Minority Voices: Addressing the Lived Experience of Black Nurses and Nurse Leaders Confronting Racism in the Nursing Profession

Racism continues to erect substantial barriers for Blacks and minorities within the nursing profession, even while the shifting US population demographics and increasing numbers of minorities make diversifying the profession imperative. Interviews with Black nurses at virtually every career stage indicate that racism remains a significant obstacle and may prevent them from ascending to leadership. Building a diverse nursing workforce and leadership is necessary to serving a diverse community, especially underserved populations. A more diverse nursing organization is better equipped to identify and address the social determinants of health affecting a given patient population and thereby more effectively alleviate health disparities.     

Ethnic diversity in the nurse workforce: a literature review

In the 2000-2003 New York State Nurses Association Strategic Plan, the Board of Directors called for an assessment of the progress made toward achieving an ethnically diverse nursing workforce as reflected in the literature. In this paper the authors have responded to that request and offer a snapshot of progress as well as standstills in the journey toward diversity. Although the literature has tended to focus on cultural competency of the healthcare worker, and includes numerous calls for action to diversify the nurse workforce, very little scholarly work has been conducted that rigorously evaluates such diversification activities. The purpose of this literature review is to explore existing scholarly work in ethnic diversity at three levels: in the general workforce, the healthcare workforce, and the nursing workforce. The authors explored the literature as it addresses two aspects: academic and career factors influencing diversity; and recruitment, retention, and other strategies employed to diversify the workforce. By exploring the existing research, gaps can be identified in order to either direct further research, or target funding to recruitment strategies to effectively enhance a more ethnically diverse nurse workforce.     

Disability Inclusion in Nursing Education

A diverse nursing workforce is essential for progress toward the achievement of health equity and the mitigation of health disparities in the United States. Diversity in health care will improve the quality of care and access to care for underrepresented groups. The noted lack of diversity in nursing education also includes persons with disabilities. The legislative history that protects persons with disabilities are widely known; however, a recent action implemented by the federal government requires all facilities that receive federal contracts to employ a percentage of their workforce with disabled individuals. This new implementation will impact many health-care facilities and will increase the demand for educating health-care professionals with disabilities. Therefore, a nursing school in the southeast region of the United States was proactive to the call for more diversity in nursing’s workforce. The school revised their essential functions/core performance (technical) standards for admission to the undergraduate nursing program by collaborating with disability experts in the Access Center. The interprofessional collaboration was instrumental in creating new core performance standards that focus on the skills necessary to practice nursing safely rather than focusing on individual strengths or weaknesses. The purpose of this article is to share the nursing school’s new core performance standards and the background information related to best practices and improving health equity in nursing related to persons with disabilities.     

Care provision for older adults: who will provide?

The aging of the baby boomers comes at a time of a growing nursing workforce shortage: registered nurses, nurse aides, and nursing faculty. Older adults have multiple physical, social, and psychological conditions, making the assessment, planning, and delivery of health care more complex than that of younger adults. Not surprisingly, this age group also utilizes the majority of health services in the country. Thus, most nurses will provide care to older adults in a variety of settings. However, the majority of nurses have little to no background in geriatric nursing. These multiple forces: aging population with complex needs, nursing work force shortage, and lack of geriatric knowledge, along with fewer resources, will have a grave impact on health care in this country in the near future. This article reviews issues related to an aging population, the projected nursing workforce shortage, and the lack of geriatric nursing education; it concludes with suggestions for future health care delivery to the geriatric population in the US     

Incorporating Social Justice,Community Partnerships,and Student Engagement in Community Health Nursing Courses

Following the increase in both evidence and awareness of the impact that social determinants and social injustices have on health, it is clear to educators that nursing students must be prepared to address and ameliorate such concerns for patients. This paper describes the approach of one nursing program to community health nursing education. The SON located in a highly diverse city, approaches community health education through the lens of the social determinants of health. Going forward, nursing programs must consider social determinants and health equity when planning community courses and across the curriculum. Approaches to community health education with a focus on health promotion for nursing students, such as the courses described in this article, may help nursing programs meet the learning needs of students and the changing face of healthcare.     

Using Twitter™ to drive research impact: A discussion of strategies,opportunities and challenges

Researchers have always recognised the importance of disseminating the findings of their work, however, recently the need to proactively plan and drive the impact of those findings on the wider society has become a necessity. Firstly, this is because funders require evidence of return from investment and secondly and crucially because national research assessments are becoming powerful determinants of future funding. In research studies associated with nursing, impact needs to be demonstrated by showing the effect on a range of stakeholders including service users, patients, carers, the nursing workforce and commissioners. Engaging these groups is a well-known challenge influenced by lack of access to academic journals, lack of time to read long complex research papers and lack of opportunities to interact directly with the researchers. This needs to be addressed urgently to enable nursing research to increase the impact that it has on health delivery and the work of clinical practitioners. Social media is potentially a novel way of enabling research teams to both communicate about research as studies progress and to disseminate findings and research funders are increasingly using it to publicise information about research programmes and studies they fund. A search of the healthcare literature reveals that advice and guidance on the use of social media for research studies is not well understood or exploited by the research community. This paper, therefore, explores how using social networking platforms, notably Twitter™ offers potential new ways for communicating research findings, accessing diverse and traditionally hard-to-reach audiences, knowledge exchange at an exponential rate, and enabling new means of capturing and demonstrating research impact. The paper discusses approaches to initiate the setup of social networking platforms in research projects and considers the practical challenges of using Twitter™ in nursing and healthcare research. The discussion is illuminated with examples from our current research. In summary, we suggest that the use of social media micro-blogging platforms is a contemporary, fast, easy and cost effective way to augment existing ways of disseminating research which helps drive impact.     

International nurse migration: lessons from the Philippines

Developed countries facing nursing shortages have increasingly turned to aggressive foreign nurse recruitment, primarily from developing nations, to offset their lagging domestic nurse supplies and meet growing health care demands. Few donor nations are prepared to manage the loss of their nurse workforce to migration. The sole country with an explicit nurse export policy and the world's leading donor of nurse labor - the Philippines - is itself facing serious provider maldistribution and countrywide health disparities. Examining the historical roots of Philippines nurse migration provides lessons from which other nurse exporting countries may learn. The authors discuss factors that have predicated nurse migration and policies that have eased the way. Furthermore, the authors analyze how various stakeholders influence migratory patterns, the implications of migration for nurses and the public in their care, and the challenges that future social policy and political systems face in addressing global health issues engendered by unfettered recruitment of nurses and other health workers.     

Nursing curriculum through a social justice lens: An upstream approach

This article describes a one‐day seminar rooted in critical interactionism for nursing students in a diverse urban setting in the United States. The authors are registered nurses and members of Nurses for Social Justice (NSJ)—a loose network of nurses and nursing students committed to societal change. Informed by the history of NSJ and larger social justice movements, the authors intentionally incorporate their personal experiences and offer an example of how nursing education can improve health at the micro and macro levels. The seminar starts with introductions and creating a safe space for authentic engagement. Students are guided to connect with their own journey to nursing and the experiences that have shaped their identities, including being oppressed and privileged. The lack of diversity within the nursing workforce and various nursing roles along the continuum of care are discussed. Case‐based scenarios are presented where students explore leveraging their power and privilege to effectively partner with individuals and communities. In closing, lessons learned are shared through a group activity that uses the ecologic model. Recommendations are made to equip nursing students with tools to better understand their role in the broader context of health.     

Workplace practices with mental health implications impacting on recruitment and retention of overseas nurses in the context of nursing shortages

In response to nursing workforce shortages, health agencies in Australia and elsewhere have sought to meet the demand for nursing services by recruiting nurses internationally. While there is a major focus on recruitment, little attention is given to factors that could enhance retention of overseas qualified nurses. There are a host of factors reported in the literature that impact upon retention of overseas nurses in the workforce, including: impact of re-settlement experiences in the new country; discriminatory practices in accessing employment and negative experiences in the work place. For the benefit of long term retention of overseas nurse graduates in the workforce in Australia and globally, these experiences are major issues needing urgent attention. This discussion paper reviews the literature to explore the impact of aggression and discriminatory practices in nursing as evidence for nurses leaving the profession, and discusses the mental health implications and consequences of such practices relating to overseas nurse graduates.     

The nurse's role in improving health disparities experienced by the indigenous Māori of New Zealand

Many countries across the globe experience disparities in health between their indigenous and non-indigenous people. The indigenous Māori of New Zealand are the most marginalized and deprived ethnic group with the poorest health status overall. Factors including the historical British colonization, institutional discrimination, healthcare workforce bias and the personal attitudes and beliefs of Māori significantly contribute to disparities, differential access and receipt of quality health services. Māori experience more barriers towards accessing health services and as a result achieve poorer health outcomes. Contradicting translations of Te Tiriti o Waitangi have created much debate regarding social rights as interpreted by Oritetanga (equal British citizenship rights) and whether or not Māori are entitled to equal opportunities or equal outcomes. Inconsistent consideration of Māori culture in the New Zealand health system and social policy greatly contributes to the current health disparities. Nurses and healthcare professionals alike have the gifted opportunity to truly change attitudes toward Māori health and move forward in adopting culturally appropriate care practices. More specifically the nursing workforce provides 80% of direct patient care, thus are in a unique position to be the forefront of change in reducing health disparities experienced by Māori. Incorporating cultural safety, patient advocacy, and Māori-centred models of care will support nurses in adopting a new approach toward improving Māori health outcomes overall.     

Health Care Disparities in Emergency Medicine

The Institute of Medicine's landmark report, "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care," documents the pervasiveness of racial and ethnic disparities in the U.S. health care delivery system, and provides several recommendations to address them. It is clear from research data, such as those demonstrating racial and ethnic disparities in emergency department (ED) pain management, that emergency medicine (EM) is not immune to this problem. The IOM authors describe two strategies that can reduce disparities in EM. First, workforce diversity is likely to result in a community of emergency physicians who are better prepared to understand, learn from, and collaborate with persons from other racial, ethnic, and cultural backgrounds, whether these be patients, fellow clinicians, or the larger medical and scientific community. Given the ethical and practical advantages of a more diverse EM workforce, continued and expanded initiatives to increase diversity within EM should be undertaken. Second, the specialty's educational programs should produce emergency physicians with the skills and knowledge needed to serve an increasingly diverse population. This cultural competence should include an awareness of existing racial and ethnic health disparities, recognition of the risks of stereotyping and biased treatment, and knowledge of the incidence and prevalence of health conditions among diverse populations. Culturally competent emergency care providers also possess the skills to identify and manage racial and ethnic differences in health values, beliefs, and behaviors with the ultimate goal of delivering quality health services to all patients cared for in EDs.     

Strategies to increase success of underrepresented: Minorities in nursing

A major concern for the nursing profession and nurse executives is the need to increase diversity in the registered nurse workforce to better mirror the U.S. population. Although the size of the RN workforce continues to be inadequate to meet societal needs, there are also particular issues related to the composition of the nursing workforce. A diverse workforce is important both to provide culturally and linguistically appropriate services (CLAS) to diverse clients and help reduce health disparities.¹     

Four parts or one whole: The National Health Service (NHS) post-devolution

Aim(s) There is a need for nurse and midwifery managers to have an understanding of devolution and its implications for them and their colleagues. This paper will explain devolution, consider some health and social care policy including similarities and differences, and assess the impact of devolution on the nursing workforce and the regulation of nursing across the four countries of the United Kingdom (UK). Background If managers are to manage effectively it is critical that they remain aware of emerging policy development and outcomes across the UK. It is now more important than ever that nurses maintain a keen eye on the impact divergent policy is having on practice as well as the UK nursing workforce. Evaluation The impact of devolution across the UK will be explored using convergence and divergence as a framework; commencing by providing an overview of devolution and health, moving on to examine health policy in action across the four countries. Key issues Healthcare is highly political in nature. Devolution has implications for all, and adds to the complexity of health and social care provision. If managers are to manage effectively it is critical that they remain aware of emerging policy development and outcomes across the UK. Conclusion It is equally important that nurses, and nurse managers, develop and draw upon their political leadership skills, actively engaging in policy debates to ensure that when policies are translated into practice their outcomes are optimal in terms of quality, efficiency and sustainability. Implications for nursing management There is a need for nurse and midwifery managers to have an understanding of post‐devolution structures and how they operate in order to work effectively, as well as to learn from the experiences of other parts of the UK.     

The Hartford Geriatric Nursing Initiative: developing a focused strategy and strong partnerships to improve nursing care for older adults

This article traces the funding priorities of the John A. Hartford Foundation—the largest private philanthropy in the United States dedicated to aging and health—to increase the competence of the health care workforce (physicians, nurses, and social workers) to care for our aging society. A review of the Foundation's 15-year and over $70 million investment in geriatric nursing is presented with emphasis on 2 critical factors—a focused strategy and strong partnerships—to build the nation's nursing capacity to meet the health care needs of older Americans. The evolution of Hartford's strategic goal to ensure that all nurses are skilled to care for older adults is shared to illustrate why the Foundation now funds nursing efforts in the primary areas of faculty development and curricular change. This article also underscores the importance of establishing a network of diverse partnerships and collaborations to maximize impact and create synergies.     

Licensed caregiver characteristics and staffing in California acute care hospital units

PURPOSE: Concerns about declining quality of care and nurse staffing shortages led to legislation mandating minimum nurse-to-patient ratios in the state of California. Although research finds that better registered nurse (RN) staffing results in higher quality of care, little evidence exists on which to base specific nurse-patient ratios. The authors describe the results of a California survey characterizing licensed caregivers, identifying staffing levels by unit type, and describing how staffing levels vary across hospital types. METHODS: A stratified random sample of general acute care hospitals was surveyed to collect cross-sectional data on hospitals' nursing workforce and staffing practices and to assess the impact of potential patient-to-nurse staffing ratios. All academic medical centers; rural, private, and city/county hospitals; and hospitals affiliated with a large group-model health maintenance organization (HMO) were eligible for inclusion. RESULTS: Eighty hospitals were surveyed, representing all major metropolitan areas in the state. Acute care hospitals in California have diverse nursing staffs with variations in education, experience, and employment status. Considerable variations in skill mix were identified, with the proportion of RNs ranging from 30% to 84%, depending on the unit type surveyed. CONCLUSIONS: As states struggle with an anticipated critical shortage of RNs, these results have several implications for health and education policy. Future studies of this type will be needed to evaluate the impact of anticipated changes in the regulation of nurse staffing.     

Project REACH: A multi-level,interdisciplinary approach to enhance student retention and success

BackgroundAn escalating nursing shortage brought attention to nursing student retention and success including graduation and licensure.PurposeThe purpose of this Health Resources and Services Administration (HRSA) project, Realizing Educational Attainment and Careers in Healthcare (REACH), was to increase nursing progression and graduation rates for undergraduate nursing students from diverse and/or under-resourced backgrounds.MethodsREACH goals focused on four levels: 1) Individual: Neutralize the impact of economic-environmental factors that are barriers for diverse and under-resourced populations to pursue a BSN, 2) Group: Bridge gaps within a social determinants framework to achieve progression and graduation, 3) Institutional: Broaden the cultural competence of faculty on campus and 4) Community: Expand the knowledge and skills of the social determinants of health and cultural competence for nurses within the largest nursing employer in the community.Results92% (35/38) of participants graduated with a BSN and 91% (32/35) of these graduates are employed as registered nurses. Sixty percent (n = 35) of participants are employed in HRSA designated Health Professional Shortage Areas or in Medically Underserved Areas/Populations as compared to 24% (n = 79) of College of Nursing students.ConclusionAn interdisciplinary approach to addressing social determinant needs allowed this project to successfully diversify the nursing workforce.     

Meaningful inclusion of diverse voices: The case for culturally responsive teaching in nursing education

Communication and diversity are essential features of safe and effective health care and of a safe and effective nursing workforce. Fostering diversity and meaningful inclusion of diverse perspectives in nursing school classrooms, labs and clinical learning environments are important steps toward building a stronger nursing workforce and health care system. This paper presents an argument for the importance of replacing the single, dominant voice in nursing education with culturally responsive teaching and offers strategies nurse educators can use to encourage students to share alternative perspectives and engage in alternative methods of discourse and communication. This essay reflects a review of the theoretical background to culturally responsive teaching and discusses how this method connects to nursing education. By engaging in culturally responsive teaching, nurse educators will prepare a nursing workforce that is ready to add multiple diverse voices to the health care team and contribute to the redesign of a safer and more effective health care system.