Nurse Educators Seize the Moment to Focus on Diversity, Inclusion and Equity

By Dorsey Griffith
Contributing Writer

As a young nursing professor and a doctoral student at Western University of Health Sciences, Eugene “Alexander” Brown, MSN, RN, FNP-C knows it’s time for nursing schools to live up to their commitments to diversity, inclusion, and cultural sensitivity in the faculty they recruit, the students they enroll and the curriculum they deliver.

After a summer of protests, calls for social justice and acknowledgment of how systemic racism and other inequities pervade society and its institutions, Brown recognizes the opportunity – and imperative – to address these realities in health care. Like nurse educators up and down the state, he is working from within his institution to seize the moment and drive needed change.

“It’s finally a conversation we are willing to have,” said Brown, who is of mixed race and knows the value of his diverse family background in caring for patients. “It wasn’t always a conversation you could have in education. It’s a blessing to have people more awakened to this as an issue we can’t ignore.

The California Association for Nurse Practitioners (CANP) is focusing on the issue, as well, and has formed the Health Justice Work Group to address issues of equity, inclusion and diversity.

“CANP is committed to looking closely at our organization on every level, to learn how we can proactively address the problems of systemic racism and inequity,” said CANP president Patti Gurney. “We are willing to look within and learn what changes we should make, as well as help to equip California NPs to care for all people in the ways we all desire and deserve. We recognize the intrinsic value of each person, always seek to honor their unique needs, while doing all we can collectively and individually to make changes that make excellent compassionate health care a reality for everyone.

When asked to help develop a curriculum for a Care Coordination and Chronic Disease Management course at Western University last summer, Brown created a lecture about vulnerable populations with case studies on patients from 12 different groups, including LGBTQ individuals, veterans, and people who are unhoused. The course encouraged students to connect with each patient’s own experience and respond with compassion and realistic and useful resources.

"We are shaping their minds, how they view the world, how they see health care and how they see their patients,” he said. “We talk about humanism. What is that? It’s seeing others and being able to relate to them even when they have different beliefs, seeing them for who they are.

Brown’s work is part of a larger effort at Western University, where faculty have created an Office of Humanism, Equity, Inclusion and Diversity with a broad mission to set goals to build cultural sensitivity and eliminate racial bias, and to make meaningful changes that ultimately better prepare students for the future workforce.

In addition to his efforts around curriculum, Brown also is working on a project focused on admissions, recruitment, and hiring. Because Western University does not have an undergraduate nursing program, they will partner with other universities and high schools to build a stronger pipeline and support for Hispanic and Black students who want to enter the nursing field. 

At Holy Names University in Oakland, leaders hope to create an anti-racism certificate program that will be offered to the community, faculty, and students. They envision a course that would be offered over a few weeks with an opportunity for continuing education credits. The program would allow for the development of content masters and possibly even ambassadors who can bring the program to different audiences. 

The university has always had a focus on social justice and equity, but an anti-racism certificate program is a more deliberate approach that would make people more accountable, said Aimee Paulson, DNP, director of the FNP program.

“While most of us recognize that racism in the workplace cannot be tolerated,” she said, “we need to have people committed to the idea that racism has no home anywhere, and we have to take responsibility and promote social justice in all settings.” 

Ensuring that nursing education program pipelines are structured to attract and retain individuals from diverse backgrounds also is paramount, Paulson said. That means schools should not make it harder to enter the profession by eliminating the ADN to MSN option, for example. 

“There has been a movement to get rid of two-year nursing programs,” Paulson said. “If we want to promote diversity of the workforce, we need to maintain the entry levels that make earning this degree and entering this profession possible.”

Many nursing schools also are looking for ways to better support students from diverse backgrounds. Holy Names, for example, just received a grant to create a mentorship program that links students with local NPs of diverse backgrounds and sponsors student memberships in professional organizations whose goals include support for nurses of color and nurses who are LBGTQ or identify with other communities. 

“Through mentorship, we are engaging students with people who have similar backgrounds as one way we can support them to stay in the program, and then we can continue to reinforce that by having them come back to serve as mentors for other students,” she said.

Donna Emanuele, DNP, RN, FNP-BC, CNS, FAANP, is director of the Western University of Health Sciences DNP Program. She is also a member and co-chair collaborating with faculty, staff, and students on the Humanism Strategic Planning Group addressing curriculum and co-curriculum with Chief of Mission Integration leadership to advance a variety of initiatives addressing Humanism, Equity, Inclusion and Diversity across the health professions programs.

She said the university is working strategically across its nine colleges and 23 programs “Putting People First” to develop goals and implement action plans to improve diversity and inclusion and to live up to the university’s humanistic principles and core values. 

“For many institutions, including our own, you need to walk the talk,” she said. “The critical conversations have to occur now. Problems surface in conscious and unconscious bias, and we should be in a position to address them as a learning and teachable moment. This is what our students are asking for.” 

Universities are also encouraging faculty and staff to educate themselves on the issues of racial and social justice and equity issues. The UCSF Office of Graduate Education, for example, sent a letter to biosciences faculty and staff acknowledging the pain that Black students and postdocs, in particular, were feeling, and encouraging everyone to engage in knowledge-sharing around Black trauma, white privilege, and anti-racism, among other topics. It included a 9-page list of educational resources.

As a women’s health specialist at UCSF, Becca Neuwirth, MSN, WHNP-BC, ANP-C, encourages every nurse practitioner to take the time to explore the UCSF document and other relevant resources. Neuwirth has long been interested in reproductive justice, but the Black Lives Matter movement, protests against police brutality, and the poorer outcomes among Blacks and Latinos infected with COVID-19 have further motivated her to examine her own biases and white privilege – which she believes can ultimately affect the quality of health care delivered.

“It goes without saying that those of us who are NPs want to be good NPs and provide quality care,” she said. “We are not doing that unless we are aware of the implicit bias that we have and the systemic issues of racism, sexism, homophobia and transphobia, among other issues of equity, that exist in the world and that our patients experience.”

Neuwirth, who taught full time in the UCSF FNP program last year, said nurse practitioners can better serve their patients when they understand that race is not a risk factor for disease, but that racism puts people of color at higher risk for chronic conditions because of the stress and trauma caused by the constant experience of racism. She cited a comprehensive white paper developed by MD/MPH program students at UCSF and UC Berkeley as an excellent resource to learn more.

Surani Hayre-Kwan, NP, DNP, Director of Professional Practice and Nursing Excellence in the Office of Patient Experience at Sutter Health, became personally engaged in diversity work after a chance encounter with a friend whose client was an author of the third edition of the book, Culture & Clinical Care.

Early in her career, Hayre-Kwan read the book’s first edition during a diversity training course that was part of her master’s degree in education in the 1980s. The book’s chapters described different cultures and ethnicities written by people from those groups. Hayre-Kwan, who frequently used it as a reference, said it had a profound influence on her approach to caregiving.

“As a provider, we have a responsibility to take care of a patient from where they are coming from, to understand what the patient needs from their point of view, not ours,” she said.

Hayre-Kwan was contacted by the co-author, Suzanne L. Dibble, now 73, who was seeking someone to update the chapter on India. Hayre-Kwan, whose father is from India, jumped at the opportunity. The book, now in its third edition, has just been published.

“I am so excited about the concept of this book,” she said. “It’s so timely because it gives people real-life information about ethnic groups we are interacting with every day in our practice, written from the perspective of the people in those cultures.”