Inclusivity in Nursing: Sustaining Professional Values in a Changing Landscape

Ellen Schimmels, PhD, DNP, PMHNP-BC, ANP-BC, CNE, FAAN

Background

The principles of diversity, equity, and inclusion (DEI) are deeply embedded in the core values of the nursing profession and are essential to the delivery of high-quality, competent care. The Nursing Code of Ethics affirms nurses’ obligation to practice with compassion and respect for the inherent dignity of every individual, free from prejudice, manipulation, or coercion (ANA, 2025, Provision 1.1). Building a health care system in which individuals receive equitable care, experience inclusion, and are protected from disparities reflects the ethical commitments nurses assume upon entering the profession.

Although the principles of DEI remain steady, over time the scope of related DEI initiatives have expanded significantly beyond their original intent. Contemporary DEI initiatives and efforts encompass a broad array of legislation and organizational practices designed to improve experiences and outcomes for marginalized social groups. Originating in the Civil Rights Movement, early DEI initiatives focused primarily on legislative reforms to promote equal employment opportunities and address discrimination rooted in the social construction of race. During the 2000s and 2010s, the framework evolved to emphasize workforce representation, organizational diversity strategies, and recognition of intersecting systems of oppression and identity-based discrimination (Kratz, 2024). The convergence of the COVID-19 pandemic and widespread social unrest further exposed longstanding inequities in health and community outcomes, renewing organizational and societal attention to equity-related priorities (Mheidly et al., 2022).

Concerns about Diversity Programs

In response to the rapid expansion of these efforts, opposition to diversity program initiatives emerged, particularly those involving the creation of DEI offices, committees, mandatory training, or consultant-driven interventions. Critics have argued that such approaches may inadvertently foster perceptions of preferential treatment, erode trust, or introduce punitive dynamics when participation or compliance is enforced (Leslie et al., 2025). Additionally, diversity initiatives have been questioned when they fail to demonstrate meaningful or measurable outcomes, further fueling skepticism regarding their effectiveness (Rae, 2025).

Federal actions have added another layer of complexity by altering the legal and political context in which DEI initiatives operate, often creating tension between institutional values and regulatory constraints. Executive Orders 14151 and 14173 resulted in the termination of DEI initiatives across federal agencies and contractors, rescinded funding, restricted certain training activities, and emphasized adherence to civil rights laws without mandates associated with some DEI-specific programming (The White House, 2025a; 2025b). These actions underscore growing national tensions surrounding the role and implementation of formal DEI programs.

Within health care, and nursing in particular, these debates are especially salient. Historically, discrimination in health care settings has been linked to gender, socioeconomic status, and race as a social construct. Patients consistently report better experiences and outcomes when cared for by providers who understand and reflect their cultural backgrounds. Accordingly, DEI initiatives in nursing have sought to recruit and retain a diverse workforce, enhance culturally competent care, and promote equitable access to professional development opportunities. Achieving these aims requires psychologically safe environments in which bias can be addressed, nurses feel empowered to speak up, and diverse perspectives are genuinely integrated into organizational decision-making (Parchment, 2023; Shah et al., 2024).

Concerns surrounding diversity program initiatives frequently focus on program design and implementation. Research on diversity training remains fragmented, with inconsistent methodologies, objectives, evaluation measures, and reported outcomes, limiting the ability to draw definitive conclusions regarding effectiveness (Leslie et al., 2025). Additionally, studies on training do not determine effectiveness, as many studies rely heavily on self-reported attitudes rather than concrete system-level outcomes such as retention, sense of belonging, behavioral change, or organizational climate. As a result, diversity training is often positioned as an overly simplified solution to a complex, multifaceted problem, constraining its capacity to generate sustained impact (Bezrukova et al., 2016; Devine & Ash, 2022). While such initiatives are often labeled ineffective, it is possible that expectations exceed what these programs are realistically designed to achieve (Leslie et al., 2025). The challenge lies less in the principles of DEI themselves than in the binary and politicized framing that frequently dominates organizational discourse. These issues warrant engagement marked by curiosity, openness, and professional dialogue rather than defensiveness or polarization.

Civility as a Foundational Element

Emerging scholarship suggests that civility is foundational to DEI principles. Respect for diversity, openness to differing perspectives, and cultural humility are consistently associated with a civil workplace climate. Research indicates that institutions with more diverse nursing faculty report lower levels of incivility, underscoring the importance of representation in academic leadership (Moore et al., 2024). Rather than involving overt aggression or physical violence, incivility consists of behaviors that violate socially accepted norms, such as disrespect and disregard for others, which can escalate into a reciprocal cycle of interpersonal equity and justice (Andersson & Pearson, 1999). However, empirical evidence directly linking inclusivity and DEI interventions to reductions in incivility remains limited. Few studies disaggregate incivility by identity variables such as race or gender, and longitudinal research is needed to assess whether improvements in diversity and inclusion lead to sustained reductions in uncivil behaviors over time (Devine & Ash, 2025; Leslie et al., 2025; Zhao et al., 2025). Critiques of DEI initiatives often cite concerns about prioritizing identity over merit, unclear actionable steps, or poorly executed programs that may foster resentment. Nurse leaders must therefore reassess inclusive strategies to ensure alignment with ethical obligations while avoiding approaches that undermine trust (Parchment, 2023).

Existing evidence also links workplace incivility to increased stress and diminished well-being among nurses (Alsadaan et al., 2024). Power imbalances are central to these dynamics, with far-reaching consequences for professional socialization and practice. For instance, nursing students exposed to faculty incivility may internalize these behaviors, perpetuating them throughout their careers (Mrayyan, 2024). Although participation in DEI initiatives is often institutionally rewarded, much of the literature relies on self-report measures that lack validated instruments and clear connections to patient outcomes or organizational performance (Shah et al., 2024). Notably, few studies conceptualize incivility explicitly as a DEI-related issue, despite clear intersections among inclusion, power, and workplace behavior.

Challenges also arise when inclusivity initiatives are not meaningfully embedded within an organization’s mission, structure, and governance. Stated values alone are insufficient; sustained cultural and structural change is required. While many interventions demonstrate short-term benefits, rigorous evaluation of long-term outcomes remains limited (Shah et al., 2024).

Increasing workforce diversity without adequate leadership preparation and diversity competence may introduce relational strain or misunderstandings (Kamau et al., 2023). Nurse managers play a critical role in fostering psychological safety, modeling ethical leadership, and ensuring accountability. System-level strategies that align leadership behaviors with organizational values are essential to maintaining workforce well-being and high-quality patient care (Santos et al., 2025).

A Focus on Nursing’s Professional Values

The limitations of many DEI initiatives reflect broader systemic challenges, including insufficient educator preparation, cultural resistance, and misalignment between espoused values and everyday practice. In higher education, curriculum-based diversity efforts frequently measure success through shifts in individual attitudes rather than system-level outcomes such as academic performance, institutional climate, or sense of belonging (Ash et al., 2025; Devine & Ash, 2022). Within nursing, silence shaped by gender norms and hierarchical structures further highlights need for reforms that promote psychological safety, support speaking up, and reinforce accountability (Hauenstein, 2025). Despite these challenges, inclusivity remains a foundational nursing value, reflected in professional standards, competencies, and ethical obligations (American Association of Colleges of Nursing, 2021; American Nurses Association, 2025).

Diversity, equity, and inclusivity remain foundational to the ethical practice of nursing and the profession’s commitment to equitable, high-quality patient care. While formal DEI programs have expanded in scope and visibility, their mixed effectiveness highlights the need to move beyond fragmented initiatives toward strategies that are ethically grounded, evidence-based, and systemically integrated. The challenges associated with DEI initiatives do not negate the importance of inclusivity; rather, they underscore the necessity for thoughtful implementation, leadership accountability, and sustained cultural change. By fostering civility, psychological safety, and openness to differing perspectives, nurse leaders can uphold professional values while navigating evolving social and political landscapes. Creating environments where respectful dialogue is encouraged, differing perspectives are valued, and members can speak up without fear of retaliation is crucial. Ultimately, advancing equity in nursing does not depend solely on the presence of DEI programs but on the profession’s enduring commitment to dignity, respect, and justice for all individuals it serves.

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