More DEI Bans Will Have Dire Side Effects for Public Health

As a registered nurse, I’ve seen how cross-cultural misunderstandings can lead to poor care for my fellow Hispanic patients and families. Sometimes this happens because medical staff see them as “good patients” who are “low-maintenance.” But in reality, they often decline to voice their needs because a cultural value, respeto, leads them to defer to authority figures. Sometimes the opposite happens: Staff may believe their Hispanic patients are unreasonably resisting the treatment they need. However, there typically are other factors at play, like increased medical mistrust among Hispanic populations, especially in the context of increased anti-immigrant rhetoric in the U.S.

My father is one of those patients who was apparently considered “low maintenance.” He recently spent a week on a surgical oncology unit and was consistently receiving insufficient pain medication. His nurse was under the impression he would ask for more pain relief if he needed it and said that he didn’t look like he was in pain. That might have made some sense if my dad’s surgery wasn’t a partial removal of the tongue — meaning he couldn’t speak.

My experiences as a nurse and caretaker suggest that these harmful cross-cultural experiences can be avoided with a more diverse healthcare workforce. And there is research to support the notion that diverse healthcare workers promote better health outcomes. For example, states with nurse workforce racial and ethnic diversity were associated with reduced risk for adverse health outcomes for Hispanic women giving birth.

I am part of the small, but growing number of Hispanic nurses in the U.S. While the U.S. Hispanic population accounts for nearly 20% of the total U.S. population, only 7% of RNs identify as Hispanic. This disparity is a significant barrier to delivering high quality, culturally appropriate care.

So how do we work toward a more representative healthcare workforce? Reflecting on my own experiences through nursing school and the experiences of other Hispanic students I’ve mentored, I see that concerted, targeted efforts are needed. This includes services from Diversity, Equity, and Inclusion (DEI) offices, support from student affinity groups, and federally funded workforce diversity programs that help students stay on track with their studies.

DEI centers often provide specialized mentorship programs to help students find scholarships or provide other financial help. One of the most commonly reported barriers that keep Hispanic students from finishing their degrees is the financial burden.

Another helpful strategy is creating Spanish-language programming that involves Hispanic students’ families during important moments like college orientation. This helps reinforce Hispanic students’ support systems as they pursue higher education.

Unfortunately, these types of programs and initiatives are being banned in many publicly funded institutes of higher education. In 2023 alone, over 45 state bills were introduced to ban antiracist efforts or DEI initiatives on college campuses. Florida, Alabama, Tennessee, and Texas have all passed bills that ban universities from using state or federal funds for DEI initiatives such as trainings or centers.

University systems are also instituting their own barriers — for example, North Carolina’s 16 public universities cut 59 DEI-related roles this past year alone. The roles that did not get cut were morphed into “Collective Well-being” positions, “Prevention Awareness and Civic Engagement Centers,” or “Offices of Equal Opportunity” to name a few. With the election of Donald Trump, we can expect even more attacks on institutions that are trying in good faith to promote diversity, equity, and inclusion.

Opponents claim that DEI initiatives promote division by emphasizing racial or ethnic differences and actually create new discriminatory practices. But that doesn’t line up with the reality on the ground.

DEI centers offer support groups for nursing and medical students with a shared identity (such as first-generation, Black, and/or Hispanic students), which studies indicate promote a sense of belonging and academic success. In my own research with nursing students, I’ve found a low sense of belonging among nursing students is one of the most salient stressors that creates barriers in their academic journeys.

Individuals in DEI roles often help advocate for inclusive student support strategies, like reporting mistreatment or microaggressions from classmates or faculty. Feeling seen and understood in these spaces helps them persist on their academic journey. DEI initiatives help people have an equal chance in higher education systems that were not designed with their needs in mind.

I fear that the possibility of even more DEI bans will have grave side effects for our healthcare system. They create a more difficult path to recruit and retain students from racially and ethnically underrepresented backgrounds — despite the fact that we know diverse staff are needed to deliver the best care possible for an increasingly diverse U.S. population. More diverse students are also more likely to go back and serve their communities, including rural areas where health worker shortages are preventing patients from getting the care they need.

Ideally, leaders who are attacking DEI would recognize these important benefits and stop inflaming division for political purposes. Those who’ve gotten support from DEI programs need to be heard in these debates so the country understands the value of these efforts, especially in healthcare.

DEI initiatives empower the healthcare workforce to truly reflect the communities it serves, enabling us to deliver exceptional care that meets the diverse needs of our patient populations, and ensuring a healthier, more inclusive future for all.

Lilian Bravo, PhD, RN, is an assistant professor at University of Miami’s School of Nursing and Health Studies. She is a proud graduate of federally funded DEI initiatives and workforce diversity programs, such as the Ronald E. McNair Scholars Program, and she is also a health policy and media fellow at the George Washington Center for Health Policy and Media Engagement.

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