Missing Persons

Where are the Minorities in WNC Nursing Professions?

By Sherri L. McLendon –

During serious illness or at end of life, patients feel more comfortable with healthcare professionals who mirror their identities in particular ways, according to Michelle Webb, Chief Operating Officer and chief nursing officer with Four Seasons Compassion for Life.

For Webb, nursing is a “calling,” but she understands that a lack of diversity in the profession is a problem which must be addressed if nurses are to provide competent, relevant, and sensitive care to their patients.

“Human nature is that people aren’t drawn to places where others don’t look like them,” she says. “The delivery of culturally competent care makes a difference in terms of health care outcomes.”

Four Seasons Compassion for Life is a nationally recognized hospice and palliative care industry leader serving western North Carolina for more than 35 years. The care provider treats illness according to each individual’s cultural, personal, and religious beliefs, but Webb believes an increasingly diverse workforce is needed in the future.

Access and outcomes for patients are limited when care providers have little resemblance to the populations they serve, according to the landmark report of the 2004 Sullivan Commission. In health care, the demographics of nurses and those of the patients they serve ideally mirror one another, but in western North Carolina, that is currently not the case, Webb says.

“We’re not going very far, very fast,” she says. “We have opportunities in western North Carolina to close disparity gaps in care and treatment for individuals with different racial, ethnic, and cultural backgrounds.”

At Four Seasons, for example, while there are a number of clinical staff members employed by the organization that represent diverse cultural or ethnic backgrounds, she is the only African American registered nurse employed by the organization, and the only person of color in a senior leadership position. Major healthcare providers locally and the national hospice community have demonstrated a commitment to promoting increased inclusion, access, and advancing diversity within the workforce.

In 2012, individuals from ethnic and racial minorities made up more than one-third of the U.S. population, or 37%, according to the U.S. Census Bureau. However, in 2013, the National Council of State Boards of Nursing found that nurses from minority backgrounds represented only 19% of all registered nurses.

Nationally, only 6% of registered nurses are African American; 83% are white. Three percent are Hispanic, and only 1% are Native American.

“Those numbers are inadequate to delivering care to the rapidly changing demographic of the U.S.,” Webb says.

With an aging work force and nursing shortages predicted, she agrees with reports which point to minority recruitment as a necessary step to address these needs in the broader health care field. In hospice, Four Seasons has already begun to develop innovations, like a new graduate internship program, to meet shortfalls. In the future, the goal is to be more inclusive and attract a diverse work force.

For patients, closing the disparity gap also means resolving trust issues, improving equal treatment, and removing historical and institutional barriers of access to health care for patients. A diverse nursing work force would begin to address these barriers, Webb notes.

According to the American Association of Colleges of Nursing, a strong connection exists between a culturally diverse nursing workforce and the ability of organizations to provide quality, culturally competent, patient care across settings.

“Cultural sensitivity improves communication, personalizes treatment, improves care, and reduces costs,” she says. “We’re aware of what lies ahead, and Four Seasons is on the journey to where we want to be.”

The organization, she says, has already made progress in terms of gender diversity. The need for cultural competency is addressed through training to address end-of-life care disparities.

Hope gives way to change. Currently, the hospice provider community nationally has demonstrated a commitment to promoting increased inclusion, access, and advancing diversity within the hospice industry workforce. To improve local diversity initiatives, the National Hospice and Palliative Care Organization has developed an “Inclusion and Access Toolbox” that provides practical guidance on how to recruit and retain a diverse workforce, provide culturally relevant care to diverse communities, and implement quality assurance and improvement activities.

Webb calls this work “promising,” for nurses within her chosen specialty of hospice and palliative care, and reflects on what this means at Four Seasons Compassion for Life.

“We work to advance the capability of staff to better care for our clients with unique cultural considerations,” she says. “Developing and policing our own abilities to deliver culturally competent care is a high priority for the organization, and for the nursing profession as a whole.”