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In this virtual panel discussion, Dr. Ernest Grant, Jason Thompson, and Dr. Jan Jones-Schenk discuss how we must eliminate barriers to equity in access and learning in order to reduce racial disparities in care.
Progress in advancing diversity in the US health care workforce has been slow. This is evidenced by the low numbers of people from historically underrepresented populations joining the health professions workforce, ongoing reports of bias and discrimination in health professions learning environments, and a continuing dearth of proven and replicable best practices to advance diversity. Many of our health professions schools and clinical practice sites are taking some action on diversity and the more contemporary concepts of equity and inclusion, but without making the necessary commitment to comprehensive, system-wide approaches that create meaningful culture change. As a result, addressing harmful bias and eliminating discrimination remain critical challenges to achieving excellence in health care and health professions education.
Within the registered nurse (RN) workforce, according to the National Council of State Boards of Nursing (NCSBN), 81% are White/Caucasian (vs 60% of the US population), while 19% of nurses are from underrepresented racial/ethnic populations.
The Accountable Care Learning Collaborative believes that nursing programs must address bias and reduce discrimination in health professions learning environments because, in not doing so, racial disparities in care will persist. In our Accountable Care Atlas, we identified a specific competency to “understand the unique cultural characteristics of the population served to implement changes in the organization to provide high-value care”. This cultural competency failure is reinforced by research that shows that care.
1:40 ACLC Leadership takes a stance on institutional racism and how BLM movement is a public health issue
4:00 Introduction to panelists: Dr. Ernest Grant, Dr. Jan Jones-Schenk, and Jason Thompson
4:50 Reference to population health research that shows us that the American health care system is not immune to institutional racial discrimination
8:05 Jason Thompson on how we can engage in a societal conversation to foster a better understanding about the presence of racism
8:26 “I can’t make you racist in 45-minutes…and I can’t undo it in 45-minutes. It takes multiple conversations and constant engagement.”
9:51 “There has never been any period in American history where the health of blacks was equal to that of whites. Disparity is built into the system.”
10:19 “Advancing health equity will require a justice-oriented framework that identifies structural racism’s manifestation in medical care.”
10:50 Reference to Don Berwick’s recent article, “The Moral Determinants of Health“
12:05 Dr. Ernest Grant on how our country can reorient value-based care and public health policies around racial and health justice
13:30 Dr. Ernest Grant on how the nursing profession can mobilize around the issue of institutional racism and health inequity
13:50 Dr. Ernest Grant references his testimony to the House Ways and Means Committee on the disparate impact of COVID-19 in the African American community
14:37 “As nurses we have the responsibility to use our voice to call for change. Our code of ethics obligates us as nurses to be allies and to speak up against racism, discrimination, and injustice.”
16:00 Dr. Jones-Schenk speaks to how we need to “go upstream to the source” to address seek solutions in reforming society
17:05 “As a profession, we make a promise to society that we will address the health needs of society. We have a responsibility for outcomes in diverse populations – not just caring for illness.”
17:45 Reference to recent article, “Value-Based Health Care must Value Black Lives” and its suggestion to reorient value-based care policies around racial and health justice
19:30 Dr. Ernest Grant on how we can hardwire conformance to social justice within the nursing profession by leading by example
20:43 Dr. Ernest Grant on nurse role modeling and the eradication of stereotypes
21:21 Dr. Ernest Grant on advancing equity in health care by reforming education, having diversity in the workforce, and offering mentorship in the profession
24:47 Dr. Jones-Schenk on how to lead a social movement in health equity with data (“Historically tyranny of the aggregate” and the need to stratify data by populations)
27:09 Dr. Jones-Schenk on the need for faculty diversity in nursing programs and how this perpetuates the problem
28:33 This month is the 10th anniversary of Institute of Medicine’s landmark report, “The Future of Nursing: Leading Change, Advancing Health” (Has anything changed?)
29:51 Jason Thompson addresses how intentionality and direct action is needed to address under-representation of women, minorities, and nurses on corporate boards and senior leadership roles
31:37 “If we are really about saving money and being efficient, and providing better care, let’s call it out for what it is. Let’s not call it health disparities…this is racism.”
33:25 Dr. Jones-Schenk reflects on the IOM “moonshot” goal of 10,000 nurses on Boards, and the progress we have made over the last decade in the leadership and empowerment of nurses
35:18 “Language matters. Sometimes we used softened language because we don’t want to hurt people’s feelings. We’re hurting more than people’s feelings right now by using overly nuanced language to describe this problem.”
36:14 Dr. Ernest Grant expounds on the “Nurses on Boards” initiative and the need for community involvement to drive change, including the type of food accessible in communities
39:10 Dr. Jones-Schenk shares a personal story about a nursing student becoming personally involved in the public health of his community by running for mayor
41:47 “The fact that the nation’s health professions have not kept pace with changing demographics may be an even greater cause of disparities in health access and outcomes than the persistent lack of health insurance for tens of millions of Americans.” (referencing the groundbreaking report, Missing Persons: Minorities in the Health Professions)
43:35 Jason Thompson discusses institutional barriers in Higher Education that disadvantage students of color
45:16 “We haven’t thought about a systematic solution…we all work in our own silos…If you have a systematic problem, you need a systematic solution.”
47:42 Dr. Ernest Grant discusses the implicit bias in the NCLEX-RN exam for nurses and other barriers in nursing education
52:00 Dr. Jones-Schenk on how to reinvigorate the promise of education for people of color and what institutions of higher learning can do to provide equity in access and learning
53:55 “We have to declare our commitment through action. This means empowering groups who can identify structural issues that support racism and then resourcing their recommendations.”
58:13 Dr. Jones-Schenk on implicit bias and micro-inequities and how to eliminate bias in teaching and learning
59:33 “We are trying to correct longstanding errors in our culture. We have to be bold and stand up to detractors that say this is just political correctness and not a big deal.”
1:00:43 “Are psychometrics considering population-specific differential analysis?”
1:01:02 “Until you see it, you can’t change it. And once you see it, hopefully you can’t unsee it. Higher Education doesn’t have a choice!”
1:01:16 Dr. Jones-Schenk refers to the recent statement from 40 health systems that racism is a public health crisis
1:02:00 Dr. Jones-Schenk refers to Macy Foundation recommendations (Addressing Harmful Bias and Eliminating Discrimination in Health Professions Learning Environments report)
1:04:48 Dr. Ernest Grant discusses what ANA is doing to empower nurses — both socially and economically – to create meaningful change in communities and within the political arena
1:09:00 Jason Thompson discusses how health disparities are created by the summation of all of our individual behaviors, and how the individual commitment makes a difference
1:10:00 Jason Thompson on how “mandatory” training doesn’t work! Only “consistent and regular” training works.
1:11:15 Drs. Ernest Grant and Jones-Schenk on how the word “mandatory” creates apprehension in the workforce and how we need to reframe the dialogue