A few years ago, a colleague at the University of Michigan approached Antonia Villarruel and said: “Gee, the dean must love you because you’re Latina and you have research grants!”
Villarruel responded flatly: “Let’s be clear: She loves me because I have grants.” End of story.
Villarruel, a Mexican-American, cites that incident as one example of the kind of microaggression she encountered in her climb from a childhood in a working class Detroit neighborhood to the upper echelons of academic nursing.
“There’s this constant message that you’re here, but you’re not good enough, so you’re always having to prove yourself,” she says. “I don’t take it personally. It’s what happens when you don’t fit the mold.”
Despite the ongoing microaggression, Villarruel has risen to become one of the most prominent Latinas in nursing—and an example of how minorities can thrive and survive in a predominantly white profession like nursing. In July, she officially became dean of the University of Pennsylvania School of Nursing, one of the country’s premier nursing schools and home to numerous leading nurse scientists.
It’s not her first time on the Philadelphia campus. Villarruel first came to the University of Pennsylvania in the 1980s to earn her master’s degree in nursing and returned in the late 1990s—after earning her doctorate in nursing at Wayne State University and completing a post-doctoral fellowship at the University of Michigan—as an assistant professor. Now back as dean, she aims to continue her work to diversify the nursing workforce—an increasingly urgent goal as the country grows more diverse.
One way to do that, she says, is to make a Penn nursing degree more accessible to students of all backgrounds. The University of Pennsylvania, she notes, offers need-based, loan-free tuition for undergraduate students, and the nursing school continues to benefit from this initiative. Two other items at the top of her agenda: supporting faculty and students to create science that will make a lasting difference in people’s lives; and ensuring that nurse innovations—particularly those that improve the quality and safety of care and promote a Culture of Health—are recognized, disseminated and widely adopted.
Villarruel’s deanship is the capstone achievement in a stellar career that began decades ago, and not by unfettered choice. Her parents allowed their three sons to choose their own careers but limited their daughter to teaching and nursing—two of the few socially acceptable professions for Latina women at the time. Villarruel decided to become a nurse—a career that, as it turns out, now has virtually unlimited leadership potential.
She graduated in the 1970s with a bachelor’s degree from a small college in Kalamazoo, Mich., and held numerous positions at the Children’s Hospital of Michigan. Her interest in research developed and was focused on improving the assessment and treatment of children’s pain, especially for minority youth. Later, thanks to her doctoral work and involvement with the Detroit Latino community, she realized the greatest impact she could make as a Latina nurse researcher would be to work on issues of particular concern to Latinos. After earning her doctorate, she pursued post-doctoral training in health promotion at the University of Michigan and, in consultation with the community, decided to focus on developing evidence-based ways to curb the high rates of teen pregnancy among Latinas.
Villarruel arrived in Philadelphia as faculty in 1995—as HIV was emerging as a major health concern among minority populations. While there, she partnered with colleagues who were developing an effective intervention to reduce sexually risky behaviors among black youth. Villarruel and her partners decided to adapt it for Latino youth to decrease sexually risky behaviors in the population and associated consequences like HIV and unintended pregnancy.
It was uncharted territory. Even though Latinos experience disproportionately high rates of teen pregnancy and HIV transmission, no one had developed culturally specific and effective ways to reduce sexually risky behavior among Latino youth—in part, she says, because of a dearth of Latino researchers in the sciences. Villarruel wrote a grant proposal to create a culturally sensitive intervention targeted at Latino youth and was rejected—again and again. “It was a struggle to get in the door,” she says. “People identified the need for the research, but the research base wasn’t strong enough to propose a solution.”
She questioned herself and her research, but persisted in spite of the rejection and eventually received funding to develop “Cuídate”—a Spanish word that means "Take care of Yourself." The six-hour intervention is delivered to small groups of Latino adolescents and promotes abstinence and safer sex within the frame of Latino culture. “I made sure I had the evidence, I made the case, and I sought and received honest critiques of my work,” she recalls. “Those lessons really helped me in the long run.”
In 1999, she received funding from the National Institutes of Health to conduct a randomized controlled trial—the gold standard in scientific research—to evaluate the effectiveness of the intervention. It was shown to reduce the number of sexual partners of participants, reduce their rate of unprotected sex, and increase the age at which they first had sex. The results were found to be sustainable over the long term.
The intervention is now used widely across the United States and Puerto Rico, reaching untold numbers of people. The Centers for Disease Control and Prevention and the U.S. Department of Health and Human Services Office of Adolescent Health have included it as one of their evidence-based interventions, and states are able to use federal funds to implement it locally.
Villarruel has since tested a similar intervention in Mexico and has added a computer-based component to help parents discuss the effects of sexually risky behaviors with their children. “I can’t be more excited about it,” she says. “It’s been a lot of fun to work with youth, parents and communities to see how they incorporate it in their services and to see the impact it has had.”
In addition to conducting pioneering research, Villarruel has played a leading role as an advocate for Latinos and other underrepresented minorities in nursing.
A longtime member of the National Association of Hispanic Nurses, she served as the organization’s president from 1996-1998. During those years, Villarruel teamed up with heads of other minority nurse groups to found the National Coalition of Ethnic Minority Nurse Associations. She also serves as co-chair of the diversity steering committee of the Future of Nursing: Campaign for Action, a joint initiative of the Robert Wood Johnson Foundation (RWJF) and AARP to transform health care through nursing. In this role, she provides guidance to help state-level coalitions design initiatives to boost the diversity of the nursing workforce in their states.
Villarruel also sits on the National Advisory Committee of the RWJF Nursing and Health Policy Collaborative at the University of New Mexico, a program that aims to prepare a new generation of policy-oriented PhD-prepared nurses who focus on vulnerable populations. She has helped the program develop strategies to recruit Latino and Native American nursing students and evaluate competencies and outcomes to ensure that its graduates are set to become policy leaders.
One key way to boost diversity is to cultivate nurse leaders who can serve as role models to aspiring nurses from underrepresented backgrounds. Villarruel has played that role every day of her professional life—from her early days as a baccalaureate-prepared clinician to her years as a pioneering nurse scientist to her current position as dean of one of the nation’s most prestigious nursing schools. She has no plans to stop. “I think we have a ways to go to fully diversify the nursing workforce,” she says, “but I’m excited by what I see happening.”