DiversityNursing Blog

For the last year, health experts have pleaded for better data to shed light on disproportionate rates of COVID-19 cases, hospitalizations and deaths among communities of color.

Since the rollout of COVID-19 vaccines, health care organizations like the American Medical Association (AMA), American Nurses Association (ANA) and the American Pharmacists Association (APhA) have been asking for more race and ethnicity vaccine data.

This important data is missing for half of coronavirus vaccine recipients. According to the CDC, the data from 52,614,231 people fully vaccinated, Race/Ethnicity was available for 28,234,374 (53.7%).

This data is imperative in ensuring an equitable response to a pandemic that continues to disproportionately affect these vulnerable populations.

“Race and ethnicity data provides critical information to clinicians, health care organizations, public health agencies and policymakers, allowing them to equitably allocate resources across all communities, evaluate health outcomes and improve quality of care and delivery of public health services,” says the open letter, sent by the AMA, APhA and the ANA.

Equitable distribution of vaccines is crucial. When states collect this information, it helps officials identify large racial gaps so they can find better ways to distribute shots.

North Carolina is leading the way in data collection. The state now has racial and ethnicity data for more than 98% of vaccine recipients.

To achieve this high rate of collection, a state-mandated software system was used which requires providers to record a person’s race and ethnicity in order to register them for a vaccination.

“The data is not just a nice-to-have, it’s a need-to-have in order to embed equity into every aspect of our response and now into vaccine operations,” says Mandy Cohen, secretary of the North Carolina Department of Health and Human Services.

"Communities should be able to generate daily and certainly weekly data to understand the demographics of who is being vaccinated. Local health departments and health institutions need to respond to these data in real time to identify where COVID-19 vaccine uptake is not matching COVID-19 disease burden," said Dr. Muriel Jean-Jacques, Northwestern University Department of Medicine vice chair of diversity, equity and inclusion, and Dr. Howard C. Bauchner of the Boston University School of Medicine, a professor of pediatrics and community health.

Many barriers make it difficult to access the vaccine.

People from hard hit communities often have limited access to digital tools needed to schedule an appointment. And often information about vaccine registration is only available in English.

States that partner with community-based organizations are administering the vaccine more equitably than others, said Rita Carreón, vice president of health at UnidosUS, a civil rights organization for Hispanic communities.

The lack of race and ethnicity data in health systems didn’t begin with this pandemic. For years, health experts have been pleading for better health data to reduce racial health disparities.

Age discrimination involves treating an applicant or employee less favorably because of his or her age, defined by the U.S. Equal Employment Opportunity Commission (EEOC).

The Age Discrimination in Employment Act (ADEA) forbids age discrimination against people who are age 40 or older.

Ageism in the Workplace

According to a 2018 AARP survey, about 3 in 5 older workers have seen or experienced age discrimination in the workplace. Also 76% of these older workers see age discrimination as a hurdle to finding a new job.

A diverse workplace is fundamental in providing the best patient care possible. But age is usually left out of an organization's Diversity, Equity and Inclusion (DEI) strategy.

Patients feel more comfortable talking with a Nurse who understands and can relate to them and their issues. Nurses who understand what ageing patients are going through can provide better care. 

Physical Strength - There is a perception older Nurses aren't physically strong enough to handle certain responsibilities such as restraining a combative patient or assisting someone into a bed or wheelchair.

Technology - Another misconception is older Nurses can't keep up with the changing technologies and medications.

Pay - An article by Arkansas State University discusses salary-based ageism in Nursing saying, "As Nurses accumulate experience, they also accumulate pay increases. As a result, employers sometimes discriminate against more experienced Nurses by hiring or promoting younger, less experienced, and therefore, less expensive Nurses."

This type of stereotyping and discrimination often leads to poor morale, job dissatisfaction, burnout and early retirement.

How You Can Reduce Ageism at Work

To combat ageism in healthcare organizations, there should be DEI policies that include a focus on age.

According to the Society for Human Resource Management (SHRM) the EEOC recommends organizations follow these strategies:

• Assess your organization's culture, practices or policies that may reveal outdated assumptions about older workers. The Center on Aging & Work at Boston College and AARP partnered to develop an assessment tool.
• Examine your recruitment practices. Does your website include photos of an age-diverse workforce? Do your job applications ask for age-related information such as date of birth or when a person graduated? Is your interview panel age-diverse? Train recruiters and interviewers to avoid ageist assumptions.
• Include age as part of your diversity and inclusion programs and efforts. Offer learning and development, including anti-bias training and courses.
• Foster a multi-generational culture that recognizes ability regardless of age and rejects age stereotypes, just as it would reject stereotypes involving race, disability, national origin, religion or sex.

Ageism in Your Patient Population

Ageist stereotypes and discrimination are also barriers to health equality for this patient population.

An article from Lippincott Nursing Center states, Older adults represent 13% of the total population in the United States, but account for over 40% of U.S. hospitalizations.

Ageism can negatively affect the care older adults receive. It's often healthcare providers attribute signs and symptoms of illness to normal aging, missing important indicators that need to be addressed.

A lot of ageist behaviors may not be intentional and will take conscious efforts to identify and change. For example, talking slowly and loudly, or assuming someone can’t comprehend what you are telling them, is common behavior around older patients and is considered ageism.

How You Can Reduce Ageist Attitudes Toward Patients

The Alliance for Aging Research warned "that unless ageist attitudes are recognized and rooted out of our healthcare system, the next generation of Americans under Medicare, the largest generation in U.S. history, will likely suffer inadequate care."

The Alliance released recommendations to address the problem of ageism:

• More training and education for healthcare professionals in the field of geriatrics.
• Greater inclusion of older Americans in clinical trials.
• Utilization of appropriate screening and preventive measures for older Americans.
• Empowerment and education of older patients.

The older patient population deserves the same quality care and attention as younger patients. Organizations must acknowledge ageism as an obstacle in providing the best care possible and take action to make healthcare more equitable and inclusive.

The CEO Action for Diversity & Inclusion is the largest CEO-driven business commitment to advance diversity and inclusion within the workplace.

CEOs at top major companies from around the world are signing this action pledge to support more inclusive workplaces.

This pledge shows the commitment and actions leaders will take to provide resources and strategies for an inclusive environment.

Health systems joining the pledge are taking a step towards positive change. A diverse and inclusive workforce helps the community and inspires innovation and creativity.

According to the CEO Action website, By 2050 there will be no racial or ethnic majority in the US.

Click here to view the list of healthcare CEO's who have signed the pledge so far.

Warren Geller, President and CEO of Englewood Health pledged to provide equal access to vaccines, helping to mitigate risk factors for those most vulnerable to COVID-19; enhancing and expanding training programs for new and current employees, focused on diversity and inclusion; and to continue on the path to diminishing healthcare disparities with the support of the Diversity and Inclusion Education Council (DIEC).

Hackensack Meridian Health CEO, Robert C. Garrett signed the pledge and said, "New Jersey is one of the most diverse states in the nation and we are deeply committed to ensuring that there is equality and opportunity for all in our hospitals and care locations. The network also has a robust and comprehensive strategy to eliminate unacceptable outcomes based on race and ethnicity, a challenge for our entire nation.''

CEO Stephen J. Ubl of the Pharmaceutical Research and Manufacturers of America (PhRMA) signed the pledge and included four goals that PhRMA is committed to working toward.

1. We will continue to make our workplace a trusting place to have complex, and sometimes difficult, conversations about diversity and inclusion. 
2. We will expand unconscious bias education.
3. We will share best—and unsuccessful—practices.
4. We will create and share strategic inclusion and diversity plans with our board of directors.

So far, nearly 2,000 CEOs and Presidents have made the pledge and it is encouraging to see this number grow. Click here to view the pledge.

In the wake of the COVID-19 pandemic, higher education is seeing a rise in demand for health and medical education.

According to Kaiser Health News, enrollment in baccalaureate Nursing programs increased nearly 6% in 2020, to 250,856, shown in preliminary results from an annual survey of 900 Nursing schools by the American Association of Colleges of Nursing.

“It’s unprecedented,” said Geoffrey Young, senior director for student affairs and programs at the Association of American Medical Colleges. In the past two decades, the average yearly increase for total applications to medical schools has been about 2.5%, he said. This year, applications are up 18% over all.

Glen Cornwall, the Dean of Tampa Bay’s Galen College of Nursing says as people see the need in the community, they’re enrolling in greater numbers. “With this pandemic, it’s that extra urge to say this is the time," he said.

Dr. Ken Kaushansky, Dean of Stony Brook University’s Renaissance School of Medicine believes the reasons behind the surge are inspired by the pandemic and the need for financial security during a time of job loss and unemployment.

"This is my 11th year and I don’t remember us going up by 14% in any year," he said. "More typical is a 3 to 4 percent increase year over year."

Dr. Demicha Rankin, Associate Dean of admissions at the Ohio State University College of Medicine believes the influx of applicants is also a factor of the growing awareness of systemic racism.

Rankin said, “It is not just the viral pandemic but also is the awakening of the dedication to addressing racism has also been a motivation for many to try to bring equitable care to their own community."

Most schools are conducting interviews virtually so students do not have to pay for in-person travel costs.

Dr. Beth Piraino, the Associate Dean of admissions and financial aid at the University of Pittsburgh School of Medicine said, "Now applicants don't have to pay to travel to interview, so they could easily interview at 20 places whereas before they may have had to restrict it."

In the midst of a global pandemic, the approach toward the academic year is very different from previous years. Nursing schools in 2021 will be a mix of online classes, in-person  clinicals, virtual and in-person simulated experiences, and some in-person and online testing.

Southern Illinois University Edwardsville School of Nursing Dean, Laura Bernaix, PhD, RN is encouraged by the increase in enrollments and believes the key to successfully adapting to this surge is the faculty.

“Great faculty, who not only are great educators in the classroom but also experts at curriculum design, are the key,” she said.

Last year, Chief Diversity Officer (CDO) hires grew by 84%, making it the fastest growing C-suite title, according to LinkedIn.

There has been a national wave of concern about racial inequities, especially in healthcare, with the arrival of the COVID pandemic.

Many healthcare organizations are increasing their Diversity, Equity and Inclusion (DEI) efforts. Leaders are addressing racial health disparities and finding ways to improve patient care for all. Part of their efforts include establishing a Chief Diversity Officer role.

Winifred King is Cook Children’s first ever Chief Diversity Officer. King said, “It is hard to put into words what this decision and investment means to people of color and anyone who has ever felt different or excluded. For all of us who may have experienced inequities and mistreatment in our lifetimes, it is comforting to be a part of an organization that accepts our differences, our failures, and is willing to look inward and truly examine what is at the heart of our culture.”

“COVID-19 is amplifying health disparities in communities of color,” said Quita Highsmith, the Chief Diversity Officer of biotech company, Genentech. “It is now time for us to stop tiptoeing around it and start thinking about what we are going to do.”

Education and awareness are playing a key role in improving health outcomes for diverse communities. The CDO coordinates efforts internally to provide staff with resources and courses, such as cultural competence training as well as finding ways externally to work with the community they serve.

In addition, the CDO helps to create recruitment programs that ensures their DEI message is reaching diverse candidates. As a member of the C-suite, the CDO can communicate to all leaders that diversity recruitment, for all position levels, should be a priority.

Studies suggest diversity in healthcare leadership enhances quality of care, quality of life in the workplace, community relations, and the ability to affect community health status.

The CDO helps to define, educate, and communicate the hospital/health system’s culture and DEI message to its staff, patient population and community.

Joseph Hill, was the first Chief Diversity Officer at Jefferson Health. He requested they establish focus groups with patients to better understand their expectations and view of the system. With the information provided by the focus groups, they found the areas that needed improvements.

HCA Healthcare created the BRAVE Conversations program, an ‘outside the box’ platform designed to facilitate interactive, inclusive, innovative and safe ways for employees to share their thoughts on issues that may be difficult to discuss.

It is imperative that leadership is committed to their DEI mission. Without it, the CDO cannot wave a magic wand and transform an entire organization overnight. It takes commitment, communication both internally and externally, resources, time, and effort from all areas of the health system.

Many health systems are focusing attention on the impact visitations and family communication has on reducing the suffering of patients and loved ones. It is traumatic for patients and families to be separated, to suffer or die alone. 

Hospitals are modifying guidelines and finding alternatives to help achieve that human connection in a safe way. 

Not only do these restricted visitation policies effect the patients and their families, it also has an effect on health care workers. 

According to STAT news, Nurses experienced intense moral distress over having to enforce these policies, which conflicted with their sense of just and humane care. 

Darlene Randolph, a registered dietician, lost her husband, Dr. Dave Rudolph, to Covid-19 and wished she could have been there for him. Working in hospitals, she knew the protocols and restrictions that had to be enforce but hoped she could do something about it. 

On Christmas Eve, Darlene wrote to Dr. Anthony Slonim, President and Chief Executive Officer of Renown Health in Reno, NV. She expressed her gratitude and thanked the staff working under dangerous circumstances and risking their lives to care for others. 

When financial resources are too thin to hire extra staff, hospitals have looked to medically trained volunteers to provide patients some comfort.

Michigan Medicine’s created the No One Dies Alone (NODA) program, where volunteer medical students bring comfort to patients who find themselves alone at the end of their lives.

“It’s not just the institutional limitations on visitors. The travel restrictions make it more difficult for those coming from far away,” said Social Work Program Manager, Amanda Schoettinger. “Some people aren’t working and might not have the money to travel. Some are sick themselves. A lot of people are afraid to come to the hospital, which is understandable."

Some health care workers are volunteering time after their long shifts to be with patients who are suffering alone.  

Ben Moor works in a Massachusetts hospital and has started volunteering since he received his vaccinations. In a STAT news article he wrote, "Shielded behind an N95, visor, gown, and gloves, I reckon I’m now about as safe as I can be. So when my day’s work as an anesthesiologist is done, I’ve started sitting with Covid-19 patients. At first I tried chatting with them, but when someone is breathing 30 times a minute through an oxygen mask, it’s difficult to be a great conversationalist. Now I talk to them, hold a hand, get them water, arrange their pillows. Sometimes I just sit there because I have this nagging, incompletely explored belief that just a human presence, someone bearing witness to their ordeal, has value. Afterward, I call the family because they are victims of this virus too."

According to research, there are risks of depression, anxiety, and post-traumatic stress disorder, in family members of patients who die in ICUs. Now there is extra stress of having to wait by the phone for terrible updates, not being able to see your loved ones, and not being able to say final goodbyes. Health systems, as busy and well-intentioned as they are, must continue to find ways to provide family-centered care. It benefits them, their patients, and the patient’s families.

Chief Nursing Officers have a wide variety of responsibilities. Their role has become more complex with the COVID-19 pandemic, social injustices, and systemic racism in the United States.

The pandemic is straining the healthcare profession. Nurses are under immense stress and Nursing leaders need to use best practices to address the mental and emotional trauma their teams are enduring.

In an article by HealthLeaders, Penn Medicine Princeton Health Chief Nursing Officer, Sheila Kempf, PhD, RN, NEA-BC said they are implementing many strategies to care for Nurses' mental health.

Some of those strategies include training staff to recognize the signs of being at high risk for emotional distress, and when peers should be referred to the Employee Assistance Program (EAP).

Also the hospital has contracted a trauma clinical Psychologist to talk with staff and run support groups with the EAP and the Ministries department.

CNO's should recommend frequent breaks or a quiet space for Nurses to retreat to.

Nurse leaders are also facing the challenges of short staffing, low resources, and supplies.

According to a survey by Inspire Nurse Leaders, 53% of Nurse Leaders reported difficulty meeting work and family needs due to inadequate staffing.

Risley-Gray also said, health systems need to hire outside help when Nurses become infected or get exposed to the virus. Aspirus is offering Nurses who have at least one year's experience a $15,000 signing bonus, as well as employing contract Nurses via private staffing companies.

2020 not only brought forth a pandemic, it also put a spotlight on systemic racism and racial health disparities.

Sharon Hampton, PhD, RN and Director of Clinical Operations at Stanford Health said, "We've discussed our ethical and moral responsibilities to deal with this crisis. Nursing is really in this position to help the public understand and to advocate."

Healthcare systems and Nurse leaders should be promoting diversity and inclusion at all levels of the workplace.

Kelly Hancock, RN, DNP and Executive CNO of the Cleveland Clinic Health System, said more diversity would help the Nursing workforce “provide more customized, culturally-sensitive and safer care” and “better assess, accommodate and cater to the healthcare needs of different minority groups.”

Those in leadership positions should reflect the diverse patient populations they serve.

According to HealthLeaders Media, a study by the Institute for Diversity and Health Equity found that racial minorities represented 32% of patients in hospitals that participated in the study, but similar representation wasn't found among the health care leadership. According to the study, 19% of first- and mid-level management positions, 14% of hospital board membership positions, and 11% of executive leadership positions were held by racial minorities.

Hospitals and health systems must commit to increasing diversity within their leadership to improve patient outcomes, reduce racial health disparities, and build stronger communities.

A 2021 list ranking the best-paying states for Nurses has been released by Business.org. They calculated this list by comparing the average Nursing salary to the average income to find the percentage difference. Then they calculated how many hours Nurses must work to afford rent.

Here are some key points from the report:

Over 2.9 million Nurses work in the United States, and make an average salary of $77,460 per year.

Nationally, Nurses make 45% more than the average salary for all other occupations. And in 15 states, Nurses make more than the national average. 

Hawaii topped the list, with Nurses making 89% more than other occupations for a total salary of $104,060.

Washington DC ranks last on the list. Nurses in DC make only 5.6% more than the average salary for all other occupations.

California boasts the highest wage per hour for Nurses, at $54.44. South Dakota has the lowest wage per hour for Nurses at $28.63.

Nationally, Nurses work an average of 29.5 hours to be able to afford a month’s rent. The national average income requires 42.7 hours of work to afford rent. 

Following Hawaii, the other top states for Nursing salaries are Nevada, California, Oregon, and New Mexico. 

To view the full list of best salaries by state, click this link.

According to a U.S. News & World report, Nurse Practitioners made a median salary of $109,820 in 2019. The best-paid 25 percent made $127,030 that year, while the lowest-paid 25 percent made $92,790. 

The best paying states for Nurse Practitioners: 

• California- $138,660

The need for in-home care has grown since COVID-19 because many fear contracting the virus in hospitals and clinics, especially among the elderly population.

With no security like hospitals usually have, home visiting Nurses put themselves at risk whenever they enter a patient's home alone. 

Ha Do Byon, Assistant Professor of Nursing at the University of Virginia School of Nursing mentions in a  STAT news article, "Even before the pandemic struck, I heard Nurses’ stories of home visits — some during my time as a visiting Nurse, and others as part of a study I am conducting to understand violence faced by home visiting Nurses. They told me about patients who blared pornography, or being groped while administering care. About patients who waved handguns and hurled racial insults. About being bitten, punched, kicked, or slapped. About dealing with screaming fits, intoxicated family members, and dogs that bit them or threatened to."

According to a 2015 study by BMC Public Health, the threat of workplace violence was one of home health workers’ top concerns, ranking above transportation issues or environmental hazards.

Developing a safety program for your home care workforce is crucial in reducing health care worker stress and turnover.

The rate of patient-on-Nurse violence among home visiting Nurses is unknown.

An article in Home Care Magazine states, only one-fifth of violent incidents “are ever reported in part due to embarrassment, organizational culture, tolerance or excusing the behavior of ‘ill’ clients." Nurses have cited fear of retribution from supervisors, the complexity of the legal system and disapproval from administrators as barriers to reporting workplace violence.

Nurses and providers can take measures to prevent violent situations.

We view Nurses and healthcare workers as heroes and we should appreciate the essential work that home visiting Nurses provide by making sure they can safely do their job and feel comfortable enough to notify management when they aren't safe.

The Foundation of the National Student Nurses’ Association is delighted to announce a new diversity scholarship award sponsored by Johnson & Johnson. Funding may be used for tuition, fees, and books. Use the same application to apply for all FNSNA scholarships. 

Students must complete the race/ethnicity question to qualify. There is $225,000 available. Awards up to $7,500.

Click here for more information: https://www.forevernursing.org/2021-online-scholarship-applicationinstructional-sheet.html

Click here for the application: https://app.mykaleidoscope.com/scholarship/fnsna2021

Deadline is February 15, 2021