A report released Monday by the Health Resources and Services Administration (HRSA) indicate that efforts to grow and diversify the nursing workforce are showing results—a welcome finding given the looming shortage of nurses and primary care providers in general.

According to the data from HRSA's National Center for Health Workforce Analysis, the nursing profession grew substantially in the 2000s, adding 24 percent more registered nurses (RNs) and 15.5 percent more licensed practical nurses (LPNs). Significantly, the growth in the supply of nurses outpaced growth in the U.S. population, with the number of RNs per capita growing by about 14 percent and the number of LPNs per capita increasing by 6 percent.

The "pipeline" carrying nurses from school to the workforce also expanded during the past decade. The number of would-be nurses who passed national nurse licensing exams to become RNs more than doubled between 2001 and 2011, while the number of LPN test-passers grew by 80 percent. Significantly, the share of licensure candidates with bachelor's degrees increased during that time, as well.

The profession also is growing more diverse, according to the data. Non-white RNs are now 25 percent of the profession, up from 20 percent 10 years ago. Nine percent of RNs are men today, up slightly from 8 percent at the beginning of the decade.

The full analysis is available at HRSA's website.

Catherine J. Malone, MBA, DBA(c), is a program associate working in the areas of diversity and nursing for the Robert Wood Johnson Foundation. This is the first in a series of posts looking at diversity in the health care workforce.

As a member of the Robert Wood Johnson Foundation’s (RWJF) Human Capital team leading the group’s diversity efforts and the Foundation’s Diversity Team, I would like to share some of our work in this area. I must start by noting that “diversity” means different things to different people. At RWJF we recognize and value all types of diversity and therefore have a broad definition of the term which is described in the Foundation “Diversity Statement” below:

“Diversity and inclusion are core values of the Robert Wood Johnson Foundation, reflected in our Guiding Principles. We value differences among individuals across multiple dimensions including, but not limited to, race, ethnicity, age, gender, sexual orientation, physical ability, religion and socioeconomic status. We believe that the more we include diverse perspectives and experiences in our work, the better able we are to help all Americans live healthier lives and get the care they need. In service to our mission, we pledge to promote these values in the work we do and to reflect on our progress regularly.”

Michael R. Bleich, PhD, RN, FAAN, is Maxine Clark and Bob Fox dean and professor at the Goldfarb School of Nursing at Barnes-Jewish College in St. Louis, Mo. He is an alumnus of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program (2000-2002).

With help from co-authors Brent MacWilliams, PhD, ANP, and Bonnie Schmidt, PhD(c), RN, in our recent American Journal of Nursing article summarizing research on men in nursing—and further inspired by a manuscript by Dena Hassouneh, PhD, ANP, entitled Anti-Racist Pedagogy: Challenges Faced by Faculty of Color in Predominantly White Schools of Nursing in the July 2006 issue of the Journal of Nursing Education—I am in a reflective place. After a nearly 40-year journey as a male in nursing, I now realize the discipline was never designed for me.

"Why did the faculty not do more to buffer me from faculty who were overtly gender-disparaging? Why were the gloves in procedural kits always sized for smaller hands?"

That is not to say that I have not had a fabulous career, worked with the finest colleagues one could imagine, or had opportunities that provided continuous challenge and opportunity. But as a discipline, nursing has had its broad shifts.  Florence Nightingale was a master of evidence-based practice and spent a lifetime elevating nursing to a discipline in a world that was political, gender-biased against women, scientifically evolving, caste-oriented, and more. The gift of structure, process, and outcomes she gave nursing are irreplaceable.

Nurses play a critical role in expanding access, improving quality, and reducing the cost of health care for millions of Americans. But today’s nursing workforce is not nearly as diverse as the country.

Numerous studies find that a more diverse nursing workforce can provide care that is more culturally competent, offering benefits to patients, the health care system, and communities. As the Institute of Medicine's landmark report, The Future of Nursing: Leading Change, Advancing Health, notes, “Because nurses make up the largest proportion of the health care workforce and work across virtually every health care and community-based setting, changing the demographic composition of nurses has the potential to effect changes in the face of health care in America." 

Click the "Read More" link to see the infographic, or download it here.

Though it remains a predominantly female profession, a new study from the U.S. Census Bureau finds that the percentage of nurses who are male more than tripled from 1970 to 2011, from 2.7 percent to 9.6 percent.

The Census Bureau’s Men in Nursing Occupations also finds the proportion of male licensed practical and licensed vocational nurses increased, from 3.9 percent to 8.1 percent. Men's representation was highest among nurse anesthetists (41%).

“The aging of our population has fueled an increasing demand for long-term care and end-of-life services," said the report's author, Liana Christin Landivar, a sociologist in the Census Bureau's Industry and Occupation Statistics Branch, said in a news release about the study. “A predicted shortage has led to recruiting and retraining efforts to increase the pool of nurses. These efforts have included recruiting men into nursing.”

The study also found that men typically earn more in nursing fields than women, but not by as much as they do across all occupations.  Male nurses earned an average of $60,700 in 2011—16 percent more than the average earnings for female nurses, which was $51,100. The difference in earnings is due partly to the concentration of men in higher-paid nursing occupations, like nurse anesthetics. “Men have typically enjoyed higher wages and faster promotions in female-dominated occupations,” the study says, a phenomenon known as the “glass escalator” effect.

Read the study.
Read a news release about the study.

Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows and grantees. Some recent examples:

Susan B. Hassmiller, PhD, RN, FAAN, RWJF senior adviser for nursing, spoke this month at the Oregon Center for Nursing conference on the future of nursing leadership, according to The Lund Report. “We need to be keeping more data, recording our expertise and speaking up for ourselves so when people say quality of care, they will also say, quality of nursing,” she said.

Alicia I. Arbaje, MD, MPH, an alumna of the RWJF Harold Amos Medical Faculty Development Program and the RWJF Clinical Scholars program, was a guest on NBC Nightly News discussing the need for older adults to live in “dynamic environments” like college towns, where they can stay physically active and socially engaged. See the clips here and here.

A white paper co-authored by RWJF Investigator Award in Health Policy Research recipient Kathleen Sutcliffe, PhD, “breaks down the behaviors of managers who are the best at anticipating, containing, and repairing catastrophes,” Business Insider reports. Among those behaviors: they overcome cognitive biases and update their beliefs, and they don't ignore small problems until they snowball into larger ones.

Science Magazine reports on research by RWJF Scholars in Health Policy Research alumnus Rashawn Ray, PhD, that finds women of color often encounter an unwelcoming environment in graduate school, and have a particularly hard time finding primary mentors who share their experiences and can provide guidance.

A report from the Association of American Medical Colleges (AAMC) documents an overall trend toward increased diversity among students applying to medical school.

AAMC’s Diversity in Medical Education: Facts and Figures 2012 finds that nearly half of the applicants to U.S. medical schools in 2011 were non-White. Whites were the largest group of applicants, followed by Asians. “Compared with 2010, in 2011 the percentage of Hispanic or Latino applicants increased by 5.7 percent and the number of Black or African American applicants grew by 5 percent,” the report says.

But only 2.5 percent of medical school applicants in 2011 were Black men. Twice as many Black women as men applied to medical school that year, creating the biggest gender gap in medical school applicants among all racial or ethnic groups.

“We have a major, major problem in this country,” Marc Nivet, EdD, AAMC’s chief diversity officer, told American Medical News. “There is just simply an enormous amount of indisputable evidence that we’re not intervening as effectively as we’d like as a society to increase the talent pool of African-Americans who are capable of taking advantage of the science curricula available up and down the pipeline.”

This is part of a series introducing programs in the Robert Wood Johnson Foundation (RWJF) Human Capital Portfolio.

The Harold Amos Medical Faculty Development Program
is on the verge of a milestone: it will observe its 30th anniversary this year.  In 2012, the program achieved another notable distinction, as a third alumnus was selected to lead an institute at the National Institutes of Health: Gary Gibbons, MD, (’88) is now director of the National Heart, Lung, and Blood Institute (NHLBI). He joined Griffin Rogers, MD, MACP, (’83) Director of the National Institute of Diabetes and Digestive and Kidney Diseases; and Roderic Pettigrew, MD, PhD, (’83) Director of the National Institute of Biomedical Imaging and Bioengineering.

Formerly known as the Minority Medical Faculty Development Program, the Harold Amos Medical Faculty Development Program (AFMDP) was created to increase the number of faculty from historically disadvantaged backgrounds who can achieve senior rank in academic medicine or dentistry, and who will encourage and foster the development of succeeding classes of such physicians and dentists. AFMDP offers four-year postdoctoral research awards to historically disadvantaged physicians and dentists who are committed to developing careers in academic medicine and to serving as role models for students and faculty of similar background.

Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows and grantees. Some recent examples:

The Baltimore Times reports on the Tour for Diversity in Medicine, founded in part by RWJF Summer Medical and Dental Education Program (SMDEP) alumnus Alden Landry, MD, MPH. Several weeks each year, the Tour visits college campuses across the country to promote careers in the health professions to students from groups underrepresented in higher education. Read more about the Tour for Diversity here and here.

Jason Karlawish, MD, recipient of an RWJF Investigator Award in Health Policy Research, spoke to the Philadelphia Inquirer about tests for Alzheimer’s disease. Read posts Karlawish wrote for the RWJF Human Capital Blog about the disease and the challenges associated with early diagnosis.

Pharmacy Times reports on a perspective piece in the New England Journal of Medicine, co-authored by Investigator Award recipient Aaron Kesselheim, MD, JD, MPH. It addresses concerns about a proposal to increase liability for generic drug manufacturers for adverse reactions. Read a post Kesselheim wrote for the RWJF Human Capital Blog about pharmaceutical industry marketing to medical students.

Practices that work within a particular framework of goals and priorities can become engrained in the work of institutions. But what happens when the framework shifts?  Regular review of practices and the assumptions that support them offers one of the best opportunities to enhance diversity and inclusion, which can in turn improve the effective results of Scholar and Fellow programs. 

The Robert Wood Johnson Foundation (RWJF) Diversity Matters Podcast Series features host Jacinta Gauda in conversation with leaders and subject matter experts on practical ways to support diversity and inclusion.  In the podcast, available now, W. David Brunson, DDS, Senior Director of the Policy Center for Access, Diversity, and Inclusion of the American Dental Education Association (ADEA), and Marc Nivet, EdD, Chief Diversity Officer, Association of American Medical Colleges (AAMC), discuss the practice of holistic review. 

Increasingly adopted by medical and dental schools, holistic review is sometimes misunderstood as affirmative action or as an initiative designed solely to increase diversity.  Nivet and Brunson will clear up these misconceptions, and explain what it is and what it is not.  Listeners will learn how the practice evolved, how it is applied equitably across the entire applicant pool, and how it aligns admissions policies, processes, and criteria with institution-specific goals.  Nivet and Brunson will also describe ADEA- and AAMC-sponsored workshops in which admissions deans, staff, and committee members learn how to integrate holistic review into their admission processes.  

Holistic review can help institutions to achieve the true culture of diversity and inclusion that they will need if they are to effectively address the nation’s challenges in health and health care.

Visit the Diversity Matters Community to download podcasts and summaries for practices that are working to increase representation in health and health care.