INSIGHT Into Diversity magazine has just recognized Frontier Nursing University’s commitment and accomplishments for the second consecutive year. FNU has now added the 2019 Health Professions HEED (Higher Education Excellence in Diversity) award to their shelf alongside their award from 2018.
About the Health Professions HEED Award
“The Health Professions HEED Award process consists of a comprehensive and rigorous application that includes questions relating to the recruitment and retention of students and employees and best practices for both; continued leadership support for diversity; and other aspects of campus diversity and inclusion,” said Lenore Pearlstein, co-publisher of INSIGHT Into Diversity magazine. The magazine is the oldest and largest publication on this topic in higher education and is well-known for its annual Higher Education Excellence in Diversity (HEED) Awards.
Pearlstein adds, “As we continue to see a record number of Health Professions HEED Award applicants each year, nearly every school tells us they use the application itself as a tool to create new programs and to benchmark their accomplishments across campus. The process allows them to reflect on their successes and also determine where more work needs to be done. We also continue to raise the standards in selecting HEED institutions.”
Diversity Impact at Frontier Nursing University
FNU’s history of emphasizing and valuing inclusion was formally instituted nine years ago, when it instituted the Diversity Impact Program in 2010. Each summer, FNU holds the Diversity Impact Conference for nurse practitioner and nurse-midwifery students plus faculty and staff to foster collaborative discussions, address health disparities, and find proactive solutions to improve minority health among underrepresented and marginalized groups.
initiatives span all facets of the university, but one of the most telling and
important data points is the percentage of students of color enrolled at FNU.
In 2009, that number was 9 percent. In 2019, it has grown to 23 percent.
“We are incredibly
proud to receive the prestigious HEED Award again this year,” said FNU
President Dr. Susan Stone. “To receive this award two years in a row is a
wonderful honor. Our graduates serve people of all races and cultures and are
increasingly coming from diverse backgrounds. It is imperative that our
students, faculty, and staff have cultural awareness and competency in order to
effectively advance our mission. The HEED Award confirms the value of our
efforts and validates our continued emphasis on diversity and inclusion within
the culture of FNU.”
INSIGHT Into Diversity Magazine
INSIGHT Into Diversity magazine is the oldest and largest diversity publication in higher education today and is well-known for its annual Higher Education Excellence in Diversity (HEED) Award. In addition to its online job board, INSIGHT Into Diversity presents timely, thought-provoking news and feature stories on matters of diversity and inclusion across higher education. Articles include interviews with innovators and experts, as well as profiles of best practices and exemplary programs. Current, archived, and digital issues of INSIGHT Into Diversity magazine are available online at insightintodiversity.com.
For further information on Frontier Nursing University and the Health Professions HEED Award, visit the FNU site.
NEW ORLEANS — Everyone has unintentional biases, but physician practices can mitigate them with a few simple steps, experts said here.
The speakers defined unintentional biases as “stereotypes or beliefs that affect our actions in a discriminatory manner.” Such bias may affect our actions in a way contrary to our intentions, two speakers said at the Medical Group Management Association annual meeting.
Unintentional biases — also known as unconscious biases — can work against a practice’s commitment to diversity in hiring and workplace inclusion, said Steve Marsh, founder of The Medicus Firm, a physician recruiting firm in Dallas. “Diversity and inclusion go hand in hand,” he said. “you can do a good job of diversity hiring, but if you don’t have an inclusive environment that’s welcoming to all the people you brought in, it’s worthless; in fact, it can backfire on you.”
Achieving these goals “isn’t real complicated, it’s just really hard
to do,” he added. “You can’t do a a crash diet on diversity hiring; you
can’t do a crash diet on inclusive culture. It’s a lifestyle, not an
188 Types of Bias
Pam Snyder, head of recruiting at Baystate Health, a healthcare system based in Springfield, Massachusetts, cited the launch of the video viewing site YouTube as an example of the perils of a non-diverse workforce. When YouTube’s mobile version launched, “there was a glitch in it — 25% of people were reporting it wasn’t working,” she said.
The reason? The mobile version was designed entirely by people who were right-handed and all turned their phones a certain way to see videos; left-handers turn their phones the opposite way, so the videos all appeared upside down. “Because they had that lack of diversity on their team, the product wasn’t launched accurately.”
A total of 188 types of unconscious bias have been identified, Snyder said. She listed four of the most common types:
Affinity bias: We tend to be more receptive to people who resemble our lives in some way. For example, Snyder was hiring a new recruiter on her team, but happened not to be there on the day one candidate came in for an interview. But during a follow-up phone call about the candidate, “I had at least three different staff people say, ‘You’re going to love her; she reminds me of your daughter.’ That was their affinity bias.”
Confirmation bias: We look for information that supports our beliefs and ignoring details to the contrary. Snyder, who is from Tennessee, explained that “when you hear someone with an accent like mine … you think they’re not well-educated. Confirmation bias is when you look for things when you’re talking to someone that confirms that.”
Halo effect: There’s something good about someone and because of the one good thing, we think everything about them is good. “In Tennessee, when we got a CV and it was from a Harvard grad, we’re like, ‘We’ve hit the jackpot,'” she said. “This halo effect was real; there were things we’d ignore about that candidate because of what was on their CV.”
Perception bias: This one is “really scary, worse than confirmation bias,” said Snyder. “You know it — you’ve met one person that had these physical and emotional attributes and you’ve formed your opinion and you can’t get away from that. That’s really the scariest when it comes to recruitment.”
Steps to Overcome Bias
To overcome unintentional bias, “the first thing we have to do is accept the fact that we have it,” said Snyder. “We can’t control the experiences we have had.” She suggested taking an “implicit association” test such as this one offered by Harvard. “You need to take an honest look at your unconscious.”
To mitigate bias and foster a diverse workplace, organizations are
moving toward competency and evidence-based recruitment, she continued.
Part of the competency-based evaluation for interviewees involves asking
behavioral event interviewing (BEI) questions involving something the
person experienced in the past. Such questions often begin with “Tell me
about a time when…”
“Tell Me About…”
For example, one practice wanted to know whether its candidates for a physician slot would be able to handle the workload, which involved seeing as many as 25 patients per day with only one medical assistant and a shared RN. So they might ask candidates the following about their previous job experience: “Tell me how many patients you saw in a day and what support you had.” If the candidate answers, “I saw 10 patients a day, and had two medical assistants and my own RN,” that might mean that the candidate isn’t a good match for the position, she said.
A question to ask when you want to find out about the candidate’s teamwork abilities is, “Describe a time when you were part of a team that worked well together. What role did you play? How did you show respect for others on the team?” said Snyder. Candidates’ egos can really be revealed with this answer; if they answer the question by just talking about themselves, “it’s a big red flag for us.”
When developing questions for a competency-based evaluation, it’s important to get buy-in from the staffers working in the department being recruited for, and to ask all the candidates the same questions, she said. Having a diverse panel of interviewers is also critical. “If you’re looking at an interview panel of all white males, you failed.” Also, panelists should work in a variety of positions at the company: “if you’re hiring a surgeon, you need someone from the surgery department that’s a non-provider … When you have those different inputs, you get a stronger decision.”
Benefits of Diversity
In addition to unintentional biases, practice managers need to be on the lookout for intentional ones as well, according to Marsh. For instance, “over the last 2 or 3 years, I’ve seen one of the biggest intentional biases ever creep in: politics,” said Marsh. “Five times in the last 2 years — not in group settings, but in individual meetings — I’ve heard, ‘We can’t recruit a Republican’ or ‘We can’t recruit a Democrat.’ I’ve heard it on both sides of the aisle. People have some very strong polarizing biases in the environment we’re in right now, but it has nothing to do with competency. It has nothing to do whether they’re good for this role.”
Hiring a diverse workforce results in more creativity, according to Marsh. “You have all these ideas coming in that you never would have had if everybody looked and acted the same,” he said. “If we’re able to create an environment where everybody has a voice, you’re going to have meetings — and be thankful for them — where somebody says, ‘I don’t think that’s a good idea.’ If you have an inclusive environment and welcome additional ideas, many times you’ll avoid pretty bad circumstances.”
Once a diverse workforce is on board, the next step is to work on inclusion, defined as “a feeling of belonging, a feeling of being appreciated for unique characteristics, and the extent to which employees feel valued, respected, accepted, and encouraged to fully participate,” said Marsh. And you have to have a meaningful process for addressing bias-related concerns. “You can do everything right, with all the good intentions in the world, but if you’re scared to address the issues, it all goes for naught because everybody’s watching.”
A fundamental tenet of culturally competent care for patients is providing clinically and personally pertinent information to patients in a language that they understand. As the diversity of non-English language speakers increases in the United States, nurses may find a new area of priority in advocating for their patients to overcome language barriers.
Fortunately, the Office for Civil Rights within
the U.S. Department of Health & Human Services (HHS), serves to protect
non-English speaking or limited English-speaking patients. Nurses,
however, can do this on a smaller scale in their daily work.
In accordance with Title VI of the Civil Rights Act of 1964, and the guidelines for developing a language access plan by HHS, health care institutions that receive federal funding must provide language assistance services suitable to the communities that they serve. This is assessed and implemented based on a stepwise approach appropriate for the patient population, qualified language service personnel, and interpretation devices and technology. Furthermore, health care personnel will be trained sufficiently and regularly to maintain an understanding of both the logistics and necessity of utilizing these services. This is especially true for nurses, who often have initial and ongoing close contact with patients.
Patients who speak limited or no English may be unwilling to admit that they do not understand the nature of their health care visit or its intended outcome. This is a detriment to both the provider and patient as the provider may proceed with a treatment plan with the belief that the patient is cooperating. It is easy to see how this can create increased stress and fear for the patient when actions are taken on behalf of their health that they did not corroborate and may not agree with. Regardless of the reasons for the patient’s decision to withhold their lack of understanding, health care professionals can take responsibility for establishing mutual understanding and help prevent these occurrences.
Utilize Available Technology
Fortunately, technology provides many resources today that allow for effective interpretation between providers and patients. Most hospitals have a team of on-site personnel that are credentialed interpreters in languages appropriate for the patient population of that site. For those languages that are less common, there are many devices, including phones and tablets, that provide immediate 24-hour access to remote medical translators in virtually every language. Many of the written documents that patients are exposed to are now offered in languages other than English as well.
Find a (Qualified) Translator
With a full understanding of the services offered, patients may decide that they prefer a family member to translate. Although it is not ideal because family members may lack health literacy, it is the patient’s prerogative to make that choice. If the patient requests that a bilingual nurse translate, he or she can only do so if the nurse has been credentialed in accordance with their facility’s policies related to medical interpreting. This is especially true regarding important documentation such as informed consent and does not include casual conversations or explanations.
It’s not a lack of resources, but a lack of understanding, that prevents non- or limited English speakers from getting what they need in health care today. Despite all of the services offered, providers may still try to take shortcuts for the sake of efficiency. As patient advocates, nurses can be mindful of patients and ensure that understanding is complete by utilizing interpreter services and reminding providers of the services available.
Under the aegis of the Diversity Impact (DI) Program at Frontier
Nursing University, faculty and students are the vanguard of the movement to diversify
the ranks of nurse practitioners and nurse-midwives and improve health care
conditions among the underserved and marginalized.
Frontier’s current Chief Diversity and Inclusion Officer, Dr. Maria Valentin-Welch, takes great pride in the students’ achievements during and after their participation in the DI program, and says: “they are applying what is taught here in regard to diversity, inclusion, and equity, not only within their new areas of employment as graduates but across their communities. Some have established underserved programs, birth centers, and international programs. These students are passionate advocates for the underserved and disenfranchised people. They are the future catalyst of change.”
In addition to distributing some $300,000 in scholarship funds received through their Health Resources and Services Administration’s Nursing Workforce Diversity Grant, the program has implemented diversity training sessions for all faculty and staff and added diversity discussions to student orientation sessions. DI participants are also encouraged to attend annual conferences dedicated to fostering a more diverse, culturally aware health care workforce—where, under the guidance of a faculty mentor, students explore the benefits of active participation in professional nursing organizations.
The thriving program at Frontier received a 2018
Health Professions Higher Education Excellence in Diversity (HEED) Award
from INSIGHT Into Diversity magazine, and was cited as
a “Top College for Diversity.” In addition, the magazine added Dr.
Valentin-Welch herself to their Top 25 Women in Higher Education roster of standout
diversity advocates at US colleges and universities.
For an experienced professional proponent of diversity
and inclusion, the most daunting challenge, according to Valentin-Welch, is maintaining
belief in the goal of “uniting folks while our nation is receiving messages of
division and promoting actions of division and lack of compassion… However, I
feel midwifery and nursing have always held an important role in not only
listening to people, but also advocating for what is right.”
For further details on the Diversity Impact Program at
Frontier Nursing University, visit here.
There is much discussion about the need for diversity in nursing and the importance of educating a health care workforce that mirrors the population. Recently, Dr. Ernest Grant, president of the American Nurses Association wrote, “A diverse workforce allows us to use our varying cultural perspectives to ensure all patients and populations receive optimal and empathic care, which also may speed up their recovery and reduce the risk of preventable chronic conditions.”
Powerful words – “speed up their recovery and reduce the
risk of preventable chronic conditions” – which are exactly the actions and
goals we should be striving to achieve in an effort to increase the health of
the population and eliminate health disparities.
While contemplating diversity in nursing, a few key population statistics are worth considering. According to the U.S. Census Bureau, 49.2% of the American population are men, 41.5% of the American population are of a race other than Caucasian, and 21.3% of the American population speaks a language other than English at home.
However, according to the 2017 National Nursing Workforce Survey, just over 9% of working RNs are men, and only 19.2% are minorities. While reliable data about the number of nurses who speak a language other than English is scarce, based on the statistics demonstrated above, it’s unlikely this number mirrors the population.
In order to reduce health disparities by addressing inequalities and eliminating care gaps, it is critical to educate a vast and diverse health care workforce. The systems that educate and train nurses should place a focus on increasing the diversity of their nursing student population. Another key step is to make programs increasingly accessible through holistic admissions processes to admit a larger number of qualified nursing students.
Additionally, providing students with exposure to patients of all types of backgrounds and demographics during education and training, will help them achieve a better understanding of patient needs and how they can connect with them to provide quality care and improved experiences. Diversity in all its forms, from innate characteristics including age, race, and mental health to acquired characteristics like religion, education, and language skills, requires an awareness and respect for every person. This helps transition students from viewing their work through a cultural competence to a more inclusive lens of cultural humility.
Building cultural humility begins with a better understanding of the unique challenges every student faces and putting in steps and processes for helping them succeed while in their program. By teaching students that they are cared for, students are able to better focus on providing exceptional care for others. Putting each student at the forefront at each touchpoint and never letting them lose sight of their passion for health care, helps them become an extraordinary nurse who cares for others.
While minority enrollment in nursing programs have nearly doubled in the last twenty years, nursing has a long way to go in appropriately representing minorities in the United States (source). The current enrollment data is insufficient to address the needs of a future diverse nursing workforce. It is imperative to advocate for minority nurses in both higher education and the profession.
Diversity in Professional Nursing
Increasing diversity among nurses is a core value of the profession. The National League for Nursing promotes diversity by endorsing a culture of inclusion and excellence by celebrating a diverse population of professionals. The American Nurses Association has a professional commitment to awareness of diversity issues and the individual nurse’s biases and perceptions. For the culmination of a diverse nursing workforce to take root, schools must aim to recruit, enroll, and retain minority nursing students.
Diversity Among Student Nurses
Modern nursing programs work to disseminate a curriculum that concentrates on how to address health disparities among ethnic minorities and others who face socioeconomic barriers. Early recruitment programs that value diversifying nursing education can bolster student retention and graduation (source).
The Diversity Impact Program
For example, Frontier Nursing University increases student recruitment and retention through the Diversity Impact Program. This program offers cultural awareness and support through a social network, activities, and events during the year to connect students, including a Diversity Impact conference.
By implementing a model where student nurses embrace and encourage cultural awareness, student retention and satisfaction improves. Creating an engaging model that embraces cultural diversity is imperative to minimize student attrition. When student nurses support each other, it enhances the outlook for the entire nursing profession.