Barriers to career advancement in the nursing profession: Perceptions of Black nurses in the United States

Age and expertise: The effects of ageism on professional recognition for senior nurses

This study explores the dual challenges of ageism and professional recognition faced by senior nurses in healthcare settings. Utilizing a phenomenological approach, we conducted semi-structured interviews with 20 registered nurses aged 50 and older in Abha City, Saudi Arabia. The analysis revealed four key themes: experiences of ageism, its impact on professional roles, discrimination and stigmatization, and the need for organizational support. Findings indicate that age-related biases lead to significant professional marginalization, reduced job satisfaction, and emotional distress among senior nurses. The study highlights the critical need for comprehensive policies, organizational support, and cultural changes to address ageism and recognize the valuable contributions of senior nurses. Promoting an inclusive work environment and equitable professional development opportunities can enhance the overall quality of care and job satisfaction for older nurses.

An integrative review of racism in nursing to inform anti-racist nursing praxis in Aotearoa New Zealand

AIM

To synthesise international literature to identify mechanisms that maintain racism in nursing and understand the factors that contribute to designing and implementing anti-racist praxis to inform nursing in Aotearoa New Zealand.

DESIGN

An integrative literature review was undertaken, integrating Indigenous Kaupapa Māori methodologies to ensure a cultural and philosophical lens.

METHODS

Peer-reviewed literature published, between January 2011 and July 2023 were sourced. Of 1296 articles, 16 met the inclusion criteria and 4 were identified via citation chaining. In total, 20 articles were included. The Johns Hopkins Research Evidence Tool was applied, findings extracted, and thematic analysis completed utilising Indigenous Kaupapa Māori principles.

DATA SOURCES

Databases, including CINAHL, Scopus, PubMed and Aus/NZ Reference Centre, were searched in July 2023.

RESULTS

Two key themes were identified: (1) colonial active resistance to change; and (2) transformational, visionary, and proactive nursing.

CONCLUSION

Nurses are well-positioned to confront the structures that maintain racism in health and education systems but are often actors in maintaining status quo. Anti-racist praxis can be a mechanism for nurses to reimagine, redefine and transform nursing care, leadership, and nursing education to begin to eradicate racism.

REPORTING METHOD

This integrative review adhered to the 2020 Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) method.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

IMPLICATIONS FOR THE PROFESSION

Racism remains prevalent in nursing and the healthcare system. It is necessary to implement anti-racist praxis and policies that resist, deconstruct, and dismantle power and racism while validating Indigenous values, beliefs and practices. This is vital to deliver equitable health care.

IMPACT

This integrative review presents lived realities and knowledge of Indigenous and racially minoritised nurses and scholars, alongside nursing allies to inform anti-racist praxis. This evidence signifies that it is time to walk the walk to challenge the colonising systems and processes that hold racism in place.

The experiences of culturally and linguistically diverse health practitioners in dominant culture practice: a scoping review

Increasing the proportion of culturally and linguistically diverse (CALD) health practitioners is identified as one strategy to address healthcare disparities that individuals from minority or under-represented backgrounds experience. However, professional and institutional cultures and structures are known to contribute to the challenges for CALD practitioners who work in dominant culture practice contexts. This scoping review used the theory of Legitimate Peripheral Participation to describe and interpret literature about the experiences of CALD health practitioners in view of informing strategies to increase their representation. A systematised search was conducted across four allied health, medicine and nursing databases. Following abstract and full text screening, articles which fit the inclusion criteria (n = 124) proceeded to data extraction. Categories relating to the experiences of practitioners were extracted, and three themes were identified that were subsequently theoretically interpreted: Discrimination, Consequences and Hierarchy. Discrimination functioned as a barrier to CALD practitioners being legitimised and able to participate equally in healthcare practice, retaining their position at the periphery of the practice community; Consequences reinforced this peripheral position and further impeded legitimation and participation; and Hierarchy was maintained through structures that reinforced and reproduced these barriers. The findings summarise how these barriers are reinforced through the intersections of professional and racial hierarchies, and highlight a need for strategies to address discrimination and structures that marginalise CALD practitioners' identity, practices and participation in their health professional communities.

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.

Decolonizing nursing education: Reflecting on Paulo Freire's pedagogy of the oppressed

Historically, nursing education's foundation has been framed by colonial practices of whiteness, which serves as a fulcrum for oppression, Western epistemic ideology, racial injustice, and health inequity. As a microcosm of the broader academy, nursing education must pivot to dismantle practices impeding the advancement of the profession and move to decolonize processes of professional edification. Decolonization is not a metaphor; it requires unlearning the deep socialization of Eurocentric perspectives embedded in nursing education and relearning in a new, inclusive manner that embraces historically marginalized knowledge systems and experiences. This paper aims to operationalize what this decolonization process would look like for nursing education while reflecting on Paula Freire's Pedagogy of the Oppressed. The authors will highlight the interrelationship of the main concepts of Paulo Freire's critical pedagogy, including liberation, critical consciousness, dialog, humanization, dehumanization, problem posing, and banking education.

Racial and ethnic diversity in academic nursing leadership: A cross-sectional analysis

BACKGROUND/PURPOSE

To characterize the representation of racial and ethnic minoritized faculty in leadership positions at the top 50 National Institutes of Health-ranked academic nursing institutions.

METHODS

We conducted a cross-sectional observational study to characterize the racial/ethnic composition of academic leaders, including those in diversity, equity, and inclusion (DEI) positions from September 2020 to December 2020.

DISCUSSION

Among the 409 leaders, the sample was predominantly composed of females (86.6%), White leaders (80.9%), affiliated with public institutions (75.1%), and in the southern region (42.1%). Exactly 13.6% were from minoritized groups. Minoritized leaders were less likely to hold dean and higher executive positions than their nonminoritized counterparts (p < .002). DEI leadership positions were mostly concentrated in lower executive positions (e.g., director) and primarily consisted of minoritized leaders (>60%).

CONCLUSION

Underrepresentation of racial and ethnic minoritized individuals in academic nursing leadership persists, necessitating structural interventions within nursing academia to promote inclusivity. Achieving this goal requires a concerted investment in diversifying academic nursing leadership and ensuring positions that minoritized leaders are in, hold weight.

From group mentoring to collective liberation: The imperative to decolonize nursing academia

BACKGROUND

Four Black early-career faculty members, one Black doctoral student, and a Black senior faculty member, (herein referred to as scholars), previously engaged in cross-cultural mentoring with a White senior researcher to bolster their scholarship.

PURPOSE

In the years following the 2020 racial reckoning, the scholars were motivated to reconvene by the realization that traditional scholarship activities of academia ignore historical educational oppression and fail to account for the contemporary effects of racism and discrimination rooted in American colonialism.

METHODS

Collaborative autoethnography, a decolonizing qualitative approach to research, was used to explicate our journeys in academia. The tenets of Freire's critical pedagogy (conscientização, scholarship, praxis) framed our collective experiences.

DISCUSSION

We describe resisting academic structures of power, discrimination, and disadvantage through reformation, crafting a vision statement, and utilizing positions of influence.

CONCLUSION

To decolonize nursing academia, we implore the scholarly community to pursue liberation and contest structures that center Whiteness and marginalize collectivism and collaboration.

Barriers and Challenges Experienced by Latina Nurse Leaders

Introduction: Leadership reflecting and representing the diversity of the workforce and patient population has been an ongoing challenge for healthcare institutions. As hospitals strategically plan to improve diversity, equity, and inclusion within their intuitions, especially in executive and other leadership roles, it must be acknowledged that only about 5.3% of the nursing workforce is Latinx and few serve in leadership positions. This study aims to learn about the barriers and challenges Latina nurse leaders have experienced in their ascension into leadership roles. Methods: Using a qualitative descriptive study approach, Latina nurse leaders were interviewed one-on-one about their nursing journey and the challenges experienced. A conventional thematic content analysis approach was used to identify common themes. Results: Seventeen Latina nurse leaders shared their experiences. The themes that emerged included: imposter syndrome being the only one, the need to work harder to be seen, age discrimination, racism and racial discrimination, lack of mentorship, and motherhood. Conclusion: Findings from this study help to highlight barriers to leadership development and success of Latina nurses. The findings can be used to encourage, mentor, and support Latina nurses throughout their careers, so they are provided with opportunities for advancement and nurtured as they become leaders.

Centering diversity, equity, and inclusion in a regional professional nursing organization

BACKGROUND

Professional nursing organizations can respond to threats to social justice by strengthening structures to support diversity, equity, and inclusion (DEI).

PURPOSE

Describe implementation strategies and outcomes to advance DEI from the Western Institute of Nursing (WIN).

METHODS

In 2019, WIN committed to prioritizing DEI by updating its vision and mission. A taskforce was assembled to conduct member surveys, focus groups, and open forums to generate recommendations on developing and implementing organizational change.

DISCUSSION

These initiatives culminated in centralized efforts that include the formation of a standing committee, ongoing member surveys, selection of diverse conference topics and speakers, adoption of inclusive practices, and ongoing assessments to make recommendations to the Board to advance DEI.

CONCLUSION

The work of the Committee ensures the organization remains committed to DEI. These strategies inform other nursing organizations as they advance DEI to impact research, education, policy, and practice.

Challenges Faced During Professional Preparation and Transition to Practice Among Diverse Early Professional Athletic Trainers

CONTEXT

Early professional (EP) athletic trainers (ATs) may encounter adjustments and develop individual identities to master a new role, which can be difficult while transitioning from student to autonomous professional. Previous literature lacks content about the transition to practice of credentialed ATs who identify as Black, Indigenous, or people of color (BIPOC).

OBJECTIVE

To identify challenges during the professional education and transition to practice of EP ATs identifying as BIPOC.

DESIGN

Qualitative study.

SETTING

Virtual interviews.

PATIENTS OR OTHER PARTICIPANTS

Fifteen recently credentialed ATs (13 women, 2 men; age = 26.73 ± 1.41 years, experience = 13.80 ± 4.03 months) who self-identified as BIPOC.

DATA COLLECTION AND ANALYSIS

We used an interview guide, validated by peer (n = 1) and expert (n = 3) review, to structure the data collection sessions. Data saturation guided recruitment, and we achieved theoretical redundancy after the final interview. We analyzed the data with a phenomenological approach and used multianalyst triangulation (n = 2) and peer review (n = 2) as credibility strategies.

RESULTS

All participants mentioned being victims of microaggressions because of their race during either their professional preparation, work environment, or both. Those who chose to report the incidents felt a lack of support from work supervisors, faculty, peers, and preceptors. Participants noted a preference for racially concordant mentoring to facilitate talking to a person who could better understand BIPOC EPs' experiences. Respondents also relied on outside support from friends and family as coping mechanisms. Finally, participants experienced perceived incompetency from supervisors due to their limited work experience as EPs and felt their professional preparation was stunted by the COVID-19 pandemic.

CONCLUSIONS

Participants perceived that their transition to practice was stressful due to the microaggressions encountered, a lack of support, and a lack of racially concordant mentoring. Diversity, equity, and inclusion training should be incorporated into athletic training education and workspaces to assist in providing more welcoming environments for BIPOC EP ATs and students.

Racial, Ethnic, and Gender Composition Among Neonatal Nurse Practitioner Faculty Ranks

BACKGROUND

Despite increases in nursing faculty diversity, representation is lacking in positions of higher faculty rank. Challenges for minority faculty include decreased awareness of promotion standards, less mentoring, and increased stress from being the sole representative of their respective underrepresented population.

METHODS

The purpose of this study was to determine the racial, ethnic, and gender composition of neonatal nurse practitioner (NNP) faculty in the United States. A nonexperimental survey was sent to all accredited NNP programs to describe demographics of NNP faculty in the United State.

RESULTS

Of the 128 survey participants, 84% self-identified as White. Forty-eight of the participants ranked Professor or Associate professor were White. In contrast, all other races only had 8 respondents who were of the higher faculty ranks. There were only 2 male participants; one identified as full professor and one as associate professor.

CONCLUSION

Limitations of this project included a small sample size leading to an inability to determine statistical significance. Previous evidence supports decreased diversity in higher faculty rank in other healthcare providers and the results of this study add to that body of literature. Barriers to increased diversification need to be rectified to ensure health equity to all patients.

The Journey and Experiences of Female Hispanic Nurse Leaders

OBJECTIVE

This study aimed to understand the experience of female Hispanic nurses in formal leadership roles.

BACKGROUND

Research has identified that a diverse nursing leadership workforce is essential to providing optimal patient care. Little is known about the phenomenon of minority nurse leaders, particularly female Hispanic nurses in leadership roles.

METHODS

Ricoeur's hermeneutic phenomenology guided the interviews of 15 female Hispanic nurses in leadership roles.

RESULTS

Three themes were generated that described the environment in which leaders lived: family, culture, and healthcare organization. Four phenomenological themes were identified: weaving my life fabric, my inner dialogue, weight on my shoulders, and paving the way.

CONCLUSION

The study findings highlight the importance of a diverse and inclusive nursing leadership workforce. By proactively addressing equal opportunities, reducing barriers to career advancement, and developing strategies to support and encourage minority nurses, organizations and communities can recruit and retain qualified underrepresented minority nurse leaders.

Nurses' comfort and well-being: A descriptive study to find out the relationship between nurses' awareness of self-comfort and well-being at long-term care settings in the state of Kuwait

The study aims to examine out nurses' awareness of self-comfort and well-being in long-term care settings in the state of Kuwait to avoid profession burnout. Nurses are vital resource to health care institutions, the attention on nurses' comfort and well-being should be given valued concerns by top management, as poor staff well-being can pose risks among them and may result in poor performance such as less quality care that is result from less productivity and if the staff well-being ignored the institution performance might be underachieved. A descriptive cross-sectional study design was utilized. The questionnaire assessed participants' socio-demographic data, comfort, and well-being. Data were collected from 260 (86.7% response rate) nurses over the course of 3 months from long-term care facilities in 2 different organizations in Kuwait. The overall nurses' comfort level was moderate with a mean percent score of 67.55 ± 12.50. However, the overall nurses' well-being level was low with a mean percent score of 49.58 ± 6.93. As well as, a strong, positive, and significant correlation was noticed between overall nurses' comfort and its domains with the overall nurses' well-being and its domain. The regression analysis revealed that nurses' perception of their comfort may predict their well-being (P < .001) and explained 34% of the variation in nurses' well-being (R2 = 0.470, β = 0.428, F = 34.762, P < .001). This study emphasized on the importance of creating a healthy, comfortable work environment that promotes nurses' well-being, as well as eliminating discomfort and job dissatisfaction from the organizational culture among nurses as it effects on the organizational performance, productivity, and quality of care.

Providing Gender Sensitive and Responsive Trauma-Informed Psychiatric Nursing Care. How Hard Can It Be?

This paper addresses the challenge of providing gender sensitive and responsive trauma-informed care (TIC) in psychiatric nursing practice. Gender identity, gender subordination, and gender-related trauma history are examined as three key individual-level factors that affect nurses' capacity to engage therapeutically to provide gender sensitive and responsive TIC. Using Peplau's Interpersonal Theory and building on a shared trauma and resilience model, gender-sensitive and responsive TIC is situated within interpersonal science and the ability of the psychiatric nurse to attune to her own and her patient's gender ideologies. Strategies for transforming practice including self-reflection, self-compassion, and peer and supervisor support are reviewed. Noting the import of the practice environment, several observations of changes needed at the level of the unit, organization, and society to effect gender equitable policies that enable the implementation of gender-sensitive and responsive TIC are made.

"To tell you the truth I'm tired": a qualitative exploration of the experiences of ethnically diverse NHS staff

OBJECTIVES

The aim of this paper was to explore the experiences and support needs of ethnically diverse healthcare staff and how they were affected by the COVID-19 pandemic.

DESIGN

A qualitative study using focus groups conducted remotely on Microsoft Teams.

SETTING

The study took place across 10 National Health Service Trusts in England; 5 were Acute Hospitals Trusts and 5 were Community and Mental Health Trusts.

PARTICIPANTS

55 participants across 16 focus groups took part in the study. Participants were all healthcare staff members from ethnically diverse backgrounds.

RESULTS

Seven themes were generated which highlighted issues of negative experiences of discrimination at work, particularly during the COVID-19 pandemic, including participants often finding line managers unsupportive, appearing to lack care and compassion, and not understanding ethnic diversity issues. Participants identified many reasons for finding it difficult to speak up when faced with such experiences, such as feeling unsafe to do so, or feeling too exhausted to keep speaking up. Other staff had more positive experiences and described supportive interventions, and despite workplace difficulties, many participants discussed remaining motivated to work in the National Health Service.

CONCLUSIONS

Negative day-to-day experiences of ethnically diverse healthcare staff, and the difficulty of speaking up about these align with other, international literature on this topic. Progress in the area of staff equality is vital if healthcare organisations are to continue to provide high-quality patient care and retain skilled, compassionate staff who value their place of work. Recent literature suggests that many initiatives to reduce inequalities have not been successful, and there is a call for fundamental, cultural-level change. Future research is needed to understand how best to implement these organisational-level changes and to evaluate their effectiveness.

Overcoming Career Advancement Barriers to Executive Leadership Roles of Nurses From Racial and Ethnic Minority Backgrounds

There is underrepresentation of nurses with racial and ethnic minority backgrounds in executive nursing leadership positions as compared with the general population. The management problem is that even when academically prepared, nurses with racial and ethnic minority backgrounds perceive that they face both singular and systemic barriers to promotional opportunities to executive nurse positions. A literature gap exists as to why this phenomenon persists. The purpose of this qualitative narrative inquiry study was to explore the personal stories and lived experiences of executive nurses with racial and ethnic minority backgrounds concerning the barriers they faced and overcame on their pathway to an executive leadership position. The conceptual framework combined the intersectionality of race and internal and external capabilities. Data collected through semistructured interviews underwent a 3-dimensional-space narrative structure and thematic analysis process. Eleven themes in 3 major categories emerged: (a) facing the challenges; (b) overcoming barriers; and (c) where my help came from. The social change implications include new knowledge for multiple stakeholders in supporting and developing nurses from racial and ethnic minority backgrounds to assist them in achieving executive nursing leadership positions, thereby increasing the number of these nurses in executive roles.

Decolonisation of the nursing education curriculum in Gauteng province, South Africa: A concept analysis

Background

Decolonisation of the nursing education curriculum has become more important than ever. The nursing profession has been colonised since its founding era by Florence Nightingale. Victorian curriculum has been taught over decades in nursing. There is a knowledge gap of what decolonisation means in the profession.

Aim

The purpose of this article is to describe the concept analysis process that was followed to clarify the concept of 'decolonisation' of the curriculum, provide conceptual meaning in nursing education, and formulate a theoretical definition.

Setting

Nursing education practice in Gauteng.

Methods

Definitions, nature, characteristics, and uses of decolonisation were sought and the researchers explored 52 publications, which included dictionaries, encyclopaedias, thesauri, conference articles, research reports, journal articles and subject-related literature across multiple disciplines, to critically analyse the concept 'decolonisation'. A 10-year period from 2012 to 2022 was used to search several databases.

Results

Defining attributes that included antecedents, process and consequences of decolonisation emerged. The antecedents were awareness, identification of colonial knowledge and thought, colonial attitudes, colonialism, racism, exclusion, denial of colonial systems and curriculum and colonial legacies in nursing education. Events after decolonisation are called consequences.

Conclusion

The formulated theoretical definition of 'decolonisation' will be operationalised as further research takes place to come up with a conceptual framework for a decolonised socially just nursing curriculum.

Contribution

This study aimed to contribute towards the understanding of what decolonisation means within nursing education and lead to development of models, theories, and strategies on how decolonisation of the nursing curriculum can be undertaken.

Measuring midwives' perceptions of their practice climate across racial-ethnic identities: An invariance analysis of the Midwifery Practice Climate Scale

Diversification of the midwifery workforce is key to addressing disparities in maternal health in the United States. Midwives who feel supported in their practice environments report less burnout and turnover; therefore, creating positive practice environments for midwives of color is an essential component of growing and retaining midwives of color in the workforce. The Midwifery Practice Climate Scale (MPCS) is a 10-item instrument developed through multiphase empirical analysis to measure midwives' practice environments, yet the MPCS had not been independently tested with midwives of color. We conducted invariance analyses to test whether latent means can be compared between midwives of color and non-Hispanic White samples. A step-up approach applied a series of increasingly stringent constraints to model estimations with multiple group confirmatory factor analyses with two pooled samples. A configural model was estimated as the basis of multiple group comparisons where all parameters were allowed to freely vary. Metric invariance was estimated by constraining item factor loadings to be equal. Scalar invariance was estimated by constraining intercepts of indicators to be equal. Each model was compared to the baseline model. The findings supported scalar invariance of MPCS across midwives of color and non-Hispanic White midwives, indicating that the MPCS is measuring the same intended construct across groups, and that differences in scores between these two groups reflect true group differences and are not related to measurement error. Additionally, in this sample, there was no statistically significant difference in perceptions of the practice environments across midwives of color and non-Hispanic White midwives (p > 0.05).

Development and Validation of the Vicarious Racism in Healthcare Workers Scale

Vicarious racism occurs when hearing about or observing people of the same racial and/or ethnic group experience racism. Healthcare workers may face unique experiences of vicarious racism through witnessing or hearing about racism that their patients and colleagues face. However, there are no validated measures of vicarious racism for the healthcare worker population. In this study, we developed and conducted an initial evaluation of the Vicarious Racism in Healthcare Workers Scale. We developed the 12-item scale based on a qualitative study exploring the experiences of racism among healthcare workers and existing literature on the topic. We administered the scale to a cohort of 259 healthcare workers identifying as a racialized minority to evaluate its factor structure, internal consistency, and construct validity. Factor analysis yielded two factors: racism in social networks and racism in society at-large. This two-factor solution had good model fit (standardized root mean square residual = 0.061). The internal consistencies of the overall scale, social networks subscale, and society subscale were excellent (α = 0.93, 0.92, and 0.89, respectively). We found evidence in support of convergent validity; scale scores were higher among Black healthcare workers compared with non-Black healthcare workers and those with greater social support needs. Scale scores were positively correlated with directly experienced racism and symptoms of posttraumatic stress, depression, and anxiety. The scale demonstrated discriminant validity; scale scores did not differ based on gender or job. The Vicarious Racism in Healthcare Workers Scale demonstrated favorable psychometric properties and may be used to assess vicarious racism in this population.

Illuminating the Contributions of African American Nurse Scientists Despite Structural Racism Barriers: A Qualitative Descriptive Study

A qualitative descriptive approach examined African American nurse scientists' (AANSs') experiences with African American research participants despite obstacles of structural racism. Fourteen nurse scientists participated in semistructured interviews that provided data for the thematic analysis. Major themes included barriers to overcome as doctoral students, cultural experiences with structural racism, designers of culturally sensitive research, and humanitarian respect and relationship depth. This is the first research study to illuminate the contributions of AANSs who lead research in health disparities. Therefore, nursing leadership needs to illuminate AANSs' contributions, increase nurse diversification, and dismantle structural racism that creates obstacles that ultimately impact population health.

Using Narrative Inquiry to Understand Anti-Muslim Racism in Canadian Nursing

BACKGROUND

Islamophobia or, anti-Muslim racism, and more specifically, gendered islamophobia targeting Muslim women who wear a hijab is rising globally and is aggravated by the COVID-19 pandemic. However, anti-Muslim racism is not well understood in Canadian nursing.

PURPOSE

This study utilized narrative inquiry to understand anti-Muslim racism through the experiences of nurses who wear a hijab with the goal of putting forward their counter-narrative that disrupts anti-Muslim racism in Canadian nursing.

METHODS

Narrative inquiry informed by Critical Race Feminism, care ethics, and intersectionality were used to analyze the factors shaping anti-Muslim racism and composite narratives were used to present the results.

RESULTS

The three composite narratives are: 'This is Who I Am: A Muslim Nurse with a Hijab and an Accent'; 'I Know What is at Play: Unveiling Operating Power Structures and Power Relations'; and 'Rewriting the Narrative: Navigating Power Structures and Power Relations'. These composite narratives constituted the nurses' counter-narrative. They revealed intersections of gendered, racial divisions of labour and religious narratives that shape anti-Muslim racism, as operating power relations in nursing, and how Muslim nurses reclaimed control to resist their racialized stereotypes.

CONCLUSION

Findings suggest that anti-Muslim racism in nursing operates through multiple intersecting power relations. Using stories can mobilize transformational change so that anti-racist practices, policies, and pedagogy can be embraced.

Career Satisfaction and Advancement Related to Mentorship Experiences of Underrepresented Nursing Faculty

AIM

This study aimed to describe the perceived impact of mentorship on career satisfaction and advancement for underrepresented nursing faculty.

BACKGROUND

Mentoring contributes to career development through a continuous learning process and support for role development.

METHOD

Fifteen underrepresented nurse faculty in academia comprised the sample for this qualitative phenomenological study.

RESULTS

Themes of career advancement and satisfaction related to mentorship included personal and professional growth, retention, lost opportunities, isolation, and multilayered mentoring.

CONCLUSION

Results of this study may be used to support the development of multilayered mentorship programs to meet the unique needs of underrepresented nurse faculty and improve diversity in nursing education.

No Health Equity Without Diversity: Strengthening Nursing Programs in Historically Black Colleges and Universities

In April 2022, Adtalem Global Education sponsored a virtual summit entitled Advancing Equity in Healthcare, in which several of the authors of this article and other prominent health-care professionals examined the need to diversify the health-care profession. Topics included educational justice and its impact on health care, the business case for transforming and advancing health equity, and addressing systemic inequities and improving health outcomes for historically marginalized persons. The summit inspired the authors to write this paper to advocate for authentic, sustainable partnerships led by Historically Black Colleges and Universities, as a means to diversify nursing leadership and to stem systemic and structural inequities in health care.

Melting the Snowy White Peaks: The needs, expectations and experiences of Black, Asian and minority ethnic student nurses to support equitable nursing education and career progression

BACKGROUND

There is an under-representation of Black, Asian and minority ethnic nurses in senior positions within the UK's national healthcare system.

OBJECTIVES

To understand student nurses' perspectives on the role of race and ethnicity on career expectations, course learning and delivery, and areas for additional training and skill development for all nurses in understanding structural inequalities in healthcare.

DESIGN

Qualitative study involving semi-structured interviews.

SETTINGS

University in south-east England, UK.

PARTICIPANTS

15 nursing students (14 women, one man) from a range of ethnic backgrounds, age-groups and nationalities.

METHODS

Interviews lasting 30-60 min were conducted with nursing students and thematic analyses undertaken.

RESULTS

Four inter-related themes were constructed: altered career expectations, lack of understanding, absent discussion of racism and missing representation. Experiences of racism were not uncommon for students from Black, Asian and minority ethnic backgrounds and these experiences affected these students' career expectations. Students described a lack of understanding about racism and that it was a taboo topic on their course and in placements.

CONCLUSIONS

Findings highlight an urgent need for universities to challenge existing nursing curricula to ensure inclusive, anti-racist educational provision that works equitably for all future nurses. The importance of representation was highlighted among those who deliver courses, in the content of nursing curriculum through inclusive education, decolonised curricula and with student voices embedded to enable the development of culturally-competent nursing graduates.

Development and Implementation of an Academic and Professional Nursing Organization Partnership to Enhance Leadership Skills and Knowledge About HIV-Related Nursing Care Among Diverse, Prelicensure, Clinical Nurse Leader Scholars

ABSTRACT

Historically, racial discrimination, few role models, and a general lack of support both in academic and professional contexts has hindered the education and career advancement of minority nursing students. The American Association of Colleges of Nursing (AACN), in its G uiding Principles for Academic-Practice Partnerships , describes the creation of an academic-professional nursing organization partnership to address barriers to the success of nursing students from underrepresented groups. In keeping with the AACN's guiding principles, the University of Maryland School of Nursing and the Association of Nurses in AIDS Care (ANAC) developed a partnership to deliver a multifaceted program for prelicensure, second-degree, Master of Science in Nursing, Clinical Nurse Leader Scholars which prepares them to address the health care needs of people living with HIV/AIDS and bolsters student leadership knowledge and skills. The objective of this article is to describe the program components, outcomes, and lessons learned from this academic-professional nursing organization partnership. The approach described may be useful for future partnerships designed to enhance leadership experiences and skills for minority nursing students and will hopefully be used to advocate for their success.

Inclusion and Belonging at the Bedside and Beyond

Inclusive work environments lead to a sense of belonging and improve retention.

A meta-synthesis of the transitioning experiences and career progression of migrant African nurses

INTRODUCTION

With the rise in global migration, hospitals and health systems in developed countries are looking to supplement their workforces with migrant nurses who have been reported to feel devalued, underutilized with experience of deskilling and unmet expectations as they transitioned. Despite the plethora of literature reporting on the experiences of internationally trained nurses, only limited work has been done regarding understanding the experiences of Migrant African nurses. Thus, this study sought to synthesize existing qualitative studies to develop in-depth understanding of the transitioning experiences of migrant African nurses, their career progression and to highlight existing gaps to guide future studies as well as inform policies.

METHOD

A meta-synthesis was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Enhancing transparency in reporting the synthesis of qualitative research statement. A pre-planned search strategy was developed guided by the SPIDER tool for qualitative synthesis searching EMBASE via OVID, CINAHL via EBSCO, PubMed, Web of Science, and PsychINFO databases. We included published studies that 1) focused on migrant African nurses, 2) employed a qualitative design and 3) reported in English.

RESULTS

The search yielded 139 studies of which nine studies met the inclusion criteria and included in final synthesis. Three themes with corresponding subthemes emerged from data synthesis: 1) Navigating reality shock (a. Navigating a new culture, b. Survival strategies and support amidst the shock); 2) Discrimination and limited opportunities for promotion (a. Prejudices and preference for White over Black, b. Lack of recognition and limited opportunities for a workplace promotion); and 3) Finding one's feet (a. Standing up for oneself and looking beyond discrimination, b. Experiencing growth).

CONCLUSION

Transitioning to a new setting can be a challenging experience for migrant African nurses warranting the availability of a tailor-made adaptation or orientation programme. Though African nurses may experience discrimination and prejudices as part of their transition, they consider their situation to be better off compared to back home. Therefore, clear transitioning policies which focus on career pathways are required by hiring institutions, and migrant nurses should be proactive in taking active roles in pushing their career ahead, instead of maintaining a culture of silence.

Mentoring Experience for Career Advancement: The perspectives of Black Women Academic Nurse Leaders

Mentoring is critical for career advancement in all professions. It is especially crucial for leadership development and succession planning. Studies suggest that increasing the racial minority representation in higher-level leadership will provide diverse skill sets, promote innovation, and yield positive outcomes. The study aimed to examine how Black women academic nurse leaders perceive mentoring in academic nursing using critical race theory as the guiding framework and explore the crucial role of mentorship in promoting and advancing Black women academic nurse leaders. The study used a narrative qualitative research design, purposive sampling, and unstructured interviews to collect and thematically analyze data. Findings fall under two major themes; being mentored and mentoring others. The findings highlight perceived significant differences in the allocation of resources and mentoring for career advancement in academic nursing for Black nurses compared to those classified as white. Increasing diversity in nursing requires deliberate effort from majority white leadership.

Building Solidarity with Black Nurses to Dismantle Systemic and Structural Racism in Nursing

Systemic and structural racism in nursing have profound impacts on Black People, Indigenous Peoples, and People of Color. They contributed to underrepresentation in faculty, senior nurse executives, and presidents' positions in academic and healthcare organizations, physical and mental health issues in racialized groups. This quality improvement study described ways in which the Black Nurses Task Force of the Registered Nurses Association of Ontario can build solidarity with nursing and government organizations to dismantle systemic and structural racism in nursing. This study used a structured online survey, comprised of quantitative and qualitative questions. The qualitative data were analyzed using interpretative thematic analysis and the quantitative data were analyzed with descriptive statistics. Findings showed that 88% of participants experienced racism and 63% said racism affected their mental health. Three themes emerged from the qualitative data: Social support for Black nurses, accountability of leaders and solidarity with Black nurses. These findings demonstrated the urgent need to dismantle systemic and structural racism in nursing.

"You have to strive very hard to prove yourself": experiences of Black nursing students in a Western Canadian province

OBJECTIVES

This study explored the experiences of Black students in two western Canadian undergraduate nursing programs.

METHODS

Using a qualitative focused ethnography design grounded in critical race theory and intersectionality, participants were recruited using purposive and snowball sampling. Data were collected through individual interviews, and a follow-up focus group. Data were analyzed using collaborative-thematic analysis team approaches.

RESULTS

n=18 current and former students participated. Five themes emerged: systemic racism in nursing, precarious immigrant context, mental health/well-being concerns, coping mechanisms, and suggestions for improvement.

CONCLUSIONS

An improved understanding of Black student experiences can inform their recruitment and retention. Supporting Black students' success can potentially improve equity, diversity, and inclusivity in nursing education programs and/or their representation in the Canadian nursing workforce.

IMPLICATIONS FOR AN INTERNATIONAL AUDIENCE

The presence of a diverse nursing profession is imperative to meet the needs to provide more quality and culturally competent services to diverse population.

Transforming nursing education in response to the Future of Nursing 2020-2030 report

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity report (NASEM, 2021) provides a comprehensive plan to improve the quality of health care and candidly acknowledges historical and contemporary issues that have stalled previous efforts to dismantle health care disparities. This article spotlights the role that nursing education, nurse leaders, and faculty play in enabling all people to achieve their highest level of health. Through the framework of the four pillars of (1) reconciling the shortage of nurses with expertise in public health and health equity, (2) creating policies that include and promote the tenets of diversity, antiracism, and well-being, (3) designing curricular resources and activities that address contemporary issues, and (4) creating and supporting an ethos that invites, retains, and graduates diverse students and facilitates a sense of belonging, our future nursing graduates will be prepared to advance health equity for all.

Nurses' perceptions of career growth: A qualitative descriptive study

AIMS

To explore nurses' experiences and perceptions of career growth and its influencing factors, as career growth is more closely associated with individual attitudes and behaviours in the new career era.

DESIGN

A qualitative descriptive design was used.

METHODS

Thirty-one nurses from 10 secondary and 8 tertiary hospitals in Sichuan Province of China were purposively selected to participate in this study. The data were collected using individual semi-structured face-to-face interviews. Two researchers independently reviewed the transcripts and emergent coding. The data were analysed using qualitative content analysis.

FINDINGS

The nurses' perceptions of career growth fully described the nurses' experience and occurred in five dimensions: career promotion, career goal progress, professional ability and quality improvement, professional identity development and increase in personal prestige. The factors influencing career growth were identified at the organizational, individual and social levels. Career growth in nursing was complex, changed over time and showed several specific characteristics compared with other careers. The nurse-specific symbol of career growth was professional identity development, which reflected career progression characteristics.

CONCLUSIONS

Career growth is a multi-dimensional concept with varying influencing factors. The meaning of career growth for nurses is distinct from that for employees in other careers.

IMPACT

Nursing managers should guide nurses to comprehensively assess their career growth from multiple perspectives, and professional identity development deserves more attention. Both organizations and individuals should take responsibility for career management to pursue career growth.

Social Justice in Nursing Education: A Way Forward

BACKGROUND

Systemic racism and inequity are embedded in higher education, especially in nursing. By disregarding health disparities and inequities, a hidden curriculum is endorsed, implicitly letting both instructors and students know that not addressing these subjects is acceptable.

METHOD

Needs assessments were performed to assess faculty and student attitudes about the needs for justice, equity, diversity, and inclusion (JEDI) concepts. Using the Plan-Do-Study-Act model, the School of Nursing leadership, faculty, and students created taskforces to implement anti-oppression curricula throughout prelicensure courses.

RESULTS

Anti-oppression curricula and workshops were piloted successfully in the first semester of prelicensure nursing. Student feedback was positive with constructive suggestions. JEDI curriculum mapping was completed across the prelicensure nursing curriculum.

CONCLUSION

JEDI concepts must be integrated across nursing curricula to identify gaps. Forming a collaboration between leadership, faculty, and students is an optimal way to proceed as they all are invested and accountable for change. [J Nurs Educ. 2022;61(8):447-454.].

"They Wanted to Talk to a 'Real Doctor'": Predictors, Perpetrators, and Experiences of Racial and Ethnic Discrimination Among Healthcare Workers

BACKGROUND

Racial and ethnic diversity of healthcare workers have benefits on team functioning and patient care. However, a significant barrier to retaining diverse providers is discrimination.

OBJECTIVE

To assess the predictors, perpetrators, and narratives of racial discrimination among healthcare workers.

DESIGN

Survey study.

PARTICIPANTS

Healthcare workers employed at academic hospitals.

MAIN MEASURES

We assessed prevalence and perpetrators of racial and ethnic discrimination using the General Ethnic Discrimination Scale. We included an open-ended question asking respondents to recount experiences of discrimination and analyzed responses using grounded theory.

KEY RESULTS

Of the 997 participants, 12.2% were females from backgrounds underrepresented in medicine (URM), 4.0% URM males, 10.1% Asian females, 4.7% Asian males, 49.1% non-Hispanic White females, and 19.8% non-Hispanic White males. Among healthcare workers of color, 85.2% reported discrimination. Over half of URM females (51.4%), URM males (52.6%), and Asian females (62.5%) reported discrimination by patients. About 20-25% of URM females, URM males, and Asian females reported discrimination by teachers, supervisors, co-workers, and institutions. In adjusted binary logistic models, URM females had 10.14 odds (95% confidence interval [95%CI]: 5.13, 20.02, p<.001), URM males 6.23 odds (95%CI: 2.59, 14.98, p<.001), Asian females 7.90 odds (95%CI: 4.07, 15.33, p<.001), and Asian males 2.96 odds (95% CI: 1.47, 5.97, p=.002) of reporting discrimination compared with non-Hispanic White males. Needing more support was associated with 2.51 odds (95%CI: 1.54, 4.08, p<.001) of reporting discrimination. Our qualitative findings identified that the murder of George Floyd intensified URM healthcare workers' experiences of discrimination through increased fear of violence and requests for unpaid diversity work. Asian healthcare workers reported that pandemic-related anti-Asian violence shaped their experiences of discrimination through increased fear of violence and care refusal from patients.

CONCLUSIONS

Our findings provide insights into experienced discrimination among healthcare workers and opportunities for hospitals to create programs that improve inclusivity.

Diversity and Inclusion or Tokens? A Qualitative Study of Black Women Academic Nurse Leaders in the United States

Severe under-representation of Black women academic nurse leaders persists in United States higher education, and a major research gap still exists regarding experiences of these leaders, and facilitators of and barriers to their success. Our objective was to examine how race and gender influence how Black women academic nurse leaders’ function in their leadership positions, how they are perceived by their peers, and how their perception of race, gender, class, and power influences diversity, equity, and inclusion initiatives in the workplace. Critical race theory was used as a guiding theory, and the study design involved narrative inquiry followed by thematic analysis. Four overarching themes with four sub-themes were revealed: (a) Paying a personal price for authenticity, (b) Being the only one is hard even when you are in charge, (c) The illusion of diversity and inclusion while trying to survive, and (d) Focusing on building and sustaining diversity, equity, and inclusion. Implications for nursing education including instituting training for faculty in anti-racist pedagogy and requiring nursing programs to meet inclusivity metrics for approval and accreditation.

Tackling discrimination and systemic racism in academic and workplace settings

Racism against Black people, Indigenous and other racialized people continues to exist in healthcare and academic settings. Racism produces profound harm to racialized people. Strategies to address systemic racism must be implemented to bring about sustainable changes in healthcare and academic settings. This quality improvement initiative provides strategies to address systemic racism and discrimination against Black nurses and nursing students in Ontario, Canada. It is part of a broader initiative showcasing Black nurses in action to end racism and discrimination. We have found that people who have experienced racism need healing, support and protection including trauma-related services to facilitate their healing. Implementing multi-level, multi-pronged interventions in workplaces will create healthy work environments for all members of society, especially Black nurses who are both clients/patients and providers of healthcare.

Supporting the Dynamic Careers of Licensed Practical Nurses: A Strategy to Bolster the Long-Term Care Nurse Workforce

As the U.S. population ages and the demand for long-term care increases, an insufficient number of licensed practical nurses (LPNs) is expected in the nursing workforce. Understanding the characteristics of LPN participation in the workforce is essential to address this challenge. Drawing on the theory of boundaryless careers, the authors examined longitudinal employment data from LPNs in North Carolina and described patterns in LPN licensure and career transitions. Two career patterns were identified: (a) the continuous career, in which LPNs were licensed in 75% or more of the years they were eligible to be licensed and (b) the intermittent career, in which lapses in licensure occurred. Findings indicated that LPNs who made job transitions were more likely to demonstrate continuous careers, as were Black LPNs. These findings suggest the importance of organizational support for LPN career transitions and support for diversity in the LPN workforce.

It is like 'judging a book by its cover': An exploration of the lived experiences of Black African mental health nurses in England

The aim of this paper was to explore the experiences of perceived prejudices faced in England by Black African mental health nurses. Purposive sampling was used to identify five nurses from sub-Saharan Africa. They were interviewed using face-to-face semi-structured interviews. Data were analysed using interpretative phenomenological analysis (IPA). The findings were reported under two superordinate themes: Judging a book by its cover and opportunities. The findings showed that Black African nurses experience deep-rooted discrimination and marginalisation. Aside from that, because of their ethnicity and the fact that they speak English as a second language, they face discrimination and have difficulty achieving leadership roles. These findings provide key stakeholders, such as nursing trade unions and professional associations, as well as NHS employers, with the opportunity to act to counter hegemony in the NHS and recognise that discriminatory and racially related barriers hinder Black African nurses from reaching their full professional potential.

Creating Collaborative Relationships With Historically Black Colleges and Universities: An Approach to Diversifying the Nursing Workforce

BACKGROUND

The lack of a diverse nursing workforce and inclusive nursing student pipeline initiatives can impact existing health disparities in the United States.

PROBLEM

Gaps in the representation of future Black nurses in schools of nursing provide missed opportunities for cultural congruence and awareness.

APPROACH

Developing collaborative relationships with historically Black colleges and universities (HBCUs) for recruitment is a mutually beneficial strategy. Undergraduate interns from 3 HBCUs attended a 6-week summer nursing immersion program at a graduate school of nursing on the campus of a predominately White institution. The aim was to provide awareness of the nursing profession and mentorship for further exploration into the profession.

CONCLUSIONS

The program managed by Black nurse faculty provides a recruitment strategy that serves as a framework to support the financial, emotional, and social needs of prospective Black nursing students.

Rejecting the myth of equal opportunity: an agenda to eliminate racism in nursing education in the United States

BACKGROUND

Unfortunately, racism and discrimination against Ethnic minority (EM) has been globalized, universally infecting industries worldwide, and the field of nursing has not been spared. In the United States (US), overt and institutionalized racism (IR) still permeates the fields of nursing, nursing leadership, and nursing education. Programs to address these disparities, and efforts by nursing professional societies and nursing education policymaking bodies to address racism in the nursing field, specifically with nursing leadership and education, have met with little success.

OBJECTIVE

The purpose of this paper is to illustrate the existence and magnitude of racism and its impact on the fields of nursing, nursing leadership, and nursing education, and to make evidence-based recommendations for an agenda for reforming nursing education in the US.

METHODS

A narrative literature review was conducted with a focus on pulling together the strongest evidence on which to base policy recommendations.

RESULTS

Based on the available literature, we put forth five recommendations aimed at modifying nursing education in the US as a strategy to counter IR in the US in the nursing field.

CONCLUSIONS

Recommendations to address IR in nursing focus on nursing education, and involve implementing programs to address the lack of opportunity for both EM students and faculty in nursing, developing an anti-discriminatory pedagogy, and incorporating diversity initiatives as key performance indicators (KPIs) in the process of approval and accreditation of nursing programs.

Barriers to career advancement in the nursing profession: Perceptions of Black nurses in the United States

Background

There is a paucity of Black and minority ethnic group nurse leaders and faculty in the nursing profession, even though the overall number of nurses within this demographic has increased. This study aimed to examine Black nurses' perceptions of the barriers to career advancement in nursing profession in the United States.

Procedure

Participants included 30 Black nurses aged 25 to 65 from health care settings across five US states recruited through purposive sampling. The study used a focused ethnographic design with semi‐structured interviews to elicit responses about participants perceptions and experiences of seeking leadership and faculty positions.

Results

Thematic analysis revealed seven main themes: maintaining white comfort, distrust, no one like me, paving the way, worthy of representation, leadership role not expected of Black nurses, and an advanced degree does not equal advanced opportunities.

Conclusion

The findings suggest that Black nurses face significant challenges in entering leadership or faculty positions. They face racial discrimination and lack access to mentorship and support which discourages sufficiently qualified and experienced nurses from applying for high‐level positions. Ensuring all nurses are afforded equal opportunity for career advancement is essential for the nursing profession's continued growth.