Reflections on a Lifetime of Promoting Health

JoAnne Banks,1 PhD, RN; Sylvia Flack,2* EdD, RN
Author Affiliations: 1 Division of Nursing, Winston-Salem State University, Winston-Salem,
North Carolina; 2 Center of Excellence for the Elimination of Health Disparities, Winston-Salem State University, Winston-Salem, North Carolina Corresponding Author: JoAnne Banks, Division of Nursing, 601 S. Martin Luther King Jr. Drive, Winston-Salem State University, Winston-Salem, NC 27110 (wallacejbatwssu.edu)
*Retired
J Best Practice Health Prof Divers: Vol. 10, No. 1, Spring 2017


Dr. Sylvia Flack, EdD, RN, an icon for health professions diversity, retired from Winston-Salem State University (WSSU) in 2016 after decades of committed service. As a leader, she is best known for saving the WSSU’s nursing program from closure and conducting an annual leadership institute to strengthen nursing education on historically Black college and university (HBCU) campuses.

This is significant in that African American nurses comprise about 6% of registered nurses in the United States, and HBCUs, which educate a disproportionate number of BSN-prepared nurses, represent only a fraction of all programs.

Dr. Flack also championed the cause of health disparities in communities of color, opening community care clinics and serving as the first director for the Center of Excellence for the Elimination of Health Disparities on WSSU’s campus. She was interviewed on by JoAnne Banks, RN, PhD, the Bertha L. Shelton Endowed Professor for Research at Winston-Salem State University, in October of 2016. This interview highlights her thoughts and reflections on health professions diversity.
---
JB: Dr. Flack, would you please tell me something about yourself and where you came from
before you became the one and only Dr. Sylvia Flack?

Dr. Flack: Well, before I became Dr. Sylvia Flack, I was Sylvia Flack. And I’m still Sylvia
Flack. I came from a little town in North Carolina, Spindale, which is in the mountains near
Ashville. I was raised on a farm, and I am the last of seven children. I had a wonderful upbringing. I had the best parents in the world—I really did. They believed in education. My mother, my parents were pro-education advocates, even at that time.
They sought out the best educational opportunities for me. It was exciting to be accepted to
the nursing program Winston-Salem State University. My mother was out in the community
drumming up financial aid for me every place and any place that she could. My dad worked
as an orderly at the local hospital. He was instrumental in arranging for me to work there in
the summer before entering WSSU. Of course, I could only work as a maid at that time. But
that experience shaped my desire to excel in nursing and health care.

JB: Historically, African Americans have been underrepresented in the health professions.
What do you see as the major reason for that? And what do you see as the most important
thing in terms of changing that?

Dr. Flack: I’ve been in health care and health education for more years than I want to tell
you. In 2018, it will be 50 years.

JB: Oh, praise God!

Dr. Flack: Yeah. And the truth is, Dr. Banks, that there hasn’t been much change related to
African Americans except for the fact that we can get into educational programs much easier
than during my education. You know, at the time I started, African Americans could only
attend historically Black institutions. Now, there were a few people, a few of my teachers, for
example, that managed to get a master’s from the University of Chapel Hill. Some of the
aspects that changed I think have helped us, but not enough. The fact that it is recognized that the nation has problems such as disparities in health and health care especially for ethnic and racial groups has presented opportunities for these groups to seek health care professions.
And so, every now and then when that disparity issue becomes politically hot, you see more
money directed toward African Americans, Hispanics, American Indians, and Asians to prepare themselves to go into health care fields. Certainly, I believe that we do not face as many biases as we used to, but they’re still there. An example: until 1967 students from the WSSU nursing program were not allowed to train at Baptist or Forsyth [Hospital]. My class was the first class to train at Baptist. During my time as dean from 1989 to 2004 we had no trouble using facilities in this area for clinical. However, facing criticism and intense scrutiny, the faculty and students had to work hard to maintain an outstanding reputation in these facilities.

JB: So, now that some things have changed, what do you feel is the role of HBCUs and minority-serving institutions [MSIs] in terms of increasing the diversity in health professions? Do you see them as still being relevant?

Dr. Flack: Well, I still think HBCUs are graduating more health care professionals, mainly from nursing. Very few HBCUs and MSIs have the variety of health programs at Winston-Salem State University. In terms of the HBCU, health care programs can really become a plus. A mission to produce health care providers can offer HBCUs the uniqueness that is needed to resist the attempts to close these schools. When I joined WSSU I recommended that each department be connected in some way to programs or initiatives in health and
health care. I could see very clearly that the number of campuses in the UNC university system could serve as a liability to the HBCUs.
The board of governors was considering closing our nursing program, and if that had happened, I don’t think Winston-Salem State would be as it is today, because nursing was and still is the premier program. So, I think the goal of HBCUs should be to respond to the needs of this nation in preparing professional for jobs in
fields where there are shortages, one of them being health and health care. They should start
integrating health-related programs or initiatives not only in schools of health sciences or departments of health but in other programs. It will give HBCUs uniqueness. This could allow the political strength to resist closing and other major changes occurring in these universities.

JB: I’ve been talking to people and reading the Chronicle of Higher Education and the Journal
of Blacks in Higher Education. It seems like some of our health profession programs at HBCUs
are really struggling right now. Do you see that as being different, say, from when you first
started your work, or has that always been the same? And what accounts for the big struggle
that we’re having?

Dr. Flack: Well, there’s a lot. We struggled. I came here kicking and screaming. I didn’t mean to come back home, but there was something, a higher power, that said, “You’re going.” I had a choice between West Virginia and Winston-Salem. My son, who was a teenager, looked in my eyes and said, “Please don’t take me to West Virginia. Let’s go to Winston-Salem State.”
But yes, HBCU programs are still struggling. The Center of Excellence for the Elimination of Health Disparities (CEEHD) through its initiative, the National Strategy, sponsored eight annual nursing leadership institutes for HBCU and MSI nursing programs. Mostly, the conversations were about the issues facing our programs. These were some of the same issues as when I joined Winston-Salem State University in 1989.
What was wrong then? What were the struggles then?
The nursing program struggled with funding, student preparation, faculty morale and preparation, resources such as computer technology, lab materials, and clinical space. We experienced pressures from the university system, board of trustees, the N.C. legislators and the N.C. Board of Nursing, university administration, and the community. These are some of the same issues that the programs are facing today. Some of the tactics that the faculty and I used to improve the WSSU nursing program may be applicable to health professional programs in today’s environment. To comply with the needs of students, constituents, and authorities, we realized that integrating diversity could change the path of our nursing program. Diversity became our goal.

We diversified the student body in race and ethnicity, in age, in educational backgrounds and abilities, in
geographical location, and in life experiences. We diversified our program initiatives. We promoted our program as a place where students can realize their dreams and ambitions.
Our plan resulted in outreaching our RN to BSN programs throughout the state, as well as a paramedic-to-BSN program. There were students who drove from Tennessee, Virginia, and South Carolina for our paramedic- and RN-to-BSN programs.

One very interesting example is the paramedic-to-BSN program. There were paramedics from all over that state interested in obtaining BSN degrees. One group from Mount Airy met with us to talk about opportunities. Their request was to help them use their skills to become registered nurses. I thought about it, and I finally said to them, “But you’re not nurses.”
So, they went away with their tails tucked under and feeling bad because they had now approached UNC-G [University of North Carolina at Greensboro] and WSSU and received negative answers. My response worried me all night long. I called them the next day and said “Come back, let’s talk more.” And we kept talking, talking, until I saw a way. After reviewing their state curriculum, I saw a way of doing it. The rest is history, the first paramedic-to-BSN program in our nation. We designed a program that would allow them to continue working as paramedics. We analyzed their paramedic curriculum and compared it with the nursing
curriculum. We determined the gaps and designed a course of study.

JB: What are your thoughts about why it is that nursing—and you can correct me if I’m
wrong—but nursing, at least at Winston-Salem State, and I suspect at other HBCUs and minority serving institutions, has been more successful as compared to some of the other health
disciplines in terms of the recruitment, retention, and graduating diverse groups of people?

Dr. Flack: Well I think it probably had something to do with the necessity. Nursing was started in ’53 for African Americans. There has always been diversity in faculty and students at the university. I think under my leadership we really started to open to White and Hispanic students. I think we attracted diverse students because of the quality of the programs, as well as the fact that many of our students were considered adult students. The university is located geography in an area of the state that meets the commuting needs of many students.
The tuition compared to private schools, of course, is attractive. Now, physical therapy, a BS program at that time of inception, started with more White students than African Americans and other ethnic groups. The objective was to admit qualified students. At that time, we did not have many African American students applying to the program.
One of the issues that I have heard from not only our health science faculty but also faculty from other universities and schools is that students are entering college not prepared. Some students and particularly racial and ethnic and some foreign national students struggle with developing analytical, critical thinking, research, and problem-solving skills, which are necessary for building a hierarchy of learning. Many students steer away from courses where these skills are developed. Students and especially those who may be considered high-risk candidates for health professional programs should be engaged early on in their education.
This would require health professional programs to get involved in secondary education with
administrators, counselors, and students. As dean, I worked with the school system here in Winston-Salem. I attended the counselors’ meetings. I work closely with superintendents and kept them informed about the SOHS [School of Health Sciences]. The dean, associate deans, and directors of HBCU health-related
programs must be involved in the community. They must be political, which is not a good
word right now, but I’m going to say it. They must be political. You got to be out there, meeting people, talking about these programs, making sure that you’re a part of that backroom
talk where resources and money are allocated. Visibility is significant to health programs
because they are judged by their demonstration of excellence.

All sources: Peoples History of Winston Salem; WS Chronicle; Division of Nursing, Winston-Salem State University, Special Report-Interview

Continue reading this interview here: https://www.wssu.edu/academics/colleges-and-departments/school-of-health-sciences/journal-of-best-practices-in-health-professions-diversity/_files/documents/articles/j-best-pract-health-prof-divers-banks-and-flack-reflections-2017.pdf