Examining and mitigating racism in nursing using the socio-ecological model.

Racism in nursing is multifaceted, ranging from internalized racism and interpersonal racism to institutional and systemic (or structural) elements that perpetuate inequities in the nursing profession. Employing the socio-ecological model, this study dissects the underlying challenges across various levels and proposes targeted mitigation strategies to foster an inclusive and equitable environment for nursing education. It advances clear, context-specific mitigation strategies to cultivate inclusivity and equity within nursing education. Effectively addressing racism within this context necessitates a tailored, multistakeholder approach, impacting nursing students, faculty, administration, professional organizations, and licensing and accrediting bodies. This all-encompassing strategy recognizes that the interplay of interpersonal dynamics, community culture, institutional policies, and broader societal structures intricately shapes individual experiences. Nurses, nurse leaders, educators, organizations, and policymakers can work together to create a more equitable and inclusive nursing profession by targeting each of these levels. This transformational process can yield positive outcomes across various environments where nurses learn, work, and serve people and enable the demographic composition of nurses to better match the populations served.

Equity and justice in health.

BACKGROUND: While justice is promised to all U.S. citizens, the truth is that the pathway to equity and justice in health is riddled with obstacles for many marginalized and minoritized groups. The United States ranks lower on crucial health measures than its high-income peer countries, reflecting differences in health outcomes for marginalized and minoritized populations. PURPOSE: Promoting equity and justice in health is vital as health shapes the daily experiences of individuals and communities, specifically those from marginalized and minoritized backgrounds. METHOD: This paper highlights the health care system and sociopolitical factors contributing to the longstanding structural barriers that impede health and the need for structural competence, advocacy, and activism in the nursing workforce. DISCUSSION: Understanding systemic issues underlying health inequities provides an opportunity to develop targeted strategies to eliminate practices perpetuating inequities and pave the way for everyone to have a fair and just opportunity to be as healthy as possible. CONCLUSION: Specific education, practice, research, and policy recommendations can advance equity and justice in health.

Invisibility/Hypervisibility paradox for Black women navigating the nursing academic environment.

The invisibility/hypervisibility paradox is Black women's complex and often contradictory experiences in the workplace. In nursing academia, Black women find themselves simultaneously experiencing invisibility and hypervisibility. This paper delves into how the paradox shows up in academic nursing. The paper's objectives are threefold: (a) to dissect the dynamics of whiteness, gender, and class within nursing education perpetuating the invisibility/hypervisibility paradox; (b) to elucidate the concept of intersectionality and the matrix of domination informing this paradox; and (c) propose strategies for Black nursing faculty to resist oppression, mitigate the paradox, and thrive in academic settings. We used high-profile cases to connect the paradox to nursing education.

Anti-DEI legislation targeting colleges and universities: Its potential impacts on nursing education and the pursuit of health equity.

BACKGROUND: This article sheds light on the sociopolitical movements that led state legislators to propose bills restricting diversity, equity, and inclusion (DEI) initiatives and the profound effect these bills, if passed, will have on advancing health equity. PURPOSE: To alert and alarm nurses and nurse educators regarding the expansiveness of the proposed legislation, highlight the harmful effects, and the necessity for a call to action. METHODS: Nurses and nurse educators must be aware of their civic and professional responsibilities to advocate for social justice to promote health equity and educational opportunities for historically excluded groups in nursing. DISCUSSION: Proposed legislative limits on DEI could have dire consequences for health, educational institutions, and the economy. CONCLUSION: Nurses and nurse educators should engage, inform, and influence policymakers on the potential harm anti-DEI legislation can have on population health.

Addressing Diversity, Equity, and Inclusivity Contributions in Academic Review.

BACKGROUND: The nursing profession and academic environments are increasingly calling for nurse educators to incorporate diversity, equity, and inclusion (DEI) goals and actions into their professional practice. Such work aligns with institutional and professional missions of social justice and antiracism. PROBLEM: Historically, there has been an undervaluing and lack of recognition in academia of DEI contributions and qualitative or community-based research focused on health equity. This lack of recognition may disproportionately impact faculty who focus their scholarship and research on marginalized communities. APPROACH: The current state of the academic review of DEI contributions for appointment, promotion, and tenure is presented. Examples for teaching, research and scholarship, practice, and service are provided. OUTCOMES: Recommendations include expanding recognition and evaluation of academic scholarship and advocacy against efforts to dismantle social justice and antiracism advances within academia. CONCLUSION: Examining hegemonic norms is vital to promote more equitable power structures in academic environments.

The Journey Toward Inclusive Excellence.

BACKGROUND: Several national organizations have issued calls for academic nursing to create inclusive environments. Inclusive environments are needed given the vast inequities that plague the demography of nursing coupled with the need to serve diverse populations. METHOD: This article describes one school's journey toward inclusive excellence. A framework and infrastructure were developed detailing the strategy to enable the school to move toward an environment that supports inclusive excellence. RESULTS: The framework identified five priority areas to mobilize change: leadership for inclusive excellence, student service delivery and engagement, recruitment retention and advancement, community engagement, and research and scholarship in health equity, along with metrics and measures to monitor progress. CONCLUSION: Inclusive excellence is an ongoing journey rather than a destination that requires leadership commitment as well as faculty, staff, and student involvement to create a diverse environment where all individuals feel valued and respected. [J Nurs Educ. 2023;62(4):225-232.].

Evaluation of an academic service partnership using a strategic alliance framework.

Strategic alliances involve the sharing of resources to achieve mutually relevant benefits and they are flexible ways to access resources outside of one's own institution. The recent landmark report from the Institute of Medicine, The Future of Nursing: Leading Change, Advancing Health, called for academic and health care organizations to strategically align around the future registered nurse workforce to improve the quality and safety of patient care. The dedicated education unit (DEU) is one practical way for 2 entities to align so that students can learn to administer safe, quality care. Because DEUs have great potential, it is critical to evaluate the alignment between the academic and service partner for appropriate fit, mutual benefit, and long-term success. In this article, we analyze the effectiveness of the Saint Louis University School of Nursing (SLUSON) and Mercy Hospital, St. Louis (MHSL) DEU project, an alliance between a medical center and school of nursing, using the Single Alliance Key Success Model.

Advancing Diversity in Nursing Education: A Groundwater Approach.

There have been increased calls for a diverse nursing workforce to resolve health inequities. While the diversity of the nursing workforce slowly improves, it lags in comparison to the diversity of the United States population. The lack of diversity in academic nursing is the root cause of the lack of a diverse nursing workforce. A groundwater approach, as developed by the Racial Equity Institute, is used to analyze systemic barriers in nursing education that hinder achieving student diversity. Using this approach, recommendations are offered to educators and regulatory organizations to change policies and practices. Inclusive educational policies and teaching practices should be adopted to recruit and retain diverse students and faculty. Nursing education accrediting bodies must implement standards requiring programs to adopt holistic admission reviews and measurable diversity outcomes for students, faculty, and staff. The National Council of State Boards of Nursing must establish a common national licensure passing standard that is based either on graduation date or upon the first attempt and includes multiple attempts within a given time frame. A groundwater approach requires a mindset shift to focus on the environment and changes in practice and policy to overcome the current structural barriers in nursing education if there is ever to be a diverse nursing workforce.

Evidence-based strategies to advance BSN student diversity.

BACKGROUND: Minoritized nurses understand the cultural and contextual circumstances that lead to health disparities, yet they are underrepresented in the RN workforce. This underrepresentation can have serious health consequences. However, to have more representation, it must be understood the pipeline for diversity begins with the admission of diverse students into baccalaureate nursing education programs. PURPOSE: This manuscript describes an Initiative that increased the enrollment of students from underrepresented backgrounds and provided the students with the support necessary for retention through graduation. METHOD: The Initiative incorporated five evidence-based strategies that created a culturally responsive academic environment and enabled diverse students to succeed. RESULTS: Forty-two students were admitted to the baccalaureate nursing program. Thirty-six of the 42 remain in the program resulting in a retention rate of 86%. Six of the thirty-six recently graduated and the remaining 30 students are on track to graduate in their respective years. CONCLUSION: Through the use of the five-prong evidence-based strategies, the School was able to establish the infrastructure to support the academic advancement and achievement of students from diverse backgrounds. The impact is yet to be determined, but more diverse individuals will graduate, suggestive of a more diverse workforce which will hopefully advance the nation toward health equity.

Common themes in clinical education partnerships.

The concurrent nursing and faculty shortages continue to be critical issues for the nation's health care system. As academic nursing programs struggle with maintaining and increasing enrollment in the midst of a faculty shortage, one solution is to expand the faculty's capacity through innovative academic-service partnerships. Schools and clinical partners identified as having implemented innovative partnerships were invited to participate in this descriptive study. Site visitations to schools in Florida and Texas were conducted to gain in-depth knowledge of the clinical education model, the academic-service partnership, and the strengths and challenges associated with planning, implementing, and sustaining programs. Four underlying features were common across the successful implementation: supportive relationships, goodness of fit, flexibility, and communication. Consideration of the four features will be useful as nursing programs and their clinical partners are developing, implementing, and evaluating new models for increasing educational capacity and lessening the nursing shortage.

Raising awareness: African American faculty perceptions of the interview process.

BACKGROUND: The American Association of Colleges of Nursing [AACN] and the National League for Nursing [NLN) recognize the importance of increasing the number of African American nursing faculty in collegiate nursing education. In other words, not hiring African American nurse faculty removes the African American perspective in advancing the tripartite mission of teaching, research, and service in academic nursing. PURPOSE: The purpose of this study was to gain a better understanding of the interview process of African American faculty who sought employment in academic nursing. METHOD: This qualitative study, guided by Critical Race Theory (CRT), used face-to-face, semi-structured interviews to explore the feelings and perceptions of nine African American female nursing educators who sought employment in academic nursing. RESULTS: Major themes that emerged from their stories associated with the interview process were the lack of clarity, lack of job security, lack of diversity within the nursing academy, and racism. Their stories provided a deeper understanding of the challenges, issues, and complexities experienced when navigating the interview process as they attempted to gain access to employment opportunities. CONCLUSION: Through examining the lived experience of the African American nurse faculty hiring process, the CRT's framework illuminated how academic nursing institutions intentionally or unintentionally confirm the notion that nursing primarily wants to remain an 'all-white profession.'

Transformational partnerships in nursing education.

Although the nursing care environment has changed significantly over the past 30 years, little has changed in the educational methods used to prepare new nurses. Since the 1930s, most clinical education in nursing has been structured with a faculty member supervising a small group of students on one or more inpatient units. Students usually move to new settings for each clinical rotation. This traditional model is heavily dependent on nursing faculty and often requires students to wait for direct faculty supervision. Students often are "strangers" to the registered nurses providing patient care in these settings. This arrangement can compromise the cohesiveness of the nursing team and limit opportunities for building professional relationships between students, registered nurses, and other members of the health care team. Developing a more structured and cohesive partnership between the registered nurse and the student, both of whom are providing care to the same patients, has the potential to revitalize clinical education in nursing.

A community-wide academic-service partnership to expand faculty and student capacity.

This article describes a unique academic-service community collaborative aimed at increasing student and faculty capacity. The state hospital association held a series of community-wide meetings with health care organization and academic leaders to discuss the growing RN and faculty shortages. Collectively, schools of nursing experienced a 70% increase in qualified applicants and could not admit all qualified applicants due to faculty constraints. A unique Workforce Collaborative Pilot Project was formed to address student and faculty capacity issues with three primary objectives: expand the pool of educators involved in preparing the next generation of nurses, increase nursing school enrollments by 335 additional nursing students each year in the metropolitan area for the next 5 years, and implement an innovative educational model that could be sustained or replicated. As a result, area schools of nursing have expanded enrollment by 1,046, and overall quality measurements and evaluative feedback remain positive.

Building bridges: an innovative academic-service partnership.

Academic and service entities can create sustainable models of collaboration that realign relationships and resources to enhance the critical competencies essential for entry into practice. Our hospital and school collaborated to implement an innovative academic-service partnership model in which the academic and the care delivery enterprises intersected to accomplish goals of mutual interest and enhance and enrich the practice environment. Two existing resources-the staff nurse and faculty-were used to realign the educational process with the realities of nursing practice in an interpretive, contextual, live unfolding clinical environment that was relevant and memorable. The students were better integrated into the clinical operations and showed increased levels of critical thinking, clinical decision-making, and clinical inquiry skills. The model holds promise to improve transition to practice, make better use of existing resources, and foster collaborative relationships among the academic, practice, and regulatory enterprises.

Five recommendations for prelicensure clinical nursing education.

The acute shortage of RNs is both well established and projected to continue. Two primary factors contributing to the nursing shortage are insufficient numbers of faculty and insufficient clinical sites for students. Innovative academic-service partnerships are realigning these scarce resources to improve the quality of clinical education and build cultures of safety. Relationships among students, staff nurses, faculty, and the institutions where they practice are central to students' socialization, professional role development, and transition to practice. Five recommendations to strengthen these professional relationships are suggested to: reenvision nursing student-staff nurse relationships, reconceptualize the clinical faculty role, enhance development for school-based faculty and staff nurses working with students, reexamine the depth and breadth of the clinical component, and strengthen the evidence for best practices in clinical nursing education. Five key outcomes are suggested to evaluate both traditional and emerging approaches to clinical nursing education.

An academic service partnership to expand capacity: what did we learn?

This article highlights the educational needs that emerged when an academic institution and a hospital partnered to produce more nurses in response to the registered nurse shortage. The partnership proposed to offer quality clinical experiences for students by having the hospital-paid nurse clinicians serve as faculty. This would enable the academic partner to increase enrollment amid limited faculty resources. The qualitative feedback received may prove useful in (1) guiding the professional development activities of future nurse clinicians who participate in education-service partnerships to expand educational capacity; (2) assisting academic nursing program administrators and faculty to expand capacity without compromising quality; and (3) assisting hospital nurse administrators to weigh risks and returns to pursue mutually beneficial outcomes.