The United States is strongly trending toward becoming more racially and ethnically diverse. The U.S. Census Bureau says, “The U.S. is projected to become a majority-minority nation for the first time in 2043. All in all, minorities, now 37 percent of the U.S. population, are projected to comprise 57 percent of the population in 2060.”
As the nation goes, so goes the mix of patients in the U.S. healthcare system.
Yet, the diversity of nurses and other healthcare providers does not match that of the patients they serve. The American Association of Colleges of Nursing reports that in 2013, “nurses from minority backgrounds represent 19 percent of the registered nurse (RN) workforce.”
Does a workforce of nurses and healthcare workers that better reflects patient diversity deliver better care?
Does It Matter?
On the one hand, quality healthcare should be blind to diversity, meaning it must be delivered without regard to race, creed, or color — of both its patients and its care providers.
But, practically speaking, people are often more comfortable with people more like them than less like them. Will a pregnant Hispanic woman who speaks only Spanish communicate effectively with an African-born male nurse who speaks English as a second language? Sure, it’s possible. Specific personalities overcome generic categories of diversity every time.
There is no doubt that healthcare outcomes are related to diversity. The American Association of Colleges of Nursing in a report called “Diversity, Inclusion, & Equity in Academic Nursing,” notes, “Health inequities, including diminished life expectancy and poor health outcomes, vary based on race, ethnicity, culture, sexual orientation, gender identity, age, and socioeconomic status.”
And yet, as a measurable health outcome, it’s not so easy to prove.
Public Health Reports by Sage Journals says, “While numerous authors have reported on the various strategies and outcomes related to enhancing workforce diversity, the contributions of minority nurses in eliminating health disparities are not well documented.”
A report by the Sullivan Commission on Diversity in the Healthcare Workforce in September 2004 stated: “Today’s physicians, nurses, and dentists have too little resemblance to the diverse populations they serve, leaving many Americans feeling excluded by a system that seems distant and uncaring.”
That’s about as compelling as it gets in the eyes of evidence-based medicine: Minorities may feel excluded from the healthcare system because the people who deliver that care do not look, speak and behave as they do.
For most decision-makers in healthcare, that’s enough to encourage them to actively seek to increase the mix of diversity among healthcare providers to match the diversity of the public — and patients — at large.
Diversity of the Mind
There is more to diversity than can be measured by demographics and ethnic identity. In most situations, simply being aware of, valuing, and learning the differences between caregiving staff and patients is enough to overcome diversity divides and deliver the highest possible quality of care.
Learning a language, for instance, also helps teach about the culture in which that language evolved. The Atlantic reports that “The best interpreters can also relay cultural traditions that can help improve diagnosis or treatment plans.” For example, in some Mexican-American communities, healers sell powders that contain toxic concentrations of lead for treating indigestion. Someone who not only speaks Spanish but understands the Mexican-American culture might recommend harmless traditional medicine, such as warm oils rubbed on the stomach while warning patients away from toxic treatments.
A deeper knowledge of diversity comes from deeply researching the particular needs of different populations. The Online Journal of Issues in Nursing notes that “the therapeutic range of lithium for manic patients in Japan and Taiwan” is considerably lower than the range for those from the United States. A native-born nurse from Japan or Taiwan would be more likely to know this than one from another culture. Better yet, a nurse from any culture who took the time to learn to speak Japanese or Taiwanese might also tend to be curious, and therefore learn, about the specific needs of their community of interest.
The value of having a culturally diverse nursing workforce is obvious, but hard to measure — and even doubly hard to achieve. It requires recruiting from culturally diverse groups as well as cross training among all groups to engender ever greater communication and understanding.
The long-term results will be outcomes that level out and become similar across all cultural and demographic boundaries and patients who are happier because they are welcomed and understood as well as healed.
Learn more about the UAH online RN to BSN program.
American Association of Colleges of Nursing
United States Census Bureau: U.S. Census Bureau Projections Show a Slower Growing, Older, More Diverse Nation a Half Century from Now
American Association of Colleges of Nursing: Enhancing Diversity in the Workforce
NCBI: Increasing Racial/Ethnic Diversity in Nursing to Reduce Health Disparities and Achieve Health Equity
The Atlantic: Speaking the Language of Health Care
The Online Journal of Issues in Nursing: Many Faces: Addressing Diversity in Health Care