Category Archives: Toward a More Diverse Health Care Workforce
This is part of the December 2013 issue of Sharing Nursing's Knowledge.
More male nurses are needed to diversify the nursing workforce and help curb a looming shortage of nurses, but U.S. TV producers aren’t helping.
That’s the conclusion of a recent study of male nurse characters on televised medical dramas in the United States. Shows including Grey’s Anatomy, HawthoRNe, Mercy, Nurse Jackie, and Private Practice reinforced stereotypes, often in negative ways, about men in nursing, the study found. It was published in August in the Journal of Advanced Nursing.
“The men were often subject to questions about their choice of career, masculinity and sexuality, and their role usually reduced to that of prop, minority spokesperson, or source of comedy,” the authors write.
Men are joining the profession in increasing numbers, but negative portrayals of male nurses on television undermine efforts to recruit and retain male nurses, they add.
Cindy Anderson, PhD, RN, WHNP-BC, FAHA, FAAN, is a professor and associate dean for research at the College of Nursing & Professional Disciplines, University of North Dakota. A Robert Wood Johnson Nurse Faculty Scholar, she received a Bachelor of Science degree in Nursing from Salem State College, and both a Master of Science degree in parent-child nursing and a PhD in physiology from the University of North Dakota. This is part of a series of posts looking at diversity in the health care workforce.
I was born and raised in the Boston area which we always referred to as the “melting pot.” My grandparents emigrated from Eastern Europe and I grew up hearing stories of the “Old Country” which included both fond memories and atrocities that drove them to leave their homes and find a better way of life in America. As a second-generation American, I have always embraced the common and unique perspectives of others from a variety of backgrounds.
I began my career as an Air Force nurse, advancing my opportunity to engage with others from varied backgrounds and cultures. In the course of my career, I found myself stationed at the Grand Forks Air Force Base in North Dakota. My initial perceptions were based upon the stereotype that North Dakota was a rural, isolated state with little diversity. My misperceptions were quickly reversed when I had a chance to engage with the community. My awareness and respect for the unique diversity of rural North Dakota has steadily grown over the last three decades which I have been fortunate to spend in this great state.
Efrain Talamantes, MD, MBA, is a Robert Wood Johnson Foundation/U.S. Department of Veterans Affairs Clinical Scholar at the University of California, Los Angeles. This is part of a series of posts looking at diversity in the health care workforce.
Diversity in health care is critical in providing quality health care to all Americans. As physicians, we care for patients from all walks of life and we strive to heal with our expertise, compassion and open-mindedness. Our health system and patients benefit greatly from health professionals who can speak and understand different languages, and who always strive to understand different backgrounds, cultures, practices, and beliefs. Research shows that diversity in the health care workforce enhances training for health professionals and improves access to quality health care.
There is an unprecedented demographic transformation happening in our country today; the majority of births are from Hispanics, Blacks, Asians and other racial and ethnic minorities. Since 1985, the number of underrepresented ethnic and racial minority medical school applicants, matriculates, and graduates has leveled off at about 15 percent, while their representation in the U.S. population has been nearly twice as high—and they are on pace to become the majority.
Martin Schiavenato, PhD, RN, is an assistant professor at the University of Miami School of Nursing and Health Studies, and a Robert Wood Johnson Foundation Nurse Faculty Scholar. This is part of a series of posts looking at diversity in the health care workforce.
It is human nature. The old adage “opposites attract” is a myth; in fact, the contrary is true. We feel more comfortable with and welcome those who share in our definition of “us” than not. Accordingly, this also forms the basis to how we define “them.” It is intuitive that we feel connected to and prefer those who share in what we believe to be our experience, and that we are suspicious and even spurn those who we feel do not. This phenomenon is referred to by psychologists as “in-group bias.”
"When it comes to providing best clinical care, race and culture matter."
In my field of pain research, there is ample documentation of how clinician preferences impact the care of patients. Clinicians better address pain management in patients who “match” their reference group or their preferences more closely. For example, better pain care is given to patients who speak the same language, are of similar socioeconomic status, or even those considered more attractive to the clinician. Subtle cues from the patient—their physical appearance, the circumstances that brought them to seek care, their behaviors and expressions—all will have a consequence on the nature of the care that they will receive. Thus, the race and culture of the clinician have the potential to be significant contributors in the quality of care that a patient will receive. This inherent tension between “us” and “them” may be particularly relevant in a country with a history of institutionalized racism.
Mable Smith, PhD, JD, MSN, BSN, RN, is founding dean of the College of Nursing at Roseman University of Health Sciences (formerly the University of Southern Nevada) and an alumna of the Robert Wood Johnson Foundation Executive Nurse Fellows program. This is part of a series of posts looking at diversity in the health care workforce.
A diverse nursing student body builds the foundation for a diverse workforce that can become effective in the provision of culturally competent care to patients. Our student body at Roseman University of Health Sciences is reflective of the diversity seen in the population that consists of Caucasians, African Americans, Hispanics, Asians, Native Hawaiian and other Pacific Islanders, to name a few. This diversity is reflected in the health care system among workers and patients. Students bring a wealth of information that is shared with each other and with faculty.
For example, in a class discussion on nutrition, students from various cultures shared how and what types of foods are used to treat certain illnesses. There were discussions on how food should be presented, such as hot versus cold, raw versus cooked. Some students shared the significance of family presence during meals even for hospitalized patients. These discussions quickly incorporated religious practices and certain etiquettes to promote “religious correctness” when interacting with various cultural and religious groups. Students also provided insight into generational differences and changes with emphasis on the fact that many in the younger generation have not adopted the strict traditions of their parents and grandparents.
LisaMarie Turk, RN, MSN, is a fellow with the Robert Wood Johnson Foundation Nursing and Health Policy Collaborative at the University of New Mexico, working toward a PhD in nursing with a health policy concentration. She was awarded a Hearst Foundation Scholarship in 2010. This is part of a series of posts looking at diversity in the health care workforce.
Ample scientific and empirical evidence supports increasing diversity in the health care workforce in order to decrease health disparities and advance health equity.
I am a registered nurse and PhD student in Nursing and Health Policy at the University of New Mexico. New Mexico is known for its depth of cultural diversity; however, this state joins the nation in experiencing negligible diversity in its health care workforce.
I was honored with the opportunity to complete a policy internship focusing on nursing workforce diversity at the Division of Nursing of the Health Resources and Services Administration’s Bureau of Health Professions. From this experience, I gained increased awareness and resources to affect change in nursing and health care workforce diversity in New Mexico.
The Potentiality of Increasing Diversity in the Health Professions from the Front Lines: Community Colleges
Ebbin Dotson, PhD, MHSA, is a 2011 Robert Wood Johnson Foundation (RWJF) New Connections grantee. He is executive director for the Health Professions Pathways Initiative at the City Colleges of Chicago. This is part of a series of posts looking at diversity in the health care workforce.
Defining potentiality in my line of work is an opportunity for me to influence and encourage the diversification of the health care workforce. Here at the community college where I work, we serve 120,000 students across seven campuses and seven satellite sites on a daily basis (1). More than 70 percent of these students categorize themselves as being Black and/or Hispanic (2). In addition, we have developed partnerships with more than 100 industries, four-year colleges and universities, and community‐based organizations to help connect our students to real-world educational and work opportunities (3). On this national platform discussing diversity, we have an opportunity to change the future course of health care through our investments in health science education and training at community colleges.
As a health professions pathways researcher, it is my desire to increase the diversity of the health care workforce as a solution toward reducing health disparities. In my opinion, more minorities in the health care workforce will have a positive impact on the care provided to minority consumers of health care. Furthermore, as an RWJF New Connections grantee, it is my role to find ways to recruit and retain health professions students using pipeline programs. So what are the effective strategies that result in a diversified health care workforce?
Angela Amar, PhD, RN, FAAN, is an associate professor at the Nell Hodgson Woodruff School of Nursing at Emory University and a Robert Wood Johnson (RWJF) Nurse Faculty Scholar. Her research focuses on traumatic experiences, especially violence, mental health responses to trauma, and aspects of forensic nursing. This is part of a series of posts looking at diversity in the health care workforce.
As a new nurse, I had just entered a patient’s room when he called out from the bathroom to ask his wife who was there. She replied, “it’s a lil’ colored girl to see you.” Luckily, I have a pretty good poker face and was able to not show outwardly how flustered I was inwardly. I was able to introduce myself and conduct my assessment in a professional manner. Over the next three days, I took care of this patient and as we built a relationship, he marveled and told his visitors what a great and smart nurse I was.
While I’d like to think that I am great and smart, I happen to know that I worked on a floor full of great and smart nurses, all of whom were Caucasian. The patient commented on attributes in me that he felt were remarkable and exceptional. He didn’t conceive that ‘a lil’ colored girl’ could be great or smart until we interacted.
"We often see the benefits of diversity as being for minorities. We seldom see that the majority benefits as well."
Fast forwarding to my role as a faculty member, I’ve worked in majority serving institutions where I’m often one of two or three African American faculty members and the numbers of African American students is also small. Frequent comments on my student evaluations are: “She’s so smart. She’s really intelligent.”
Regina Stokes Offodile, MD, CHSE, is an assistant professor in the Department of Medical Education, Division of Clinical Skills and Competencies at Meharry Medical College. She currently instructs first- and second-year medical students on clinical skills, physician patient interaction, and clinical correlations of breast disease. Her research interests include cultural competency. She is pursuing a Masters in Health Professions Education at Vanderbilt University. This is part of a series of posts looking at diversity in the health care workforce.
Cultural diversity in the health care workforce may be something that many have not thought about or considered a topic of concern. It is a concept that health care providers, health care delivery systems, and hospitals need to have on their radar. Having a culturally diverse workforce is a matter of patient safety. Employing a diverse workforce increases the likelihood of having employees who understand how a wide cross section of patients looks at disease, its diagnosis and treatment. A diverse workforce may also address the language barriers and cultural disconnect that may exist in some health care delivery systems.
In order to meet the increasing culturally diverse patrons of health care, there will be a need to have a corresponding change in the health care workforce. There will also be a burden on medical schools and residency training programs to produce culturally competent physicians, and to increase the number of physicians who are able to interact with and treat a culturally diverse patient population.
Carmen R. Green, MD, is an alumna of the RWJF Health Policy Fellows program. She is the associate vice president and associate dean for health equity and inclusion at the University of Michigan Health System, and a professor of anesthesiology, obstetrics and gynecology, and health management and policy. This is part of a series of posts looking at diversity in the health care workforce.
More than a decade into the 21st century, Americans still face diminished health and tremendous variations in health care, depending on what they look like, where they come from, where they live, what they earn, and other factors. Significant and persistent variability in clinician decision-making also exists based upon these factors.
The reasons for these inequities lie in part in disparities in the infrastructure for screening, diagnosing, treating and supporting patients leading to unequal treatment.
In an increasingly aging, female, and diversifying society, it is vital to have a diverse workforce to not only help put patients of varying backgrounds at ease but to provide care that is responsive to their needs and to achieve the best health care outcomes. It may be difficult for underrepresented and vulnerable people to trust the health care system if the employees largely come from the same place and have one perspective. Some of those perceptions actually become realities as biases can negatively affect patients that are marginalized and lower on the socioeconomic totem pole.