By Dr. Geraldine Q. Young,
DNP, APRN, FNP-BC, CDE, FAANP
Chief Diversity and Inclusion Officer, Frontier Nursing University
Changes have occurred since the Civil Rights Movement of the 1960s to improve the treatment of Black people; however, the underpinnings of systemic and structural racism are alive and well in the United States. Through the inequitable outcomes of the COVID-19 Pandemic, 2020 bestowed upon us an undeniable reality check on the national impact of systemic and structural racism in our healthcare delivery system. As of March 17, 2021, the Centers for Disease Control (CDC) (2021) reported 533,057 COVID deaths in the U.S., 289,119 of which were reported by race. Of those 289,119 deaths in which the race was known, 14% of the victims were identified as Black, non-Hispanic. Although underrepresented in the U.S., Black people disproportionately led the death toll rates as they suffer from existing socioeconomic hardships in addition to the adversities brought on by the pandemic.
The COVID-19 Pandemic has shone a light on the health disparities and inequalities that people of color suffer from daily. The lack of trust for the COVID-19 vaccine embodied within the Black community due to historical and current medical negligence and bias provided by a vastly white population of healthcare professionals compounds this problem. In November 2020, a survey conducted by the National Association for the Advancement of Colored People (NAACP) revealed that only 14 percent of Black respondents trusted the vaccine and only 18 percent indicated that they would definitely get vaccinated.
Health care disparities extend beyond the pandemic, however. For example, according to 2017 data from the CDC, Black women are three to four times more likely to die of pregnancy complications than white women. Contributing factors to these disparities are financial, bureaucratic, transportation, language barriers, and care that is not consistently culturally appropriate or respectful.
To abate these tragic, disproportionate outcomes and build trust within the U.S. health care delivery system, the healthcare workforce must become more diverse. Our nation’s population is continuously changing and becoming more diverse. The healthcare workforce must change to match. The United States Census Bureau predicts that by 2045, over half of the U.S. population will consist of minority populations. The American Association of Colleges of Nursing (AACN) stated, “with projections pointing to minority populations becoming the majority, professional nurses must demonstrate a sensitivity to and understanding of a variety of cultures to provide high-quality care across settings.”
Culturally congruent health care providers representing racial, ethnic minority populations improve trust in the health care delivery system, quality of care, and outcomes of minority populations. A 2017 report by the National Institutes of Health determined that cultural respect was an essential factor in reducing healthcare disparities and improving access to quality health care for diverse patients. According to data from the National League of Nursing and the U.S. Census Bureau, approximately 80% of registered nurses, nurse practitioners, and nurse-midwives are white. Schools of nursing must also develop strategies for increasing diversity within the nursing workforce.
An example of this shift can be found at Frontier Nursing University, which, over the past decade, has placed an emphasis on diversity, equity, and inclusion (DEI), with a particular focus on increasing the enrollment and graduation rates of students of color. FNU included DEI in its strategic plan to address issues surrounding access to health care, health outcomes, health disparities, health inequities, and to increase diversity in nursing. These efforts will play a significant role in ameliorating health disparities and inequities. FNU’s SOC enrollment has grown from 9% in 2010 to over 25% in 2020. FNU is continuing on the trajectory of integrating DEI and antiracism throughout the university to support racial, ethnic underrepresented students. Resilience during the COVID-19 Pandemic permitted FNU to graduate 841 students, including 208 students of color, yielding an increased workforce diversity to care for diverse, rural, underserved populations. Additionally, FNU’s current retention rate for SOC is 84%, exceeding the university’s goal of 80%, and the number of faculty of color is on the rise, currently standing at 14%.
FNU is an example of the intentional focus required to begin building a more diverse, culturally competent health care system. We have known and understood for a while now that the lack of diversity among primary health care providers was a contributing factor to the glaring disparities in health care outcomes among diverse populations. The past year only acted to exacerbate the problem and heighten our awareness of the need for immediate change and action. If we have learned anything from the pandemic, it is that diversity, equity, and inclusion are the keys to the future success of our nation’s health care delivery system.
Carrie Belin is an experienced board-certified Family Nurse Practitioner and a graduate of the Johns Hopkins DNP program, Johns Hopkins Bloomberg School of Public Health, Georgetown University School of Nursing, and Johns Hopkins School of Nursing. She has also completed fellowships at Georgetown and the University of California Irvine.
Angie has been a full-scope midwife since 2009. She has experience in various birth settings including home, hospital, and birth centers. She is committed to integrating the midwifery model of care in the US. She completed her master’s degree in nurse-midwifery at Frontier Nursing University (FNU) and her Doctorate at Johns Hopkins University. She currently serves as the midwifery clinical faculty at FNU. Angie is motivated by the desire to improve the quality of healthcare and has led quality improvement projects on skin-to-skin implementation, labor induction, and improving transfer of care practices between hospital and community midwives. In 2017, she created a short film on skin-to-skin called 
Justin C. Daily, BSN, RN, has ten years of experience in nursing. At the start of his nursing career, Justin worked as a floor nurse on the oncology floor at St. Francis. He then spent two years as the Director of Nursing in a small rural Kansas hospital before returning to St. Francis and the oncology unit. He has been in his current position as the Chemo Nurse Educator for the past four years. He earned an Associate in Nurse from Hutchinson Community College and a Bachelor of Science in Nursing from Bethel College.
Brandy Jackson serves as the Director of Undergraduate Nursing Programs and Assistant Educator at Wichita State University and Co-Director of Access in Nursing. Brandy is a seasoned educator with over 15 years of experience. Before entering academia, Brandy served in Hospital-based leadership and Critical Care Staff nurse roles. Brandy is passionate about equity in nursing education with a focus on individuals with disabilities. Her current research interests include accommodations of nursing students with disabilities in clinical learning environments and breaking down barriers for historically unrepresented individuals to enter the nursing profession. Brandy is also actively engaged in Interprofessional Education development, creating IPE opportunities for faculty and students at Wichita State. Brandy is an active member of Wichita Women for Good and Soroptimist, with the goal to empower women and girls. Brandy is a TeamSTEPPS master trainer. She received the DASIY Award for Extraordinary Nursing Faculty in 2019 at Wichita State University. 
Dr. Sabrina Ali Jamal-Eddine is an Arab-disabled queer woman of color with a PhD in Nursing and an interdisciplinary certificate in Disability Ethics from the University of Illinois Chicago (UIC). Dr. Jamal-Eddine’s doctoral research explored spoken word poetry as a form of critical narrative pedagogy to educate nursing students about disability, ableism, and disability justice. Dr. Jamal-Eddine now serves as a Postdoctoral Research Associate in UIC’s Department of Disability and Human Development and serves on the Board of Directors of the National Organization of Nurses with Disabilities (NOND). During her doctoral program, Sabrina served as a Summer Fellow at a residential National Endowment of the Humanities (NEH) Summer Institute at Arizona State University (2023), a summer fellow at Andrew W. Mellon’s National Humanities Without Walls program at University of Michigan (2022), a Summer Research Fellow at UC Berkeley’s Othering & Belonging Institute (2021), and an Illinois Leadership Education in Neurodevelopmental and related Disabilities (LEND) trainee (2019-2020).
Vanessa Cameron works for Vanderbilt University Medical Center in Nursing Education & Professional Development. She is also attending George Washington University and progressing towards a PhD in Nursing with an emphasis on ableism in nursing. After becoming disabled in April 2021, Vanessa’s worldview and perspective changed, and a recognition of the ableism present within healthcare and within the culture of nursing was apparent. She has been working since that time to provide educational foundations for nurses about disability and ableism, provide support for fellow disabled nursing colleagues, and advocate for the disabled community within healthcare settings to reduce disparities.
Dr. Lucinda Canty is a certified nurse-midwife, Associate Professor of Nursing, and Director of the Seedworks Health Equity in Nursing Program at the University of Massachusetts Amherst. She earned a bachelor’s degree in nursing from Columbia University, a master’s degree from Yale University, specializing in nurse-midwifery, and a PhD from the University of Connecticut. Dr. Canty has provided reproductive health care for over 29 years. Her research interests include the prevention of maternal mortality and severe maternal morbidity, reducing racial and ethnic health disparities in reproductive health, promoting diversity in nursing, and eliminating racism in nursing and midwifery.
Dr. Lisa Meeks is a distinguished scholar and leader whose unwavering commitment to inclusivity and excellence has significantly influenced the landscape of health professions education and accessibility. She is the founder and executive director of the DocsWithDisabilities Initiative and holds appointments as an Associate Professor in the Departments of Learning Health Sciences and Family Medicine at the University of Michigan.
Dr. Nikia Grayson, DNP, MSN, MPH, MA, CNM, FNP-C, FACNM (she/her) is a trailblazing force in reproductive justice, blending her expertise as a public health activist, anthropologist, and family nurse-midwife to champion the rights and health of underserved communities. Graduating with distinction from Howard University, Nikia holds a bachelor’s degree in communications and a master’s degree in public health. Her academic journey also led her to the University of Memphis, where she earned a master’s in medical anthropology, and the University of Tennessee, where she achieved both a master’s in nursing and a doctorate in nursing practice. Complementing her extensive education, she completed a post-master’s certificate in midwifery at Frontier Nursing University.
Dr. Tia Brown McNair is the Vice President in the Office of Diversity, Equity, and Student Success and Executive Director for the Truth, Racial Healing, and Transformation (TRHT) Campus Centers at the American Association of Colleges and Universities (AAC&U) in Washington, DC. She oversees both funded projects and AAC&U’s continuing programs on equity, inclusive excellence, high-impact practices, and student success. McNair directs AAC&U’s Summer Institutes on High-Impact Practices and Student Success, and TRHT Campus Centers and serves as the project director for several AAC&U initiatives, including the development of a TRHT-focused campus climate toolkit. She is the lead author of From Equity Talk to Equity Walk: Expanding Practitioner Knowledge for Racial Justice in Higher Education (January 2020) and Becoming a Student-Ready College: A New Culture of Leadership for Student Success (July 2016 and August 2022 Second edition).