Increasing diversity in the nursing workforce has been cited as key to decreasing long-standing health disparities in the United States. [1][2][3] Yet, Black, Hispanic/ Latinx, Native American, and Asian American nurses remain inadequately represented in the health care workforce. 4 Most recent data from the 2018 National Sample Survey of Registered Nurses (RNs) show that White, non-Hispanic RNs accounted for 73.3% of the RN workforce, followed by Hispanic/Latinx (10.2%), Black non-Hispanic/Latinx (7.8%), Asian non-Hispanic/Latinx (5.2%), and American Indian or Alaska Native non-Hispanic/Latinx (0.3%) RNs. 5 Although the number of underrepresented minority (URM) nurses in the US workforce has increased over time, these figures are not reflective of the demographic characteristics of the US population. 4,6,7 Mounting evidence shows that nursing workforce diversity is essential to the provision of high-quality care and culturally effective care. 1,8,9 This is particularly important in light of the coronavirus disease-2019 (COVID-19) pandemic, which has disproportionately impacted Black, Hispanic/Latinx, and Native American communities-further magnifying existing health disparities among these groups. 5,[10][11][12] Therefore, assessing factors associated with success for URM students in nursing is an essential step toward removing barriers that hinder nursing workforce diversity and developing interventions that enhance successful academic outcomes (eg, retention) for this group.Graham et al 13 conducted an integrative literature review from 1985 to 2015 that focused on examining facilitators and barriers to success among URMs and highlighted academic factors that may affect retention in the nursing program. The authors identified specific barriers to students' success, including faculty practices and interaction with peers. To expand on this body of literature, our systematic review sought to appraise the current literature to provide a more current understanding of barriers and facilitators to
A set of 300 vaginal smears was interpreted by 13 cytologists from six European laboratories, who were requested to report inadequate and suboptimal smears. The set had been appropriately seeded to reach approximately 10% inadequate and 20% suboptimal smear frequency. According to the majority report, 230 smears were classified as adequate (76.7%), 43 as inadequate (14.3%), and 27 as suboptimal (9.0%). Agreement with the majority report ranged from 52% to 91% (average 78%). Kappa statistics for reporting inadequate smears showed a high level of agreement for five cytologists, and fair to good agreement for eight. In contrast, kappa statistics for reporting suboptimal smears showed fair to good agreement with the majority report only in five instances, whereas agreement was poor for eight cytologists. 'Inadequate smear' rates may be used to compare the quality of smears received in different laboratories, as there is a high level of agreement among cytologists as to what constitutes an inadequate smear. However, this is not true for "suboptimal smear" rates, and more precise reporting criteria must be defined and tested if an intermediate category is to be retained to report poor quality smears: more precise reporting criteria must be defined and tested if an intermediate category is to be retained to report poor quality smears.
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