Walk into any hospital across the country and chances are the nurses who work there don’t reflect the rich diversity of the U.S. population.
The demographic discrepancy threatens to undermine efforts to improve patient care and narrow health disparities, key Black nurse leaders said earlier this month as the nation was commemorating Black History Month.
The lack of diversity is a problem now, but nurse leaders say it is all the more grave in light of projections that racial minorities will represent the majority of the population by mid-century. Yet the nursing workforce, the largest group of health care professionals in the country, is predominantly White.
“Caring for the emerging majority in our country requires that we have a diverse nursing workforce that is much more reflective of our populace,” said Linda Burnes Bolton, Dr.P.H., M.P.H., M.S.N. vice president for nursing, chief nursing officer and director of nursing research at Cedars-Sinai Medical Center in Los Angeles and a former president of the National Black Nurses Association. “If we’re all the same, we limit our ability to learn about how we can improve the practice of nursing.”
Drawing attention to the problem is a report on the future of nursing released last fall by the Institute of Medicine (IOM) that urges nurses, health professionals and others to step up efforts to increase the diversity of the profession. The report, called The Future of Nursing: Leading Health, Advancing Change, calls for a “greater emphasis” on increasing diversity of the workforce and ensuring that nurses are able to provide culturally relevant care. Learn about the Robert Wood Johnson Foundation’s Future of Nursing: Campaign for Action.
To enhance diversity, the report recommends changes to the nurse education system. It urges academic nurse leaders to partner with health care organizations, school systems, and other community organizations to recruit and advance nursing students from all backgrounds.
It also urges donors to expand funding for accelerated graduate degree programs for nurses to increase the diversity of nurse faculty, scientists and researchers. And it calls for mentoring and bridge programs that connect undergraduate programs with graduate-level ones.
“The IOM report will assist in shining a light on the problem,” Burnes Bolton said. But, she added, the nursing community and others need to follow through to speed up progress. “The most important thing is that the report doesn’t sit on the shelf.”
The Robert Wood Johnson Foundation has committed itself to increasing diversity in nursing through programs such as New Careers in Nursing, which works to increase the diversity of nursing professionals to help alleviate the nursing shortage, and the Robert Wood Johnson Foundation Ph.D. in Nursing with a Concentration in Health Policy at the University of New Mexico, which prepares nurses, especially those from underserved populations in the Southwest, to become distinguished leaders in health policy.
Other RWJF programs aim to increase the diversity of all health professionals, including nurses, such as Project L/EARN, which provides undergraduate college students traditionally underrepresented in graduate education with a 10-week summer internship designed to make them stronger candidates for admission to graduate programs.
Another proactive step will come this summer at the annual conference of the National Black Nurses Association, which is celebrating its 40th anniversary this year. The group plans to launch a youth summer enrichment program at the Indianapolis conference to educate and help prepare minority students for careers in nursing. “We’re trying to build the pipeline,” said Debra A. Toney, Ph.D., R.N., F.A.A.N., president of the National Black Nurses Association, a former RWJF Executive Nurse Fellow (2006-2009), and president of a health care service organization in Nevada.
Still, much more work is needed to ensure that all patients get the culturally sensitive care they need, said Beverly Malone, Ph.D., R.N., F.A.A.N., head of the National League for Nursing; the first Black woman to head the Royal Academy of Nursing; and a member of the National Advisory Committee of the RWJF Nurse Faculty Scholars program. “Increasing diversity takes time,” she said. “It takes a strategic plan, and the budget to go with it, and that’s what we’re missing.”
And it’s not just nurses who need to take action, Burnes Bolton added. “The nursing community is part of the solution, but it’s only part of it. It requires government agencies, the U.S. Congress, the business community, the service community and consumers together to make change. It’s not just about nursing. It’s about getting to a healthier nation.”
More Diverse Nation Needs More Diverse Nursing Workforce
More diversity among nurses fosters better interaction and communication with patients of a variety of all backgrounds, the IOM report states. Previous IOM reports buttress this claim, finding that greater racial and ethnic diversity among providers leads to stronger relationships with patients in nonwhite communities. According to the 2002 IOM report, Unequal Treatment: Addressing Racial and Ethnic Disparities in Health Care, diversification of the health care workforce is an effective way to narrow racial and ethnic health disparities.
A more diverse nursing workforce will become even more critical as the U.S. population becomes increasingly diverse, nurse leaders say.
Minority groups currently comprise about a third of the U.S. population and are poised to reach majority status in 31 years, according to the U.S. Census Bureau. Yet the nursing workforce remains predominantly White. Indeed, Whites comprise 66 percent of the population but represent 83 percent of the nation’s RNs, according to the 2008 National Sample Survey of Registered Nurses.
Blacks, by comparison, comprise 12 percent of the population but just 5 percent of the nation’s RNs. The discrepancy is even starker for Latinos, who make up 15 percent of the population but hold just 4 percent of the nation’s RN jobs. American Indian or Alaska Natives represent 1 percent of the population but hold 0.3 percent of R.N. jobs.
Asians are the only minority group that defies the trend. People who describe themselves as Asian, Native American, or Pacific Islander comprise 4.5 percent of the population but represent 6 percent of the RN workforce.
Men are also vastly outnumbered. The number of male RNs has soared in the last two decades, rising from 45,060 in 1980 to 168,181, according to the Health Resources and Services Administration. But despite this progress, men still make up only 7 percent of all RNs.
Gregory Jones, B.A., R.N., who works at the specialty resource unit of Cincinnati Children’s Hospital Medical Center, tells of being one of just two men in a class of 50 nurses recently. A nurse for six years, Jones said, “We’re a diverse population and we need a diverse nursing workforce. You can’t have just one particular type of person in this field. You need to make a heart-to-heart connection with patients and their parents.”
“Once you make that connection,” Jones added, “you build trust and give security to the patient. I’m an African-American man – 6’3” and 300 pounds – so I don’t fit the nurse stereotype. But I can break the ice, make connections. We need a little bit of every type of person to make this a strong workforce.”
William T. Lecher, R.N., M.S., M.B.A., N.E.-B.C., president of the American Assembly for Men in Nursing, said the organization’s goal is that men will be 20 percent of the people in nurse education programs by the year 2020. The Assembly is active in the work of the Center to Champion Nursing in America, and helping to advance the Future of Nursing’s diversity recommendations. It is developing a social media and YouTube campaign, to launch by October. The campaign will address questions including: How does a boy tell his parents that he wants to become a nurse?
For men who want to go into nursing, “the barriers are the same as they’ve always been,” Lecher said. He reports visiting his children’s classrooms and having their classmates say, “You can’t be a nurse because you’re a man.” There are still cultural issues, he says: “America still sees nursing as not men’s work. I’ve been a nurse for a long time, and I’ve never looked back, never regretted it. The nursing shortage will not be solved unless gender is part of our focus. There’s room for all of us.”
The nation’s campuses already hold promise for the future in diversifying the nursing workforce.
In the 2008-2009 school year, ethnic minority groups made up 28 percent of those in associate’s degree nursing programs; 24 percent of those in bachelor’s degree nursing programs; 24 percent of master’s degree nursing program students; and 20 percent of doctorate nursing degree students, according to the National League for Nursing.
Still, diversity in nursing education “continues to be a challenge,” especially in advanced education, according to the IOM report.
“Not much progress has been made,” Toney said. “The population is changing quickly, and we have not kept up with it, and I don’t know if we will catch up. I think that we just have to keep trying.”
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