DiversityNursing Blog

By Shantelle Coe RN BSN - Diversity and Inclusion Consultant

Creating an environment that embraces diversity and equality not only attracts the most qualified nursing candidates, but an inclusive environment also helps to assure that the standards of nursing care include “cultural competency.”  Cultural differences can affect patient assessment, teaching and patient outcomes, as well as overall patient compliance.

Lack of cultural competence is oftentimes a barrier to effective communication amongst interdisciplinary teams, which can often trickle down to patients and their families.

With the increase in global mobility of people, the patient population has become more ethnically diverse, while the nursing forces remain virtually unchanged.  Nursing staff work with patients from different cultural backgrounds.  Consequently, one of the challenges facing nurses is the provision of care to culturally diverse patients.  Hospitals and healthcare agencies must accommodate these needs by initiating diversity management and leadership practices.

According to Cross, T., Bazron, B., Dennis, K., and Isaacs, M. (1989); these are the 5 essential elements that contribute to an institutions ability to become more culturally competent:

• Valuing diversity

• Having the capacity for cultural self-assessment.

• Being conscious of the dynamics inherent when cultures interact.

• Having institutionalized cultural knowledge.

• Having developed adaptations of service delivery reflecting an understanding of  cultural diversity. 

A culturally competent organization incorporates these elements in the structures, policies and services it provides, and should be a part of its overall vision.

From all levels, the nursing workforce should reflect the diversity of the population that it serves.  A more diverse workforce will push for better care of underserved groups.  It’s important to note that that diversity, inclusion, and cultural awareness isn't just about race or ethnicity.  We must always keep in mind socioeconomic status, gender, and disability in our awareness.

Becoming more inclusive is a shared responsibility between nurses and healthcare agencies.  Becoming an “agent of change” within your facility can inspire awareness and affect attitudes and perceptions amongst your peers. 

Nurses and healthcare workers must not rely fully on the hospital and healthcare systems to institute an environment of cultural awareness.   

Nurses can increase their own cultural competencies by following a few guidelines:                                   

• Recognizing cultural differences and the diversity in our population.

• Building your own self-awareness and examining your own belief systems.

• Describing and making assessments based on facts and direct observation.

• Soliciting the advice of team members with experience in diverse backgrounds.

• Sharing your experiences honestly with other team members or staff to keep communication lines open.  Acknowledging any discomfort, hesitation, or concern.

• Practicing politically correct communication at all times –  avoid making assumptions or stereotypical remarks.

• Creating a universal rule to give your time and attention when communicating.

• Refraining from making a judgment based on a personal experience or limited interaction.

• Signing up for diversity and inclusions seminars.

• Becoming involved in your agencies diversity programs – find out what your resources are - most institutions have something in place.

By incorporating a few of these steps into your daily nursing practice, you are taking steps towards becoming culturally competent.

Inclusive nurses demonstrate that we are not only clinically proficient and culturally competent, but are the essence and spirit of the patients that we care for.

By Christina Orlovsky, senior writer, and Karen Siroky, RN, MSN, contributor

As the nation’s population becomes more diverse, so do the needs of the patient population that enters U.S. hospitals. As caregivers with direct contact with patients from a wide spectrum of races, ethnicities and religions, nurses need to be aware and respectful of the varying needs and beliefs of all of their patients.

In its position statement on cultural diversity in nursing practice, the American Nurses Association (ANA) states that: “Knowledge of cultural diversity is vital at all levels of nursing practice…nurses need to understand: how cultural groups understand life processes; how cultural groups define health and illness; what cultural groups do to maintain wellness; what cultural groups believe to be the causes of illness; how healers cure and care for members of cultural groups; and how the cultural background of the nurse influences the way in which care is delivered.”

Additionally, the Joint Commission requires that all patients have the right to care that is sensitive to, respectful of and responsive to their cultural and religious/spiritual beliefs and values. Assessment of patients includes cultural and religious practices in order to provide appropriate care to meet their special needs and to assist in determining their response to illness, treatment and participation in their health care.

There are a number of ways to comply with the requirements for providing culturally diverse care.

First, be self-aware; know how your views and behavior is affected by culture. Appreciate the dynamics of cultural differences to anticipate and respond to miscommunications. Seek understanding of your patients cultural and religious beliefs and values systems. Determine their degree of compliance with their religion/culture, and do not assume.

Furthermore, respond to patients’ special needs, which may include food preferences, visitors, gender of health care workers, medical care preferences, rituals, gender roles, eye contact and communication style, authority and decision making, alternative therapies, prayer practices and beliefs about organ or tissue donation.

Kathleen Hanson, Ph.D., MN, associate professor and interim executive associate dean for academic affairs at the University of Iowa, summarized the importance of learning cultural diversity in nursing education.

“Cultural competency is threaded throughout the nursing school curriculum. We teach every course with the idea that there’s content that may need to be explained for a diverse student group,” Hanson said. “In nursing, cultural competency has been around for a long time. I think that’s probably something that the nursing profession recognized maybe a bit before some other disciplines. We’ve always worked in public health, so we have always seen the diversity of America.”

Hanson concluded: “We need to be able to care for diverse populations because our country is growing increasingly diverse. Oftentimes persons who are in minority groups or who are underrepresented have different health care needs. It’s important for us to have a student population that is as equally diverse as our client; we need to prepare a workforce that not only knows how to work with diverse peoples, but also represents them.”

by Lynda Lampert

If you have an iPhone, iPad or other mobile device, you likely have a ton of apps taking up space. While some of those apps are likely tailored for fun (Angry Birds, Words with Friends), there’s no question that you can use your smartphone to serve your nursing career.

Of course, when you’re in your scrubs and ready to tackle the shift, using mobile apps to get information on drugs to anatomy to conditions is a no-brainer way to better treat your patients and keep reference materials easily accessible. Here’s a look at 20 top clinical apps for nurses in 2012!

Not all of these apps are free, but when you think about the great services they provide—such as keeping you on top of ever-changing medical data—it’s well worth the money.

This table shows the number of students enrolled in generic (entry-level) Baccalaureate, Master's, and Doctoral (research-focused) programs in nursing from 2002 to 2011.

Credit

By: Robert Rosseter

Nursing’s leaders recognize a strong connection between a culturally diverse nursing workforce and the ability to provide quality, culturally competent patient care.  Though nursing has made great strides in recruiting and graduating nurses that mirror the patient population, more must be done before adequate representation becomes a reality. The need to attract students from under-represented groups in nursing – specifically men and individuals from African American, Hispanic, Asian, American Indian, and Alaskan native backgrounds – is gaining in importance given the Bureau of Labor Statistics’ projected need for more than a million new and replacement registered nurses by 2016.

Diversity in the Nursing Workforce & Student Populations

• According to the U.S. Census Bureau, the nation's minority population totaled 102.5 million or 34% of the U.S. population in 2007.  With projections pointing to even greater levels of diversity in the coming years, nurses must demonstrate a sensitivity to and understanding of a variety of cultures in order to provide high quality care across settings.  

• According to data from the 2008 National Sample Survey of Registered Nurses (NSSRN), nurses from minority backgrounds represented 16.8% of the registered nurse (RN) workforce. Considering racial/ethnic backgrounds, the RN population is comprised of 5.4% African American; 3.6% Hispanic; 5.8% Asian/Native Hawaiian; 0.3% American Indian/Alaskan Native; and 1.7% multi-racial nurses. 

• Though men only comprise 6.2% of the nation’s nursing workforce, this percentage has climbed steadily since the NSSRN was first conducted in 1980. The number of men in nursing has increased from 45,060 nurses in 1980 to 189,916 nurses in 2008. http://bhpr.hrsa.gov/healthworkforce/rnsurvey04

• According to the National Sample Survey, RNs from minority backgrounds are more likely than their white counterparts to pursue baccalaureate and higher degrees in nursing.  Data show that while 48.4% of white nurses complete nursing degrees beyond the associate degree level, the number is significantly higher or equivalent for minority nurses, including African American (52.5%), Hispanic (51.5%), and Asian (75.6%) nurses. RNs from minority backgrounds clearly recognize the need to pursue higher levels of nursing education beyond the entry-level.

• According to AACN's report on 2010-2011 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, nursing students from minority backgrounds represented 26.8% of students in entry-level baccalaureate programs, 26.1% of master’s students, and 23.3% of students in research-focused doctoral programs. In terms of gender breakdown, men comprised 11.4% of students in baccalaureate programs, 9.5% of master’s students, 7.5% of research-focused doctoral students, and 9.0% of practice-focused doctoral students. Though nursing schools have made strides in recruiting and graduating nurses that reflect the patient population, more must be done before equal representation is realized. 
  
• The need to attract diverse nursing students is paralleled by the need to recruit more faculty from minority populations.  Few nurses from racial/ethnic minority groups with advanced nursing degrees pursue faculty careers. According to 2010 data from AACN member schools, only 12.6% of full-time nursing school faculty come from minority backgrounds, and only 6.2% are male. www.aacn.nche.edu/IDS

Recognizing the Need to Enhance Diversity

• All national nursing organizations, the federal Division of Nursing, hospital associations, nursing philanthropies, and other stakeholders within the health care community agree that recruitment of underrepresented groups into nursing is a priority for the nursing profession in the U.S.   

• Nursing shortage reports, including those produced by the American Hospital Association, the Robert Wood Johnson Foundation (RWJF), the Joint Commission, and the Association of Academic Health Centers, point to minority student recruitment as a necessary step to addressing the nursing shortage. media-relations/fact-sheets/nursing-shortage

• Besides adding new clinicians to the RN workforce, a diverse nursing workforce will be better equipped to serve a diverse patient population.  According to an April 2000 report prepared by the National Advisory Council on Nurse Education and Practice, a culturally diverse nursing workforce is essential to meeting the health care needs of the nation and reducing the health disparities that exist among minority populations. http://bhpr.hrsa.gov/nursing/nacnep/reports/first/5.htm

• A report released by the Sullivan Commission on Diversity in the Healthcare Workforce in September 2004 stated: “The fact that the nation’s health professions have not kept pace with changing demographics may be an even greater cause of disparities in health access and outcomes than the persistent lack of health insurance for tens of millions of Americans. Today’s physicians, nurses, and dentists have too little resemblance to the diverse populations they serve, leaving many Americans feeling excluded by a system that seems distant and uncaring.” Download the entire report, titled Missing Persons: Minorities in the Health Professions.

Strategies to Enhance Diversity in Nursing Education

A lack of minority nurse educators may send a signal to potential students that nursing does not value diversity or offer career ladder opportunities to advance through the profession.  Students looking for academic role models to encourage and enrich their learning may be frustrated in their attempts to find mentors and a community of support. Academic leaders are working to address this need by working to identify minority faculty recruitment strategies, encouraging minority leadership development, and advocating for programs that remove barriers to faculty careers.

AACN, in collaboration with leading foundations and stakeholders, has taken the following steps to enhance diversity in nursing education:

• In January 2010, AACN published a new set of competencies and an online faculty tool kit at the culmination of a national initiative funded by The California Endowment titled Preparing a Culturally Competent Master’s and Doctorally-Prepared Nursing Workforce. Working with an expert advisory group, AACN identified a set of expectations for nurses completing graduate programs and created faculty resources needed to develop nursing expertise in cultural competency. This work complemented a similar project for undergraduate programs which resulted in the publication of the document Cultural Competency in Baccalaureate Nursing Education and the posting of an online toolkit for faculty.

• In April 2008, the Robert Wood Johnson Foundation joined with AACN to launch the RWJF New Careers in Nursing Scholarship Program. This program is designed to alleviate the nation’s nursing shortage by dramatically expanding the pipeline of students from minority backgrounds in accelerated nursing programs. Scholarships in the amount of $10,000 each will be awarded to 1,500 entry-level nursing students over the next three years. Preference will be given to students from groups underrepresented in nursing or from a disadvantaged background.

• AACN and the California Endowment are collaborating on a three-year program to offer the Minority Nursing Faculty Scholarship Program to increase the number of nurse educators from underrepresented minority groups. This program provides financial support and mentoring to students pursuing graduate degrees who are committed to teaching in a California school of nursing after graduation. To date, 23 graduate nursing students have been selected to receive scholarship funding. 

• AACN and the Johnson & Johnson Campaign for Nursing’s Future launched the Minority Nurse Faculty Scholars Program in 2007 which is modeled after the California Endowment program. In addition to $18,000 in scholarship funding, the program also features mentorship and leadership development components to assure successful completion of graduate studies and preparation for a faculty role. Ten scholars are currently receiving funding through this program.

• AACN is collaborating with a variety of national nursing organizations to advocate for more federal funding for Nursing Workforce Development Programs, including funding for Nursing Workforce Diversity Grants. This program provides funding for projects to increase nursing education opportunities for individuals from disadvantaged backgrounds, including racial and ethnic minorities underrepresented among registered nurses. In FY 2007, these grants supported the education of 32,847 nurses. 

• AACN’s Executive Director Polly Bednash serves as the representative from Nursing on the Sullivan Alliance to Transform America’s Health Professions. Composed of national leaders in health professions education, this interprofessional working group focuses on advancing strategies to increase the number of healthcare providers from minority populations. The Sullivan Alliance’s latest initiative focuses on establishing statewide collaborative groups to coordinate efforts to enhance diversity in the health professions. 

Here is a chart let you know the largest number of healthcare professions which is 2.6 million registered nurses in USA also show how much they earn in different levels.
Nurses have always played a first-rate role in people’s lives. They perform a wide range of clinical and non-clinical functions that are necessary in the delivery of health care
Certified Registered Nurse Anesthetist salary around $135,000
Nurse Researcher salary around $95,000
Psychiatric Nurse Practitioner salary around $95,000
Nurse Practitioner salary around $78,000
Clinical Nurse Specialist salary around $76,000
Gerontological Nurse Practitioner salary around $75,000

By: Tanya M. Odom, Ed.M.

Diversity and inclusion is an evolving field. As a learner and practitioner, I work to embrace the expanding definitions while respecting the importance of the historic diversity topics of race and gender.

How we approach conversations about difference can determine how we embrace new definitions of identity, and the “agility” needed to learn, grow, and support all people in organizations.

Multiracial people are one of the fastest growing groups in the United States. As Andrea Williams mentioned in her article about multiracial students in the April/May 2012 issue of INSIGHT Into Diversity, “the 2010 Census marked the second time in the survey’s history that responders were allowed to check more than one box regarding their race; the first was in 2000. And as a result, demographers now have access to data that allows for comprehensive comparison and charting of the mixed race population. The results are remarkable: from 2000 to 2010, the number of multiracial American children – who will soon be attending colleges and universities across the country – rose by almost 50%, to 4.2 million.

The changing demographics have inspired people to create language like “the multicultural generation” and “ethnically ambiguous,” among others. Williams’ article presents some important reflection about creating schools and universities that support multiracial students.

Not-for-profit organizations and corporations will also need to update their language, understanding, and awareness to include multiracial employees, and employees with multiracial families.

A June 2012 Fast Company article talked about the importance of “cultural agility.” They defined “cultural agility” as “the capacity to recognize, understand, and respond appropriately to various cultures, and to work within those cultures to achieve business results.” The language of “agility” is also highlighted in the Center for Creative Leadership’s recent newsletter. They talk about flexibility and agility as a key to leadership. Agility is an important part of the learning and awareness in diversity and inclusion. Multiracial identity is not new, nor is the presence of multiracial families in our organizations.

There is a global history of multiracial people. There is a substantial scholarship focusing on the role of multiracial people in our history, media, etc. What we have not seen at the same level is the inclusion of multiracial people in diversity and inclusion dialogues and programs. As a multiracial global diversity and inclusion practitioner and coach, I have learned that, as with all diversity topics, there are varying levels of awareness about what multiracial identity means to employees and to diversity and inclusion initiatives.

One of the first times that I was part of a professional “group” of multiracial individuals was while attending a Working Mother Media Women’s conference. I remember feeling the uniqueness of the experience.

Participants in workshops or present at some of my speeches would approach me and talk about their “invisible diversity,” which for some meant their multiracial identity. For others, it meant their partner, spouse, or child of a different race. Often they swapped tales of not having a place to share their diversity stories.  

The presence of multiracial individuals and families can challenge our notions and comfort around talking about race and history, race and families, and race and racism.

Multiracial individuals and families are part of the changing workforce. In the spirit of learning agility, I would suggest that organizations learn to incorporate language and programs that include multiracial individuals and families.

We can continue to be “agile” in our learning about multiracial identity by:

• Assessing data collection that does not allow for identifying as multiracial individuals and families;
• Including multiracial groups as part of the growing affinity/ERG/Networking groups within organizations;
• Allowing multiracial people to self-identify – and not identify employees based upon what we observe;
• Updating our language and communication to include multiracial identity and;
• Learning more about national groups (SWIRL, MAVIN, etc.) that address multiracial identity and families.

Our learning and growth continues as long as we remain “agile.” The inclusion of more stories, experiences, and identities makes the journey even richer.

Tanya Odom, Ed.M, is a part-time Senior Consultant with The FutureWork Institute and a member of the INSIGHT Into Diversity Editorial Board.

Published in September/October 2012 issue.

With the battle over immigration raging on and racial and ethnic minorities surpassing whites for the first time, there's no question the U.S. is getting more diverse.

A newly released study from Brown University has pinpointed just where the most diversity is taking place, scoring metro areas by how evenly each city's population is spread across the five racial groups: Non-Hispanic whites, Hispanics of any race, African-Americans, Asians and an “other” category comprised of Native Americans, Alaska Natives and people of two or more races.

According to the US2010 Project, immigrants from Latin America, Asia, and elsewhere have expanded the population of minority residents beyond African Americans, a trend that experts say will eventually lead to as many "minority" as "non-minority" residents, if it continues.

As of 2010, western, southern and coastal metropolitan areas continue to be the most diverse, with California's Vallejo-Fairfield claiming the top spot.

Without cultural diversity amongst healthcare providers, it is almost impossible to provide quality nursing care to people from different ethnic and socioeconomic backgrounds. A multicultural representation of nurses, physicians and clinicians is important to ensure the healthcare being delivered is sensitive and meets the physical and holistic needs in our “patient palette”.

In the United States, a rise in the population and increase in minorities further challenges our healthcare system to provide appropriate care to the ever changing population it serves.

Some of the major findings in a study on the changing demographics and the implications for physicians, nurses and other healthcare workers conducted by the US Department of Health and Human Resources are bulleted here:

• Minorities have different patterns of health care use compared to non-minorities. Disparities in access to care account for part of the difference in utilization.
• Demand for health care services by minorities is increasing as minorities grow as a percentage of the population. Between 2000 and 2020, the percentage of total patient care hours physicians spend with minority patients will rise from approximately 31percent to 40 percent.
• Minorities are underrepresented in the physician and nurse workforce relative to their proportion of the total population.  As minorities constitute a larger portion of the population entering the workforce, their representation in the physician and nurse professions will increase. The U.S. will increasingly rely on minority caregivers.
• Minority physicians have a greater propensity than do non-minority physicians to practice in urban communities designated as physician shortage areas. An increase in minority representation in the physician workforce could improve access to care for the population in some underserved areas.

The study also summarizes: “Advocates for increased minority representation in the health workforce argue that increasing the number of minority physicians will improve access to care for minorities and vulnerable, underserved populations. These advocates argue that increased representation of minorities in the health workforce not only will increase equity, but will also improve the efficiency of the health care delivery system”. (HRSA 2000)

Men (of all backgrounds) are also far under-represented in nursing.  Less than 1 percent of the population are male nurses.

As our nursing population lacks diversity, statistics show that the US population is becoming more diverse and will continue on through the decades.

Below are projections for the increase in diversity amongst minorities in the United States:

Source: Modified version of Census Bureau middle series projections.

As our demographics continue to change, one of our greatest challenges is getting hospital organizations along with healthcare administration to realize that, in order to provide the best care and ensure successful patient outcomes, we have to embrace diversity. This is especially challenging to nurses because they will be expected to deliver care that encompasses these differences. Many nursing task force teams and associates have been organized to address this issue of healthcare diversity, such as:

• Asian American/Pacific Islander Nurses Association, Inc. (AAPINA)
• National Alaska Native American Indian Nurses Association, Inc. (NANAINA)
• National Association of Hispanic Nurses, Inc. (NAHN)
• National Black Nurses Association, Inc. (NBNA)
• Philippine Nurses Association of America, Inc. (PNAA)

For nursing care of all cultures and backgrounds, we owe it to our profession to increase our awareness and get involved to ensure delivery of the best care possible. One of the most important steps any of us can take is to first embrace diversity.