Introduction
The dawn of the 21st century has ushered in a new era that brings with it the promise of a better, bigger and brighter future. But hidden under the veils of this ultra-modern society are glimpses of the past; evils of a forgotten era that still lurk in the corners. From racism to terrorism, there are several social evils that need to be put to rest. One such successful attempt was made by Dr. Sylvia Ann Flack, an African American, who carved out a unique identity for herself owing to her contribution to the health care industry. Realizing the disparity in the medical services meted out to the blacks and whites, Dr. Flack’s determination to achieve parity in health care among all socio-economic groups within and beyond the Winston-Salem area is truly laudable.
Background
When Sylvia was in high school, she used to work in the same hospital as that of her father. She was allowed to work only as maid in a part of the hospital known as the Annexe that was reserved for black patients. It was then that she first realized the disparity in the health care services provided to whites as opposed to that provided to other minorities and decided to do something about it. She obtained her bachelors in nursing in 1968 from Winston-Salem State University and later on obtained her masters in 1977. She obtained her doctorate in education in 1988. She started off as a Staff nurse at Rutherfordton Memorial Hospital and then went on to prove her mettle as a nurse in several other hospitals. In 1972, she held her first administrative position as Director of Continuing Education. She then moved on to teaching and took up the position of Instructor at Garden Webb College in 1974.
After a series of jobs where she held the positions of director, assistant professor, assistant dean, advisor etc., in 1995 she returned to Winston-Salem State University as Dean of School of Health Sciences. After nearly 10 years of service as a Dean during which time she managed to bring about tremendous reforms in the nursing education system, Dr. Sylvia then became the Executive director, Centre of Excellence for the Elimination of Health Disparities. Her dedication to the health care industry and her strong will power made her the voice of countless African Americans who suffered silently to the throes of racism (The University of North Carolina, 2014-2015)
Roles and Responsibilities
For most of her professional life, Dr. Sylvia retained administrative positions, often laying the groundwork for improvement in the nursing program and emphasising the need to abolish the disparity in health care services. The 1968 graduate of Winston-Salem State University was eventually brought back to her alma mater as the first dean of the School of Health Sciences in a bid to save the university’s dying nursing program. Not only did she manage to resurrect the program, but she also gave back to the community in the most remarkable way. She founded the Academic Primary Care Center with an aim of providing health services to nearly 4,000 public housing residents. Besides providing health care to the minorities in Winston-Salem, it also provided nursing students with an opportunity to experience first-hand the nuances of nursing. She paved the way for creating awareness regarding the disparities in health services, conducted extensive research, worked for providing increased access to health care for minorities, acquired funds for numerous community service projects and research work and was instrumental in creating partnerships between the university and the medical community, government and local organizations (The University of North Carolina, 2014-2015).
Achievements
Dr. Sylvia has an endless list of achievements to her name, the most noted ones are:
She founded the Community practice and Wellness Centre which cared for over 4000 residents;
She secured millions of dollars through research and training grants;
She helped save the nursing program at WSSU;
She founded the Centre of Excellence for Elimination of Health Disparities;
She led the nation’s largest national conferences on health disparities -‘Faces of a Healthy Future: National Conference to End Health Disparities I & II” (The University of North Carolina, 2014-2015);
Awards and Recognition
She was recently conferred the 2015 James E. Holshouser Jr. Award for Excellence in Public Service. Among her many awards, her most cherished one came from the WSSU Nursing Alumni Chapter which named her the “Most Distinguished Alumni” in 2005. She also received the 2008 Leadership in Health Disparities Award from NIH.
The Leader of Tomorrow: Basic Leadership Principles
A good leader has exciting ideas and makes inspiring speeches whereas a great leader takes action and that’s what Dr.Sylvia managed to accomplish. She has the true defining principles of a leader. Among her several leadership principles, the most noted one is her initiatives that are directed at making things better. Her outstanding people skill, her incredible personality, and her principle of maintaining others’ self-esteem reverberated with the nursing student community who recognized the magnitude of the problem and worked to put health care disparity to an end. She believed in leadership by example and set a standard for students to aspire to. She helped develop the leadership capacity at all levels of the organization, stressing the importance of nursing leaders, which, in turn, reinforced the notion of her being an ideal leader. She believes that there’s always room for growth and has never stopped trying to do a little more for the world.
Key Management Functions of Dr.Sylvia
The Challenges Ahead
The United States along with several other countries in the world face unique challenges when it comes to delivering health care. An increased number of aged population drives the demand for more health care services. A 2009 AARP report stated that patients with chronic conditions suffered first-hand the lack of proper healthcare among providers which often resulted in unnecessary hospitalizations, repeat tests etc.; an acute shortage of health care professionals in underdeveloped and minority-community areas is another impediment to providing quality health care services. The future lies with the workforce who needs to be better prepared to handle the growing challenges in health care. Nurses, especially, need to assume roles in chronic disease management, health coaching, and quality improvement in order to make the health care system a more efficient one. However, achieving unanimity and making quality health care accessible to all is a challenge in itself. This is where the need to train more nurses from the minority communities steps in.
The Three Pillars for Change
Advancing Education Transformation
An IOM report claims that for nurses to play pivotal roles in improving the health care industry, they need to be better prepared to face the complexity in the health care system today. Continuing education, retention of clinical skills and leadership abilities can help achieve uniformity and make quality health care a reality.
Removing Barriers to Practice and Care
The Organisation for Economic Co-operation and Development Health Working in 2010 reported that many countries are seeking ways to improve health care delivery by revaluating the roles of nurses and concludes that developing advanced roles for nurses could make access to quality care possible. The need to remove all barriers and enabling all registered professional nurses (ARPNs) to practice to the full extent of their training and education is necessary.
Nursing Leadership
In order to influence change, nurses need to see themselves as decision makers so that they can help lead improvements in health care quality, access and safety. Individuals involved in health care play increasingly interdependent roles. Leaders who merely direct and expect orders to be followed are not ones who can succeed. A leader like Dr. Sylvia is an excellent example of harbouring change through her competent direction as well as execution of tasks at hand. There’s a need to develop a similar style of leadership which involves working with others and mutual respect for others in the profession. The benefits of such collaboration haven been documented and improved patient outcomes, cost cutting, reduced length of hospital stay; nurse retention etc. can be noticed. Developing leadership competency in nurses and promoting collaborative management of practice can help shatter the walls of hierarchy and promote better health care.
The Need for African American Nursing Leaders
The nursing profession needs to reflect the patients it serves and must deliver culturally competent care. Racial and ethnic disparities continue to persist to this day. The WHO believes that social and biological factors contribute to health disparities. The conditions in which people are born, grow, work can be social determinants of health. Studies have shown that minority communities are the worst hit, with African Americans at the receiving end of issues arising out of health disparities. The National Black Nurses Foundation conducted a research project and found that nurse vacancy and turnover was the highest in African Americans and this nursing shortage made addressing key health care issues in the African-American communities very difficult. A culturally diverse nursing workforce is quite necessary to meet the health care needs of the nation. Otherwise the poor resemblance health care professionals bear with the diverse populations they serve can leave several minority communities feeling distant and uncared for.
The lack of African American nursing leaders may send out the wrong signal to potential nursing students that the profession does not value diversity, which may cause a still greater drop in the number of nurse practitioners from the minority community. This is why the need to prepare and train African American leaders in nursing is stronger than ever. While nurses do not begin their careers with the thoughts of becoming leaders; all nurses need to develop leadership skills to make the vision of transformed and disparity-free health care system a reality (Minority Nurse, 2016; HHS, nd).
Removing Barriers to Practice
Most of the African American community falls under the economically weaker sections of the society, which makes access to quality nursing education quite a challenge for them. However, with tremendous reforms and nursing leaders like Dr. Sylvia Ann Flack setting examples, it is now possible for nurses to break all barriers and achieve the unimagined. AACN has collaborated with several national nursing organizations to increase nursing education opportunities for people from disadvantaged sections of the society. The 2004 IOM report showed that 16% of the US population comprised African American, but they accounted for less than 6% of the physicians in US. The figures are even more depressing when it comes to the nursing profession.
With an aging and sicker population, America is faced with a shortage of primary health care professionals. Today, the world has realized the need for nurses to acquire proper training and education, and several reforms to promote the profession among the minorities have been taken up. Advance practice registered nurses (ARPNs) can enable access to cost-effective, convenient, and high quality care. The only things in the way are state laws that prove to be barriers when it comes to enabling more nurse practitioners from utilising their fullest education and training. These barriers lead to a delay in providing care to consumers, especially in the rural areas, where very few health care professionals are available. A wide spread campaign that began has managed to remove statutory barriers in eight states that had earlier prevented nurse practitioners from providing health care to the maximum extent of their training
IOM, Health Care Disparities and More
Why is health care different if you’re poor, black or a member of a minority community? While politicians proudly declare that America’s medical care is the best in the world, the reality is quite different. The most recent National Healthcare disparities report states that 30-40% of African Americans experience poorer health outcomes that their white counterparts. Not only does this shorten their life spans but it also causes productivity losses of about 60 billion each year.
The death rate from illnesses such as diabetes, breast cancer and heart disease is more in low-income neighbourhoods and African-American communities. Traditionally, community-based programs were never considered important for health care interventions. What is crucial is the understanding that stems from the realization that while it is easy to suggest lifestyle changes to improve a patient’s health; their limited access to healthy resources also needs to be addressed.
At the turn of the 21st century, the biggest question that is to be asked is: how far have we come in reducing disparities? An IOM report highlighted the importance of focus on quality health care and also the reforms that have since addresses the health disparities. The creation of the National Center for Minority Health and Health Disparities was a first step that triggered a sea of change. The likes of Dr. Sylvia have managed to realize what most leaders in the past could not and current trends in health practice revolve around greater interaction among communities and health care providers. Such collaboration has now led to the creation of care organization such as those authorized under the Affordable Care Act of 2010. The act not only makes availing insurance easier, but also provides several subsidies to make medical facilities more affordable. The Accountable Care organizations authorized under it also take responsibility for broad health care outcomes for a defined set of the population (Peek, 2012).
Today Vs Yesterday
Back in 1879, Mary eliza Mahoney enrolled into a training program in New England and endured 16 hours of gruelling labour. She refused to succumb to restrictions imposed due to racial differences and went on to become the first ever registered African American black nurse. Nursing was never the same again! Another registered nurse Lillian Holland Harvey became Dean of Tuskegee University School of Nursing in 1948. She established Alabama’s first Bachelor’s in nursing. Her initiative was directed with an aim of delivering equal professional acknowledgement to all, despite the harsh segregation that prevailed in the 1940s.
Another woman, Betty Smith Williams, realized the need for providing an impetus for black nurses to act collectively and founded the National Black Nurse Association in 1971. Several instances of several other leaders in history have proved time and again that change is inevitable. Today, while black nurses are accepted and recognized, they are still held down by racial and ethnic disparities that are prevalent to this day. Our leader, Dr. Sylvia’s work revolved around putting to rest the widespread disparity in the health care system. Her initiatives were focussed on creating awareness and imbibing her leadership qualities in the African American nurses of tomorrow.
Leaders Who Created an Impact
Dr.Sylvia carried out extensive research to find out the nature, occurrence and prevalence of disparity across various communities. She believed that the only way to overcome the odds is to educate young minds on ways to obtain a quality health care system and achieve uniformity for people of all ethnic backgrounds. She used the immersion method of teaching to ensure that her message makes a strong impact amongst the nursing student community and today, she has made several of her students, nursing leaders. While Dr. Sylvia’s contribution is remarkable, there are several other African American leaders who’ve also managed to make an impact.
Care Beyond the Hospital Walls
Dr.Connie Hill, an African American nurse, never intended to be a leader. Her desire to extend acute health care beyond the hospital walls was stronger than ever when she noticed a child that had been on incubator for nearly two years. In 2004 the Consortium for Children with Complex Medical Needs was formed. Now, it is possible for some children to go back home to receive care (The National Academies of Sciences, Engineering, and Medicine, 2011).
Building Diversity
Kenya D Haney, a married mother of two, enrolled into nursing school with a desire to give back to the community. However, the bias she noticed deterred her determination. Despite all odds, she completed her program and later went on to become the director of NSNA, which aims to retain nurses of diverse ethnic backgrounds among other initiatives (The National Academies of Sciences, Engineering, and Medicine, 2011).
Strategies for Leadership Advancement
IOM in its report “The Future of Nursing: Leading Change, Advancing Health” makes specific recommendations related to advancement of nursing leadership. According to the report, the recommendations are
The development of payment models affecting the delivery of nursing care.
Advance research on models of care and solutions to patient-care problems through the collaboration and pooling of funds.
Innovation in medical and health devices and IT sector
Opportunities for nurses to initiate programs directed towards improving health and healthcare.
The primary strategy calls for nurses to assume responsibility for personal and professional growth through education, and advancement of leadership skills should be prioritised the most. Emphasis on integrating leadership theory and inclusion of representation from the nursing profession on the boards, management teams of public-private and governmental healthcare decision-making bodies can help advance leadership skills.
A New Style
As mentioned earlier, the traditional healthcare environment where nurses, physicians, and patients are interdependent needs to be eradicated. A partnership-based leadership strategy is necessary to improve the outcome. Not only will this facilitate better communication between various members of the healthcare environment, but it also helps foster the development of a disparity-free healthcare model – one that isn’t self-centred.
Conclusion
Although some of the prevalent gender and role issues remain unaddressed, the work of African American leaders such as Dr. Sylvia Ann flack and others prove to be a strong call to action for individuals involved in the nursing profession to play its full role as a driver to create and sustain an American healthcare system that works at every level to cater to the needs of every community in a cost-effective, safe, reliable, and accessible manner. With advanced reforms being initiated and the need to purge out ethnic and racial disparity in the health care system being realized, the day is not far off when the health care system will be disparity-free. The need for nursing leaders is higher than ever, but the question remains: Will nurses answer the call and put an end to disparity?
References
HHS, (nd), HHS action plan to reduce racial and ethnic health disparities, Retrieved from http://minorityhealth.hhs.gov/npa/files/plans/hhs/hhs_plan_complete.pdf
Minority nurse (2016), Looking for Black nurses leaders: a call to action, Retrieved from http://minoritynurse.com/looking-for-black-nurses-leaders-a-call-to-action/
Peek, E. M., (2012), Early lessons from an initiative on chicago’s south side to reduce disparities in diabetes care and outcomes, Health Aff., 31(1), 177-186.
The National Academies of Sciences, Engineering, and Medicine, (2011), The future of nursing: leading change, advancing health, Retrieved from http://www.nap.edu/read/12956/chapter/10#232
The University of North Carolina, (2014-2015), Flack continues to fight health disparity in Forsyth County, Retrieved from http://www.northcarolina.edu/node/3542.
