Healthcare is limited in productivity if executed with a one-size-fits-all approach, therefore, the implementation of cultural competency in nursing is imperative for providing patients the care that they require as unique individuals. Introducing a diverse nursing workforce will allow for varying attitudes, values, goals, and practices to come together in pursuance of a more inclusive and culturally competent environment for all.
Cultural diversity in the nursing workforce is necessary in order to disband health disparities and promote health equity (Phillips, et al., 2014). Despite this need, Fullwood (2019) acknowledges an inadequate representation of African Americans in the U.S. nursing workforce. To gain clarity in regards to the demand for cultural diversity in the United States nursing workforce, we will focus on the history of African Americans in nursing, health disparities associated with the African American communities, and possible solutions that the healthcare education system and the healthcare industry can implement in order to recruit African Americans nurses.
African Americans have a deep-rooted history in nursing in the United States, confronted with the challenges of segregation and discrimination. Academic nursing education first began in 1862, though African American women had little freedom to pursue a career in nursing (Masters, 2018, p. 28). The education system during this era was in favor of whites and tainted with prejudice, depriving African Americans from free will to seek the ‘American dream’. During the early 1900s, African Americans had difficulties finding schools of nursing, professional organizations, and places of employment that would accept their applications (Masters, 2018, p. 34).
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African American nurses were restricted from the examinations for nurse registration, and hospitals commonly set quotas for African American nurses, from which further issues arose as they struggled to gather clientele that could afford their services (Masters, 2018, p. 34). The restraints placed upon African Americans throughout American history have affected their involvement and trust in healthcare, as well as their access to healthcare to great extents; these issues still impact African Americans and the quality of American healthcare to this day.
In our society, individuals are interdependent and the biases and cultural ignorance of those involved in healthcare have an immense influence over the healthcare system and its outcomes.
African Americans have the highest overall incidence of death rates from cancer of the lung, colon, rectum, prostate, and breast than any other ethnic/racial group. African Americans also have the highest incidence of and death rate from HIV-AIDS. Heart disease, diabetes and infant mortality rates are highest among African Americans. African Americans have the highest rates of homicide deaths (Clemons, et al. 2017).
The shocking statistics pertaining to African American health in the United States are not coincidental, the oppression of African Americans is still very much apparent to this day. Having diversity in the nursing workforce is vital to improving the outcome of African American healthcare. We need African Americans to have representation in the nursing workforce to develop cultural competence in nursing and to serve the changing and ever-expanding patient demographics. Reggie Fullwood, an African American writing for The Jacksonville Free Press, describes his preference of having an African American physician.
My primary care physician is an African American male doctor, and not because I don’t think that a white physician can do a good job, but because I feel more comfortable knowing that he’s an expert in the health issues that are prominent in the black community (2019).
It is important to consider that ethnic groups can be genetically and/or environmentally predisposed to certain conditions; cultural competence in healthcare is the best approach for educating the nursing workforce about these issues, in order to address these concerns. According to Fullwood (2019), experts predict the United States population will be predominantly composed of “minorities” by 2050. Unsuitably so, African Americans tend to be less trusting of hospitals and other healthcare settings than whites, which can lead to discrepancies with treatment and research (Clemons, et al. 2017).
If patients do not have confidence in the healthcare system, they are less likely to seek medical attention when necessary, which can be adverse to the growing demographic of African Americans in the United States. As stated by Clemons, et al. (2017), African Americans are less willing to participate in research trials, which can halt progress in understanding the processes of diseases, the effects of medications and treatment, and the overall improvement of the healthcare system. By supporting a diverse nursing workforce, the healthcare industry can build relationships with the African American communities, encourage patient trust, and therefore, increase patient safety.
To increase diversity in the nursing workforce, it is essential to implement strategies that will result in the recruitment of more African American nursing students and nurses. Organizations such as the National Black Nurses Association, the Association of Black Nursing Faculty, and the National Coalition of Ethnic Minority Nurse Associations are committed to reducing health disparities by bridging the gap in representation of minority students; they offer diverse nursing faculties, tutoring by faculty and peers, counseling, cultural competence training, grants, scholarships, and other financial assistance (Phillips, et al. 2014).
The aforementioned types of support being offered have been proven in research to reduce retention rates among minorities and ensure nursing education success. It is also necessary to improve public relations to attract African American students to nursing and reduce nursing related stigma (Henkelman, 2014). Institutions can decrease race-related stereotyping in regards to nursing by including the representation of African American students in brochures and advertisements, and starting the recruitment of minorities early on in middle and high school.
Nursing schools and organizations should also create a focus on developing initiatives to assist African American and minority students in finding internships and employment opportunities before they graduate, in order to ease their transition into the nursing profession and help to ensure they stay committed. By enacting recruitment strategies to heighten minority admissions, decreasing nursing-related stigma and stereotypes, and offering assistance with transition into internships and employment, nursing schools and organizations will be able to change the demographic of nursing to mirror the population.
As stated by Dr. Martin Luther King Jr. in Chicago, Illinois, on March 25, 1966 in his Speech to the Medical Committee for Human Rights, “Of all forms of inequity, injustice in health care is the most shocking and inhuman.”
The repercussions of centuries of African American oppression will not diminish within the span of one generation, nor will the attitudes that conceived it. Though diversity in the nursing workforce and cultural competence will make great strides in the effort to reduce health disparities among the African American population. Nursing schools, nursing organizations, and the healthcare system are ultimately in charge of the future demographics of nurses and can work to support the inevitable future where “minorities” become the majority. We cannot erase history, but can learn from it, act to implement change for the future, and disrupt it from recasting its dark shadow over the American healthcare system.
References
- Clemons, M. L., Brown, D. L., & Dorsey, W. H. L. (Eds.). (2017). Dream and legacy : Dr. martin luther king in the post-civil rights era. Retrieved from https://ebookcentral.proquest.com
- Fullwood, R. (2019, August 22). Lack of African American Nurses a Major Issue. The Jacksonville Free Press, pp. 4–4. Retrieved from http://search.proquest.com/docview/2292922767/
- Henkelman, W., E. (2014). Diversity in nursing education. Nevada RNformation, 23(2), 5. Retrieved from https://nuls.idm.oclc.org/login?url=https://search-proquest-com.nuls.idm.oclc.org/docview/1518914564?accountid=25320
- Masters, K. (2018). Role Development in Professional Nursing Practice (5th ed.) (pp. 28, 34). Burlington, MA: Jones & Bartlett Learning.
- Phillips, J., & Malone, B. (2014). Increasing Racial/Ethnic Diversity in Nursing to Reduce Health Disparities and Achieve Health Equity. Public Health Reports, 129(1_suppl2), 45–50. https://doi.org/10.1177/00333549141291S209
