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Sample Essay Paper on Building A Diversified Workforce for A Better Healthcare
Building a Diversified Workforce for a Better Healthcare
Recent census reports reveal that there is increasing diversity in the United States. By midcentury, it is predicted that ethnic and racial minorities will constitute more than half of the country’s population. Considering these statistics, a culturally diverse workforce in the healthcare sector is necessary to meet the needs of the growing diverse population. Recruiting and retaining minority healthcare practitioners continues to be a crucial component of addressing the challenge of diversity in the workforce and the nursing education community. Key stakeholders in the healthcare sector, including the National League for Nursing, the American Nurses Association, and the Institute of Medicine, agree that diversity of the healthcare workforce and nursing students is a high priority. By increasing the rate of diversity in the healthcare sector and graduation of minority students, there could be an increased representation of minorities in the nursing workforce.
The story of diversity in the nursing education system mirrors the diversity issue witnessed among advanced nurses. In 2015, the National League of Nursing conducted a census survey investigating the existing diversity in the APRN faculty. The survey revealed that all ethnic minorities and men are underrepresented. For instance, full-time female nurses formed 94% of the faculty population, while males represented 6% of the faculty (National League for Nursing, 2015). Concerning racial and ethnic rating, whites occupied the most high-ranking faculty positions, forming 88.3% of the population. On the other hand, minority groups, such as Latino, Asian, and Black, only occupied 3.7%, 2.7%, and 8.4% of the positions, respectively (National League for Nursing, 2015). According to Nair and Adetayo (2019), the lack of diversity in the nursing faculty prevents the existence of concurrence or attraction of a diverse student body.
Significance of a Diverse Workforce in the Healthcare Sector
Apart from the achieved fairness and equity in the workplace, there are several reasons for the creation of a diverse workforce in healthcare. Some of the significance of diversity include:
Advancing Cultural Competency in the Workforce
One of the reasons for diversity is the increasing number of culturally competent healthcare workers. Cultural competence refers to the skills, knowledge, behavior, and attitude necessary for health practitioners to provide quality care to persons from different ethnic and cultural backgrounds (Parhar & Sensoy, 2011). According to Murray (2019), given the increasingly changing population demographics in the U.S., future healthcare professionals will be expected to take care of patients from backgrounds different from theirs. As such, healthcare practitioners should have a deep understanding of why and how different belief systems, ethnic origins, cultural biases, family structure, and other cultural factors influence how individuals experience illness, respond to treatment, and adhere to the treatment plans (Nair & Adetayo, 2019). Nurses and physicians who are not mindful of the effects of existing religious taboos, language barrier impact, and unconventional explanatory disease models are not likely to meet the needs of patients or offer optimal care services.
Nurses and physicians cannot become competent by simply reading textbooks or attending lectures. They need to learn in academic environments that are emblematic of the setting they would deliver healthcare services. This logic is analogous to that which upholds the significance of cultural diversity in every aspect of higher education. In his own words, Lee Bollinger, the Columbia University president, noted that ethnic and racial diversity in learning institutions is paramount to students’ ability to work and live in a diverse community (Bollinger, 2003). Several empirical analyses on diversity support Bollinger’s argument. Analysis by Cohen, Gabriel, and Terrell (2002) confirm that student involvement and racial diversity has a significant impact on learning and how students carry out themselves in their professional world, including breaking the prevailing racial separation patterns. Only through interaction with students from other racial and ethnic backgrounds can nurses transcend their viewpoints and perceive them through the lens of others.
Creating More Access to High-Quality Healthcare Services
Another reason for creating a diversified workforce in nursing is to provide access to quality care for individuals who are underserved in society. Inadequate access to key health services is a significant problem among minority communities. Most of the health professions shortage areas (HPSAs) in the U.S. are dominated by people from minority groups (Bond et al., 2008). Physician supply in California, for instance, is inversely proportional to the number of Hispanic and African Americans served. Individuals from minority groups who access these services are less likely to receive quality care even with high income and better insurance. Studies have shown, for example, that the Hispanic population and black Americans are less likely to get bypass surgery, HIV infection treatment, or proper pain management. Minority groups are more likely to go through medical procedures, such as amputation and bilateral orchiectomy, which can be prevented through optimal medical care.
Existing array of data document that physicians of Hispanic, African American, and Native American origin are more likely to practice in underserved communities, unlike their white counterparts. Moreover, Hispanic and African American physicians are more likely to offer care to individuals with Medicaid and those from poor backgrounds (Woodley & Lewallen, 2020). Evidence also shows that ethnic and racial concordance between patient and physician results in patient satisfaction (Veal, Bull, & Miller, 2012). These data help to substantiate the existing reality that nurses and physicians of minority origin are more likely to consider practicing in underserved areas and that patients are highly satisfied when they are served with physicians from their ethnic and racial heritage.
Ethnic and racial disparities in hospitals and other healthcare settings are well documented. Unlike the white population, African Americans have a low life expectancy, with a higher risk of stroke, diabetes mellitus, and cancer. African Americans and Native Americans also experience higher infant mortality and HIV infection rates than whites (Bond et al., 2008). Population-specific studies have also revealed that the black community is more likely to suffer from hypertension, which leads to coronary heart diseases. Amidst the fact that there exist differences in the socioeconomic, environmental, and risk factors among different racial groups, researchers agree that many negative health outcomes experienced by minority groups are managed through outpatient care (Veal et al., 2012; Bond et al., 2008). The persistent biases among healthcare institutions and providers greatly contribute to unequal treatment.
Strengthening the Agenda of Medical Research
Another reason to promote diversity in the healthcare workforce is to strengthen and broaden medical research in the U.S. According to Hansen & Beaver (2012), the country is currently plagued with several health problems, most of which affect individuals from minority groups. It is arguable that the health sector has a sufficient understanding of these challenges to come up with solvable recommendations. However, additional clinical and health services research is urgently needed. One explanation for the insufficient research is that most research agenda are addressed by individuals with careers in investigation. These individual investigators only focus their research on what they find interesting, which is usually dependent on personal ethnic and cultural filters (Loftin et al., 2012). As such, finding solutions to the country’s most burning health problems requires a research team that is more ethnically and racially diverse. There is a need to ensure that there is a diverse student body in health professional schools to create such a workforce.
Ensuring Effective Management of the Health System
Diversity aids in the augmentation of a pool of experienced medical professionals and policymakers capable of assuming management roles in the healthcare system. Providing relevant healthcare services to a diverse group can pose a difficult management challenge for practitioners, healthcare providers, all levels of governments, healthcare program managers, and healthcare funders (Loftin et al., 2012). A diverse management team to make tactful and critical medical decisions would be advantageous for success. Moreover, as in the case of other sectors of the economy, healthcare organizations can create a diverse leadership team with a talent pool reflecting racial, gender, and ethnic diversity of the country. Similarly, healthcare policymakers who represent the American population can greatly influence the future of healthcare policy (Nair & Adetayo, 2019). However, a lack of minority representation in the top medical management ranks presents a barrier to achieving quality care.
Barriers to Diversity in the Healthcare Workforce
The lack of a diversified workforce in healthcare is majorly caused by a lack of diversity in medicine and nursing education programs. The minority groups, particularly Hispanic/Latinos and African Americans, remain to be the most underrepresented groups in the healthcare workforce. In a 2017 survey conducted by the National Nursing Workforce, it became apparent that only 19.2% of minority groups are represented in the nursing sector amidst the fact that they form nearly 42% of the population (Woodley & Lewallen, 2020). Although the number of minority enrollees in healthcare-related programs increased to 32.2% by 2018, there is still a need to increase the number to mirror the country’s minority population (Woodley & Lewallen, 2020). An effective way to create a diversified workforce is to admit more students from minority groups in nursing programs.
One of the barriers to a diversified workforce in healthcare is the long-standing socioeconomic and environmental conditions that hinder the ability to become competitive applicants in medicine and nursing education programs. These social determinants usually have a profound impact on the chances of minority students to progress in education. There is a huge gap between the dominant and non-dominant racial groups in the country. According to the U.S. Census Bureau (2019), the gap between the rich and the poor populations grew to its highest level in 2018, with Hispanic and Black individuals falling in the lower rungs. The existing inequalities tend to be the cause of the disparities in academic attainment and advancement. Income is also a definitive component of population location or residential neighborhood (Nair & Adetayo, 2019). Most highly resourced schools are often located in the high-income areas and have enough resources to invest in education, including high-quality teachers, better school facilities, advanced courses, and teacher-to-student ratios (Owens, 2018). On the other hand, schools in poor neighborhoods have lesser resources, leading to poor educational quality and pre-college entry preparation.
Another barrier to diversity is the process of admission. Based on merit, the admission policies are seemingly equitable, fair, and designed to include all students with the highest success probability (Woodley & Lewallen, 2020). Students with the best grade points and high scores in the standardized test are more likely to gain admission to the nursing program (Williams et al., 2018). In case of capacity challenges, the decisions on admission are based on the grade point ranking through a descending order. Students with the highest test scores always get the opportunity for admission until the maximum number limit is attained, which is then followed by a waiting list. The standard procedure, however, acts as a structural barrier for ethnically or racially diverse students (Veal et al., 2012). Although it offers equality, it has adverse outcomes for disadvantaged groups. The enrollment system disregards the existing inequality in the previous academic environment of students and the comparative resources needed for precollegiate education.
A significant obstacle affecting prospective APRNs is access to graduate education. It is a reality that the academic programs offered for higher nursing education are limited due to a shortage in the faculty, which affects all the nursing education levels. Out of the rejected 64,000 qualified nursing education applicants, 15% were at a master's level, and 3% at the doctoral level (Nurse Practitioner Schools, 2020). Since the demand is higher than the supply, the number of aspiring APRNs who are able to gain skills and knowledge to advance their nursing practice gets limited. According to Veal et al. (2012), prospective APRNs with minority backgrounds always have limited choices in the field. The increased competition for admission and limited access to nursing programs acts as an impediment to the increasing diversity in the nursing pool. Although the limited supply has a direct effect on diversity, the indirect impact of rejections remains a significant component.
The high cost of advancing nursing education is also a major barrier to APRN diversity. In a report published by the Georgetown University Center on Education and the Workforce, licensed vocational nurses and practical nurses had the highest diversity in 2016, with 43% representing the minority population (Nurse Practitioner Schools, 2020). However, the BLS (2017) found that only 23% of the workforce constitute non-white nurses (U.S Bureau of Labor Statistics, 2020). This disproportionality is associated with the fact that nurses from minority communities have lower educational attainment levels, and thus, lower earning. The opportunity costs and the costs of an advanced degree make diversity an expensive reality. While LPN programs may cost about $4,000-$28,000 a year, an APRN program may take 2-4 years at the cost of $38,000-$200,000 (Nurse Practitioner Schools, 2020).
Researchers have proposed various ways to break down diversity barriers in healthcare. The strategies can be implemented at the high school level, college level, and the organizational level to ensure diversity right from the learning institutions.
Recommendations Before College
One of the programs that can promote diversity among future nursing students is the jump start program. The program was created as a recruitment strategy that introduces a healthcare career to students who have just graduated from high school before choosing their college majors (Veal et al., 2012). In these programs, students, usually above the age of 18, get mentorship and interact with staff members, such as nurse practitioners, nurses, physicians, and radiology technologists. The students attend lectures, which are conducted by healthcare team members, and participate in several surgical and diagnostic procedures. According to Hansen & Beaver (2012), jump start programs enable students to engage in unlicensed healthcare activities like transporting laboratory specimens, answering phones, and filing patient data. They may also engage in data collection and project management.
The Health Occupations Students of America (HOSA) had also been introduced to promote diversity among the healthcare workforce. Introduced in 1976, the programs offer support to students who have a vested interest in pursuing health science courses (Nair & Adetayo, 2019). HOSA offers programs that focus on recognition, development, and motivation for students in secondary and higher learning levels who are pursuing biomedical science or health science programs (Nair & Adetayo, 2019). With up to 165,000 members, the program stimulates the interest of students from diverse backgrounds to major in nursing-related courses.
Another significant program, dual enrollment, is significant in increasing the graduation rates of diverse students, particularly those from minority groups. This program was designed to enable high school students to go for college classes while undertaking their high school classes (Owens, 2018). Through a partnership with the U.S. Department of Education and colleges, programs that utilize this process to offer college credit make it possible for high school students to complete the courses tuition-free. The dual enrollment program sometimes even covers the lab fees and textbook costs (Cohen et al., 2002). The earned college credits offer students a higher priority to have successful registration when applying for nursing-related courses.
Recommendations during College
There are two schools of thought that can address the gaps that exist in students' graduation rates in nursing education. The deficit remediation model is focused on addressing the needs of students of color, including defects, concerns, and deficits to "fix" minority students. The second model, the strength-based model, stresses the significance of the talents of students. This model posits that when students are aware of their strengths or talents, they will be motivated to fulfill their college experiences, retention, and increase classroom engagement.
Deficit Remediation Model in HBCUs. This model focuses on the efforts of mediating dropout rates and academic engagement on the needs and deficit of the students. The needs attributed to the success and persistence of black students include close social relationships with peers from the same ethnic group whom they mediate against overt racism and share experiences. According to Strayhorn (2017), peer groups of the same racial origin mediate against the existing opportunity gaps in colleges and universities. In a 2018 survey conducted by Brooms on Black Male Initiative Programs, it was apparent that minority students can confidently discuss their lived campus experiences in a safe open space, thus developing a sense of belonging (Broom, 2018). The 36 participants of the study reported that they developed a feeling of belonging, which strongly relate to retention and engagement rates (Broom, 2018). Attached to this was a heightened sense of self in which the students of color empowered each other through increased responsibility and accountability to one another. The survey illustrates how effective the deficit remediation model is in reducing the graduation rate gaps in colleges and universities.
Hunn (2014) agrees that white colleges are able to decrease the gaps in graduation rates for students of color through a diverse curriculum. The author asserts that school faculty can work with students to create themes in academic disciplines and courses that enhance the experience of African American students (Hunn, 2014). Students should then be placed in groups that take the same classes in order to study outside the classroom together and avoid overdependence on each other for better grades. In subsequent years, students should form team-based learning groups whereby they can work collaboratively to improve their grades (Hunn, 2014). In order to increase on-time graduation, the University of Texas (UT) offers the PACE program (Path to Admission Co-Enrollment). The program enables students to take one class in their first year at the university while taking other courses in their nearby community colleges (Alvarado, Connerat, & Smith, 2018). In the following years, the students enroll in UT full-time, in which they remain on-time for college graduation.
Strength-based Model. This approach to retention and engagement is becoming very popular in higher education institutions. The model considers students’ potential and resources to be the determinant of their success. According to Soria and Taylor (2016), the strength-based approach assesses, teaches, and creates learning opportunities that enable students of color to realize their potential and apply them to promote their personal and academic achievement. However, Anderson (2004) noted that most students are not aware of their talent or what to excel in, thereby limiting their potential. The first step to a strength-based approach is to have the nursing faculty and students take an assessment to identify the strengths of the students (Anderson, 2004). This can be achieved by using the Clifton StrengthsFinder model that outlines 34 talent themes based on the way an individual thinks, behaves, and feels (Clifton & Harter, 2003). Strengths can be achieved when the identified talents are nurtured. These studies all agree that once students identify their strengths, they can align their abilities, which increases their level of collaboration.
Recommendations at the Organizational Level
Colleges and healthcare organizations should allocate funds that can help nurses to advance their education to address the existing disparities in education and healthcare workplaces. The faculty members of graduate and undergraduate nursing programs should make sure that every student is informed of financial aid or grants available (Hansen & Beaver, 2012). The management team and peers should be involved in encouraging students from minority groups to advance in nursing education. The healthcare field should ensure that all racial and ethnic groups are well represented in order to have a clinically proficient and educated diverse nursing team.
The increasing diversity of the healthcare workforce can result in several consequences. A diverse workforce constitutes a culturally competent pool of practitioners who provide optimal care. Diversity also enables nurses and physicians to acquire the necessary skills and attributes needed to offer adequate care to all patients, including those from minority backgrounds. Moreover, physicians representing all ethnic and racial backgrounds are more likely to provide high-quality care to underserved populations. A diversified workforce can also broaden the research agenda of the medical field; thus, addressing key challenges affecting the general public. Therefore, this paper proposes several strategies that can be implemented at the pre-college, college, and organizational levels to create a diversified workforce. HOSA and jump-start programs have facilitated the agenda of inclusion in nursing education.
Anderson, E. C. (2004). What are strengths-based education? A tentative answer by someone who strives to be a strengths-based educator. Unpublished manuscript, Educational Leadership, Azusa Pacific University, Azusa, CA. Retrieved from https://strengths.uark.edu/documents/what-is-strengths-based-education.pdf
Bollinger, L. C. (2003). The need for diversity in higher education. Academic Medicine, 78(5), 431-436. https://journals.lww.com/academicmedicine/Fulltext/2003/05000/The_Need_for_Diversity_in_Higher_Education.2.aspx
Bond, M. L., Gray, J. R., Baxley, S., Cason, C. L., & Denke, L. (2008). Nursing education research: voices of Hispanic students in baccalaureate nursing programs: are we listening?. Nursing Education Perspectives, 29(3), 136-142. https://journals.lww.com/neponline/Fulltext/2008/05000/NURSING_EDUCATION_RESEARCH__VOICES_of_Hispanic.8.aspx
Brooms, D. R. (2018). ‘Building Us Up’: Supporting Black Male College Students in a Black Male Initiative Program. Critical Sociology, 44(1), 141-155. https://doi.org/10.1177%2F0896920516658940
Cohen, J. J., Gabriel, B. A., & Terrell, C. (2002). The case for diversity in the health care workforce. Health Affairs, 21(5), 90-102. https://doi.org/10.1377/hlthaff.21.5.90
Hansen, E., & Beaver, S. (2012). Faculty support for ESL nursing students: Action plan for success. Nursing Education Perspectives, 33(4), 246-250. https://journals.lww.com/neponline/Abstract/2012/07000/Faculty_Support_for_ESL_Nursing_Students__Action.7.aspx
Hunn, V. (2014). African American students, retention, and team-based learning: A review of the literature and recommendations for retention at predominately white institutions. Journal of Black Studies, 45(4), 301-314. https://doi.org/10.1177%2F0021934714529594
Loftin, C., Newman, S. D., Dumas, B. P., Gilden, G., & Bond, M. L. (2012). Perceived barriers to success for minority nursing students: An integrative review. ISRN Nursing, 2012. https://doi.org/10.5402/2012/806543
Murray, T. (2019). Diversity Matters: Why Don't We See It in the Registered Nurse Workforce?. Journal of Nursing Education, 58(12), 679-680. https://doi.org/10.3928/01484834-20191120-01
Nair, L., & Adetayo, O. A. (2019). Cultural Competence and Ethnic Diversity in Healthcare. Plastic and Reconstructive Surgery Global Open, 7(5). https://doi.org/10.1097/GOX.0000000000002219
National League for Nursing. (2015). NLN Faculty Census Survey 2014-2015. Retrieved from http://www.nln.org/newsroom/nursing-education-statistics/annual-survey-of-schools-of-nursing-academic-year-2015-2016
Nurse Practitioner Schools. (2020). The Lack of Diversity in Advanced Nursing. Retrieved from https://www.nursepractitionerschools.com/blog/diversity-in-advanced-nursing/
Owens, A. (2018). Income segregation between school districts and inequality in students' achievement. Sociology of Education, 91, 1–27. https://doi.org/10.1177/0038040717741180
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