Creating inclusive learning environments

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Creating Inclusive Learning EnvironmentsVernell P. DeWitty, PhD, RNMarch 2016

During the fall 2014, you, The Board of Directors for the American Association of Colleges of Nursing, appointed a work group to examine how the organization might approach the issue of diversity and inclusion among our member schools. Today, we present to you a report with four major recommendations for consideration.

As the country's population continues to change and as more people gain access to the healthcare system, nursing schools must admit, educate, and graduate nurses capable of providing high-quality, culturally responsive care to all patients. This fundamentally important work requires strengthening the capacity to adapt and innovate traditional approaches to nursing education while re-examining efforts to ensure that diversity and inclusion as core values for all academic institutions. Preparing a richly diverse nursing student population is essential to improving health outcomes for the nation and achieving a robust supply health care providers who better reflect the society we se...1

Evidence indicates that diversity is associated with improved access to care for racial and ethnic minority patients, greater patient choice and satisfaction, and better educational experiences for health professions students, among many other benefits.

Institute of Medicine (2004) BACKGROUND

Why Diversity MattersQuality of learning environmentBroader experiences deepens educational analysisIncrease tolerance and reduce prejudiceIncrease health care providers for underserved populationsGlobal markets require diverse workforce to meet increased demands


DefinitionsDiversity: refers to all the ways in which people differ and the effect of those differences on our thinking and behavior. This includes socioeconomic status, race, ethnicity, language, gender, religion and age.Inclusion: A core element of diversity that creates a climate where all those participating feel able to actively engage, feel safe, and feel welcome.Culture: Deeply instilled values and beliefs of an organization.Climate: Behaviors, attitudes, perceptions, that reflect the beliefs and values of an organization.


Cultural CompetencyCultural competency, defined as the ability of health-care providers to function effectively in the context of cultural differences, has been shown to improve the quality of health care received by racial/ethnic minority groups.


INCLUSIVE Learning EnvironmentsInclusive Excellence builds greater excellence and improves organizational cultureNursing has social mandate to provide care for a culturally diverse patientsStudent learning is enriched by diverse inclusive environments

The Association of American Colleges and Universities has coined the term inclusive excellence as a way of connecting diversity with excellence (Williams, 2005). Diversity, when viewed through this lens, is tightly coupled with developing a culture of inclusion that fully appreciates the differences of perspective. Together, diversity and inclusion have become a powerful strategy for building innovation and high performing organizations. (Nivet, 2011; Williams, 2005).

Diversity and inclusion are success factors for todays organizations and increased emphasis should focus on the strategic benefits. The nursing profession is challenged to recruit and retain a culturally diverse workforce, however, this increased need is not new to the profession; however, the need to successfully address this issue has never been greater.


Dimensions of DiversityRecruitment and RetentionDiversity TrainingMentoringDiversity ManagementOrganizational Development

A new study published by the Urban Universities for Health finds that health professions schools that use a holistic admissions process that takes into account more than an applicants grades and test scores, achieve an entering class that is more diverse and in most cases there is no change in measures of academic quality, student academic performance, or student retention. The report found that 40 percent of the schools that used a holistic admissions process reported an increase in grade point average for the first-year class, while 50 percent said there was no change in the academic performance of the class admitted under a holistic admissions process.Being a good health professional is about more than scientific knowledge. It also requires an understanding of people. Schools that are engaged in Holistic review are better able to find students who have the attributes and abilities to become outstanding humanistic health professionals and leaders in their field..



Organizational practices that promote a climate of respect, fairness, justice and equity is grounded on a framework of organizational policies and practices that are integrated system-wide through the organization; building and developing cultural competencies for individuals and groups.

Inclusion is about helping individuals to feel relatively more comfortable and safe, especially when they are members of groups that have been traditionally marginalized or subordinated. In a learning environment the focus should be on building cultural competence. Classroom experiences include learning the process of dialogue and developing norms for the learning community. Establishing expectations and explaining the concept of dialogue and boundaries; helping students learn to manage difficult conversations related to diversity.



Over the past seven years, the NCIN program shifted from simple assessments of the increased numbers of underrepresented students in the applicant pool and admitted to the program, but we started to focus on creating an inclusive learning environment for these underrepresented students. When we started to learn from the UR students that often the study groups were formed within the first week of classes, we explored and identified with our h our grantees strategies to mitigate such practices and to create inclusiveness. Recruitment, enrollment were not enough we must create environments where persons from diverse backgrounds feel welcomed to participate and fully engage in the learning process.


Baccalaureate Enrollment

Baccalaureate Graduation

Diversity in Health Occupations

While efforts to diversify the nurse workforce are beginning to produce results, minority representation among registered nurses still lags behind the overall U.S. population. Xue and Brewer (Xue & Brewer, 2014) reported that the gap in minority representation between the nurse workforce and the overall population has widened from 15.8% in 1998 to 19.3%. This gap was primarily due to underrepresentation of African Americans and, especially, Hispanics in the workforce.

In comparison to other Health Professions, nursing ranks third in terms of diversity.12

Doctoral Student Enrollment

National Population and NCIN

Table 1. U.S. Health Occupations by Race, 2010-2012 (HRSA)*


Black/African Americans(%)

Hispanic or Latino(%)Asian (Non-Hispanic)(%)American Indian/Alaska Native(%)Native Hawaiian/ Pacific Islander(%)White(Non-Hispanic)(%)

Registered Nurses(2,682,262)




US Population (2013)

*Not all totals equal 100 percent due to rounding. Numbers in parenthesis represent estimates. NR- data not reported


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