facilities was a safety issue.

A 2003 survey on workplace intimidation conducted by the Institute for Safe Medication Practices found that 40% of clinicians have kept quiet or remained passive during patient care events rather than question a known intimidator. Elaborating on this issue, the Commission’s Sentinel Event Alert cites several reasons why disruptive behaviors go unreported, such as fear of retaliation, the stigma associated with “blowing the whistle” on a colleague, and leniency towards physicians who generate high amounts of revenue.

But, so serious is the epidemic of workplace bullying—with particular emphasis on the nursing sector—that 26 state legislatures have proposed legislation to address this concern, beginning with California in 2003. The model, the Healthy Workplace Bill, provides very specific employee and employer remedies, protections, and sanctions. There is clearly a movement to expand safety in the workplace from the purely physical aspect to the equally important emotional and psychological aspects.

When Nurses Hurt Nurses

Kathleen Bartholomew, RN, MN, renowned for nursing consulting and training, cites episodes of nurse bullying that astonishes: a nurse hides a surgeon’s favorite instrument when a substitute fills in as the scrub; a circulator, a nurse who makes preparations for an operation and continually monitors the patient and staff during the surgery, doesn’t tell a new nurse who is scrubbed that she knows the shunt the surgeon selected has fallen on the floor; a newly hired RN who was previously a scrub technician is shunned by both camps. These episodes, Bartholomew says, pose the question whether this is what life is like in the OR.

When the administration at Indiana University Ball Memorial Hospital studied the issue of bullying, it was clear that the problem existed beyond nursing units. “It starts with physician to physician and then trickles down the chain of command,” says Renee Twibell, PhD, the lead investigator and an associate professor of nursing at Ball State University. “If the doctor kicks the nurse, that nurse turns around and kicks the new nurse or the CNA.”

The consequences of adult bullying have led investigators to name it as a significant occupational stressor in the workplace. Moreover, the Center for American Nurses labels workplace bullying a serious issue affecting the nursing profession in particular, and defines it as any type of repetitive abuse in which the victim suffers verbal abuse, threats, humiliating or intimidating behaviors, or behaviors that interfere with the victim’s job performance and are meant to place the health and safety of the victim at risk.

Are all nursing sectors equally at risk? Specifically, I was curious to know whether military nurses have a similar experience. Having spoken with Lieutenant Colonel Angelo D. Moore, PhD, the deputy chief for the Center for Nursing Science and Clinical Inquiry at Fort Bragg Womack Army Medical Center for a previous story, I remembered what he had said. Moore turned my inquiry around and wondered whether gender issues might be at work in some bullying episodes. The ratio of male to female nurses in the military is thrice that of the nonmilitary nursing sector and, according to Moore, the combination of having been to war and the culture of the military contributes to very few incidents where bullying was alleged.

Still, bullying is a complex phenomenon. Although bullies are responsible for their behaviors, investigators have analyzed several potential factors that prime the workplace for bully behaviors, which include organizational leadership and culture, the social system, character traits of the victim, and character traits of the bully. Bullying clearly qualifies as hostile workplace behavior, and if the target can claim protected class status, it becomes a major legal issue for hospitals and care centers. A 2011 study of student nurses by the American Nursing Association reported that 53% of study participants had been “put down” by a staff nurse, and 52% had been threatened or experienced verbal violence at work.

Cheryl Dellasega, PhD, faculty member at the Penn State University College of Medicine and author of When Nurses Hurt Nurses: Recognizing and Overcoming the Cycle of Bullying, provides significant research that led her to state that there are cases where the nurse manager or charge nurse—often a highly competent, valuable nurse that the administration does not want to lose—may act as a bully, playing favorites when it comes to assignments or time off. “If they are role modeling this stuff, it will be worse among the staff,” Dellasega told NurseZone.com. “If they get the message that it’s OK to treat people like this, everybody will.”

Moving Forward                                                    

So, what’s the remedy? Bullying in the workplace is both an awareness and a leadership issue. Moreover, as is so often the case in workplace practices, the leadership should be careful not to be caught being party to making case law by a complainant seeking to link hostile workplace to bullying as a protected class member. Hospital management might address the presence or prevalence of bullying behavior by examining how it is factored into their training in root-cause analysis, as well as what their whistleblowing protection policy provides.

Nurse leaders must establish clear guidelines about what behaviors will not be tolerated and what is unacceptable, Dellasega believes. She also recommends creating a suggestion system so nurses can anonymously report things that happen on the unit, and asking for feedback about what would make the work environment better.

Gabriela Cora, MD, takes a harder stand, saying hospital administrators should have zero tolerance for bullying behavior. “Lay a plan for improvement,” Cora adds. “Reward them when they improve their behavior and be ready to fire them if they continue the bullying behavior. Second, avoid praising or rewarding nurses for their work performance if they are bullies. Instead, respectful treatment of patients and positive interactions with colleagues should be rewarded.”

Ultimately, it’s all about modeling positive behaviors and holding employees accountable. If the policy is zero tolerance for bullying, it should mean just that—zero tolerance.


The Generational Shift: How to Manage Different Generations in the Workforce

The Generational Shift: How to Manage Different Generations in the Workforce

With four generations of nurses working side by side in hospitals—each with different strengths and approaches—how can nurse leaders promote intergenerational harmony? By understanding the values of each group, connecting a diverse staff to a common vision, and customizing leadership style, nursing experts say.

The four generations populating the workforce include the traditionalists or veterans, who were born before or during World War II (1925-1945); the baby boomers (1946-1964); the Gen Xers (1965-1980); and, Generation Y, also known as the Millennials (1981-2000).

One of the biggest differences between each group revolves around communication styles, says Rose O. Sherman, RN, NEA-BC, FAAN, professor and director of the Nursing Leadership Institute at Christine E. Lynn College of Nursing at Florida Atlantic University.

“I do a lot of research with nurse leaders, and it is communication that is presenting them with problems. The average nurse manager has 60-plus people to supervise, and there will be a cross-generational workforce” and leaders must make adjustments, says Sherman. “That same type of communication will not work for every generation.”

For example, veterans and boomers enjoy getting information through memos, phone calls, and staff meetings. These nurses prefer face-to-face communication and may appear too talkative to younger co-workers. Vets and boomers “have long preambles. When they want to tell you something they want to give you background. . . they want to make sure you understand the background story,” says Kelley Arllen, RN, MSN, CCCE, staff development/childbirth education, Department of Education and Research at the Virginia Hospital Center. “It’s important to listen to that and not just pooh-pooh it and say, ‘What’s your point?’”

Tension occurs since “Gen X and Y, to an extent, speak bluntly and quickly. They want to be very to the point, so that makes it hard for them sometimes to listen to the preamble. The vets and boomers think they are blunt and rude people, so there can be a disconnect there,” Arllen continues.

Millennials, who have grown up “attached to their smartphone devices” want communication short, to the point, and they want the communication loop closed, says Sherman. “They don’t want to sit at endless meetings where processes are being discussed and there doesn’t appear to be any outcomes.”

They like texting and social media as their primary form of communication versus e-mail and face-to-face discussions. Savvy nurse managers are learning no one-size-fits-all approach exists and they will have to communicate differently and in a way that is meaningful to each age group.

“I read somewhere. . . about a communication timeline,” says Arllen. “If a veteran asks you a question, they need an answer within a week. If a boomer asks you a question, they need an answer within a few days. If Gen X asks, they will wait for a response for about 24 hours. For Gen Y, they need a response immediately. I think part of that is we used to write letters, then we did more with telephone calls, and then e-mail, and now it’s texting.”

The Millennials’ preference for informal communication may come at a price, argues Beth A. Smith, MSN, RN, director of the Nurse Residency Program at Penn Medicine, who works with many new nurses. “I think there’s a need for development with interpersonal skill development. I sense in the Millennial generation a general unease about how to communicate with physicians, patients, and family members,” says Smith, who is also a nursing professional development specialist at the Hospital of the University of Pennsylvania.

The generations differ with their attitudes about job expectations and life-work balance, experts say. Some of that may reflect different generations being at different stages in their careers. For example, the vets and boomers are more interested in career stability compared to Gen X and Y. The youngest nurses are more interested in being coached and mentored and having a healthy personal life.

Life-work balance wasn’t important to boomers who were so grounded in their jobs that they sometimes were extreme with their allegiance, says Sherman. But Gen X and Y “are really interested in having work-life balance and that will impact their decisions about different jobs they take.”

The concept of loyalty to an organization is also changing for every generational group after massive corporate layoffs. Nurses of all ages “don’t feel like organizations have been loyal to them. Gen Y tends to be more loyal to the teams and managers they work for than the organization they work for,” explains Sherman.

The first building block to successfully managing a multigenerational workforce requires leadership to respect the differences between the generations and embrace a belief that diversity in the workplace is good. Other major components include a willingness to change one’s leadership style and a drive to bring people together by looking for common ground.

“In a health care setting, everyone on the team can agree the reason they are there is to support the patient and family,” says Sherman. “We might have differences on how that is best managed, but we all want to see the same outcomes.”

Creating an inclusive governance structure also matters. Invite nurses from each generation to the table for decision-making, says Smith. Another strategy for managing a four-generation staff is to customize rewards, incentives, and career development to appeal to each different generation. Leaders must find a way to define and create a common language and culture. All generations have a defined work ethic and a desire for respect and recognition, but it looks different for each generation, says Arllen, who recommends two books on the topic: The Nurse Manager’s Guide to an Intergenerational Workforce and Managing the Generation Mix.

Arllen suggests that teams come up with representatives from each generation to answer a series of questions that will reflect differences, such as: “What does coming to work on time mean?,” “Does it mean starting at 7 a.m., or does it mean you are ready to work at 7?,” “What does business- causal mean?,” and “Are flip flops and sleeveless tops okay because that’s what Generation X is going to wear, or did you have slacks and sweaters in mind?” Other possible topics could include cursing at work or bringing food into a meeting. Build on common values and make sure the team figures out how the group is going to communicate.

Once these things are in place, focus on the mission and review it regularly. Then “you will have a better cohesion because you are including the generational things, but you are realizing that your team can be more than the generational things and work together,” Arllen says.

Smith agrees. “If you can create a dialogue and allow their strengths to come through, you will clearly impact workplace satisfaction,” she says. “You will impact retention, which has a financial component to any organization, and you will impact productivity.”

Robin Farmer is a freelance writer based in Virginia.


How Mentoring Programs Influence Workforce Diversity

How Mentoring Programs Influence Workforce Diversity

Karen Bankston, PhD, MSN, FACHE, didn’t have management in her career sights when she started as a fledgling emergency room nurse in 1976 at then-Southside Hospital in Youngtown, Ohio. She wasn’t thinking much beyond giving the best care possible to patients with traumatic injuries and acute health issues.

Yet Bankston’s chief nursing officer, Ruth Eldridge, MSN, RN, had a different idea. She saw enough leadership potential in her young nurse to offer herself as a mentor. Bankston admits that she didn’t even know what the term meant back then. But with Eldridge’s counseling persistence, her career took a rewarding trajectory, eventually leading to her present position as associate dean for clinical practice, partnership, and community engagement at the University of Cincinnati’s College of Nursing.

It’s from that perch that Bankston now offers similar counsel to nurses-in-training. As faculty advisor for AMBITION—Advising Minorities By Inspiring and Transforming Them Into Outstanding Nurses—she wants to impart the same wisdom that her now retired mentor did to her years ago. “I’ve always been grateful to Ruth. If she hadn’t taken that step and said to me, ‘I’m going to help guide you because I see that you can do some great things,’ I might have had a totally different career than the one I’m enjoying today.”

A Place at the Table

Perhaps you’ve had a similar experience. Someone spotted you as a diamond in the rough, a professional gem ready to be mined and polished. Or maybe you were the one searching for a seasoned colleague to help you buff your skills, build your portfolio, or strategize your next move. In either case, you’ve likely reaped the benefits in forging relationships with people who have your back and your best interests at heart.

But in the bigger universe, how does mentoring actually help diversify the nursing workforce? What role does it play in answering the calls of the National Academies’ Institute of Medicine (IOM) and other nursing organizations for increasing diversity and giving an ever-changing patient population culturally competent care?

Mentoring can have widespread implications beyond boosting individual careers. By giving minority nurses and nurse practitioners a necessary leg-up in broadening their options and fine-tuning their skills, mentoring changes the face of one organization and the makeup of the entire field. By encouraging persons of color to join, grow, succeed, and stay in the profession, it expands diversity, one person at a time.

More specifically, developing a mentoring relationship exposes you to jobs you’ve never heard of—and to people who’ve never heard of you. It shows you that others have done what you’ve only thought of doing in passing. Now that you know their path, however, you can accomplish those goals too! Finally, by tapping people you respect for their wisdom, you ready yourself as an effective participant at any leadership table. In doing so, you’ll bring diversity to the highest decision-making levels of the profession’s ladder, not just those lower rungs.

As Commander James Dickens, DNP, NP, FAANP, US Public Health Services, Office of Minority Health, Dallas-based Region VI, observes: “Nurses always talk about having a place at the table, but I think it’s more important than just that. You also need to have a fundamental understanding of what occurs…of what roles you and your colleagues bring to the team. Sometimes you may be the only nurse or nurse practitioner sitting there, so it’s important to understand the expectations.”

An Invitation into the Fold

Yet you can’t diversify the leadership table if you’re not in the profession in the first place. Although mentoring is an essential technique for helping nurses and nurse practitioners of color enter the job market and capitalize on their skills, it’s also an effective tool in attracting promising young men and women into the field initially.

By encouraging ethnically and racially diverse students to take the academic plunge, mentors play a critical role in expanding the nursing universe at the earliest possible juncture. They’re key for steering mentees as they navigate the rigors of training programs that are both new and challenging. They’re a sounding board when the educational waters get murky or rough. But their primary role, beyond helping fledgling nurses graduate with flying colors, is to make sure persons of diversity understand that they have a place in the profession and are capable of the work.

“People sometimes have the perception that they can’t succeed at nursing, especially if they’re part of a racial minority or from a different culture or lower socio-economic background,” says Willa Hill Fuller, RN, executive director of the Orlando-based Florida Nurses Association and a veteran mentor and mentee. “They didn’t have a mom like my mother who just never let me think that I couldn’t do something. Mentors can help eliminate those kinds of attitudes, so their mentees can realize their potential.”

Growing up disadvantaged, Gordon Gillespie, PhD, RN, a Robert Wood Johnson Foundation Nurse Faculty Scholar and assistant professor at the University of Cincinnati’s College of Nursing, had no aspirations to be a nurse. Like many men, he initially bought into the gender biases surrounding the profession, stereotypes that can stifle that initial interest and prevent retention. But Gillespie had a major supporter in his mother-in-law, herself an RN. She not only saw his potential, but eventually, with the help of other nurses, convinced him that nursing fit him to a “T.”

“As I look back, it’s almost a miracle that I graduated from college, let alone became a PhD,” he says. “But someone looked at me and said, ‘I have faith in you. I believe in you. I will challenge you.’ That’s where mentorship is really essential. It can keep students in a program until graduation so we have that diverse workforce.”

Today, Gillespie is both a mentor and mentee. As part of a scholarship program designed to single out the next generation of academic leaders, he’s put together a team of role models to facilitate his own growth beyond the doctorate and the experience he’s already amassed. For Gillespie, that includes two campus colleagues—one a nurse and the other from a different discipline—to help him deal specifically with being a good researcher, teacher, and fellow professional within his program. A third mentor, separate from both nursing and Cincinnati, serves as his external “safeguard.” She offers a broader perspective on a given situation from her spot in Baltimore. “I used to believe that having a one-on-one relationship with a single mentor was the perfect situation,” he says. “But now I realize that a package of mentors is excellent. It’s going from good to great.”

The model has worked so well for Gillespie that he uses it as a guide in mentoring his own students, particularly the young men he meets as the faculty advisor for the College of Nursing’s MENtorship program. With the ultimate goals of enrollment and retention to graduation and beyond, MENtorship was initiated to help male nursing students not only recognize the possibilities of a career in a caring profession, but also to deal with the real-life issues of choosing one dominated by women. In doing so, the discussion between mentors and mentees—upper classmen for lower classmen, and licensed nurses for seniors—often centers on dispelling gender myths and dealing with the challenges of caring for the opposite sex.

Gillespie’s mission is to turn out male nurses who are not only potential leaders, but also content enough in their own skin to stick with the profession. “Our goal is to give these young men the support they need so they’re very comfortable with who they are as men in nursing,” Gillespie says. “We want them to be able to go out and broadcast to the world, ‘Here I am. I’m proud of what I do.’”

Formalizing Tasks

To be effective, should mentoring occur vis-à-vis a formal structure or can you connect successfully in other “organic” ways? Truth is, whether you come together in the framework of a program or by linking with people whose substance and style you admire, you can have a very successful relationship. That is, as long as you’re on the same page in terms of goals, expectations, and even practicalities. There are times, however, when a formal construct not only cements mentoring as an important part of a nurse’s professional life and training, but also serves as a significant tool for bringing and keeping more persons of color into the fold.

For instance, in 2008, the Robert Wood Johnson Foundation (RWJF) joined with the American Association of Colleges of Nursing (AACN) to launch the RWJF Careers in Nursing Scholarship Program, an effort to alleviate the nation’s nursing shortage by dramatically expanding the pipeline of students from minority backgrounds via accelerated nursing programs. Since its inception, RWJF has awarded some 2,700 $10,000 scholarships, through grantee schools of nursing, to entry-level nursing students coming into the field from other careers. Preference is given to awardees from underrepresented groups or disadvantaged backgrounds.

To achieve that success, however, program officials knew early on that they had to establish consistency in how their grantees—nursing programs throughout the country—not only defined mentoring, but how they would be implementing it. Out of the concerns that people don’t confuse mentoring with academic counseling came a toolkit (www.NewCareersinNursing.org) to guide grantees in setting up a program.

“If organizations can formalize their mentoring efforts, I think the odds are much better that they’ll see success,” says Vernell P. DeWitty, PhD, RN, program deputy director. “But even if they don’t have the resources we provide our grantees, as long as they have a good understanding of what mentoring should look like and how it should be approached, I think it can work.”

Likewise, for the past six years Marquette University’s College of Nursing has used Project BEYOND (Building Ethnic Youth Opportunities for Nursing Diversity), an effort funded by the Federal Health Resources and Services Administration, to increase the number of minority BSN students admitted to and graduating from its nursing program. Mentoring is one aspect of an agenda that also includes tutoring, structured leadership programming, and peer-to-peer support.

In terms of connecting, both mentors and mentees come together in what’s called the “World Café,” a meet-and-greet event conducted much like speed dating. Mentees spend five minutes with each licensed RN to share information and measure the chemistry. Before formalizing any relationship, however, they spell out their three top choices from which program directors make the final match. From there, it’s a matter of meeting initially to firm up the details, which must include at least two face-to-face meetings per semester. Most mentoring pairs, however, are regularly in touch throughout their collaboration.

Since the goal is academic success, Project BEYOND features a separate specialist who also oversees a small cadre of upper grads or graduate assistants who peer tutor younger students. “We find that peer mentoring can be very effective because the relationship with another student is often easier to establish than with a faculty member or nurse,” says Juanita Terrie Garcia, MEd, RN, Project BEYOND coordinator. “Mentees have a level of confidence that they’ll benefit from their mentors because they’ve just gone through something similar. It’s fresh.”

Since the inception of Project BEYOND, Marquette nursing officials have witnessed an increase in minority enrollment from 12% to 18% with retention rates of 96% to 100%. That’s translated into more than 30 underrepresented minority students successfully graduating, with seven enrolling in graduate programs. Project staff members believe they’re making progress because they’ve taken a “holistic” approach to raise not only academic skills, but self-confidence as well.

“One of the most significant factors affecting the success of minority students is their level of confidence,” says Gloria Rhone, MSN, RN, Project BEYOND’s academic support coordinator. “They have to deal with all sorts of stereotypes about their ability to perform whether they’re applicable or not. So having somebody there to motivate them, encourage them, and just be a good listener can help build that self-esteem.”

Opening Doors, Expanding Opportunities

By connecting with supportive and insightful individuals, minority students can indeed bolster their initial skills so they’re ready to be successful, working members of the profession. Yet establishing mentoring relationships after you’ve finally entered the workplace as a licensed practitioner can be just as fruitful as connecting with role models in training. Mentoring throughout your working years not only secures your personal long-term success, but also introduces your talent, perspective, and vision to the organization.

By assisting new (or seasoned) nurses in plotting their career paths and fine-tuning their skills, mentors help mentees take their ambitions to the next fulfilling level. Whether you connect formally or informally, working with a mentor is a way to network with colleagues, demonstrate your abilities, and grow into jobs that fit your ambitions and long-term plans. From promotions to PhDs, mentoring brings a bevy of people into the job force, priming them for the next move. But for starters, it bridges the inevitable gap between education and practice so there can be no doubt that a new face on the block will be a valuable asset.

Once they come on board at Minneapolis-based Fairview Health Services, for instance, new graduates, along with nurses new to an acute care setting, undergo a variety of steps to ensure their initial success and long-term tenure. Beyond orientation and a preceptor to help them navigate the hospital and their unit, they’re also part of a year-long nursing residency program, an added layer of training and support. It’s then that they buddy with a mentor—usually a nurse manager or other nurse leader—to master the nuances of Fairview’s unique workplace.

They may also join the system’s diversity circle, a separate mentoring effort that brings minority professionals together to broaden their networking reach in meeting leaders of color. Although diversity is part and parcel of every endeavor, the circle puts real faces to the concept that you can grow within the organization.

Indeed, later on when they’re ready to take on more responsibilities, they’ll have access to developmental programs available to every promising nurse. But initially, the focus is on grappling with the challenges of picking up the pace and seeing greater numbers of patients than they did in training. It’s about learning how to be in command of their new environment—and comfortable enough to commit for the long haul.

“It’s important to connect people with people,” says Laura D. Beeth, Fairview’s systems director, talent acquisition. “It shows that you care about them…that you’re not just throwing them out there. Instead, you’re giving them a safe place to ask questions, especially when they’re overwhelmed and need to reach out.”

In terms of diversity, Fairview’s residency program is far from the organization’s only attempt to broaden its nursing corps. Officials have established a veritable roadmap of pipeline programs to lure minority persons into the medical field, whatever their ultimate career choice. From support for two Minneapolis health career-focused high schools to individual scholarships and summer internships, Fairview has instituted opportunities at every step of the training continuum to find, attract, and fund potential nurses of color.

Much of the activity begins with the hospital’s award-winning SCRUBS Camps, an annual opportunity for minority teens, among other high schoolers, to live and breathe what it’s like to work in medical careers. So named for the attire of the attendees, SCRUBS is an intense three- to five-day college campus tutorial involving a largely hands-on agenda. Participants network with faculty members who, if only for a short time, mentor them on their choices.

Although her introduction to Fairview didn’t involve summer camp, Marion Lee, RN, BA, MSN, has benefited in other ways from her relationship with the health system and her colleagues. Besides a $10,000 sponsorship to finish her nursing education (via an accelerated master’s degree), Lee has reaped many rewards from the preceptors and mentors she’s encountered as both a student and newly minted professional. The people surrounding her have been instrumental, for instance, in helping her sharpen her skill sets, especially in approaching patients, interacting with their families, and managing her time doing both.

But the biggest advice she’s received may involve just being sensitive to other cultures. Even though Lee is Mexican by birth, she has to keep in mind that patients from other areas of the world don’t always appreciate her Latino warmth. “We’re very touchy, feely people,” Lee says. “We love to hug and touch. Sometimes patients look so lonely that I just want to hold their hands. But I have to step back and realize that I can’t do that. I have to remember that there are boundaries.”

Testing New Waters

Like Lee, you may have discovered your niche at the bedside. But not every nurse will find caring for patients his or her forte. Fortunately, in today’s market there are other ways to use your skills and unique background. Whether filling a for-profit or not-for-profit position, nurses and nurse practitioners are sought-after commodities in all sorts of places that need their clinical expertise and patient perspectives.

So how can mentoring ensure that minority nursing professionals have options beyond traditional health care jobs? By helping mentees fine-tune their business savvy and sharpen their political senses, mentors are critical assets in broadening choices beyond direct patient care. They facilitate diversity not only by helping nurses boost their competencies in areas never addressed in nursing school, but also by steering them to new options for their expertise.

As Elizabeth Allee, BSN, clinical trial project manager for Indianapolis-based Eli Lilly and Company, observes: “Mentoring in a corporate environment is extremely, extremely important. In a hospital, a nurse is a nurse, even though every area is different. But when you come into a company, your knowledge and training can be used across multiple departments. You need a mentor to help you leverage your expertise so someone will look at you and say, ‘This person would be a great fit for our team!’”

Allee credits the right people for giving her the right advice at the right time as she’s transitioned from her first Lilly job in global patient safety to her current role overseeing global clinical trials for various therapeutic teams. Ten mentors along the way have helped her navigate the politics of the organization and readied her for the next step. Today, she’s returning the favor by marshaling advice for 12 fellow employees, many of whom are nurses of color.

She’s also a founding leader of the Lilly Nursing Forum, a ground zero effort for promoting both patient-centered community initiatives and nursing professionals. Even though there’s no formalized mentoring structure within the forum, the networking that occurs exposes nurses to opportunities not always obvious in a behemoth corporation. Allee, for instance, just returned from a six-month assignment in China, a stint that wasn’t on her career radar until she learned of it through her forum contacts.

Among their activities this year, forum participants are keying into Lilly’s corporate initiative, “Fit for Life,” by focusing on career as one of several wellness areas. As part of that agenda, Allee predicts an increased emphasis on mentoring, not only as a strategy to help individual nurses realize their potential within the company, but also to help the company retain its nursing talent.

When Dorothy Jackson, RN, MS, came to Lilly in 2006, she brought along 20 years of diverse experience in surgical, coronary care, ICU, and community health nursing. As a former clinical research coordinator for an outside cardiology group, her past experience fit nicely into her first job, a contract employee on Lilly’s cardiovascular research team. Today, Jackson serves as a global lead for case management, meaning she provides safety collection oversight for Lilly’s endocrine clinical drug trials.

She’s also a Lilly Nursing Forum leader, a position suggested initially by her friend and current mentor, Liz Allee. Jackson had worked with two previous mentoring colleagues before tapping her former department co-worker to help her identify her next professional steps. Together, the two are focused on fine-tuning her career development plan so the path she chooses fits her strengths and skills.

Besides offering advice and networking contacts, Allee has encouraged her mentee at every turn to chase new pursuits in broadening herself and upping her profile. When the nursing forum started, for instance, she urged Jackson to join, even though her mentee was hesitant of the time commitment. Allee persevered, however. Today, they’re collaborating not just on Jackson’s future, but also in creating educational outreach projects using a variety of forum nurses. It’s a natural fit for Jackson, who does health training and diabetes education in her community.

“Liz made me take a second look at something I probably would have passed on,” says Jackson. “She kept saying, ‘You’d be good at this. You do community service all the time. You have a good outlook on nursing. Let’s do this together.’ I think an important part of being a good mentor is simply looking at a person and saying, ‘You’d be a great fit.’”

Good Mentors Worth Gold

What makes for good mentoring? There’s no one-size-fits-all formula in selecting people to emulate or tap for their advice. But here are some factors that you may want to think about as you make your choices.

Numbers and variety count. Mentoring doesn’t have to be one-stop shopping. Putting together a team of people who can work with you on a variety of fronts can help you address issues beyond even nursing. One of the best mentors DeWitty had as a young unit head nurse, for instance, was her hospital director. He gave her the opportunity to sit in on meetings and afterwards ask any questions about the deliberations. By delving into the details of such conversations, she had a better understanding of how things worked. To broaden her perspective, DeWitty has tapped people from fields other than nursing throughout her career. The variety, she says, “not only gives you a different perspective but also helps you become a much more rounded professional.”

Think culture and beyond. Don’t limit yourself to nurses who share your race or ethnicity. Even though it’s important to find examples of people within your own community who’ve excelled at what you want to do, it’s just as important to match your needs with the best resources available. The first mentor who made such a difference in Bankston’s life, for instance, was Caucasian. Likewise, it was expected that DeWitty would pair with African American nurse mentors during her PhD program. But she had lived and worked most of her life in a culturally diverse environment, so she looked for a role model mix. “Similarities in ethnicities are important,” she says. “But you should go deeper to see if two people are operating on the same wavelength and are really the best match.”

Reach beyond your environment. Nowhere is it written that you have to limit your choices to those directly surrounding you. A good mentor can be as close as the next office or as far away as a distant land. Just as long as you have a structure in place for connecting with someone efficiently, you can make those long distance collaborations work nicely. For instance, Dickens, who usually confines his advice as a mentor to masters-degree hospital administration nurses stateside, also mentors a chief nursing officer at an American hospital in Saipan. He’s helping her traverse the concerns of being isolated geographically in a hospital that needs help with its CMS (Centers for Medicare and Medicaid Services) status when she’s not necessarily being prepared for the job.

Be flexible. If you’re the mentee, don’t be afraid to ask for a referral or to end the relationship when you’ve gone beyond what this person can offer you. If you’re the mentor, be ready to suggest another nurse or professional who has the right contacts and advice if that’s not you. Dickens, for instance, doesn’t hesitate to push people along or connect them with new sources. “It’s extremely fluid,” he says. “Some of my mentees have outgrown me because their career trajectory has set them in another direction. I understand that. I say, ‘Look, I want to keep you in my back pocket. I’ll never go away. I’ll always be available to you.’”

A Final Note

Whether you’re starting your career or just moving into the next phase, seeking the counsel of wise and diverse colleagues can make the difference between success and failure. Mentoring is critical at every step in a minority nurse’s professional journey—to soar academically as a student, to transition into the workplace as a novice, and to plot the best career path as an experienced pro. It can provide nurses of color the kind of insight and edge that helps them succeed personally as they bring needed diversity to their patients, colleagues, and the profession at large.

Bankston, for instance, has benefited immensely from her mentor’s early and frequent message: To be taken seriously, especially in a world fraught with biases, she’d need to be at the top of her game. Whether that meant polishing her skills, dusting off her professional demeanor, or adding another credential to a growing resume, Bankston responded by listening, learning, and doing. When Eldridge pointed out, for instance, that Bankston’s hand movements were a distraction when she presented, she practiced diligently in front of the mirror to employ them effectively. Likewise, when her mentor suggested that an advanced degree would be paramount in the roles she envisioned for her young charge, she started thinking PhD.

Today, Bankston counts stints as both a hospital chief nursing officer and chief executive officer among the titles she’s earned since her mentor first spotted those leadership qualities. As the faculty advisor for AMBITION, a peer-to-peer tutoring group, she wants young minority nursing students not just to have the right skills to behave admirably in the workplace, but to master the rigors of nursing school so they can get their foot in the door. By pairing upper classmen with freshmen who need to overcome any hurdles, AMBITION alleviates the isolation that Bankston herself felt in nursing school 40 years ago. It also keeps a new generation of minority nurses committed to a profession they, in turn, will diversify.

“As minority nurses, we need people in our lives who’ve already navigated the waters,” says Bankston. “Finding mentors who are both trustworthy and honest can help us recognize the potential missteps and even push us when we think that we just can’t do anymore. They’re very important in our career journey.”