Category Archives: Voices from the Field
Angela Amar, PhD, RN, FAAN, is an associate professor at the Nell Hodgson Woodruff School of Nursing at Emory University and a Robert Wood Johnson (RWJF) Nurse Faculty Scholar. Her research focuses on traumatic experiences, especially violence, mental health responses to trauma, and aspects of forensic nursing. This is part of a series of posts looking at diversity in the health care workforce.
As a new nurse, I had just entered a patient’s room when he called out from the bathroom to ask his wife who was there. She replied, “it’s a lil’ colored girl to see you.” Luckily, I have a pretty good poker face and was able to not show outwardly how flustered I was inwardly. I was able to introduce myself and conduct my assessment in a professional manner. Over the next three days, I took care of this patient and as we built a relationship, he marveled and told his visitors what a great and smart nurse I was.
While I’d like to think that I am great and smart, I happen to know that I worked on a floor full of great and smart nurses, all of whom were Caucasian. The patient commented on attributes in me that he felt were remarkable and exceptional. He didn’t conceive that ‘a lil’ colored girl’ could be great or smart until we interacted.
"We often see the benefits of diversity as being for minorities. We seldom see that the majority benefits as well."
Fast forwarding to my role as a faculty member, I’ve worked in majority serving institutions where I’m often one of two or three African American faculty members and the numbers of African American students is also small. Frequent comments on my student evaluations are: “She’s so smart. She’s really intelligent.”
Regina Stokes Offodile, MD, CHSE, is an assistant professor in the Department of Medical Education, Division of Clinical Skills and Competencies at Meharry Medical College. She currently instructs first- and second-year medical students on clinical skills, physician patient interaction, and clinical correlations of breast disease. Her research interests include cultural competency. She is pursuing a Masters in Health Professions Education at Vanderbilt University. This is part of a series of posts looking at diversity in the health care workforce.
Cultural diversity in the health care workforce may be something that many have not thought about or considered a topic of concern. It is a concept that health care providers, health care delivery systems, and hospitals need to have on their radar. Having a culturally diverse workforce is a matter of patient safety. Employing a diverse workforce increases the likelihood of having employees who understand how a wide cross section of patients looks at disease, its diagnosis and treatment. A diverse workforce may also address the language barriers and cultural disconnect that may exist in some health care delivery systems.
In order to meet the increasing culturally diverse patrons of health care, there will be a need to have a corresponding change in the health care workforce. There will also be a burden on medical schools and residency training programs to produce culturally competent physicians, and to increase the number of physicians who are able to interact with and treat a culturally diverse patient population.
Carmen R. Green, MD, is an alumna of the RWJF Health Policy Fellows program. She is the associate vice president and associate dean for health equity and inclusion at the University of Michigan Health System, and a professor of anesthesiology, obstetrics and gynecology, and health management and policy. This is part of a series of posts looking at diversity in the health care workforce.
More than a decade into the 21st century, Americans still face diminished health and tremendous variations in health care, depending on what they look like, where they come from, where they live, what they earn, and other factors. Significant and persistent variability in clinician decision-making also exists based upon these factors.
The reasons for these inequities lie in part in disparities in the infrastructure for screening, diagnosing, treating and supporting patients leading to unequal treatment.
In an increasingly aging, female, and diversifying society, it is vital to have a diverse workforce to not only help put patients of varying backgrounds at ease but to provide care that is responsive to their needs and to achieve the best health care outcomes. It may be difficult for underrepresented and vulnerable people to trust the health care system if the employees largely come from the same place and have one perspective. Some of those perceptions actually become realities as biases can negatively affect patients that are marginalized and lower on the socioeconomic totem pole.
Janice “Nisa” Bruce is the director of San Juan College Department of Nursing in Farmington, NM. She has a BA from San Francisco State University, a BSN from East Central University Oklahoma, and an MS from the University of Oklahoma, College of Nursing. She has been in nursing higher education since 1988, and is completing her 20th year at San Juan College.
We began our New Mexico community college-university collaboration in late 2009 with the publication of a university-generated white paper articulating the Institute of Medicine (IOM) recommendations citing the need for more baccalaureate nurses to meet the health care needs of the 21st century. Of course to community college associate degree educators, that proposal smacked of the old entry level into practice argument that has divided nursing educators for decades. We gnashed our teeth, we complained to each other, we argued that the literature was flawed. Then we got busy. And the New Mexico Nursing Education Consortium (NMNEC) was born.
Little by little, over time, the pieces have fallen into place.
Timothy Landers, RN, CNP, PhD, is an assistant professor at The Ohio State University and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar.
The Great Challenges Program is an ongoing effort by the TEDMED community to provide innovative, interdisciplinary perspectives on the most complex and challenging issues in health care. A year-long dialogue facilitated through social media tools and panels of experts continued at the annual gathering of TEDMED 2013.
One of the themes of TEDMED 2013 was the creative and thoughtful use of big data and small data to improve health and health care.
Small data includes individual level information specific to an individual or circumstance. In small data, “n=ME.” A vast amount of individual level information is now routinely collected. However, a large volume of data is not required for small data to be useful—in the words of one TEDMED speaker, it’s not the volume of the data, but the complexity of existing data. Data must be available and accessible in order to be useful as well.
Big data refers to patterns of data and information available at the population level. The goal of big data is to use information and take a “macroscopic” view of health. It includes the ability to recognize patterns that are not obvious or readily apparent. Big data analysis permits us to go from pieces of data to collective wisdom, a theme of TEDMED 2013.
Kim D’Abreu is Senior Vice President for Access, Diversity, and Inclusion in the Policy Center at the American Dental Education Association. D’Abreu was previously the deputy director for the Pipeline Profession and Practice: Community-Based Dental Education program of the Robert Wood Johnson Foundation. This is part of a series of posts looking at diversity in the health care workforce.
The words we use matter. That’s why the American Dental Education Association (ADEA) is shifting the conversation away from the “deficit model” for recruiting students from underserved backgrounds. ADEA is specifically avoiding language that suggests “the numbers just aren’t there” or “the pool is not qualified.” When we describe underserved students as low-income or less prepared educationally, it suggests that the problem lies with them. It undervalues the students and ignores the wealth that they bring to the table in terms of cultural competence, initiative, and willingness to provide care to communities that need it most. But far worse, the deficit model allows the real institutional obstacles that these students face to remain in place.
Olga Yakusheva, PhD, is an associate professor of economics at Marquette University. Richard C. Lindrooth, PhD, is an associate professor at the University of Colorado Anschutz Medical Campus. Both are grantees of the Robert Wood Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative.
Technological innovation is rapidly transforming patient care. A new generation of innovations will potentially change the most fundamental aspect of the patient experience – patients’ interactions with physicians and nurses. The FDA recently approved the first autonomous telemedicine robot for use in acute care hospitals. Even more advanced technologies, some capable of processing up to tens of millions of pages of plain medical text per second, are being tested and may soon be used to diagnose conditions and recommend treatment, with limited input from clinicians.
"We suggest that nurses should embrace rather than fear these innovations."
This new technology has the potential to perform several tasks more efficiently than clinicians, albeit with some limitations. It can quickly and effectively sift through large amounts of information and, based on a complex set of guidelines, create a probability-weighted list of diagnoses and recommendations. The result will be purely evidence-based and free of human cognitive decision-making biases. The technology can drastically speed diffusion of new research and guidelines through electronic dissemination, similar to automatic software updates, and make most novel treatment regimens instantly available to patients.
Keon L. Gilbert, DrPH, MA, MPA, is an assistant professor in the Department of Behavioral Science & Health Education at St. Louis University's College for Public Health and Social Justice. As a Robert Wood Johnson Foundation New Connections grantee, his research focuses on the social and economic conditions structuring disparities in the health of African American males. His work seeks to identify sources of individual, cultural, and organizational social capital to promote health behaviors, and health care access and utilization, to advance and improve the health and well-being of African American males. This is part of a series of posts looking at diversity in the health care workforce.
I became a public health professional because I recognized a need to find opportunities and strategies to prevent the chronic diseases I saw silently killing African Americans in the community where I grew up. I vividly recall as a child the whispers surrounding the deaths of community members about cancer, diabetes (or sugar-diabetes, as it is commonly referred to in many communities still today), heart attacks, and strokes. I knew there was stigma and fear, but never heard of programs, interventions, or opportunities to stop these trends.
My interest in addressing these problems led me to pursue summer programs and internships during high school that allowed me to witness amputations of uncontrolled diabetic patients who had a range of clinical and social co-morbid conditions. Many of these amputees were living in poverty, they had Medicare or Medicaid, and the majority happened to be African American. This experience raised the question about prevention: How could I prevent African American men and women from having amputations? I never heard this conversation around prevention in my community. Many people seemed to accept the reality of developing these chronic conditions as a fate that could not be controlled.
I knew there had to be another way.
Gary H. Gibbons, MD, is director of the National Heart, Lung, and Blood Institute at the National Institutes of Health. He is an alumnus of the Robert Wood Johnson Foundation Harold Amos Medical Faculty Development Program. This is part of a series of posts looking at diversity in the health care workforce.
Growing up in a predominantly African American neighborhood in Philadelphia, high blood pressure, strokes, and heart attacks were common. When I got to medical school, I asked one of my professors why the African American community tended to have a higher prevalence of these medical conditions. He introduced me to biomedical science for the first time and challenged me to pursue that question on my own. I've continued to look for the answer to that provocative question ever since.
Similar to that early experience, mentorship has been a determining factor in my career trajectory. I might not have pursued a research career at all if it hadn't been for Harvard Medical School professor A. Clifford Barger who inspired me to ask and answer difficult research questions. The Robert Wood Johnson Foundation’s Harold Amos Program pushed me further with their emphasis on mentorship, which gave me a sense of community with the many scholars interested in the same research problems. It was my experience with a National Institutes of Health T32 training grant when I was starting out as an investigator that inspired me to give back to a younger set of minority researchers by becoming a K Award mentor and leading a T32 program at Morehouse School of Medicine.
Ann Marie P. Mauro, PhD, RN, CNL, CNE, is a clinical associate professor, fellow with the Hartford Institute for Geriatric Nursing, and the program liaison and project director for the Robert Wood Johnson Foundation New Careers in Nursing scholarship program at the New York University (NYU) College of Nursing, which has made extensive use of simulation. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.
For students in the health professions, the beauty of simulation is the ability to apply their critical thinking and assessment skills in a safe environment where they can learn without fear of harming a patient. Sometimes I think people learn much better from their mistakes. While simulation does not completely replace traditional clinical experiences, it is a great teaching strategy to help standardize students’ learning experiences, at both the undergraduate and graduate levels.
You can achieve targeted learning outcomes for students who have the opportunity to work with patients with specific health concerns. When we take students into a traditional clinical setting, we do not have control over which patients might be available and what students might be able to do. It is getting particularly challenging not only to find clinical sites, because of competition among schools, but to deal with health care organizations that have transitioned to electronic health records and electronic medication administration records, which are difficult for faculty and students to access. Furthermore, it is time-consuming and costly for faculty to be trained on different systems.