‘21 and Blonde’
Until recently, college nursing courses used only white manikins as medical models. Most manufacturers didn’t make them with any other skin tone, says Laura Gonzalez, a former clinical associate professor in the University of Central Florida’s College of Nursing.
While the nursing field is slowly becoming more diverse, it’s still mostly white. “When people talk about the traditional nursing student, she is 21 and blonde,” says Gonzalez, who is now vice president for clinical learning resources at Sentinel U, a company that creates simulation platforms for health-care education. About 41 percent of students in bachelor’s programs in nursing are now people of color. Close to 80 percent of registered nurses and nursing faculty members are white, according to the American Association of Colleges of Nursing.
There’s an urgent need for colleges to diversify the nursing ranks, Gonzalez says, and ensure that nurses are equipped to provide care to an increasingly diverse American population. People in some racial and ethnic minority groups tend to have higher rates of diabetes, heart disease, and other chronic health conditions than white people do. And in many cases, they distrust health-care providers because of the field’s long history of mistreating people of color.
There are many barriers to diversifying the profession, Gonzalez says. It’s tough to get into nursing school, and if students don’t do well in high-pressure weed-out science courses, their chances of admission take a hit. Many nursing schools require standardized-test scores, a realm where inequity has been well documented. Nursing schools also don’t have enough capacity — instructors, clinical sites, and classroom space — even for the most qualified students.
When it comes to diversifying the faculty, academe is a tough sell: Nurses need an advanced degree, and they can earn far more money working in private practice or elsewhere.
The American Nurses Association, which sets guidelines for the nursing profession, created a standard on the importance of understanding cultural differences in 2015, and nursing schools have updated their curricula in response. But that’s not enough, Gonzalez says, because most professors are still “teaching from a particular lens.”
Among students, she says, “there are learners who have never been outside of their community, outside of their county, outside of their state.” When those newly minted nurses start working at a hospital, they’re very smart, Gonzalez says, but they “may be entering a completely different environment.”
Those nurses might not know that, before providing care to a Muslim woman, they might need to ask her father’s permission to examine her. They also might need to explain to that patient what they’re about to do before removing her hijab. Even if nurses learned in a course that Black women die in childbirth more often than white women do, they might not know the right questions to ask a pregnant Black woman about her specific health risks, like high blood pressure.
Virtual Diversity
When it comes to cultural competence in nursing education, certain models have proved effective — especially those that involve hands-on learning, as opposed to lectures about stereotyping. In 2021, the American Association of Colleges of Nursing published a resource for faculty members on strategies for teaching cultural competence. The association’s member colleges also endorsed a new model for nursing education that stresses cultural sensitivity.
Desiree A. Díaz, an associate professor in Central Florida’s College of Nursing, prefers the idea of cultural congruence to cultural competence. As she sees it, competence in every culture just isn’t possible, she says. What’s important is for nursing students to learn to consider a patient’s cultural background — and to ask questions instead of making assumptions.
Díaz gives the example of educating patients on diabetes nutrition when they come from a culture that primarily eats certain foods. What happens when a nurse tells patients “to not eat rice and beans when that’s all they’ve known?” she says. Their culture, she says, “has major implications for their interactions, their health, and everything else that goes with it.”
One rapidly growing model with early signs of success is virtual simulation training for nursing students, an approach that aims to put diversity in the foreground.
During the pandemic, many overwhelmed hospitals stopping taking on nursing students for a while. But students still needed to make progress on their hundreds of required clinical hours. So many colleges scaled up their use of virtual platforms to help nursing students stay on track, allowing them to interact with patients in online scenarios.
Sentinel U’s medical-simulation platform is one of dozens on the market. The company works with more than 200 colleges, Gonzalez says. It’s affiliated with Post University, a for-profit institution in Connecticut.
Faculty members who designed the Sentinel U platform worked with DEI experts to ensure that the virtual patients represented a wide range of backgrounds: African American, gender nonbinary, Sikh, Hindu, Native American. Patients were given a “story” that accurately reflected their culture.
In 2021 and 2022, Sentinel U led a study of seven colleges, including minority-serving institutions, that used the nursing-simulation platform. Colleges were given free access, with the goal of seeing whether nursing students who did online simulation had the same academic outcomes as nursing students who did face-to-face learning.
The results were promising, Gonzalez says: Nursing students who learned online performed just as well as, and in some cases better than, their peers.
Gonzalez is also president of the International Nursing Association of Clinical and Simulation Learning, the first Hispanic woman to serve in that role. By creating diverse characters and story lines, she says, virtual nursing education can help better prepare students for their careers and “bring diversity straight to their laptop.” —Sarah Brown
