DiversityNursing Blog

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.

In our growing diverse society, health care workers need to understand that applying only traditional westernized medical practices isn't appropriate for many patients and families. Health professionals must have an awareness of different cultural practices and spiritual beliefs in order to reduce racial and ethnic disparities in health care.

According to the American Hospital Association, cultural competency in health care describes the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including the tailoring of health care delivery to meet patients' social, cultural and linguistic needs.

There can be language barriers so make sure you know your patient’s preferred method of communication and arrange an interpreter. Non-verbal communication may differ across cultures. Don’t make any assumptions without knowing the person's customs.

Many cultures have special dietary considerations. Hospital staff should be educated about food culture, which is a term used to describe the non‐nutritive, yet nonetheless significant, aspects of food, such as when food is eaten and how it is served.

For example, Jewish patients do not eat pork or shellfish. Muslim patients also do not consume pork. Muslims will eat only permitted food (halal) and will not eat or drink anything that is considered forbidden (haram). Halal food requires that Allah's name is invoked at the time the animal is killed. Lamb, beef, goat and chicken, for example, are halal as long as a Muslim kills them and offers a prayer. Fish and eggs are also halal. Buddhist are mostly vegetarian, though Buddhists may eat meat if it has not been killed for them specifically.

Health care workers should use effective communication to increase their understanding about the patient's spiritual beliefs and practices. Your workplace should offer spiritual counselors like a chaplain or a rabbi. It is a good idea to have a non-denominational prayer and meditation room which can serve as an inclusive sacred space for staff and patients of all religious backgrounds.

Management should take an active role in promoting culturally competent workplace training courses and resources.

Our calendar of cultural dates is a great tool to assist staff with respectful scheduling and diversity celebrations.

Ingrid Silva, a ballerina of The Dance Theatre of Harlem, is using the current closing of theaters and performance venues to expose racial bias in healthcare. In the past, Ingrid received praise and recognition for creating a line of ballet shoes in an array of skin tones for dancers of all races and cultures.

Silva founded a nonprofit organization called EmpowHer. EmpowHer NY is a social catalyst that ignites the conversation about women who break through the glass ceiling imposed by society and live authentically according to their truth.

Recently EmpowHer and The Bloc teamed up to create a video called 'The Call Project'.

According to Forbes, this project is an experiment where actress Corin Wells made multiple calls to a 24-hour Nurses health hotline. Wells used a white-coded name and voice as well as a Black-coded name and tone. The results showed that 77% of her “black” alias calls ended with a recommendation to go to an urgent care facility, a protocol for minor health issues. However, her “white alias,” using the same script, was advised to go to the ER, which is protocol for any patient with urgent symptoms of an appendicitis.

Empowher believes, "When it comes to getting proper healthcare, it shouldn’t matter what your name is or how you sound like. Your pain shouldn’t be underestimated because of biological myths that are not only scientifically false but also fantastical in nature."

The goal of this experiment is to address racial biases in healthcare and to make unconscious bias training mandatory for hospitals and healthcare to ensure quality healthcare.

Silva said, “It’s been past time for us to speak up on this matter for the black community worldwide. This is our way of saying enough already!”

You can join the movement in the fight for equality in healthcare. EmpowHer is offering a petition to make unconscious bias training a mandatory requirement for hospitals across the country. You can sign the petition here.