University of Southern California Dissertations and Theses

Examining the current diversity, equity, and inclusion initiatives from nurse anesthesia programs in California to support nurse anesthesia residents: an exploratory observational study

(USC Thesis Other)

Examining the current diversity, equity, and inclusion initiatives from nurse anesthesia programs in California to support nurse anesthesia residents: an exploratory observational study

PDF

Download a page range

Download transcript

Copy asset link

Request this asset

Transcript (if available)

Content DIVERSITY, EQUITY, AND INCLUSION INITIATIVES i
Examining the Current Diversity, Equity, and Inclusion Initiatives from Nurse Anesthesia
Programs in California to Support Nurse Anesthesia Residents: An Exploratory Observational
Study
by
Jessica Loggins
A Doctoral Capstone Presented to the
FACULTY OF THE USC KECK SCHOOL OF MEDICINE
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the Requirements for the Degree
DOCTOR OF NURSE ANESTHESIA PRACTICE
May 2024

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES ii
Distribution of Work
The following manuscript was contributed to in equal parts by Dillon Hall, Jessica Loggins, and
Erin Ramirez

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES iii
Dedication
This work is proudly dedicated to people who served as inspiration. From parents and spouses to
friends and classmates, who supported us during this research project.
To our chair and committee who dedicated time to assisting us through this process.
Dillon Hall, Jessica Loggins, and Erin Ramirez

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES iv
Table of Contents
Dedication......................................................................................................................................iii
List of Tables.................................................................................................................................. vi
Abstract......................................................................................................................................... vii
Chapter 1 ........................................................................................................................................ 1
Introduction................................................................................................................................................1
Research Question and Specific Aims.......................................................................................................3
Background & Significance.......................................................................................................................4
Recent DEI Efforts in the United States................................................................................................................ 4
DEI in Decreasing Healthcare Disparities........................................................................................................... 4
DEI Efforts in Universities.................................................................................................................................... 6
DEI Efforts in Nursing Schools............................................................................................................................. 6
DEI Efforts in Nurse Anesthesia Programs .......................................................................................................... 7
Chapter 2 ........................................................................................................................................ 8
Methods .....................................................................................................................................................8
Literature review................................................................................................................................................... 8
Subject recruitment ............................................................................................................................................... 8
Survey .................................................................................................................................................................... 9
Statistical analysis............................................................................................................................................... 12
Chapter 3 ...................................................................................................................................... 13
Literature Review ....................................................................................................................................13
Nursing Programs............................................................................................................................................... 13
Nurse Anesthesia Programs................................................................................................................................ 19
Chapter 4 ...................................................................................................................................... 21
Results......................................................................................................................................................21
Subject characteristics ........................................................................................................................................ 21
Overall institution ............................................................................................................................................... 21
Diversity .............................................................................................................................................................. 22
Equity .................................................................................................................................................................. 22
Inclusion.............................................................................................................................................................. 22
Free response ...................................................................................................................................................... 23
Chapter 5 ...................................................................................................................................... 24
Discussion & Conclusion ........................................................................................................................24
Strengths and Limitations........................................................................................................................27
Conclusion ...............................................................................................................................................28
References..................................................................................................................................... 30
Appendix A.................................................................................................................................... 36

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES v
Appendix B.................................................................................................................................... 37
Appendix C.................................................................................................................................... 42
Figure 1......................................................................................................................................... 52

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES vi
List of Tables
Table Page
Table 1 .......................................................................................................................................... 46
Table 2 .......................................................................................................................................... 48
Table 3 .......................................................................................................................................... 50
Table 4 .......................................................................................................................................... 51

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES vii
Abstract
Background: There is a lack of diversity in the healthcare profession, including the certified
registered nurse anesthetist profession. This lack of diversity has resulted in healthcare
disparities amongst minorities. There is a need to admit and support students of minority
backgrounds in nurse anesthesia educational programs to help increase diversity.
Purpose: The purpose of this paper was to investigate the current diversity, equity, and
inclusions initiatives in nurse anesthesia educational programs to assess the need for more
support for minority students. This paper also looked to find effective strategies to implement in
nurse anesthesia programs, which have been found to increase retention of minority students.
Methods: A literature review was conducted to find retention strategies for minority students in
nursing and nurse anesthesia educational training programs. California nurse anesthesia
educational programs students and directors were surveyed to assess the current DEI initiatives
and their effectiveness. Statistical analysis was run to compare if there was a difference between
students of different racial backgrounds feelings regarding DEI in their program.
Results: There was not a statistically significant difference between the students of minority
backgrounds scoring of DEI when compared to students of non-minority backgrounds.
Discussion: The lack of diversity in the nurse anesthesia profession continues to be an issue.
Larger studies in nurse anesthesia programs including more rural, less diverse communities
should be conducted to assess the need for support of students of minority backgrounds enrolled
in nurse anesthesia educational programs. Studies should be conducted to evaluate the
effectiveness of educational, financial, and emotional support in assisting minority students
successfully complete nurse anesthesia educational programs.

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 1
Chapter 1
Introduction
According to the 2014 United States (U.S.) Census Bureau’s Population Estimates
Report, it is projected by 2040, 50.3% of Americans will be from a racial or ethnic minority
group. Health and healthcare disparities amongst racial/ethnic minority groups in the U.S. have
historically existed, are well-documented, and can have serious health consequences for minority
groups (Centers for Disease Control and Prevention, 2011). Greater diversity in the healthcare
workforce plays a significant role in lessening healthcare disparities and has been shown to
improve patient experience, improve access, and increase patient satisfaction amongst a
culturally and ethnically diverse populations. With evidence supporting the existence of health
disparities and substandard experiences in access and quality of care for minority groups, there
has been an ever-increasing push for a more diverse and culturally competent healthcare
workforce in the U.S. (Jackson & Gracia, 2014). See Appendix A for operational definitions.
As indicated by the 2011Centers for Disease Control and Prevention (CDC) Health
Disparities and Inequalities Report, racial/ethnic minorities have poorer health outcomes from
preventable and treatable diseases when compared to the general population. Additionally, the
Agency for Healthcare Research and Quality’s 2019 National Healthcare Quality and Disparities
Report revealed worsening disparities among every minority group in multiple metrics amongst
five categories: patient safety, person-centered care, care coordination, effectiveness of care, and
healthy living. Research has shown between the years 2003-2006, $230 billion dollars would
have been saved by eliminating health disparities for minority populations (Ehie et al., 2021).
As racial/ethnic groups begin to comprise a greater portion of the population in the U.S.,
one suggested intervention to address and lessen health disparities is to expand and diversify the

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 2
healthcare workforce (American Psychological Association, 2012). Creating a more diverse,
equitable, and inclusive workforce begins with recruiting and retaining students from diverse
backgrounds and underrepresented minority groups. While universities in the U.S. continue to
make efforts to support a diverse population of learners, it is important to support and retain
these students (Akande, 2014).
Historically, racial and ethnic minorities have been underrepresented in the healthcare
workforce within the U.S. (LaVeist & Pierre, 2014). As one of the largest groups of healthcare
professionals, nurses have the potential to significantly influence a demographic shift of the
healthcare workforce (McNally et al., 2019). A 2017 survey conducted by the National Council
of State Boards of Nursing (NCSBN) and The Forum of State Nursing Workforce Centers
reported nurses from minority backgrounds represent 19.2% of the Registered Nurse (RN)
workforce and 80.8% identified as White/Caucasian. The underrepresentation of minorities in
the healthcare workforce becomes even more apparent in professions requiring graduate
education, such as nurse practitioners, physicians, and certified registered nurse anesthesiologists
(CRNAs). According to Data USA (2020), 78.4% of nurse practitioners and 68.2% of physicians
identify as White/Caucasian. The lack of diversity is even more prominent within the CRNA
community. In their 2018 Diversity, Equity, and Inclusion (DEI) Position Statement, the
American Association of Nurse Anesthesiologists (AANA) reported out of over 52,000 currently
practicing CRNAs in the United States, only 10% were people of color and 90% classified
themselves as White.
This paper seeks to explore a small subset of the healthcare workforce and investigate
what current DEI initiatives are present and effective in ensuring the success of diverse nurse
anesthesia residents (NARs) within California nurse anesthesia programs (NAPs).

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 3
Research Question and Specific Aims
The research question guiding this paper is as follows: How are nurse anesthesia
programs in California supporting diversity, equity, and inclusion for diverse nurse anesthesia
residents?
The specific aims of this paper are as follows:
1. Conduct a critical review of the literature review regarding current DEI initiatives
within nurse and nurse anesthesia educational programs.
2. Survey California nurse anesthesia program directors regarding the DEI, DEI
initiatives within their program, and perceived effectiveness of self-identified
initiatives.
3. Survey NARs in California to query DEI initiatives within their program and
perceived effectiveness of identified initiatives.

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 4
Background & Significance
Recent DEI Efforts in the United States
DEI is a movement which has become incorporated in nearly every aspect of society and
has gained attention within many universities (Metzger et al., 2020). According to a national poll
conducted by Monmouth University, between 2015 and 2021, the percent of Americans who
believe racial discrimination is a “big problem” increased from 50% to 79%. Time Magazine
(2020) credits events like the murders of George Floyd and Ahmaud Arbery as the sources
responsible for waking up the American people to the presence of racial injustices. This
awakening is the source of new public debate and protest in which black and white protestor
allies have come forward by the thousands under the Black Lives Matter movement (Worland,
2020). In response, businesses have begun to allocate additional funding towards bridging the
gap of the racial disparities present in their workspaces. The Wall Street Journal recognized
companies ranging from Facebook to JPMorgan Chase to Nike who have pledged millions to
billions of dollars towards racial-equity efforts within society and their own workplace (Weber,
2020). The Harvard Business Review estimated nearly half of all midsize companies and almost
all Fortune 500 corporations have implemented DEI training (Williams et al., 2020).
DEI in Decreasing Healthcare Disparities
Racial/ethnic minorities have poorer health outcomes from preventable and treatable
diseases such as cardiovascular disease, cancer, asthma, and HIV/AIDS than Whites; these
populations also experience adverse social determinants of health and are disproportionately
represented among the uninsured (Jackson & Gracia, 2014). Social determinants of health
include housing quality, access to healthy foods, quality education, and neighborhood safety to
name a few. The literature supports the notion that an increase in healthcare workforce diversity

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 5
will and does have a direct correlation to decreasing healthcare disparities (Jackson & Gracia,
2014; LaVeist & Pierre, 2014).
According to Marrast et.al. (2014), non-White physicians cared for 53.5% of minority
patients and 70.4% of non-English speaking patients. There is a greater number of minority
healthcare providers who practice in underserved areas. Additionally, patients have reported
greater satisfaction, improved compliance, and increased involvement in medical decisions when
receiving care from minority providers. This subsequently increases minority patients' access and
utilization of health services, which is associated with better health outcomes and the expansion
of services to underserved minorities on a geographical level. In addition to benefiting current
health care outcomes, diversifying the healthcare workforce is also linked to enhancement of
healthcare research, as it broadens the number of ethnic perspectives and encourages inclusion of
racial minorities as participants in clinical trials (LaVeist & Pierre, 2014).
The U.S. Department of HHS (2011) launched the HHS Action Plan to Reduce Racial
and Ethnic Disparities, building from the Patient Protection and Affordable Care Act (PPACA),
which seeks to advance five major goals: 1) to transform healthcare; 2) to strengthen the
infrastructure and workforce of the nation’s health and human services; 3) advancing the health,
safety, and well-being of the American people; 4) advancing scientific knowledge and
innovation; and 5) increasing the efficiency, transparency, and accountability of HHS programs.
A primary implementation to achieve these goals is the creation of scholarships and internship
opportunities. The National Health Service Corps (NHSC) has awarded scholarships and loan
repayment options for individuals practicing in underserved communities, with over half of these
scholarships being awarded to those of ethnic minorities. Additionally, the CDC Undergraduate
Health Scholars Program (CUPS) provides an internship program at four institutions to increase

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 6
engagement opportunities within the healthcare workforce for racial minorities. These
interventions seek to increase diversity within healthcare professionals.
DEI Efforts in Universities
According to the U.S. Census Bureau (2020), approximately 40% of white students
graduate with a four-year college degree or higher, compared to 26% of African American
students, 18% of Hispanic students, and 58.1% of Asian students. A recent focus of universities
has been on the addition of DEI offices, creation of diversity statements, and working towards
cultivating an environment that attracts students from a wider range of ethnic, racial, and
demographic backgrounds (Nunes, 2021). Students who have a diverse, equitable, and inclusive
learning environment will translate this positive experience into their daily practice and lifestyle
(Condon et al., 2013).
DEI Efforts in Nursing Schools
Nursing makes up one of the largest professions in healthcare and they have recognized
their need to diversify in response to the swiftly evolving demographics of the country.
Interventions focused on academic, social, and financial support were found to help increase
retention and graduation rates of disadvantaged nursing students. Faculty workshops have been
used to help increase the ability to effectively teach and mentor minority students. The necessity
of recruitment efforts to increase diversity of nursing students, but also the continued support to
ensure their success while in the programs is highlighted in the literature (Condon et al., 2013;
McNally et al., 2019; Phillips & Malone, 2014).
In 2017 the American Association of Colleges of Nursing’s (AACN) annual survey
reported a lack of minority faculty present in education, with only 16% of full-time staff coming
from minority backgrounds. The limited number of minority faculty to serve as role models and

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 7
mentors was a suggested barrier to recruitment and retention of students from minority
backgrounds. There are efforts to support minority nursing faculty with scholarship, loan
repayment programs, and professional development opportunities to help alleviate this barrier. It
was also noted that tutoring, counseling, and cultural competency training was associated with
successful graduation of minority students.
DEI Efforts in Nurse Anesthesia Programs
The Council of Accreditation (COA) oversees the accreditation of all nurse anesthesia
programs in the U.S. and Puerto Rico. In the Standards for Accreditation of Nurse Anesthesia
Educational Programs, DEI is listed as a value. Although the COA requires the utilization of
policies and procedures that are equitable and do not discriminate on the basis of race or color,
the COA omits any specific curriculum, faculty, or student standards related to DEI. This reflects
the COA’s acknowledgement of the importance of DEI in NAPs, but there is still a lack of
measurable initiatives in place for the accrediting process.
The Diversity in Nurse Anesthesia Mentorship Program (2020) is an organization
independent of any specific nurse anesthesia program. The mission of the Diversity in Nurse
Anesthesia Mentorship Program is to inform, empower, and mentor underserved populations to
prepare them for a successful future and career in anesthesia. This program is designed to allow
racial minority nurses and nursing students to gain insight and guidance for admission into
NAPs. Participants are exposed to a CRNA networking community that includes opportunities
for mentoring, participating in mock interviews, critiquing essays and resumes, and shadowing
for CRNA experience. This program has successfully mentored over 658 members, who have
gained admittance into 92 of the 124 NAPs across the nation.

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 8
Chapter 2
Methods
Literature review
A literature review was conducted utilizing scholarly databases inclusive of PubMed,
ERIC, InPsych, SAGE Journals, and Google Scholar. Search and MESH terms included:
“diversity,” “equity,” “inclusion,” “graduate students,” “retention,” “nursing,” “nurse,” “SRNA,”
and “anesthesia.” Inclusion criteria consisted of articles ranging from 2011- 2021, published in
English, peer-reviewed, and those that had subjects relevant to diversity, equity, and inclusion.
Exclusion criteria included those articles prior to 2011, studies done outside of the U.S., those
whose participants were not of the undergraduate/graduate level of education, and those with
broader ranges of diversity outside of racial/ethnic minorities. A total of 340 articles were
accessed;12 met inclusion and exclusion criteria. The use of snowballing found two additional
articles of relevance. After reviewing the 14 articles for relevance, level of evidence, and
applicability, a total of eight publications were included in the comprehensive review of the
literature. (See Figure 1).
Subject recruitment
A convenience sample was used for data collection. A point of contact was made with
directors or nurse anesthesia resident (NAR) liaisons from each school to disseminate the survey
via email to the five nurse anesthesia programs (NAPs) in California including Samuel Merritt
University, University of Southern California, National University, Loma Linda University, and
Kaiser Permanente School of Anesthesia California State University Fullerton. Contact was kept
with the liaison from each program and two additional reminder emails were sent. At the time of
surveying, a total of 330 NARs were enrolled in the five programs. One program director from

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 9
each of the five programs was contacted directly via email and sent two reminder emails if
unresponsive to complete a survey. Both samples were allotted a total of one month to complete
the survey.
Survey
This study employed a mixed-methods exploratory and observational approach. In
collaboration with a biostatistician, two surveys were constructed. The first survey was sent to
NARs in California via REDCap to identify demographics, current DEI initiatives
within their NAP, and perceived effectiveness of these initiatives (see Appendix B).
Demographic questions included ethnicity, age, sex, gender identity, sexual orientation,
nurse anesthesia program enrolled in, year in the program, born in the United States, language
spoken at home, and methods of paying for the program. The demographics sought to observe
the amount of diversity within each program and if that played a role in their perception of their
programs DEI efforts. A separate survey was sent to directors of the NAPs to identify
demographics, current DEI initiatives within their NAPs, and perceived effectiveness of these
initiatives (see Appendix C). Both surveys included an open response area for suggestions to be
submitted.
There is no validated tool available to assess DEI within educational programs.
Resources were used to help construct our survey tool. The Diversity Engagement Survey (DES)
assesses academic medical centers inclusion efforts and creates a strategy for achieving diversity
goals (Person et al., 2018). They found their 22-item tool was reliable when conducted on a
group of 13,694 individuals at 14 academic medical centers in the United States. In addition, the
IDEAL survey from Stanford was referenced to construct our survey. They focused on four
topical areas including diversity, inclusion and belonging, harmful experiences, and informing

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 10
action (Lowery et al., 2021). The IDEAL survey had 332 questions, including their demographic
questions, and was used to survey 14,907 Stanford respondents. There was no validity test
performed on the survey. Both surveys were used to find questions that would pertain to nurse
anesthesia programs and DEI. After construction of our preliminary survey, three individuals
outside of the anesthesia community were used to test the survey to help identify any errors and
give feedback for potential improvement. Additionally, a PhD biostatistician was consulted when
constructing the survey. Changes were made to the survey accordingly before finalization.
The student questions aimed to assess perception of four categories: diversity, equity,
inclusion, and overall institutional DEI. Diversity questions included were: “the faculty at this
program treat all students fairly,” “there is a diverse student population within this program,”
“this program demonstrates a commitment to meeting the needs of students from all
backgrounds,” “students and faculty of different backgrounds and ethnicity are valued within this
program,” and “I have experienced and/or witnessed racial aggression between program faculty
and students.” Equity questions included were: “the faculty at this program treat all students
fairly,” “the program makes faculty and students aware of the procedures for reporting incidents
of discrimination and/or bias in class and in clinical,” and “I believe this program and its leaders
will take appropriate action in response to incidents of discrimination and bias.” Inclusion
questions included were: “this program fosters an environment that allows students and faculty
to be themselves at school without fear,” “This program and the faculty respect each individual
and value their differences,” “getting to know classmates and faculty of different backgrounds
has been easy for me at this program,” “faculty and students of different backgrounds interact
well within this program,” “racial, ethnic, sexual, and gender-based jokes or slurs are not
tolerated within this program,” and “I have felt excluded and/or bias against me in this program.”

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 11
Overall institution DEI questions were: “the nurse anesthesia program I attend encourages
diversity, equity, and inclusion,” “leadership and faculty of this anesthesia program show that
diversity and equity are important through their actions and words,” “diversity, equity, and
inclusion initiatives are important and necessary,” “this program is committed to improving the
diversity and inclusion of the students and faculty,” “the program’s policies and procedures
encourage diversity, equity, and inclusion,” “this program provides an environment for the free
and open expression of ideas, opinions, and beliefs,” “my program director and associated
faculty members are committed to and support diverse, equity, and inclusion,” “my program
director and associated faculty members handle matters related to diversity, equity, and
inclusion,” and “this program makes an effort to provide education that promotes diversity,
equity, and inclusion in the workplace.”
The director surveys were separated into the same four categories for analysis. Diversity
questions included were: “this program takes active measures to seek a diverse candidate pool
when interviewing and selecting potential students,” “leadership and faculty of this anesthesia
program show that diversity and equity are important through their actions and words,” “there is
a diverse student population within this program,” “our faculty incorporates diverse cultural
content into curriculum,” and “students and faculty of different backgrounds and ethnicity are
valued within this program.” Equity questions included were: “the program fosters an
environment that allows students and faculty to be themselves at school without fear,” “the
faculty at this program treat all students fairly,” and “this program demonstrates a commitment
to meeting the needs of students from all backgrounds.” Inclusion questions included were:
“racial, ethnic, sexual, and gender-based jokes or slurs are not tolerated within this program” and
"this program provides an environment for the free and open expression of ideas, opinions, and

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 12
beliefs.” Overall institution DEI questions were: “our program provides diversity, equity, and
inclusion initiatives outside of the university itself,” “our programs diversity, equity, and
inclusion education initiatives are effective,” “incorporating diversity, equity, and inclusion
initiatives into our anesthesia program is important,” “in my opinion, diversity, equity, and
inclusion is incorporated into the curriculum and class time,” and “the students of this program
would be comfortable coming to faculty with diversity, equity, and inclusion issues.”
Statistical analysis
Each survey question was stratified into one of the four categories: diversity, equity,
inclusion, and overall institutional DEI as outlined above. Each question had the option of one to
five, where one indicated a positive correlation (strongly agree) and five indicated a negative
correlation (strongly disagree) with the question. Each category score was calculated by adding
the points for each question in that category. A total score for all four categories was calculated
by combining the points for every category. The diversity score was comprised of five questions,
and scores of five to 25 were possible. The equity score was three questions, and scores of three
to 15 were possible. The inclusion score was made up of six questions, with scores of six to 30
possible. Overall DEI scores included nine questions, and scores of nine to 45 were possible.
Total scores included all 23 questions, allowing for possible scores of 23-115. A Kruskal-Wallis
test was utilized to compare median scores across the groups. The students were stratified by
race and then by primary language spoken at home for analysis of statistical significance. Due to
identical racial ethnicity and language spoken at home, no stratification of the directors was
necessary.

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 13
Chapter 3
Literature Review
Nursing Programs
Condon et al. (2013) created a program to target ethnically diverse students, assisting
them in admittance and success in a nursing program and on the nursing board examination. The
program was based on an academic success model that consisted of the following: 1) prerequisite courses; 2) academic, social, and financial support; and 3) faculty development
workshops. They assisted 77 disadvantaged students in their study, 90.9% of these students
graduated and 98.6% passed the National Council Licensure Examination (NCLEX).
Disadvantaged students were defined as those from a minority background, low educational
backgrounds, poor GPAs, and low socioeconomic backgrounds. The students were surveyed to
evaluate the effectiveness of the individual interventions. The majority of students found the
following assistance was important to their success: study groups (71.4%), academic advising
(73.2%), tuition discounts (94.2%), living stipends (87.2%), social support (70.9-88.9%), and
necessary computers/supplies (93.5%). In addition, the faculty noted the workshops were useful
and led them to change their overall content and teaching/testing methods. Condon et al. also
noted a need for diverse faculty mentors and faculty development programs that educate on
recruitment, retention, and advisement of disadvantaged students.
Murray et al. (2016) conducted a project to recruit and retain minorities in nursing
education. The sample comprised of a total of 392 students from highly diverse high schools,
with subsequent enrollment of 21 students into nursing education programs. A retention
specialist was hired and worked closely with school of nursing (SON) personnel to direct
students to the appropriate resources to meet their needs. These resources included tutoring,

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 14
exam preparation, note taking skills, reading comprehension, study group support, and writing
consultations. The retention specialist held open meetings to allow the students the space to share
their feelings and experiences regarding the struggles in the program, which created an
opportunity for a sense of community to develop within the students. Another form of social
support was the establishment of informal peer mentors and formal faculty mentors. In addition,
there was funding to support the attendance of minority students at conferences to observe
successful role models in the profession. Scholarships amounting to $100,000 dollars were
granted to junior and senior students to help with the financial burden associated with the
program. Finally, students were advised to take weekly standardized practice tests and meet a
minimum passing score to prepare for the NCLEX. The study found their retention rates
increased from 84.6% to 93.4% after the utilization of a retention specialist. The percentage of
students who either dropped out of the university, switched majors, or were dismissed from the
program was reduced from 9% to 6% after the addition of retention services to the targeted
population.
Ferrell et al. (2016) conducted a mixed methods approach study at two institutions. One
was a privately funded institution offering traditional and second-degree accelerated bachelor’s
degrees, and the other institution was a publicly funded community college offering associates
degrees. Between the two institutions, 31 minority students enrolled to participate in the survey.
They administered the Minority Student Nurse Questionnaire (MSNQ) to all 31 students, which
included questions related to demographic data, tutoring and mentoring services, racial selfidentification, academic success in courses, and the usefulness of a preadmission’s assistance
program. The survey was a mixed method approach consisting of Likert scale questions and
included a short free response comment section. The authors reported 84% of students had

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 15
access to free tutoring services, but only 32% of students utilized these services. Mentoring was
available to 33%, but only 5% reported participating in the activity and 55% of students
participated in non-program related minority groups on campus. Regarding financial support
most students relied on multiple sources: 65% were granted scholarships, 74% depended on
federal subsidized and unsubsidized loans, 45% were given grants, and 42% had personal funds
for payment of tuition. In addition, more than 22 of the students held employment during their
schooling and 23 students felt that a pre-admissions assistance program would be helpful.
Another important finding from the study was students strongly disagreed with the statement ‘the
number of minorities in this program is representative of the number of minorities in the state.
Kolowitz et al. (2018) described and presented evaluation findings from the Careers
Beyond the Bedside (CaBB) program, which used strategies to recruit and retain
underrepresented ethnic minorities (UREM) and disadvantaged students to nursing school. This
program was supported by a three-year Nursing Workforce Diversity grant from Health
Resources and Services Administration (HRSA) from 2012 to 2015. The CaBB program had two
objectives: to increase diversity in the BSN program at the University of North Carolina at
Chapel Hill (UNC-CH), and to encourage and support timely enrollment into graduate school.
The long-term goal of this experimental program was ultimately to increase the number of
UREM nursing faculty representing clinical researchers, educators, and leaders in nursing. The
CaBB program used strategies to address factors described in Jeffreys’s 2012 Nursing
undergraduate Retention and Success model, which included targeting disadvantaged and
UREMs while acknowledging and valuing students’ values and cultural beliefs. Academic
factors included career planning, tutoring, and encouraging the use of resources. Professional
integration factors included group mentoring sessions, research mentoring, and celebrations.

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 16
Environmental factors included scholarships. Academic outcomes include being admitted to
nursing school and to participate in research, education, and eventually applying to graduate
school. Psychological outcomes from this model included increasing motivation and persistence,
satisfaction, and feelings of support for disadvantaged and UREM students. The program first
conducted a needs assessment to explore students’ academic challenges and assess their use of
existing university resources. Components and interventions of the CaBB program included
academic advising, program seminars, peer mentoring, work-study mentoring, scholarships, and
tutoring. Academic advisors met one-on-one with pre-nursing students across the university and
provided information about the curriculum and course requirements, as well as career options in
nursing, optimal ways to navigate course requirements, and suggestions on how to strengthen
their application to the school of nursing. During year one of the CaBB program, academic
advisors met with 65% of the CaBB pre-nursing students (n=51). CaBB program monthly
seminars were used to debunk myths about careers in nursing, share the presenter’s love for the
profession, disseminate the diverse roles for nurses, discuss issues surrounding diversity, create a
community for mentoring, and assist students in the application process. The CaBB faculty
mentors organized these seminars and served as role models for students, sharing their own
unique experiences and perspectives. The mentors were comprised of faculty who were diverse
in age, ethnicity, gender, educational backgrounds, and nursing specialties. The first year (2012-
2013) they had 87 pre-nursing students, and 16 nursing students attended the seminars for a total
of 104 students, with 42 who were considered disadvantaged (defined as at least one of the
following indicated: first generation, Carolina Covenant, Need-based awards, or from a rural
county), and roughly 52% being from an UREM group. The following year (2013-2014) they
had 71 pre-nursing students and 25 nursing students in attendance for these seminars for a total

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 17
of 97 students, with 67 students considered disadvantaged and over 62% from an UREM group.
The protocol for the process of collecting demographic information from students and having
them evaluate CaBB program seminars was submitted to the UNC IRB for review and was
determined to be exempt. Evaluations regarding the effectiveness of the seminars contained
positive feedback from students stating, “the sessions were interesting and informative.” There
were several mentoring opportunities including the seminars which created group mentoring, as
well as the use of the Association of Nursing Students members to offer peer mentoring. In
addition, eight students participated in nursing research work study opportunities and partook in
one-on-one mentoring with research team members. The CaBB program also supplied needbased scholarships to disadvantaged students. A total of 54 scholarships were awarded to 35
students. By the end of the study, 29 of the 35 students had graduated. Two of the students were
admitted to the class that started the following year. Students commented that the scholarships
helped by decreasing the amount of time they had to work which reduced stress, allowed for
more time to study, and allowed for time to volunteer or take summer courses. Academic
services were available and targeted to help with the most difficult curriculum including
pharmacology and pathophysiology. Of the 21 students who completed evaluations for tutoring,
90% regarded the tutoring as either helpful or very helpful on the Likert scale. Overall, the
results from this program support Jeffrey’s 2012 Nursing Undergraduate Retention and Success
(NURS) model, which presents a framework for examining variables that affect undergraduate
and graduate student retention and success. The results of this report also support continued
investment in programs and resources to promote the success of UREM and disadvantaged
students who wish to successfully pursue a career in the field of nursing. Programs like CaBB
grounded in evidence and theory can lead to meaningful increases in recruiting and retaining

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 18
UREMs and disadvantaged students and can be easily replicated in other university settings.
Tab (2016) conducted a study regarding the “Are You In to Nursing (RUN 2 Nursing)”
program, which is a nursing workforce diversity program paid for by the U.S. Department of
Health and Human Services. With IRB approval, they collected data through a convenience
sample from 62 minority students and 22 faculty members. The program was implemented over
three years and was extended for a fourth year. The study utilized descriptive statistics, including
a mean and standard deviation, to analyze the effectiveness of their faculty mentoring and peer
tutoring. The faculty was required to meet with their assigned mentees at least three times a
semester for a year and completed evaluations for each mentee. The faculty completed an18-item
questionnaire that utilized a Likert scale which measured the mentee’s participation, motivation,
and academic advancement. Mentees also completed surveys where they assessed their
experience, satisfaction level, and academic success. The minority students rated the faculty as
being available (4.96 out of 5), encouraging (4.96 out of 5), and supportive (4.84 out of 5) on a
five-point Likert scale. The peer tutoring was conducted by junior level nursing students who
provided curriculum specific academic help to culturally diverse students for 15 hours each
week. Minority students reported the tutoring provided academic enhancement (4.72 out of 5),
support and feedback (4.74 out of 5), and built student relationships (4.71 out of 5). The program
had a retention rate of 93% of minority students who successfully graduated, and of those who
graduated, 96% passed their boards on their first attempt.
In a scoping study by Metzger et al. (2020), the perspectives of underrepresented
minority students in BSN programs were examined, with 30 descriptive studies ranging from
2001 to 2016. Data collection was performed utilizing PubMed, Web of Science, and CINAHL,
and keywords included “diversity,” “inclusion,” “inclusivity,” and “undergraduate education.”

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 19
Of the 30 descriptive studies identified, the data was compounded into various categories based
off common themes. The authors identified three major concepts: 1) nursing students from
underrepresented minority groups experience discrimination from peers, faculty, and clinicians
in the classroom and clinical setting; 2) the cumulative effect of discrimination is a lack of
belongingness, which is associated with adverse outcomes; and 3) all aspects of nursing students’
learning community act as facilitators or barriers to inclusivity or a sense of belongingness. One
major barrier to the success of these minority students is stereotype biases lead to decreased
participation and engagement due to a lack of belongingness. Students who are not engaged or
participating will not gain the invaluable clinical knowledge and skills necessary to provide highquality patient care.
Nurse Anesthesia Programs
Kilburn et al. (2019) published findings after utilizing a series of interventions aimed to
increase the diversity of the applicant pool and students admitted into NAPs. They
retrospectively looked at 407 applicants to a single NAP over three, 12-month long periods. The
strategies used for recruitment consisted of three aspects: education, focused recruitment, and
creation of an inclusive institutional environment. In their education and recruitment efforts, they
provided informative meetings at ethnically diverse workplaces, national conferences for people
of color, and community colleges to gain interest in the profession. To cultivate a welcoming
environment for diverse students, the program partnered with their university’s Office of Equity
and Diversity to implement strategies. The recruitment efforts were extensive, and the use of a
recruitment and retention director was necessary for successful implementation. The authors also
performed a thorough examination of the admissions process to create a more equitable
environment and decrease potential barriers for minority applicants. One intervention

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 20
implemented was the diversification of the interview panel to include non-white members, a
more even distribution of gender, and more variety in the years since graduation from a NAP. A
Health Science Reasoning Test was also added to the admission process and was considered
along with standard grade point averages (GPA) and graduate records examination (GRE)
scores. The pre-intervention data from 2015-2017 showed that 14.4% of the applicant pool
identified as people of color. In the 2016-2018 cohort, after recruitment strategies were utilized
to attract minority candidates, 24.5% of candidates identified as non-White. The percentage of
students of color admitted into a NAP increased from 6% to 24%, representing a statistically
significant increase from one student to seven students (p <0.05).

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 21
Chapter 4
Results
Subject characteristics
The survey results were compiled per subgroups as aforementioned. There was a 26%
(86/330) response rate from the students, and a 60% response rate from the directors (3/5).
Among the student respondents, the majority identified as Non-Hispanic White (40.9%) or Asian
(33%) and between the ages of 21-40 (96.6%). For languages spoken at home by student
respondents, the majority spoke English (79.5%), while 5.7% spoke Spanish and 14.8% selected
other (see Table 4). Among the director respondents, 100% identified as Non-Hispanic Whites
between the ages of 41-50 (66.7%). See Table 1 for further characteristics.
Overall institution
Questions within this subgroup were categorized based off how the overall
institution/university was perceived to value DEI. There was no statistically significant
difference among overall institution scores when stratified by race (p=0.44) or language spoken
at home (p=0.82). See Table 2 and Table 3 for further data regarding student survey responses.
More than 1/3 of all Non-Hispanic Whites and Asians marked all ones (strongly agree) for these
questions, while no Blacks marked all ones. Conversely, the Black and Hispanic groups averaged
three or less (neutral) for all questions in this group, while Non-Hispanic Whites were the only
group to have scores above 28, indicating an average of four or five (disagree to strongly
disagree) on all questions. Among director scores, 33% scored nine (strongly agree), 33% scored
between 10-18 (strongly agree to agree) and 33% scored between 19-27 (strongly agree to
neutral). See Table 4 for director response data.

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 22
Diversity
There was no statistically significant difference among diversity scores when stratified by
race (p=0.23) or language spoken at home (p=0.87). See Table 2 and Table 3 for details. More
than 1/3 of all Non-Hispanic Whites and Asians marked all ones (strongly agree) for these
questions, while no Blacks marked all ones. Conversely, the Black and Hispanic groups averaged
three or less (neutral) for all questions in this group, while Non-Hispanic Whites were the only
group to have scores above 25, indicating an average of four or five (disagree to strongly
disagree) on all questions. Among director scores, 33% scored all five and 67% scored between
six to 10 (strongly agree to agree).
Equity
There was no statistically significant difference among diversity scores when stratified by
race (p=0.57) or language spoken at home (p=0.28). More than 1/3 of all Non-Hispanic Whites
and Asians marked all ones (strongly agree) for these questions, while no Blacks marked all
ones. Conversely, the Black and Hispanic groups averaged three or less (neutral) for all questions
in this group, while the Non-Hispanic Whites and Hispanic groups were the only groups to score
above 15, indicating an average of four or five (disagree to strongly disagree) on all questions.
Among director scores, 67% scored all three and 33% scored between four to six (strongly agree
to agree).
Inclusion
There was no statistically significant difference among diversity scores when stratified by
race (p=0.50) or language spoken at home (p=0.93). More than 1/3 of all Non-Hispanic Whites
marked all ones (strongly agree) for these questions, while no Blacks marked all ones.
Conversely, the Hispanic and Asian groups averaged three or less (neutral) for all questions in

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 23
this group, while 100% of Blacks scored seven to 12 (strongly agree to agree). The NonHispanic Whites were the only group to have scores above 30, indicating an average of four or
five (disagree to strongly disagree) on all questions. Among director scores, 67% scored two
(strongly agree) and 33% scored between three to four (strongly agree to agree).
Free response
The survey did include a free response for comments at the end, where nurse anesthesia
residents were able to give feedback regarding their overall feelings related to the DEI of their
nurse anesthesia program. Only six nurse anesthesia residents chose to leave comments and of
the six, four students were Hispanic, while one was Non-Hispanic White, and one was Black.
The general feedback from the comments was the need for greater support, the need for
diversification of faculty and state leadership (i.e., California Association of Nurse Anesthetist
(CANA)), and continued diversification of the students accepted into programs. One nurse
anesthesia resident suggested the national organization, Diversity in Nurse Anesthesia
Mentorship Program, should be incorporated into programs. Students from multiple programs
and multiple races (Hispanic, Black, and Non-Hispanic White) noted the lack of diversity in the
faculty. One student stated there was only one non-white faculty member and they were just
recently hired on. There was no free response section for the director’s survey.

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 24
Chapter 5
Discussion & Conclusion
In the year 2040, over half of all Americans will be from a racial/ethnic minority group
(Jackson & Gracia, 2014). Healthcare disparities amongst minority groups objectively exist and
cost the U.S. billions of wasted dollars in healthcare spending (Jackson & Gracia, 2014).
Profound efforts must be taken, especially by those in the healthcare field, to address this issue.
The literature presents evidence stating greater diversity in the healthcare workforce plays a
critical role in decreasing healthcare disparities amongst ethnic and racial minority groups.
Increased diversity in healthcare personnel has also been shown to improve patient experience,
access, and increase patient satisfaction among culturally and ethnically diverse populations
(Jackson & Gracia, 2014). With evidence supporting diversity in healthcare personnel as one
possible solution to address the issue of health disparities and substandard experiences in access
and quality of care for minority groups in the U.S., there has been an expanding effort to train a
more diverse and culturally competent healthcare workforce in the U.S (American Psychological
Association, 2012).
DEI is now a movement which has become incorporated into not only businesses, but
nearly every aspect of society, including universities (Williams et al., 2020). Establishing a more
diverse and inclusive workforce starts with not only recruiting, but also retaining students from
diverse backgrounds and underrepresented minority groups. The field of nursing can
significantly influence a demographic shift of the healthcare workforce with increased
recruitment, training, and retention of racial/ethnic minorities (McNally et al., 2019). According
to the AACN (2019), minorities currently only make up about 19% of the nursing workforce. In
health professions requiring graduate education, specifically nurse anesthesiology, the

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 25
underrepresentation of minorities becomes more apparent, with minorities representing only
about 10% of the workforce (AANA, 2018). There is a need for not only increased recruitment,
but increased retention of racial/ethnic minorities in universities training healthcare professionals
in graduate medical and nursing education.
The literature review on DEI initiatives and recruitment/retention strategies for nurse
anesthesia educational programs showed there is work being done to increase recruitment of
diverse populations and to create equal-access opportunities for ethnic/racial minorities to gain
admittance, to nursing programs at least. Many NAPs have “DEI Initiatives” in place; however,
these are usually adopted from the universities general policies on DEI, rather than specifically
created and implemented by the program itself. There is very little documented information on
retention strategies within NAPs to see minority NARs through the program and into a
successful and meaningful career.
For nursing programs, studies on recruitment and retention of minority and disadvantaged
students consistently showed most students found study groups, academic advising, tuition
discounts, living stipends, social support, and necessary computers/supplies to be critically
important to their success (Condon et al., 2013). Additionally, the faculty in these studies stated
the DEI workshops were useful and led them to change their overall content and teaching
methods. There is a lack of minority faculty present in nursing education, with only 16% of fulltime staff coming from minority backgrounds (AACN, 2017). Therefore, another suggested
barrier to recruitment and retention of minority students suggested was the limited number of
minority faculty to serve as role models and mentors. One study cited a retention specialist, open
forums to discuss challenges amongst students, informal peer support and formal mentors,
tutoring, exam preparation, scholarships to aid with financial burden, reading comprehension,

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 26
and professional shadowing opportunities increased retention rates and decreased dropout rates
amongst ethnic minorities in nursing programs (Murray et al., 2016). Other studies also showed
discrimination, stereotype biases, and a general feeling of not belonging were all major barriers
to minority student success and decreased their participation/engagement in nursing programs
(Metzger et al., 2020).
Regarding NAR programs, there is scant literature available on recruitment or retention
of diverse minority populations. Kilburn et al. (2019) showed the strategies used by a NAP for
recruitment of diverse minority populations consisted of informative meetings at ethnically
diverse workplaces, national conferences for people of color, and community colleges. The NAP
also partnered with their university’s Office of Equity and Diversity to implement strategies,
such as the diversification of the interview panel to include non-white members and a more even
distribution of gender, and the use of a recruitment and retention director, which aided in
successful implementation with a thorough examination of the admissions process, ultimately
creating a more equitable environment and decreasing barriers for minority applicants.
The results from the surveys sent out to students of California NAPs (University of
Southern California Keck School of Medicine, Kaiser Permanente, Loma Linda University,
Samuel Merritt University, and National University), as well as the surveys sent out to the
program directors, showed no differences among racial subgroups. However, of the total student
scores, no Black or Hispanic students strongly agreed with all the questions. This shows although
California is a diverse state, and our survey results displayed an overall positive perception on
DEI initiatives within NAPs, certain minority groups may still feel there is more work to be
done. This was also reflected in the free response comments of the survey, which highlighted a
lack of diverse faculty and support for diverse minority groups.

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 27
The purpose of surveying California nurse anesthesia program directors was to evaluate
their understanding of DEI, DEI initiatives within their program, and perceived effectiveness of
self-identified initiatives. The purpose of surveying current NARs in California was to query DEI
initiatives within their program and perceived effectiveness of identified initiatives.
Strengths and Limitations
There were several actual and potential limitations to this study. The survey in this study
is subject to sampling bias, response bias, and other factors which could have affected the results
of the surveys. Cultural background and personal experience influenced the writers of this paper
and may contribute to cultural bias in the study. Additionally, all three authors are currently
enrolled in the same nurse anesthesia program, which may contribute to implicit bias. However,
cultural background and personal perspective may have been a strength in influencing this paper,
as the writers are ethnically diverse and of different genders. The lack of literature and studies
investigating diversity retention and recruitment specific to nurse anesthesia programs was a
limitation to the literature review that was performed. However, a strength of the literature
review was all data and research was from the last 10 years, all data was from scientific,
reputable, peer-reviewed journals or public databases. Key words were also used in the search
for literature and data to narrow information down to relate specifically to diversity, ethnicity,
and inclusion within medical graduate programs.
These results also only represent California nurse anesthesia programs; California is one
of the most diverse states in the United States where no race or ethnic group constitutes most of
the population, which most likely heavily influenced the results of our surveys. The study sample
was small due to convenience sampling and response rate. The response rate from students may
have been greater with less time constraints and more incentive to take the survey. Additionally,

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 28
surveys could have been distributed to all senior faculty within the anesthesia programs to
increase sample size instead of only program directors. A strength was collecting actual student
and program director perspectives on DEI in nurse anesthesia programs in addition to an
extensive literature review.
Although created from validated tools in measuring DEI, the survey employed for this
study was novel and future studies should examine the validity of this survey. This novel
observational study contributes to a growing body of research in the realm of DEI in nurse
anesthesia programs. This study is the first of its kind to specifically address diversity, equity,
and inclusivity within nurse anesthesia programs, and hopefully this will influence more
literature and research within this realm.
Conclusion
The underrepresentation of minorities in the healthcare workforce is obvious in
professions requiring graduate education, such as nurse practitioners, physicians, and certified
registered nurse anesthesiologists (CRNAs). Data USA (2020) shows 78.4% of nurse
practitioners and 68.2% of physicians identify as White/Caucasian. The lack of diversity is even
more apparent within the CRNA community. The American Association of Nurse
Anesthesiologists (AANA) reported in 2018 out of over 52,000 currently practicing CRNAs in
the United States, 10% were people of color and 90% identified as White/Caucasian. Creating a
more diverse, equitable, and inclusive workforce that better mirrors our country’s increasing
diversity begins with not only recruiting but also retaining students from diverse backgrounds
and underrepresented minority groups. This is especially important not only in undergraduate
programs, but graduate programs as well. While universities in the U.S. continue to make efforts
to recruit a diverse population of learners, it is important to support and retain these students

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 29
throughout their education. Given the current numbers and lack of literature, there is much more
work to do in the realm of DEI in the field of nurse anesthesia.
Additional research investigating specific gaps in recruitment and retention of nurse
anesthesia residents should be considered. Further literature reviews should be conducted
investigating medical schools and businesses for DEI initiatives focused on retention of
ethnically diverse minority groups. Our final recommendation would be for nurse anesthesia
programs to adopt a DEI recruitment and retention model of their own, in addition to the
university they associate with, which prioritizes their unique student body’s needs and program
requirements. Programs, strategies, and initiatives outlined in this paper may serve as models for
nurse anesthesia programs in the future in developing their own DEI recruitment and retention
programs.

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 30
References
AACN Fact Sheet - Enhancing Diversity in the Nursing Workforce. (2019, April 1).
www.aacnnursing.org. https://www.aacnnursing.org/news-information/factsheets/enhancingdiversity#:~:text=Considering%20racial%2Fethnic%20backgrounds%2C%20the
AANA Diversity, Inclusion, and Equity Vision and Position Statement (2018).
https://aana.hawksearch.com/sites/aana/link.aspx?id=2d1d05d2-953f-4d5a-b20fa4bcbdb5c04a&q=https%3A//www.aana.com/docs/default-source/practice-aana-comweb-documents-%28all%29/professional-practice-manual/diversity-inclusion-andequity120128731dff6ddbb37cff0000940c19.pdf%3Fsfvrsn%3Deefe45b1_14&i=1&pk=
1b012873-1dff-6ddb-b37c-ff0000940c19&mlt=0
Akande, B. O. (2014, Jul 31). Moon Goal for Colleges: Retention of Diverse Students. Diverse
Issues in Higher Education, 31, 22.
http://libproxy.usc.edu/login?url=https://www.proquest.com/magazines/moon-goalcolleges-retention-diverse-students/docview/1551192706/se-2?accountid=14749
American Psychological Association. (2012, October 17). Ethnic and racial minorities and
socioeconomic status. American Psychological Association.
http://www.apa.org/pi/ses/resources/publications/factsheet-erm .aspx
Bureau, U. C. (2021, October 08). National Population by Characteristics: 2010-2019. Retrieved
from https://www.census.gov/data/tables/time-series/demo/popest/2010s-nationaldetail.html
CDC health disparities and inequalities report—United States, 2011. MMWR Surveill Summ.
2011;(60 Suppl):1–114. [Google Scholar]
Condon VM, Morgan CJ, Miller EW, Mamier I, Zimmerman GJ, Mazhar W (2013). A program

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 31
to enhance recruitment and retention of disadvantaged and ethnically diverse
baccalaureate nursing students. J Transcult Nurs. 2013 Oct;24(4):397-407. doi:
10.1177/1043659613493437. Epub 2013 Jul 8. PMID: 24014490.
Dapremont, J. A. (2012). A review of minority recruitment and retention models implemented in
undergraduate nursing programs. Journal of Nursing Education and Practice, 3(2).
doi:10.5430/jnep.v3n2p112
Dictionary by Merriam-Webster: America's most-trusted online dictionary. (n.d.).
Retrieved from https://www.merriam-webster.com/
Data USA. (2020). Retrieved September 27, 2022, from https://datausa.io/
Diversity in Nurse Anesthesia Mentorship Programs. (2020). Retrieved from
https://diversitycrna.org/
Ehie, O., Toledo, P., Wright, C., & Adams, J. (2021). What Is the Role for Anesthesiologists and
Anesthesia Practices in Ensuring Access, Equity, Diversity, and Inclusion? ASA Monitor,
85(S10), 45-48. doi:10.1097/01.asm.0000795196.13554.35
Enhancing diversity Factsheet. American Association of Colleges of Nursing. (2019, April).
Retrieved February 22, 2022, from
https://www.aacnnursing.org/Portals/42/News/Factsheets/Enhancing-DiversityFactsheet.pdf
Ferrell, D.K., & DeCrane, S.K. (2016). S.O.S. (Students’ Optimal Success): A model for
institutional action to support minority nursing students. Journal of Cultural Diversity,
23(2), 39-45.
Jackson, C. S., & Gracia, J. N. (2014). Addressing health and health-care disparities: the role of a
diverse workforce and the social determinants of health. Public health reports

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 32
(Washington, D.C.: 1974), 129 Suppl 2(Suppl 2), 57–61.
https://doi.org/10.1177/00333549141291S211
Kilburn, F., M.A., Hill, Linda, DNP,D.N.Sc, C.R.N.A., Porter, M. D., M.Ed, & Pell, C., PhD.
(2019). Inclusive recruitment and admissions strategies increase diversity in CRNA
educational programs. AANA Journal, 87(5), 379-389. Retrieved from
http://libproxy.usc.edu/login?url=https://www.proquest.com/scholarly-journals/inclusiverecruitment-admissions-strategies/docview/2306438900/se-2?accountid=14749
Kowlowitz, V., Johnson Rowsey, P., Woods-Giscombe, C., Kneipp, S.M., Page, J., & Fowler
Gray, T. (2018). Careers Beyond the Bedside: An effective program to increase diversity
in nursing. Journal of Cultural Diversity, 25(2), 41-48.
LaVeist, T. A., & Pierre, G. (2014). Integrating the 3Ds--social determinants, health disparities,
and health-care workforce diversity. Public health reports (Washington, D.C. : 1974),
129 Suppl 2(Suppl 2), 9–14. https://doi.org/10.1177/00333549141291S204
Lowery, B., Dunkley, P., Yan, S., Rane, D., Abdel Magid, H., Pena, E. dela, Ware, N., Boxer,
L., & Cornell, S. (2021, December). About the survey. IDEAL Diversity Equity and
Inclusion Survey. Retrieved January 8, 2022, from
https://idealdeisurvey.stanford.edu/about-survey
Marrast LM, Zallman L, Woolhandler S, Bor DH, McCormick D. Minority Physicians’ Role in
the Care of Underserved Patients: Diversifying the Physician Workforce May Be Key in
Addressing Health Disparities. JAMA Intern Med. 2014;174(2):289–291.
doi:10.1001/jamainternmed.2013.12756
Metzger, M., Dowling, T., Guinn, J., Wilson, D.T. (2020). Inclusivity in Baccalaureate Nursing
Education: A Scoping Study. Journal of Professional Nursing, pp. 5-14, Volume 36, Issue

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 33
1, 2020. ISSN 8755-7223. https://doi.org/10.1016/j.profnurs.2019.06.002.
Murray, P. (2021, April 15). Public weighs in on potential race relation impact of trial verdict.
Monmouth University Polling Institute. Retrieved February 21, 2022, from
https://www.monmouth.edu/polling-institute/reports/monmouthpoll_us_041521/
Murray TA, Pole DC, Ciarlo EM, Holmes S. A Nursing Workforce Diversity Project: Strategies
for Recruitment, Retention, Graduation, and NCLEX-RN Success. Nursing education
perspectives. 2016;37(3):138-143. doi:10.5480/14-1480
Nunes, L. (2021, January 6). New Directions for Diversity, equity, and inclusion in Higher
Education. Association for Psychological Science - APS. Retrieved November 29, 2021,
from https://www.psychologicalscience.org/observer/words-to-action.
Person, S. D., Jordan, C. G., Allison, J. J., Fink Ogawa, L. M., Castillo-Page, L., Conrad, S.,
Nivet, M. A., & Plummer, D. L. (2015, December). Measuring diversity and
inclusion in academic medicine: The Diversity Engagement Survey. Academic medicine:
journal of the Association of American Medical Colleges. Retrieved January 7, 2022,
from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5823241/
Phillips, J. M., & Malone, B. (2014). Increasing Racial/Ethnic Diversity in Nursing to Reduce
Health Disparities and Achieve Health Equity. Public Health Reports, 129, 45-50.
doi:10.1177/00333549141291s209
Sullivan Commission on Diversity in the Healthcare Workforce (2016). Missing persons:
minorities in the health professions. Washington: Sullivan Commission.
https://campaignforaction.org/wp-content/uploads/2016/04/SullivanReport-Diversity-inHealthcare-Workforce1.pdf
Sumpter, D. F., & Carthon, J. M. B. (2011). Lost in Translation: Student Perceptions of Cultural

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 34
Competence in Undergraduate and Graduate Nursing Curricula. Journal of Professional
Nursing, 27(1), 43–49. https://doi.org/10.1016/j.profnurs.2010.09.005
Tab, M. (2016). Helping minority students from rural and disadvantaged backgrounds succeed in
nursing: A nursing workforce diversity project. Online Journal of Rural Nursing &
Health Care, 16(1), 59-75. https:// doiorg.proxy195.nclive.org/10.14574/ojrnhc.v16i1.362
U.S. Census Bureau (2020). U.S. Census Bureau Releases New Educational Attainment Data.
https://www.census.gov/newsroom/press-releases/2020/educational-attainment.html
Internet release date: March 30, 2020.
US Department of Health. (2011). HHS action plan to reduce racial and ethnic health disparities:
Implementation Progress Report 2011-2014. ASPE. Retrieved February 21, 2022, from
https://aspe.hhs.gov/reports/hhs-action-plan-reduce-racial-ethnic-health-disparitiesimplementation-progress-report-2011-2014-0
Weber, L. (2020, December 21). Companies have promised $35 billion toward racial equity.
where is the money going? The Wall Street Journal. Retrieved November 29, 2021, from
https://www.wsj.com/articles/companies-have-promised-billions-toward-racial-equitywhere-is-the-money-going-11608570864.
Weech-Maldonado, R., Elliott, M., Pradhan, R., Schiller, C., Hall, A, Hays, R.D. (2012). Can
hospital cultural competency reduce disparities in patient experiences with care? Med
Care. Nov 2012;50 Suppl:S48-55.
Williams, J. C., Thomas, D. A., & Harvard Business Review. (2020, September 14). Why
diversity programs fail. Harvard Business Review. Retrieved November 29, 2021, from
https://hbr.org/2016/07/why-diversity-programs-fail.

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 35
Worland, J. (2020, June 11). America's long overdue awakening on systemic racism. Time.
Retrieved February 21, 2022, from https://time.com/5851855/systemic-racism-america/
2019 National Healthcare Quality and Disparities Report. (2021, June). Retrieved from
https://www.ahrq.gov/research/findings/nhqrdr/nhqdr19/index.html

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 36
Appendix A
Term Operational Definition
Diversity The state of having people who are different
races or who have different cultures in a group
or organization (Dictionary by MerriamWebster).
Inclusion The act or practice of including and
accommodating people who have historically
been excluded (as because of their race,
gender, sexuality, or ability) (Dictionary by
Merriam-Webster).
Equity Fairness or justice in the way people are
treated (Dictionary by Merriam-Webster).
Culture The beliefs, customs, arts, etc., of a particular
society, group, place, or time (Dictionary by
Merriam-Webster).
Cultural Competence The ability to collaborate effectively with
individuals from different cultures; such
competence improves health care experience
and outcomes (AANA, 2021).
Health Disparity A higher burden of illness, injury, disability,
or mortality experienced by one group relative
to another (AANA, 2021).
Healthcare Disparity Differences between groups in health
insurance coverage, access to and use of care,
and quality of care. These differences are
closely linked to social, economic, and
environmental disadvantages in minority
groups (AANA, 2021).

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 37
Appendix B
Survey Tool #1 – Students
1. Are you 18 years or older? You must be 18 years or older to complete this survey
a. Yes I confirm I am 18 years or older
b. No
2. Click below to agree to participate and complete the following nurse anesthesia program
diversity initiative survey
a. Yes, I consent to participate in this survey
b. No, I do not consent to participate in this survey
3. What is your age?
a. Under 21
b. 21-30
c. 31-40
d. 41-50
e. 51 & over
f. Prefer not to answer
4. What is your biologic sex?
a. Male
b. Female
c. Prefer not to answer
5. What is your gender identity?
a. Female
b. Male
c. Non-binary
d. Intersex
e. Other
6. Sexual orientation
a. Heterosexual
b. Homosexual
c. Bisexual
d. Other:
7. What is your ethnicity?
a. American Indian or Alaska Native
b. Asian
c. Black or African American
d. Hispanic or Latino
e. Native Hawaiian or other Pacific Islander
f. White
g. Other:
8. What year in the program are you?
a. 1st year
b. 2nd year
c. 3rd year
d. 4th year or greater
9. Were you born in the United States?

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 38
a. Yes
b. No
c. Prefer not to answer
10. What is your primary language spoken at home?
a. English
b. Spanish
c. Other:
11. Which nurse anesthesia program are you currently attending?
a. Loma Linda University
b. Samuel Merritt University
c. University of Southern California
d. Kaiser Permanente School of Nurse Anesthesia
e. National University
1. What is your primary means for paying for CRNA tuition (select all that apply):
a. Student Loans
b. Grants/Scholarships
c. Savings
d. Working through school
e. Assistance from parents/family
2. What nurse anesthesia program I attend encourages diversity, equity, and inclusion:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
3. Leadership and faculty of this anesthesia program show that diversity and equity are
important through their actions and words:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
4. Diversity, equity, and inclusion initiatives are important and necessary:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
5. This program is committed to improving the diversity and inclusion of the students and
faculty:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 39
6. The program fosters an environment that allows students and faculty to be themselves at
school without fear:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
7. This program and the faculty respect each individual and value their differences:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
8. The faculty at this program treat all students fairly:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
9. In this program, the faculty appreciate others whose backgrounds, beliefs, and
experiences are different from their own:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
10. There is a diverse student population within this program:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
11. Getting to know classmates and faculty of different backgrounds has been easy for me at
this program:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
12. The program’s policies and procedures encourage diversity, equity, and inclusion:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
13. The program makes faculty and students aware of the procedures for reporting incidents

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 40
of discrimination and/or bias in class and in clinicals:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
14. I believe this program and its leaders will take appropriate action in response to incidents
of discrimination and/or bias:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
15. Faculty and students of different backgrounds interact well within this program:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
16. This program demonstrates a commitment to meeting the needs of students from all
backgrounds:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
17. Students and faculty of different backgrounds and ethnicity are valued within this
program:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
18. Racial, ethnic, sexual, and gender-based jokes or slurs are not tolerated within this
program:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
19. This program provides an environment for the free and open expression of ideas,
opinions, and beliefs:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 41
e. Strongly disagree
20. My program director and associated faculty members are committed to and support
diverse, equity, and inclusion:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
21. My program director and associated faculty members handle matters related to diversity,
equity, and inclusion matters appropriately and satisfactorily:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
22. This program makes an effort to provide education that promotes diversity, equity, and
inclusion in the workplace:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
23. I have experience and/or witnessed racial aggression between program faculty and
students (i.e. faculty on faculty, student on student, faculty on student, etc.)
a. Always
b. Frequently
c. Occasionally
d. Almost never
e. Never
24. I have felt excluded and/or bias against me in this program
a. Always
b. Frequently
c. Occasionally
d. Almost never
e. Never
25. Suggestions/recommendations for improvement:

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 42
Appendix C
Survey Tool #2 - Directors
1. Are you 18 years or older? You must be 18 years old to participate
a. Yes
b. No
2. Click below to agree to participate and complete the following Diversity, Equity, and
Inclusion within nurse anesthesia programs study
a. Yes, I consent to participate in this survey
b. No, I do not consent to participate in this survey
3. What is your age?
a. Under 30
b. 31-40
c. 41-50
d. 51 & over
e. Prefer not to answer
4. What is your biologic sex?
a. Male
b. Female
c. Prefer not to answer
5. What is your gender identity?
a. Female
b. Male
c. Non-binary
d. Other
6. Sexual orientation
a. Heterosexual
b. Homosexual
c. Bisexual
d. Other:
7. Ethnicity
a. American Indian or Alaska Native
b. Asian
c. Black or African American
d. Hispanic or Latino
e. Native Hawaiian or other Pacific Islander
f. White
g. Other:
8. Were you born in the United States?
a. Yes
b. No
c. Prefer not to answer
9. What is your primary language spoken at home
a. English
b. Spanish
c. Other:

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 43
10. Which nurse anesthesia program are you currently directing?
a. Loma Linda University
b. Samuel Merritt University
c. University of Southern California
d. Kaiser Permanente School of Nurse Anesthesia
e. National University
1. Our program provides diversity, equity, and inclusion initiatives outside of the university
itself:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
2. Our program’s diversity, equity, and inclusion education initiatives are effective:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
3. Incorporating diversity, equity, and inclusion initiatives into our anesthesia program is
important:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
4. In my opinion, diversity, equity, and inclusion is incorporated into the curriculum and
class time:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
5. The students of this program would be comfortable coming to faculty with diversity,
equity, and inclusion issues:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
6. This program takes active measures to seek a diverse candidate pool when interviewing
and selecting potential students:
a. Strongly agree
b. Agree
c. Neutral

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 44
d. Disagree
e. Strongly disagree
7. Leadership and faculty of this anesthesia program show that diversity and equity are
important through their actions and words:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
8. The program fosters an environment that allows students and faculty to be themselves at
school without fear:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
9. The faculty at this program treat all students fairly:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
10. There is a diverse student population within this program:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
11. This program demonstrates a commitment to meeting the needs of students from all
backgrounds:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
12. Students and faculty of different backgrounds and ethnicity are valued within this
program:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
13. Racial, ethnic, sexual, and gender-based jokes or slurs are not tolerated within this
program:
a. Strongly agree
b. Agree

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 45
c. Neutral
d. Disagree
e. Strongly disagree
14. This program provides an environment for the free and open expression of ideas,
opinions, and beliefs:
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree
15. Our faculty incorporates diverse cultural content into curriculum
a. Strongly agree
b. Agree
c. Neutral
d. Disagree
e. Strongly disagree

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 46
Table 1
Characteristics of Sample Population
STUDENTS
(N=88)
DIRECTORS
(N=3)
Ethnicity
Non-Hispanic White
Hispanic
Black
Asian
Other
36 (40.9)
15 (17.1)
4 (4.5)
29 (33.0)
4 (4.5)
3 (100.0)
0 (0.0)
0 (0.0)
0 (0.0)
0 (0.0)
Age
21-30
31-40
41-50
51 & Over
Prefer Not to Answer
43 (48.9)
42 (47.7)
2 (2.3)
0 (0.0)
1 (1.1)
0 (0.0)
0 (0.0)
2 (66.7)
1 (33.3)
0 (0.0)
Sex
Male
Female
Prefer Not to Answer
37 (42.0)
50 (56.8)
1 (1.1)
3 (100.0)
0 (0.0)
0 (0.0)
Gender Identity
Male
Female
38 (43.2)
50 (56.8)
3 (100.0)
0 (0.0)
Sexual Orientation
Heterosexual
Homosexual
Bisexual
Other
78 (88.6)
5 (5.7)
4 (4.5)
1 (1.1)
3 (100.0)
0 (0.0)
0 (0.0)
0 (0.0)
Year in Program
1st year
2nd year
3rd year
30 (34.1)
29 (33.0)
29 (33.0)
N/A
N/A
N/A
Born in the U.S.
Yes
No
68 (77.3)
20 (22.7)
3 (100.0)
0 (0.0)
Language Spoken at Home
English
Spanish
Other
70 (79.5)
5 (5.7)
13 (14.8)
3 (100.0)
0 (0.0)
0 (0.0)
Program Currently Attending/Directing
Loma Linda University
Samuel Merritt University
University of Southern California
Kaiser Permanente
National University
16 (18.2)
5 (5.7)
35 (39.8)
23 (26.1)
9 (10.2)
0 (0.0)
1 (33.3)
1 (33.3)
1 (33.3)
0 (0.0)
Primary Means for Paying for School

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 47
Student Loans
Grants/Scholarships
Savings
Working
Assistance from Family
69 (78.4)
17 (19.3)
43 (48.9)
7 (8.0)
14 (15.9)
N/A
N/A
N/A
N/A
N/A

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 48
Table 2
Student survey results by ethnicity
ALL
(N = 86)A
NONHISPANIC
WHITE
(N = 34)A
HISPANIC
(N = 15)
BLACK
(N = 4)
ASIAN
(N = 29)
OTHER
(N = 4)
PVALUEB
Total Score
(med (IQR))
23
24-46
47-69
70-92
93-115
35 (25 -
45)
15 (17%)
52 (60%)
15 (17%)
2 (2%)
2 (2%)
32 (24 - 44)
8 (24%)
19 (56%)
4 (12%)
1 (3%)
2 (6%)
39 (29 - 48)
0 (0%)
9 (60%)
5 (33%)
1 (7%)
0 (0%)
42.5 (41 -
47)
0 (0%)
3 (75%)
1 (25%)
0 (0%)
0 (0%)
34 (25 -
45)
6 (21%)
18 (62%)
5 (17%)
0 (0%)
0 (0%)
39 (29 -
43.5)
1 (25%)
3 (75%)
0 (0%)
0 (0%)
0 (0%)
0.35
Diversity
Score (med
(IQR))C
5
6-10
11-15
16-20
21-25
7.5 (5 -
9)
27 (31%)
47 (55%)
7 (8%)
3 (3%)
2 (2%)
6 (5 - 9)
13 (38%)
15 (44%)
3 (9%)
1 (3%)
2 (6%)
9 (6 - 9)
2 (13%)
10 (67%)
1 (7%)
2 (13%)
0 (0%)
9.5 (9 -
10.5)
0 (0%)
3 (75%)
1 (25%)
0 (0%)
0 (0%)
8 (5 - 9)
11 (38%)
16 (55%)
2 (7%)
0 (0%)
0 (0%)
7 (5.5 -
8.5)
1 (25%)
3 (75%)
0 (0%)
0 (0%)
0 (0%)
0.23
Equity Score
(med (IQR))D
3
4-6
7-9
10-12
13-15
5 (3 - 7)
29 (34%)
34 (40%)
19 (22%)
1 (1%)
3 (3%)
4.5 (3 - 6)
14 (41%)
12 (35%)
5 (15%)
1 (3%)
2 (6%)
5 (4 - 7)
3 (20%)
6 (40%)
5 (33%)
0 (0%)
1 (7%)
6 (6 - 6.5)
0 (0%)
3 (75%)
1 (25%)
0 (0%)
0 (0%)
5 (3 - 6)
11 (38%)
11 (38%)
7 (24%)
0 (0%)
0 (0%)
6 (4.5 -
6.5)
1 (25%)
2 (50%)
1 (25%)
0 (0%)
0 (0%)
0.57
Inclusion
Score (med
(IQR))E
6
7-12
13-18
19-24
25-30
9 (6 - 11)
22 (26%)
51 (59%)
10 (12%)
1 (1%)
2 (2%)
8 (6 - 11)
12 (35%)
19 (56%)
1 (3%)
0 (0%)
2 (6%)
9 (7 - 13)
3 (20%)
6 (40%)
5 (33%)
1 (7%)
0 (0%)
10.5 (9.5 -
11)
0 (0%)
4 (100%)
0 (0%)
0 (0%)
0 (0%)
8 (7 - 11)
6 (21%)
19 (66%)
4 (14%)
0 (0%)
0 (0%)
10 (7.5 -
11)
1 (25%)
3 (75%)
0 (0%)
0 (0%)
0 (0%)
0.50
Overall DEI
Score (med
(IQR))F
9
10-18
19-27
28-36
37-45
13 (9 -
18)
26 (30%)
42 (49%)
15 (17%)
2 (2%)
1 (1%)
12 (9 - 18)
13 (38%)
15 (44%)
3 (9%)
2 (6%)
1 (3%)
13 (11 - 21)
2 (13%)
9 (60%)
4 (27%)
0 (0%)
0 (0%)
17 (15.5 -
20)
0 (0%)
3 (75%)
1 (25%)
0 (0%)
0 (0%)
13 (9 - 18)
10 (34%)
12 (41%)
7 (24%)
0 (0%)
0 (0%)
15.5 (11 -
18)
1 (25%)
3 (75%)
0 (0%)
0 (0%)
0 (0%)
0.44

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 49
A. N=2 Non-Hispanic White did not complete survey; B. p-value from Kruskal-Wallis test; C. 5
questions (possible score = 5-25); D. 3 questions (possible score = 3-15); E. 6 questions (possible score =
6-30); F. 9 questions (possible score = 9-45).

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 50
Table 3
Student survey results by primary language spoken at home
ALL
(N = 86)A
ENGLISH
(N = 68)A
SPANISH
(N = 5)
OTHER
(N = 13)
PVALUEB
Total Score (med (IQR))
23
24-46
47-69
70-92
93-115
35 (25 - 45)
15 (17%)
52 (60%)
15 (17%)
2 (2%)
2 (2%)
35 (24.5 - 45.5)
12 (18%)
41 (60%)
12 (18%)
2 (3%)
1 (1%)
34 (29 - 47)
0 (0%)
3 (60%)
2 (40%)
0 (0%)
0 (0%)
34 (24 - 41)
3 (23%)
8 (62%)
1 (8%)
0 (0%)
1 (8%)
0.81
Diversity Score (med
(IQR))C
5
6-10
11-15
16-20
21-25
7.5 (5 - 9)
27 (31%)
47 (55%)
7 (8%)
3 (3%)
2 (2%)
7.5 (5 - 9)
22 (32%)
36 (53%)
6 (9%)
3 (4%)
1 (1%)
9 (6 - 9)
0 (0%)
5 (100%)
0 (0%)
0 (0%)
0 (0%)
8 (5 - 9)
5 (38%)
6 (46%)
1 (8%)
0 (0%)
1 (8%)
0.87
Equity Score (med (IQR))D
3
4-6
7-9
10-12
13-15
5 (3 - 7)
29 (34%)
34 (40%)
19 (22%)
1 (1%)
3 (3%)
5.5 (3 - 7)
22 (32%)
28 (41%)
15 (22%)
1 (1%)
2 (3%)
7 (6 - 7)
1 (20%)
1 (20%)
3 (60%)
0 (0%)
0 (0%)
5 (3 - 6)
6 (46%)
5 (38%)
1 (8%)
0 (0%)
1 (8%)
0.28
Inclusion Score (med
(IQR))E
6
7-12
13-18
19-24
25-30
9 (6 - 11)
22 (26%)
51 (59%)
10 (12%)
1 (1%)
2 (2%)
9 (6.5 - 11)
17 (25%)
41 (60%)
8 (12%)
1 (1%)
1 (1%)
8 (6 - 13)
2 (40%)
1 (20%)
2 (40%)
0 (0%)
0 (0%)
8 (7 - 10)
3 (23%)
9 (69%)
0 (0%)
0 (0%)
1 (8%)
0.93
Overall DEI Score (med
(IQR))F
9
10-18
19-27
28-36
37-45
13 (9 - 18)
26 (30%)
42 (49%)
15 (17%)
2 (2%)
1 (1%)
13 (9 - 18)
20 (29%)
32 (47%)
14 (21%)
1 (1%)
1 (1%)
11 (10 - 18)
1 (20%)
4 (80%)
0 (0%)
0 (0%)
0 (0%)
13 (9 - 17)
5 (38%)
6 (46%)
1 (8%)
1 (8%)
0 (0%)
0.82
A. N=2 English speaking did not complete survey; B. p-value from Kruskal-Wallis test; C. 5 questions
(possible score = 5-25); D. 3 questions (possible score = 3-15); E. 6 questions (possible score = 6-30); F.
9 questions (possible score = 9-45).

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 51
Table 4
Director survey results
ALL
(N = 3)
Total Score (med (IQR))
15
16-30
31-45
46-60
61-75
22 (15 - 30)
1 (33%)
2 (67%)
0 (0%)
0 (0%)
0 (0%)
Diversity Score (med (IQR))A
5
6-10
11-15
16-20
21-25
8 (5 - 9)
1 (33%)
2 (67%)
0 (0%)
0 (0%)
0 (0%)
Equity Score (med (IQR))B
3
4-6
7-9
10-12
13-15
3 (3 - 6)
2 (67%)
1 (33%)
0 (0%)
0 (0%)
0 (0%)
Inclusion Score (med (IQR))C
2
3-4
5-6
7-8
9-10
2 (2 - 4)
2 (67%)
1 (33%)
0 (0%)
0 (0%)
0 (0%)
Overall DEI Score (med (IQR))D
5
6-10
11-15
16-20
21-25
9 (5 - 11)
1 (33%)
1 (33%)
1 (33%)
0 (0%)
0 (0%)
C. 5 questions (possible score = 5-25); D. 3 questions (possible score = 3-15); E. 2 questions (possible
score = 2-10); F. 5 questions (possible score = 5-25).

DIVERSITY, EQUITY, AND INCLUSION INITIATIVES 52
Figure 1.
Records identified from*:
Databases (n = 340)
Keywords: diversity, equity,
inclusion, graduate students,
retention, nursing, nurse,
SRNA, anesthesia
Snowballing: (n = 8)
Records removed before
screening:
Duplicate records removed
(n = 52)
Records marked as ineligible
by automation tools (n = 68)
Records removed for other
reasons (n = 55)
Records screened
(n = 173)
Records excluded**
(n = 161)
-articles prior to 2011
-studies done outside the U.S.
-not undergraduate/graduate
level education
Reports sought for retrieval
(n = 12)
Reports not retrieved
(n = 2)
-inaccessible, not relative to
ethnic/racial diversity specifically
Reports assessed for eligibility
(n = 10)
Reports excluded: 4
Reason 1 (n = Focused on
cultural competence)
Reason 2 (n = not focused
on undergraduate/graduate
education)
Reason 3 (n = unreliable
resource)
Studies included in review
(n = 6)
Identification of studies via databases and registers
Identification Screening Included

Abstract (if available)

Abstract Background: There is a lack of diversity in the healthcare profession, including the certified registered nurse anesthetist profession. This lack of diversity has resulted in healthcare disparities amongst minorities. There is a need to admit and support students of minority backgrounds in nurse anesthesia educational programs to help increase diversity.

Purpose: The purpose of this paper was to investigate the current diversity, equity, and inclusions initiatives in nurse anesthesia educational programs to assess the need for more support for minority students. This paper also looked to find effective strategies to implement in nurse anesthesia programs, which have been found to increase retention of minority students.

Methods: A literature review was conducted to find retention strategies for minority students in nursing and nurse anesthesia educational training programs. California nurse anesthesia educational programs students and directors were surveyed to assess the current DEI initiatives and their effectiveness. Statistical analysis was run to compare if there was a difference between students of different racial backgrounds feelings regarding DEI in their program.

Results: There was not a statistically significant difference between the students of minority backgrounds scoring of DEI when compared to students of non-minority backgrounds.

Discussion: The lack of diversity in the nurse anesthesia profession continues to be an issue. Larger studies in nurse anesthesia programs including more rural, less diverse communities should be conducted to assess the need for support of students of minority backgrounds enrolled in nurse anesthesia educational programs. Studies should be conducted to evaluate the effectiveness of educational, financial, and emotional support in assisting minority students successfully complete nurse anesthesia educational programs.

Linked assets

University of Southern California Dissertations and Theses

Conceptually similar

PDF

Examining the current diversity, equity, and inclusion initiatives from nurse anesthesia programs in California to support nurse anesthesia residents: an exploratory observational study

PDF

Examining the current diversity, equity, and inclusion initiatives from nurse anesthesia programs in California to support nurse anesthesia residents: an exploratory observational study

PDF

Addressing financial support for nurse anesthesia residents: literature review with policy recommendations

PDF

Instagram as an engagement tool for awareness of the environmental impacts of anesthesia

PDF

Addressing financial support for nurse anesthesia residents: literature review with policy recommendations

PDF

Addressing financial support for nurse anesthesia residents: literature review with policy recommendations

PDF

Integration of point-of-care ultrasound (POCUS) simulation curriculum in nurse anesthesia education

PDF

Instagram as an engagement tool for awareness of the environmental impacts of anesthesia

PDF

Integration of point-of-care ultrasound (POCUS) simulation curriculum in nurse anesthesia education

PDF

Achieving global health understanding among medical learners: a literature review with profession-based recommendations

PDF

Anesthesia awareness with recall: an integrative review and best practice recommendations

PDF

Anesthesia awareness with recall: an integrative review and best practice recommendations

PDF

Preoperative anesthesia recommendation for elective surgical patients who inhale cannabis

PDF

Wellness programs for healthcare graduate students: a literature review with recommendations for nurse anesthesia programs

PDF

Integration of point-of-care ultrasound (POCUS) simulation curriculum in nurse anesthesia education

PDF

Instagram as an engagement tool for awareness of the environmental impacts of anesthesia

PDF

Second victim programs within the hospital setting: an extensive literature review with practice recommendations

PDF

Effective methods for addressing psychological challenges among anesthesia providers returning from practice in austere environments: a literature review with professional recommendations

PDF

Effective methods for addressing psychological challenges among anesthesia providers returning from practice in austere environments: a literature review with professional recommendations

PDF

Development of a perioperative drug screening algorithm for patients with a history of cocaine and methamphetamine use presenting for an elective procedure with anesthesia

Asset Metadata

Creator Loggins, Jessica L. (author)

Core Title Examining the current diversity, equity, and inclusion initiatives from nurse anesthesia programs in California to support nurse anesthesia residents: an exploratory observational study

School Keck School of Medicine

Degree Doctor of Nurse Anesthesia Practice

Degree Program Nurse Anesthesiology

Degree Conferral Date 2024-05

Publication Date 10/09/2023

Defense Date 09/11/2023

Publisher Los Angeles, California (original), University of Southern California (original), University of Southern California. Libraries (digital)

Tag DEI,diversity,equity,inclusion,nurse,nurse anesthesia,nurse anesthesia programs,nurse anesthesia residents,OAI-PMH Harvest

Format theses (aat)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Bamgbose, Elizabeth (committee chair), Goodrich, Amanda (committee member), Singleton, Ann (committee member)

Creator Email jessloggs@gmail.com,jlloggin@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC113758813

Unique identifier UC113758813

Identifier etd-LogginsJes-12419.pdf (filename)

Legacy Identifier etd-LogginsJes-12419

Document Type Capstone project

Format theses (aat)

Rights Loggins, Jessica L.

Internet Media Type application/pdf

Type texts

Source 20231013-usctheses-batch-1101 (batch), University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the author, as the original true and official version of the work, but does not grant the reader permission to use the work if the desired use is covered by copyright. It is the author, as rights holder, who must provide use permission if such use is covered by copyright.

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA

Repository Email cisadmin@lib.usc.edu