DiversityNursing Blog

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. 

Here is a chart let you know the largest number of healthcare professions which is 2.6 million registered nurses in USA also show how much they earn in different levels.
Nurses have always played a first-rate role in people’s lives. They perform a wide range of clinical and non-clinical functions that are necessary in the delivery of health care
Certified Registered Nurse Anesthetist salary around $135,000
Nurse Researcher salary around $95,000
Psychiatric Nurse Practitioner salary around $95,000
Nurse Practitioner salary around $78,000
Clinical Nurse Specialist salary around $76,000
Gerontological Nurse Practitioner salary around $75,000

By: Tanya M. Odom, Ed.M.

Diversity and inclusion is an evolving field. As a learner and practitioner, I work to embrace the expanding definitions while respecting the importance of the historic diversity topics of race and gender.

How we approach conversations about difference can determine how we embrace new definitions of identity, and the “agility” needed to learn, grow, and support all people in organizations.

Multiracial people are one of the fastest growing groups in the United States. As Andrea Williams mentioned in her article about multiracial students in the April/May 2012 issue of INSIGHT Into Diversity, “the 2010 Census marked the second time in the survey’s history that responders were allowed to check more than one box regarding their race; the first was in 2000. And as a result, demographers now have access to data that allows for comprehensive comparison and charting of the mixed race population. The results are remarkable: from 2000 to 2010, the number of multiracial American children – who will soon be attending colleges and universities across the country – rose by almost 50%, to 4.2 million.

The changing demographics have inspired people to create language like “the multicultural generation” and “ethnically ambiguous,” among others. Williams’ article presents some important reflection about creating schools and universities that support multiracial students.

Not-for-profit organizations and corporations will also need to update their language, understanding, and awareness to include multiracial employees, and employees with multiracial families.

A June 2012 Fast Company article talked about the importance of “cultural agility.” They defined “cultural agility” as “the capacity to recognize, understand, and respond appropriately to various cultures, and to work within those cultures to achieve business results.” The language of “agility” is also highlighted in the Center for Creative Leadership’s recent newsletter. They talk about flexibility and agility as a key to leadership. Agility is an important part of the learning and awareness in diversity and inclusion. Multiracial identity is not new, nor is the presence of multiracial families in our organizations.

There is a global history of multiracial people. There is a substantial scholarship focusing on the role of multiracial people in our history, media, etc. What we have not seen at the same level is the inclusion of multiracial people in diversity and inclusion dialogues and programs. As a multiracial global diversity and inclusion practitioner and coach, I have learned that, as with all diversity topics, there are varying levels of awareness about what multiracial identity means to employees and to diversity and inclusion initiatives.

One of the first times that I was part of a professional “group” of multiracial individuals was while attending a Working Mother Media Women’s conference. I remember feeling the uniqueness of the experience.

Participants in workshops or present at some of my speeches would approach me and talk about their “invisible diversity,” which for some meant their multiracial identity. For others, it meant their partner, spouse, or child of a different race. Often they swapped tales of not having a place to share their diversity stories.  

The presence of multiracial individuals and families can challenge our notions and comfort around talking about race and history, race and families, and race and racism.

Multiracial individuals and families are part of the changing workforce. In the spirit of learning agility, I would suggest that organizations learn to incorporate language and programs that include multiracial individuals and families.

We can continue to be “agile” in our learning about multiracial identity by:

• Assessing data collection that does not allow for identifying as multiracial individuals and families;
• Including multiracial groups as part of the growing affinity/ERG/Networking groups within organizations;
• Allowing multiracial people to self-identify – and not identify employees based upon what we observe;
• Updating our language and communication to include multiracial identity and;
• Learning more about national groups (SWIRL, MAVIN, etc.) that address multiracial identity and families.

Our learning and growth continues as long as we remain “agile.” The inclusion of more stories, experiences, and identities makes the journey even richer.

Tanya Odom, Ed.M, is a part-time Senior Consultant with The FutureWork Institute and a member of the INSIGHT Into Diversity Editorial Board.

Published in September/October 2012 issue.

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.

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.

Source: Nursingideas.ca

In an era in when hospitals compete for patients by boasting the latest clinical technology, the most prestigious physicians and impressive amenities, patient satisfaction is most influenced by human factors, especially superior service-related communication skills between hospital staff and patients, according to the J.D. Power and Associates 2012 National Patient Experience Study released today.

The study measures patient satisfaction across all areas of the inpatient and outpatient hospital experience, including: interactions with healthcare professionals; tests and procedures; admission and discharge; and facility environment. It serves as a benchmark for the J.D. Power and Associates Distinguished Hospital Program. This distinction program acknowledges high levels of performance by a hospital in achieving an “outstanding” inpatient, emergency department, cardiac, maternity or outpatient experience. 

The study finds that recently-hospitalized patients have high levels of overall satisfaction. Overall patient satisfaction with their inpatient hospitalization averages 825 index points on a 1,000-point scale, similar to that of guests at luxury hotels, among whom satisfaction averages 822. In outpatient settings, overall patient satisfaction is higher, averaging 863. However, patient satisfaction dips to 788 for emergency department visits.

“Hospitals may attempt to attract patients and staff by adding equipment or sprucing up their facilities,” says Rick Millard, senior director of the healthcare practice at J.D. Power and Associates. “From the perspective of patients, it might be more worthwhile to invest in finding and keeping staff with superior interpersonal skills.”

Investments in staff can be overlooked, as Millard notes many hospitals have spent a lot of money in recent years to make their facilities look and feel more like hotels. Yet, facility characteristics are more important for hotels than for hospitals.  For upscale hotels, the facility accounts for nearly one-half (48 percent) of guests’ overall satisfaction, while in an inpatient setting the hospital facility represents just 19 percent of patients’ overall satisfaction. 

“Having an appealing hospital facility matters, but an experienced and socially skilled staff has a greater impact on patient satisfaction,” says Millard. “Personal interactions with the staff have a profound impact in both inpatient and outpatient settings.”

Doctors and nurses account for 34 percent of the overall experience ratings for inpatients, and their influence is even higher (43 percent) among patients in emergency settings. Among outpatients, doctors and other healthcare professionals represent 50 percent of their overall experience.

Solid interpersonal skills are especially necessary for handling the types of problems that may arise during hospitalization. When problems do occur, they may jeopardize patient satisfaction. According to the study, staff service and staff attitude are the most common types of problems that patients experience. Patients who say they had any problem with their room or hospital staff rate their overall experience a 5.3 a 10-point scale, compared with 8.7 among patients that did experience any problems.  

“When problems occur, they produce opportunities to demonstrate a genuine interest in the patient’s needs,” says Millard. “Resolving problems is clearly associated with higher ratings by patients. This has become more important as hospital reimbursement is now linked to patient satisfaction as measured by the government through the HCAHPS [Hospital Consumer Assessment of Healthcare Providers and Systems] survey.”

Millard notes that one area where hospitals can learn from hotels is how transitions occur. The admission and discharge process in hospitals is analogous to check-in and check-out in the hotel industry. Among inpatients, 35 percent of the overall patient experience is predicted by the admission and discharge process; yet the impact is much less in emergency and outpatient settings, where it is 19 percent and 12 percent, respectively.

“The first and last impressions are very important for a patient, much like they are for hotel guests,” says Millard. “Getting a patient into a room quickly at the start of their hospital stay, and ensuring a smooth process during discharge, along with a follow-up call once the patient gets home to make sure they’re doing okay, goes a long way toward achieving high satisfaction.”

Nongovernmental, acute-care hospitals throughout the nation are eligible for the J.D. Power and Associates Distinguished Hospital recognition program. Recognition is valid for one year, after which time the hospital may reapply. The service excellence distinction is determined by surveying recently discharged patients regarding their perceptions of their hospital experience and comparing the results to the national benchmarks established in the National Patient Experience Study.

The 2012 National Patient Experience Study is based on responses gathered between December 2011 and March 2012 from more than 10,275 patients who received care in inpatient, emergency or outpatient facilities in the United States.

Source: Infection Control Today

By Carolina Madrid

August 31, 2012

We tend to categorize every ethnic community outside of  Whites as a minority or diverse population group, but there’s a gray area that we’re failing to pay close attention to: the bicultural and multiracial population. It was the fastest-growing youth group in the country in the last decade, increasing almost 50 percent to 4.2 million, according to Census 2010.

As our nation’s population becomes more diverse, the bicultural population will continue growing and the segregated communications approaches that have worked in the past will not work with this audience any longer. Use the guide below as an overview to understanding biculturalism and how you can think about it in an upcoming campaign.

A cultural tug of war

Being bicultural, multicultural or multiracial means that you have ties to different cultures. It can mean that you grew up in the United States with roots in another country or that you have parents from distinct ethnic backgrounds. Either way, there’s usually a sense of being pulled in two different directions while trying to maintain both or assimilate into another.  Why does this matter? Because someone who you thought was a Hispanic, Spanish-speaking person may not be receptive to messaging that speaks solely to Latinos.

Inglés or Spanish?

The language preference of bicultural individuals varies.  Younger populations who went to school in the United States tend to prefer English, while older populations will favor their native language.  There’s also the second-generation population who doesn’t prefer one or the other. The language you use will largely depend on the demographic.

What am I?

The degree to which individuals associate themselves with a given cultural background also varies. Just as there are those who believe in maintaining a sense of heritage, there are those who don’t want to stay in touch with their roots and prefer to assimilate into only one culture. This is why it’s important to stay away from explicit cultural messaging that would isolate or turn off the bicultural or multiracial population.

Univision or CNN?

Just because someone speaks Spanish doesn’t mean he or she watches Univision, the nation’s largest Spanish-language network. In fact, he or she will likely prefer to watch English-language TV. Still, on CNN, there is an opportunity to reach the bicultural population with messaging about the Hispanic or Asian population.

Fusion nation

Fusion cuisine is a perfect example of the adaptation and merging of two different cultures. You appreciate the base flavor of the dish, while adding in contemporary ingredients and spices for a blend that’s the best of both worlds. Don’t be afraid to also use this approach in your communications programs, using a mix of messages.

Contextual decision-making

How you communicate with a bicultural population will also depend on the message that you’re trying to convey. Different scenarios will call for the incorporation of cultural messaging, while other times, this might seem forced. But what is certain is that early awareness and the ability to use it wisely will reap the rewards of a genuine connection.