DiversityNursing Blog

By: Ambriel Maji

Every student nurse needs to have a strong understanding of culture and ethnic considerations so that they may be able to care for their patient's as whole. Many nurses when not faced with diversity are not fully understanding to exactly what culture is.

Culture is a set of learned values, customs, practices and beliefs that are shared by a group of people or are passed from one generation to another. A subculture shares many of the same characteristics with a primary culture but they may have patterns of behavior or ideals that differ and separate themselves from the rest of a cultural group.

Not all members of a culture will have the same behavior though; some of the differences are age, religion, dialect, socioeconomic backgrounds, geographic locations, gender identities, gender roles, and the degree of values that are adopted in a current country.

Stereotyping is something a nurse must learn not to do because culture can influence each person in varies ways and not each person from a certain culture may feel the same way as another person. Stereotyping is a generalized feeling about one group that is formed based on behavior, of an individual or a group. Ethnic stereotyping is a fixed concept of how all members of a certain group may think or act.

Race is considered a group of people who share biologic and physical characteristics, while ethnicity is a group of people who share a common social and cultural heritage based on beliefs, traditions, and national origin, physical and biologic characteristics.

Transcultural nursing is the understanding and integrating of the many variables in culture and subculture practices into all the aspects of nursing care. Different cultures have a variety of practices that may relate to response to illness and death, care of people of different age groups, childbirth, diet and nutrition, and even health care in general and treatment methods.

The nurse must be aware of personal culture beliefs and practices of their patient and understand that these beliefs put influence on their ability to care for those patients of different cultural backgrounds. By understanding these personal beliefs it gives the nurse the ability to react to different cultures with understanding, respect, openness, and acceptance of the differences between them. Depending on the location you work you may come across many different cultures and subcultures it is a nurse's duty to become versed in the different patients they may take care of.

Source: Yahoo Voices

To be culturally competent the nurse needs to understand his/her own world views and those of the patient, while avoiding stereotyping and misapplication of scientific knowledge. Cultural competence is obtaining cultural information and then applying that knowledge. This cultural awareness allows you to see the entire picture and improves the quality of care and health outcomes.

Adapting to different cultural beliefs and practices requires flexibility and a respect for others view points. Cultural competence means to really listen to the patient, to find out and learn about the patient's beliefs of health and illness. To provide culturally appropriate care we need to know and  to understand culturally influenced health behaviors.

In our society, nurses don't have to travel to faraway places to encounter all sorts of cultural differences, such as ethnic customs, traditions and taboos. The United States provides plenty of opportunities for challenges stemming from cultural diversity. To be culturally competent the nurse needs to learn how to mix a little cultural understanding with the nursing care they offer. In some parts of the United States culturally varied patient populations have long been the norm . But now, even in the homogeneous state of Maine where we reside, we are seeing a dramatic increase in immigrants from all over the world.  These cultural differences are affecting even the most remote settings.

Since the perception of illness and disease and their causes varies by culture, these individual preferences affect the approaches to health care. Culture also influences how people seek health care and how they behave toward health care providers. How we care for patients and how patients respond to this care is greatly influenced by culture. Health care providers must possess the ability and knowledge to communicate and  to understand health behaviors influenced by culture. Having this ability and knowledge can eliminate barriers to the delivery of  health care.  These issues show the need for health care organizations to develop policies, practices and procedures to deliver culturally competent care.

Cross, T., Bazron, B., Dennis, K., and Isaacs, M. (1989)  list five essential elements that contribute to an institution’s or agency’s ability to become more culturally competent. These include: 

1. valuing diversity; 
2. having the capacity for cultural self-assessment; 
3. being conscious of the dynamics inherent when cultures interact; 
4. having institutionalized cultural knowledge; and 
5. having developed adaptations of service delivery reflecting an understanding of cultural diversity. 

These five elements should be manifested at every level of an organization, including policy making, administration, and practice. Further, these elements should be reflected in the attitudes, structures, policies, and services of the organization.

Developing culturally competent programs is an ongoing  process, There seems to be no one recipe for cultural competency. It's an ongoing evaluation, as we continually adapt and reevaluate the way things are done. For nurses, cultural diversity  tests our ability to truly care for patients, to demonstrate that we are not only clinically proficient but also culturally competent, that we CARE..

Meyer CR.(1996) describes four major challenges for providers and cultural competency in healthcare. The first is the straightforward challenge of recognizing clinical differences among people of different ethnic and racial groups (eg, higher risk of hypertension in African Americans and of diabetes in certain Native American groups). The second, and far more complicated, challenge is communication. This deals with everything from the need for interpreters to nuances of words in various languages. Many patients, even in Western cultures, are reluctant to talk about personal matters such as sexual activity or chemical use. How do we overcome this challenge among more restricted cultures (as compared to ours)? Some patients may not have or are reluctant to use telephones. We need to plan for these types of obstacles. The third challenge is ethics. While Western medicine is among the best in the world, we do not have all the answers. Respect for the belief systems of others and the effects of those beliefs on well-being are critically important to competent care. The final challenge involves trust. For some patients, authority figures are immediately mistrusted, sometimes for good reason. Having seen or been victims of atrocities at the hands of authorities in their homelands, many people are as wary of caregivers themselves as they are of the care.

As individuals, nurses and health care providers, we need to learn to ask questions sensitively and  to show respect for different cultural beliefs.  Most important, we must listen to our patients carefully. The main source of problems in caring for patients from diverse cultural backgrounds is the lack of understanding and tolerance. Very often, neither the nurse nor the patient understands the other's perspective. 

Source: CulturalDiversity.org

By: Mark E. Dixon

The nursing shortage isn't going away, but a federal commission had discovered one positive side effect - the shortage has helped make nursing one of the most ethnically diverse of the healthcare professions.

That's relatively speaking, of course.

Nurses are 50 percent more likely than physicians to be minorities, according to the final report of the Sullivan Commission on Diversity in the Healthcare Workforce.

Even so, Blacks, Hispanics and American Indians together total only 9 percent of nurses, despite representing about 25 percent of the U.S. population. By comparison, only 6 percent of physicians are minorities.

Minorities make up about 10 percent of nursing baccalaureate faculties and 4.2 percent of medical school professors. Nurse educators are more than twice as likely to be members of a minority group as are medical school professors. 

The problem with a disproportionately white healthcare workforce is that it cannot adequately serve a population that is increasingly non-white, according to the commission report.

"Diversity in the health workforce will strengthen cultural competence throughout the health system," the commission said. "Cultural competence profoundly influences how health professionals deliver healthcare."

According to the commission, language barriers in particular are a critical issue; 20 percent of Americans speak a language other than English at home.

Minority groups receive poorer quality healthcare and experience higher mortality rates from heart disease, HIV/AIDS, diabetes, mental health and other illnesses. Minority children are more likely to die from leukemia than white children. 

An increase of more than 20,000 minority nurses is needed to increase their proportion of the nursing workforce by 1 percent.

By the middle of this century, the U.S. population could be more than 50 percent nonwhite, according to the commission's report.

Recommended Strategies

Established in 2003, the Sullivan Commission was formed to recommend strategies to improve access to care and dismantle barriers to health professions' education.

Chaired by former U.S. Secretary of Health and Human Services Louis W. Sullivan, the 15-member commission consists of experts from the health, higher education, business and legal arenas.

The Sullivan Commission's findings were endorsed by the American Association of Colleges of Nursing, whose president, Jean E. Bartels, PhD, RN, called on legislators, nursing practice leaders and nurse educators to implement the commission's recommendations.

Bartels said: "National nursing organizations, the federal Division of Nursing, hospital associations, nursing philanthropies, and other stakeholders within the healthcare community agree that recruiting under-represented groups into nursing is a priority for the profession and an important step toward addressing the nursing shortage."

Commission recommendations included:

· Health profession schools should hire diversity program managers and develop plans to ensure institutional diversity.

· Colleges and universities should provide an array of support services to minority students, including mentoring, test-taking skills and application counseling. 

· Schools granting baccalaureate nursing degrees should provide "bridging programs" that help graduates of 2-year programs transition to 4-year institutions.  Associate nursing graduates should be encouraged to enroll in baccalaureate programs.

· Professional organizations should work with schools to promote enhanced admissions policies, cultural competence training and minority student recruitment.

· To remove financial barriers to nursing education, funding organizations should provide scholarships, loan forgiveness and tuition reimbursement programs.

· Congress should substantially increase funding for diversity programs within the National Health Service Corps and Titles VII and VIII of the Public Health Service Act.

Diversity Friendly

Meanwhile, nursing seems to be friendly to workers who are minorities.  

A study by Vanderbilt University nursing researcher Peter Buerhaus, PhD, RN, FAAN, showed that part of the 9 percent increase in the nursing workforce from 2001 to 2002 was due to nurses over 50 returning to the hospital.  

Hospitals are making work environments more supportive for older workers. For example, some offer scheduling flexibility and reduced physical requirements.

In addition, the acute nursing shortage and innovations such as talking thermometers have enabled nursing programs and employers to hire people with vision and hearing loss or impaired mobility.

A 2003 Bureau of Labor Statistics survey showed that Hispanics - 13.7 percent of the U.S. population - comprise just 4.4 percent of all medical records and health information technicians, 2.8 percent of pharmacists and 1.3 percent of emergency medical technicians and paramedics. Blacks (12.8 percent) comprise 2.6 percent of physical therapists, 1.3 percent of opticians and less than 1 percent of dental hygienists.

Asians, who make up 4.2 percent of the U.S. population, are represented at that rate or higher in most healthcare segments - particularly physicians and surgeons (16.1 percent), and clinical laboratory technologists and technicians (12.3 percent). However, they are underrepresented as licensed practical and vocational nurses (3.6 percent), dental hygienists (1.4 percent) and dispensing opticians (1.3 percent).

Source: Advance for Nurses

Benefit Bank of Fort Smith has provided two gifts totaling $300,000 to the University of Arkansas at Fort Smith, with university officials saying the gifts will have a positive impact on UAFS students and the community.

A $250,000 professorship – titled the Benefit Bank Endowed Professor of Nursing – will provide a perpetual source of support outside the scope of the University’s regular budget, while a $50,000 gift will fund the Benefit Bank Adult High-Fidelity Simulator, called a “sim-man,” which will be the second such simulator for the UAFS College of Health Sciences.

Bank officials cited a nursing faculty shortage, a shortage of nurses in Arkansas and UAFS nursing laboratory needs in making the gift to UAFS.

Rod Coleman, chair of the Benefit Bank Board of Directors, said the bank plans to be active partners with the College of Health Sciences.

“We congratulate UAFS on what they have done in the past and what they will do in the future to advance health care in the region,” Coleman said in a UAFS-released statement. “We prayerfully hope lives will be changed by our involvement.”

Coleman said UAFS officials have said they find it difficult to find qualified nursing professionals in the region who have the credentials to instruct in a university setting.

“The Benefit Bank Endowed Professor of Nursing will allow the University to recruit and retain faculty that they might not have been able to pursue,” said Coleman. “We are pleased to help UAFS and our community with this gift and with the gift to purchase a sim-man.”

UAFS administrators said having a second sim-man will be a plus for the University. Nursing students currently have a 10:1 ratio of students to in the current “sim man” lab. The new simulator will result in a 5-to-1 ratio.

The Benefit Bank gifts were announced at a recent meeting of the UAFS Foundation Board by Coleman and other Benefit Bank board members, including John Taylor, Rusty Jacobs, Keith Gibson, Dr. Carl Friddle, Leo Anhalt and Benefit Bank president Joe Edwards.

UAFS Chancellor Dr. Paul B. Beran said UAFS considers Benefit Bank’s gift to have major impact on the University.

“This gift will help the University increase the number of students accepted into the nursing program by 20 per year and provide the faculty necessary for the program,” Beran said. “The Benefit Bank endowed professorship will not only help us increase the number of nursing faculty, but it will help our recruiting efforts for hiring qualified nursing faculty members.”

Dr. Carolyn Mosley, dean of the College of Health Sciences, said the gift will be a step toward providing additional registered nurses into healthcare settings in Arkansas.

“Arkansas currently ranks below the national average of registered nurses per 100,000 population,” said Mosley. “Of the six surrounding states, only two have lower percentages of nurses than Arkansas. The nursing shortage is national and worldwide, therefore, Arkansas nursing programs must educate a greater number of nurses to address the state’s current shortages.”

Mosley said UAFS graduates have a 100% employment rate and have an “excellent reputation.”

The Pendergraft Health Sciences Center opened in 2004 and houses programs in nursing, dental hygiene, imaging sciences and surgical technology, as well as the Powell Student Health Clinic and the Counseling Clinic.

Source: The City Wire

By Hailey Fairchild

One of the most common stereotypes about the field of nursing is that it’s a female profession, but some students in Ohio State’s nursing program are hoping to defy that norm.

In popular films and television shows, such as “Nurse Betty,” “Pearl Harbor,” “Nurse Jackie” or “HawthoRNe,” the main role of the nurse is played by a woman.

The U.S. Department of Health and Human Services Health Resources and Services Administration found in its 2008 National Survey of the registered nurse population that of the more than 3 million licensed registered nurses living in the United States, only 6.6 percent were males.

Steven Shaw, a third-year in nursing and president of Buckeyes Assembly for Men and Nursing, believes being a nurse is a rewarding field for any individual, regardless of gender.

“Nursing is a very challenging, rewarding and highly marketable career choice,” Shaw said. “Nursing is constantly evolving and improving due to nursing research … the nurse gets to see the differences they make in their patient’s lives on a daily basis.”
And Shaw isn’t alone.

U.S. News & World Report listed registered nurse second on its 100 Best Jobs of 2013. U.S. News & World Report said the field is ranked highly because it’s rapidly expanding and nurses are in high demand.

The report said nursing has been one of the jobs that flourished despite the harsh economic times. The top-ranked job was dentistry.

Despite the growing number of people entering the nursing field and the high demand, the percentage of male nurses is still low.

“I do not understand why there is such a disparity between the number of men and women in the nursing field. It must be that a majority of males have a misconception about nursing,” Shaw said.

Jennifer Robb, coordinator for Diversity Recruitment and Retention at the College of Nursing, had similar thoughts on the subject.

“Traditionally it has been a female-dominated field. Part of my role is to increase the number of unrepresented students in nursing and often times when I contact high school counselors about it, they said, ‘OK, I will tell my girls about it.’ I just do not think the men are being exposed to it enough,” Robb said.

However, OSU has been praised for the number of male students it has in its program. In 2008, the American Assembly for Men in Nursing named OSU’s College of Nursing the Best Nursing College for Men. At the time only 10 percent of the undergraduate nursing students were male; however, that has risen to 14 percent in 2013, Robb said. The graduate program has also seen a big jump in the past five years, rising to 20 percent from 15 percent of the students being male, Robb said.

Even though percentages at OSU are greater than those nationally, the College of Nursing is still working to increase the diversity among students, especially the male population, Robb said. The College of Nursing Student Ambassadors have been reaching out to get new people to explore nursing.

“All throughout the year we do programs where students can come in and do hands-on activities and interact with some of our student ambassadors,” Robb said. “We work with elementary-age students, high school students and even college-age students.”
Andrew Bogart, a second-year in nursing, said society is becoming more accepting of having male nurses, and he feels right at home in Newton Hall, where the College of Nursing is housed.

“This year’s sophomore (class) in the College of Nursing has the largest percentage of male students in the history of the program. That’s exciting,” Bogart said. “There’s over 20 men in my class of about 160, so I don’t feel out of place atall.”

Source: The Latern                                                                                                  

CentraState Healthcare System located in Freehold, NJ is a nonprofit community health organization consisting of an acute-care hospital, an ambulatory campus, three-senior living communities, a family medicine residency program, and a charitable foundation. Over the years, CentraState has employed multiple family members from numerous families in NJ.

In this “Focus on Diversity” issue of our bimonthly eNewsletter, we are featuring 4 members of the Santos family who work at CentraState – 3 family members have worked at CentraState for over 24 years! Joe Santos is the spokesperson for the Santos family.

Pat Magrath from DiversityNursing.com recently had the opportunity to chat with Joe Santos, RN and Unit Manager at CentraState’s Manor Rehab Healthcare Center. Joe said “every day is a different day working in the Rehab Center. My patience is tested daily and I love it”.

Joe grew up in the Philippines and while living there, Joe’s father was diagnosed with cancer. Joe took care of his father. He loved taking care of him and discovered he had a passion for it. Joe was always interested in science and medicine, but medical school in the Philippines was too expensive, so he became a Mining Engineer. When Joe immigrated to the US in 1989, no one needed his mining engineer skills so he went to CentraState and applied for a job as an orderly. He was hired the next day.

Joe has worked at CentraState for 24 years. While working as an orderly, he went to school and became an LPN. CentraState encouraged him to further his education and paid his tuition fees to become an RN where he is now the Unit Manager at the Manor. Over the years, Joe has been appointed Acting Director of Nursing, not once, but twice. He was happy to help out, but he was not interested in the position on a permanent basis.

Many years ago, there was a pretty lady named Evangeline living in Joe’s apartment complex. She too grew up in the Philippines and was already an RN at CentraState. They met and soon married. Evangeline has also been at CentraState for 24 years! She worked in Orthopedics for 16 years, transferred to short-stay Surgery for 2 years and currently works at the CentraState Family Medicine Center. They have 2 daughters and are expecting their first grandchild. Perhaps like their parents, they’ll be working at CentraState too!

Joe’s brother, Teodoro started working at CentraState in 1989 -- the same year as Joe and Evangeline. His career started as a cook in the hospital and 9 years ago, he became the Senior Cook at the Manor where Joe works.

Joe’s niece, Charmaine, has worked as a Patient Care Technician in the 5 North Progressive Care Unit for 6 years.

Well there you have it… 4 members of the Santos family – Joe, Evangeline, Teodoro and Charmaine... all happily and productively working at CentraState.

I had to ask… What makes CentraState such a great place to work? Joe responded… When they all immigrated to the US, they lived close to the hospital which was much smaller at the time. The convenient location and the “one big happy family” feel at the hospital, gave the Santos family a terrific opportunity for employment. They grew in their careers among genuinely friendly and caring people.

As the years have gone by, CentraState has expanded and it still feels great to be working there with talented, caring staff and family. As Joe told me, “we live in the community, work in beautiful facilities, enjoy generous benefits, and appreciate the ability to continue to grow in our careers at CentraState where we have been supported and encouraged”.

Dolores N. Napolitano, Manager of Recruitment for CentraState Healthcare System stated “we value our employees and feel like they are our family members too. When individuals who are actually blood related family work here, it makes it even more special and unique.  CentraState is their hospital in more ways than one because they live in the community and work here as well. The Santos’ are one of many multi-generational families working at CentraState and we embrace the concept and actuality of it.  It is only a part of what we do to acknowledge and support the diverse staff we have and the community that we serve".

"We welcome you and your family to visit our website http://www.centrastate.com/Careers/Nursing-Career-Information and check out our job opportunities.”

By Alvin Tran

More than 27 million Americans will soon gain health coverage under the health law. But who will treat them all?

With such a large coverage expansion, and with an anticipated shortage of primary care physicians available to serve them, some states have or are considering allowing so-called advanced practice nurses -- those with advanced degrees -- to treat more patients. David Hebert is at the issue’s center. Hebert, a veteran health care lobbyist and former CEO of the American College of Nurse Practitioners, is the first CEO of the American Association of Nurse Practitioners (AANP) -- a new group with 42,000 members recently formed from the merger of the American College of Nurse Practitioners and the American Academy of Nurse Practitioners.

Hebert says that despite doubts from some doctor groups, nurse practitioners are honing their craft in patient care and research to position themselves to help care for this new influx of patients, and they’re doing so without sacrificing the quality of care.

KHN's Alvin Tran sat down recently with Hebert to discuss the changing role nurse practitioners may soon have, as well as some physicians' efforts to stop them.

Here are edited excerpts of that discussion:

Q. As of 2012, 18 states and the District of Columbia allow nurse practitioners to diagnose, treat patients and prescribe medications without a doctor’s involvement. What is the biggest impediment to expanding to other states? How are you planning to expand that to the other states?

Well, the problem is that there are certain states that require physicians' supervision of nurse practitioners or there may well be some kind of restrictive collaborative agreement that is imposed upon the nurse practitioner. Often times, that makes it very difficult for nurse practitioners to practice. Sometimes there may be a physician who is unwilling to supervise. Other times you may have an issue where the physician chooses to not form a collaborative agreement with nurse practitioners. So, part of the issue is that we have anticompetitive regulations in place.

There are a number of things that we want to do at the federal level. We are hopeful that legislation is going to be reintroduced this Congress that will allow nurse practitioners in Medicare to admit patients for home health care. Right now, the admission can only be done by a physician. Given the fact that we've had research indicating that it would be cost effective, we can get people out of nursing homes and hospitals quicker. It really makes good public policy sense. Particularly, if you got a situation in a rural area where the nurse practitioner and the patient is waiting for the physician to sign the order to admit into home health.

Same thing is true on hospice. We've not been able to get legislation passed that allows nurse practitioners to admit to hospice. We’re not currently permitted by statute to formaccountable care organizations on our own. That opens up a lot of possibilities for safe and effective, cost effective health care.

Q. Physicians groups, including the American Medical Association, have opposed efforts to expand the scope of practice of nurse practitioners and raised concerns of patient safety, contending that physicians' extended training makes them more qualified to handle such issues. How do you make sure that patients are protected?

There have been studies over the years that shows that our outcomes are the same or better than primary care physicians. The fact is that it’s a total red herring. Nurse practitioners have been practicing safely and providing great outcomes for decades.

Q. Medicare’s reimbursement rate for NPs is 85 percent of the physician rate for the same services. Should these rates be the same for both providers?

One hopes that, when all is said and done, whether they're working with a physician or billing on their own, it should be 100 percent of what a doctor is paid because the fact is, they're providing the same services that a physician is providing. Quite frankly, it doesn't make any sense.

Q. What role do you think NPs will have once the federal health law takes effect in 2014?

I think that once you have a full implementation of the expanded Medicaid provisions of the ACA, you’re going to see increased demand for primary care. Unless there’s someone there to provide that care, the intent of the ACA will not be fulfilled. You’re going to see a lot of patients who may be insured or have coverage under Medicare and Medicaid, but may not be able to get services.

I think the major challenges will be to look at regulations that artificially restrict a nurse practitioner’s ability to practice within their scope. If patients want to choose a nurse practitioner, they should be free to do so.

Q. Your tenure as CEO began last month, what’s at the very top of your 'to-do list'?

We are looking at rebranding and a more enhanced public relations campaign. We're looking at increasing membership. Right now we’re about 42,000 members and there are 155,000 nurse practitioners in this country. So, we have room for growth. We’re going to be spending some time ramping up our association activities.

Source: Kaiser Health News

By Brian Womack - for Bloomberg

Facebook Inc., operator of the world’s largest social-networking service, is seeking a global head of diversity, as the quickly expanding company’s recruits people from different backgrounds to foster creativity.

The position includes responsibilities around employee recruitment, development and retention, the company said on its website. The diversity chief will build and manage a team focused on diversity, according to the posting.

Facebook, grappling with large rivals such as Google Inc. is ramping up hiring, growing 44 percent to 4,619 employees in the fourth quarter from a year earlier. Chief Executive Officer Mark Zuckerberg said last month the company plans to “continue to grow our headcount quickly in 2013.”

“We’re a fast-growing company, and this role will help us formalize processes that ensure we scale our diversity at the same rate,” Slater Tow, a spokesman for Facebook, said in an e- mailed statement. “In the past, our diversity and inclusion efforts were decentralized amongst many employees and, given our stage of growth, we are consolidating our work and people into one team.”

Among Facebook’s efforts is a new search service the company began to roll out last month. The company is also bolstering its mobile offerings, including an upgrade to its application for smartphones based on Google’s Android software.

While Facebook’s staff is growing quickly, it’s still much smaller than some of its rivals. Google, for example, has more than 10 times as many people.

The diversity position will be based at Facebook’s headquarters in Menlo Park, California.

“We’ve always focused on recruiting the very best and brightest,” Tow said. “We are big believers that creativity happens with people who have different perspectives and background.”