The past year has opened everyone’s eyes a lot wider to the problems of racial and social injustice. The COVID-19 pandemic has revealed shocking disparities in health care, as people of color have suffered far more disability and death than other groups. In many cases, this disparity of care is based in part on lack of minority representation in health care.
A review of 16 studies of inclusion, published in 2019 in the Journal of the National Medical Association, concluded that there are positive associations between diversity, quality and financial performance. Of the 16 studies reviewed, health care-specific studies showed that “patients generally fare better when care was provided by more diverse teams. Professional skills-focused studies generally find improvements to innovation, team communications and improved risk assessment. Financial performance also improved with increased diversity. A diversity-friendly environment was often identified as a key to avoiding frictions that come with change.”
Yet too many industries and businesses lack the kind of representation from minority populations that really push the envelope. In nursing, only about 20% of practicing nurses are nonwhite, and just 9% are men, says Ernest Grant, president of the American Nurses Association.
Grant, the first man ever to be elected president of the ANA, has been in the nursing field for 30 years and is an internationally respected expert in burn care and fire safety. As an African American male nurse, he knows he is the embodiment of diversity. He also knows that there are far too few like him in the field.
“I would describe the current state of diversity as changing, but it’s a very slow change. We have moved the needle a little bit in that direction, but there needs to be more diversity within the profession,” he says.
Patients Benefit from Diversity
Patients benefit from a workforce that represents them, says Sheldon D. Fields, a registered nurse, research professor and the inaugural associate dean for equity and inclusion at Penn State University College of Nursing. “There are tons of studies saying that patients do better and are more willing to listen to health care advice from someone who reflects their values, sense of self and culture,” he says.
Nurses comprise the largest proportion of the entire health care workforce, and they are the most trusted, Fields says. “Nursing has a sacred societal obligation to take care of anybody with the same human dignity and compassion. We can only do that by being representative of the society in which we have been called to serve.”
Fields cites the rollout of the COVID-19 vaccine as a perfect example. The accepted storyline is that people of color are more hesitant to take the vaccine, but that hesitancy was eased when the National Black Nurses Association, which he serves as first vice president, partnered with local health departments to set up pop-up clinics in Black communities, including in churches. “We are having a lot more success because those communities trust us more easily,” he says.
Fields blames the profession itself for being “derelict” in assuming the responsibility to do more to diversify. That’s changing, though. Organizations like the ANA, NBNA and American Association of Colleges of Nursing are now taking the ball and moving it forward. “The plain and simple fact is that we need to represent the population we serve,” says Brigit M. Carter, registered nurse, associate professor and associate dean for diversity, equity and inclusion at Duke University School of Nursing. “I think we are improving. Are we anywhere near where we need to be? No,” she says.
‘A Pipeline Issue’
The field hopes to move closer to where it needs to be, thanks in large part to an infusion of federal money and grants from those nursing organizations to address the problem. “Part of the main issue is a pipeline issue,” Fields says, meaning the need to encourage younger males and people of color to consider and train for a career in nursing. “It starts by educating people about what nurses really do, and starting early.”
Fields and Grant both go into elementary schools — or did regularly pre-pandemic, anyway — to teach what nursing is and how to get the education necessary to do it. Grant, for one, cuts an imposing figure. “I am an African American male, 6 foot 6, and for me to impress upon young Black or Hispanic males, or even white males, they may say, ‘If he can do it, why can’t I?'” he says. He points out that students considering being an engineer or pharmacist will be interested to learn that nursing requires many of the same courses: “So we can be role models by who we are and the difference we make. If that sparks an interest for a young child, and we can provide guidance, that’s one way we can do that.”
Removing the barriers to higher education is another important way. Along with the obvious need for financial support just to get into and afford college, diversity proponents believe that many nursing schools focus too much on grades and standardized test scores, and not enough on life skills. “We are proponents of holistic admissions to nursing school,” Fields says. “That means admissions, to all areas of health care, should not be based on a numeric algorithm. You can have straight As, but you could also have no personality, no compassion and be borderline psychopath, as a lot of type-A people are. We want people with a sense of humanity and compassion. Maybe they got a C in a science class; that shouldn’t bar them from admission.”
And the need for support doesn’t end there. “A major issue is, once we get them in (college), can we keep them,” Carter says. That requires both academic advisement and social supports, “to create what we say is a sense of belonging,” she says, in a world that doesn’t look or act like they do. Many also need technical resources; “Not everyone can afford a fancy laptop or an iPhone,” she says, requirements for today’s digital, online education.
Today’s Students, Tomorrow’s Leaders
Those minority students who get the help often go on to pursue even higher educational levels. According to the AACN, nurses from minority backgrounds are more likely than their white counterparts to pursue baccalaureate and higher degrees in nursing. Their data show that 48.4% of white nurses complete nursing degrees beyond the associate degree level, but the number is higher among African American (52.5%), Hispanic (51.5%) and Asian (75.6%) nurses. “Whether it’s in educational settings or in the workplace, that is what will get us to where we need to be,” Carter says.
To get there, minority nursing students also need mentors to show them the way, and nursing organizations are working hard to provide that experiential guidance from “nurses who look like me,” Fields says. That includes in higher levels of nursing administration. “I want every major school of nursing to commit to having a chief diversity officer like myself. We have to do things differently. Most schools’ faculty and administration are also overwhelmingly female and overwhelmingly white. There is no representation at the table in most schools of nursing. Once you add more seats, you introduce a shared vision and optimized belief in what the nursing profession could look like,” he says.
Fields adds that nursing students themselves want to see increased diversity. A white student once told him that the class all looked the same, and they knew that is not what the world looks like. “They asked me, ‘What would you do to help us have Black and Latino classmates?'” he says. “I was pleasantly surprised at the question.”
Grant, Fields and Carter all agree that the work to make that happen is being done, but better results are still to be seen. They are optimistic, though. “It seems that applications to nursing school appear to be more diverse, which is great, but it’s definitely going to take some time,” Grant says. “I am looking at it with hopeful eyes.”
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