A patient was scheduled to have open-heart surgery at a Nashville hospital last year when a thorny problem arose. The woman’s husband insisted that no African-American men be present in the operating room during the surgery. According to newspaper accounts, he told the surgeon that his wife did not want black men viewing her nude body. The couple had approached a doctor at another hospital, who had refused the request. But the surgeon in this case chose to honor it, fearing that the patient would not agree to the lifesaving operation otherwise.
So when an African-American male perfusionist was assigned to operate the heart-lung machine on the day of the operation, the surgeon replaced him with a white technician. The move angered many local health care professionals and the surgeon later called his decision a mistake.
But for the Tennessee Hospital Association, the troubling incident became an opportunity for learning. The association’s Council on Diversity addressed the issue head-on and developed a case study for its member hospitals to use in their diversity training initiatives.
Diversity has been a buzzword in the corporate world for the last decade. Many large corporations have hired diversity consultants and created internal diversity management positions to help their organizations recruit and retain a more diverse work force, create corporate cultures that value diversity and address racial conflicts. Some of these initiatives came about after companies were sued for bias, while others grew out of employers’ proactive realizations that having a culture that valued diversity would give them a competitive edge in the marketplace.
Although health care organizations have been a bit slower to come to the diversity table, a growing number are beginning to address this issue. Groups such as the Tennessee Hospital Association’s Council on Diversity are working hard to open up discussion on difficult topics and spark action to encourage equal opportunity in the workplace. Some of these efforts are being led by minority nurses, whose education, training and life experience have specially equipped them to handle this critical issue.
“Certainly I think nurses are well suited for these [diversity management] roles,” says G. Rumay Alexander, RN, EdD. “Nursing is a good springboard for a lot of things, but the rest of the world has wanted to keep nurses in traditional roles.”
Alexander, an African-American nurse, leads the Council on Diversity for the Tennessee Hospital Association. She helped create the group through her position as the association’s senior vice president for clinical and professional practices.
Rupert M. Evans Sr., MPA, FACHE, president and CEO of the Institute for Diversity in Health Management (IFD) in Chicago, also believes minority nurses can play an important role in diversity initiatives, particularly in efforts to build better relationships with communities and remove cultural barriers to health care.
“Nurses have a lot of experience in patient education and staff development,” he points out, adding that this makes them naturals for helping health care organizations improve their cultural competence.
Deborah Washington, RN, MSN, director of diversity for patient care at Massachusetts General Hospital in Boston, says nurses are passionate about caring for patients, which is the basis of equal opportunity health care--providing quality care regardless of race, gender, age or ethnicity. “A good nurse will never back off from the question of ‘What can I do to provide the best for my patient?’” she says. “Nursing, regardless of a nurse’s race or ethnicity, is all about quality of care.”
Minority nurses, Washington adds, bring directness to discussion about diversity. “We are initiators of the conversation that needs to be had. We bring energy to that conversation.”
Evans reports seeing a significantly growing interest in diversity among health care organizations in the last year. He believes this stems from the simple recognition that society is changing rapidly and that organizations must respond accordingly. Creating workplaces that value diversity isn’t just about doing the right thing—it also makes good business sense.
“It’s really a matter of survival,” agrees Cynthia Barnes-Boyd, RN, PhD, FAAN. “With so much competition in the health care industry, hospitals can’t afford to have patients not select them because they don’t feel comfortable there.”
Boyd, an African-American nurse, is director of the Great Cities Neighborhood Initiative at the University of Illinois in Chicago. In her job, she administers a variety of community-based projects, such as school-based clinics and a home health care program for families with special needs. She is also an expert in helping organizations, such as hospitals and health care centers, meet the needs of diverse communities.
In her position at Massachusetts General, Washington, who also is African-American, facilitates conflict resolution among staff and management, teaches culturally competent care and serves on a variety of committees that address diversity issues. A former biomedical tester, Washington had begun a second career as a staff nurse at Massachusetts General when a supervisor asked her to chair a committee to address work force issues. Later she was appointed to her current position.
Washington says her training as a psychiatric nurse provides a valuable background for helping people resolve conflicts and discuss issues openly. “I like to be straightforward and direct,” she explains. “This is an environment where nothing is swept under the rug, and I like that a lot.”
Not all diversity management positions are formally appointed posts created by organizations. Sometimes these jobs are initiated by individual health care professionals who feel strongly about the issue and want to be a part of the solution.
Alexander, for instance, started the Council on Diversity for the Tennessee Hospital Association because she saw the need to recruit more minorities into health care. Better patient-care decisions are made when there is racial, ethnic, age and gender diversity, she says, because a wider variety of perspectives is represented.
When confronted with the lack of minorities in hospital management positions, hospital administrators would often say they wanted to hire people of color but seldom came across qualified minority applicants. The Council on Diversity responded with a summer internship program that places minority management students in Tennessee health care facilities.
Similarly, Boyd created the position she holds at the University of Illinois. Early in her career as a critical care nurse in neonatal and intensive care units, she realized she wanted to work on the other end of disease. Rather than treating people after they had become desperately ill, she wanted to help prevent illness and develop programs for underserved populations. Boyd has since led a variety of programs at community health care centers and the university. She urges minority nurses to be proactive and create opportunities to address diversity issues, rather than waiting to be appointed.
“Every position I’ve had I wrote the [job] description for and pitched it to the organization,” she recalls.
Boyd feels strongly that nursing professionals should become actively involved in championing diversity. “The way to be a part of it is to make yourself part of it,” she says. For example, nurses can volunteer for diversity committees at their institutions, become active in community programs that promote diversity, and propose solutions when they see problems of bias or conflict.
As the health care industry becomes increasingly concerned with maintaining profitability and cost-effectiveness, nurses who want to pitch the idea of initiating a diversity committee or diversity management position must be ready to show how it will benefit the organization’s bottom line. Picking the right time to present your case can also make a difference.
Alexander says she would not have been able to create the Council on Diversity when she started working for the Tennessee Hospital Association in 1980. At that time, she was the association’s first minority in upper management. “Initially I knew I could not bring the issue up,” she remembers. “First I had to gain trust.”
Through the years, she sent up “trial balloons” to gauge receptiveness. “I kept being that gentle little nudge,” she says. And then five years ago, she received the go-ahead to work on developing the minority internship program and the Council on Diversity.
A nurse must have support within an organization to succeed in leading any new effort. A turning point for Alexander was when she got a new boss who truly understood and supported the diversity initiative—and her. “The more allies you have, the better,” she stresses. “You have to have that nucleus of support. You can’t do it by yourself.”
For diversity efforts to succeed, Evans says, their goals must be woven into the organization’s strategic mission and be supported from the top down. Diversity initiatives that are assigned to only one position or department without being integrated throughout the organization run the risk of being lopped off when it’s cost-cutting time.
Washington agrees. She says valuing diversity is part of Massachusetts General’s mission, and she feels she has strong support from her organization’s leadership. But that’s not the case at every health care facility, she cautions. Sometimes diversity initiatives occur at the middle-management level and suffer from a lack of support from the top.
Diversity is also important in scientific research, where it encompasses more than just ethnic, racial and cultural differences. In her position as senior associate for science management at United Information Systems, Inc., in Bethesda, Md., Rosemary Torres, RN, JD, also serves as diversity and outreach manager. It’s her job to recruit a diverse group of scientists to sit on peer-review panels for federally funded scientific research. Torres, who is Hispanic, looks for top scientists who represent diverse fields and geographical areas as well as a spectrum of different educational and cultural backgrounds. Diversity among scientists is essential because it provides a broad perspective for finding comprehensive answers, she explains.
Torres herself has created a diverse career that has helped her broaden her own perspective in addressing health care issues. As a health law attorney and nationally recognized expert in women’s health, she has worked in a wide variety of clinical settings and offered her expertise in the development of health care policies.
“I’m an atypical nurse,” she says. “I created a career path that enabled me to assess and impact the full stage of a patient’s life.”
There are many other ways nurses of color can get involved in diversity and equal opportunity efforts without actually holding a formal diversity management position. For example, you can promote diversity in the workplace informally by mentoring other minority nurses. Another option is to reach out to local minority communities. As a Girl Scout leader, for instance, Boyd helped her troop learn about breast cancer and educate the women in their families about the disease.
What skills and qualities must nurses possess to play leading roles in diversity initiatives? “Self awareness is critical,” according to Boyd. “We have to be willing to look at ourselves and examine our own biases in forming relationships.”
Nurses who want to help their employers reach out to diverse communities also need to have patience and a thick skin, she adds. “Just because you have a degree and a title, people aren’t going to automatically trust you.”
Although nurses don’t have to have a human resources background to work in diversity management positions, Alexander says it’s crucial to have an understanding of how the entire health care system works. Other essential qualities include the ability to form trusting relationships and the courage to speak up.
Even though an encouraging number of health care organizations are beginning to embrace diversity issues, Alexander believes much work still lies ahead.
“At the majority of meetings I attend, I’m the only minority person sitting there,” she says. “I will know we’ve made an impact when people are sitting around a table where there is no diversity and someone at that table says, ‘This isn’t right.’”