DiversityNursing Blog

LGBTQ+ health is a growing national concern due to increasing evidence of health care disparities experienced by the LGBTQ+ community.

LGBTQ+ people face many barriers within health care, including discrimination, ignorance, and fear. So it can be difficult for these patients to confide in and trust healthcare providers. However, there are things that can be done to make patients feel more comfortable.

According to a Johns Hopkins Nursing article by Alex Nava, small but powerful expressions of affirmation and acceptance of support like wearing a rainbow pin, tells the patient that you see them and they are welcome there.

Increasing your knowledge of LGBTQ+ health can help you provide more culturally sensitive care. There is plenty of educational content out there like the field guide published by the Joint Commission called, Advancing Effective Communication, Cultural Competency and Patient and Family-Centered Care for the LGBTQ+ Community. Healthy People 2020 is another great resource to check out.

You should be aware of using terms correctly and avoiding others that may offend someone. DiversityNursing.com offers a great glossary of terms to help you!

According to Nurse.org, a LGBTQ+ patient may “scan” an environment to determine if it is a safe place to reveal personal information. To make patients feel more at ease, they recommend your reception or waiting room area include:

• A visible nondiscrimination policy
• A rainbow flag, pink triangle, or other symbols of inclusiveness
• Availability of unisex restrooms
• Health education literature with diverse images and inclusive language, including information about LGBTQ+ health
• Posters announcing days of observance such as World AIDS Day, Pride, and National Transgender Day of Remembrance

Your health organization should also use gender-inclusive medical forms.

You should ask the patient what pronouns they use. It is also important that you correct other staff members who may address the patient incorrectly, even when the patient isn't around.

Ask open-ended questions such as “Tell me about yourself? Are you involved in a relationship?” But don't assume anything, let the information they share guide the rest of your interview.

According to the Hospital for Special Surgery (HSS), you should be aware of issues particular to, or different for, the LGBTQ+ population such as:

• Coming out
• Having children—reproduction or adoption
• Parenting and creating families
• Adolescence
• Aging
• Legal rights as parents and partners

Patients often feel better talking to someone they can relate to. Hiring members of the LGBTQ+ community as part of your staff is great for patients and the organization. These team members can become mentors for others.

We as Nurses can help LGBTQ+ patients feel safe and supported by implementing these suggestions.

The 2020 Nurse Salary Research Report,  by Nurse.com and Relias, surveyed more than 7,400 Nursing professionals nationwide.

Relias Vice President of Marketplaces, Darius Matthews, said "We hope Nurses will use these survey results to examine their individual career paths and how they can make an even bigger impact — from caring for their patients to connecting with their families at home to expanding their educations and career horizons. For employers, this data is a valuable look into how they can create and support a more equitable environment for Nursing staff."

According to the report, men continue to make more than women despite male RNs reporting less education and being less likely to be certified. The median salary for all RNs in the sample is $73,000, with $80,000 for male RNs and $72,703 for female RNs.

The report also examined demographic data and found for Registered Nurses, 78% are white, 6% Hispanic, 9% Black, 5% Asian, 1% American Indian/Alaskan Native, 1% Native Hawaiian/Pacific Islander, and 1% Other.

Data shows the highest-earning RN roles and median salaries are:

• Executive- $150,000
• Vice President- $150,000
• Director- $105,000
• Nurse Manager- $92,000
• Assistant Nurse Manager- $90,000
• Supervisor- $79,000

Case Manager- $78,000

More than 38% of all Nurses surveyed are considering additional training and education. Cost, flexibility, and online options were the 3 most important factors when choosing a Nursing program.

Nurses with a Master's degree have an opportunity to earn more money in their careers. According to the US Bureau of Labor Statistics, the median pay for Masters educated Nurses is $115,800/year or $55.80/hour. 

Research shows, the salary of Registered Nurses has grown, on average, by 1.51%/year since 2010.

When discussing Nursing salaries, it is important to consider the state and city. Some locations pay more due to the cost of living in that area.

According to Becker’s Hospital Review, the top 5 states paying Registered Nurses the most are California, Hawaii, Massachusetts, Alaska and Oregon.

More Universities and Colleges have considered hiring Chief Health Officers (CHO) as the COVID-19 pandemic rages on. Some responsibilities of the CHO would be to lead campus health and safety measures, create connections with state and local hospitals, and be the voice of information to students, employees and parents.

Dr. Preeti Malani has been CHO at the University of Michigan since 2017 and is a great role model for someone who is considering taking on this position.

Dr. Malani has been highly visible throughout this outbreak, sharing safety tips on social media, appearing in a number of interviews, and participating on coronavirus task forces.

When a school feels strongly about a certain topic, they create an executive role around it, like a Chief Diversity Officer for example. Now, health is an imperative issue that should be properly addressed.

“The mere appointment of a CHO would send a strong message about the school’s commitment not only to the well being of its students, faculty, and staff but also to the health of the public at large,” said Malani.

After the pandemic passes, Malani hopes her visibility at the University of Michigan will help her make progress on other college health issues like vaccines, health-care equity and student mental health.

Dr. Benoit Dubé is the Chief Wellness Officer (CWO) at The University of Pennsylvania. He’s part of a Recovery Planning group tasked with examining the elements needed to be in place to allow a safe return to more normal campus operations.

Dr. Dubé explains the best approach for reducing COVID-19 transmission is to follow a hybrid in-person and online semester model. The University is also mandating the flu vaccine this fall.

Ohio State University’s CWO, Bernadette Melnyk developed several anxiety-reducing strategies to use to help manage and prevent the spread of this infectious disease. She created a webinar video Key Strategies for Relieving Anxiety During the COVID-19 Pandemic.

Melnyk also created the acronym COPE COVID:

Control the things that you can, not the things you can't
Open up and share your feelings
Practice daily stress reduction tactics, including physical activity
Engage in mindfulness; be here now; worry will not help!

Count your blessings daily
Overturn negative thoughts to positive
Volunteer to help others
Identify helpful supports and resources
Do your part to prevent spread of the virus

Schools that don't have the resources to bring on a CHO can try other options, like working with local and state health agencies, hiring a health consultant, and partnering with close institutions or academic medical centers.

The Clinical Nurse Leader (CNL) role was created by the American Association of Colleges in Nursing (AACN) in 2003.

According to a journal from the US National Library of Medicine National Institutes of Health, The CNL understands microsystem issues and their relationship to larger organizational issues. This perspective provides a two-way flow of information to and from health system leaders as they direct an institutional response to the pandemic around issues such as assessing patterns of spread, patient acuity, appropriate staffing levels, and personal protective equipment utilization.

A successful CNL must be confident in their communication abilities. They're expected to provide the coaching and direction staff needs to adapt to frequent changes. Whether it be transforming hospital departments into COVID-19 units or creating sanitation and PPE protocols for staff.

Communication is also key in keeping staff informed and calm throughout the pandemic by addressing any questions or concerns they have. Nurses want to feel that management has their backs, and CNLs are the ones they will look to in times of need.

Leaders should be responsible for supporting the well-being and mental health of the healthcare team. CNLs should advocate for adequate programs and resources for Nurses to cope and deal with stress.

Not only should Nurse leaders advocate for their fellow Nurses, they should also be the voice for their patients.  According to NursingCenter, the CNL acts as a patient advocate by incorporating patients' unique values, desires, needs, and perspectives into patient care delivery.

Another way Nurse leaders advocate for patients during COVID-19 is providing a way for patients to communicate with their families. Because of the pandemic, visitation is prohibited. Leaders work with management to provide devices for patients to see and talk with loved ones.

Lastly, a successful Nurse leader must be resilient. Personal resilience is key and leaders can find it by…

• Letting go of what they can't control
• Leading with their head as well as their heart
• Showing strength through vulnerability

The CNL is a valuable member of the Nursing profession and team. They do their best to maintain safety while providing the best patient care possible during this extremely stressful pandemic.

Aside from skin cancer, breast cancer is the most common form of cancer affecting women in the U.S. The chance for a female to be diagnosed with breast cancer during her lifetime has increased from 1 in 11 women in 1975 to 1 in 8 women.

Increased emphasis on early detection and more effective treatments have decreased mortality rates in the white population. Although the mortality rates have declined in some ethnic populations, the overall cancer incidence among African American and Hispanic populations have continued to grow.

Research has shown that Black women are more likely to die from breast cancer than any other ethnic group. Black women:

• are more likely to be diagnosed with triple-negative breast cancer, which means the cancer has no receptors for the hormones estrogen and progesterone, as well as no receptors for the HER2 protein; this limits the medicines that can be used to treat the cancer
• are more likely to be diagnosed with later-stage disease than other women
• have the lowest survival rates in each stage of diagnosis

There are many factors that play a role in the disparities. Black women are more likely to have diabetes, heart disease, and obesity, and are less likely to breastfeed after childbirth, which are all risk factors for breast cancer. They are also more likely than white women to have inadequate health insurance or access to health care facilities, which may affect access to screening, follow-up care, and completion of therapy.

In order to close the breast cancer mortality gap, prevention programs must increase and policies need to improve.

Increasing screening rates, providing timely access to diagnostic testing, and improving access to comprehensive, quality healthcare coverage and cancer treatment care are all imperative.

That also includes increasing outreach to Black women so they're aware about their breast cancer risks and can seek preventive care.

Molecular geneticist and Associate Professor of cell and developmental biology research in surgery, Dr. Melissa Davis points out that part of the problem in addressing these disparities and, in turn, finding more effective medications to improve outcomes, is that minorities haven’t traditionally been included in adequate numbers in research studies or clinical trials. “A lot of breast cancer investigations that have resulted in advances in treatment have overwhelmingly involved white women,” she says. “So the treatments work better in those populations than in others. We’re trying to change that.”

The Center for Disease Control and Prevention’s (CDC) National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides uninsured and underinsured women access to no-cost screening, diagnostic, navigation, and education/outreach services, as well as a pathway to cancer treatment care.

All women regardless of age, ethnicity, economic status, or other health conditions deserve the best breast cancer care and the best prognosis possible.

Frontline healthcare workers face stressors during normal times, but especially now during a pandemic and hospitals are finding new ways to help their staff cope. 

Recently, University Hospitals in Ohio announced they would be trying out a 10-month pilot program that provides sleep pods for their teams. Doctors, Nurses and staff in the UH Cleveland Medical Center Emergency Department will have access to two HOHM units as a space to safely recharge.

Each 43.5 square-foot pod is designed to block out sound and features a twin-sized bed, a privacy and sound-blocking curtain, charging stations, and a tablet to control reservations. 

“Our UH Cleveland Medical Center Emergency Department frontline caregivers have been working tirelessly for months to combat the COVID-19 pandemic,” said Robyn Strosaker, MD,, University Hospitals Cleveland Medical Center Chief Operating Officer. “In the midst of all this trauma and stress, we’ve continuously looked for new ways to support our team, and HOHM sleep pods are a way we can help address their wellbeing.”

Some hospitals are making design changes to their break rooms as a way to try and help healthcare workers manage their stress throughout the day. 

Nurses may be reluctant to take breaks especially during times of crisis. But taking breaks during your shift can help prevent burnout. So when a Nurse does decide to take a break, there should be a space where they can fully decompress and have time to gather their thoughts and recharge. 

Research has found strong evidence between exposure to natural environments and recovery from physiological stress and mental fatigue. Break rooms are becoming a green space with plants and images on the walls of natural landscapes. Create a sitting space with cushioned chairs or ottomans by windows that have a nice view outside. Offer the option of listening to calming music or nature sounds inside the break room. 

Hospitals are also offering time for their staff to spend with support animals. 

Nonprofit organization Canine Companions for Independence provided Jordy, a lab/golden retriever cross to help frontline workers at Santa Rosa Memorial Hospital. 

“The science confirms what we already know, pets provide comfort and support during hard times,” said Jessica Lacanlale, MSN, Trauma Program Manager at Santa Rosa Memorial Hospital. “The stress of caring for patients and working long hours is intense; but spending a little time with Jordy lifts my spirits and helps me get through the long days.”

Health Systems like Yale New Haven Health are offering confidential well-being check-in programs. This offers employees an opportunity to meet with an expert social worker or clinician one-on-one to discuss their needs and access resources to manage stress and improve well-being.

“People often downplay their own needs, saying ‘I’m OK’ when asked how they are doing,” said Javi Alvarado, YNHHS’ director of social work and co-chair of the WELD Council. “These visits create an opportunity to be better than ‘OK’ and truly grow from recent challenges.” 

During this pandemic, it is critical hospitals and health systems recognize what stress looks like and takes steps to help their staff cope with it. Equally as important is that healthcare workers know where they can go for help. This means internal communications to staff is key to express your awareness of the stress and the assistance being offered.

An estimated 4%, or about 150,000, Nurses in the U.S. are Filipino, but comprise nearly a third of Registered Nurse deaths due to COVID-19.

Business Insider reported, Nurses of Filipino descent account for 31.5% of the workforce's COVID-19 deaths.

In California, where about 20% of Nurses identify as Filipino, they account for nearly 70% of COVID-19 deaths in the profession, according to the Mercury News. Statewide, Asian Americans make up about 5% of coronavirus cases and 11.7% of deaths, compared to their 15% of the population.

Zenei Cortez, an RN who works at Kaiser Permanente’s South San Francisco Medical Center and, as co-president of the California Nurses Association/National Nurses United worries that her fellow Filipino Nurses are less likely than other Nurses to demand workplace protections.

“Culturally, we don’t complain. We do not question authority,” Cortez said. Many Filipino Nurses feel a strong sense of group loyalty, or the importance of putting the welfare of the group over that of the individual; in Tagalog, the word is pakikisama. “We are so passionate about our profession and what we do, sometimes to the point of forgetting about our own welfare,” she said. “We treat our patients like they are our own family.”

It’s the lack of proper PPE that has pushed some Filipino Nurses to speak out, when in the past they stayed silent about their working conditions.

“What I am seeing now is that my colleagues who are of Filipino descent are starting to speak out,” Zenei said. “We love our jobs, but we love our families too.”

Catherine Ceniza Choy, a professor of ethnic studies at UC Berkeley whose work has focused on the history of Filipino American Nurses said, Filipino American Nurses are more likely to work in higher risk roles such as the intensive-care unit, emergency medicine or telemetry, putting them directly in the path of COVID-19.

“Filipino Nurses, here specifically in the U.S., are concentrated specifically in in-patient critical care services,” Choy said. “Many of them are also caregivers at home, not only of children, but also their parents and other elders. And so part of the problem with the pandemic is these multiple layers of vulnerability and exposure.”

Jollene Levid and other volunteers have been keeping track of Filipino health care workers who've died from the disease worldwide. Their website, Kanlungan.net, which means shelter or refuge, is an online memorial with pictures and stories of those who've been lost.

The website reads "KANLUNGAN is intended to be a memorial to the transnational people of Philippine ancestry who make up a huge sector of the global healthcare system. This is to remember them as human beings, not simply as a labor percentage, a disease statistic, or an immigration number. And since the Internet is forever, we hope that KANLUNGAN will keep reminding the world of the skills, dedication, and the self-sacrifice demanded of health care workers so humanity may be healed."

School Nurses have become the main point of contact for any and all things COVID-19 related. They are a key component in making sure schools stay open.

The American Academy of Pediatrics (AAP) recommends that every school have a Nurse on site.

But, according to the National Association of School Nurses, before the pandemic, a quarter of American schools did not have a Nurse.

Now states are scrambling to hire School Nurses as students go back to school.

“Most school Nurses are the only health care experts in their school community able to understand infection control and do disease surveillance,” said Linda Mendonca, president-elect of the National Association of School Nurses (NASN). “But not every school has a Nurse who’s going to look after the children and staff. You need that expertise as a resource to safely reopen schools.”

COVID has made the role of a school Nurse even more complex, adding many challenges and new responsibilities for keeping children and staff safe.

They're responsible for complying with applicable federal, state, and local laws, regulations, ordinances, executive orders, policies, and any other applicable sources of authority, including any applicable standards of practice.

Nurses will also have to create plans for how high-risk students will return to school. They'll also help with screening protocols, creating safe classroom setups, hand washing and sanitation stations, and PPE distribution.

The school Nurse should collect and share school data in compliance with state and federal confidentiality regulations.

Once a coronavirus case is identified, school Nurses and local public health officials will work together to determine which students or staff might have been exposed to the infected person.

Face masks will be one of the main ways of limiting the spread of the virus in schools this fall. However, with younger students there's a risk of children trading masks or not keeping them on.

Social distancing is another key factor in keeping everyone safe, NASN guidelines suggest, staggered start times, small group and outdoor activities, no sharing of musical instruments, and meals in classrooms.

Liz Pray, MSN-Ed, RN, NCSN, School Nurse for the Moses Lake School District in Washington State and President of the School Nurse Organization of Washington said, "If I could offer any words for nurses feeling overwhelmed, I would encourage them to allow themselves and others a little grace. Everyone is struggling. Tempers are short, people are on edge and it’s been very difficult for students, parents and team members to adjust to these changes. Remember to take a step back, take a deep breath and take care of yourself."

Our healthcare system must work hard to increase diversity within their workforce and create an inclusive environment. Diversity and Inclusion (D&I) strategies are necessary for health systems to provide the best care possible to an evolving population.

A sense of Belonging is equally as important. Just because an employee is working in an organization, it doesn't necessarily mean they feel they belong there.

The feeling of belonging is a fundamental human need. It is an extremely powerful force. Without it, your D&I strategy could fail.

The term Diversity, Inclusion and Belonging (DI&B) was created by Pat Wadors. She said, "D&I may capture your head, but belonging captures your heart.”

“When someone is different and insecure and they get to be authentic and are welcomed in a team, we can unlock their super powers and bring out the best—not only in that person, but the team and, therefore, the product, the service, the company, the world,” says Wadors.

Covering or masking is when someone tries to fit in with the dominant culture and downplay who they really are. Research from a Deloitte study of more than 3,000 people found that 61% of people cover at work, even more so if they are Black (79%) or LGBTQ+ (83%).

Neuroscience researchers have found that exclusion lights up the same regions of the brain as physical pain. “Being excluded is painful because it threatens fundamental human needs, such as belonging and self-esteem,” says Dr. Kipling Williams of Purdue University.

When someone feels excluded over a long period of time, and every day they have to return to an environment where they feel like they do not belong, they'll end up leaving.

Dr. Christine Cox of New York University’s Langone School of Medicine has identified six areas that are enhanced by inclusion and worsened by exclusion: intelligent thought and reasoning, self-care and self-improvement, prosocial behavior, self-regulation, a sense of purpose, and well-being. Each of these items represents real financial gains or losses for teams and organizations.

According to Wadors, in order to create a culture of belonging, teams and managers should reflect on three questions:

1. How does your organization celebrate differences?
2. As an employee, do you feel safe if you make a mistake?
3. Does someone at work care about you?

A Forbes article mentions, another way that a sense of belonging can be nurtured is by creating a stronger sense of community.  A sense of community can be nurtured by regular interactions and collaboration. We tend to stereotype people less and are less fearful of difference when we are more familiar with them or spend more time with them.

But most importantly, there must be trust. Employees should have trust in the company's mission, in the leadership's vision and in their goals. Once every employee feels that they belong in the organization, this will lead to a more positive and inclusive workplace.

Clinical trials are necessary to provide evidence for the benefits and safety of new treatments. Racial and ethnic minorities continue to be underrepresented in these clinical trials.

Black or African Americans represent 13.4% of the U.S. population, yet reports show they make up only 5% of clinical trial participants. Hispanic or Latino origin represent 18.1% of the U.S. population but only 1% of clinical trial participants.

The clinical trial population must be diverse enough to represent the patients who will be using the medicine.

According to a ScienceDirect study, Inclusion of diverse participants in clinical research may lead to more robust and complete data that broadens the understanding of racial and ethnic differences in treatment responses that, in turn, may contribute to reduced disparities in outcomes.

Richardae Araojo, who is the FDA Associate Commissioner for Minority Health and Director of the Office of Minority Health and Health Equity said, “There are many different reasons why minorities have been under-represented in clinical trials. One barrier to participation that we all know well is a lack of trust because of past historical abuses. Other barriers to participation may differ based on the population you are seeking to enroll and may include language and cultural differences, health literacy, religion, and a lack of awareness and knowledge about what a clinical trial is and what it means to participate.”

Araojo continued by saying “Some barriers may be due to aspects of the trial design such as inadequate recruitment and retention efforts, accessibility to the site location, frequency of study visits, transportation, participation may conflict with caregiver or family responsibilities, and may cause time away from jobs and other commitments. Often times, there may be a perception that minorities do not want to participate, and they simply aren’t asked.”

Recently, the National Institutes of Health launched the All of Us Research Program. This program is inviting one million people across the U.S. to help build one of the most diverse health databases in history.

The All of Us Research Program is a great example of inclusive research that can help ensure better health outcomes for all.

The Food and Drug Administration (FDA) released a draft guidance on improving the diversity of patient populations in clinical trials.

The draft makes numerous recommendations on how to increase diversity in clinical trials. These recommendations include enrichment, inclusive trial practices and design, and methodological ways to bring in a wider range of patient populations.

The benefits of increased diversity in clinical trials are enormous. Enrolling diverse patients in clinical trials improves the likelihood that they will benefit from research data. Trial results will be more represented and relevant for the entire population.