Change From Within
As protesters marched against police violence and racism in cities across the U.S. last summer, Lisa Lewis started hearing from Penn Nursing colleagues who asked, “What can I do in the anti-racist fight?” Her response: “We need you now, and we also need you two weeks from now, two months from now, two years from now.”
The reply highlighted a concern that such energy would wane as soon as media attention wandered. Nearly one year later though, says Lewis, newly appointed Associate Dean for Equity and Inclusion at Penn Nursing, “people are still on fire for making systemic changes around bias and racism, particularly at the structural and systemic levels.”
Her advice to Penn colleagues last year also underscores how diversity, equity, and inclusion (DEI) in higher education won’t be fully realized by one committee, one survey, or one appointee. Lewis says she appreciates that Dean Antonia Villarruel has made very public DEI commitments, outlined specific expectations, and identified various departments and people with responsibility for effecting positive change across the School.
What’s at stake is starkly pinpointed in Penn Nursing’s 2018 diversity action plan: “The importance of diversity to nursing science is incalculable. In a society faced with ever-increasing national and global health disparities and lack of access to quality health care, it is crucial to have diverse faculty conducting research, educating future nurse leaders, and shaping practice to improve the health of the nation and the world.”
The School’s definition of diversity is broad and is reflected in the efforts of other academic organizations, too. Lewis is currently chairing Eastern Nursing Research Society’s advisory group which is tasked with recommending ways for making the climate inclusive and welcoming for all. “That’s different racial and ethnic backgrounds, sexual and gender diversity,” she notes.
Higher ed job boards may have seen an uptick in DEI postings over the last year, but many Penn Nursing alumni have been tackling barriers to entry for decades. Here, Lewis explains Penn Nursing’s new DEI-driven “Guiding Principles,” student expectations for a social justice-centered learning experience, and more. We also asked three alumni in higher ed leadership roles—Sheldon Fields, Diane Breckenridge, and Angela Amar—to share their perspectives on advancing equity from the classroom to the health care setting.
Ask Lisa Lewis to look at the new “Guiding Principles for Learning and Working Together at Penn Nursing” and identify just one that resonates most with her, and she laughs and gasps all at once, like a parent having to choose their “favorite” child. Fair enough. The list, officially released in spring 2021, was a year in the making, and the result of a schoolwide survey along with energy, intention, and collaboration from many stakeholders, Lewis among them. Pressed, she relents.
“If someone said you have to just choose one, ‘dialogue to learn,’” Lewis answers. “That principle is about engaging in conversation, fostering the exchange of ideas to promote the growth of our School, and also speaking up when we do not understand or agree with others. I think if we had more hard dialogue to learn, we’d be much further along in addressing bias and racism and microaggressions.”
There are five principles total. Lewis says she thinks of them as an “ethical compass.” In addition to dialogue, the others address inclusion, treating others thoughtfully, being compassionate, and striving for excellence. Though active campus life has been reduced due to COVID, the plan is to eventually have the principles posted prominently.
“They’re a set of beliefs that we have endorsed at the School of Nursing to describe ideals about the ways in which we—that’s students, staff, and faculty— work together and engage with one another and not only with one another, but with individuals who also enter our space,” says Lewis, adding that with the rise of online meetings in the last year, that means virtual spaces, too.
Preparing Tomorrow’s Nurse Leaders
Nursing schools across the country are looking critically at what they teach and how they teach it through a DEI lens. Lewis believes Penn Nursing has done well with infusing social justice into the learning experience, but the School is examining its curriculum, one of 12 steps in its fight against systemic racism and bias, as identified by Dean Villarruel in 2020.
Educators should fully expect students to hold them accountable, according to Lewis. “Our students have just been wonderful examples of individuals who are committed to social justice and advocacy,” Lewis says. “One of the reasons they come to Penn Nursing is because of our focus on social justice, and I don’t see that going away.”
Lewis has been at Penn Nursing since 2005 and she became Assistant Dean for Diversity and Inclusivity in 2015. Her new appointment has her shifting her focus from barriers for individuals to the entire system. She’s starting by developing a framework for, she says, “measuring and evaluating what we’re doing, so that we can see what the outcomes are and where we have successes and where we may need to do more work.”
When it comes to what does move DEI forward in nursing education, she says that unfortunately there’s not yet a substantive body of evidence: “I know that sounds really bad, but that’s the reality of it. There’s some evidence, but not a whole lot.” Lewis has a solid working theory about that dearth from her own experiences as well as what she’s observed. “Those of us who work in this space, we always say we don’t have enough resources. So we hustle and we do programs and we do what we think works. We’ve not really done a good job of measuring the outcomes of all the good work that we’re doing. I think we have lots of anecdotal information—and that is important; we definitely need narratives from people that they feel like there’s a difference—but we also need hard data to really shed light on whether or not the programs and initiatives that we’ve implemented are really working.”
Once a framework for evaluating outcomes is in place, schools like Penn Nursing will be in a better position to sustain what is an ongoing process. “You diagnose, you treat, you implement, and then you evaluate, and then you start all over again based on the outcome. If we don’t get the effect that we were hoping for, well why didn’t we?” Lewis says. “You’re continually evaluating and reassessing and course correcting.”
She emphasizes that no one can do this work in isolation and that she appreciates sharing in networks like a DEI group at Penn that meets monthly. “We’ve come to realize that there are many of us doing this work, whether it’s an official role or not,” Lewis says. “The goal is to share ideas, think about resources, and think about ways we can make these efforts not so siloed. And that has been a game-changer for those of us who work in this space on campus.” She’s also a member of the American Association of Colleges of Nursing’s diversity, equity, and inclusion group, where she keeps an eye on the nursing education landscape across the country.
“Advocacy for vulnerable populations, populations that are underrepresented for appropriate health care, and even addressing health care disparities is firmly in nursing’s DNA,” Lewis says. “I think over time, we sort of disconnected from who we are in terms of social justice. And now we’re reclaiming it again.”
Sheldon Fields recently filled the first-ever Associate Dean for Equity and Inclusion position at Penn State, and he brings 30-plus years to the role with experience in administration, entrepreneurship, HIV/AIDS prevention research, health policy, and more.
On inaugurating a DEI position
“I am a part of what I think of as a new generation of nursing administrators who are focusing on DEI given the current state of our country and its reckoning with its racial past. I know of several open positions at major universities and colleges across the country. That’s a good thing. Nursing has finally realized that they really should bring in experts in this area, in how to move DEI initiatives.”
On silo hazards “
The work of DEI should not be only relegated to those of us in the profession who are ethnic minorities or from historically underrepresented populations. Our white nursing colleagues must do their part in this work. While we can guide and we can create the programs and help to create the infrastructure for successful DEI initiatives, these initiatives will fail if they do not have buy-in from the very top, with a very clear, strategic plan built into everything that happens with faculty, staff, and students.”
On nursing’s history
“The modern-day nursing narrative starts and ends with Florence Nightingale and it is a very Eurocentric, white perspective on a foundation of the nursing profession, and it is wholly incorrect. It leaves out quite a few people and pioneers, brown and Black and other people of color who had a profound impact on the nursing profession.” To remedy this problem, Fields says, “put nursing history back in undergraduate nursing curricula.”
On serving students
“As a Black Latino male nurse, I bring a personal perspective and a lived experience of what it is to be someone who has always been seen as an ‘other’ in the nursing profession, to give me a certain level of sensitivity and perspective that makes this work very much worthwhile. We owe it to those who are seeking to be nurses to really expand who we allow to be a nurse. Our classrooms need to be more diverse, in all ways, not just racial and ethnic, but gender and gender expression, and religion.”
On health policy
Fields was the first male registered nurse selected for the prestigious Robert Wood Johnson Foundation Health Policy Fellowship program, during which he worked on the Affordable Care Act as a health policy adviser for Maryland Senator Barbara A. Mikulski. “She was a huge advocate for older health care, Alzheimer’s, women’s health, HIV/AIDS, and all those issues that we were able to address. It dovetailed very well with my commitment to doing work in health care disparities and finding ways to increase health equity and health justice.”
With stints at Emory University, Georgetown University, and Boston College prior to landing at UNLV, Angela Amar has made a national impression on nursing education, and she has seen diversity programs make a positive difference. Through an Emory partnership with a community college, she saw over half of the participants go on to enter PhD programs. “That’s not the typical trajectory, to think of community college students, then going to Emory and getting a PhD as well,” she says. “They all represent diversity and add new perspectives to nursing. So we are changing the dynamic for the students but also for the institution. The institution benefits from having a deviation from what we typically see within our programs.”
On the path here
As a doctoral student at Penn, Dr. Amar was on the University’s diversity committee. “If I wasn’t interested in things that pertain to people who look like me, then why would I expect other people to do it?” However, as she’s increasingly taken on more leadership roles in nursing education, she has come to a realization. “I learned that I don’t always have to be the person who is in charge of those initiatives. I can use my voice in leadership meetings, in national meetings, and within my own school and at the university level to speak out for people who don’t have a voice, to make sure that perspective is heard and appreciated, and to also work to hold people accountable.”
On the value of diversity
“People think of diversity sometimes as something that really benefits ‘these poor students,’ and, ‘oh my God, look at the difference we’re making.’ We don’t always think about the fact that having that varied perspective, having the different lenses, having students who are from other countries, enriches everyone.”
On nursing’s role in social justice
“When we start talking about some of the things within diversity that lead to people being oppressed, like racism or classism, heterosexism as well as sexism, we need those voices and we need to be able to understand that, because these are the lives of our patients as well. Until we can really include that as part of the way we think about people and the way we think about situations, we aren’t fully meeting our social mission.”
The roots of Diane Breckenridge’s commitment to leveling the playing field for all who want to study nursing are rooted in her own student days in the 1970s when she says she saw 11 out of the 28 in her graduating class fail to pass the state board. She went on to create the program that’s nationally recognized today as Strategies for Success.
On developing Strategies for Success
Breckenridge started what became the Strategies for Success program in 1988, calling it the “New Access Student.” A risk assessment profile identifies challenges, like having to work two outside jobs while in school, unreliable childcare at home, and speaking English as a second language. When Breckenridge discovered through research that ESL students took 30 percent longer to process exams, she developed tutoring techniques to help them finish tests in the allotted time. She worked with counselors at Philadelphia high schools to ensure students interested in nursing were taking the right courses like chemistry. In 2010, thanks to a $1 million-plus grant, she was able to take the work she’d been doing for decades and establish the Strategies for Success Center at La Salle University, which was later named for her.
On nursing’s role in equitable health care
Charles R. Drew University is a private historically Black graduate school with a social justice and health equitydriven mission in a majority-Latinx neighborhood of Los Angeles. With COVID-19 disproportionately affecting people of color in the U.S., Breckenridge made sure the nursing school’s students could volunteer at a local testing center as part of their education thanks to an affiliation agreement with the health department. “76 percent of our neighbors are Hispanic, and it’s so important we are there for them. We started our own testing center in April, with Martin Luther King Jr. Community Hospital across the street, based on the neighborhood health center principles