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Meeting Nursing Demand Through Diversity

For the past decade, the nursing profession has made diversity a priority. While the numbers in the profession — less than 25 percent minority nurses — do not yet mirror the general population of the United States — 38 percent non-White people — solid efforts and strategies are at work to facilitate change.

In the near future, a severe shortage of nurses is expected due to the healthcare needs of aging baby boomers, new opportunities for nurses to take the lead in primary care and current nurses retiring.

Dr. Lisa LewisDr. Lisa Lewis

The fact sheet published by the American Association of Colleges of Nursing (AACN) notes that registered nursing (RN) is listed among the top growing occupations according to the Bureau of Labor Statistics’ Employment Projections 2014-24. The expansion of the RN workforce will warrant an increase of approximately 439,300 individuals by 2024. There will also be a need for 649,100 replacement nurses due to attrition and retirement. That means there are going to be more than one million nursing jobs to fill that need for qualified RNs.

Recruiting and training nurses who reflect the diversity of the American population are important to maximizing healthcare outcomes.

“Healthcare is an extremely personal experience,” says Dr. Joyce Knestrick, president of the American Association of Nurse Practitioners. “Patients want to have a relationship with their provider and cultural connections can help patients feel more comfortable in discussing their health concerns and issues.”

From 2008 to 2015, the Robert Wood Johnson Foundation sponsored AACN’s New Careers in Nursing (NCIN) scholarship program. Grants went out to 130 schools in 41 states and the District of Columbia that funded students in both bachelor’s and master’s programs. The end result is 2,706 individuals earned the bachelor’s of nursing degree (BSN) and 801 earned their master’s.

Data gathered provides valuable insights into how to successfully support students from underrepresented populations so they not only enroll in nursing school but also graduate and become part of the nursing workforce. Scholarships that cover incidentals in addition to tuition are helpful. Another factor is community engagement, says Dr. Vernell DeWitty, former deputy director of NCIN and now AACN’s director of diversity and inclusion. AACN also advocates for a pre-entry immersion program that includes time management, study skills, math and medical terminology.

“They really have to learn to manage their time and resources if they’re going to be successful,” DeWitty says. “This program contributed in a significant way to the low rate of attrition that we experienced.”

Mentoring is also very important. With funding from the Vice Provost’s Excellence Through Diversity funds and the Promise of Nursing for Pennsylvania nursing school grants, the University of Pennsylvania School of Nursing developed a structured peer mentoring program for first-year underrepresented minority BSN students. There is also the We Stand with Penn Nursing Students Initiative, a resource list of faculty, staff and postdoctoral fellows who identify as either underrepresented minorities or allies. A survey is in development for alumni.

Penn Nursing Students’ Emergency Fund for Incidental Purchases is financed by donations from faculty and staff at Penn. “The easily accessible emergency fund is intended to support incidental purchases such as groceries and toiletries,” says Dr. Lisa Lewis, associate professor of nursing and assistant dean for diversity and inclusion.

Dr. Seun Ross, director of nursing practice and workforce development for the American Nurses Association, says there needs to be more avenues for young people to learn about nursing — such as collaborations with high schools. An innovative example of that is the Rhode Island Nurses Institute Middle College Charter High School, the first public charter high school in the U.S. focused on nursing and healthcare.

AACN has undertaken a new project to increase diversity in nursing schools through a re-envisioned admissions process.

A 2014 report from the Urban Universities for Health showed that other schools in the health professions were already utilizing holistic admissions reviews — looking at qualified applicants in a more comprehensive way than just grade point averages and test scores. It enables schools to consider a broad range of factors that showcase an individual’s potential, which have been found to provide a significant boost to diversity. At the time of the report, 93 percent of dental schools, 91 percent of medical schools and 78 percent of doctor of pharmacy programs were utilizing holistic admissions reviews versus just 47 percent of nursing schools.

To rectify the situation, the Nursing Workforce Diversity program of the Health Resources and Services Administration (HRSA) is providing funds for 31 nursing schools on the understanding those schools must enter into a relationship with a professional organization that will provide training. AACN is partnering with 29 of those nursing schools. HRSA, which has several nursing diversity initiatives, has agreed to fund these programs for four years, so the programs have time to see an impact.

“First, we help them with the recruiting,” says DeWitty. “We also introduce and encourage them to implement pre-entry programs. We offer information and guidance about mentoring programs. These are strategies they can put in place and hopefully help those students be successful.”

Nursing school enrollment is not increasing at a rate commensurate with the growing demand. According to AACN’s report on 2016-17 enrollment and graduations in baccalaureate and graduate programs in nursing, U.S. nursing schools turned away 64,067 qualified applicants in 2016 because there wasn’t enough faculty.

“Faculty shortage makes it difficult to enroll larger classes,” says Lewis.

The average age of doctorally-prepared nurse faculty is around 56 and 55 for master’s degree holders. With a substantial number of nursing faculty contemplating retirement, there is an urgency to develop new, young faculty.

Some schools have implemented “grow our own” programs where BSN students who show potential for becoming teachers are identified. The school then offers to significantly subsidize their graduate studies on the understanding that upon completion they will teach at the school for at least three years.

University of Pennsylvania has a BSN to Ph.D. program called the Hillman Scholars Program in Nursing Innovation. At the College of Health Professions and Lienhard School of Nursing at Pace University, two home grown faculty members have already taken their spots. They are teaching undergraduate students and are working on developing their research. Pace’s “grow our own” specifically targets minority students.

“We recently started a Ph.D. program and we have about 10 students in that program,” says Dr. Harriet Feldman, a professor and dean of Pace’s nursing school. “Two of them are [currently] clinical faculty (teaching clinical practice and working with students in the field). Assuming everything goes well, they will reach their Ph.D.s in a few years and be able to enter tenure-track roles, whether here or somewhere else.”

Ross says that, when she was an undergraduate nursing student at Coppin State University, the professors created a love for the profession and a desire to continue the school’s legacy.

“When professors create that desire in the students to give back to the university and to their community, that’s when those students want to come back and teach,” says Ross, who also strongly voices the opinion that, if faculty positions paid salaries commensurate with clinical work, more people in the nursing workforce would pursue teaching.

To help build motivation among Pace students, education courses are in the graduate curriculum. At present, approximately half the students in the school of nursing are underrepresented minorities.

“We’re planting seeds,” says Feldman, who is also launching a distinguished lecture series to provide exposure for the nursing program to diverse individuals. “We’ve also built an environment where people want to teach. We have terrific outcomes in terms of our students finding employment and passing licensure and certification exams.”


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