Why Are There So Few People of Color in Nursing?

The way to improve diversity in nursing is to expand opportunities for leadership, mentorship, and outreach, and to rethink admissions policies, said nurses and academicians during a webinar hosted by the National Academies of Sciences, Engineering, and Medicine (NASEM) on Wednesday.

The panel discussion was part of a four-part series tied to the release of NASEM’s consensus study, “The Future of Nursing 2020-2030: Charting a Path to Achieving Health Equity.”

“The profession of nursing is not diverse,” said Sheldon Fields, PhD, RN, CRNP, associate dean for equity and inclusion and a research professor at Penn State University’s College of Nursing. Nurses are mainly women and mostly white, he noted.

While some progress has been made in diversifying the nursing workforce, approximately 69% of nurses are white, said Peter Buerhaus, PhD, RN, director of the Center for Interdisciplinary Health Workforce Studies at Montana State University, citing data from the 2018 American Community Survey. He noted that only 12% of nurses are Black.

Additionally, in some parts of the country, the nursing workforce is not at all representative of the population it serves, said Fields.

One way to confront the problem of diversity is to expand the number of minority nurses in leadership roles and for those nurses to share their stories, said Rear Admiral Aisha K. Mix, BSN, DNP, MPH, Chief Nurse Officer for the Commissioned Corps of the U.S. Public Health Service, who is African American.

“As a 15-year-old mom, and now sitting here as the Chief Nurse of the United States of America, that’s a story that needs to be told,” said Mix. “Because there is a teen mother out there, but no one has ever told her that she can do it. And so I stand here before you and everyone to say, ‘Yes, you can.'”

Mix said she consciously tries to raise her own visibility to help other young people see that, despite their circumstances, there’s an open door for them in the nursing field.

Holistic Admissions Policies

Another way to improve diversity in the nursing profession is to promote holistic admissions in nursing school programs and remove unnecessary “barriers of entry,” said Fields.

Some colleges and universities recently dropped the requirement for applicants to submit SAT and ACT scores. Fields argued that “something similar” could be done in nursing; for example, scrapping the Test of Essential Academic Skills (TEAS).

The idea behind holistic admission, Mix said, is to foster diversity by looking not only at academic achievement, but also students’ backgrounds — “their qualities and their specific skills that they’re bringing that will allow for them to be successful within the context of a nursing profession and our community.”

Ebony Hailey, a nurse care coordinator on the care management initiatives team at the Camden Coalition of Healthcare Providers in New Jersey, who is African American, said her transcript is what’s currently preventing her from entering a BSN program. More nursing programs should look at the “whole person” when evaluating applicants, she added.

“[E]very withdrawal, every dropped class, every grade below a C has a story behind it,” she noted.

When she did get her grades back on track, Hailey was told her courses had expired and she had to retake them. So, she did. But to even apply to the six nursing schools in her area, she will have to take a separate test for each one.

“So, barrier after barrier after barrier,” she said.

Through the Camden Coalition, Hailey said she is taking advantage of a more inclusive culture and the fact that it offers opportunities to those whom other programs might have excluded, including those with a criminal background and those who don’t have the “ideal resume.”

The first 60 days of the program are considered probationary for participants. “Give someone a chance, and they may excel,” she said.

Mentorship

Scholarships and mentoring programs are also critical to expanding the nursing workforce.

Mix received a scholarship from the Nursing Workforce Diversity Program from the Health Resources & Services Administration. One of the most important aspects of the program was its mentors, Mix said. It made all the difference “to have someone tap you on the shoulder and say, ‘Hey, I know you can do better than what you’re doing.'”

She recalled how shocked she was when one of the faculty members called her mother during the second semester of her freshman year. But in the end, she was grateful because her mentor noticed that her grades were slipping and she was at risk of losing her scholarship.

Mix also noted that attending one of the “HCBUs” — historically Black colleges and universities — meant that the issue of race was no longer part of the discussion and “that has allowed me to stand and walk a little bit taller, because I came from an environment that allows me to flourish without having to defend who I am.”

Outreach

Nurses also need to begin outreach to young people sooner, said panelists.

In 2002, when Johnson & Johnson launched its Campaign for Nursing’s Future, Buerhaus recalled that there had already been 5 years of decline in enrollment in nursing schools. The campaign sent hard copies of recruitment materials to every high school in the country, which helped encourage more students to look into nursing careers.

Replicating that approach could be helpful, while also thinking about other ways to continue to reach even younger students, he said.

As the vice president of the National Black Nurses Association, Fields said that he often visits schools and hears things like, “You can’t be a nurse, you’re a man.” The simple idea of exposing children to diversity in the field is important, he said.

Students also need to know the rigor that’s required to excel in the field, according to Mix. “You know you have to be good in math. You have to understand science. These are the foundation and fundamental courses that you have to be successful in, in order to actually matriculate into a nursing program.”

At the Academy of Health Sciences in Maryland, high school students take college-level classes through a partnership with Prince George’s Community College. By not challenging students at the middle and high school levels, “we’re already doing them a disservice,” she noted.

The Elephant in the Room

All of these strategies are important to improving diversity in the nursing workforce, but health equity cannot be achieved without first proactively confronting racism, both structural and institutional, Fields said.

Nurses can lead on anti-racism initiatives, but they must be implemented “purposefully and intentionally,” he stressed.

Mix agreed, adding that antiracist culture has to extend to nurses themselves. “It does us no good to remind nurses every day, in and out, of how we have to treat people fairly, how we have to respect the needs, respect the differences of our patients, while we find ourselves not receiving that same treatment within our work environment.”