Making a diversity difference : stories of leadership in creating a more inclusive nursing profession

Societies in the developed world are becoming increasingly diverse as they experience growth in the number and size of minority groups, including visible minorities, immigrants, and, in some countries, Indigenous peoples. Society’s institutions, including the health care system and its professional groups, are increasingly challenged to enhance their understanding of and respect for such societal diversity in providing services, and to work to reflect this diversity in the makeup of their membership. While many of the health care professions, including nursing, have acknowledged the importance of inclusion of individuals from diverse groups, their successes in meeting targeted increases have been limited. The purpose of this research was to elicit stories of nursing leadership that successfully promoted diversity and enhanced inclusiveness within the profession. The research problem was stated as follows: What were the experiences and stories of nurse leaders who successfully provided leadership to increase diversity and inclusion within the profession? The study used modified narrative inquiry research methods. The research was built on a conceptual framework consisting of three major concepts: diversity, critical leadership, and professional closure. The study focused on the stories of five Canadian nurse leaders who described and explained through their stories their leadership characteristics and challenges. Their stories of promoting diversity and inclusion were explored from a critical perspective, using literature found primarily in the fields of nursing and education to guide the exploration. These leaders’ stories revealed their understanding that the nursing profession currently expected its members to represent the norm-- white middle class females. The stories showed that the participating nurse leaders generally had views of diversity that were broader than culture, ethnicity and race, the views that were most commonly addressed in the mainstream nursing literature. Their broad views of diversity included difference based on gender, sexual orientation, and ability. These views often arose from personal experiences of difference related to ethnicity, language, country of origin, gender, presence of an accent, or family circumstances. The leaders interviewed indicated that they saw a lack of tolerance for difference within the profession, but not simply in relation to cultural or physical difference. They described a lack of acceptance within the profession of different ways of thinking and being—referred to in the study as diversity of thought. They reported that the profession expected and reinforced conformist thinking and tended to support the status quo. The study findings contributed to an expanded understanding of the conceptual approach of critical leadership as a process to support diversity and promote inclusion in the profession. A conceptual framework for critical leadership, based on the work of Foster (1986; 1989) and Ryan (2006a; 2006b) was enhanced and expanded as a result of the study findings. Critical leadership involved critique, transformation, education, ethics, and inclusion. The study findings supported the view that the profession of nursing, perhaps inadvertently, limited access to the profession by marginalized groups. This process was called professional closure, and occurred as a result of increasing entrance requirements, inconsistent language requirements, and segmenting minority groups in lower paid practical nurse and front line positions, with little opportunity for advancement. These findings about diversity and leadership, and about leadership for diversity, challenged the nursing profession to look beyond its day-to-day busyness, and to move beyond its current locked-down, controlled, risk-averse practices. The study findings challenged the profession to embrace the possibilities of increasing its diversity and inclusiveness, with the ultimate goal of building a better, stronger, more just profession and a better, stronger, more just society. The study has significant implications for theory, practice, research and policy in the profession. From a theoretical perspective, the study pointed to the need for the nursing profession to contemplate its social obligations with respect to promoting social justice in society. The study findings suggest that the profession might engage in national level policy discussions committed to increasing the diversity of the profession in order to reflect the community it serves. This study suggests the need for additional qualitative and quantitative studies on critical leadership to further develop the conceptualizations that evolved in this study. Policy discussions are implicated to address approaches to difference, inclusion, culture, cultural competence, cultural safety, affirmative action and inclusive policy in nursing, nursing education and health care institutions