Leaders can play key role in ensuring health workforce is representative
By Lauren Dobson
May 30, 2022
- Nursing as a profession in Canada is largely homogeneous, thus failing to represent Canada’s diverse demographics.
- For the nursing profession to better reflect the population it serves, nursing leaders must acknowledge the lack of diversity and inclusivity in nursing education programs.
- Nine strategies are identified for nursing leaders to increase diversity and inclusivity in nursing education.
Nurses care for individuals in their most vulnerable, intimate moments. They are called upon in both an aspirational and a regulatory way to enable people to attain their highest possible level of health and well-being (Canadian Nurses Association, 2017). However, achieving this objective is hampered by the fact that the workforce does not reflect the demographics of individuals receiving care. Diversity and inclusivity are attributes that the nursing profession should strive for, but it is still overwhelmingly not reflective of Canada’s demographics, with the majority of front-line nurses being White, heteronormative females, especially at the leadership and managerial levels (Merry, Vissandjée, & Verville-Provencher, 2021).
Leaders in nursing education must recognize the prevalence of homogeneity in nursing education programs and take individual and collective responsibility to diversify the profession. The purpose of this article is to explore the need for diversification and inclusivity in regulated nursing programs and the ways that fulfilling this need could advance the profession. This article will also examine how nursing leaders can play a central role in increasing inclusivity and diversification in nursing programs, and how they can help recruit and retain students who reflect Canada’s demographics.
Diversity is defined as “having or being composed of differing elements” (Merriam-Webster, n.d.), or even more simply as “a point of difference” or merely “variety” (Collins, 2012). In the context of nursing leadership, diversity is understood to reflect differing sexes, races, cultures, religions, ages and abilities within the profession (Chicca & Shellenbarger, 2020; LeBlanc et al., 2020). Although there is little debate surrounding the importance of diversity in nursing, there is a significant “disconnect” between intention and implementation (Chicca & Shellenbarger, 2020).
Leaders play a role in enticing underrepresented populations to seek a career in nursing.
Even though 50 per cent of Canada’s population is male and 30 per cent of the population is non-White, the profession remains predominantly female, White and heterosexual (Fontenot & McMurray, 2020; Jefferies, Tamlyn, Aston, & Tomblin Murphy, 2019). By comparison, in Canadian medical schools, which have been traditionally male dominated, 56 per cent of students are now female, which more accurately reflects the Canadian population at large (Canadian Medical Association, 2019).
Males are not the only ones to be underrepresented in nursing; non-Whites also remain vastly underrepresented (Jefferies et al., 2019; Morrison et al., 2021). According to the University of Saskatchewan, “Aboriginal people make up 3.0% of the registered nursing workforce, but form 4.9% of the overall Canadian population” (Exner-Pirot, 2016). Since these statistics were published in 2016, there has been an increase in Aboriginal representation in nursing, as the Truth and Reconciliation Commission of Canada (2015) called for in Action #23 (Canadian Indigenous Nurses Association, 2019). However, there is still a shortage of Indigenous nurses, researchers and educators, thus leaving out important values and contributions to education (Brockie et al., 2021). Premji and Etowa (2014) found that minority ethnic groups “were under-represented in managerial positions and over-represented in lower-ranking positions” (Jefferies et al., 2019). Part of the problem is that diverse students are not being recruited or retained in nursing schools, and Indigenous health is not prioritized as a core component of some education programs (Brockie et al., 2021; Jefferies et al., 2019).
A lack of diversity also perpetuates discrimination in the nursing profession, indirectly leading to an exclusive environment where minority groups have noted feeling as if they do not belong or are omitted (Metzger, Dowling, Guinn, & Wilson, 2020). To address this, nursing culture should shift to one that embraces inclusivity, which can be understood as the “intentional incorporation of strategies and practices that foster a sense of belonging by promoting meaningful interactions among persons and groups representing different traits, perceptions, and experiences” (Metzger et al., 2020). Inclusivity is imperative in the nursing environment to help foster diversity and thus eliminate disparities and improve health outcomes (Chicca & Shellenbarger, 2020).
Relation to nursing leadership
The health-care system needs regulated nurses who are prepared to provide care in a variety of settings and to a diverse population (Chicca & Shellenbarger, 2020). A nursing workforce that does not reflect the nation’s demographic profile risks widening the health disparities that exist among majority and minority groups (Cary, Randolph, Broome, & Carter, 2020). Nursing education can play a pivotal role in enabling greater inclusivity and belongingness (Metzger et al., 2020). Nursing leaders are in the best position to attract a mixed student population, which will ultimately help achieve diversity and inclusivity in the workforce (Gates, 2018; Morrison et al., 2021). Leaders who embrace inclusivity harness the potential to build relationships, generate engagement and staff buy-in, increase performance, and enable positive health outcomes as well as a positive staff and patient experience (Morrison et al., 2021). Nursing leaders act as champions of change by promoting self-value, belonging and fairness (Morrison et al., 2021). With the right kind of leadership, nurses will feel empowered to help minority populations that are being silenced by the health-care system.
Strategies for improvement
Many researchers have acknowledged the need to attract and retain students of diverse genders, sexual orientations, races, cultures, religions, ages and abilities (Anthony, 2004; Cary et al., 2020; Gates, 2018; Jefferies et al., 2019; Merry et al., 2021; Morrison et al., 2021). Nursing leaders play a role in enticing underrepresented populations to seek a career in nursing (Kearns & Mahon, 2021; Morrison et al., 2021). When striving to increase diversity and inclusivity in nursing education, nursing leaders should consider the following strategies identified in the current literature:
- Ensure that clinical learning environments are diverse and include diverse demographics of patients (Chicca & Shellenbarger, 2020).
- Alleviate financial barriers endured by minority groups (Cary et al., 2020; Jefferies et al., 2019; Gates, 2018).
- Expose diverse youth to nursing experiences (Jefferies et al., 2019).
- Facilitate the integration of internationally educated nurses (Jefferies et al., 2019).
- Provide social support and mentoring for diverse students to encourage success (Cary et al., 2020; Jefferies et al., 2019)
- Integrate a diversity officer into human resources and admissions to advocate for minority groups (Jefferies et al., 2019).
- Challenge stereotypes by increasing the visibility of underrepresented groups in front-line and leadership positions (Jefferies et al., 2019).
- Consider options that are flexible and convenient, such as offering courses online and in the evening, thus accommodating a broader student population (Gates, 2018).
- Remove outdated admission and recruitment policies that might facilitate further homogeneity in nursing (Fontenot & McMurray, 2020).
Nursing leaders should understand that recruitment must explicitly address the invisibility and underrepresentation experienced by minorities in nursing (e.g., males, Indigenous people) (Jefferies, et al.,2019). However, it is essential to acknowledge that some challenges to diversity are beyond the control of the nursing leader (Gates, 2018). For example, students may be ill-prepared for the rigours of nursing school due to inadequate preparatory schooling (Gates, 2018). Another example may be that because all schools compete to attract students, minority students will be drawn to another institution for reasons unrelated to nursing (Gates, 2018). These reasons can include barriers, such as location and cost, and other factors that may make minority students view other types of professional training more favourably.
Nurses take pride in caring for everyone, regardless of age, gender, race, diagnosis, religion, culture, language, etc. However, Canadian regulated nurses themselves fail to reflect the diverse population they care for, with the profession being overwhelmingly White and female. Nursing leaders have the power to change this by working to increase diversity and inclusion in nursing education, thus generating a diverse workforce for the future. Leadership that both attracts and retains diverse student populations, including males and Indigenous nurses, is required. This is a worthwhile endeavour, as the literature shows that diversity and inclusion not only enhances patient satisfaction, outcomes and compliance, but also improves nurses’ communication, engagement and success. Greater diversity and inclusion fosters cultural safety and competent care, thereby increasing health-care accessibility for marginalized patients.
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Lauren Dobson is a fourth-year BScN honours student in the Faculty of Nursing, University of Alberta.