The healthcare industry is in a constant state of flux. But while technologies are rapidly changing, the industry is still cast in monochrome with little racial or gender diversity. There are definitely large societal issues at root – like the massive expense of becoming a doctor and lack of adequate STEM education in many inner-city elementary schools – that will take a generation to solve. But while these massive gaps remain, it is often hard to see incremental progress.
Recently, I found a study that gave me a small glimmer of hope that progress is happening. According to Professional Diversity Network, recruiters and HR professionals accelerated their search for diverse talent in healthcare in January. Specifically, the Professional Diversity Network’s Diversity Jobs Index, which tracks the demand for diverse talent across sectors, jumped 11 percent from December 2014 in healthcare.
The Professional Diversity Network pointed to a few factors that could have attributed to the change. For example, the study suggests that many more small clinics across the country, particularly in urban settings, have increased their workforces.
While the Professional Diversity Network pointed to trends that could be the cause, I believe this is evidence that diversity programs like the Institute for Diversity, Ms. Tech and Instituto Health Sciences Career Academy are finally beginning to have an impact not just on awareness, but also on behaviors.
Diversity programs are crucial because they not only acknowledge that problems exist, but they create communities to offer training and support to help women, minorities, and other under-acknowledged groups succeed. For example, IHSCA prepares inner city high school students for a career in healthcare with tutoring and mentorship programs.
This is great news not only for the women, minorities, veterans or disabled professionals being employed, but also for the healthcare industry as a whole. Healthcare professionals service every ethnic group and gender, so the more that doctors and nurses can empathize and understand their patients, the better care they will give. In part, that empathy and understanding relies on working in a diverse environment.
So to answer the question I posed in the headline: yes we should get our hopes up. Healthcare executives are in fact beginning to value and invest in diversity, which is a sign of positive change. There is still a long way to go, and who knows if there will ever be an all minority board of a hospital, but we’re heading in the right direction.
Like many healthcare providers in the Los Angeles area, and well beyond to healthcare organizations throughout the United States, City of Hope has recognized the growing need for clinical professionals and staff that more closely mirror the patients it serves in its catchment area. And with a local population that is nearly half Hispanic, that means recruiting more Hispanics into the industry, as well as providing much needed career development opportunities. But whereas most in the industry are just beginning to acknowledge the need, City of Hope has taken the lead to recruit more Hispanics into the industry and also has started to build a Hispanic talent pipeline for the immediate and not so distant future.
According to Ann Miller, senior director of talent acquisition and workforce development, "Even when people in the industry recognize the need for more Hispanics, or just a more diverse workforce, it can feel overwhelming trying to figure out what actions to take and how to build a strategy around it. But once you see the data laid out in front of you, and see that 46 percent of your primary service area is Hispanic, you realize it would be optimal to figure out how to recruit a workforce that looks more like the population you are serving. Beyond that, it's also important to employ a bilingual staff that can speak the language and understand the culture to best meet the needs of the community being served."
Once you recognize the need, it's time to start asking the questions that will help you fill the gaps:
- How do you find and appeal to the types of people you need to start building relationships with? Who are the influencers and the connectors?
- How do you get your recruitment team looking toward the future and building a pipeline, when limited resources are focused on more immediate needs?
- How do you get buy-in from senior management and enlist other departments throughout the organization?
- How do you partner with others in the industry who recognize the need but have yet to become active in the pursuit of common goals?
Here's how City of Hope has started to answer these questions as it takes the lead in addressing these timely industry issues. Stephanie Neuvirth, Chief Human Resources and Diversity Officer, has said that it's not easy to build a diverse healthcare or biomedical pipeline of talent, even when you understand the supply and demand of your primary service area and the business case becomes clearer. "Few in the industry are taking the helicopter perspective that is needed to really see the linkage between the different variables that must be factored in to solve the problem," she says.
Even in healthcare, it's not simple, and it takes time to develop the paths, the relationships and the pipeline to cause real and sustainable change. It takes linking a workforce talent strategy to the broader mission and strategic goals of the organization. And it takes collaboration with the community, schools, government, parents and everyone who touches the pipeline to help achieve the necessary and vital missing pieces of the puzzle.
Talent Acquisition and Workforce Development
What you first have to realize is that there is an immediate but also a long-term gap to fill, which represent two sides of the same coin: talent acquisition and workforce development. We know we can best serve our community by mirroring the community that we serve, and that doesn't stop with the talent that we attract today; it's an imperative that depends on the talent pipeline that we build for the future.
City of Hope's approach has been to start fast and strong with some immediate steps that can then be built upon and cascaded out into a longer term strategy for the future. The good news is that if your goal is to look like the community you serve, you don't have to look far for the talent you need. It's right in your own backyard. But there's still a lot of work to be done in terms of educating people about potential careers in healthcare -- clinical and otherwise -- developing the workforce skills and knowledge that they will need, and planting the seeds in the next generation.
It's particularly disheartening to hear about the young people graduating from high school and college who can't get jobs, when there are growing shortages in the healthcare industry - the nation's third largest industry, and projected to be its second largest in just seven years. According to a recent report by The Economist, U.S. businesses are going to depend heavily on Latinos - the country's fastest-growing and what it calls "irreversible" population -- to fill the gaps not just in healthcare but across all industries.
If you look just at nursing, the single largest profession in California, you can see how far we have to go. Only 7 percent of the 300,000 nurses in the state are Hispanic. The clinical gaps extend to doctors, just 6 percent Latino; pharmacists, less than 6 percent; and the list goes on and on.
Teresa McCormac, nurse recruiter, is one of the people at City of Hope working to build the Hispanic talent pipeline, beginning with the need for Spanish speaking nurses. She is responsible for elevating City of Hope's presence in the community through word of mouth referrals and by getting active in broader outreach online, in publications and at local, college and national events, such as the National Association of Hispanic Nurses (NAHN) annual conference taking place in Anaheim, CA this July.
"It's important to have a passionate champion for the candidates, as well as our hiring managers and the organization. My role is to get the word out into the community about City of Hope and connect with the talent we need to fill our current and future openings," she says.
This requires a multi-prong approach to recruitment efforts, where you must act to attract candidates not only for current needs, but down the road five-ten years, and even further into the future.
This begs the question: how do you get more Hispanics and other diverse students interested in the sciences and considering careers in healthcare?
Traditionally, recruiters focus on those currently working in healthcare to fill immediate gaps, as well as those working in other industries with transferable skills, who might be interested in working in healthcare in a non-clinical capacity, such as IT or marketing. They also look at colleges with nursing and other clinical programs -- particularly those with high concentrations of Hispanics and other diverse students -- where they can conduct outreach efforts, build partnerships and establish a presence.
But building a talent pipeline requires that you reach students well before the college years, when they are still in high school, and even earlier as middle and grade-schoolers. It takes time to get the message out there and have it stick, so the bigger and bolder you can go, the better. That was City of Hope's thinking behind the launch of its Diversity Health Care Career Expo in September 2014, which made quite an impact with the community and opened eyes to the variety of career opportunities within healthcare. It also opened City of Hope's eyes to the level of interest from the community when 1500 people showed up for this first of its kind event.
What started as an idea for a diversity career fair to fill immediate positions quickly grew to encompass a workforce development component to include students, parents, as well as working professionals interested in transitioning into healthcare. The Career Expo brought a level of awareness never seen before in the community -- and did so very quickly. For example, it allowed healthcare professionals to connect the dots between math and science classes students were taking and how this learning applied in the real world of healthcare -- and the different careers these types of classes are helping to prepare them for if they stick with them. It also allowed parents to understand how to help their children prepare for jobs that are available and will continue to be available in the future. They also gained insights into how growing up with smartphones and other electronic devices has given their children a distinct advantage that previous generations didn't have -- enabling them to leverage their everyday use of technology into transferable skills that could lead towards a career in Information Technology, which offers a very promising career path within the healthcare and biomedicine industries.
Catching students early on to spark their interest and expose them to healthcare careers and professionals who can encourage and support them along the way requires that you go out into the community as well. Toward that end, City of Hope has partnered with Duarte Unified School District and Citrus College on a program called TEACH (Train, Educate and Accelerate Careers in Healthcare).
According to Tamara Robertson, senior manager of recruitment, the TEACH partnership provides students with the opportunity to gain college credit while still in high school by taking college-level classes at no cost. This puts them on the fast track to higher education and career readiness by giving them essential skills and capabilities to enter the workforce soon after graduating high school, or to continue their education with up to one year of college coursework already completed. Eighteen students were accepted into the program in its first year.
Each partner plays a valuable role in the program. City of Hope provides students with opportunities to gain first-hand exposure to healthcare IT by giving overviews of the various areas within IT, providing summer internships, and offering mentoring and development interactions. Duarte High School is the conduit for the program by selecting the students for the program and facilitating the learning, and Citrus College develops the curriculum that enables students to earn college credits and IT certifications. It's ideal for students who may not have the means to continue on to college, but can work for an organization like City of Hope that offers opportunities to start their IT career as a Helpdesk or Technology Specialist. In addition, they can take advantage of tuition reimbursement should they choose to further their education and development.
In today's world, social media must be in the recruitment mix, especially if you want to engage with Hispanics who index higher on time spent on social media than the general population and any other group. Statistically, 80 percent of Hispanics utilize social media compared to 75 percent of African Americans and 70 percent of non-Hispanic whites. It's also a great way to reach not just active candidates in search of a new position, but passive ones employed elsewhere whose interest may be peaked when a more interesting opportunity presents itself.
This is where Aggie Cooke, branding and digital specialist, comes in -- leveraging social media as a core component of City of Hope's outreach efforts to potential candidates. She takes a three-legged approach to the use of social media for recruitment:
1. Branding - offering relevant content that portrays the culture and appeals to a candidate's values and broader career aspirations;
2. Targeting - identifying potential candidates who have skills and experiences that the organization needs today and in the future; and
3. Engaging - creating a relationship by inviting candidates to dialog with City of Hope.
You can reach more people through social media -- even if they're not active job seekers -- by posting information that is relevant to their field and interests. For example, oncology nurses will be interested in what you have to say about the latest developments in the world of oncology.
Though it can seem overwhelming with so many messages out there competing for people's attention, you can break through with content that is authentic, timely and purposeful. You can also make an impact by tailoring your content to the medium you are using. For example, a story about a scientific breakthrough at City of Hope would play well on LinkedIn, while pictures of happy employees taking a Zumba class together would engage potential candidates on Instagram. Social media also enables you to expand the reach and prolong the life of live events. For example, attendees of the Career Expo last year engaged online with live tweets and Instagram pictures from the event and later provided comments and feedback about their experience that will be instrumental in planning this year's event.
Going forward, successful programs and events, like TEACH and the Diversity Health Care Career Expo, will be expanded upon, as City of Hope continues to lead the way in talent acquisition, workforce development and creating a talent pipeline for Hispanics and the future of healthcare.
Historically, both men and women have filled the challenging and rewarding role of a nurse. It wasn’t until the Civil War, when nearly 3 million men filled the ranks of two competing American armed forces, that women began to dominate the field.
Today, over 43 million Americans are aged 65 or older – a number that is expected to double over the next 35 years. A larger elderly population means a greater need for long-term health services, and as a result, the healthcare field is one of the fastest-growing industries.
Why does this matter?
1. The U.S. is already on the verge of a nursing shortage.
The American Association of Colleges of Nursing reports that the U.S. is experiencing a shortage of Registered Nurses (RNs) that is expected to intensify as Baby Boomers age and the need for health care grows.
Did you know only 7 percent of nurses are currently men? According to the latest National Sample Survey of Registered Nurses conducted by the Health Resources and Services Administration, the percentage of male nurses has more than doubled in the past three decades, but still lingers at 7% today. This number is expected to triple within the next few decades as the need for both male and female healthcare professionals continues to grow.
2. A diverse population needs a diverse nursing staff.
According to the American Association of Colleges of Nursing (AACN), men are enrolling in nursing programs at a higher rate compared to the past. The IOM report states that there still need to be an emphasis on gender diversification and inclusion in the workforce.
The IOM Report also states that the nursing profession “needs to continue efforts to recruit men; their unique perspectives and skills are important to the profession and will help contribute additional diversity in the workforce.” The increase in men pursuing a nursing career will help create a more diverse healthcare environment.
3. Discrimination issues must be overcome.
The idea that men cannot be nurses will never be eradicated until men take to the profession in greater numbers. While nursing is seen as a nontraditional career for men today, the stereotype must change -- nursing is simply too important of a job, and too attractive of a career.
“There are just far too many benefits that come along with nursing, such as a flexible schedule, a secure position, and high pay,” notes the website NursingWithoutBorders.org, “and so it’s therefore difficult for anyone to refuse to pursue a field that only continues to grow.”
CentraState Healthcare System located in Freehold, NJ is a nonprofit community health organization consisting of an acute-care hospital, an ambulatory campus, three-senior living communities, a family medicine residency program, and a charitable foundation. Over the years, CentraState has employed multiple family members from numerous families in NJ.
In this “Focus on Diversity” issue of our bimonthly eNewsletter, we are featuring 4 members of the Santos family who work at CentraState – 3 family members have worked at CentraState for over 24 years! Joe Santos is the spokesperson for the Santos family.
Pat Magrath from DiversityNursing.com recently had the opportunity to chat with Joe Santos, RN and Unit Manager at CentraState’s Manor Rehab Healthcare Center. Joe said “every day is a different day working in the Rehab Center. My patience is tested daily and I love it”.
Joe grew up in the Philippines and while living there, Joe’s father was diagnosed with cancer. Joe took care of his father. He loved taking care of him and discovered he had a passion for it. Joe was always interested in science and medicine, but medical school in the Philippines was too expensive, so he became a Mining Engineer. When Joe immigrated to the US in 1989, no one needed his mining engineer skills so he went to CentraState and applied for a job as an orderly. He was hired the next day.
Joe has worked at CentraState for 24 years. While working as an orderly, he went to school and became an LPN. CentraState encouraged him to further his education and paid his tuition fees to become an RN where he is now the Unit Manager at the Manor. Over the years, Joe has been appointed Acting Director of Nursing, not once, but twice. He was happy to help out, but he was not interested in the position on a permanent basis.
Many years ago, there was a pretty lady named Evangeline living in Joe’s apartment complex. She too grew up in the Philippines and was already an RN at CentraState. They met and soon married. Evangeline has also been at CentraState for 24 years! She worked in Orthopedics for 16 years, transferred to short-stay Surgery for 2 years and currently works at the CentraState Family Medicine Center. They have 2 daughters and are expecting their first grandchild. Perhaps like their parents, they’ll be working at CentraState too!
Joe’s brother, Teodoro started working at CentraState in 1989 -- the same year as Joe and Evangeline. His career started as a cook in the hospital and 9 years ago, he became the Senior Cook at the Manor where Joe works.
Joe’s niece, Charmaine, has worked as a Patient Care Technician in the 5 North Progressive Care Unit for 6 years.
Well there you have it… 4 members of the Santos family – Joe, Evangeline, Teodoro and Charmaine... all happily and productively working at CentraState.
I had to ask… What makes CentraState such a great place to work? Joe responded… When they all immigrated to the US, they lived close to the hospital which was much smaller at the time. The convenient location and the “one big happy family” feel at the hospital, gave the Santos family a terrific opportunity for employment. They grew in their careers among genuinely friendly and caring people.
As the years have gone by, CentraState has expanded and it still feels great to be working there with talented, caring staff and family. As Joe told me, “we live in the community, work in beautiful facilities, enjoy generous benefits, and appreciate the ability to continue to grow in our careers at CentraState where we have been supported and encouraged”.
Dolores N. Napolitano, Manager of Recruitment for CentraState Healthcare System stated “we value our employees and feel like they are our family members too. When individuals who are actually blood related family work here, it makes it even more special and unique. CentraState is their hospital in more ways than one because they live in the community and work here as well. The Santos’ are one of many multi-generational families working at CentraState and we embrace the concept and actuality of it. It is only a part of what we do to acknowledge and support the diverse staff we have and the community that we serve".
"We welcome you and your family to visit our website http://www.centrastate.com/Careers/Nursing-Career-Information and check out our job opportunities.”
This article is an excerpt from Diversity Best Practices' new book, the HR Executive Diversity Primer.
What’s the best way to structure a diversity function? The answer is as individual as companies themselves. Let’s look at three organizations—Sodexo, Johnson & Johnson, and Rockwell Automation—that have established different, yet equally effective, configurations of their diversity offices.
With 400,000 employees across the globe (125,000 in North America) and operations in 33,400 sites in 82 countries, Sodexo is among the world’s top 25 employers, as a provider of integrated food services and facilities management. Betsy Silva Hernandez, Sodexo’s senior director for corporate diversity and inclusion, describes the corporate culture as high touch with an orientation toward action. It’s a high-touch culture, because the company is very relationship based and uses the power of influence to drive its diversity efforts. Its action orientation shows up as the company’s business leaders push for quick results, yet they also want the diversity strategy to be customized to their local context.
Silva Hernandez explains how the company’s decentralized structure is reflected in the structure of the diversity office. Depending on the location of a regional market (North America, Europe, Central or South America, and others), the company uses multiple infrastructure models. The decentralized model is further intensified by its French ownership, which brings its own inclusion issues. While the structure has evolved over time, the formal diversity effort began in 2002 with the creation of the company’s diversity leadership council.
Along with the North American CEO, this council was charged with developing the diversity and inclusion strategy, setting priorities, and providing oversight for the effort. Later the strategy was broadened to include a committee of operational leaders comprised of members from the executive committee and market presidents. Their task was to implement the strategy and embed it throughout the organization by working with the company’s Cross Market Diversity Council (CMDC) and its employee business resource groups (EBRGs). The CMDC and EBRGs provide the grassroots support for inclusion initiatives. According to Silva Hernandez, this structure represents a top-down, middle-out, bottom-up approach to the inclusion strategy.
The efforts of Sodexo’s diversity and inclusion team on behalf of 125,000 North American employees, and influencing 270,000 other employees in locations around the world, are augmented by its EBRG members and other volunteers across the organization. Volunteer impact is monumental. For example, roughly 90 percent of Sodexo’s 25,000 North American managers participate in EBRGs. And the EBRGs are instrumental in how the company delivers its inclusion results.
Volunteers may provide the much-needed resources to drive the inclusion efforts. However, as Sodexo’s Chief Diversity Officer Rohini Anand explains, the inclusion strategy is also based on the shared services model. The corporation provides and funds support services for the entire corporation, with local operations furnishing additional resources. Yet, even a company as committed to diversity as Sodexo has had to face the realities of a global economy. For two consecutive years, Silva Hernandez has seen the diversity budget cut, while responsibilities have increased. The Sodexo diversity office has had to deliver more with less money.
While Sodexo’s North American diversity strategy is only 10 years old, it is considered a mature, highly regarded function. Companies across the globe use Sodexo as the benchmark they aspire to reach. The company also illustrates the evolving nature of the diversity function.
Initially, Anand reported to the senior vice president of HR. Soon after, diversity was repositioned so that she reported to North American CEO George Chavel, and now she has a bifurcated reporting relationship to both the North American CEO and Global CEO Michel Landel. Although her area no longer reports directly to HR, Anand explains that both areas enjoy a strong partnership. “We’re separate, but we’re strong partners,” she says.
The diversity department has changed in the past and Anand understands that it could change again. “Diversity was a part of HR, then separated from HR, and depending on the needs of the organization, we would certainly recalibrate that relationship,” she said. “Obviously, our effort continues to be a work in progress."
Johnson & Johnson
Johnson & Johnson (J&J) is a global leader in healthcare, consumer products, pharmaceutical products, and medical devices. It’s a 125-year-old company with $65 billion in revenues. J&J’s Smita Pillai, director of global diversity and inclusion, medical devices and diagnostics, explains that J&J’s culture is best considered a hybrid between a lean culture at its headquarters in New Brunswick, N.J., and a more high-touch culture in its 250 operating companies that span 57 countries across the globe.
J&J’s structure also mirrors its hybrid culture, which is decentralized at the regional and local levels but supported by a more-centralized core strategy in its corporate offices. In this way, J&J’s global diversity and inclusion office has the best of both worlds. The central office establishes an overall strategy and provides some independent funding, while the local companies roll out the strategy and allocate funding from their budgets to support diversity initiatives.
According to Pillai, the company’s CDO reports directly to the CEO, and manages six director-level direct reports. With an annual budget of $5 million, the diversity function numbers about 16 employees, including directors and administrative assistants. Pillai said Johnson & Johnson can’t run a global diversity operation with the current structure at the corporate level, so the diversity function works in close partnership with HR and its teams.
While J&J’s office of diversity and inclusion has a well-deserved reputation, internally and externally, as an established leading-edge operation, Pillai recognizes that its structure may evolve as the company adapts to an ever-changing global landscape.
With more than 20,000 employees, revenues of $6.2 billion and operations in 80 countries, Rockwell Automation is a business-to-business firm that is a leading provider of integrated systems for process manufacturing. According to Joan Buccigrossi, director of global inclusion and engagement, the diversity department was deliberately and strategically structured to serve as an inside consultant to the leaders and managers of the company. The responsibility for creating a culture of inclusion rests totally with the company’s leaders, not with HR.
With only two part-time staff members in the diversity office, Buccigrossi operates in a lean culture with a highly matrixed structure that leverages the power of influence across the organization. While she reports to the senior vice president of HR, Buccigrossi explains that her customers are the company’s business and function leaders, who initiate actions and develop the diversity direction. In this way, HR does not set the inclusion agenda or its engagement strategy. That’s done by Rockwell’s leaders and managers. “The danger of housing diversity in HR is that it can make the effort more of an initiative, something being done to leaders, rather than an effort they are intimately involved in,” Buccigrossi said.
“At Rockwell, leaders and managers are change agents.”
As in many firms, HR provides needed metrics, encourages tough conversations, and challenges and supports leaders and managers, Buccigrossi said. It is the department heads and their employees who fund the strategy and take ownership to ensure it succeeds. She cites an example with the North America sales division. The department decided that all managers and employees receive specialized education in order for everyone to become change agents. The department funded the effort and played a key role in the design and implementation of the learning modules. “The education is much more effective than any ‘training’ pushed out from HR would have been” she added.
While Buccigrossi’s diversity function does not have a budget, for real, the company’s functional leaders are prepared to support diversity initiatives from their funds. This arrangement works well for Rockwell. Everyone remembers 2008 and 2009, when the global and national economies were reeling from the fiscal freefall and companies were tightening their belts. In 2009, Rockwell’s diversity office was able to spend significant dollars on inclusion initiatives for employees. How? The business functions believed that such training was valuable and provided the necessary funding.
While Rockwell’s inclusion and engagement (I&E) department is tiny, in reality, the diversity and inclusion team consists of everyone in the company. According to Buccigrossi, all diversity and inclusion work is done by the people in the businesses and functional areas. They created Inclusion Change teams, which are tasked with performing cultural assessments, identifying barriers to inclusion, planning and executing actions to remove those barriers, and measuring results. Rockwell also uses rotational staffing assignments in I&E for up-and-coming and established leaders, although participants keep their day jobs.
According to Buccigrossi, the consultant approach works well for Rockwell, because it blends in with the company’s culture and structure. This is how everyone works and business objectives are met. As a result, the consultant model reflects the current corporate environment and drives its inclusion strategy.
By Shantelle Coe RN BSN - Diversity and Inclusion Consultant
Creating an environment that embraces diversity and equality not only attracts the most qualified nursing candidates, but an inclusive environment also helps to assure that the standards of nursing care include “cultural competency.” Cultural differences can affect patient assessment, teaching and patient outcomes, as well as overall patient compliance.
Lack of cultural competence is oftentimes a barrier to effective communication amongst interdisciplinary teams, which can often trickle down to patients and their families.
With the increase in global mobility of people, the patient population has become more ethnically diverse, while the nursing forces remain virtually unchanged. Nursing staff work with patients from different cultural backgrounds. Consequently, one of the challenges facing nurses is the provision of care to culturally diverse patients. Hospitals and healthcare agencies must accommodate these needs by initiating diversity management and leadership practices.
According to Cross, T., Bazron, B., Dennis, K., and Isaacs, M. (1989); these are the 5 essential elements that contribute to an institutions ability to become more culturally competent:
- Having the capacity for cultural self-assessment.
- Being conscious of the dynamics inherent when cultures interact.
- Having institutionalized cultural knowledge.
- Having developed adaptations of service delivery reflecting an understanding of cultural diversity.
A culturally competent organization incorporates these elements in the structures, policies and services it provides, and should be a part of its overall vision.
From all levels, the nursing workforce should reflect the diversity of the population that it serves. A more diverse workforce will push for better care of underserved groups. It’s important to note that that diversity, inclusion, and cultural awareness isn't just about race or ethnicity. We must always keep in mind socioeconomic status, gender, and disability in our awareness.
Becoming more inclusive is a shared responsibility between nurses and healthcare agencies. Becoming an “agent of change” within your facility can inspire awareness and affect attitudes and perceptions amongst your peers.
Nurses and healthcare workers must not rely fully on the hospital and healthcare systems to institute an environment of cultural awareness.
Nurses can increase their own cultural competencies by following a few guidelines:
- Recognizing cultural differences and the diversity in our population.
- Building your own self-awareness and examining your own belief systems.
- Describing and making assessments based on facts and direct observation.
- Soliciting the advice of team members with experience in diverse backgrounds.
- Sharing your experiences honestly with other team members or staff to keep communication lines open. Acknowledging any discomfort, hesitation, or concern.
- Practicing politically correct communication at all times – avoid making assumptions or stereotypical remarks.
- Creating a universal rule to give your time and attention when communicating.
- Refraining from making a judgment based on a personal experience or limited interaction.
- Signing up for diversity and inclusions seminars.
- Becoming involved in your agencies diversity programs – find out what your resources are - most institutions have something in place.
By incorporating a few of these steps into your daily nursing practice, you are taking steps towards becoming culturally competent.
Inclusive nurses demonstrate that we are not only clinically proficient and culturally competent, but are the essence and spirit of the patients that we care for.
By Christina Orlovsky, senior writer, and Karen Siroky, RN, MSN, contributor
As the nation’s population becomes more diverse, so do the needs of the patient population that enters U.S. hospitals. As caregivers with direct contact with patients from a wide spectrum of races, ethnicities and religions, nurses need to be aware and respectful of the varying needs and beliefs of all of their patients.
In its position statement on cultural diversity in nursing practice, the American Nurses Association (ANA) states that: “Knowledge of cultural diversity is vital at all levels of nursing practice…nurses need to understand: how cultural groups understand life processes; how cultural groups define health and illness; what cultural groups do to maintain wellness; what cultural groups believe to be the causes of illness; how healers cure and care for members of cultural groups; and how the cultural background of the nurse influences the way in which care is delivered.”
Additionally, the Joint Commission requires that all patients have the right to care that is sensitive to, respectful of and responsive to their cultural and religious/spiritual beliefs and values. Assessment of patients includes cultural and religious practices in order to provide appropriate care to meet their special needs and to assist in determining their response to illness, treatment and participation in their health care.
There are a number of ways to comply with the requirements for providing culturally diverse care.
First, be self-aware; know how your views and behavior is affected by culture. Appreciate the dynamics of cultural differences to anticipate and respond to miscommunications. Seek understanding of your patients cultural and religious beliefs and values systems. Determine their degree of compliance with their religion/culture, and do not assume.
Furthermore, respond to patients’ special needs, which may include food preferences, visitors, gender of health care workers, medical care preferences, rituals, gender roles, eye contact and communication style, authority and decision making, alternative therapies, prayer practices and beliefs about organ or tissue donation.
Kathleen Hanson, Ph.D., MN, associate professor and interim executive associate dean for academic affairs at the University of Iowa, summarized the importance of learning cultural diversity in nursing education.
“Cultural competency is threaded throughout the nursing school curriculum. We teach every course with the idea that there’s content that may need to be explained for a diverse student group,” Hanson said. “In nursing, cultural competency has been around for a long time. I think that’s probably something that the nursing profession recognized maybe a bit before some other disciplines. We’ve always worked in public health, so we have always seen the diversity of America.”
Hanson concluded: “We need to be able to care for diverse populations because our country is growing increasingly diverse. Oftentimes persons who are in minority groups or who are underrepresented have different health care needs. It’s important for us to have a student population that is as equally diverse as our client; we need to prepare a workforce that not only knows how to work with diverse peoples, but also represents them.”
By: Robert Rosseter
Nursing’s leaders recognize a strong connection between a culturally diverse nursing workforce and the ability to provide quality, culturally competent patient care. Though nursing has made great strides in recruiting and graduating nurses that mirror the patient population, more must be done before adequate representation becomes a reality. The need to attract students from under-represented groups in nursing – specifically men and individuals from African American, Hispanic, Asian, American Indian, and Alaskan native backgrounds – is gaining in importance given the Bureau of Labor Statistics’ projected need for more than a million new and replacement registered nurses by 2016.
Diversity in the Nursing Workforce & Student Populations
- According to the U.S. Census Bureau, the nation's minority population totaled 102.5 million or 34% of the U.S. population in 2007. With projections pointing to even greater levels of diversity in the coming years, nurses must demonstrate a sensitivity to and understanding of a variety of cultures in order to provide high quality care across settings.
- According to data from the 2008 National Sample Survey of Registered Nurses (NSSRN), nurses from minority backgrounds represented 16.8% of the registered nurse (RN) workforce. Considering racial/ethnic backgrounds, the RN population is comprised of 5.4% African American; 3.6% Hispanic; 5.8% Asian/Native Hawaiian; 0.3% American Indian/Alaskan Native; and 1.7% multi-racial nurses.
- Though men only comprise 6.2% of the nation’s nursing workforce, this percentage has climbed steadily since the NSSRN was first conducted in 1980. The number of men in nursing has increased from 45,060 nurses in 1980 to 189,916 nurses in 2008. http://bhpr.hrsa.gov/healthworkforce/rnsurvey04
- According to the National Sample Survey, RNs from minority backgrounds are more likely than their white counterparts to pursue baccalaureate and higher degrees in nursing. Data show that while 48.4% of white nurses complete nursing degrees beyond the associate degree level, the number is significantly higher or equivalent for minority nurses, including African American (52.5%), Hispanic (51.5%), and Asian (75.6%) nurses. RNs from minority backgrounds clearly recognize the need to pursue higher levels of nursing education beyond the entry-level.
- According to AACN's report on 2010-2011 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, nursing students from minority backgrounds represented 26.8% of students in entry-level baccalaureate programs, 26.1% of master’s students, and 23.3% of students in research-focused doctoral programs. In terms of gender breakdown, men comprised 11.4% of students in baccalaureate programs, 9.5% of master’s students, 7.5% of research-focused doctoral students, and 9.0% of practice-focused doctoral students. Though nursing schools have made strides in recruiting and graduating nurses that reflect the patient population, more must be done before equal representation is realized.
- The need to attract diverse nursing students is paralleled by the need to recruit more faculty from minority populations. Few nurses from racial/ethnic minority groups with advanced nursing degrees pursue faculty careers. According to 2010 data from AACN member schools, only 12.6% of full-time nursing school faculty come from minority backgrounds, and only 6.2% are male. www.aacn.nche.edu/IDS
Recognizing the Need to Enhance Diversity
- All national nursing organizations, the federal Division of Nursing, hospital associations, nursing philanthropies, and other stakeholders within the health care community agree that recruitment of underrepresented groups into nursing is a priority for the nursing profession in the U.S.
- Nursing shortage reports, including those produced by the American Hospital Association, the Robert Wood Johnson Foundation (RWJF), the Joint Commission, and the Association of Academic Health Centers, point to minority student recruitment as a necessary step to addressing the nursing shortage. media-relations/fact-sheets/nursing-shortage
- Besides adding new clinicians to the RN workforce, a diverse nursing workforce will be better equipped to serve a diverse patient population. According to an April 2000 report prepared by the National Advisory Council on Nurse Education and Practice, a culturally diverse nursing workforce is essential to meeting the health care needs of the nation and reducing the health disparities that exist among minority populations. http://bhpr.hrsa.gov/nursing/nacnep/reports/first/5.htm
- A report released by the Sullivan Commission on Diversity in the Healthcare Workforce in September 2004 stated: “The fact that the nation’s health professions have not kept pace with changing demographics may be an even greater cause of disparities in health access and outcomes than the persistent lack of health insurance for tens of millions of Americans. Today’s physicians, nurses, and dentists have too little resemblance to the diverse populations they serve, leaving many Americans feeling excluded by a system that seems distant and uncaring.” Download the entire report, titled Missing Persons: Minorities in the Health Professions.
Strategies to Enhance Diversity in Nursing Education
A lack of minority nurse educators may send a signal to potential students that nursing does not value diversity or offer career ladder opportunities to advance through the profession. Students looking for academic role models to encourage and enrich their learning may be frustrated in their attempts to find mentors and a community of support. Academic leaders are working to address this need by working to identify minority faculty recruitment strategies, encouraging minority leadership development, and advocating for programs that remove barriers to faculty careers.
AACN, in collaboration with leading foundations and stakeholders, has taken the following steps to enhance diversity in nursing education:
- In January 2010, AACN published a new set of competencies and an online faculty tool kit at the culmination of a national initiative funded by The California Endowment titled Preparing a Culturally Competent Master’s and Doctorally-Prepared Nursing Workforce. Working with an expert advisory group, AACN identified a set of expectations for nurses completing graduate programs and created faculty resources needed to develop nursing expertise in cultural competency. This work complemented a similar project for undergraduate programs which resulted in the publication of the document Cultural Competency in Baccalaureate Nursing Education and the posting of an online toolkit for faculty.
- In April 2008, the Robert Wood Johnson Foundation joined with AACN to launch the RWJF New Careers in Nursing Scholarship Program. This program is designed to alleviate the nation’s nursing shortage by dramatically expanding the pipeline of students from minority backgrounds in accelerated nursing programs. Scholarships in the amount of $10,000 each will be awarded to 1,500 entry-level nursing students over the next three years. Preference will be given to students from groups underrepresented in nursing or from a disadvantaged background.
- AACN and the California Endowment are collaborating on a three-year program to offer the Minority Nursing Faculty Scholarship Program to increase the number of nurse educators from underrepresented minority groups. This program provides financial support and mentoring to students pursuing graduate degrees who are committed to teaching in a California school of nursing after graduation. To date, 23 graduate nursing students have been selected to receive scholarship funding.
- AACN and the Johnson & Johnson Campaign for Nursing’s Future launched the Minority Nurse Faculty Scholars Program in 2007 which is modeled after the California Endowment program. In addition to $18,000 in scholarship funding, the program also features mentorship and leadership development components to assure successful completion of graduate studies and preparation for a faculty role. Ten scholars are currently receiving funding through this program.
- AACN is collaborating with a variety of national nursing organizations to advocate for more federal funding for Nursing Workforce Development Programs, including funding for Nursing Workforce Diversity Grants. This program provides funding for projects to increase nursing education opportunities for individuals from disadvantaged backgrounds, including racial and ethnic minorities underrepresented among registered nurses. In FY 2007, these grants supported the education of 32,847 nurses.
- AACN’s Executive Director Polly Bednash serves as the representative from Nursing on the Sullivan Alliance to Transform America’s Health Professions. Composed of national leaders in health professions education, this interprofessional working group focuses on advancing strategies to increase the number of healthcare providers from minority populations. The Sullivan Alliance’s latest initiative focuses on establishing statewide collaborative groups to coordinate efforts to enhance diversity in the health professions.
With the battle over immigration raging on and racial and ethnic minorities surpassing whites for the first time, there's no question the U.S. is getting more diverse.
A newly released study from Brown University has pinpointed just where the most diversity is taking place, scoring metro areas by how evenly each city's population is spread across the five racial groups: Non-Hispanic whites, Hispanics of any race, African-Americans, Asians and an “other” category comprised of Native Americans, Alaska Natives and people of two or more races.
According to the US2010 Project, immigrants from Latin America, Asia, and elsewhere have expanded the population of minority residents beyond African Americans, a trend that experts say will eventually lead to as many "minority" as "non-minority" residents, if it continues.
As of 2010, western, southern and coastal metropolitan areas continue to be the most diverse, with California's Vallejo-Fairfield claiming the top spot.
In addition to location and how evenly a city's population was distributed across racial groups -- a perfectly diverse place would have a population with exactly 20 percent of each category and a total score of 100 -- the community characteristics researchers correlated with diversity were: large total and foreign-born populations; high rental occupancy, as a community needs a supply of rental housing to accommodate newcomers; a range of occupational options, including entry-level jobs; and a low minority-to-white income ratio.
Check out this
article to see the most and least diverse cities in the U.S.
By: Shantelle Coe
Without cultural diversity amongst healthcare providers, it is almost impossible to provide quality nursing care to people from different ethnic and socioeconomic backgrounds. A multicultural representation of nurses, physicians and clinicians is important to ensure the healthcare being delivered is sensitive and meets the physical and holistic needs in our “patient palette”.
In the United States, a rise in the population and increase in minorities further challenges our healthcare system to provide appropriate care to the ever changing population it serves.
Some of the major findings in a study on the changing demographics and the implications for physicians, nurses and other healthcare workers conducted by the US Department of Health and Human Resources are bulleted here:
- Minorities have different patterns of health care use compared to non-minorities. Disparities in access to care account for part of the difference in utilization.
- Demand for health care services by minorities is increasing as minorities grow as a percentage of the population. Between 2000 and 2020, the percentage of total patient care hours physicians spend with minority patients will rise from approximately 31percent to 40 percent.
- Minorities are underrepresented in the physician and nurse workforce relative to their proportion of the total population. As minorities constitute a larger portion of the population entering the workforce, their representation in the physician and nurse professions will increase. The U.S. will increasingly rely on minority caregivers.
- Minority physicians have a greater propensity than do non-minority physicians to practice in urban communities designated as physician shortage areas. An increase in minority representation in the physician workforce could improve access to care for the population in some underserved areas.
The study also summarizes: “Advocates for increased minority representation in the health workforce argue that increasing the number of minority physicians will improve access to care for minorities and vulnerable, underserved populations. These advocates argue that increased representation of minorities in the health workforce not only will increase equity, but will also improve the efficiency of the health care delivery system”. (HRSA 2000)
Men (of all backgrounds) are also far under-represented in nursing. Less than 1 percent of the population are male nurses.
As our nursing population lacks diversity, statistics show that the US population is becoming more diverse and will continue on through the decades.
Below are projections for the increase in diversity amongst minorities in the United States:
Source: Modified version of Census Bureau middle series projections.
As our demographics continue to change, one of our greatest challenges is getting hospital organizations along with healthcare administration to realize that, in order to provide the best care and ensure successful patient outcomes, we have to embrace diversity. This is especially challenging to nurses because they will be expected to deliver care that encompasses these differences. Many nursing task force teams and associates have been organized to address this issue of healthcare diversity, such as:
- Asian American/Pacific Islander Nurses Association, Inc. (AAPINA)
- National Alaska Native American Indian Nurses Association, Inc. (NANAINA)
- National Association of Hispanic Nurses, Inc. (NAHN)
- National Black Nurses Association, Inc. (NBNA)
- Philippine Nurses Association of America, Inc. (PNAA)
For nursing care of all cultures and backgrounds, we owe it to our profession to increase our awareness and get involved to ensure delivery of the best care possible. One of the most important steps any of us can take is to first embrace diversity.
About the Author: Shantelle Coe RN, BSN, has 14 years of nursing experience and is currently a Senior Manager (US Commercialization) for one of the largest international biotechnology sales and education companies. She manages a team of Clinical Nurse Educators that provide medical device training to hospitals and physicians in the US and abroad.