Beyond the Buzzwords: How Nursing Schools Can Break Barriers to Incorporating DEI Initiatives

Genevieve Carlton, Ph.D.
Updated November 17, 2023
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    Nursing schools face barriers when it comes to diversity, equity, and inclusion. A new study suggests how nursing schools can implement DEI initiatives.
    Nursing students looking at an x-ray in classCredit: Getty Images
    • Promoting DEI benefits nursing students, schools, and the profession.
    • A recent study addresses the barriers nursing schools face regarding DEI.
    • Successfully promoting DEI at nursing schools requires a significant investment.

    The lack of diversity is a problem in nursing. Currently, 80% of registered nurses (RNs) identify as white, compared to 72% of the overall U.S. population, according to the 2022 National Nursing Workforce Study. But the nursing field has grown more diverse in the past few years. The percentage of Hispanic or Latino RNs nearly doubled from 4% in 2015 to 7% in 2022.

    How can the nursing field continue to support diversity? Recruiting nursing students from underrepresented groups can help ensure that future generations of RNs are as diverse as their patients, something we know is good for patients. Yet racism and discrimination remain widespread in nursing, presenting significant hurdles to diversifying the field.

    These problems start long before nurses enter the workforce. Nursing schools are critical in promoting inclusivity and diversity, yet 40% of nurses surveyed in 2023 said they experienced racism or discrimination during their nursing education. Black nursing students were the most likely to face racism, with 60% reporting that racism or discrimination was part of their nursing school’s culture.

    Nursing schools must go beyond discussing DEI and enact impactful initiatives to promote diversity. A recent study revealed where nursing schools should start.

    Defining Diversity, Equity, and Inclusion in Academic Institutions

    Nurses want nursing schools to incorporate DEI training. In a 2023 study, 79% of nurses surveyed agreed that nursing education should increase its DEI focus, particularly on topics like unconscious bias and systemic racism in healthcare.

    • Unconscious bias: Unconscious bias refers to stereotypes and beliefs that shape actions and decisions without a conscious choice. In healthcare, for example, this can mean providing less pain management to women or Black patients because of an unfounded assumption that they have a higher pain tolerance.
    • Systemic racism: Racial prejudices shape society, culture, and politics. In healthcare, systemic racism can negatively contribute to the health outcomes of communities of color. For example, research has demonstrated that discrimination in hospitals contributes to high maternal mortality rates for Black women.

    Academic institutions can function more effectively when prioritizing diversity, equity, and inclusion. In addition to benefiting students, faculty, and programs, DEI initiatives also strengthen the labor force by improving equity and diversity in healthcare, business, education, and other industries that hire college graduates.

    Diversity is particularly critical in nursing. A recent survey found that 75% of Asian nurses have experienced discrimination and burnout. Historically, people of color have been excluded and mistreated in nursing, both as nurses and as patients. In 2022, the American Nursing Association formally apologized for excluding Black nurses and committed to integrating DEI programs to address systemic racism in nursing.

    But what, exactly, does diversity, equity, and inclusion mean in the context of higher education?

    Diversity refers to actively recruiting, supporting, and retaining students, faculty, and staff who identify as members of different racial or ethnic groups, gender identities, religions, or sexual orientations. Diversity in socioeconomic situations, backgrounds, and experiences enriches campus life as members of the campus community share their unique perspectives.

    Equity means understanding systemic barriers and how they limit people’s potential. Rather than offering every student identical opportunities, an equitable approach supports each student based on the disparate barriers they have faced.

    Inclusion means that all members of the campus community are invited to join every aspect of campus life and academic instruction and support. Everybody receives respectful treatment from each other and the institution. By recognizing the benefits of diversity, colleges can foster an inclusive environment where every member of the community can thrive.

    In spite of the benefits of prioritizing DEI efforts, many nursing schools face barriers when it comes to putting into practice the steps that promote diversity, equity, and inclusion.

    Barriers to Implementing DEI Initiatives

    What barriers prevent nursing schools from implementing DEI initiatives? A 2023 study in the Journal of Nursing Education highlighted some challenges.

    For example, institutional racism and implicit biases shape nursing curricula, often in invisible ways. A 2021 Nurse Educator article concluded that case-based learning focusing on individual patients often ignores social determinants of health for other groups. These factors, which frequently include structural racism for patients of color, shape their health and patient outcomes. The study recommended revising case studies to account for the positionality of the individual in the case and to actively address race.

    Privilege and power differences also shape how nursing schools approach DEI issues. In 2022, nearly 80% of faculty at nursing schools identified as white, according to a National League for Nursing (NLN) survey. College administrators are even more likely to be white. A 2020 report from the American Council on Education found that 85% of department chairs and 88% of provosts and chief academic affairs officers are white.

    By building recruiting and promotion pathways that consider implicit bias and actively recruiting and mentoring faculty and administrators of color, schools can genuinely diversify their faculty and staff to reflect the diversity of current U.S. society.

    The American Association of Colleges of Nursing (AACN) created a diversity toolkit for nursing schools in 2021. AACN’s recommendations mirror the 2023 Journal of Nursing Education study’s suggestions.

    For example, AACN recommends that nursing schools establish clear policies that place DEI at the core of the school’s mission. That requires a clear DEI strategic plan, a budget allocated to DEI, and leadership buy-in.

    Nursing schools will struggle to incorporate DEI initiatives without action on the part of nurse educators and college leadership.

    Proposed Strategies to Implement DEI Initiatives in Nursing School

    What strategies can nursing schools adopt to successfully implement DEI initiatives?

    At the administrative level, administrators and stakeholders must actively incorporate DEI into their mission and values. The Journal of Nursing Education study suggests a clear articulation of inclusiveness and equity, focusing on the nursing school’s commitment to DEI. A strong commitment at the administrative level can shape decision-making and resource allocation throughout the program.

    The study also recommends forming a diverse DEI council representing students, faculty, and staff. Similarly, AACN proposes creating an advisory council of members with diverse backgrounds to encourage DEI initiatives. The council should include representatives across the nursing school and other key stakeholders.

    Nursing schools can also take actionable steps, particularly around faculty hiring and equity. Increasing faculty diversity can mean stronger voices advocating for DEI awareness and more student mentorship opportunities. Equity reviews in compensation and promotion can also ensure fair treatment for faculty from underrepresented groups.

    AACN Student Body Recommendations

    Nursing schools can take several steps toward improving equity and diversity in their student body. AACN recommends a focus on recruitment, admissions, and retention.

    Pipeline programs encouraging diverse students to apply to nursing school can boost diversity. So can articulation agreements with local community colleges and nurse educator programs. Emphasizing holistic admissions can also benefit nursing students from diverse backgrounds. A 2022 study on nursing education evaluated the impact of holistic review and determined that it effectively “promotes diversity of nursing students and future nurse providers.”

    Retention remains a barrier to student body diversity. According to the NLN, approximately 25% of nursing students leave their programs before graduation. A 2019 study found that nursing students of color may experience an attrition rate of double that of their white classmates. Based on the number of nursing students experiencing racism or discrimination, it’s not surprising that students of color leave nursing programs at a higher rate.

    Mentorship, academic advising, and support groups can improve retention rates. Nursing schools can support students directly through scholarships and grants, which improve retention rates. Hiring more underrepresented faculty and training faculty on implicit bias and stereotyping can also promote DEI efforts for students.

    Nursing schools must actively redesign curricula to promote DEI. In addition to creating a sense of belonging for underrepresented students, schools must actively train white nurses to identify implicit bias and recognize the impact of systemic racism on health outcomes. These curriculum changes, which nursing students overwhelmingly support, will produce nurses better equipped to treat all their patients.

    In Conclusion

    Nursing schools that support DEI efforts will see many benefits, including higher retention rates and a more inclusive culture. And by promoting DEI in nursing schools, the profession as a whole benefits. Most of all, health outcomes for patients of color can improve.

    Page last reviewed on October 26, 2023