Have you ever noticed animosity toward nursing students on your unit? Nurses constantly tell me that they're tired of taking on nursing students to help with care during their shifts. If English is a second language for the student, the push-back is even harder. The list of complaints is long, but generally includes: How will they provide care if they can't speak English? They're slow. They keep asking me questions. They need too much supervision.
I get it-as a nurse your time is limited. You have so many obligations and the last thing you want to do is spend extra time explaining things. As an instructor, I try to make sure that students primarily come to me with questions and only speak with the nurse for those things that necessitate his or her involvement. This may include access to medications or obtaining the latest patient report. However, students need to practice their communication and interpersonal skills. Only real immersion provides this practice.
Obviously, unfriendly or disinterested behavior from nurses affects students. After all, would you dismiss a patient with English as a second language? No, most likely you'll use whatever resources are available, such as therapeutic communication and translator services, to ensure that the patient's needs are met. So why is it that some nurses quickly dismiss students and don't afford them the same attention? We must consider that culturally competent behaviors aren't just for patients; nursing students also need them.
Reducing disparities
In the United States, we're faced with a disparity between the racial/ethnic makeup of the nurses providing care and that of the patients needing care. American racial and ethnic minority populations are rapidly growing. In 2012, the foreign-born population of the United States was estimated at 40.8 million (13%) of the total population. By 2050, racial and ethnic minority representation is expected to rise from 29.7% to over 50%. This has led to a diverse patient population.
Currently, the RN workforce is comprised of 83% White/Caucasian, 6% African American, 6% Asian, 3% Hispanic, 1% Native American/Alaska native, 1% Native Hawaiian/Pacific Islander, and 1% other nurses. However, the general population is comprised of 77.4% White/Caucasian, 13.2% African American, 5.4% Asian, 17.4% Hispanic, 1.2% Native American/Alaska native, 0.2% Native Hawaiian/Pacific Islander, and 2% others. This racial and ethnic disparity between care providers and patients has been cited as a major contributor to inequality in healthcare.
Research has shown that racial and ethnic minorities are more likely to have cardiovascular disease, cancer, diabetes, and HIV/AIDS. When given a choice, patients are more likely to choose a healthcare provider with a similar racial or ethnic background and be more satisfied with the care they receive. It's imperative that the disparity between the racial/ethnic makeup of nurses and patients be addressed if we want to improve minority patients' healthcare access, quality, and outcomes.
The Institute of Medicine published "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care" in 1999, which recommended that more minorities be represented in the healthcare workforce and cross-cultural education be included in all healthcare programs. In order for nursing to meet this mandate, more minority nurses must graduate from nursing programs. Unfortunately, students of color lag behind White students in program completion and NCLEX-RN pass rates. The literature explaining this finding is inconclusive but suggests that factors such as racism, stereotyping, and lack of cultural competence may negatively influence how nurse educators interact with minority students, thereby affecting their success rates.
Nursing students experience a variety of stressors, such as fear of failure, financial issues, and lack of free time. Unfortunately, racial and ethnic minority students experience additional unique issues, such as isolation, lack of understanding about cultural differences, and lack of support from people in power such as instructors. In addition, some minority students have identified language and communication, loneliness, discrimination, and prejudice as added barriers to success.
A welcoming environment
On the first day of clinical, my nursing students are always excited to start a new adventure. In our preconference, we talk about prioritizing nursing care, how we're visitors on the various units, and our goals are to be patient advocates and help with nursing care for the day. In short, my students learn how to be professionals and an asset to the profession. But no matter how much I prepare the students, I've noticed that nurses' behavior toward them makes all the difference.
When we meet in our postconference to assess the day and whether we met our goals, the overwhelming theme that the students discuss is the nurses' attitudes and behaviors toward them. This is true for both fundamental and senior students. They want to be accepted by the nurses on the unit, be useful, and feel that they're a part of the profession.
The literature has identified certain behaviors that are helpful in retaining and graduating culturally diverse nursing students. These behaviors include showing caring behavior, providing timely feedback, mentoring, validating students' cultural differences, creating supportive environments, and role modelling positive behaviors. All of these behaviors can easily be adopted by any nurse working in any setting who comes in contact with a student. I propose that when nurses exhibit behaviors that signify nursing students are a task to be dealt with rather than valuable members of the team, we're violating the first provision of the American Nurses Association's Code of Ethics for Nurses: to practice with compassion and respect for the inherent dignity of every individual.
Students often tell me that the best experiences they've had included rotations during which nurses, although busy with their regular duties, acknowledged their presence. These nurses took a moment to welcome the students to the unit and made them feel as though they were an important part of the profession. When nurses offered words of encouragement, my students soared with hope. I believe that we may not realize how powerful we are; just as holding a patient's hand during a painful procedure is comforting, so too is a nurse asking a nursing student, "Are you okay or do you need help?"
Caring and therapeutic communication are at the core of what we do as nurses on a daily basis. Almost 40 years ago, the concept of transcultural nursing and the Culture Care Theory were introduced to help nurses understand diverse care factors and provide individualized care. I believe that this cultural competency must be reflected in how we as nurses interact with each other, as well as how we engage the next generation of nurses.
Inclusivity is key
Although this article focuses on culturally diverse nursing students, the caring behaviors discussed can benefit all nursing students. Let's work on role modeling inclusive behavior for our nursing students.
on the web
Agency for Healthcare Research and Quality: 2015 National Healthcare Quality and Disparities Report http://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/nhqdr15
American Association of Colleges of Nursing: Enhancing Diversity in the Workforce http://www.aacn.nche.edu/media-relations/fact-sheets/enhancing-diversity
American Association of Colleges of Nursing: Spotlight on Nursing Education: Summary of Nursing Student Diversity http://www.aacn.nche.edu/government-affairs/Spotlight-Diversity-Data.pdf
U.S. News & World Report: "Racial Bias in Medicine Leads to Worse Care for Minorities" http://health.usnews.com/health-news/patient-advice/articles/2016-02-11/racial-b
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