Embracing Diversity in Nursing to Improve Healthcare

Historically, the nursing profession has adapted to meet the ever-changing needs of the communities it serves. The challenge facing healthcare today is the requisite for an organized commitment to support and embrace diversity while promoting concepts of inclusion, cultural competence, and clinical excellence.  It is nursing’s professional obligation to advocate for quality patient care for all members of society — and nursing is up for this challenge.

[Above: Lee Anne Lightfoot (left) and Danielle M. Quintana]

Defining Diversity
Diversity encompasses age, culture, beliefs, customs, ethnicity, race, religion, gender, sexual orientation, gender identity, geographical location, educational background, and socioeconomic status, and these facets should be represented among nursing students, faculty, and staff. It is essential for nurses to understand the scope of diversity in order to seamlessly deliver quality healthcare across the continuum.

Promoting Progress
In 2001, the American Association of Colleges of Nursing (AACN) urged nursing programs to strengthen their efforts to attract and retain diverse students in order to mirror the nation’s population. Fifteen years later, while nursing education programs and the profession have made progress in terms of embracing diversity, there is still more work to be done.

Students at the University of Houston School of Nursing
Students at the University of Houston School of Nursing

There is a strong need to recruit diverse faculty to nursing education. According to AACN data from 2016, only 14.8 percent of full-time nursing professors are from minority populations, and just 6.9 percent are men. There is also an imperative to recruit more diverse students into nursing programs. In 2012, individuals from underrepresented minorities made up 28.3 percent of all nursing students in baccalaureate programs. In 2014, that number rose slightly to 30.1 percent, supporting the notion that there is great opportunity for improvement. In order to serve diverse populations, efforts must be made to increase diversity in the nursing workforce.

Leading the Way
According to the Rice Kinder Institute for Urban Research, Houston, Texas, is the most racially and ethnically diverse large metropolitan area in the nation. Sugar Land, a suburb of Houston in which the University of Houston School of Nursing (UHSON) is located, mirrors these demographics. In fact, in a 2013 New York Times article, Houston political strategist Mustafa Tameez discussed the diverse community of Sugar Land. “[It] has become a multicultural city — rather than a melting pot — with various ethnic communities, each maintaining its identity.” This city is a microcosm of what the rest of the country will look like in the next 20 to 30 years.

Considering the increasingly diverse populations that healthcare professionals serve, what are nursing programs doing to prepare for the future?

This question is being addressed at UHSON. The school is leading the way in exemplifying what diversity in nursing should look like and has exceeded the national trend in underrepresented minorities in nursing education. The student body at UHSON is 62.6 percent diverse, which is represented by American Indians (3.4 percent), Asians (21.1 percent), Hispanics (23.7 percent), and African Americans (14.4 percent). This complement of diverse students is a result of not just regional demographics and geographic circumstance, but also strategic planning. Although these numbers are significantly higher than national averages, recruitment and retention strategies are in place to support the continued growth of diversity at the school.

Infusing Best Practices
Preparing for the future should begin with the development of a mission statement and strategic plan to formally designate diversity as a priority in nursing programs. The journey starts by encouraging minority students to apply. Once they enroll, support mechanisms should be implemented to promote success in each of the following areas: scholarship, leadership, national recognition, and clinical excellence. The ultimate goal is graduation, licensure, and employment in the community.

Best-practice initiatives for diverse nursing students must also be developed to support clinical and academic achievement. To accomplish this objective, consider implementing some of the following strategies that have worked well at UHSON. These practices approach diversity from a multitude of angles:

● Articulation agreements like the Consortium for Advancing Baccalaureate Nursing Education in Texas (CABNET), which provides students with a seamless transition from an associate degree nursing program to a baccalaureate of science in nursing program

● Affiliation agreements that provide students with multifaceted, cross-cultural, and clinical experiences in urban, suburban, and rural settings

● A welcome ceremony designed to introduce new students and their families to the profession and strengthen their support networks

● Cultural competency exercises and activities integrated into the curriculum to enhance knowledge, understanding, and respect for different groups

● A dedicated advancement specialist available to students to support their academic success

● Mentorship initiatives such as a male faculty-led program designed to support male student retention, academic progress, and achievement

● Faculty implicit bias surveys to heighten awareness, increase sensitivity, and encourage the embracement of the teaching-learning process

● Faculty appointments that mirror the diversity of the student and community populations

● Marketing materials designed to attract minority students

● Library and writing resources to support English as a Second Language (ESL) students

● Recruitment efforts targeted toward prospective diverse students

Advancing Health
In 2008, the Robert Wood Johnson Foundation and the Institute of Medicine partnered to launch a two-year initiative to assess and transform the nursing profession with the goal of advancing health. The report, titled The Future of Nursing: Leading Change, Advancing Health, provides a thorough examination of how nurses’ roles, responsibilities, and education should be adjusted to meet the needs of an aging, increasingly diverse population and to respond to a complex, evolving healthcare system. Mirroring the diverse population with an equally diverse student body positions nurses to achieve those goals and eliminate health disparities.

According to the AACN, “with [U.S. Census] projections pointing to minority populations becoming the majority by 2043, professional nurses must demonstrate a sensitivity to and understanding of a variety of cultures to provide high-quality care across settings.” Continued analysis of current and future trends is necessary for nurses to respond to an increasingly diverse world.

Institutions of higher education, especially those preparing students for the healthcare industry, must embrace diversity or be left behind. It is forward thinking that will position nursing schools to meet or exceed the ever-changing needs of students and the communities they will serve.●

Lee Anne Lightfoot, MSN, RN, NE-BC, and Danielle M. Quintana, MSN, RN, CNOR, are assistant clinical professors at the University of Houston School of Nursing.