WEBVTT 00:00:05.340 --> 00:00:06.340 position:50% align:middle Good morning. 00:00:06.340 --> 00:00:14.014 position:50% align:middle I am so thrilled and honored to join you this morning for the APRN round table. 00:00:14.715 --> 00:00:22.560 position:50% align:middle And I'm especially thrilled to have time to speak to you about a topic that is near and dear to me, 00:00:22.560 --> 00:00:25.544 position:50% align:middle Diversity in the APRN Workforce. 00:00:25.930 --> 00:00:34.590 position:50% align:middle It's a topic that is personal to me but, also, one that is important given my role as a health 00:00:34.590 --> 00:00:43.970 position:50% align:middle equity researcher, interested very much in ways that we might improve health outcomes, increase health equity, 00:00:43.970 --> 00:00:46.169 position:50% align:middle and reduce health disparities. 00:00:46.550 --> 00:00:53.975 position:50% align:middle And so, before I begin, I always like to share what brings me to a topic. 00:00:54.750 --> 00:01:02.392 position:50% align:middle And so I've been a nurse practitioner for over 20 years, and I completed a psychiatric primary care nurse 00:01:02.392 --> 00:01:07.481 position:50% align:middle practitioner program at the University of Pittsburgh in the late '90s. 00:01:07.802 --> 00:01:13.630 position:50% align:middle And it was during my time as a nurse practitioner student that I had a preceptor. 00:01:13.630 --> 00:01:17.935 position:50% align:middle Her name was Ms. Anne, and we worked in a community health center together. 00:01:18.290 --> 00:01:24.210 position:50% align:middle And it was while working with Ms. Anne that> I saw myself in her and I knew that 00:01:24.210 --> 00:01:27.513 position:50% align:middle I wanted to center my practice in community health. 00:01:28.316 --> 00:01:34.650 position:50% align:middle At the time that she was my preceptor, I didn't realize that it was very rare or it would be 00:01:34.650 --> 00:01:42.010 position:50% align:middle very uncommon over the course of my nurse practitioner practice that I would ever see another nurse 00:01:42.010 --> 00:01:43.824 position:50% align:middle practitioner who looked like me. 00:01:44.350 --> 00:01:50.740 position:50% align:middle In fact, during my first six years of practice, I saw literally no nurse practitioners who 00:01:50.740 --> 00:01:51.743 position:50% align:middle looked like me. 00:01:52.110 --> 00:01:58.896 position:50% align:middle And during my time at Pitt, in my classrooms, I saw no other nurse practitioners who looked like me. 00:01:59.450 --> 00:02:05.480 position:50% align:middle And so the lack of diversity in the APRN workforce certainly is one that is personal to me, 00:02:05.480 --> 00:02:12.870 position:50% align:middle but it also has implications for patient care, particularly care of patients or individuals 00:02:12.870 --> 00:02:15.822 position:50% align:middle from underrepresented and diverse communities. 00:02:15.980 --> 00:02:23.510 position:50% align:middle And so it's with that that I share some concerns about diversity that I have 00:02:23.510 --> 00:02:29.201 position:50% align:middle but, also, look forward to a conversation about how we might meet the urgency of the moment. 00:02:30.464 --> 00:02:34.870 position:50% align:middle And so to start off our time together, I thought I would share a few objectives. 00:02:34.870 --> 00:02:37.589 position:50% align:middle Yes, they're a little ambitious, but we're going to do it. 00:02:38.347 --> 00:02:44.240 position:50% align:middle And so for the next 40 minutes or so, I'm going to lay the groundwork for what the current 00:02:44.240 --> 00:02:48.193 position:50% align:middle racial and ethnic composition of the APRN workforce is. 00:02:49.360 --> 00:02:55.095 position:50% align:middle How is the advanced practice nurse workforce impacted by the lack of diversity? 00:02:55.490 --> 00:03:05.136 position:50% align:middle How do APRN regulators and other stakeholders benefit from improved diversity, inclusivity, and equity? 00:03:05.240 --> 00:03:10.368 position:50% align:middle And what are the patient implications for quality, safety, access? 00:03:11.050 --> 00:03:14.810 position:50% align:middle And then I'd like to ask about the quality of the data. 00:03:14.810 --> 00:03:17.279 position:50% align:middle Is it good? If not, why not? 00:03:17.430 --> 00:03:24.605 position:50% align:middle And what do we need to get a more complete picture about what diversity in the APRN workforce looks like? 00:03:25.350 --> 00:03:31.411 position:50% align:middle We're then going to move on to describe the current environment and barriers to increasing diversity. 00:03:31.860 --> 00:03:41.050 position:50% align:middle And lastly, I'm going to leave you with a few strategic activities to help advance DEI objectives, 00:03:41.050 --> 00:03:48.030 position:50% align:middle but it's really a launching point for our conversation during the Q and A to discuss what you are 00:03:48.030 --> 00:03:53.710 position:50% align:middle currently doing, what some of your barriers are, and what are the collective activities that we should 00:03:53.710 --> 00:03:55.455 position:50% align:middle be engaging in together. 00:03:56.390 --> 00:03:59.510 position:50% align:middle Before I begin, an acknowledgment. 00:03:59.830 --> 00:04:09.590 position:50% align:middle And so diversity is certainly expressed in multiple forms, including but not limited to race/ethnicity, 00:04:09.590 --> 00:04:18.350 position:50% align:middle gender, gender identity, sexual orientation, SES status, national origin, religious beliefs, 00:04:18.350 --> 00:04:21.273 position:50% align:middle disability status, political views. 00:04:21.510 --> 00:04:26.400 position:50% align:middle And I want to acknowledge this because we have such a short time together. 00:04:26.400 --> 00:04:31.984 position:50% align:middle And so I won't be touching on all forms of diversity during our time today, but I will be 00:04:31.984 --> 00:04:40.333 position:50% align:middle specifically discussing diversity through the lens of race and ethnicity of the APRN workforce. 00:04:40.610 --> 00:04:47.050 position:50% align:middle But I want to say that as a caveat because we should be thinking about diversity in its 00:04:47.050 --> 00:04:53.600 position:50% align:middle broadest sense, particularly for those individuals who may have been systematically excluded 00:04:53.600 --> 00:04:55.685 position:50% align:middle from the APRN workforce. 00:04:57.100 --> 00:05:02.358 position:50% align:middle And so I want to make sure we're all on the same page and singing from the same hymnal. 00:05:02.358 --> 00:05:05.553 position:50% align:middle And so what then is workforce diversity? 00:05:05.850 --> 00:05:12.700 position:50% align:middle And so diversity in health occupations is measured by the representation of minority groups 00:05:12.700 --> 00:05:20.008 position:50% align:middle in the health occupation relative to their representation in the U.S. populace. 00:05:20.220 --> 00:05:26.604 position:50% align:middle And so lower representation of racial and ethnic minority members in a health occupation 00:05:26.604 --> 00:05:33.062 position:50% align:middle relative to their numbers in the general population signifies that the racial or ethnic group is 00:05:33.062 --> 00:05:35.284 position:50% align:middle underrepresented in the occupation. 00:05:35.440 --> 00:05:41.505 position:50% align:middle And so just for a point of reference, about 60% of the U.S. populace is white, 00:05:41.505 --> 00:05:46.020 position:50% align:middle and that means 40% would identify as a racial or ethnic minority. 00:05:46.020 --> 00:05:52.599 position:50% align:middle And so with that platform, we're going to see the state of diversity 00:05:52.599 --> 00:05:54.110 position:50% align:middle in the APRN workforce. 00:05:54.110 --> 00:06:02.373 position:50% align:middle And so the first slide that I'll share with you is from the National Center for Health Workforce Analysis 00:06:02.373 --> 00:06:04.017 position:50% align:middle from 2017. 00:06:04.262 --> 00:06:10.704 position:50% align:middle And so if you look at this data, which actually was derived between 2011 and 2015, 00:06:10.704 --> 00:06:18.851 position:50% align:middle for advanced practice registered nurses at that time, 84% of the APRN workforce was white. 00:06:19.490 --> 00:06:29.823 position:50% align:middle About 5.7% is black or African American, 4.5% self-identified as Hispanic, 4.1% as Asian, 00:06:30.830 --> 00:06:40.510 position:50% align:middle American-Indian self-reported less than a half a percentage, and Native Hawaiian and Pacific Islanders 00:06:40.510 --> 00:06:41.780 position:50% align:middle was not reported. 00:06:41.780 --> 00:06:48.532 position:50% align:middle And so that signifies that it's too small a number to be able to report. 00:06:48.960 --> 00:06:58.676 position:50% align:middle And so this gives us a sense for what the APRN workforce looked like between 2011 and in 2015. 00:06:58.676 --> 00:07:04.770 position:50% align:middle And so, quite rightfully, these numbers may have improved over the last seven years, 00:07:04.770 --> 00:07:11.297 position:50% align:middle but we know that shifts in the composition of the workforce actually shift quite slowly. 00:07:11.480 --> 00:07:17.349 position:50% align:middle And so we should surmise that this is probably about where we are today. 00:07:18.410 --> 00:07:23.259 position:50% align:middle And so using another data source, this one is from the American Community Survey 00:07:23.259 --> 00:07:29.492 position:50% align:middle from 2019, so a little bit more up to date, but this is looking only at nurse practitioners 00:07:29.492 --> 00:07:31.414 position:50% align:middle and nurse midwives. 00:07:31.760 --> 00:07:38.767 position:50% align:middle However, again, we see 77.5% of nurse practitioners and nurse midwives are white, 00:07:39.542 --> 00:07:49.302 position:50% align:middle non-Hispanic black is the second most common race or ethnicity in this occupation, representing about 8.72% 00:07:49.302 --> 00:07:51.683 position:50% align:middle of nurse practitioners and nurse midwives. 00:07:52.307 --> 00:08:01.858 position:50% align:middle And so depending on who is being accounted for, whether we're including all APRNs or we're just looking 00:08:01.858 --> 00:08:09.943 position:50% align:middle at a cross-section of nurse practitioners and nurse midwives, there can be some shifts or changes 00:08:09.943 --> 00:08:12.010 position:50% align:middle in the percentages of minorities. 00:08:12.010 --> 00:08:16.067 position:50% align:middle And so more minorities represented here likely because more minorities 00:08:16.067 --> 00:08:18.260 position:50% align:middle in the nurse practitioner workforce. 00:08:18.260 --> 00:08:21.778 position:50% align:middle And I say that because, next, we're going to talk about specialties. 00:08:22.098 --> 00:08:32.100 position:50% align:middle And so using data from the American Midwifery Certification Board, their 2020 Demographic Report, 00:08:32.100 --> 00:08:39.080 position:50% align:middle we see about 85% of nurse midwives in the U.S. self-identify as white or Caucasian. 00:08:39.080 --> 00:08:47.837 position:50% align:middle And this is across just short of 13,000 certified midwives in the United States. 00:08:47.970 --> 00:08:57.218 position:50% align:middle We see approximately 7% of AMCB-certified midwives self-identify as black. 00:08:57.918 --> 00:09:05.223 position:50% align:middle And we see about 4.73% self-identify as Hispanic or Latino. 00:09:07.800 --> 00:09:12.244 position:50% align:middle When we look at CRNAs, we see a similar picture. 00:09:12.533 --> 00:09:25.916 position:50% align:middle Of the 59,000-plus CRNAs n the United States, about 12% in total self-identify as nurses 00:09:25.916 --> 00:09:31.182 position:50% align:middle or CRNAs of color, 3% self-identify as African American, 00:09:31.182 --> 00:09:36.457 position:50% align:middle 4% as Hispanic, 4% as Asian Pacific Islander. 00:09:36.740 --> 00:09:43.380 position:50% align:middle And so I think if we look across various data sources, across APRN specialties, 00:09:43.380 --> 00:09:49.700 position:50% align:middle we get a pretty clear picture that across APRN specialties, with some variation with nurse 00:09:49.700 --> 00:09:57.678 position:50% align:middle practitioners, that white APRNs are overrepresented in the profession. 00:09:57.678 --> 00:10:01.047 position:50% align:middle So what about other data sources? 00:10:01.382 --> 00:10:06.255 position:50% align:middle And what do we think about the quality of the data, about the completeness? 00:10:06.592 --> 00:10:15.610 position:50% align:middle And so when we evaluate the types of data sources that are most available to us, 00:10:15.610 --> 00:10:22.340 position:50% align:middle many are providing a quantitative assessment of composition based off self-identity, 00:10:22.340 --> 00:10:24.498 position:50% align:middle whether that be race or ethnicity. 00:10:24.950 --> 00:10:33.330 position:50% align:middle What is missing, at least I would argue, are other types of data sources, perhaps qualitative. 00:10:33.330 --> 00:10:37.848 position:50% align:middle So what are the experiences of APRNs of color? 00:10:38.190 --> 00:10:42.703 position:50% align:middle What are the historical contributions of APRNs of color? 00:10:42.910 --> 00:10:48.375 position:50% align:middle And what is the impact, evidence of impact of their contributions to the workforce? 00:10:48.731 --> 00:10:54.420 position:50% align:middle And because this data is often not available, or we're not collecting it, 00:10:54.420 --> 00:11:03.290 position:50% align:middle it renders the contributions in the mere presence and the experiences of APRNs of color as either 00:11:03.290 --> 00:11:05.254 position:50% align:middle incomplete or obscured. 00:11:06.090 --> 00:11:11.370 position:50% align:middle And I would go as much as to say, is that the lack of sufficient data, 00:11:11.370 --> 00:11:18.670 position:50% align:middle particularly about the contributions of APRNs of color, limits their representation, their visual 00:11:18.670 --> 00:11:23.340 position:50% align:middle and their cultural representation, in the APRN workforce. 00:11:23.601 --> 00:11:31.620 position:50% align:middle And it almost whitewashes the profession in a way that fails to provide students of color with an archetype 00:11:31.620 --> 00:11:33.409 position:50% align:middle toward which they can aspire. 00:11:33.620 --> 00:11:37.671 position:50% align:middle And so we often hear you cannot be what you cannot see. 00:11:38.030 --> 00:11:45.245 position:50% align:middle And so I really would like to challenge us about our data, the level of completeness, 00:11:45.678 --> 00:11:55.593 position:50% align:middle and the ways in which we think about completing a much more complete and accurate portrayal of APRNs 00:11:55.593 --> 00:11:57.343 position:50% align:middle from diverse backgrounds. 00:11:57.900 --> 00:12:05.210 position:50% align:middle And so let me provide a few examples that I found as I was preparing for our time together today. 00:12:05.210 --> 00:12:13.039 position:50% align:middle This is a video that was developed by the American Association of Nurse Practitioners. 00:12:13.350 --> 00:12:15.370 position:50% align:middle It's a five-minute video. 00:12:15.370 --> 00:12:17.447 position:50% align:middle It's available on YouTube. 00:12:18.140 --> 00:12:25.624 position:50% align:middle It was published and produced in 2005 to celebrate the first 40 years of the nurse practitioner workforce. 00:12:26.340 --> 00:12:32.739 position:50% align:middle And so it's interesting because, as you know, the nurse practitioner profession was developed 00:12:32.739 --> 00:12:36.721 position:50% align:middle in the 1960s in the throes of the civil rights movement. 00:12:36.970 --> 00:12:43.203 position:50% align:middle And its purpose, in part, was to address the needs of the underserved. 00:12:43.290 --> 00:12:47.157 position:50% align:middle And in many respects, those underserved community members were 00:12:47.157 --> 00:12:51.597 position:50% align:middle black and brown patients, and individuals, and community members. 00:12:51.860 --> 00:12:58.830 position:50% align:middle And so this video uses as the backdrop images of the civil rights movement, 00:12:58.830 --> 00:13:03.280 position:50% align:middle and there are black and brown patients throughout the imagery of the video. 00:13:03.280 --> 00:13:05.114 position:50% align:middle And it's really compelling. 00:13:05.940 --> 00:13:14.550 position:50% align:middle What also happens in this video is that you see no, absolutely no APRNs of color providing care. 00:13:14.550 --> 00:13:20.530 position:50% align:middle So you see all white nurse practitioners providing care to black and brown patients, 00:13:20.530 --> 00:13:27.760 position:50% align:middle but you never see nurse practitioners of color represented in the first 40 years of the profession. 00:13:27.840 --> 00:13:30.084 position:50% align:middle And it's not because they weren't there. 00:13:30.305 --> 00:13:38.179 position:50% align:middle And so I just offer this as an opportunity for us to think about how are we representing the profession 00:13:38.179 --> 00:13:48.424 position:50% align:middle and in what ways does this representation inadvertently, again, obscure the contribution, 00:13:48.424 --> 00:13:53.810 position:50% align:middle obscure the very presence of APRNs from diverse backgrounds? 00:13:54.020 --> 00:13:56.940 position:50% align:middle So this video is from 2005. 00:13:57.422 --> 00:14:04.022 position:50% align:middle And so I imagine that there might be other ways that APRNs of color are represented. 00:14:05.020 --> 00:14:12.510 position:50% align:middle But it was interesting because as I continued to prepare, I came across a more up-to-date manuscript. 00:14:12.510 --> 00:14:19.310 position:50% align:middle And so this manuscript was published in 2020 in the "Journal of the American Association 00:14:19.310 --> 00:14:20.870 position:50% align:middle of Nurse Practitioners." 00:14:21.690 --> 00:14:31.022 position:50% align:middle And ironically, the title of this particular article is called "The Perils of Not Knowing the History 00:14:31.022 --> 00:14:33.078 position:50% align:middle of the Nurse Practitioner Role." 00:14:34.023 --> 00:14:37.110 position:50% align:middle And this isn't to pick on the manuscript itself. 00:14:37.110 --> 00:14:43.920 position:50% align:middle It's actually a very interesting manuscript, and its purpose is important. 00:14:43.920 --> 00:14:49.374 position:50% align:middle It is so important for us to acknowledge our history as a profession. 00:14:49.749 --> 00:14:59.400 position:50% align:middle And in order to conduct this particular study, the researchers, they interviewed six trailblazers 00:14:59.400 --> 00:15:02.167 position:50% align:middle in the nurse practitioner profession. 00:15:02.640 --> 00:15:05.669 position:50% align:middle They're referred to as pioneer nurse practitioners. 00:15:05.800 --> 00:15:10.655 position:50% align:middle And there were six in total, five female, one male. 00:15:10.750 --> 00:15:18.770 position:50% align:middle And they were asked about how the NP role developed and what pushback was met from healthcare professionals, 00:15:18.770 --> 00:15:26.059 position:50% align:middle the patients, what hindered their practice, how it was resolved, how the NP practice had changed. 00:15:26.453 --> 00:15:28.830 position:50% align:middle And they discussed pearls of wisdom. 00:15:29.160 --> 00:15:35.710 position:50% align:middle And I enjoyed the article, but as I reviewed it, I wondered what would this article have looked like if 00:15:35.710 --> 00:15:43.885 position:50% align:middle we had asked these same questions of nurse practitioners or APRNs from diverse backgrounds? 00:15:44.180 --> 00:15:49.906 position:50% align:middle What would we have learned about their experiences in the healthcare profession, 00:15:49.906 --> 00:15:55.314 position:50% align:middle about their pushback barriers to their practice? 00:15:55.520 --> 00:16:01.620 position:50% align:middle What would we have learned from the Latino, Latinx, or Hispanic nurse practitioner caring 00:16:01.620 --> 00:16:03.472 position:50% align:middle for immigrant populations? 00:16:03.720 --> 00:16:09.458 position:50% align:middle What would we have learned from the native nurse practitioner caring for Indigenous populations? 00:16:09.570 --> 00:16:16.630 position:50% align:middle What would we have learned about nurse practitioners who not only practiced with underserved communities 00:16:16.630 --> 00:16:19.459 position:50% align:middle but lived in those communities themselves? 00:16:20.080 --> 00:16:28.620 position:50% align:middle And so I use this as an example for us to contend with ourselves as a profession and to think about the ways 00:16:28.620 --> 00:16:33.223 position:50% align:middle in which we provide a more holistic and complete history. 00:16:34.720 --> 00:16:39.880 position:50% align:middle And so I think, or I hope that you join me in thinking that we have work to do. Right? 00:16:39.880 --> 00:16:44.401 position:50% align:middle And so if you're like me, I am solution oriented. 00:16:44.646 --> 00:16:51.994 position:50% align:middle And when presented with a problem, I'm very interested in how we improve. 00:16:52.350 --> 00:16:55.810 position:50% align:middle And so if you're like me, you want to know what are the strategies? 00:16:55.810 --> 00:16:57.985 position:50% align:middle What are the tactics? What do we do? 00:16:58.430 --> 00:17:04.576 position:50% align:middle And if we don't do it, what are the consequences, right, to the patients and the communities we care for? 00:17:05.440 --> 00:17:10.610 position:50% align:middle Before we can strategize about solutions, we have to take a little bit of a step back and 00:17:10.610 --> 00:17:12.893 position:50% align:middle ask ourselves, how did we get here? 00:17:13.270 --> 00:17:20.370 position:50% align:middle Because we know that any forward progress to address and to increase workforce diversity must acknowledge 00:17:20.370 --> 00:17:25.367 position:50% align:middle that the composition of the current workforce did not happen in a vacuum, right? 00:17:25.421 --> 00:17:26.840 position:50% align:middle So it didn't happen by accident. 00:17:26.840 --> 00:17:28.164 position:50% align:middle It happened by design. 00:17:28.164 --> 00:17:36.720 position:50% align:middle And so if we want to strategize or even use design thinking, we have to recognize that this is a challenge 00:17:36.720 --> 00:17:39.980 position:50% align:middle that occurred by design, and then it can be redesigned. 00:17:39.980 --> 00:17:40.785 position:50% align:middle Okay? 00:17:40.880 --> 00:17:46.240 position:50% align:middle And so with that understanding, one of the reasons that we have such lack of diversity 00:17:46.240 --> 00:17:51.210 position:50% align:middle in the APRN workforce is that the RN workforce isn't very diverse. 00:17:51.210 --> 00:17:56.786 position:50% align:middle And so we're drawing for graduate students from a pool that's not very diverse. 00:17:57.120 --> 00:18:05.138 position:50% align:middle And so one of the ways that we might think about increasing our APRN representation is by increasing 00:18:05.138 --> 00:18:10.983 position:50% align:middle the representation of diverse nurses working in the healthcare workforce. 00:18:11.290 --> 00:18:16.227 position:50% align:middle And so, again, as you can see, about 81% of RNs are white. 00:18:17.044 --> 00:18:23.460 position:50% align:middle And while the percentage of Hispanic and black RNs have increased over time, 00:18:23.460 --> 00:18:34.296 position:50% align:middle you can see that even between 2013 and 2020, the representation of black RNs increased from 6% 00:18:34.296 --> 00:18:37.530 position:50% align:middle to 6.7% in 7 years. 00:18:37.530 --> 00:18:43.252 position:50% align:middle And so, once again, these demographic shifts occur very slowly. 00:18:43.330 --> 00:18:49.137 position:50% align:middle And so if we expect to see real change over time, we have to get to work today. 00:18:49.560 --> 00:18:57.708 position:50% align:middle Another challenge to the APRN workforce diversity is the very limited diversity among APRN faculty. 00:18:57.860 --> 00:19:03.980 position:50% align:middle And so, again, when we think about faculty and when we think about preceptors, drawing back to the antidote 00:19:03.980 --> 00:19:10.425 position:50% align:middle that I shared at the top of my time with you today, it is so critically important for students to see 00:19:10.425 --> 00:19:15.440 position:50% align:middle themselves mirrored so they can see their actual and eventual self. 00:19:15.440 --> 00:19:23.246 position:50% align:middle And so as we think about efforts for recruitment and diversity into the APRN workforce among the diverse 00:19:23.246 --> 00:19:30.058 position:50% align:middle APRNs we have now, we have to think about strategic ways to provide opportunities for faculty 00:19:30.058 --> 00:19:32.625 position:50% align:middle and preceptorships as well. 00:19:34.637 --> 00:19:45.415 position:50% align:middle And so we have acknowledged that the workforce, the APRN workforce, lacks diversity due to the limited 00:19:45.415 --> 00:19:48.674 position:50% align:middle pool in the RN workforce into faculty. 00:19:49.250 --> 00:19:57.260 position:50% align:middle But we also have to acknowledge and reckon with decades and decades of systemic and structural racism that has 00:19:57.260 --> 00:20:04.363 position:50% align:middle actively excluded admission of diverse nurses into the APRN workforce. 00:20:04.363 --> 00:20:06.588 position:50% align:middle So you might say, well, what do I mean by that? 00:20:07.470 --> 00:20:17.000 position:50% align:middle And so to that, I draw your attention to restrictive admissions processes that did not necessarily allow 00:20:17.000 --> 00:20:21.301 position:50% align:middle nurses from diverse backgrounds into graduate education. 00:20:21.750 --> 00:20:32.161 position:50% align:middle And so those restrictive admission policies, over time, result in fewer opportunities for diverse nurses to be 00:20:32.161 --> 00:20:36.525 position:50% align:middle able to achieve or access graduate training. 00:20:36.880 --> 00:20:44.740 position:50% align:middle Many admissions criteria continue to utilize standardized testing, such as the GRE, 00:20:44.740 --> 00:20:50.336 position:50% align:middle which are known to have little predictive value for success in graduate education. 00:20:51.230 --> 00:20:58.955 position:50% align:middle And finally, there continues to be anecdotal and research studies to suggest that educational 00:20:58.955 --> 00:21:07.830 position:50% align:middle and work environments for RNs and APRNs of color continue to be hostile, hostile with overt racism, 00:21:07.830 --> 00:21:11.064 position:50% align:middle hostile with microaggressions. 00:21:11.449 --> 00:21:20.930 position:50% align:middle And this type of structural and environmental context impedes our opportunities to draw individuals 00:21:20.930 --> 00:21:25.662 position:50% align:middle from diverse backgrounds into APRN professional roles. 00:21:25.662 --> 00:21:31.665 position:50% align:middle And so at the same time that we're thinking about recruitment, we have to think about these systemic 00:21:31.665 --> 00:21:40.760 position:50% align:middle and structural ways that recruitment and retention is challenged, unless we deal with some of these systemic 00:21:40.760 --> 00:21:42.282 position:50% align:middle and structural barriers. 00:21:44.190 --> 00:21:51.461 position:50% align:middle Another reason for us to deal with systemic and structural racism is because both of these factors are 00:21:51.461 --> 00:21:55.106 position:50% align:middle inextricably linked to health disparities. 00:21:55.290 --> 00:21:58.551 position:50% align:middle And so this is a Kaiser Foundation Framework. 00:21:58.551 --> 00:22:05.351 position:50% align:middle And you can see the ways in which health disparities are driven by social and economic inequities. 00:22:05.697 --> 00:22:09.570 position:50% align:middle And all of these factors, all of these social and economic factors, 00:22:09.570 --> 00:22:15.970 position:50% align:middle whether it be neighborhood, education, food, community, and healthcare system, yes, 00:22:15.970 --> 00:22:22.460 position:50% align:middle there are structural factors, but racism and discrimination is the thread that is 00:22:22.460 --> 00:22:31.510 position:50% align:middle linked across all of them and leads to disparities and inequities in employment, in food and security, 00:22:31.510 --> 00:22:33.384 position:50% align:middle in social integration. 00:22:34.140 --> 00:22:38.800 position:50% align:middle And for the healthcare system, racism and discrimination leads to disparities 00:22:38.800 --> 00:22:45.795 position:50% align:middle in healthcare coverage and provider availability, and access to linguistically and 00:22:45.795 --> 00:22:48.195 position:50% align:middle culturally appropriate care. 00:22:48.450 --> 00:22:52.137 position:50% align:middle It certainly leads to a decrease in quality of care. 00:22:52.350 --> 00:22:59.772 position:50% align:middle What I would add to this is that racism and discrimination has led to the lack of diversity that we 00:22:59.772 --> 00:23:04.053 position:50% align:middle see in the RN and the APRN workforce today. 00:23:04.360 --> 00:23:12.319 position:50% align:middle And I will go on to argue that that lack of diversity in the nursing and the APRN workforce due to systemic 00:23:12.319 --> 00:23:19.100 position:50% align:middle and structural racism has direct effects and an impact on disparate outcomes that we see today 00:23:19.100 --> 00:23:20.473 position:50% align:middle in many settings. 00:23:21.090 --> 00:23:29.260 position:50% align:middle And so for us to address and create solutions for the lack of diversity in the APRN workforce, 00:23:29.260 --> 00:23:34.930 position:50% align:middle we have to really, again, contend and reckon with these systemic 00:23:34.930 --> 00:23:36.955 position:50% align:middle and these structural barriers. 00:23:37.410 --> 00:23:45.530 position:50% align:middle And so in 2017, a colleague and I, Lusine Poghosyan, a professor at Columbia University, 00:23:45.530 --> 00:23:53.260 position:50% align:middle began to contend not so much with structural racism, but certainly, factors and mechanisms that might 00:23:53.260 --> 00:24:00.683 position:50% align:middle influence the nurse practitioner's ability to provide holistic and comprehensive care. 00:24:01.190 --> 00:24:09.190 position:50% align:middle And so in thinking about these mechanisms, we reviewed the literature to look to see the ways 00:24:09.190 --> 00:24:15.260 position:50% align:middle in which regulatory barriers, such as scope of practice, context, 00:24:15.260 --> 00:24:22.980 position:50% align:middle and working conditions such as the work environment, nurse practitioner supply, primary care capacity, 00:24:22.980 --> 00:24:29.039 position:50% align:middle how might all of these things, including the diversity of the NP workforce, 00:24:29.039 --> 00:24:35.840 position:50% align:middle how might these factors or mechanisms influence racial and ethnic health disparities? 00:24:36.700 --> 00:24:42.180 position:50% align:middle When it came to the nurse practitioner workforce diversity component, in particular, 00:24:42.180 --> 00:24:49.400 position:50% align:middle we argued that the value of nurse practitioner workforce diversity was linked 00:24:49.400 --> 00:24:51.970 position:50% align:middle to four important factors. 00:24:52.130 --> 00:25:00.442 position:50% align:middle We argued that APRNs from diverse backgrounds are more likely to work in underserved communities. 00:25:00.680 --> 00:25:05.026 position:50% align:middle And with that being the case, that this may help to increase access and 00:25:05.026 --> 00:25:06.639 position:50% align:middle utilization of services. 00:25:06.639 --> 00:25:12.970 position:50% align:middle So those are two reasons that increasing or having diverse APRNs in the workforce. 00:25:12.970 --> 00:25:17.880 position:50% align:middle And, again, this model is related to nurse practitioners, but I argue that it extends more 00:25:17.880 --> 00:25:19.910 position:50% align:middle broadly to APRNs. 00:25:19.910 --> 00:25:21.905 position:50% align:middle So access and utilization. 00:25:22.980 --> 00:25:27.367 position:50% align:middle Nurse practitioners from underrepresented backgrounds bring diverse perspectives. 00:25:28.129 --> 00:25:32.001 position:50% align:middle And because of that, because of this knowledge of community, 00:25:32.001 --> 00:25:35.363 position:50% align:middle you're able to bring to bear cultural responsiveness. 00:25:35.363 --> 00:25:41.516 position:50% align:middle That is important for care of patients because it enhances culturally responsive care, 00:25:41.516 --> 00:25:45.537 position:50% align:middle but it's also important to the other providers who are in that setting, 00:25:45.537 --> 00:25:54.960 position:50% align:middle where the APRNs or nurse practitioners serve as experts, as liaison experts, in how to provide 00:25:54.960 --> 00:25:59.088 position:50% align:middle culturally responsive and linguistically responsive care. 00:25:59.560 --> 00:26:05.530 position:50% align:middle And finally, the third rationale for increasing diversity in the workforce. 00:26:05.530 --> 00:26:08.110 position:50% align:middle And I'll say that this isn't an exhaustive list. 00:26:08.110 --> 00:26:14.380 position:50% align:middle There are surely other reasons to increase diversity, but also because of increased rapport. 00:26:14.380 --> 00:26:18.536 position:50% align:middle I can't tell you how many times I've had patients from diverse backgrounds tell me, 00:26:18.536 --> 00:26:23.370 position:50% align:middle " When you walked in the room, I just took a sigh of relief because I knew that you'd 00:26:23.370 --> 00:26:26.937 position:50% align:middle be able to just understand where I was coming from." 00:26:26.937 --> 00:26:33.320 position:50% align:middle And so mitigating those feelings of frustration, of communication barriers, 00:26:33.320 --> 00:26:37.790 position:50% align:middle of overt discrimination and bias from the healthcare system and providers, 00:26:38.100 --> 00:26:42.380 position:50% align:middle mitigating mistrust and the avoidance of healthcare services overall. 00:26:42.380 --> 00:26:47.890 position:50% align:middle We can't undercount the importance of rapport, relationship, and trust-building. 00:26:47.890 --> 00:26:52.366 position:50% align:middle And so for those reasons, representation matters to patients 00:26:52.366 --> 00:27:00.660 position:50% align:middle but also to environments because we know that diverse perspectives helps everyone in the healthcare setting, 00:27:00.660 --> 00:27:04.452 position:50% align:middle including patients as well as providers. 00:27:05.399 --> 00:27:10.580 position:50% align:middle And so, you know, over the past two years, in particular, as a country, 00:27:10.580 --> 00:27:13.620 position:50% align:middle we've been contending with structural and systemic racism. 00:27:14.120 --> 00:27:21.720 position:50% align:middle Structural and systemic racism go well beyond the last two years, but we have been more overtly and honestly 00:27:21.720 --> 00:27:23.760 position:50% align:middle contending with those constructs. 00:27:23.760 --> 00:27:30.613 position:50% align:middle So I don't want to confuse in this place, structural and systemic racism have a long history in the U.S. 00:27:31.220 --> 00:27:37.710 position:50% align:middle And so the reason I bring this up is that when you look at that 2017 model that I shared with you, 00:27:37.710 --> 00:27:40.390 position:50% align:middle structural and systemic racism wasn't mentioned. 00:27:40.390 --> 00:27:50.599 position:50% align:middle And as we continue to evolve in the way that we understand the importance of diversity and inclusivity, 00:27:51.438 --> 00:27:58.640 position:50% align:middle how, in fact, to improve diversity, we have to contend with the ways that structural and 00:27:58.640 --> 00:28:08.940 position:50% align:middle systemic racism interact with our regulatory policies, interact with practice environments to, 00:28:08.940 --> 00:28:13.801 position:50% align:middle directly and indirectly, influence health disparities. 00:28:14.580 --> 00:28:21.157 position:50% align:middle And so what I've been thinking about more recently is the ways in which these constructs represent 00:28:21.157 --> 00:28:23.407 position:50% align:middle cumulative disadvantage, right? 00:28:23.750 --> 00:28:32.630 position:50% align:middle And so what does it mean for patients from diverse backgrounds to live in a state with reduced scope 00:28:32.630 --> 00:28:41.410 position:50% align:middle of practice while being cared for in a practice environment that is unsupportive of nurse practitioners 00:28:41.410 --> 00:28:46.080 position:50% align:middle by a nurse practitioner workforce that lacks health disparities, right? 00:28:46.080 --> 00:28:52.352 position:50% align:middle And so instead of thinking about the direct effect of one of these constructs, 00:28:52.770 --> 00:29:02.130 position:50% align:middle it may do us well to think about the ways in which having any one or a combination of these disadvantages 00:29:02.130 --> 00:29:05.829 position:50% align:middle may ultimately represent cumulative disadvantage. 00:29:06.046 --> 00:29:13.010 position:50% align:middle And so, in that way, this helps us think about a more complex engagement 00:29:13.010 --> 00:29:14.473 position:50% align:middle with some of these constructs. 00:29:14.473 --> 00:29:22.120 position:50% align:middle And this is where my thinking has evolved over time and the ways in which, as a researcher, 00:29:22.120 --> 00:29:27.767 position:50% align:middle I'm hoping to really complicate some of the ways that we've looked at these relationships previously. 00:29:29.477 --> 00:29:38.240 position:50% align:middle And so my work, admittedly, has not looked directly at diversity in the APRN workforce, 00:29:38.240 --> 00:29:43.146 position:50% align:middle but I do want to highlight a few things that I've noticed along the way. 00:29:43.910 --> 00:29:49.819 position:50% align:middle In particular, in 2020, our research team was really interested 00:29:49.819 --> 00:29:59.640 position:50% align:middle in the relationship between supportive clinical practice environments and reports of delivery 00:29:59.640 --> 00:30:00.980 position:50% align:middle of patient-centered care. 00:30:00.980 --> 00:30:03.600 position:50% align:middle And so we know patient-centered care is important. 00:30:03.600 --> 00:30:09.871 position:50% align:middle And for this particular study, we surveyed nurse practitioners working across more than 00:30:09.871 --> 00:30:12.587 position:50% align:middle 1500 practices in 4 states. 00:30:13.270 --> 00:30:20.155 position:50% align:middle We wanted to know, in particular, whether nurse practitioners routinely integrated 00:30:20.155 --> 00:30:23.614 position:50% align:middle the cultural needs and preferences of their patient-centered care. 00:30:23.930 --> 00:30:30.360 position:50% align:middle And we wanted to know whether or not there was an association with the likelihood of integrating 00:30:30.360 --> 00:30:35.541 position:50% align:middle patient-centered care in the practice environments where nurse practitioners were employed. 00:30:36.300 --> 00:30:40.300 position:50% align:middle And so to answer that first question, I will tell you, yes. 00:30:40.300 --> 00:30:46.640 position:50% align:middle In practice environments that were more supportive of nurse practitioners, 00:30:46.640 --> 00:30:51.840 position:50% align:middle nurse practitioners reported more frequently integrating cultural needs and preferences 00:30:51.840 --> 00:30:53.085 position:50% align:middle of their patient-centered care. 00:30:53.085 --> 00:31:01.670 position:50% align:middle So that's the answer to that particular question, that aim, and that is the summary of what you'll find 00:31:01.670 --> 00:31:03.030 position:50% align:middle in this particular article. 00:31:03.030 --> 00:31:09.000 position:50% align:middle But I wanted to draw your attention to something that we thought was interesting and that in future research 00:31:09.000 --> 00:31:12.307 position:50% align:middle would require more explication. 00:31:12.435 --> 00:31:17.700 position:50% align:middle And so when you looked at this total sample, over 1700 nurse practitioners working 00:31:17.700 --> 00:31:28.380 position:50% align:middle across 1500 practices, and what you'll see is about 75% to 76% of nurse practitioners reported that they 00:31:28.380 --> 00:31:32.921 position:50% align:middle routinely and frequently integrated cultural needs and preferences into care. 00:31:33.468 --> 00:31:34.750 position:50% align:middle And so that's a good thing. 00:31:34.750 --> 00:31:39.172 position:50% align:middle We would hope 100% do, but three-quarters of nurses say, 00:31:39.172 --> 00:31:46.302 position:50% align:middle "We routinely integrate patient needs and preferences," compared to 24% who said they did not. 00:31:46.870 --> 00:31:51.410 position:50% align:middle But one of the things that we thought was interesting is that when we looked at routine integration 00:31:51.410 --> 00:31:58.226 position:50% align:middle of patient-centered care and we looked across race and ethnicity, that there were definitely some differences. 00:31:58.570 --> 00:32:07.190 position:50% align:middle And so if you look, for example, across racial groups, 74% of white nurse practitioners said that they 00:32:07.190 --> 00:32:12.963 position:50% align:middle integrate cultural needs and preference, compared to 89%, nearly 90%, of black 00:32:12.963 --> 00:32:18.470 position:50% align:middle nurse practitioners reported that they routinely integrate the needs, cultural needs, 00:32:18.470 --> 00:32:20.382 position:50% align:middle and preferences of their patient-centered care. 00:32:20.382 --> 00:32:25.148 position:50% align:middle Eighty-four percent of Asian nurses, or excuse me, nurse practitioners say the same. 00:32:25.337 --> 00:32:31.264 position:50% align:middle Eighty-three percent of Latino nurse practitioners report routinely integrating their cultural 00:32:31.264 --> 00:32:32.877 position:50% align:middle needs and preferences into care. 00:32:33.400 --> 00:32:37.620 position:50% align:middle And so I'll admit that these are descriptive findings. 00:32:37.620 --> 00:32:43.622 position:50% align:middle The goal of the study wasn't to then go on to see if there was a relationship between diversity and 00:32:43.622 --> 00:32:48.860 position:50% align:middle patient-centered care, though that is the natural next step in this line of inquiry. 00:32:48.860 --> 00:32:52.914 position:50% align:middle But I wanted to say that this is at least suggestive of something. 00:32:53.260 --> 00:33:00.520 position:50% align:middle You know, one of the reasons and the rationale we offered in our prior framework about the value 00:33:00.520 --> 00:33:07.200 position:50% align:middle of diversity was very much due to an increase in utilization, an increase in access, 00:33:07.200 --> 00:33:12.038 position:50% align:middle an increase in rapport, and an increase in culturally responsive care. 00:33:12.280 --> 00:33:18.258 position:50% align:middle And we pause at that in a framework, but I suggest that we're starting to see some of that 00:33:18.258 --> 00:33:25.814 position:50% align:middle empirical evidence if you see some of the outcomes across the nearly 1800 nurse practitioners that 00:33:25.814 --> 00:33:27.061 position:50% align:middle we surveyed here. 00:33:27.920 --> 00:33:35.530 position:50% align:middle And our goal moving forward is to advance this empirical knowledge to look at, in particular, 00:33:35.530 --> 00:33:42.450 position:50% align:middle the outcomes of patients from diverse backgrounds who may or may not be in these racially or ethnically 00:33:42.450 --> 00:33:48.643 position:50% align:middle concordant clinician-patient, or provider-patient dyads. 00:33:50.312 --> 00:33:52.131 position:50% align:middle And so what do we do, right? 00:33:53.110 --> 00:33:54.911 position:50% align:middle Where do we move forward? 00:33:55.369 --> 00:33:59.956 position:50% align:middle And I think we can take some of our marching orders from the recently published 00:33:59.956 --> 00:34:02.410 position:50% align:middle Future of Nursing report, 2030. 00:34:03.203 --> 00:34:08.134 position:50% align:middle In it, the report says, "While higher proportions of people of color individuals, 00:34:08.134 --> 00:34:14.892 position:50% align:middle with the exception of Hispanics, are obtaining a master's or a Ph.D. degree, 00:34:14.892 --> 00:34:23.411 position:50% align:middle and especially a DNP degree, APRNs have a long way to go to match RNs in achieving 00:34:23.411 --> 00:34:25.723 position:50% align:middle a more diverse workforce." 00:34:26.250 --> 00:34:35.950 position:50% align:middle It goes on to add that the APRN workforce will need to rapidly become more diverse over the next decade 00:34:35.950 --> 00:34:42.785 position:50% align:middle or it will fall further behind in reflecting the racial makeup of many of the people it serves. 00:34:42.785 --> 00:34:53.760 position:50% align:middle And so what I believe that The Future of Nursing report provides us is a clarion call to get to work 00:34:53.760 --> 00:34:56.315 position:50% align:middle and get to work urgently and rapidly. 00:34:56.760 --> 00:35:02.820 position:50% align:middle And so I'm going to leave you with a few strategies and suggestions, but really I believe this to be 00:35:02.820 --> 00:35:06.540 position:50% align:middle an opportunity for further discussion and reflection. 00:35:07.430 --> 00:35:13.717 position:50% align:middle And so one of the ways, I think, that we integrate diversity into the APRN workforce is 00:35:13.717 --> 00:35:19.758 position:50% align:middle by integrating diversity, equity, and inclusion into our mission, vision, and values. 00:35:20.155 --> 00:35:26.406 position:50% align:middle And I say that because as someone who has been on many a diversity task force, 00:35:26.406 --> 00:35:32.760 position:50% align:middle committee, workgroup over the past 20-plus years, this work is often an aside. 00:35:32.760 --> 00:35:33.934 position:50% align:middle It's a service. 00:35:34.820 --> 00:35:36.866 position:50% align:middle It's service. It's extra. 00:35:36.866 --> 00:35:44.901 position:50% align:middle And it may not always be a part of the organizing framework of the organization itself, right? 00:35:44.901 --> 00:35:51.580 position:50% align:middle And so instead of DEI being something on the side, if it's really, really in the middle and everything 00:35:51.580 --> 00:35:57.280 position:50% align:middle flows from it, you begin to see some of your strategies and your tactics. 00:35:57.280 --> 00:36:05.620 position:50% align:middle You develop evaluation metrics to ensure that what you've identified as a strategic goal is actually being 00:36:05.620 --> 00:36:10.170 position:50% align:middle actualized in the mission, vision, and value through tactic strategies 00:36:10.170 --> 00:36:11.413 position:50% align:middle and evaluation metrics. 00:36:11.413 --> 00:36:12.000 position:50% align:middle So that's one. 00:36:12.000 --> 00:36:17.610 position:50% align:middle So no matter where you sit, if you're a regulator, if you're a credentialer, if you're a faculty member, 00:36:17.610 --> 00:36:24.710 position:50% align:middle you have the positionality and the opportunity to ensure that DEI is not a side project. 00:36:24.710 --> 00:36:29.821 position:50% align:middle It is deeply embedded and rooted in the core values of your organization. 00:36:30.470 --> 00:36:37.710 position:50% align:middle And then if you are a regulator or a credentialer, or you're in leadership in a professional organization, 00:36:37.710 --> 00:36:43.896 position:50% align:middle you know, particularly accrediting bodies can play an important role because you help to set the standards. 00:36:43.896 --> 00:36:52.470 position:50% align:middle And so by requiring reporting and by insisting on policies and practices for the institutions or 00:36:52.470 --> 00:36:57.380 position:50% align:middle organizations that you're evaluating, these organizations and institutions respond. 00:36:57.380 --> 00:37:01.589 position:50% align:middle So if they know they're being evaluated on it, then they know they'll go back and they need to address it 00:37:01.589 --> 00:37:03.989 position:50% align:middle in a more comprehensive way. 00:37:04.140 --> 00:37:08.430 position:50% align:middle But it's not just about regulators and credentialers ensuring that others are doing it, 00:37:08.430 --> 00:37:11.860 position:50% align:middle regulators and credentialers need to do this internal work. 00:37:11.860 --> 00:37:16.502 position:50% align:middle You know, what are your own policies, and practices, and systems related to diversity? 00:37:16.880 --> 00:37:19.471 position:50% align:middle And in what ways are you holding yourselves accountable? 00:37:19.960 --> 00:37:25.290 position:50% align:middle And if you don't have the expertise to do so, then what are you doing to outsource it to ensure that you're 00:37:25.290 --> 00:37:33.411 position:50% align:middle able to address some of these systemic ways that exclusion and systemic racism occur? 00:37:33.411 --> 00:37:35.990 position:50% align:middle And sometimes it occurs underneath, right? 00:37:35.990 --> 00:37:40.472 position:50% align:middle We don't overtly see it because you're saying, "Well, we're not overtly racist." 00:37:40.760 --> 00:37:49.800 position:50% align:middle And so the ways in which exclusion occurs can be more implicit, which is why it's so important for us to have 00:37:49.800 --> 00:37:53.692 position:50% align:middle these really honest dialogs with one another. 00:37:54.300 --> 00:38:00.360 position:50% align:middle And then to those of you who are in funding opportunity spaces, you know, I would encourage you to think 00:38:00.360 --> 00:38:09.024 position:50% align:middle about the way diversity and inclusivity is integrated into your funding priorities. 00:38:09.679 --> 00:38:21.661 position:50% align:middle Many times, the priorities of funders don't include DEI as a recognized intellectual scholarly endeavor. 00:38:21.856 --> 00:38:28.580 position:50% align:middle And when we do that, we fail to validate the very importance of diversity 00:38:28.580 --> 00:38:36.400 position:50% align:middle and particularly evaluating the ways in which diversity and regulatory constraints may, in fact, 00:38:36.400 --> 00:38:40.860 position:50% align:middle represent these cumulative disadvantages for our marginalized communities. 00:38:40.860 --> 00:38:48.010 position:50% align:middle And so it's so important for us to lend the weight and the credibility of DEI scholarship 00:38:48.010 --> 00:38:54.090 position:50% align:middle so that we're able to continue to really move the needle forward in terms of the way we think 00:38:54.090 --> 00:39:01.722 position:50% align:middle about evaluating the impact of DEI on the profession and also the patients we serve. 00:39:02.806 --> 00:39:08.711 position:50% align:middle Regulators, credentialers, professional organizations, how diverse is your leadership, right? 00:39:08.711 --> 00:39:10.238 position:50% align:middle Representation matters. 00:39:10.436 --> 00:39:16.492 position:50% align:middle And we know without a seat at the table, that we continue to kind of reinforce what we've always done. 00:39:16.710 --> 00:39:19.700 position:50% align:middle And so if you look around the table, you look around your offices, 00:39:19.700 --> 00:39:26.500 position:50% align:middle you look around your board of advisors and everyone is very homogenous, there are opportunities to think 00:39:26.500 --> 00:39:34.200 position:50% align:middle about the ways in which to increase the heterogeneity of composition, but also the heterogeneity 00:39:34.200 --> 00:39:35.330 position:50% align:middle of thought, right? 00:39:35.330 --> 00:39:43.090 position:50% align:middle When we bring diverse perspectives into our conversations, into our meetings, and into our boards, 00:39:43.090 --> 00:39:46.660 position:50% align:middle it really enriches the dialog and our outcomes. 00:39:46.660 --> 00:39:53.120 position:50% align:middle And so I'd encourage you to look for opportunities to increase representation in your membership, 00:39:53.120 --> 00:39:58.730 position:50% align:middle in your leadership, in your processes, in your disciplinary actions, 00:39:58.730 --> 00:40:02.280 position:50% align:middle in the way you manage continuing education and your licensees. 00:40:02.280 --> 00:40:11.676 position:50% align:middle Like, whatever you do, how are you valuing DEI in every facet of what you do? 00:40:12.250 --> 00:40:15.082 position:50% align:middle And there are certainly opportunities to do so. 00:40:15.490 --> 00:40:18.170 position:50% align:middle Finally, invest, right? 00:40:18.170 --> 00:40:21.120 position:50% align:middle This is an invest and a develop moment. 00:40:21.560 --> 00:40:29.828 position:50% align:middle There are really good examples of diversity pipeline programs directly into APRN roles. 00:40:30.500 --> 00:40:35.116 position:50% align:middle I bring to your attention the Diversity in Nurse Anesthesia Mentorship Program, 00:40:35.116 --> 00:40:38.503 position:50% align:middle which was founded and developed by Dr. Wallena Gould. 00:40:39.260 --> 00:40:48.470 position:50% align:middle She and I were actually inducted into the academy in the same year, and her work in mentoring and fostering 00:40:48.470 --> 00:40:54.566 position:50% align:middle nurses from diverse backgrounds into CRNAs roles is nothing short of stunning. 00:40:54.566 --> 00:41:03.030 position:50% align:middle So if you know of a nurse of color who is interested in going into a CRNA role, 00:41:03.030 --> 00:41:06.760 position:50% align:middle this is a program that you certainly want to refer. 00:41:06.760 --> 00:41:09.160 position:50% align:middle If you can't refer, develop. 00:41:09.240 --> 00:41:17.196 position:50% align:middle And there are really good exemplars of evidence-based practices to develop pipeline programs. 00:41:18.000 --> 00:41:25.210 position:50% align:middle Our work, which was developed or published in 2014, describes the results of a national survey 00:41:25.210 --> 00:41:29.285 position:50% align:middle for recruitment and retention in U.S. nursing schools. 00:41:29.386 --> 00:41:36.340 position:50% align:middle And what we found even in that study is that most pipeline programs are developed to increase diversity 00:41:36.340 --> 00:41:37.570 position:50% align:middle in the baccalaureate. 00:41:37.570 --> 00:41:41.330 position:50% align:middle We found very few pipeline programs that were geared to the APRN. 00:41:41.330 --> 00:41:46.010 position:50% align:middle So this is a opportunity for development, but evidence-based development. 00:41:46.010 --> 00:41:53.670 position:50% align:middle And so the reason we did this type of study is because diversity pipeline programs include a host 00:41:53.670 --> 00:42:00.221 position:50% align:middle of interventions, some of which are very, very important and some of which you can see 00:42:00.221 --> 00:42:02.880 position:50% align:middle in a direct association for recruitment and retention. 00:42:02.880 --> 00:42:08.159 position:50% align:middle And so if you're developing these pipeline programs, it's important to ensure that you're developing 00:42:08.159 --> 00:42:10.245 position:50% align:middle the ingredients that lead to success. 00:42:10.245 --> 00:42:13.457 position:50% align:middle And so there's evidence to support that work. 00:42:14.120 --> 00:42:18.300 position:50% align:middle And so I'll leave you with the need for data, and I'm kind of coming back full circle 00:42:18.300 --> 00:42:19.610 position:50% align:middle to where we started. 00:42:19.994 --> 00:42:29.760 position:50% align:middle And, again, this is to urge us to create a more complete picture of APRN from diverse backgrounds. 00:42:29.760 --> 00:42:35.810 position:50% align:middle Beyond the quantitative surveys and assessments, there are ways to determine the experiences 00:42:35.810 --> 00:42:42.540 position:50% align:middle and perspectives, there are ways to center their experiences and their leadership. 00:42:42.540 --> 00:42:49.720 position:50% align:middle If we want to address health inequity, then we need to draw from practitioners who have keen 00:42:49.720 --> 00:42:55.620 position:50% align:middle and precise expertise in living with and being from diverse communities. 00:42:55.620 --> 00:42:58.425 position:50% align:middle And so what are those opportunities for leadership? 00:42:58.425 --> 00:43:01.280 position:50% align:middle What are those opportunities to bring them to the table? 00:43:01.280 --> 00:43:08.215 position:50% align:middle What are those opportunities to co-create models of care to address and reduce health disparities? 00:43:08.930 --> 00:43:12.849 position:50% align:middle And then there's always the need, and I am biased because I'm a researcher, 00:43:12.849 --> 00:43:15.167 position:50% align:middle to evaluate impact and outcomes. 00:43:15.270 --> 00:43:21.373 position:50% align:middle And so we need to measure, and we need to really reproduce knowledge 00:43:21.373 --> 00:43:30.630 position:50% align:middle so that we can continue to expand, replicate, and really provide opportunities for a diverse 00:43:30.630 --> 00:43:38.175 position:50% align:middle workforce to render care to diverse and underrepresented communities. 00:43:38.640 --> 00:43:42.966 position:50% align:middle And so, with that, I'm going to end our time together from the formal presentation, 00:43:42.966 --> 00:43:46.752 position:50% align:middle but I really, really look forward to your questions. 00:43:46.752 --> 00:43:47.556 position:50% align:middle Thank you.