Since the inception of the National League for Nursing (NLN) research grants program in the early 2000s, emphasis has been placed on addressing the priority criterion of recruiting a diverse participant sample. This priority is situated within the NLN core value of diversity (http://www.nln.org/about/core-values) and the NLN vision of achieving diversity and meaningful inclusion in nursing education (NLN, 2016). Diversity represents our embracing "the uniqueness of and differences among persons, ideas, values, and ethnicities" and is "influenced by the intersections of race, ethnicity, gender, sexual orientation, socio-economic status, age, physical abilities, religious and political beliefs, or other ideologies" (NLN, n.d.). Unfortunately, for many grant applicants, the failure to address this priority is often a significant limitation of their proposal.
Researchers in nursing education acknowledge limitations in capturing diversity in the participant population, with many studies reporting samples representing predominantly white female students and faculty. This lack of sample diversity is a significant study limitation, as findings are applicable only to a segment of the population. Understanding how diverse students best learn and how to recruit diverse students and faculty must be a focus for nursing education researchers if we are to have a comprehensive understanding of our impact as educators.
It is our ethical mandate to strive for appropriate representation in research samples. Without embracing this mandate, equity and inclusion efforts will not be reflected in research results, limiting the impact of our work. By employing sampling methods to acquire diverse samples, researchers can provide needed information to create a diverse nursing workforce. These efforts start with intentional and thoughtful design of studies reflecting sampling methods predicated on the need for inclusivity.
It is our ethical mandate to strive for appropriate representation in research samples. Without embracing this mandate, equity and inclusion efforts will not be reflected in research results, limiting the impact of our work.
What can researchers do to make visible the acknowledgment of inclusion criteria? They can build diverse teams, design relevant recruitment and retention strategies, expand their definition of diversity, develop appropriate data collection materials, and build flexibility into data collection procedures.
Inclusion efforts begin as researchers conceptualize the study and develop teams, partnering, for example, with schools having a diverse student/faculty population or networking with colleagues from diverse backgrounds. Partnering with historically black college and universities may be one way to capture greater racial and ethnic diversity and expand sample characteristics.
Recruitment for diversity starts with screening. Do researchers intentionally screen potential participants for diversity while protecting their privacy? Building trust is crucial, but it is possible that potential participants do not trust the research process (Ellard-Gray et al., 2015). With current requirements for social and physical distancing, we lose the benefit of personal, face-to-face recruitment, and we need to explore alternative strategies. Researchers may consider piloting screening and recruitment strategies to identify approaches to remove barriers for diverse participant inclusion.
Recruitment materials need to reflect the diversity of the sample being recruited. Foronda et al. (2017) conducted a study evaluating the presence of racial diversity in simulation advertisements. The team discovered that the majority of manikins and body parts (94 percent) displayed at an international conference were white. Used for recruitment purposes, such advertisements might limit who considers responding and ultimately participating. Advertising in safe and private locations can also increase trust in the research process while providing confidentiality for those who choose to participate.
Beyond racial and ethnic diversity of research samples, researchers should intentionally recruit sexual and gender minorities when appropriate. This begins with having foundational knowledge to take a gender-informed approach to nursing research and being inclusive of all gender identities at all stages, from research purpose to the dissemination of results. Gender inclusivity advances nursing research, education, and practice by guiding the development of knowledge and interventions to reduce disparities among all gender identities.
The design of data collection materials is critical. The population of nursing faculty and students is changing, and demographic forms need to have inclusive options. For example, excluding questions regarding sexual orientation and gender identity preserves the status quo and perpetuates sexual and gender minority disparities. Gender identity questions should include multiple inclusive options, such as transgender, genderfluid, nonconforming, and genderqueer, and not be limited to gender binary options. Sexual orientation questions should aim to obtain data on sexual identity, sexual behavior, and sexual attraction (Patterson et al., 2017), if appropriate for the research purpose.
Flexibility is important during data collection to retain students or faculty. In the national simulation study by Hayden et al. (2014), retention of minority students was reported as a significant concern. Recognizing and acknowledging the obstacles for potential participants and exploring options with them to decrease the burden of participation need to be included in the study design. This includes the consideration of stipends or compensation appropriate for recruited samples to assist in retention.
As a community of researchers in nursing education, we must share strategies in our publications that have and have not worked in our efforts to acquire and retain sample diversity. The body of research evidence in nursing education must ultimately reflect the clients for whom we care. A lack of diversity in our research samples represents an ethical conundrum. Having a professional nursing workforce that represents the global community must be our goal, and unless we consciously seek to recruit, retain, and learn from a diverse participant sample, equity and inclusion in nursing education and the workforce are simply words.
We have much more work to do to meet this challenge. We have much to learn from our clinical colleagues who have been addressing this issue longer than we have. The longer it takes researchers in nursing education to become sensitive to all variations of diversity, the more likely we will potentiate the diversity and representation inequities in nursing. Addressing diversity as a priority is a matter of equity, fairness, respect, and justice for our participants and the global community!
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