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.

Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni and grantees. Some recent examples:

The New Jersey Nursing Initiative (NJNI), a project of RWJF and the New Jersey Chamber of Commerce Foundation, has graduated its first cohort of doctorally prepared nurses, NJ Spotlight reports. The new graduates are on track to become nursing professors, to help address New Jersey’s staggering 10.5 percent nurse faculty vacancy rate. Read more about the New Jersey Nursing Scholars who graduate this month.

In an op-ed for the Daily Journal, New Jersey Nursing Scholar Marlin Gross, MSN, APN, NP-C, writes, “I’m able to combine my love of nursing practice and education because NJNI put me on a fast track to a master’s degree in nursing… I also benefited from the program’s professional and personal development activities and its many mentoring and networking opportunities. But most importantly, NJNI helped me re-imagine my future. I now see myself as an emerging nurse leader and plan to enroll in a doctorate program in the fall to realize that vision.” Robert P. Wise, FACHE, a member of NJNI’s Leadership Council, also wrote about NJNI in an op-ed for The Times of Trenton.

Insight Into Diversity reports on the Dental Pipeline National Learning Institute, an RWJF-funded project led by the American Dental Education Association and the University of the Pacific Arthur A. Dugoni School of Dentistry. It is funding dental schools to create new recruitment projects that will help increase the number of underrepresented students at their institutions. Read a post on the RWJF Human Capital Blog by National Learning Institute Director Paul Glassman.

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.

A new research brief from the American Dental Association’s Health Policy Resources Center finds that an increasing number of Americans visited emergency departments (ED) for dental-related care between 2000 and 2010, as a percentage of total dental visits. ED visits for dental care increased from 1.1 million in 2000 to 2.1 million in 2010.

The increase was primarily among young adults (age 21 to 34), which the researchers hypothesize is due to a decline in dental benefits among this age group. Young adults were more likely than others to report that they could not afford dental care in the past 12 months, the brief says, and recent studies have shown that there has been a shift in the pattern of dental benefits.

“Unfortunately, the Affordable Care Act (ACA) did little to address the issue of dental utilization in emergency departments,” the brief says. The law does not mandate dental benefits for adults, and insurance plans sold through most states’ exchanges are unlikely to include dental benefits. However, pilot programs in some states have shown promise for diverting patients with dental complaints from EDs and increasing their access to dental care.

“In the coming years, advocates for oral health will have to consider other innovative ways to increase access to dental care in order to decrease dental care utilization in hospital emergency departments,” the brief concludes. “Without further interventions from policy makers, dental ED visits are likely to increase in the future, straining our health care system and increasing overall health care costs. Now more than ever, innovative solutions are needed to improve access and oral health.”

Read the brief on patients visiting emergency departments for dental care.

Janice “Nisa” Bruce is the director of San Juan College Department of Nursing in Farmington, NM.  She has a BA from San Francisco State University, a BSN from East Central University Oklahoma, and an MS from the University of Oklahoma, College of Nursing.  She has been in nursing higher education since 1988, and is completing her 20th year at San Juan College.

We began our New Mexico community college-university collaboration in late 2009 with the publication of a university-generated white paper articulating the Institute of Medicine (IOM) recommendations citing the need for more baccalaureate nurses to meet the health care needs of the 21st century. Of course to community college associate degree educators, that proposal smacked of the old entry level into practice argument that has divided nursing educators for decades. We gnashed our teeth, we complained to each other, we argued that the literature was flawed. Then we got busy. And the New Mexico Nursing Education Consortium (NMNEC) was born.

Little by little, over time, the pieces have fallen into place. 

Timothy Landers, RN, CNP, PhD, is an assistant professor at The Ohio State University and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar.

The Great Challenges Program is an ongoing effort by the TEDMED community to provide innovative, interdisciplinary perspectives on the most complex and challenging issues in health care. A year-long dialogue facilitated through social media tools and panels of experts continued at the annual gathering of TEDMED 2013.

One of the themes of TEDMED 2013 was the creative and thoughtful use of big data and small data to improve health and health care.

Small data includes individual level information specific to an individual or circumstance. In small data, “n=ME.” A vast amount of individual level information is now routinely collected. However, a large volume of data is not required for small data to be useful—in the words of one TEDMED speaker, it’s not the volume of the data, but the complexity of existing data. Data must be available and accessible in order to be useful as well.

Big data refers to patterns of data and information available at the population level. The goal of big data is to use information and take a “macroscopic” view of health. It includes the ability to recognize patterns that are not obvious or readily apparent. Big data analysis permits us to go from pieces of data to collective wisdom, a theme of TEDMED 2013.

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Kim D’Abreu is Senior Vice President for Access, Diversity, and Inclusion in the Policy Center at the American Dental Education Association.  D’Abreu was previously the deputy director for the Pipeline Profession and Practice: Community-Based Dental Education program of the Robert Wood Johnson Foundation. This is part of a series of posts looking at diversity in the health care workforce.

Words Matter

The words we use matter. That’s why the American Dental Education Association (ADEA) is shifting the conversation away from the “deficit model” for recruiting students from underserved backgrounds.  ADEA is specifically avoiding language that suggests “the numbers just aren’t there” or “the pool is not qualified.” When we describe underserved students as low-income or less prepared educationally, it suggests that the problem lies with them. It undervalues the students and ignores the wealth that they bring to the table in terms of cultural competence, initiative, and willingness to provide care to communities that need it most. But far worse, the deficit model allows the real institutional obstacles that these students face to remain in place.

The Robert Wood Johnson Foundation (RWJF) Center for Health Policy at Meharry Medical College will graduate six scholars with certificates in health policy during Meharry Medical College’s 138th Commencement Exercise this weekend. Having completed the Center’s health policy education program, the scholars are poised to join the nation's leading health policy experts, researchers, and analysts. They will focus on caring for minority and underserved communities in their careers.

The graduating scholars are:

• Kevin Blythe, MSPH, School of Medicine
• Lamercie Saint Hilaire, School of Medicine
• Ashley Huderson, School of Graduate Studies and Research
• Brandon Morgan, School of Dentistry
• Rebbie S. Timmons, School of Graduate Studies and Research
• Nadia Winston, School of Graduate Studies and Research
  

Learn more about the scholars and what lies ahead for each graduate in the health policy arena.
Learn more about the RWJF Center for Health Policy at Meharry Medical College.