Workforce solutions to address health disparities

Underrepresented nurses' perceptions of a mentorship program supporting their applications for advanced practice nursing programs: A descriptive cross-sectional survey study

BACKGROUND

The diversity in the workforce of Certified Registered Nurse Anesthetists does not reflect the changing demographics.

PURPOSE

This study aimed to evaluate a national mentorship program supporting underrepresented nurses' applications for nurse anesthesia education programs.

METHODS

Convenience sampling was employed to recruit the participants for this descriptive cross-sectional survey. The survey had 23 questions, including 21 multiple-choice questions and two open-ended questions.

FINDINGS

A total of 1,133 participants participated in the survey study. The average score of overall respondents' satisfaction level on the program was 4.87, with almost all participants (1,116, 98.6%) feeling satisfied or very satisfied with the program. The respondents provided 565 comments on the program (i.e., nine domains and 49 themes) and 842 learning reflection notes (i.e., eight domains and 53 themes).

DISCUSSION

This national initiative is a promising intervention to help underrepresented nurses get ready for nurse anesthesia education program applications.

Using Bibliometric Data to Define and Understand Publishing Network Equity in Anesthesiology

BACKGROUND

Anesthesiology departments and professional organizations increasingly recognize the need to embrace diverse membership to effectively care for patients, to educate our trainees, and to contribute to innovative research. 1 Bibliometric analysis uses citation data to determine the patterns of interrelatedness within a scientific community. Social network analysis examines these patterns to elucidate the network's functional properties. Using these methodologies, an analysis of contemporary scholarly work was undertaken to outline network structure and function, with particular focus on the equity of node and graph-level connectivity patterns.

METHODS

Using the Web of Science, this study examines bibliographic data from 6 anesthesiology-specific journals between January 1, 2017, and August 26, 2022. The final data represent 4453 articles, 19,916 independent authors, and 4436 institutions. Analysis of coauthorship was performed using R libraries software. Collaboration patterns were assessed at the node and graph level to analyze patterns of coauthorship. Influential authors and institutions were identified using centrality metrics; author influence was also cataloged by the number of publications and highly cited papers. Independent assessors reviewed influential author photographs to classify race and gender. The Gini coefficient was applied to examine dispersion of influence across nodes. Pearson correlations were used to investigate the relationship between centrality metrics, number of publications, and National Institutes of Health (NIH) funding.

RESULTS

The modularity of the author network is significantly higher than would be predicted by chance (0.886 vs random network mean 0.340, P < .01), signifying strong community formation. The Gini coefficient indicates inequity across both author and institution centrality metrics, representing moderate to high disparity in node influence. Identifying the top 30 authors by centrality metrics, number of published and highly cited papers, 79.0% were categorized as male; 68.1% of authors were classified as White (non-Latino) and 24.6% Asian.

CONCLUSIONS

The highly modular network structure indicates dense author communities. Extracommunity cooperation is limited, previously demonstrated to negatively impact novel scientific work. 2 , 3 Inequitable node influence is seen at both author and institution level, notably an imbalance of information transfer and disparity in connectivity patterns. There is an association between network influence, article publication (authors), and NIH funding (institutions). Female and minority authors are inequitably represented among the most influential authors. This baseline bibliometric analysis provides an opportunity to direct future network connections to more inclusively share information and integrate diverse perspectives, properties associated with increased academic productivity. 3 , 4.

Structural Racism and Use of Labor Neuraxial Analgesia Among Non-Hispanic Black Birthing People

OBJECTIVE

To assess the association between structural racism and labor neuraxial analgesia use.

METHODS

This cross-sectional study analyzed 2017 U.S. natality data for non-Hispanic Black and White birthing people. The exposure was a multidimensional structural racism index measured in the county of the delivery hospital. It was calculated as the mean of three Black-White inequity ratios (ratios for lower education, unemployment, and incarceration in jails) and categorized into terciles, with the third tercile corresponding to high structural racism. The outcome was the labor neuraxial analgesia rate. Adjusted odds ratios and 95% CIs of neuraxial analgesia associated with terciles of the index were estimated with multivariate logistic regression models. Black and White people were compared with the use of an interaction term between race and ethnicity and the racism index.

RESULTS

Of the 1,740,716 birth certificates analyzed, 396,303 (22.8%) were for Black people. The labor neuraxial analgesia rate was 77.2% for Black people in the first tercile of the racism index, 74.7% in the second tercile, and 72.4% in the third tercile. For White people, the rates were 80.4%, 78.2%, and 78.2%, respectively. For Black people, compared with the first tercile of the racism index, the second tercile was associated with 18.4% (95% CI, 16.9-19.9%) decreased adjusted odds of receiving neuraxial analgesia and the third tercile with 28.3% (95% CI, 26.9-29.6%) decreased adjusted odds. For White people, the decreases were 13.4% (95% CI, 12.5-14.4%) in the second tercile and 15.6% (95% CI, 14.7-16.5%) in the third tercile. A significant difference in the odds of neuraxial analgesia was observed between Black and White people for the second and third terciles.

CONCLUSION

A multidimensional index of structural racism is associated with significantly reduced odds of receiving labor neuraxial analgesia among Black people and, to a lesser extent, White people.

Barriers and Facilitators to Implementing Holistic Admission Review in Graduate Advanced Nursing Programs

BACKGROUND

There are strong recommendations and high demand for the use of holistic admission review (HAR). However, there is no study exploring and identifying barriers and facilitators to implementing HAR in health care education programs.

METHOD

This qualitative descriptive study aimed to understand the key determinants influencing the integration of HAR in graduate advanced nursing programs. Two online focus groups with content analysis were used to identify barriers and facilitators.

RESULTS

The findings highlight 39 key determinants of HAR implementation in the graduate advanced nursing program; the determinants included four neutral influencing factors, 18 barriers, and 17 facilitators. These influencing factors aligned with all four domains in the Consolidated Framework for Implementation Research (CFIR) and with 20 of the 39 CFIR constructs.

CONCLUSION

By taking into account the facilitators and barriers, graduate advanced nursing programs may use effective implementation strategies to integrate HAR changes and guide their evolving admissions processes. [J Nurs Educ. 2023;62(10):570-574.].