Ep. 98: Breaking Barriers: The Power of Workforce Diversity in Health Care

Diversity in health care is more than just a buzzword — it is essential for delivering culturally competent care, addressing health disparities, and creating an inclusive environment for patients, families and providers. For the Latino/Hispanic community, which constitutes a significant and growing portion of the U.S. population, having health care providers who understand their cultural context can lead to better patient outcomes. Building a workforce pipeline for Latino and Hispanic individuals is essential to serve this population and to create an inclusive health care environment.

Joining in the discussion are nurse innovator Dr. Bonnie Clipper as well as Nemours Children’s workforce partnership development director Dr. Margaret LaFashia, and Merry Ann Carde Garcia, a member of Adelante — a Latino/Hispanic employee resource group, who weigh in with national and system perspectives.

Guests:
Bonnie Clipper, DNP, Nurse Futurist and Founder & CEO, Virtual Nursing Academy
Margaret LaFashia, DNP, Director of Workforce Partnerships, Nemours Children's Health
Merry Ann Carde Garcia, RN, Administrative Manager, Nemours Children's Health

Host/Producer: Carol Vassar

Views expressed by guests do not necessarily reflect the views of the host or management.

Subscribe, review or let your voice be heard at NemoursWellBeyond.org.

Transcript

Intro:

Welcome to Well Beyond Medicine, the world's top-ranked Children's Health podcast produced by Nemours Children's Health. Subscribe on any platform at Nemourswellbeyond.org or find us on YouTube.

Carol Vassar, host/producer:

Each week we're joined by innovators and experts from around the world, exploring anything and everything related to the 80% of child health impacts that occur outside the doctor's office. I'm your host, Carol Vassar, and now that you are here, let's go.

Music:

Let's go. Well Beyond Medicine!

Carol Vassar, host/producer:

According to the US Census Bureau, people of Hispanic heritage of any race made up almost one-fifth, 19.5% of the US population. In 2023, according to the Pew Research Center, Hispanics have played a major role in US population growth Over the past decade. The US population grew by 24.5 million from 2010 to 2022, and Hispanics accounted for 53% of that increase, a greater share than any other racial or ethnic group. As we honor Hispanic Heritage Month on the Well Beyond Medicine podcast, we're talking with experts on the importance of diversity in the healthcare workforce. In a few minutes, we'll discuss Nemours' efforts in bringing more Hispanics into the workforce through mentorship, shadowing, training, and continued support. Right now, though, a national and more general perspective on healthcare workforce diversity comes from Dr. Bonnie Clipper. Bonnie is a nurse futurist and technology innovator with more than 40 years of clinical and leadership experience. We turn to her to ask a vital question: what is the importance of culturally and linguistically diversifying the healthcare workforce? Here's Dr. Bonnie Clipper.

Dr. Bonnie Clipper:

It's so important that clinicians and caregivers look like the communities that they serve, and there's a lot of depth to that, right? Because it's important to understand, be culturally respectful and sensitive, and to really learn what communities maybe have gone through. What does that history look like? What are the things that are important to different communities? So if you're from the community, it is likely going to be easier to understand, to empathize, and to convey that in a much more authentic way, so I think really looking like the communities that we serve, I think that's important from a workforce perspective.

Carol Vassar, host/producer:

Now, you've been in the nursing business, as you said, for a very long time. Talk about how you've seen the growth of adversity in the workplace, the healthcare workspace, and how it has benefited others, including and especially patients.

Dr. Bonnie Clipper:

I think that we're seeing it across the board in a lot of the different professions, so no matter if it's nursing, medicine, or therapies. What I think is interesting is that it gives us a much better way to identify and solve problems when we have a diversity of thought, and that means that we need to be thoughtful about who is at the table when we are defining and solving problems so that we really do get the benefit of different mindsets, different experiences, and different voices. So, each of us brings such a different lived experience to the table that I think it's important to have a really broad set of those ideas when we look at solving problems so that we aren't solving them based on assumptions that may or may not be accurate.

Carol Vassar, host/producer:

Yeah. I wanted to ask you what happens when we don't have diversity at the table?

Dr. Bonnie Clipper:

I think when we don't have diversity or even diversity of thought at the table, the problem is that we all see things potentially the same way, and that's a risk because that means we could be missing other ways to view the problem. So I like to use a human-centered design approach and really begin to think about when we include people in the problem and if we were to apply a design thinking lens to this, the first step in that process is really to empathize before we get into accurately defining the problem.

So when we think about empathizing, that assumption starts with the fact that we have a little bit of a baseline understanding in why something contextually may or may not be. I think it's really paramount that we have different voices in the room, different thoughts in the room, different experiences in the room so that we can add all of that to the problems that we are defining and the solutions that we come up with. It's going to give us a much more rich and likely scalable and sustainable solution when we can bring different voices in, and we make sure to include everyone that's invested in the challenge or the problem.

Carol Vassar, host/producer:

You have experience in developing technology. You're a futurist. How do you see technology? Can it be leveraged to help us diversify the workforce?

Dr. Bonnie Clipper:

The answer to that is yes, and I also think that there are some pitfalls that we have to avoid, particularly when you think about there's so much opportunity. We all use this term AI, yet what does that exactly mean? What are you going to do with it? How are you going to use it? I think this is going to be a little of a dual-sided challenge because while we're creating these amazing tools that have AI built into them, that will absolutely assist us, whether it's in recruitment, retention, education, whatever that might be.

However, the other side of that is we really have to be very mindful about how we build the algorithms and how we test the algorithms so that they are inclusive, equitable, and fair to begin with. Otherwise, all we are doing is potentially automating a bad process, an unfair process, an inequitable process, so we really do need to think about that, and I think that that even starts back with inclusivity. Let's make sure we have the right people, groups, categories, whatever that might mean. I think we do have to have diversity and diversity of thought involved in the very, very start, the inception of these amazing technological advances.

Carol Vassar, host/producer:

With more and more diversity, not only in the healthcare workforce but across the workforce in general, as you pointed out, are you seeing improvements for patients as they are coming through the doors of hospitals and healthcare facilities across the nation?

Dr. Bonnie Clipper:

I do think that technology is going to make quite an impact, particularly as we think about things like access. So we know that we have a lot of communities. Whether it's a rural community that might potentially be underserved from a healthcare perspective or even an inner-city community that might be underserved, we do know that technology is beginning to break down those barriers of access so that patients might not always have to seek out transportation and find a way to a clinic visit, a provider visit, but rather these things now might be able to be done by virtual care or telehealth. So I think that we're starting to see an impact there. I believe it's going to take more time for us, truly, to begin to dismantle some of those structural barriers that have been in place around transportation, around access, around affordability before we actually start to see the outcomes. At the end of the day, I think the proof is in the pudding.

I think we all want to see that outcomes in care, outcomes in health actually improve. Those are the measures that we're looking at, and we still have a way to go on those. I think we have to continue to be very mindful that our communities, they're growing, they're changing, so I think we have to find ways to reach down lower grades into schools to begin to interest and educate little kids, young people about different healthcare professions, and that means that we do have to put some thought into accessing all of the communities, not just select communities, because I think we're going to have just absolutely brilliant providers, incredible nurses, fantastic therapists that come out of every single community, but first, we actually have to teach them what we do and what a career could look like in these areas. So we have to also go in there, educate, and then help mentor, role model, and cultivate what we do as clinicians because it's such an amazing opportunity we have to impact patients' lives. I think we need to spread more of that.

Carol Vassar, host/producer:

Dr. Bonnie Clipper is a nurse leader, educator, technology innovator, and futurist based in Austin, Texas. Diversity in healthcare is more than just a buzzword. It's essential for delivering culturally competent care, addressing health disparities, and creating an inclusive environment for both patients and providers. With the nation's growing Hispanic population, creating a workforce pipeline for this community is crucial. Nemours is doing just that, according to our next guests. Margaret Lafasha is Nemours director of Workforce Partnership development, and Merry Ann Carde Garcia is an administrative manager for Nemours Children's Health. Both Margaret and Merry Ann are nurse leaders based in Delaware and members of the Nemours Associate Resource Group, ARG Adelante. This ARG's mission is to create a diverse and culturally competent environment at Nemours, where all associates feel they have a voice, and where the Latino-Hispanic families served feel their needs are being met, and workforce development within the Latino-Hispanic community is right up their alley. Here's Margaret Lafasha.

Margaret LaFashia, DNP, Nemours:

In 2020, in my research, Hispanics made up 17% of the health aid workforce, of which 12% were EMTs. 8% are nurses, and 6% are physicians, for a total of 13% in the US healthcare workforce. I only have numbers for Nemours-Delaware Valley. These numbers were pulled in 2021, of which 13% of our patient population identified as Hispanic, whereas less than 4% of our nursing staff, which is registered nurses and APRNs, identify as Hispanic.

Carol Vassar, host/producer:

So there's still some growth in the workforce end of things that can happen. Let's talk first about why diversity, especially Hispanic representation, is crucial in the healthcare workforce.

Margaret LaFashia, DNP, Nemours:

Well, the issue of healthcare disparities is complex, but it's clear that an increase in minority representation improves patient access to culturally relevant care, which can positively impact patient outcomes. Healthcare access among Hispanics differs based on how long you've lived in the United States, is found that the longer that you've been in the country, the more likely you are to visited a doctor, but yet only still seven out of 10 Hispanics actually go and visit a doctor on an annual basis.

Carol Vassar, host/producer:

So, as we look at the healthcare workforce, it does not accurately reflect the population that we are seeing. What are the challenges that the Hispanic community faces when it comes to entering and perhaps advancing their careers in healthcare?

Margaret LaFashia, DNP, Nemours:

I would say it falls into four different buckets, the first being education. Few individuals pursue careers in medicine because there are limited pathways starting in K through 12 education. The second would be social and economic factors. Employment demands to support a family will outweigh the want to do education or aspire to go and get an advanced degree. The third is there's a lack of role models, representation of Hispanics in the healthcare workforce, and then finally, language barriers is a big one.

Carol Vassar, host/producer:

I was going to ask about modeling. How important is it to see somebody who looks like you, who talks like you in a position of leadership, or in a position, a managerial position in the healthcare workforce, when somebody is thinking about a career in healthcare?

Margaret LaFashia, DNP, Nemours:

I'll start, but I'll let Merry Ann answer because I know that she does a great job of taking on students into her practice site, but I think from specifically dealing with healthcare as an industry, healthcare is very personal. And so from that perspective, the comfort, being in front of a provider or a nurse that looks like you speaks your language, probably would encourage or help you want to go see in healthcare clinic.

Carol Vassar, host/producer:

Merry Ann, you're nodding your head. Tell us what your thoughts are.

Merry Ann Carde Garcia, RN, Nemours:

Yes. Oh, I can talk. This is a good one for me. I'm one of those students. I'm one of those students. I went to school in Puerto Rico for my nursing degree, and I finished my bachelor's in nursing in Puerto Rico. When I came to the States, it was difficult for me because here I am a nurse, and I couldn't work in the United States because of not having the license for the states. We have our own boards, and then the states have their own boards as well. It took me a while until I started getting into the gist of it, and I felt indifferent, but then, as we continue to see the differences in healthcare from where I'm from and from the United States, I can see, not that they excluded me from it, but they showed me ways on how to improve myself.

In Puerto Rico, we're just viewed in the hospitals as just numbers because everybody goes to healthcare, and it's very different in the United States. I know that when we got together, and I started working here, I could see the need for nurses, Hispanic nurses, to help this population. A lot of the patients that we have will not seek care, one, because they either don't have insurance, two, they're from a country that they probably try to escape. They're afraid that "If I go to get seek healthcare, they're going to deport me," so a lot of the things are seeked outside of the hospital, and people are just scared.

But when I talk to my patients, and we have Hispanics that come here, and they're afraid to even say anything, but when I talk to them and give them the opportunity, "Don't worry. We're not here to tell on you. We're here to take care of your child, so I don't need to know that information. I just need to make sure your child is safe, and everything's okay." Then, they feel comfortable because they know I'm speaking to them in their language, and here they start opening up and talking to you. I think having diversity in the healthcare is very, very important because it gives them that personalized care that they need. They might not open up to Margaret quite easily if she not understanding what they're going through, and I'm not saying that I went through that situation, but it is a different culture. If you're not from that culture, you're not understanding why they do things the way they do.

Carol Vassar, host/producer:

Merry Ann, I'm curious. What prompted you? What inspired you to become a nurse, and what barriers did you face or felt you faced because you are Hispanic?

Merry Ann Carde Garcia, RN, Nemours:

Yes, so nursing has always been in my family. My grandmother took care of patients in her home. She had a small nursing home, seven patients, and I used to watch her as she took care of these patients and how she cared for them. She had that relationship with these patients, and it was like this loving relationship, and I wanted to be a part of that. I wanted to help people get better. Even though they're geriatric patients, but I can see the love that she gave them and provided them to get better in their health. I mean, we all know the outcome, but she made them comfortable all that time. Seeing her do that and taking care of patients, that made me want to do the same thing. Pediatrics has been always something I always wanted to be in. I love children. And when I saw this opportunity at Nemours, yes, in the beginning I was afraid because I was like, "I'm Hispanic, who's going to give me a leadership position because I'm Hispanic?"

When they gave me that opportunity, it did change my opinion around, not only anybody else can, but we can too. This was a big step, a big milestone. I did manage an office in Milford for an OBGYN, but I didn't think that for Nemours, a big healthcare system, that I will land this type of opportunity. I'm very grateful for that, and I'm able to, like Margaret said, anytime that we have students, it doesn't matter what background or where they're from, I want to give them that opportunity that I was given for them to be able to exceed. It doesn't matter who you are, which you are; that you have a chance. I want the children and students to feel that way. I want to give them that opportunity. When I bring them in here, I'll tell them my story. I'll talk to them. I'll tell them, "Look, I went through all this. This is all that I went through. If I went through this, you can do this," and so, hopefully, that's a good, positive outcome for our students, but I'm always on board and giving that, students and giving them the opportunity to grow.

Carol Vassar, host/producer:

As you work with patients, Merry Ann, you alluded to culture and cultural competency, which may be a phrase that's on the way out, but you did allude to the fact that the Hispanic culture is different, you understand it, you grew up in it, it is in your DNA. Talk about how that kind of manifests as you work with patients or have worked with patients in the past, just knowing the culture and the importance of that.

Merry Ann Carde Garcia, RN, Nemours:

Carol, it's so funny because when I worked for another organization, I had to go in to translate to a patient, and the funny part was everybody thinks, "Oh, you're translating. It's Spanish. Everything is Spanish." No, it's not. We have different people from different places, and not always the language. Spanish is the same. Not always the words mean the same thing. When I went, and this is when I first came to the United States, I had to translate for this patient. He was from Mexico, and Spanish in Mexico is different from Spanish in Puerto Rico. When I went to translate for this patient, I used a word that meant one thing to us in a positive way, but for him, it meant something negative, that language. Then, I stood back, and I had to rethink my words to be able to translate to him.

Then, that's when I realized, "You know what? Even though we are Hispanics, there's a language barrier that can happen as well, not only in English." So then, what I started doing is started researching about Mexico and their words, what words are different from us? I started to get involved with other people around the community and talking to them, "Oh. What does this word mean to you, and what does this is word mean to us?" And that's how I started using those words, started building it in my vocabulary, and try to figure out, and always now I ask, "Where are you from?" because I don't want to commit that same error that I did before to make sure that we're communicating in our same language.

Carol Vassar, host/producer:

I'm glad you pointed that out. It's important for people to understand that, when you use the term Hispanic, it is not monolithic. It is very, very diverse. You're talking about people from Mexico, Puerto Rico, Spain, other parts of the world, Spanish perhaps being a little different, as you pointed out, for each and every one of them, and the subtleties are demanding of that cultural competency, especially in the healthcare setting.

Merry Ann Carde Garcia, RN, Nemours:

And I agree with you, Carol. I'm sorry. I think a lot of people need to understand that, not because we speak Spanish, it's all the same. It is not. There is differences, and we need to know the difference that there is so that we can have better communication, and their cultures are different.

Carol Vassar, host/producer:

Absolutely. Margaret, I'm curious. Institutions like Nemours, how can we better support young people coming up in the Hispanic community, diverse as it is, as they pursue healthcare degrees or certifications and make their way into this field?

Margaret LaFashia, DNP, Nemours:

First of all, leaders of any institution, specifically at Nemours as well, need to encourage training and development to educate staff about recognizing unconscious biasness to help spur the growth for minorities. Here at Nemours, and Merry Ann has been a big part of it as well, we started developing a pipeline program and establishing partnerships with area schools to encourage students at all levels of education to enroll in healthcare programs, to graduate from healthcare programs, to learn about healthcare programs, and this is really intended to really target the underrepresented minority into healthcare and encourage them to pursue a career path in healthcare.

Carol Vassar, host/producer:

You talk about partnerships. You alluded to that. How is Nemours engaging with the Hispanic community and partners therein to promote careers in healthcare to narrow that gap?

Margaret LaFashia, DNP, Nemours:

A lot of our partnerships, really within my group, our partnerships start with identifying schools, middle schools, and high schools in the communities that surround Nemours here in Wilmington, as well as in Orlando, Pensacola, and Jacksonville, and these are usually communities where our patient population comes from. And so, these are students that also are our patients. These are students that look like our patients, they speak the same language, and those are the ones that we need to identify as our future healthcare workforce and encourage them to come to Nemours, not as a patient, but come to Nemours and see it and feel it from a healthcare provider's perspective, so we encourage them to come in and shadow. They come in and spend a day in the life of a nurse or a day in the life of a respiratory therapist. It's a new direction we're going in.

It's called the Nemours Healthcare Academy, and they spend the day with that particular career path and learn and understand what that role is. It also allows them an opportunity to ask questions of the provider, the nurse, the respiratory therapist, how they got into their career, one-on-one conversations, and really understand what it means to be in the walls of the hospital system. On the ambulatory side and including Merry Ann's clinic in Middletown, we also encourage the students to pick up co-op positions where they get paid while they're finishing up their high school, their senior year, to come in and to learn what it means to be a medical assistant in our primary care and specialty care sites. Again, this allows them to work with a preceptor one-on-one, they get one-on-one training, and again, that one-on-one conversation, learning about the role and understanding what it means to be in that healthcare pathway.

Then, they eventually get to take on patient assignments themselves, and so they, again, learn what it means to be in healthcare, and it doesn't stop there. Our partnership is not about just getting them to graduate high school. Our partnership is to encourage them to continue on that career path In healthcare. There's a lot of things that you can do in healthcare. The media doesn't do a great job of promoting all the different pathways in healthcare. They really show the physician, they show the nurse, but there's so many other aspects that you can go in healthcare, and until you actually are living the day in the life of a healthcare provider, whether it's a nurse or respiratory therapist, do you learn what else exists out there? And so, we really give them an immersion experience, and it so far has been really successful.

Carol Vassar, host/producer:

Merry Ann's been nodding her head as you've been talking about all of this.

Merry Ann Carde Garcia, RN, Nemours:

Oh, yeah.

Carol Vassar, host/producer:

So I want to ask you, Merry Ann, have you seen this in action?

Merry Ann Carde Garcia, RN, Nemours:

Yes.

Carol Vassar, host/producer:

Is there a student perhaps you can talk about who has been part of these mentorship programs or shadowing programs who has benefited from them?

Merry Ann Carde Garcia, RN, Nemours:

Yeah, so we had two students. I want to say, was it two years ago, Margaret? That we started with the Co-op program. They were shadowing for the whole year until they graduated, and then we kept them on board, because they did such a great job, and they were so into the training and learning about healthcare. One of them is still with us. She still works with us. She's going to the university, and she's going into the nursing field. The other student, she is also in the university, but she got a job at Nemours, at the hospital, so now she's working for Nemours and on the floor as a medical assistant.

She still writes to me, and she says, "I really appreciated the opportunity that you gave me when I first came into your office and given me the opportunity to grow, and that has really helped me understand what role I wanted to do in my career." I was so excited to see these children grow with you, basically, and now they're working as medical assistants, which is a huge step. We have another one that just started this last week. She's another co-op student, and she's eager to learn. Hopefully, we'll show her the same ropes and have her on board and join Nemours. Even if they don't stay in my office, as long as they went to Nemours, I know we did a good thing, because they're still moving to bigger things at Nemours.

Margaret LaFashia, DNP, Nemours:

And Carol, I wanted to add on to Merry Ann's comments. You had stated, you asked about partnership. So I kept referring to our external partnerships, but when it comes to Nemours better supporting Hispanic students, it also is our internal partners. When I say internal partners, it's folks like Merry Ann, the nurse managers, the nursing directors, and the operational managers at our sites with our ambulatory settings, as well as in our acute care setting at the hospital. I need their partnership as well. They have to be willing to take on these students. They have to be willing to host them. They have to be willing to identify preceptors, and be willing to put a plan together to help encourage them to be successful while they are at Nemours. And so, it does take folks like Merry Ann to be on board and assist with that because the students that she just referred to would not have found success if it wasn't for Merry Ann's leadership and partnership with these endeavors. And so, while we do recognize the external partners, it starts with the internal partners because you can't build a program without everyone on board.

Carol Vassar, host/producer:

And as you're building programs, as you're getting mentees in the door, Merry Ann has been very excited to talk about the fact that you want to keep them. Once people do become associates, how do you go about maintaining that and making certain that people of Hispanic heritage feel included and welcomed here at Nemours?

Margaret LaFashia, DNP, Nemours:

So I'll start, and then if Merry Ann wants to add on, I'm not sure if you're familiar, but once you become an employee of Nemours, you are then eligible for tuition reimbursement, and so the one student that she referred to, who is now at the university enrolled in the nursing program, this is one of the original barriers that we identified in our research, was financial. One of the reasons why many of the minority representation does not go into healthcare is financial. And so, Nemours breaks down that barrier. Once you become an employee, you are eligible for tuition reimbursement, so now the dream of becoming a registered nurse for this individual is coming to fruition, and, so, that is important to point out.

Secondly, a lot of the times too is these students, while they are on co-op, I will go back to their schools, and the class that's coming up behind them, I will encourage them to do speaking opportunities and talk about their experiences. So when you have a student that looks like the student by it sitting in front of you and talking about their experience at Nemours, it excites the student that's coming up in the next grade to potentially want to follow the same pathway. And so, again, all the literature states that you have got to start young. You have to start in middle school. You have to have to start encouraging them into understanding what a career in healthcare is because, again, there's a lot of influences around this, a lot of online influences, TV influences, and so it's upon us to go in and really also start to be that influence as well.

Carol Vassar, host/producer:

Merry Ann, if you had a young Hispanic individual in front of you and they were aspiring to enter the healthcare workforce, what would you say to encourage them?

Merry Ann Carde Garcia, RN, Nemours:

Keep moving forward. You can do it, and I would definitely take them under my arms and show them, get them those shadowing experiences. Like Margaret says, "If you're not sure what you want, well, let's get you some shadowing experience so that you can see what is going to work for you." Give them those tools to keep them looking for that relationship in healthcare, and not everything's pretty because it's not. We got to show them the good and the bad so that they see that this is, I don't want you to come in here and be like, "Oh, everything's so perfect and rainbows," and then when they see something happen in a negative way, "Oh, but you didn't tell me this was going to happen."

But if you give them from the start, "This is going to happen. This is things that we all go through. These are situations," just being honest with them comes a long way.

Margaret LaFashia, DNP, Nemours:

I was just going to add on to Merry Ann. We actually graduated our first cohort back this year in May '22 students, and of them, 85% of them were bilingual, and we asked them the same question. We asked them, "What would you say to the class behind you and going into healthcare?" And a couple of things that stood out was to do it, ask questions, be a sponge, be willing to start the ground level, and work your way up. It is a good-paying career pathway, and never stop learning.

Carol Vassar, host/producer:

Margaret Lafasha is Nemours' Director of Workforce Partnership Development. Merry Ann Carde Garcia is a Nemours administrative manager. Both are based in Wilmington, Delaware.

Music:

Well Beyond Medicine.

Carol Vassar, host/producer:

Many thanks to both Margaret and Merry Ann, as well as Dr. Bonnie Clipper for joining us on this episode of the Nemours Well Beyond Medicine Podcast, and thanks to you for listening. Some of our most recent episodes have taken us to Philadelphia to celebrate Childhood Cancer Awareness Night and to a McDonald's in Delaware to learn more about how workforce development works there. If you missed these or any of our nearly 100 Well Beyond Medicine Podcast episodes, fear not. You can always go to NemoursWellBeyond.org to listen to any previous episode. You can also subscribe to the podcast there too. That way, you'll never miss an episode. That's NemoursWellBeyond.org. Our production team today includes Cheryl Munn, Susan Masucci, Lauren Teta, and Steve Savino. Join us next time as we talk about the importance of voting. I'm Carol Vassar. Until then, remember, we can change children's health for good, well beyond medicine. Let's go well beyond medicine.