Strong diversity programs at the education level improve healthcare equity, research says.
Increasing diversity in nursing is considered essential to improving health equity, according to research that indicates benefits to communication, access to care, and patient satisfaction.
Cultivating such diversity must begin in nursing schools, where they can partner with the K-12 education system and diversify areas from where they accept students, says Caroline Njau, MBA, BSN, RN, NEA-BC, chief nursing officer (CNO) and senior vice president of patient care services for Children's Minnesota in Minneapolis.
"If your nursing college matches your [homogenous] city, you're not seeing the bigger world," she says. "It might mean that you look at a different community or county that is more diverse to try to see how you can bring in those students to your institution."
These three nursing schools are among those that are strengthening their diversity and inclusion programs:
Chamberlain University
Chamberlain University, with the largest school of nursing in the country, has developed a research-based framework—the Social Determinants of Learning™—to advance nationwide efforts in creating a more diverse pipeline of students entering the nursing profession.
The framework connects with social determinants of health, the widely accepted model that outlines conditions influencing health status and which serves as a reference point for healthcare leaders to define patient-focused community health solutions.
The Social Determinants of Learning framework identifies six core factors for schools of nursing to build a more diverse pipeline for school of nursing graduates:
- Physical health
- Psychosocial health
- Economic stability
- Physical environment/community
- Social environment/community
- Self-motivation
The framework, which is detailed in the paper Developing a Social Determinants of Learning Framework: A Case Study (Nursing Education Perspectives), includes examples of evidence-based initiatives addressing these factors, which can bridge social barriers to learning:
- Student admissions: Holistic admissions processes evaluate factors beyond standardized test scores and GPA. Chamberlain, based in Chicago, has adopted practices using personalized and data-driven approaches to assess student potential and outcomes.
- Student success: Personalized learning approaches, developed through the Chamberlain Care Student Success Model, encourage strong student outcomes. Pre-licensure BSN graduates experienced nearly a 13% increase in NCLEX pass rates from 2016 to 2020, and in 2020 the rates were above the national average, according to the team’s analysis.
- Mindfulness: An eight-week program integrated into Chamberlain’s pre-licensure BSN program was designed to support student psychological health as part of managing stressors that can be a barrier to student progress. More than 60 percent of participating students reported a reduction in stress levels.
Columbia University School of Nursing
The recently established Center for Sexual and Gender Minority Health Research (CSGMHR) at Columbia University School of Nursing in New York City is designed to help eliminate health disparities among sexual and gender minority (SGM) populations.
"While recognition of LGBTQ people's unique needs is growing, we lack solid evidence on how marginalization, stigma, and discrimination impact health," says Tonda Hughes, PhD, executive director of the CSGMHR, associate dean of global health, and the Henrik H. Bendixen Professor at Columbia Nursing.
"The center [supports] rigorous interdisciplinary research on the social, political, and economic determinants of health for SGM populations," she adds, "which will, in turn, inform practice and form a knowledge base for interventions to address health disparities."
Lack of access for SGM people to respectful, affirmative health care is well documented. Many LGBTQ individuals report having experienced discrimination by clinicians, including outright refusal of medical care, surveys have found.
Columbia Nursing has long been a research leader on SGM health, co-founding the Program for the Study of LGBT Health in 2012, together with the Division of Gender, Sexuality, and Health at New York State Psychiatric Institute/Columbia University Department of Psychiatry.
In 2019, the school hosted the first National Nursing LGBTQ Health Summit to create a national health action plan to raise awareness of and improve LGBTQ health.
Frontier Nursing University
While hospitals and other healthcare organizations work to rectify the health disparities and inequities revealed by COVID-19, one Kentucky nursing school has steadily contributed toward a more diverse, culturally competent healthcare system for more than a decade.
Frontier Nursing University (FNU), in Versailles, Kentucky, has strengthened its nationally recognized Diversity Impact Program to triple its student of color population from 9% to 28% in the last decade to better provide racially concordant care, or having a shared racial identity between a healthcare provider and patient, according to Geraldine Young, DNP, APRN, FNP-BC, CDCES, FAANP, FNU's chief diversity and inclusion officer.
Increasing that percentage has been intentional and strategic, Young says.
"When you have programs that focus in on diversity, equity, and inclusion, then you create an atmosphere of belonging, and you're doing things for diversity that are intentional," she says.
Frontier changed to a holistic admissions process and added in measures to ensure the inclusion or admission of students from a diverse backgrounds and rural and underserved areas by, for example, attending such conferences as the National Black Nurses Association or The National Association of Hispanic Nurses.
"The Diversity Impact Program became a part of the Office of DEI in 2018," Young says. "Creating the Chief Diversity and Inclusion Officer leadership role as a member of the President's Cabinet and the Office of DEI along with the activities of the HRSA Nursing Workforce Diversity Grant has been impactful as well. The holistic admissions changes noted were a result of the grant."
To retain students, Frontier provides mentoring programs, scholarships for students of color, tutoring, and peer mentoring, Young says.
"Not only do we look at bringing them in," she says, "but we … assist them in making sure they sustain throughout the process to be able to successfully graduate."
This story was updated December 24, 2021.
“If your nursing college matches your [homogenous] city, you're not seeing the bigger world," she says. "It might mean that you look at a different community or county that is more diverse to try to see how you can bring in those students to your institution.”
Caroline Njau, MBA, BSN, RN, NEA-BC, chief nursing officer (CNO) and senior vice president of patient care services, Children's Minnesota, Minneapolis.
Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand.