The Nurse Executive Practicum

Summary of Key Findings
This paper aimed to determine the obstacles hindering diversity in nursing and the evidence-based mechanisms that could make nursing a more inclusive discipline. This was done to address the deep-rooted presence of racism in the nursing profession (Nardi et al., 2020) and highlight the ways a more diverse workforce of nurses could deliver a higher quality of care to patients of color (Shepherd et al., 2018). A key finding of the literature review was that biased and racist hiring practices prevented nurses of color from becoming leaders in the occupation. The discrimination found within medical leaders’ hiring practices made it difficult for Black nurses to advance and demonstrate examples of their knowledge and experience in professional settings (Iheduru-Anderson et al., 2022; Nardi et al., 2020; Persaud, 2019). Graduates’ lack of knowledge about diversity could be a reason for nursing’s current state, as the literature review also found papers that highlighted students’ inability to correctly define what diversity is and how it should be practiced in medicine (Mshigeni et al., 2020).
Interpretation of Results
The results of the literature review show that nursing’s lack of diversity is the result of ineffective nurse education programs and the failed re-training of active medical leaders. Hiring more nurses from minority backgrounds would improve facility diversity, but adding more nurses to the current environment is not the sole solution. The results of the literature review showed that cultural competence programs should be implemented in academic and clinical environments so stakeholders can ensure the long-term decline of racism in nursing.
Relation to Existing Literature
Recent literature promotes the improvement of nursing students and active nurses’ cultural competence. Soleimani and Yarahmadi (2023) found connections between nurses’ academic degrees and empathy and their levels of cultural competence. Tappy and Bonito (2024) found that nurses’ cultural competence was impacted by their cultural education, empathy, empowerment, language proficiency, and work experience. These findings show that nurses’ academic backgrounds and experience in the field can determine their thoughts on diversity. This is why promoters of diversity must intervene with cultural competency training at the early stages of nurses’ careers and education.
Literature shows that virtual training programs and simulated sessions with actors portraying patients can be used to improve nurses’ cultural competence (Rahimi et al., 2023; Walkowska et al., 2023). The intervention group in Rahimi et al.’s (2023) study demonstrated improved cultural competence after they completed a virtual training program. Likewise, Walkowska et al. (2023) found that students’ cultural competence improved after engaging in cross-cultural interactions with simulated patients. This means there are at least two methods advocates for diversity can use to improve the current state of the nursing profession.
The evidence provided by Walkowska et al. (2023) and Rahimi et al. (2023) shows that medical leaders should pursue cultural competence training for themselves and their nurses as soon as possible. This practical solution can provide immediate benefits for nurses and eliminate the knowledge gap highlighted in this paper’s literature review. Medical leaders should also consider hiring knowledgeable nurses as well. Tappy and Bonito (2024) listed master’s degrees as a solution for nurses’ lack of cultural competence. According to the authors, specialist programs awarding master’s degrees exposed nurses to the “impact of culture on the delivery of healthcare” (Tappy & Bonito, 2024). This means hiring nurses with master’s degrees can immediately integrate higher levels of cultural competence into facilities.
Tailoring the Solution to Different Nursing Environments
This solution will help nursing schools that lack a diverse workforce. Ganek et al. (2023) recommend the use of diversity, equity, and inclusion (DEI) in academic contexts. Cultural competence programs could improve nurse educators’ knowledge of minority students’ struggles. Leaders in academia must understand the importance of diversity in nursing as well. Academic leaders define the cultural expectations of their schools (Ganek et al., 2023). This means academic leaders must assess the potential of cultural competence training programs and determine how to implement them effectively. Cultural competence training programs focused on academia may focus more on pedagogy, cultural awareness, and the design of culturally diverse curricula.
Clinical environments are expected to implement diversity policies made by national and state governments (Clark et al., 2023). Hospital administrators must solicit cultural competence training programs that adhere to governments’ standards. While searching for cultural competence training, hospital administrators should also consider the employees they are shopping for. Nurses have their barriers to overcome (Clark et al., 2023; Ganek et al., 2023). Purchasing training programs that do not respect nurses’ needs could make their lack of diversity worse. This means clinical environments’ cultural competence training programs should focus on professionalism, nursing skills, the need for minority nurses, and how minority nurses can advocate for diverse patients.
Barriers to Implementing the Proposed Solution
There is a shortage of nurse educators from diverse backgrounds (Ganek et al., 2023). The American Association of Colleges of Nursing (AACN) declared a need for more diverse nursing schools in the past (Ganek et al., 2023). Despite this, 18% of nursing educators identified as minorities in 2019 (Ganek et al., 2023). Ganek et al. (2023) write that more nurse educators from diverse backgrounds are needed to attract minority students. This improvement would provide more representation for future nurses who lack diverse sources of guidance (Ganek et al., 2023).
Clark et al. (2023) found that facilities’ funds for DEI programs are not spent properly. Clark et al. call for pipeline programs that encourage minority nursing students to pursue the profession. Clark et al. also state that facilities should hire more teachers from diverse backgrounds. National policies provide the language needed to justify investments in DEI (Clark et al., 2023). Hospital administrators’ failure to implement these policies when budgeting causes diversity programs to fail (Clark et al., 2023).
The previous literature explains why cultural competence training programs fail. Diverse nurse educators are needed to teach minority students who need encouragement. Experienced minority nurses can provide the support needed for diverse nursing students and novice nurses to adjust. Unfortunately, the lack of diverse nurse educators contributes to the lack of diversity in the profession. This means the barriers impeding the proposed solution’s success are unlikely to disappear without additional intervention.

Alternative Explanations
The American government’s lack of policy attacking racism in nursing may be a major barrier as well. Current literature suggests that hiring diverse nurses and implementing cultural competence training will improve diversity in the profession. However, the creation of policies promoting diversity in nursing schools could address racism in the field as well. These policies could be implemented in public colleges and universities and provide financial support to private schools that enact new internal policies themselves.
Future Research Directions
Future research must explore the viability of creating new policies that promote diversity in nursing education and leadership. Nursing’s lack of diversity is a two-pronged problem, and advocates must address students’ inability to define diversity and leaders’ biased hiring practices. A quantitative study examining the impact of diversity policies designed to help other professions and industries can be performed to determine if enacting legislation aimed toward the nursing sector is a viable endeavor. The proposed study can measure the number of complaints related to discrimination during the hiring process and in practical settings before and after the implementation of diversity-focused policies. This straightforward study would provide the foundation needed to test if other interventions contributed to declines in discrimination-related complaints as well.
Future studies should also investigate the content of successful cultural competence training programs. Learning what effective cultural competence training sessions should include will help researchers make practical recommendations to nurse educators. These recommendations will save time on curriculum planning and increase the likelihood of the intervention’s success. Qualitative content analysis can be done to find the most prominent traits and themes of impactful cultural competence training programs.
The literature review confirmed that racism in nursing is a real problem. This problem persists because of nursing students’ lack of knowledge about diversity and medical leaders’ biases. Current literature highlights the use of cultural competence training as an effective solution to racism in nursing. However, there are other routes advocates can take to improve the state of the profession as well. This includes hiring nurses from culturally diverse backgrounds with master’s degrees and enacting new policies that promote diversity within nursing education and practice. 
Clark, S. G., Cohen, A., & Hoard-Garris, N. (2023). Moving beyond words: Leveraging financial resources to improve diversity, equity, and inclusion in Academic Medical Centers. Journal of Clinical Psychology in Medical Settings, 30, 281-287.
Ganek, E., Sazon, R. A. P., Gray, L., & Sherry, D. (2023). An introduction to faculty diversity, equity, and inclusion for excellence in nurse education: Literature review. Asian/Pacific IslandNursing Journal, 7, 1-8.
Iheduru-Anderson, K., Okoro, F. O., & Moore, S. S. (2022). Diversity and inclusion or tokens? A qualitative study of Black women academic nurse leaders in the United States. Global Qualitative Nursing Research, 9, 1-13.
Mshigeni, S. K., Okolo, S., Mshigeni, D., & Becerra, M. (2020). What diversity means to undergraduate health science students. Journal of Higher Education Theory and Practice, 20(6), 55-62.
Nardi, D., Waite, R., Nowak, M., Hatcher, B., Hines‐Martin, V., & Stacciarini, J. M. R. (2020). Achieving health equity through eradicating structural racism in the United States: A call to action for nursing leadership. Journal of Nursing Scholarship, 52(6), 696-704.
Persaud, S. (2019). Addressing unconscious bias: A nurse leader’s role. Nursing Administration Quarterly, 43(2), 130-137.
Rahimi, M., Shahraki, S. K., Fatehi, F., & Farokhzadian, J. (2023). A virtual training program for improving cultural competence among academic nurse educators. BMC Medical Education, 23(445).
Shepherd, S. M., Willis-Esqueda, C., Paradies, Y., Sivasubramaniam, D., Sherwood, J., & Brockie, T. (2018). Racial and cultural minority experiences and perceptions of health care provision in a mid-western region. International Journal for Equity in Health, 17, 1-10.
Soleimani, M. & Yarahmadi, S. (2023). Cultural competence in critical care nurses and its relationships with empathy, job conflict, and work engagement: A cross-sectional descriptive study. BMC Nursing, 22(113).
Tappy, Y. P. & Bonito, S. R. (2024). Cultural competence in nursing: Unlocking the key factors – A systematic review. Journal of Bionursing, 6(1), 31-40.
Walkowska, A., Przymuzala, P., Marciniak-Stepak, P., Nowosadko, M., & Baum, E. (2023). Enhancing cross-cultural competence of medical and healthcare students with the use of simulated patients – A systematic review. International Journal of Environmental Research and Public Health, 20(3).

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