Growing up, Adriana Perez experienced the kinds of challenges that are at the core of the immigrant experience in America. She learned English as a second language, attended underperforming public schools in a small town, and struggled to pay for college because her parents—who were farm workers—couldn’t afford to send her.
Through it all, Perez focused on the gifts she received during her upbringing: love and support from her family, guidance from her teachers and mentors, a strong work ethic derived from a culture that values hard work, and a personal drive to make a difference in her community.
When she reached adulthood, she made an unusual choice—at least for her demographic group: She became a nurse. Now an assistant professor of nursing at Arizona State University, Perez, PhD, ANP, is a member of the most underrepresented racial or ethnic group in nursing.
In 2013, Latinos comprised 3 percent of the nation’s nursing workforce, according to a survey by the National Council of State Boards of Nursing and the National Forum of State Workforce Centers, and 17 percent of the nation’s population, according to a U.S. Census Bureau fact sheet. And their numbers are growing: By 2060, Latinos are projected to comprise nearly one-third of the U.S. population. But their growth in nursing has been slow, Perez said.
Recruiting more Latino nurses is about more than parity in the nursing workforce; it’s about improving health and health care for Latinos, who have disproportionately high rates of HIV transmission, teen pregnancy, and chronic conditions like obesity and diabetes, according to data compiled by the Centers for Disease Control and Prevention. Latinos also are less likely to have health care coverage than other racial or ethnic groups.
More Latino nurses can help narrow disparities, experts say, because they are more likely to be able to provide culturally and linguistically appropriate care to Latino patients. “Having a culturally competent nurse really makes a difference in terms of compliance and patient outcomes,” said Elias Provencio-Vasquez, PhD, RN, FAAN, FAANP, dean of the nursing school at the University of Texas at El Paso and an alumnus of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program (2009-2012). “Patients really respond when they have a provider who understands their culture.”
The Institute of Medicine (IOM)—the esteemed arm of the National Academy of Sciences that advises the nation’s leading decision-makers on matters relating to health and medicine—agrees. In 2004, it published a report calling for a more diverse health care workforce to improve quality and access to care and to narrow racial and ethnic health disparities. And in 2010, the IOM released a report that included calls for greater diversity within the nursing profession in particular.
Latinos Aren’t Flocking to Nursing
Yet despite their growing numbers, Latinos are not flocking en masse to the nursing profession.
That’s in large part because of inequity in education, said Dan Suarez, BSN, MA, president of the National Association of Hispanic Nurses. “Many Latinos come from poor educational systems, and few concentrate on the kinds of science and math courses that are needed to enter nursing school. Latinos have the highest high school drop-out rate in the nation, and many students are just focused on staying in school and making it to graduation.”
Meanwhile, there are relatively few Latino nurse leaders and educators who can serve as role models, coaches and mentors to the next generation of nurses, Perez said. “When young people aren’t able to see themselves in those roles, it’s hard to imagine that they could be in that role.”
Language and culture also play a role. Latino parents often discourage Latino youth—and especially boys—from pursuing nursing because it is regarded as a low-status, low-pay service job in Mexico and parts of Latino America, Suarez said. “Parents tell their children they can do better than nursing ... Nursing has an image problem, and we’re trying to change that.”
The culture’s emphasis on traditional gender roles also discourages Latina wives and mothers from working outside the home and, if they do, from pursuing leadership positions, said Mary Lou de Leon Siantz, PhD, RN, FAAN, a professor at the Betty Irene Moore School of Nursing at UC Davis and an RWJF Executive Nurse Fellows program alumna (2004-2007). “The majority of Latina nurses go into associate degree programs and don’t see the need to go back for more education.”
Racism against Latinos, she added, is “full-blown,” especially amid the national debate over immigration. Academics and others retain unconscious biases against Latinos and members of other groups that are underrepresented in nursing.
RWJF is committed 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 RWJF Nursing and Health Policy Collaborative at the University of New Mexico, which prepares nurses, especially those from underserved populations in the Southwest, to become distinguished leaders in health policy. The Future of Nursing: Campaign for Action, a joint initiative of RWJF and AARP, is working to diversify the nursing workforce, with help from Perez and others. The National Association of Hispanic Nurses, meanwhile, offers scholarships to Latino nursing students.
But more needs to be done, Siantz and others said. Educational bridge programs to help students transition into nursing school are needed, as are interventions to dispel negative stereotypes about nursing among Latinos and increased mentorship for aspiring nurses and nursing students. “Latino nurses often talk about the influence of a family member, or a role model, or a mentor who told them to be a nurse,” said Perez, whose grandmother, a nurse in Mexico, encouraged her to pursue nursing in the United States. “We need to do more of that kind of outreach.”