Diversity in Nursing: Will It Ever Match Patient Demographics?

By Debra Wood, RN, contributor

Recognizing how a diverse nursing workforce can help achieve health equity for patients from different backgrounds, nursing leaders have developed a variety of initiatives that are showing results. Yet more work is needed to achieve diversity in nursing that more closely resembles patient demographics.
“The demographics are changing,” said Beverly Malone, PhD, RN, FAAN, CEO of the National League for Nursing in Washington, D.C. “This is our history in the United States of America, and we need to be aware of it.”

Veronica Vital, PhD, RN, assistant professor at Chamberlain College of Nursing in Phoenix and a member of the board of directors for the National Association of Hispanic Nurses (NAHN), added, “It is projected that by 2050, minorities will represent approximately 50 percent of the U.S. population, and therefore, diversifying the demographic of the nursing profession is important so nurses can mirror the face of the communities we serve.”

NAHN has received a National Institutes of Health grant for a radio and social media campaign to promote the nursing profession and encourage young Latinos to become nurses. NAHN provides scholarships for students seeking a career in nursing and for those choosing to advance their career.

“Diversity in health care matters, because when you have a diverse health care provider workforce, then you have the ability to achieve better health outcomes,” explained Vernell Dewitty, PhD, RN, director of the New Careers in Nursing Scholarship Program at the American Association of Colleges of Nursing (AACN). “We know that, because there has been some evidence that tells us so.”

A 2006 Health Resources and Services Administration (HRSA) study found that increasing diversity in nursing and the overall health care workforce can improve access to and the quality of care minorities and underserved populations receive. This is because minority providers exhibit a greater willingness to practice in areas with minority populations, and they deliver culturally and linguistically appropriate services.

“Patients who have providers who look more like them have improved communications, and it improves the decision making,” Dewitty said. “Greater diversity increases the level of trust.”

AACN and the Robert Wood Johnson Foundation (RWJF) launched the New Careers in Nursing Scholarship Program in 2008 to increase the numbers of under-represented persons in nursing. Since that time, 2,382 nurses have completed the program. The program has awarded 3,321 scholarships, with some students still completing their nursing studies. AACN is seeking funders to continue the program after this year.

Then in 2010, the Institute of Medicine included among its recommendations in the “Future of Nursing” report the need to diversify the nursing workforce, including nurses with bachelor’s degrees and nurses with doctoral degrees. The RWJF- and AARP-supported Campaign for Action has taken those recommendations seriously. Each application for funding must include a plan to address nursing diversity. The Diversity Steering Committee, comprised of leaders of minority nursing organizations, reviews each application.

“Diversity is a big deal with the strategies we are addressing,” said Sue Hassmiller, RN, FAAN, PhD, a senior program officer and team lead for human capital at the RWJF. “We take this very seriously, and we are having good results.”

The Montana Action Coalition has developed a diversity in nursing plan to bring more Native Americans into the profession. The “Caring for Our Own” Program at Montana State University provides faculty support and tutors to Native American students in obtaining a BSN. Blackfeet Community College, on the Blackfeet reservation about 350 miles north of the university, has established a registered nursing program, so candidates do not need to travel to get their degree.

Elda G Ramirez, PhD, RN, FNP-C, FAANP, a professor at the University of Texas Health Science Center at Houston School of Nursing, has a different take on the topic of nursing diversity. She said the profession needs more nurses who are rich and poor and more average students, who have the personality and ability to build relationships.

“We are counting out groups of people who would be amazing nurses,” Ramirez said. “There are so many definitions about what diversity means.”
Ramirez believes all patients should receive the best care, regardless of their race or ethnicity.

Several barriers exist to having a more diverse nursing workforce, including admission policies and weak minority representation among nursing faculty and within health care organizations.

“It’s a big-time faculty problem,” said Malone, adding that diversity in the faculty ranks is not improving, but it is getting better among the population of nurses in the workforce.

The NLN Jonas Scholars Program provides fellowships to support nursing education research students. Several are studying diversity issues and a number are from diverse backgrounds.

“People need role models, to see people who look like them and feel comfortable talking to,” Hassmiller added. “Mentors are so important.”

Janet C. Mentes, PhD, APRN, FAAN, at the University of California, Los Angeles School of Nursing, is a co-principal investigator in the National Institutes of Health-funded Bridges to the Doctorate program, which encourage diversity in research and faculty roles. Minority students from the entry-level master’s program at Charles Drew University interested in a doctorate and research in health care in different ethnic groups receive mentoring for 6–9 months before applying.

“Students feel comfortable when they see someone from their background they can relate to,” Mentes said. “A lot of the nursing knowledge we have is based on majority culture….I encourage these students to take what we know and take it to diverse patient populations.”

AACN is nearing the end of a pilot program to increase the diversity of nurse leaders, researchers and faculty. The program encouraged graduates from New Careers in Nursing to continue with their studies and enter a doctoral program. Participating faculty members served as mentors.

“They bring a different voice and speak to the issues that need to be addressed in health care,” Dewitty said. “We are making progress, but there’s more to be done.”

Comparison of Nursing Diversity to General Population
Ethnic or Gender Group Registered Nurse Population General Population
Caucasian 83% 77.7%
African American 6% 13.2%
Asian 6% 5.3%
Hispanic 3% 17.1%
American Indian/ Alaskan Native 1% 1.2%
Native Hawaiian/ Pacific Islander 1% 0.2%
Females 93%* 51%
Males 7%* 49%

Nursing diversity data from the National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers 2013 study.
Population demographics data, U.S. Census, 2014.
* U.S. Census reports males comprise 9.6% of the nursing workforce.

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