Culture of Health Blog

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.

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. 

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.

Gary H. Gibbons, MD, is director of the National Heart, Lung, and Blood Institute at the National Institutes of Health. He is an alumnus of the Robert Wood Johnson Foundation Harold Amos Medical Faculty Development Program.

Growing up in a predominantly African American neighborhood in Philadelphia, high blood pressure, strokes, and heart attacks were common. When I got to medical school, I asked one of my professors why the African American community tended to have a higher prevalence of these medical conditions. He introduced me to biomedical science for the first time and challenged me to pursue that question on my own. I've continued to look for the answer to that provocative question ever since.

Similar to that early experience, mentorship has been a determining factor in my career trajectory. I might not have pursued a research career at all if it hadn't been for Harvard Medical School professor A. Clifford Barger who inspired me to ask and answer difficult research questions. The Robert Wood Johnson Foundation’s Harold Amos Program pushed me further with their emphasis on mentorship, which gave me a sense of community with the many scholars interested in the same research problems. It was my experience with a National Institutes of Health T32 training grant when I was starting out as an investigator that inspired me to give back to a younger set of minority researchers by becoming a K Award mentor and leading a T32 program at Morehouse School of Medicine.

Adejoke Ayoola, PhD, RN, is an assistant professor with the Calvin College Department of Nursing in Grand Rapids, Michigan, 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.

Nurses in the United States are caring for a progressively more diverse population. In 2008, ethnic and racial minority groups accounted for about one third of the United States population. According to the United States Census Bureau, people from ethnic and racial minority groups— namely Hispanic, black, Asian, American Indian, Native Hawaiian and Pacific Islander—will together outnumber non-Hispanics over the next four decades. Minorities, now 37 percent of the U.S. population, are projected to comprise 57 percent of the population in 2060. The total minority population would more than double, from 116.2 million to 241.3 million over the period (U.S. Census Bureau, 2012).  So it is essential to have a nursing workforce that will reflect the population of the United States so as to deliver cost-effective, quality care and improve patients’ satisfaction and health outcomes, especially among ethnic and racial minorities.

The importance of promoting diversity in the nursing workforce is acknowledged by various nursing agencies and health organizations, including the American Association of Colleges of Nursing (AACN, 2013).  Diversity in the nursing workforce provides opportunities to deliver quality care which promotes patient satisfaction and emotional well-being. 

When I take my students to the hospital for their clinical rotations in acute care, I often assign those who are Spanish-speakers to Spanish-speaking patients. It has often been a win-win situation for both my students and the patients. Recently we cared for a Hispanic patient who did not speak English and had just given birth to her first baby. Her face lit up when my student spoke to her in Spanish! There was no one else with the woman, so the student’s ability to interact with her in a language she understood made a big difference. We noticed positive progress in the patient’s emotional and physical state as a result of her interaction with the student during the shift.

Monique Trice, 24, is a University of Louisville School of Dentistry student who will complete her studies in 2015. Trice completed the Summer Medical and Dental Education Program (SMDEP) in 2008 at the University of Louisville site. Started in 1988, SMDEP (formerly known as the Minority Medical Education Program and Summer Medical and Education Program), is a Robert Wood Johnson Foundation–sponsored program with more than 21,000 alumni. Today, SMDEP sponsors 12 sites, with each accepting up to 80 students per summer session. 

Diversity is more than ethnicity. It also includes geography, perspective, and more. I was raised in Enterprise, Ala., which is in Coffee County. The community’s demographic and geographic makeup set the stage for an oral health care crisis. Here’s how:

• Enterprise is a community of 27,000 and just 15 licensed general dentists, three Medicaid dental providers, and zero licensed pediatric dentists to service Coffee County, a population of 51,000. In 2011, Alabama’s Office of Primary Care and Rural Health reported that 65 of the state’s 67 counties were designated as dental health shortage areas for low-income populations.
• According to this data, more than 260 additional dentists would be needed to bridge gaps and fully meet the need. For some residents, time, resources, and distance figure into the equation, putting dental care out of reach. In some rural communities, an hour’s drive is required to access dental services.
• Lack of affordable public transportation creates often-insurmountable barriers to accessing dental care.

Growing up in a single-parent household, my siblings and I experienced gaps in dental care. Fortunately, we never suffered from an untreated cavity from poor oral health care, but many low-income, underserved children and adults are not so lucky.

Though it remains a predominantly female profession, a new study from the U.S. Census Bureau finds that the percentage of nurses who are male more than tripled from 1970 to 2011, from 2.7 percent to 9.6 percent.

The Census Bureau’s Men in Nursing Occupations also finds the proportion of male licensed practical and licensed vocational nurses increased, from 3.9 percent to 8.1 percent. Men's representation was highest among nurse anesthetists (41%).

“The aging of our population has fueled an increasing demand for long-term care and end-of-life services," said the report's author, Liana Christin Landivar, a sociologist in the Census Bureau's Industry and Occupation Statistics Branch, said in a news release about the study. “A predicted shortage has led to recruiting and retraining efforts to increase the pool of nurses. These efforts have included recruiting men into nursing.”

The study also found that men typically earn more in nursing fields than women, but not by as much as they do across all occupations.  Male nurses earned an average of $60,700 in 2011—16 percent more than the average earnings for female nurses, which was $51,100. The difference in earnings is due partly to the concentration of men in higher-paid nursing occupations, like nurse anesthetics. “Men have typically enjoyed higher wages and faster promotions in female-dominated occupations,” the study says, a phenomenon known as the “glass escalator” effect.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.

A report from the Association of American Medical Colleges (AAMC) documents an overall trend toward increased diversity among students applying to medical school.

AAMC’s Diversity in Medical Education: Facts and Figures 2012 finds that nearly half of the applicants to U.S. medical schools in 2011 were non-White. Whites were the largest group of applicants, followed by Asians. “Compared with 2010, in 2011 the percentage of Hispanic or Latino applicants increased by 5.7 percent and the number of Black or African American applicants grew by 5 percent,” the report says.

But only 2.5 percent of medical school applicants in 2011 were Black men. Twice as many Black women as men applied to medical school that year, creating the biggest gender gap in medical school applicants among all racial or ethnic groups.

“We have a major, major problem in this country,” Marc Nivet, EdD, AAMC’s chief diversity officer, told American Medical News. “There is just simply an enormous amount of indisputable evidence that we’re not intervening as effectively as we’d like as a society to increase the talent pool of African-Americans who are capable of taking advantage of the science curricula available up and down the pipeline.”

Myra Parker, JD, PhD, is acting instructor at the Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington and a Robert Wood Johnson Foundation (RWJF) New Connections grantee. This post is part of a series in which RWJF scholars, fellows and alumni who are attending the American Public Health Association annual meeting reflect on the experience.

I took my seven-year-old daughter to help me pick up my registration materials at the Moscone Center. I was thrilled to map the American Indian, Alaska Native and Native Hawaiian (AI/AN/NH) sessions and discover they are located in one of the central buildings this year! It’s terrific to be able to attend the general sessions AND those specific to my community, which has not always been the case with AI/AN/NH sessions held in off-site hotels last year in Washington, D.C.

My daughter was amazed and excited to see the performances outside the convention center. The artistic displays added to the air of festivity as American Public Health Association (APHA) attendees took over the Moscone area. I was excited to see the diversity of attendees across many different professional backgrounds and ethnic/cultural communities.

We attended the American Indian, Alaska Native and Native Hawaiian Caucus General Membership Business Meeting. This was the first time I had the opportunity to attend the business meeting, which included officer elections for the upcoming two years, introductions of members and visitors, and updates on the caucus budget and events. The caucus was able to fund six undergraduate, masters, and doctoral students from AI/AN/NH communities to attend APHA this year at $2,000 each. This is a wonderful new opportunity for these students, each of whom also applied to present a poster at the conference. I plan to attend the caucus social on Monday evening, which includes a silent auction of native art! This fundraiser contributes to the cost of providing caucus-specific sessions as well as to the student scholarship fund. I also learned that if we pack a room at the conference, there is a higher chance the caucus will be able to offer these sessions next year.

Comilla Sasson, MD, MS, FACEP is an attending physician at the University of Colorado Hospital and Assistant Professor in the Department of Emergency Medicine at the University of Colorado.  Sasson was a Robert Wood Johnson Foundation (RWJF) Clinical Scholar at the University of Michigan from 2007 to 2010. Her latest study is published in the October 25th, 2012 issue of the New England Journal of Medicine.

Dead. How do you make someone “undead?” How, with just your two hands, can you prolong the time that paramedics have to restart a person’s heart? How can a normal, ordinary person make a difference and literally save a life?

We know that a person’s chances of surviving an out-of-hospital sudden heart arrest decreases by 10 percent for every one minute he/she does not get CPR (cardiopulmonary resuscitation).  I had learned about hands-only CPR in my medical training.  Hands-only CPR is where all you have to do is push hard and fast (to the tune of “Staying Alive”) at a 100 times a minute until helps arrives.

But time and time again, I cared for African-American patients in Atlanta who had laid in their families’ homes for critical minutes as their brains slowly died from a lack of blood supply from the heart.  Their hearts had stopped and no one called 911. No one placed their hands on the chest and started doing hands-only CPR.

Maybe this is just Atlanta? Is it the color of a person’s skin or is the place where he or she collapses that makes the difference?

In my Robert Wood Johnson Foundation Clinical Scholars Program (RWJCSP) at the University of Michigan (2007-2010), I learned about the importance of neighborhoods in determining a person’s health.  After wading through the literature, my a priori hypothesis was that having someone stop to provide CPR is completely dependent upon others; therefore, the neighborhood plays a large role in whether or not someone does CPR.

After consulting with my two RWJCSP alumni mentors, David Magid, MD, MPH, and Arthur Kellermann, MD, MPH, FACEP, the question became clear: What role does the racial and socioeconomic composition of a neighborhood have on an individual’s likelihood of receiving life-saving bystander CPR?