With the growing diversity of patient populations and the persistence of health disparities among different populations, health care providers have become increasingly aware of the need to develop their cultural competency skills through diversity, equity, and inclusion (DEI) training.

Research shows that DEI training can positively impact patient outcomes in several ways, including by improving treatment adherence, increasing patient trust and engagement, and reducing health care costs. Additionally, DEI training can help health care teams function more effectively, reducing professional conflict and improving patient experiences.

The significance of DEI for the health care industry is multidimensional, with numerous implications for both patients and health care workers. Exploring these implications and the many topics that DEI training may address is the first step toward understanding its importance in today’s health care landscape.

As the U.S. population becomes increasingly diverse, the health care workforce needs to reflect this diversity to be able to deliver the highest quality care to all patients. This includes the nursing profession, which comprises the largest group of health care professionals.

Currently, the nursing profession lacks diversity. According to the National Council of State Boards of Nursing (NCSBN), approximately 80% of nurses in the U.S. are white, while Black, Hispanic, and Asian nurses comprise only 19% of the nursing workforce. Men make up only 9% of the nursing workforce.

The American Association of Colleges of Nursing (AACN) stated in September 2022 that diversifying the nursing workforce was a top priority for achieving health equity and could help expand and improve patient education, satisfaction, and adherence to treatment plans. The AACN also says that increasing nurse diversity has the potential to improve communication between patients and nurses, which could, in turn, improve health outcomes.

One strategy to increase diversity in nursing is to recruit individuals from underrepresented groups. This can be achieved through targeted outreach programs that provide information about nursing careers to students from diverse backgrounds. Scholarships and financial assistance programs can also help to make nursing education more accessible to individuals from underrepresented groups.

Another strategy is to provide resources, support, and mentoring to nurses from diverse backgrounds. This can help to improve retention rates and create opportunities for career advancement. Professional nursing organizations can offer networking opportunities, leadership training, and mentorship programs to nurses from underrepresented groups.

Professional nursing organizations, such as the American Nurses Association (ANA) and the National Black Nurses Association (NBNA), have recognized the need to increase diversity in nursing and are taking action to address this issue. Organizations like these aim to create opportunities for individuals from diverse backgrounds to enter and advance in the nursing profession — encouraging the hiring and promotion of nursing professionals from diverse backgrounds.

The following are some of the many organizations that are working to diversify the nursing profession.

• The National Black Nurses Association (NBNA) represents over 308,000 Black nurses and nursing students across the country, advocating for policies and practices that promote DEI in health care and providing leadership development opportunities for Black nurses.
• The Asian American Pacific Islander Nurses Association (AAPINA) represents nurses and nursing students of Asian American and Pacific Islander (AAPI) descent, works to increase the visibility of AAPI nurses in health care, and promotes cultural competency among health care providers.
• The National Alaska Native American Indian Nurses Association (NANAINA) promotes the health and well-being of Native American and Alaska Native communities through the professional development of Native American and Alaska Native nurses.
• The National Association of Hispanic Nurses (NAHN) promotes the recruitment and retention of Hispanic nurses through leadership, advocacy, education, and research.
• The Philippine Nurses Association of America (PNAA) provides scholarships and mentorship to and advocates for Filipino-American nurses in health care and nursing education.
• The National Coalition of Ethnic Minority Nurse Associations (NCEMNA) is a coalitional organization that represents several ethnic minority nursing associations, including NANAINA, NAHN, NBNA, and PNAA, among others. The organization promotes the recruitment, retention, and advancement of ethnic minority nurses.
• The American Association for Men in Nursing (AAMN) represents male nurses in the U.S. The organization collaborates with other health care organizations and policymakers to address gender-based disparities in nursing.
• GLMA Nursing represents LGBTQ+ nurses and nursing students in the U.S. One of the group’s key priorities is to increase the number of LGBTQ+ nurses in the nursing profession by providing support and resources to LGBTQ+ nursing students.
• The National Organization of Nurses with Disabilities (NOND) represents nurses with disabilities. Its mission is the inclusion and full participation of nurses with disabilities in the nursing profession.

Additionally, studies show that increasing minority representation in nursing leadership can promote innovation and better patient outcomes. Many nursing mentorship programs are designed to foster the success and retention of nurses from diverse backgrounds, including the following:

• The NBNA Collaborative Mentorship Program is a mentoring program that pairs experienced nurses with nursing students and early career nurses from underrepresented minority groups. The program aims to provide guidance, support, and networking opportunities to help these nurses develop their professional skills and advance their careers.
• NAHN: Hispanic Nursing Mentors Connection provides opportunities for mentees to learn from experienced Hispanic nurses, attend professional conferences, and engage in leadership development activities.
• The Diversity in Nurse Anesthesia Mentorship Program provides mentorship and professional development opportunities to help nursing students from underrepresented minority groups achieve their career goals and contribute to the field of nurse anesthesia.

Understanding the basics of DEI is fundamental to understanding both the importance of these diversity efforts and why nursing professionals benefit from DEI training.

Diversity, in the context of health care, refers to the representation of different races, ethnicities, genders, ages, abilities, and other variables such as veteran status within both the workforce and the patient population. As the population of the United States continues to diversify, the health care industry needs to prioritize diversity so it can provide effective and culturally sensitive care.

However, simply having a diverse health care workforce is not enough. The health care industry must also work to improve its policies and practices to support patients from diverse backgrounds. This includes providing DEI training to health care providers.

A strong correlation has been shown between DEI training in health care and improvements in care delivery, efficiency, and overall patient outcomes. For example, a National Medical Association meta-analysis of health care DEI efforts found that patient care quality and organization adaptability to change improved in “diversity-friendly” work environments but declined in environments where diversity and DEI trainings were less frequent and perceived as less valuable.

Equity in health care refers to fair and just opportunities for all individuals to access health care and work in the health care industry, regardless of their age, ability, race, gender, or any other factors. Achieving equity in health care requires addressing systemic barriers to health care access and addressing disparities in health outcomes across different demographic groups.

Workplace equity is also crucial for health care organizations. Organizations that hire and promote nurses can advance equity by:

• Creating transparent pay structures that enable nurses to compare their salary and total compensation information, which promotes equitable pay
• Adopting clear and transparent promotion tracks so that nurses at all levels can understand the requirements for advancement in their field
• Fostering a culture of honesty, respect, and support — which includes addressing any nurse bullying or inappropriate workplace conduct

Inclusion in health care is the practice of creating a supportive and respectful environment for all professionals and patients. Inclusive policies and practices encourage individuals to feel valued and included, regardless of their background. This includes promoting diversity in leadership and decision-making roles and creating an environment where individuals feel comfortable expressing their opinions and concerns.

DEI training broadly refers to any organized effort aimed at promoting diversity, equity, and inclusion in the workplace. This training can take many forms, ranging from one-time workshops to long-term, comprehensive training programs.

Following are some examples of general resources for DEI training:

• “A Comprehensive Guide to DEI Training,” from 360Learning, explains that diverse teams are more productive and innovative on average compared to nondiverse teams. This guide explains how to do a diversity audit — an assessment of an organization’s current needs, such as complying with regulations, improving company culture, or boosting retention.
• The Association for Talent Development’s “What Is DEI Training?” explains why some DEI initiatives succeed while others fail. It explores how creating a safe and supportive environment for discussing DEI issues is a must, as is conducting training that enables teams to find solutions to their problems and not just identify problems without possible solutions.
• “Onboarding Empathy: 12 Best Practices for DEI Training,” from Forbes, explains why DEI training must be ongoing, engaging, and collaborative rather than “siloed” to human resources.
• “How Diversity Training for Health Care Workers Can Save Patients’ Lives,” from USA Today, explains why diversity training in health care settings is critical to overcoming inequities in access to care.

So what is DEI training in the context of health care? Effective DEI training for health care professionals can cover topics such as cultural competency, implicit bias, disability awareness, and LGBTQ+ health care. DEI training can help health care staff and leadership identify and address biases, build stronger relationships across diverse groups, and create a more inclusive workplace culture. It can also help increase awareness and understanding of the experiences of marginalized groups and create more equitable nurse advancement policies and practices.

Despite the many potential benefits of DEI training, in 2021, only 62% of health care professionals worked at organizations with DEI initiatives, according to a Relias national survey of 1,200 health care workers. And of those, just 40% required managers to participate in the training.

Because of the growing diversity of patient populations and the inherently complex nature of medical care, DEI training in health care covers numerous topics. Some common DEI training topics in health care include the following:

• Social determinants of health (SDOH): Social, political, economic, and environmental factors that can contribute to the health and well-being of individuals and communities
• Health disparities: Differences in health care access, quality, and outcomes based on factors such as race, ethnicity, gender, socioeconomic status, and geography
• Intersectionality: How multiple aspects of a person’s identity, such as their race, gender, and class, interact simultaneously and can affect their health care experiences
• Implicit bias: Unconscious attitudes and beliefs that health care professionals may hold toward certain groups of people, which can negatively impact their interactions with patients
• Racial equity: The opportunity for all individuals to access health care and work in the health care industry, regardless of their race
• Disability inclusion: Providing people with disabilities with the care, accommodations, and evidence-based practices that properly address their needs and challenges
• LGBTQ+-affirming care: Culturally competent care for members of the LGBTQ+ community, especially for those in vulnerable groups such as transgender individuals, that is based on their unique health needs and health care barriers

DEI training can be a challenging undertaking, but many DEI training materials are available to support nurses and nursing teams looking to conduct their own trainings:

• The Social Determinants of Health Academy is a virtual training program designed to teach health care professionals about SDOH.
• “Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity” is a report by the independent nonprofit KFF that explains SDOH and how they impact health.
• DEI for Primary Care Clinical Providers and Non-clinical Staff — SDOH is an online training module offered by the North Carolina Area Health Education Centers that explains SDOH and how nurses can advocate for their patients so that their patients can live longer, healthier lives.
• “Preparing Today’s Nurses: Social Determinants of Health and Nursing Education” is an academic article written for nursing professionals with recommendations for incorporating SDOH into nursing education programs and DEI training.
• “Be Prepared for the Future of Nursing: Social Determinants of Health and Health Equity” is a blog post by health education platform Osmosis that explains SDOH and the strategies nursing professionals can use to improve patient health at a population level.

• “Achieving Health Equity Through Better Understanding” is a blog post by the American Association of Nurse Practitioners (AANP) that connects nurse professionals with resources on addressing health disparities.
• Diversity, Equity, and Inclusion for the Healthcare Employee is a DEI training course by Relias that explains how culturally competent health care can reduce health disparities.
• The Deloitte Health Equity Dashboard provides quick and up-to-date health equity metrics that can be useful for discussions in DEI trainings.
• The Future of Nursing 2020-2023 offers evidence-based information on the health implications of social inequities. It can be a useful tool for explaining the concept of health disparities — something that may be crucial for a DEI training on the concept of health equity.

• “Intersectionality in Healthcare” defines and describes the concept of intersectionality and offers guidance on training health care professionals, including nurses, on the concept of intersectionality.
• “An Intersectionality Approach to the Process of Cultural Competemility” is a journal article that describes intersectionality and a transcultural approach to nursing.
• ​​“Intersectionality and Nursing Leadership” explains the current limits of academic research on nursing and intersectionality.

• Addressing Implicit Bias in Nursing is a continuing education course developed by the American Journal of Nursing.
• Diversity Science offers an online implicit bias training course for nurses.
• Implicit Association Test by Project Implicit is the original and most highly regarded test to determine unconscious associations and biases. This test can be taken as a part of a nursing DEI training course and used to springboard conversations about bias in the workplace.

• Actionable Allyship to Address Racism in Nursing is a free training course designed by the American Nurses Association to promote racial equity in nursing.
• A Tool Kit for Addressing Racism in Nursing and Healthcare was designed by the Organization of Nurse Leaders (ONL) for facilitating DEI trainings on systemic racism in nursing.

• Communicating with and About People with Disabilities is a guide from the Centers for Disease Control and Prevention (CDC) that explains the concept of people-first language and other language tips for communicating respectfully with and about people with disabilities.
• Nurses with Disabilities describes the spectrum of disabilities in the nursing profession and provides tips on how to make accommodations for nurses with disabilities.
• The National Organization of Nurses with Disabilities is an organization devoted to public education and advocacy for nurses with disabilities.

• “Cultural Competence in the Care of LGBTQ Patients” explains common barriers that people in the LGBTQ+ community face when trying to navigate U.S. health care systems, and how nurses can display cultural competence in the care of LGBTQ+ patients.
• “Nursing Advocacy for LGBTQ+ Populations” is the most recent position statement by the American Nurses Association on LGBTQ+ discrimination in health care and what nurses must do to support patients of all sexual orientations, gender identities, and gender expressions.
• Emergency Nurses Association (ENA) Pride Month resources are ENA-endorsed resources that can connect nurses with information about LGBTQ+ patients and their experiences.
• The American Trans Resource Hub offers resources about gender-affirming health care providers and organizations. Nurses can add their profiles or organizations to the provider map to signal their support for transgender patients and employees or to connect with other gender-affirming nurse professionals.

Cultural competence in health care refers to the ability of health care professionals to understand and appreciate the unique cultural values, beliefs, and practices of their patients.

One example of cultural competence for nurse professionals is understanding the importance of family involvement in patient care for certain cultural groups. For example, in many Hispanic cultures, family involvement in medical decision-making and care is highly valued. Nurses who are culturally competent recognize and respect this preference by engaging with patients’ families and considering their input in the care plan.

Similarly, in some East Asian cultures, patients may be hesitant to question or challenge their health care providers out of respect, so culturally competent nurses proactively encourage open communication and ensure that their patients feel comfortable asking questions or expressing concerns.

In another example of cultural awareness, understanding military culture is important for civilian nurses treating self-stigma among veterans.

When providers are culturally competent, they can communicate more effectively with their patients, understand their health beliefs and behaviors, and tailor treatment plans to meet their specific needs. This, in turn, can lead to improved patient satisfaction, greater adherence to treatment protocols, and, ultimately, better health outcomes.

Cultural competence training in health care creates inclusive and supportive environments for patients as well as for health care workers. When nurses feel supported and valued in their work environment, they are more likely to be motivated to perform their jobs well, leading to increased job satisfaction and retention rates. Nursing teams that promote cultural competence and inclusivity help their colleagues feel comfortable sharing their own experiences, which can create a sense of community and belonging in the workplace.

Several DEI training certification programs are available for nursing students and professionals, as well as health care professionals more broadly. Some examples include:

• The American Association of Critical-Care Nurses sometimes offers continuing education courses on the topics of equity, diversity, and inclusion.
• The Healthcare Executive Diversity and Inclusion Certificate Program is offered by the Association of American Medical Colleges. While not specific to nurses, the program may be useful for nurse leaders and those wishing to become nurse leaders.
• The Certificate in Diversity Management in Health Care from the American Hospital Association is an immersive fellowship program designed for health care leaders who are involved with diversity and equity programs at their organizations. The fellowship takes 10 to 12 months to complete.

When nursing professionals participate in DEI training, it can lead to improved patient outcomes, reduced health disparities, and the creation of supportive work environments.

Through DEI training, nursing professionals can gain the skills and knowledge they need to provide patient-centered care that is respectful of diverse cultural backgrounds and beliefs. This type of training can also improve communication between health care providers and patients, which can result in greater trust, satisfaction, and adherence to treatment protocols.

As nurses demand DEI training to address health disparities and promote equity in health care, better health outcomes will become possible for all patients.