DiversityNursing Blog

Growing up, Adriana Perez experienced the kinds of challenges that are at the core of the immigrant experience in America. She learned English as a second language, attended underperforming public schools in a small town, and struggled to pay for college because her parents—who were farmworkers—couldn’t afford to send her.

Through it all, Perez focused on the gifts she received during her upbringing: love and support from her family, guidance from her teachers and mentors, a strong work ethic derived from a culture that values hard work, and a personal drive to make a difference in her community.

When she reached adulthood, she made an unusual choice—at least for her demographic group: She became a nurse. Now an assistant professor of nursing at Arizona State University, Perez, PhD, ANP, is a member of the most underrepresented racial or ethnic group in nursing.

In 2013, Latinos comprised 3 percent of the nation’s nursing workforce, according to a survey by the National Council of State Boards of Nursing and the National Forum of State Workforce Centers, and 17 percent of the nation’s population, according to a U.S. Census Bureau fact sheet. And their numbers are growing: By 2060, Latinos are projected to comprise nearly one-third of the U.S. population. But their growth in nursing has been slow, Perez said.

Recruiting more Latino nurses is about more than parity in the nursing workforce; it’s about improving health and health care for Latinos, who have disproportionately high rates of HIV transmission, teen pregnancy, and chronic conditions like obesity and diabetes, according to data compiled by the Centers for Disease Control and Prevention. Latinos also are less likely to have health care coverage than other racial or ethnic groups.

More Latino nurses can help narrow disparities, experts say, because they are more likely to be able to provide culturally and linguistically appropriate care to Latino patients. “Having a culturally competent nurse really makes a difference in terms of compliance and patient outcomes,” said Elias Provencio-Vasquez, PhD, RN, FAAN, FAANP, dean of the nursing school at the University of Texas at El Paso and an alumnus of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program (2009-2012). “Patients really respond when they have a provider who understands their culture.”

The Institute of Medicine (IOM)—the esteemed arm of the National Academy of Sciences that advises the nation’s leading decision-makers on matters relating to health and medicine—agrees. In 2004, it published a report calling for a more diverse health care workforce to improve quality and access to care and to narrow racial and ethnic health disparities. And in 2010, the IOM released a report that included calls for greater diversity within the nursing profession in particular.

Latinos Aren’t Flocking to Nursing

Yet despite their growing numbers, Latinos are not flocking en masse to the nursing profession.

That’s in large part because of inequity in education, said Dan Suarez, BSN, MA, president of the National Association of Hispanic Nurses. “Many Latinos come from poor educational systems, and few concentrate on the kinds of science and math courses that are needed to enter nursing school. Latinos have the highest high school drop-out rate in the nation, and many students are just focused on staying in school and making it to graduation.”

Meanwhile, there are relatively few Latino nurse leaders and educators who can serve as role models, coaches and mentors to the next generation of nurses, Perez said. “When young people aren’t able to see themselves in those roles, it’s hard to imagine that they could be in that role.”

Language and culture also play a role. Latino parents often discourage Latino youth—and especially boys—from pursuing nursing because it is regarded as a low-status, low-pay service job in Mexico and parts of Latino America, Suarez said. “Parents tell their children they can do better than nursing ... Nursing has an image problem, and we’re trying to change that.”

The culture’s emphasis on traditional gender roles also discourages Latina wives and mothers from working outside the home and, if they do, from pursuing leadership positions, said Mary Lou de Leon Siantz, PhD, RN, FAAN, a professor at the Betty Irene Moore School of Nursing at UC Davis and an RWJF Executive Nurse Fellows program alumna (2004-2007). “The majority of Latina nurses go into associate degree programs and don’t see the need to go back for more education.”

Racism against Latinos, she added, is “full-blown,” especially amid the national debate over immigration. Academics and others retain unconscious biases against Latinos and members of other groups that are underrepresented in nursing.

RWJF is committed to increasing diversity in nursing through programs such as New Careers in Nursing, which works to increase the diversity of nursing professionals to help alleviate the nursing shortage, and the RWJF Nursing and Health Policy Collaborative at the University of New Mexico, which prepares nurses, especially those from underserved populations in the Southwest, to become distinguished leaders in health policy. The Future of Nursing: Campaign for Action, a joint initiative of RWJF and AARP, is working to diversify the nursing workforce, with help from Perez and others. The National Association of Hispanic Nurses, meanwhile, offers scholarships to Latino nursing students.

But more needs to be done, Siantz and others said. Educational bridge programs to help students transition into nursing school are needed, as are interventions to dispel negative stereotypes about nursing among Latinos and increased mentorship for aspiring nurses and nursing students.  “Latino nurses often talk about the influence of a family member, or a role model, or a mentor who told them to be a nurse,” said Perez, whose grandmother, a nurse in Mexico, encouraged her to pursue nursing in the United States. “We need to do more of that kind of outreach.”

Source: http://www.rwjf.org

New learning institute builds on past success to diversify the dental profession

By Janet Edwards

At the age of 13, Esther Lopez, DDS, knew intimately her mother’s battle with cancer because she served as the primary translator between the patient, a native of Ecuador, and her doctors. Even at such a young age, Lopez vowed the excruciating experience would influence her life’s work. She didn’t know the term “public health” then, but that’s where she would later find fulfillment, through dentistry. In part, Lopez credits the now defunct, but still influential, Dental Pipeline program for helping her achieve that dream. A new project, the Dental Pipeline National Learning Institute, builds on the program that brought Lopez into dentistry.

Esther Lopez is a dentist in Oak Park, Ill. Through both private practice and volunteer public health efforts, she works with low-income and minority populations, groups that typically find dental services inaccessible, complex, and unwelcoming. In large part, Lopez credits a now-defunct minority recruitment program, the Dental Pipeline, for the opportunity to do such work, a longtime ambition that often seemed out of reach.

Lopez is one of a small number of minority dentists in the country—only 9 percent of practicing dentists are African American, Hispanic, or American Indian. While these underrepresented groups comprise nearly 30 percent of the general population, they account for just 13 percent of first-year dental students. Dental schools and their community partners seek to close that gap through a new program that adopts lessons learned from the Dental Pipeline.

Dental Pipeline National Learning Institute
The original Dental Pipeline launched with funding from The Robert Wood Johnson Foundation (RWJF) and The California Endowment. In all, 23 (out of 62) U.S. dental schools were involved in the decade-long program, which ended in 2011. Widely credited with transforming dental education, the Dental Pipeline resulted in better access to care for underserved populations, along with more student exposure to community-based services and higher enrollment among minority students.

A new program launched in fall 2012, the Dental Pipeline National Learning Institute (NLI), is intended to build on that success. Project partners are the American Dental Education Association and the University of the Pacific Arthur A. Dugoni School of Dentistry, in San Francisco, Calif. Support comes from an initial 18-month, $650,000 grant funded by RWJF.

Eleven schools were tapped as NLI participants. Each institution receives $12,000 to cover the cost of building a recruitment project or community-based education component. The program includes a three-day training course covering best practices, advocacy and leadership, and various mentoring opportunities.  

Paul Glassman, DDS, professor and director of Community Oral Health at University of the Pacific, is project director. The primary goal is to expose other dental schools to methodologies developed as part of the Dental Pipeline “so they wouldn’t be reinventing the wheel,” he says.   

Evidence of the Dental Pipeline’s success is found in the numbers, Glassman says. “Schools involved in the Pipeline managed to dramatically increase—double, triple, even quadruple—the number of underrepresented minority students entering their schools. [Enrollments of] other dental schools not involved in the program stayed static,” he says. 

The NLI is a one-year program. Participants are dental school faculty members who collaborate with a partner from a local organization, such as a minority-focused college or community health center. “We want some significant community partner involved because we’re really trying to emphasize the fact that in this very complex world that we live in, dental schools really can’t break through these barriers by themselves. The way to make progress in our current world is through partnerships and establishing networks,” Glassman says.  

Like its predecessor, the NLI is also designed to develop future leaders in the push to provide more diverse dental care in community-based health settings, Glassman says. Barriers to health care for low-income and minority individuals, which result in less dental care and more dental disease, are well documented, he adds.  

“Minority populations tend to have more dental disease than more affluent populations and majority populations. They tend to have more barriers to access to care, so they get care less regularly,” he says. Paying for dental care is a serious obstacle, along with language and cultural challenges. “They feel uncomfortable going into a dental office because they feel someone isn’t going to understand them,” he says.  

“We’re expecting people who go through this program to become future leaders in this area, so within their own school and their community, and maybe even regionally, they’re going to be someone steeped in this whole idea of the dental profession doing a better job of improving the health of underserved populations and keep the momentum going,” he says.

The Minority Enrollment Challenge  

While the Dental Pipeline made positive inroads toward recruiting minority dental students, the NLI is designed to keep the momentum going, says Kim D’Abreu, senior vice president for access, diversity, and inclusion for the ADEA.   

The effort continues to face several high priority challenges. A large pool of minority students who could succeed in dental school remains untapped, D’Abreu says, including 12,500 students of color who graduate with majors in the biological sciences each year. “A 2003 focus group study published in the Journal of Dental Education found that early and frequent exposure to dentistry and dentists in practice is essential for minority students to consider the profession. Dental schools need additional tools and strategies to attract a talented group of underrepresented minority students,” she says. 

The process by which dental schools evaluate student candidates is undergoing review, Glassman says.        

“Traditionally, admission is based on grade point average, extracurricular activities, and other sorts of measures that aren’t necessarily the measures that students from minorities have excelled in … because they were working while they were in school and facing other social challenges in their lives,” he says. While it makes it harder for them to get through the admission process, it doesn’t necessarily mean they are less qualified or passionate about a career in dentistry, he says. Schools are now adopting a whole file review approach, one less focused on the numbers, Glassman says.  

The whole file review, which takes into consideration a host of cognitive and non-cognitive variables, has already proven to be effective and is just one of other successful admissions strategies shared with NLI institutional participants, D’Abreu says.

Engaging Students in Community Health
Along with recruitment of minority students, another goal of the Dental Pipeline was to get students to spend more of their clinical time in community health settings, a mission that continues under the NLI program.  

“(In the Dental Pipeline) we increased the number of days from three to four to up to 50 days for senior dental students as part of the education program,” Glassman says. “The hope is that in doing so, these students become more comfortable with community sites, they understand more about that kind of delivery mechanism, become more comfortable with diverse populations, and are better able to serve those populations in the future.”  

Esther Lopez knows too well the importance of that exposure. Her father, a Cuban-born immigrant, abandoned the family of three children, including a brother and sister, following the death of her mother. But in the midst of her undergraduate work in biology at DePaul University—coursework Lopez had hoped would lead to medical school—her father returned, homeless and afflicted with health issues that eventually led to two strokes. He had no job and no insurance. Between studies, Lopez pleaded with pharmaceutical companies for free medicine, and again served as a translator with various health agencies and doctors. 

“We were able to get some assistance,” Lopez says. “Things were going as well as they could have, considering the fact that we didn’t have health insurance. I really wanted to stay in school so I tried as best I could to find resources to help us along the way.”  

By the time her father died in 2000, Lopez, exhausted, had given up on medical school, but she was more determined than ever to help resolve the challenges facing low-income and minority individuals seeking medical care. She completed her bachelor’s degree, and then enrolled in the master’s program in public health at the University of Illinois at Chicago (UIC). With her coursework finished, Lopez continues to work on her thesis.  

While attending UIC, she joined a research project involving people with periodontal disease and diabetes.   

“We were trying to determine what needs existed for people that had diabetes, and if they even knew there was a corollary between that and periodontal disease, specifically in the Latino community. I got engaged, really excited, and decided dentistry intrigued me,” Lopez says. 

With the help of the Dental Pipeline, she enrolled in UIC’s College of Dentistry. “Dental school is really, 
really expensive. The fact that we have programs like the Dental Pipeline for people like me is just amazing,” she says. Lopez received some tuition reimbursement from the program and worked as a research assistant in exchange for remaining tuition waivers.  

While in dental school, she joined a group of fellow students in establishing the first student-run dental clinic in the United States.   

Located on the north side of Chicago, the clinic still operates in Goldie’s Place, which serves as a place for homeless adults to get back on their feet. In 1997, a single dentist began providing services. In 2008, Lopez and others created the student component.  

“Goldie’s Place helps dental students become part of the change, which is what I really wanted to do,” says Lopez, who served for a time as clinic director after graduating 
from dental school.  

As a student, she often spoke with colleagues about the challenges of health care in low-income communities. “A lot of times someone who comes from privilege has blinders to different barriers that exist. I think it’s more impactful when you’re hearing from a colleague about things that make it hard for you to succeed,” she says.   

No matter a person’s race, ethnicity, or income level, dental needs will always be the same: a cavity is always a cavity, an extraction is an extraction, Lopez says. “But the way they perceive disease is always different,” she says, a concept that young dental students initially struggle with at Goldie’s Place. “It’s hard for them to understand, but it’s true. When you come from an underprivileged background, it’s not that you’re neglecting yourself; it’s just that it’s more important to feed your child. Or pay your rent.”  

Communicating correct information in a way that is easy for clients to understand is imperative, Lopez says. “It’s important to service them understanding their cultural needs.”  

Today, many of her classmates continue to work with grassroots organizations. One student has written a manual on how to establish a student-run dental clinic based on the Goldie’s Place model. “They’re addressing dental health issues not one person at a time, but communities at a time,” Lopez says. Other community-based health organizations in Chicago are beginning to incorporate the model for student clinicians, she says.  

“I’m proud of the fact that … I was able to do something like participate in the Goldie’s Place dental clinic. There are so many great things going on there. Every time I hear of some success on their part it makes me happy. If it weren’t for the Dental Pipeline I wouldn’t have been able to do that. It’s meant a lot, not just for me, but for community members that really needed it.”  

Lopez continues to volunteer at Goldie’s Place, and as part of a Chicago Community Oral Health Forum project to assess the dental health needs of adults and children. The Dental Pipeline gave Lopez the opportunity to both share her hard-won knowledge in the realm of public health and to establish a meaningful career addressing the issues, she says.  

“I’m really excited that programs like this exist because they give students like me a chance to fulfill their dreams,” Lopez says. “It really does make me feel a sense of responsibility, because there was an organization that backed me, to really give back to the community in a significant way.”

Source: Insight Into Diversity 

Is something similar to the Dental Pipeline National Learning Institute happening in your area to increase the number of minorities that go in to the Nursing profession as well as offer Nursing access to undeserved populations? Comment below!

From diversityinc.com

In the fall of 2005, Alister Martin seemed the most unlikely candidate for Harvard Medical School. Laid up in the hospital with “my face so swollen my mother didn’t recognize me,” he says, the high-school senior was recovering from a brutal gang attack. The situation had escalated to a point that law enforcement advised Martin’s mother, a Haitian immigrant, to pull her son from Neptune (N.J.) High School to avoid further trouble.

So Martin’s mom secured a $15,000 loan and sent her son to the private Bollettieri Tennis Academy in Florida, where he completed his GED online while practicing 16 hours a day. Martin’s drive and unwavering desire to become a physician pointed him to Rutgers University’s Office for Diversity and Academic Success in the Sciences (ODASIS), whose Access-Med program prepares promising Black, Latino and other undergrads from underrepresented and economically disadvantaged groups for careers in medicine.

Four years later, Martin graduated from Rutgers with a 3.85 GPA and will begin Harvard Medical School this fall. “A miracle happened,” says Martin.

Each year, ODASIS serves roughly 500 at-risk undergrads, and nearly 800 of them have graduated since the program’s founding in 1985. Among the ODASIS class of 2009, 86 percent were accepted to medical school, up from 70 percent in 2007.

Still, Black, Latino and American Indian med students are rare. Three years ago, more than 40,000 people applied to medical school in the United States, with Blacks, Latinos and American Indians making up only about 15 percent of the applicant pool, reports the Association of American Medical Colleges (AAMC), while comprising about one-third of the population. That same year, only 8.7 percent of doctors were from these underrepresented groups, according to a study published in the Journal of Academic Medicine.

The latest AAMC data shows only slight improvement: Among the 42,269 med-school applicants in 2009, only 16 percent were Black, Latino or American Indian. And this disparity extends beyond the potential physician pool—a mere 6.9 percent of people from underrepresented groups ended up as dentists in 2007, only 9.9 percent were pharmacists and just 6.2 percent were registered nurses.

But it’s critical that people from underrepresented groups be recruited into healthcare and other science, technology, engineering and math (STEM) fields because it will increase the quality of care for those groups and spur innovation. Black, Latino and American Indian/Pacific Islander physicians are nearly three to four times more likely than whites to practice in underserved communities, reports the AAMC.

The dearth of diversity in all STEM professions is what inspired the launch of ODASIS. In 1986, when the initiative first began, only one Black student from Rutgers was accepted to medical school, and he eventually became a radiologist.

STEM-Enrichment Success

ODASIS is a rigorous program that offers four years of step-by-step supplemental instruction, academic enrichment and career advice designed to increase the pipeline of underrepresented talent in all STEM fields. The program is managed by Trinidad native Dr. Kamal Khan, a tireless instructor and caring mentor. He ensures that a four-year academic plan is developed for each incoming freshman so he/she stays on track and pursues the appropriate opportunities.

As a result, these students, often the first in their families to attend college, gain self-confidence. Before ODASIS, says Martin, “I never really believed in myself.”

Academic customization and an integrated-learning approach have helped make ODASIS a success. As part of the Access-Med program, for example, Khan formed collaborative relationships with local healthcare institutions to provide students with research training, professional learning and hands-on experience. Most unique to this pipeline program is the seven-month MCAT (Medical College Admission Test)/DAT (Dental Admission Test) prep course.

Khan often starts working with students who have been identified as having an interest in the sciences the summer prior to their first semester at Rutgers. To facilitate the transition for these incoming freshmen, Khan developed a five-week summer prep program to expose students to basic math and chemistry that allows them to earn college credits toward their degree. This summer, with financial support from Merck & Co., Khan and his team are working with 25 students to help hone their basic math skills “so they can hit the ground running” when they enter college.

“Students were coming in not prepared to take science courses,” he says. “They didn’t have the basic college math to take a college science course. So [we'd have] to support them in the basics. And then by the time they finished the basics, they were in their second year and would say, ‘I don’t want to take the sciences. I’m going to be here forever.’”

But thanks to the support of local organizations, the Educational Opportunity Fund Central Office and Johnson & Johnson, Khan is creating a feeder pool of potential ODASIS students by working with local students as early as ninth grade. The goal: to provide laboratory exposure, SAT-prep instruction, college-admissions counseling and career advice. This year, more than 300 12th-grade students attended the ODASIS Saturday Scholars Academy, one of four separate college-prep programs Khan oversees.

“We also do workshops with parents,” he says. “We get parents very involved.”

What motivates ODASIS students to succeed? Setting high standards and being held accountable for their actions, says Khan. “If you walk into class late or you miss a session and get three red flags, you’re out of the program,” he says. “Why so strict? If you want to be a doctor and you miss the operation, someone dies. So we try to teach them to become mature at a young age.”

In addition to their regular coursework, ODASIS students are required to attend roundtable-style academic support sessions, study halls (up to 9 hours a week for freshmen), testing, motivational workshops and more. They also meet one-on-one with advisers twice a month to review their progress.

“If you’re not doing well, they will call your family,” warns Mekeme Utuk, an ODASIS graduate who just completed her first semester at Harvard Medical School.

In exchange, the students, who often come from economically disadvantaged backgrounds, appreciate the support and opportunity. “All that I could take tutoring for, I took. I thought, ‘Why not? It can’t hurt; it’s just extra practice,’” recalls Utuk, whose parents are Nigerian immigrants.

The program also teaches undergrads how to study, critical for challenging courses such as organic chemistry. “I really didn’t know how to study. In high school, I would just cram for exams. But I didn’t know how to break down a chapter and take good notes … and learn through repetition,” says Utuk. “ODASIS made me a better thinker.”

From http://www.diversityinc.com

Federal healthcare law changes dramatically impact how the  industry—hospitals, health-insurance companies and pharmas—do business today. University Hospitals in Cleveland has been aggressively reaching out to the newly insured, predominantly Blacks and Latinos. University Hospital’s Case Medical Center’s Rainbow Babies & Children’s Hospital, known asUH Rainbow, is receiving a $12.8-million grant to implement a Physician Extension Team, which works to improve the healthcare of about 68,000 children on Medicaid with high rates of emergency-room visits.

Dr. Drew Hertz, medical director for UH Rainbow Care Network and an assistant clinical professor at Case Western Reserve University School of Medicine, was a guest speaker at DiversityInc’s Innovation Fest! event where he explained how this innovative program will provide 24/7 access to nurses and doctors for referrals, advice and healthcare coordination. University Hospitals is one of the 2012 DiversityInc Top 5 Hospital Systems. View the video below.