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Meeting the Need: Nursing Schools Chart Steps Toward Diversity - By Susan Borowski

Nursing is one of the top 10 careers for job growth listed by the U.S. Department of Labor, so as a profession in and of itself, nursing shows great promise — but even more so for minorities, given the increasing demand for cultural competency in patient care.

While the number of minorities enrolling in nursing programs is rising, the trend is not keeping pace with the changing demographic of the United States. Minorities will outnumber whites in this country in just three decades, according to U.S. Census projections, but they comprised just 26.8 percent of undergraduate nursing students in 2010-2011, according to an American Association of Colleges of Nursing (AACN) report on enrollment.

The safety of patients depends on their ability to be understood by healthcare providers, says G. Rumay Alexander, EdD, RN, clinical professor and director of the Office of Multicultural Affairs at the University of North Carolina School of Nursing. This means not only knowing about medications prescribed for certain disorders and what complications may be encountered, but also understanding a patient’s values and culture.

“Those who teach care providers must convey cultural relevancy,” Rumay says. “People expect us to provide safe care for them, which means that all of us need to understand these diverse populations. Whether it’s research, practice or service, we’re all responsible for equipping ourselves with that kind of knowledge.”

Few nursing schools have an office devoted exclusively to diversity. Fortunately, there are exceptions.  

University of North Carolina School of NursingG. Rumay Alexander, EdD, RN, director of the Office of Multicultural Affairs and clinical professor, UNC School of NursingG. Rumay Alexander, EdD, RN, director of the Office of Multicultural Affairs and clinical professor, UNC School of Nursing

The University of North Carolina at Chapel Hill School of Nursing manages its diversity initiatives through its Office of Multicultural Affairs. Led by Alexander, the nursing school’s diversity initiatives include the Pauline W. Brown Diversity Scholarship Award, which grants a scholarship to a student studying diversity in health care; an Ethnic Minority Visiting Scholar Lecture Series, which features the contributions of minority scholars; and the Courageous Dialogues program, which involves facilitated conversations to help faculty and staff explore issues related to diversity and inclusion.

Alexander helps faculty design more inclusiveness into their assignments and activities, and strives to create a climate that welcomes all students. She also works with admissions and curriculum committees.

“Most admissions criteria require students to write essays,” says Alexander. “If those sitting on the admissions committee say that English must be perfect, and someone writes in a way that is not perfect, but you understand what they’re conveying, which one is more important? My position is that you can teach them the English, but there are other things you cannot teach that you want in the qualities of a nurse.”

And while the number of males entering the nursing profession is increasing, “we as a society have to get past the stereotype that nursing is for women,” says Alexander.

To encourage dialogue on diversity and inclusion issues, Alexander will assign an article, movie, book chapter, play, or have a group of drama students create a reenactment of a situation that occurred, and then facilitate a discussion about it.

“We recently did a poverty simulation,” says Alexander. “People received assignments to play certain roles. I got them to walk in the shoes of someone whose socio-economic status is beyond anything they’ve ever fathomed. We talked about how it felt to experience those things.

“For example, it’s one thing to be white and poor; it’s another to be Native American and poor, or LGBT and poor. That’s not something everyone realizes,” she says.

Alexander says 98 percent of faculty and staff members participate in the Courageous Dialogues program. “It speaks very well for the school,” she says.

One way she gets people to understand the effect of their words and actions is to quote an old African proverb that has become well known around the school: “The axe forgets, but the tree remembers.”

The School of Nursing continually looks for ways to maximize its diversity. The goal of Pamela Johnson Rowsey, PhD, RN, coordinator of student diversity and recruitment, is to increase the number of baccalaureate students from underrepresented groups by 40 percent. To this end, she received a three-year, $640,000 grant from the Health Resources Service Administration, “Careers Beyond the Bedside.”

One goal of the grant program is to enroll a minimum of three underrepresented students in a doctoral program within one year of graduation. “Our workforce should ideally reflect what our state looks like to help alleviate disconnects between providers and the populations we serve,” says Rowsey.

Jana Lauderdale, PhD, RN, FAAN, assistant dean of the Office of Diversity and Inclusion and associate professor, Vanderbilt School of NursingJana Lauderdale, PhD, RN, FAAN, assistant dean of the Office of Diversity and Inclusion and associate professor, Vanderbilt School of NursingA teaching and learning experience in a Vanderbilt skills labA teaching and learning experience in a Vanderbilt skills lab

Vanderbilt University School of Nursing

As part of her job, Jana Lauderdale, PhD, RN, FAAN, evaluates Vanderbilt University’s School of Nursing curriculum on an annual basis. Lauderdale is assistant dean of the Office of Diversity and Inclusion and an associate professor. She reviews curriculum for cultural content and to ensure clinical experiences involve diverse populations in the region.

“You can’t know everything about everyone’s culture, but you do have to understand the populations you care for,” she says.

Vanderbilt’s undergraduate nursing students gain a broad understanding about underserved populations, Lauderdale says. “Our program is predicated on the care of vulnerable populations. Many students go to underserved populations, rural areas, reservations, the Appalachians, or homeless clinics in urban areas. We make sure that cultural competency is embedded across our curriculum.”

One of the school’s most successful programs is Academic Enhancement. “It’s for our incoming graduate students that we consider high risk,” says Lauderdale. “They may be students from rural areas or places where their high school didn’t offer the kind of coursework that would prepare them for graduate level work, they may have been out of school for a number of years or they’re switching to nursing from another profession.”

Students meet in bi-weekly sessions as a group; these sessions are videotaped so distance-learning students can benefit as well.

“We are also very strong in promoting successful interdisciplinary collaboration across campus,” says Lauderdale. One example is the Shade Tree Clinic, a free clinic run entirely by medical students to meet the needs of underserved populations in the area. Students from both the medical and nursing schools gain valuable, hands-on experience while serving the needs of the community.

Nursing diversity toolkits offered on Vanderbilt University Medical Center’s website are also a collaborative venture. One toolkit, the Resource on Transcultural Nursing, includes case studies of conflicts or misunderstandings that occurred in patient health care because the caregiver lacked understanding of the patient’s culture.

The medical school was awarded certification in 2012 as a Healthcare Equality Index (HEI) Leader in Lesbian Gay Bisexual and Transgender Health Care by the Human Rights Campaign. It was the only facility in Tennessee to earn the designation. 

“We emphasize the fact that our medical disciplines don’t practice in a silo,” says Lauderdale. “We all have to talk and work through topics to provide better care for patients.”

Jennifer Robb, coordinator for recruitment and retention, and Diversity Committee chair, OSU College of NursingJennifer Robb, coordinator for recruitment and retention, and Diversity Committee chair, OSU College of NursingOSU Student nurses performed biometric screenings as a public service for the Million Hearts Initiative during the 2012 Ohio State Fair.OSU Student nurses performed biometric screenings as a public service for the Million Hearts Initiative during the 2012 Ohio State Fair.

The Ohio State University College of Nursing

Although OSU’s College of Nursing does not have a designated office for diversity initiatives, Jennifer Robb is a full time coordinator for diversity recruitment and retention and chair of the Diversity Committee.

“Our Diversity Committee is comprised of faculty, staff and students and meets monthly to ensure we have a welcoming and safe climate for diversity and inclusion,” says Robb. “Every three years, we conduct a climate assessment and use the results to guide our initiatives. We regularly host diversity trainings, forums, panels, and film discussions to engage faculty, staff, and students in honest dialogue in a safe environment.”

There are several diversity-related student groups, including Student Ambassadors, N-SPIRE, the Student Diversity Committee and the Buckeye Assembly for Men in Nursing.  

“Our biggest diversity recruitment program is the Summer Institute for Diversity in Nursing,” says Robb. In this program, high school students spend time on campus over four days in August to obtain hands-on nursing experience with patient simulators, attend lectures, participate in skills labs, and tour the campus. Participants receive information about admissions and financial aid, and receive assistance preparing for the ACT.   

The goal of the program is to increase the number of underrepresented populations in nursing, which includes not only racial minorities, but also men. Most students who attend are economically disadvantaged.   

The summer program isn’t the only effort aimed at building a diverse pipeline. “Students at a young age need to be informed of the many opportunities in nursing and the need to develop a strong academic record,” says Robb. “We collaborate with community members, non-profit organizations, schools, and Ohio State health sciences colleges to develop outreach and recruitment events for underrepresented elementary, high school, and college students,” says Robb. “We have over 50 student ambassadors who volunteer at these events to share their love of nursing.”

The American Assembly for Men in Nursing named Ohio State the Best Nursing College for Men in 2008. At the time, 10 percent of undergraduate nursing students were male; in 2013, that number has risen to 14 percent. The graduate program has seen an increase from 15 to 20 percent in the number of male students.

Best Diversity Practices

Nursing programs seeking to enhance their diversity and inclusion programs should treat diversity like any other strategic priority, says Alexander, “which means you have a plan, goals, objectives, and accountability. That also means you give it money, time, and resources.”

Having a diversity champion on the school’s leadership team is also important: “There should be a safe place for people to raise their questions and examine their assumptions on the organizational level, as well as the personal level,” Alexander says.

Networking among colleagues also plays a big role in the national effort to bring more diversity to nursing, Lauderdale says. “Talk to someone that has an active, successful diversity program,” she says. “I receive three or four calls every few months from people looking for information and help developing a diversity program. I’m very open to sharing what I’ve done here.”

“It’s easy to let the numbers become the driver, but you cannot build with just the recruitment and retention of faculty, staff, and students,” Alexander says. “You must also create a climate where there is equality of opportunity and the ability of all humans to flourish.”

Jennifer Robb agrees. “When current students feel respected and welcome, they will be your most powerful recruitment tools because they will share their positive experiences about your program with prospective students and the community.”

The time for nursing schools to act is now, says Alexander. “This is not work that’s going away. This is going to be huge. We have massive changes before us and we have to get ready for them.”

Susan Borowski is a contributing writer for INSIGHT Into Diversity magazine.

Published in our April/May 2013 issue. 

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