DiversityNursing Blog

COVID-19 has shone a light on how systemic racism plays a role in health disparities among Black people. 

According to Scientific American, the overall death rate from COVID-19 is 2.4 times greater for African Americans than it is for white people. 

Camara Phyllis Jones, an Epidemiologist who recently served as president of the American Public Health Association said, “People of color right now are more likely to be infected, and we’re more likely to die. What we’re seeing here is the direct result of racism.”

Hypertension, obesity, diabetes and other risk factors for severe coronavirus complications, are more prevalent in minority populations.

According to an article from STAT, Black people in the U.S. are more likely than white people to live in food deserts, meaning they have limited access to fresh fruit or vegetables. They are also less likely to be able to access green spaces, and more likely to live in areas without clean water or air.

Household spread is the most common form of virus transmission. Many people of color live in overcrowded homes and communities so it's difficult to social distance. It is also difficult to find an outdoor place to social distance as there are fewer publicly provided resources, such as parks and bike lanes, for minority-dense neighborhoods.

The best advice to fighting the virus is to stay at home but, unfortunately essential workers don't have this option. Not only are fewer Black and Latino adults able to work from home, but they're also overrepresented in essential jobs.

These health disparities are further worsened by an unequal healthcare system. People of color often have unequal access to care, and when they do receive care it is often poorer quality.

The National Academy of Medicine (NAM) released a report that found “racial and ethnic minorities receive lower-quality health care than white people—even when insurance status, income, age, and severity of conditions are comparable.”

In order for things to change, the entire health care field, from medical schools to hospitals and even medical device manufacturers, need to work to unravel and address racism within the healthcare system.

Progress will take time and efforts must occur on every societal level. This involves a wide range of actions, like improving wages and closing pay gaps, improving access to health insurance, providing better access to fresh foods and green spaces, and ensuring more diversity in the health care system so healthcare workers can provide culturally competent care.

The National (CLAS) Standards is a great strategy intended to advance health equity, improve quality, and help eliminate healthcare disparities, by providing a set of 15 action steps for healthcare organizations to implement.

The National CLAS Standards are as follows:

Principal Standard

1. Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.

Governance, Leadership and Workforce

2. Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy, practices, and allocated resources.
3. Recruit, promote, and support a culturally and linguistically diverse governance, leadership, and workforce that are responsive to the population in the service area.
4. Educate and train governance, leadership, and workforce in culturally and linguistically appropriate policies and practices on an ongoing basis.

Communication and Language Assistance

5. Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at no cost to them, to facilitate timely access to all health care and services.
6. Inform all individuals of the availability of language assistance services clearly and in their preferred language, verbally and in writing.
7. Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters should be avoided.
8. Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area.

Engagement, Continuous Improvement, and Accountability

9. Establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them throughout the organization's planning and operations.
10. Conduct ongoing assessments of the organization's CLAS-related activities and integrate CLAS-related measures into measurement and continuous quality improvement activities.
11. Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health equity and outcomes and to inform service delivery.
12. Conduct regular assessments of community health assets and needs and use the results to plan and implement services that respond to the cultural and linguistic diversity of populations in the service area.
13. Partner with the community to design, implement, and evaluate policies, practices, and services to ensure cultural and linguistic appropriateness.
14. Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify, prevent, and resolve conflicts or complaints.
15. Communicate the organization's progress in implementing and sustaining CLAS to all stakeholders, constituents, and the general public.

Bonnie Castillo, is the Executive Director of National Nurses United (NNU) and a former Intensive Care Nurse. 

Back in January, Castillo was concerned by news reports about a virus that was devastating Wuhan, China. So she called for a meeting with the NNU's Director of health and safety and its industrial hygienist to go through scientific reports.

After learning more about the coronavirus, she directed her staff to investigate how prepared U.S. hospitals were for an outbreak.

According to the New York Times, Bonnie said, “As a Nurse, there are just times when it’s very intuitive. You just sense that something catastrophic is going to happen.”

The NNU contacted hundreds of hospitals asking for detailed information about how much personal protective equipment (PPE) they had. The union also surveyed thousands of Nurses asking how they felt about their health facilities’ readiness.

While the survey is ongoing, here are highlights as of March 3, 2020 tallying responses from more than 6,500 Nurses in 48 states, including the District of Columbia and the Virgin Islands.

Some highlights from the survey include:

• Only 44% report that their employer has provided them information about novel coronavirus and how to recognize and respond to possible cases.
• Only 29% report that there is a plan in place to isolate a patient with a possible novel coronavirus infection. 23% report they don't know if there is a plan.
• Only 63% of nurses report having access to N95 respirators on their units. 27% have access to PAPRs. 
• Only 30% report that their employer has sufficient PPE stock on hand to protect staff if there is a rapid surge in patients with possible coronavirus infections. 38% don't know.
• Only 65% report having been trained on safely donning and doffing PPE in the previous year.

At the beginning of March, Castillo’s team sent a letter to Vice President Mike Pence and the coronavirus task force coordinator Dr. Deborah Birx, warning that “the majority of U.S. health care facilities are completely unprepared to safely contain Covid-19.”

Then they asked the Occupational Safety and Health Administration (OSHA) to issue an “emergency temporary standard” for infectious diseases which would prompt employers to implement safety standards such as providing more effective N95 masks to Nurses working with coronavirus patients, instead of basic surgical masks. But OSHA didn't take Bonnie's advice.

The Centers for Disease Control and Prevention (CDC) then acknowledged that hospitals did lack sufficient PPE. So the CDC decided to loosen restrictions and required hospitals to provide their staff with only surgical masks, not N95 masks in many situations.

Castillo and her team were rightfully upset and decided to push publicly for more PPE. They held more than 350 socially distanced protests and 2 vigils in front of the White House for Nurses who died from COVID-19. 

"Nurses are not afraid to care for our patients if we have the right protections," Bonnie told NPR. "But we're not martyrs sacrificing our lives because our government and our employers didn't do their jobs."

After protests, some officials began allowing the N95 masks for all Nurses working with Covid-19 patients.

In May, House Democrats passed a stimulus bill that included some of the Nurses’ demands, including mass production of PPE through the Defense Production Act and an emergency temporary standard for infectious diseases.

Bonnie is still fighting for adequate PPE for Healthcare workers as the coronavirus rages on and concerns grow about a second wave of infections in the fall. She is an advocate and a cheerleader for all Nurses. It is imperative Nurses and all Healthcare workers get the PPE they need to protect themselves and their families, so they can provide care for their patients.

Black Lives Matter protests are happening all across America and as people take to the streets to protest, medical workers are doing their part in supporting protesters.

After working tirelessly for long hours and risking their own lives on the front lines caring for coronavirus (COVID-19) patients, Nurses are leaving their shifts and going straight to protests to help those who've been injured.

Martha Dawson, DNP, RN, a professor and the president of the National Black Nurses Association, said Nurses and frontline healthcare workers of color were deeply saddened after the killing of George Floyd, an unarmed Black man who was killed in Minneapolis, Minnesota, at 46 after a white policeman pushed his knee into Floyd’s neck for more than eight minutes.

Dawson told Refinery29, “For Nurses of color working on the frontlines, it’s disheartening to still realize that you’re living in a country where you’re under-appreciated and judged, first, on the color of your skin, rather than the content of your character. And you have to recognize that the concern with the death in Minnesota is just now emerging as one stressor on top of the many stressors of the pandemic.” 

Nurses want their voices heard at rallies but they also want to help protesters who have been shot with rubber bullets, sprayed with tear gas, or have been otherwise physically injured. 

Not all protests have become violent. But when they have, healthcare workers have also found themselves in the line of fire while treating injured protesters.

According to an article from Shape.com, a Minneapolis Nurse said police stormed a medical tent and opened fire with rubber bullets while she was working to treat a man bleeding badly from a rubber bullet wound.

"I was trying to look at the wound and they were shooting at us." The wounded man tried to protect her, she said, but eventually, she decided to leave. "I told him I wouldn't leave him, but I did. I feel so bad. They were shooting. I was scared," she recounted through tears.

Nurses are using social media to share tips on how to stay safe from coronavirus while protesting and where to find free medical help for those injured during protests.

One Nurse tweeted, "I am a licensed Nurse with an organized group of frontline medics. We are all healthcare workers (doctors, nurses, EMTs) and we provide safe spaces of first aid care for anyone who might have minor injuries related to police protest. We prioritize care for Black, Indigenous, and People of Color (BIPOC) folks."

Another person tweeted health safety tips for protesting during a pandemic.

Nursing schools all over the country are switching from traditional clinical studies to virtual simulations. Colleges are offering online clinicals in several different ways.  

There is no national governing body recommending what each program does since Nursing education programs are approved by each state’s governing board.

The Society for Simulation in Healthcare (SSH) and the International Nursing Association of Clinical Simulation and Learning (INACSL) encouraged that, “regulatory bodies and policymakers demonstrate flexibility by allowing the replacement of clinical hours usually completed in a healthcare setting with that of virtually simulated experiences.”

Some students interact with avatars while others use unfolding case studies in which actors play out different scenarios, said Patty Gagliano, Indian River State College Assistant Dean of Nursing.  

Angela Ramos, second-year Nursing student at Indian River, is completing this semester's clinicals by passing medications to her patients through an online simulation platform, v-STEM. 

Most states in the United States allow up to 25% of clinical hours to be simulation-based and some states permit over 50%.

In Florida, the state has relaxed limits on the percentage of clinical hours that can be done through simulations, with programs now able to go up to 50% or more, said Cynthia Cummings, associate professor at the University of North Florida.

Georgia Gwinnett College is using two simulator programs that allows students to work together in online scenarios mirroring what they’d be doing in person, once they are Registered Nurses.

“Once you start, it’s just like going to the hospital,” said Desi Kennedy, a Nursing student set to graduate this month. “We have to give reports on four different patients. We break off into groups and decide what our priorities should be and how we should delegate certain tasks. We have huddle sessions about our patients. Those situations are really realistic, things can change really fast.”

Not all institutions are following the virtual trend. Kirkwood Community College in Cedar Rapids, Iowa have continued with in-person clinicals.

College officials opted instead to reduce the number of clinical hours students in the final semester would complete, said Kathryn J. Dolter, Dean of Nursing at the college. 

While there's "definitely a place for simulations" and what most schools are doing now is helpful, the simulations don't take the place of being with patients, Nurses and Doctors, said Cindy Dawson, Chief Nurse Executive and Associate Director at University of Iowa Hospitals and Clinics.

Donna Meyer, Chief executive of the Organization for Associate Degree Nursing said, "Simulations can be helpful to the education process and even stimulate a student’s critical thinking. Plus, virtual simulations are very structured. Faculty want their students to have strong outcomes, so the simulations are still very stringent.”

A virtual connection for Nursing students is crucial for continuing education and skill development during a pandemic.

DiversityNursing.com announced the Winner of their 2020 DiversityNursing.com $5,000 Education Award. We are delighted to announce our Winner is Henrietta Buckley of St Louis, MO! Henrietta has enjoyed her career as a Nurse for 19 years and is currently working on her Master’s degree in Nurse Education.

Henrietta plans to use her DiversityNursing.com $5,000 Education Award toward her Master’s degree. Her words of advice to new Nurses “always be open to learning. Every day I’m learning new things. Be open to having students to mentor – you will feel their energy and excitement”.

DiversityNursing.com is particularly honored to provide their Award this year as 2020 is the Year of the Nurse and Midwife. It is also poignant because of the burden the coronavirus has put on our Nurses and Healthcare workers.

This is the 12th year DiversityNursing.com has bestowed their Annual $5,000 Education Award. Pat Magrath, National Sales Director at DiversityNursing.comsaid “Our $5,000 Education Award is our way of giving back to the Nursing community. Our Award can be used to continue Nursing classes, payment toward Nursing school loans, or attendance at a Nursing conference.”

For the past 12 years, many thousands of Nurses have registered on the DiversityNursing.com website for the Award. During Nurses Week in early May, 1 lucky name is drawn out of thousands to win the $5,000 Education Award. Pat said “Registration is quick and there is no essay requirement, which the Nurses love!”.

Past Award Winners can be found here: 
https://diversitynursing.com/past-education-award-winners/

Nurses are being cheered around the world for their courage, compassion, and hard work fighting the coronavirus. We should always celebrate Nurses, especially now. 

WHO Director-General Tedros Adhanom Ghebreyesus said, "As you know, during the COVID-19, they're in the front line and they're risking their lives to save others, but not only during COVID-19. Nurses are a bridge between the health system and the community and they have been doing so ever since the Nursing profession actually started."

While we really can't ever thank Nurses enough, here are ways we can express appreciation for them.

1)    Stay Home - The most important way Nurses can be thanked is to stay home when they can.

2)    Continue Social Distancing - Don’t get too relaxed about following social distancing measures.

3)    Donate - Much needed professional grade masks or other PPE.

4)    Cards, Signs, Social Media Posts – get creative and do something locally or nationally.

5)    Gift Cards - Mary Babel, an RN in Jacksonville, FL suggests gift cards to restaurants that offer curbside pickup. Some people are donating gift cards for busy Nurses to buy their families food and some are donating gift cards to buy whole Nursing staff meals! 

6)    Care Packages – For local Nurses and Travel Nurses in over-stressed pandemic areas. To create a care package for Travel Nurses, think small like portable door locks, external battery chargers, collapsible or travel size containers, individual snack size items, power bars, etc.

7)    Compression Socks - Can make a difference in soothing aches and preventing swelling. It’s a gift that truly keeps on giving as 1 pair can last a long time providing many comfortable shifts.

8)    Cell Phone Sanitizer - According to Nurse.org, cell phone sanitizer is a 100% practical gift. Nurses can sanitize their contaminated cell phones and have one less thing to worry about as a possible source of infection.

We all like to feel we’re appreciated. Now is a great time to show all Nurses our appreciation. 

Many Nurses and Doctors said in interviews with TIME, that fighting COVID-19 is making them feel more dedicated to their chosen career, and determined to persevere and help their patients. But, many also said they were struggling with negative feelings.

Healthcare workers are afraid of spreading the virus to their families, frustrated about the lack of PPE, and feel they can’t do enough for their patients. First responders are tired from long shifts, and are extremely sad for their dying patients, of which many are passing away alone. This is heartbreaking.

Dr. Jay Kaplan, an emergency room Physician and wellness specialist at LCMC Health system in New Orleans, lets his staff know they aren't alone. He listens as Nurses and Doctors share their fears and problems.

Kaplan tells them it’s okay to get sad or angry over the coronavirus. He reads them his poems. He shares that one day he came home and cried to his wife because he was  overwhelmed by the rate of dying patients.

“We need to break the culture of silence and let people know it’s okay not to have it all together all the time,” he said.

Kaplan’s “wellness visits” are a key strategy in preventing healthcare workers from spiraling into depression and post-traumatic stress disorder during the pandemic. Many hospitals across the U.S. are launching similar initiatives.

Mount Sinai hospitals in New York City ramped up initiatives, such as a 24/7 mental health crisis line and one-on-one counseling. It also launched a wellness and resilience center that will track staffers' mental health long term.

Dr. Deborah B. Marin, Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai and Director of the new center said,  “This multi-disciplinary center will consider the physical, emotional, mental and spiritual needs of our entire health care community, including those on the frontline and in supporting roles. Working closely with every department across the health system, our aim is to not only address  but to also prevent the development of mental health issues before they occur by intervening early, offering resilience training and treatment for every health care working in need. It’s important that we launch now as this crisis continues to evolve and take a toll on our community.”

Several healthcare workers in the TIME interviews said, among all the uncertainty and fear, they have found some relief in support from their families, communities, and one another.

We’re offering this article during Nurses Week as a reminder to all to be as patient, kind and loving to our Nurses, Healthcare workers, first responders, grocery store employees and all the people out there working to keep us safe. Thank you!

From car rental companies to sports apparel makers, organizations across the country have shifted operations to support health care workers in the fight against the coronavirus pandemic.

Hertz provided $2 million in free vehicle rentals to more than 2,000 healthcare workers in New York City. 

A Physician Assistant, working in an ICU in the Bronx, said "I work 12.5 and 24 hour shifts, taking care of the sickest COVID-19 patients in our hospital. A lot of us are working overtime, picking up shifts for sick colleagues, traveling to hospitals further away because they're in need. Hertz really made our ability to get to work much easier and safer so that we have more mental, emotional and physical energy to care for our patients.”

Diamond-managed properties around the world are also giving medical personnel and first responders a free place to stay while they work on the front lines of the crisis.

"Like many, we have been looking for ways to help," Diamond Resorts said. "We realized we are in a unique position to provide accommodations that are particularly well-suited for social distancing."

The company's suites are larger than typical hotel rooms with the majority including full, in-suite kitchens with refrigerators, ovens and stoves, full bathrooms and laundry facilities, according to Diamond Resorts.

Fanatics produces jerseys for Major League Baseball and announced it will halt production of jerseys to make nonsurgical-grade, single-use masks and gowns for Doctors, Nurses and healthcare personnel on the frontline battling the virus.

Michael Rubin, the company's chairman said, "This unprecedented public health emergency has compelled our country to be more collaborative, innovative and strategic than ever before. As the demand for masks and gowns has surged, we're fortunate to have teamed up with Major League Baseball to find a unique way to support our front-line workers in this fight to stem the virus, who are in dire need of critical supplies."

Bauer Hockey traditionally produces hockey equipment, some of which includes plastic face masks for helmets. The company thought it would make sense to produce bigger plastic face shields for doctors and nurses using similar materials. 

Bauer vice president of global marketing Mary-Kay Messier said, "Nurses and Doctors are pleading for these masks, and they aren't waiting for their institutions to get them to them. The fact that these people are going to work every day, risking their lives and don't ever think about it but don't have the equipment to protect themselves is unacceptable."

Airbnb launched a global initiative to help health care professionals, relief workers and first responders. The company hopes to help house about 100,000 workers on the front lines. Airbnb will waive all fees for stays. 

“Medical workers and first responders are providing lifesaving support during the coronavirus outbreak and we want to help,” Airbnb’s co-founder Joe Gebbia said. “We’ve heard from countless hosts around the world who want to provide a comforting home to heroic first responders. We are connecting our nonprofit partners, government agencies and others with our incredible host community to work together in these extraordinary times.”

Brooks Running donated 10,000 pairs of shoes to health care workers on the front lines of the pandemic.

"If you’re part of the healthcare community responding to COVID-19, we want to make your work a little more comfortable with a free pair of shoes. It’s our way of saying thank you for all you do," the company posted on Instagram earlier this month. 

Another shoe company, Crocs, is also donating shoes. The company is working to donate 10,000 pairs of shoes a day to those on the front lines of the battle against the pandemic. The company already has more than 40,000 people in line for a pair. 

Dr. Scholls Wellness Company is donating $1.3 million in insoles to support health care workers. This includes 100,000 pairs of Dr. Scholl’s Massaging Gel Work insoles, which the company says reduces muscle fatigue and also absorbs shock. The company plans to send donations to hospitals across the country, especially those in hot spots.

Until May 31, Starbucks will be giving a free tall brewed coffee to anyone one identifies as a first responder or front line worker supporting our healthcare system. This includes police officers, firefighters, paramedics, doctors, nurses, hospital and medical staff, and medical researchers. 

In these trying times, it’s comforting to see by action and commitment, that we are all in this together. Giving back, in any way, with even the smallest acts of kindness has a significant impact on our personal and professional wellbeing. Thank you to all the Nurses, Healthcare workers, and companies helping our medical teams, for all you do to keep us safe and healthy. You confirm our belief that there are wonderfully thoughtful and committed people in this world that truly care. 

As COVID-19 continues to impact communities around the world, people are coming together to help one another now more than ever.  

Ashley Lawrence, a 21-year-old in Kentucky, noticed that since so much of the population now are opting to wear protective face masks, those who are deaf or hard of hearing and rely on lip reading are struggling to access critical information. 

So she and her mom set to work sewing masks using plastic fabric and bed sheets, experimenting with various attachments for people who use cochlear implants and hearing aids and can’t wrap mask straps around their ears.

On the DHH Mask Project GoFundMe page Lawrence said she would distribute the masks for free to those who request them so they can provide them to their Doctors if they need medical attention.