DiversityNursing Blog

Racial concordance signifies the connection between the racial or ethnic backgrounds of patients and their healthcare providers, showcasing its profound impact on patient care, communication, trust, and overall health outcomes.

While racial concordance in Nursing offers various benefits, it's important to recognize it's not always feasible or practical to match every patient with a Nurse of the same racial or ethnic background. Emphasizing racial concordance should not overshadow the importance of Diversity, Equity, and Inclusion (DEI) within the Nursing workforce. 

Improved Communication 

This shared background fosters a sense of understanding and connection that goes beyond mere words - it's a deep-rooted familiarity with traditions, beliefs, and values that allows for seamless communication and empathy. Patients feel validated and heard when they can freely express their concerns and health needs in a language that resonates with their cultural identity. This bond of shared ethnicity or race creates a safe space for open dialogue and mutual respect, paving the way for a more holistic and personalized approach to healthcare.

Enhanced Trust 

Trust is a crucial component of the patient-provider relationship. Racial concordance can contribute to building trust between patients and Nurses, as patients may feel that their Nurse understands their unique experiences, challenges, and perspectives. This trust can lead to greater adherence to treatment plans and better health outcomes.

Cultural Competence

Nurses who share the same racial or ethnic background as their patients may possess a deeper understanding of cultural beliefs, practices, and health-seeking behaviors. This cultural competence enables Nurses to provide more personalized and culturally sensitive care, which can positively impact patient satisfaction and outcomes. Nurses of all backgrounds should receive training in cultural competence and communication skills to effectively care for patients from all backgrounds.

Reduced Health Disparities 

Racial and ethnic minorities often face disparities in healthcare access, quality, and outcomes. Racial concordance in Nursing can help mitigate these disparities by improving communication, trust, and cultural competence. Patients from marginalized communities may feel more empowered to seek care and engage in preventive health measures when they have Nurses who understand their unique needs and experiences.

Opportunity For Learning

Having a diverse workforce not only provides Nurses with the opportunity to learn from each other's unique life experiences and cultures but also fosters a rich environment for collaboration and growth. Nurses from different racial and ethnic backgrounds bring a wealth of knowledge and perspectives to the table, allowing for a dynamic exchange of ideas and practices. This diversity enriches the overall care provided to patients, as Nurses can draw upon a wide range of insights and approaches to address the needs of individuals from various backgrounds. Embracing diversity within the Nursing profession not only enhances the quality of care but also promotes a culture of inclusion and understanding that benefits both healthcare providers and patients alike.

Racial concordance in Nursing can play a significant role in improving patient care, communication, trust, and health outcomes, particularly for racial and ethnic minority populations. However, it's essential to address the broader issues of Diversity, Equity, and Inclusion within the healthcare workforce to ensure all patients receive high-quality, culturally sensitive care, regardless of the racial or ethnic background of their providers.

For the last year, health experts have pleaded for better data to shed light on disproportionate rates of COVID-19 cases, hospitalizations and deaths among communities of color.

Since the rollout of COVID-19 vaccines, health care organizations like the American Medical Association (AMA), American Nurses Association (ANA) and the American Pharmacists Association (APhA) have been asking for more race and ethnicity vaccine data.

This important data is missing for half of coronavirus vaccine recipients. According to the CDC, the data from 52,614,231 people fully vaccinated, Race/Ethnicity was available for 28,234,374 (53.7%).

This data is imperative in ensuring an equitable response to a pandemic that continues to disproportionately affect these vulnerable populations.

“Race and ethnicity data provides critical information to clinicians, health care organizations, public health agencies and policymakers, allowing them to equitably allocate resources across all communities, evaluate health outcomes and improve quality of care and delivery of public health services,” says the open letter, sent by the AMA, APhA and the ANA.

Equitable distribution of vaccines is crucial. When states collect this information, it helps officials identify large racial gaps so they can find better ways to distribute shots.

North Carolina is leading the way in data collection. The state now has racial and ethnicity data for more than 98% of vaccine recipients.

To achieve this high rate of collection, a state-mandated software system was used which requires providers to record a person’s race and ethnicity in order to register them for a vaccination.

“The data is not just a nice-to-have, it’s a need-to-have in order to embed equity into every aspect of our response and now into vaccine operations,” says Mandy Cohen, secretary of the North Carolina Department of Health and Human Services.

"Communities should be able to generate daily and certainly weekly data to understand the demographics of who is being vaccinated. Local health departments and health institutions need to respond to these data in real time to identify where COVID-19 vaccine uptake is not matching COVID-19 disease burden," said Dr. Muriel Jean-Jacques, Northwestern University Department of Medicine vice chair of diversity, equity and inclusion, and Dr. Howard C. Bauchner of the Boston University School of Medicine, a professor of pediatrics and community health.

Many barriers make it difficult to access the vaccine.

People from hard hit communities often have limited access to digital tools needed to schedule an appointment. And often information about vaccine registration is only available in English.

States that partner with community-based organizations are administering the vaccine more equitably than others, said Rita Carreón, vice president of health at UnidosUS, a civil rights organization for Hispanic communities.

The lack of race and ethnicity data in health systems didn’t begin with this pandemic. For years, health experts have been pleading for better health data to reduce racial health disparities.

Last year, Chief Diversity Officer (CDO) hires grew by 84%, making it the fastest growing C-suite title, according to LinkedIn.

There has been a national wave of concern about racial inequities, especially in healthcare, with the arrival of the COVID pandemic.

Many healthcare organizations are increasing their Diversity, Equity and Inclusion (DEI) efforts. Leaders are addressing racial health disparities and finding ways to improve patient care for all. Part of their efforts include establishing a Chief Diversity Officer role.

Winifred King is Cook Children’s first ever Chief Diversity Officer. King said, “It is hard to put into words what this decision and investment means to people of color and anyone who has ever felt different or excluded. For all of us who may have experienced inequities and mistreatment in our lifetimes, it is comforting to be a part of an organization that accepts our differences, our failures, and is willing to look inward and truly examine what is at the heart of our culture.”

“COVID-19 is amplifying health disparities in communities of color,” said Quita Highsmith, the Chief Diversity Officer of biotech company, Genentech. “It is now time for us to stop tiptoeing around it and start thinking about what we are going to do.”

Education and awareness are playing a key role in improving health outcomes for diverse communities. The CDO coordinates efforts internally to provide staff with resources and courses, such as cultural competence training as well as finding ways externally to work with the community they serve.

In addition, the CDO helps to create recruitment programs that ensures their DEI message is reaching diverse candidates. As a member of the C-suite, the CDO can communicate to all leaders that diversity recruitment, for all position levels, should be a priority.

Studies suggest diversity in healthcare leadership enhances quality of care, quality of life in the workplace, community relations, and the ability to affect community health status.

The CDO helps to define, educate, and communicate the hospital/health system’s culture and DEI message to its staff, patient population and community.

Joseph Hill, was the first Chief Diversity Officer at Jefferson Health. He requested they establish focus groups with patients to better understand their expectations and view of the system. With the information provided by the focus groups, they found the areas that needed improvements.

HCA Healthcare created the BRAVE Conversations program, an ‘outside the box’ platform designed to facilitate interactive, inclusive, innovative and safe ways for employees to share their thoughts on issues that may be difficult to discuss.

It is imperative that leadership is committed to their DEI mission. Without it, the CDO cannot wave a magic wand and transform an entire organization overnight. It takes commitment, communication both internally and externally, resources, time, and effort from all areas of the health system.

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.

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.

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

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

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

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

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

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

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

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

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

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

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

November is Diabetes Awareness Month. This is the perfect time to discuss diabetes health disparities. Racial and ethnic minorities have higher prevalence rates, worse diabetes control, and a higher rate of complications, according to an article from the U.S. National Institutes of Health's National Library of Medicine.

According to the American Diabetes Association (ADA), compared to white adults, the risk of having a diabetes diagnosis is

·         77% higher among African Americans

·         66% higher among Latinos/Hispanics

·         18% higher among Asian Americans

The article from the ADA also notes, even though there is a high rate of this condition, minorities receive lower care quality and experience more barriers to self-management than white patients. They are less likely to receive advised services such as annual hemoglobin A_1c (HbA_1c) testing, annual LDL cholesterol (LDL-C) testing, and an annual retinal examination. 

Minorities are more likely than white people to live in areas of low socioeconomic status. These neighborhoods lack shared ideas about health promotion, access to healthcare services, healthy foods, and safe places to exercise. These are all needed to improve an individual’s management of their diabetes.

The Office of Minority Health (OMH) at the Food and Drug Administration (FDA) said they are teaming up with the American Diabetes Association and other groups to help people prevent and treat diabetes, and to specifically address the disparities in minority groups.

An article from the Food and Drug Administration said, "OMH's outreach work includes raising awareness of the need for more research in diabetes therapies that address racial and ethnic differences. OMH is also working to make sure minorities are included as subjects in clinical trials of medical products for the treatment of diabetes and other diseases."

The Centers for Disease Control and Prevention (CDC) started the National Diabetes Prevention Program (National DPP) which is a partnership of public and private organizations who work together to provide an affordable, evidence-based lifestyle change program to help people with prediabetes prevent or delay type 2 diabetes.

However, according to the CDC some racial and ethnic minority groups were enrolling in the program at lower rates than other groups. To help increase access, the CDC recently funded 10 national organizations to start new in-person programs in underserved areas (regions with fewer resources to address health disparities). In addition to in-person delivery, the program can also be accessed online, by distance learning, or through a combination of these formats.

Women of color in the United States suffer unacceptably poor maternal health outcomes, including high rates of death related to pregnancy or childbirth.

The Pregnancy Mortality Surveillance System started in 1987 and since then, the number of reported pregnancy-related deaths in the United States increased from 7.2 deaths per 100,000 live births to 17.2 deaths per 100,000 live births in 2015.

Considerable racial/ethnic disparities in pregnancy-related mortality exist. During 2011–2015, the pregnancy-related mortality ratios were—

• 42.8 deaths per 100,000 live births for black non-Hispanic women.
• 32.5 deaths per 100,000 live births for American Indian/Alaskan Native non-Hispanic women.
• 14.2 deaths per 100,000 live births for Asian/Pacific Islander non-Hispanic women.
• 13.0 deaths per 100,000 live births for white non-Hispanic women.
• 11.4 deaths per 100,000 live births for Hispanic women.

Variability in the risk of death by race/ethnicity indicates that more can be done to understand and reduce pregnancy-related deaths.

According to a report from the Centers for Disease Control and Prevention, African American mothers die at a rate that's 3.3 times greater than whites, and Native American or Alaskan Native women die at a rate 2.5 times greater than whites.

Pregnancy-related mortality rates are also high among certain subgroups of Hispanic women. A Science Direct article says, pregnancy-induced hypertension was the leading cause of pregnancy-related death for Hispanic women.

The CDC report also shows roughly 3 in 5 pregnancy-related deaths are preventable. But, the health care system fails to listen to diverse population's health concerns and so the maternal mortality rate keeps rising.

According to the Healthy People Final Review, Approximately 25% of all U.S. women do not receive the recommended number of prenatal visits.  This number rises to 32% among African Americans and to 41% among American Indian or Alaska Native women.

An article from the Center for American Progress believes there is little research on what social factors contribute to poor delivery and birth outcomes for American Indian and Alaska Native women because of the small population size and racial misclassifications. But they do know these women face many barriers when it comes to getting healthcare.

The National Partnership for Women & Families explains African American women experience more maternal health complications. 

• African American women are three times more likely to have fibroids than white women. Fibroids are benign tumors that grow in the uterus and can cause postpartum hemorrhaging. Also the fibroids occur at younger ages and grow more quickly for African American women.
• African American women display signs of preeclampsia earlier in pregnancy than white women. Preeclampsia involves high blood pressure during pregnancy and can lead to severe complications including death if not properly treated.
• African American women experience physical “weathering,” meaning their bodies age faster than white women’s due to exposure to chronic stress linked to socioeconomic disadvantage and discrimination over the life course, this makes pregnancy riskier at an earlier age.

The CDC report also shows that more than a third of pregnancy-related deaths were due to cardiovascular conditions. Cardiovascular disease is more common among black women and can occur at earlier ages than in white women.

It is very clear that health disparities have a lot to do with racism. Until it is addressed and programs are put in place to combat racism in healthcare, mortality rates will continue to rise.