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Increasing Diversity
in the Nursing Workforce: The Hispanic
Challenge
Nilda (Nena) Peragallo, Dr.P.H., R.N.,
F.A.A.N.
Dean & Professor
University of Miami, School of Nursing
Miami, Florida
Abstract
The impact of the critical shortage of
nurse nationwide is even more profound
in the minority population. With an increase
in Hispanic population growth and a subsequent
increase in their health care needs, there
too must be an increase in the availability
of services provided. An increase in the
number of professional nurses who are
Hispanic is crucial in the provision of
health care service to minority populations.
The health care needs of a minority population
are uniquely addressed by nurses who are
from the same minority group. A directed
effort must be make to promote nursing
as a career choice in the Hispanic population
and programs need to be designed to support
and mentor Hispanic nursing students,
as well as recruit, retain, and graduate
them in a timely manner. Similar programs
must be developed and directed toward
increasing Hispanic nursing faculty. Cultural
appropriate care which is essential to
the Hispanic nurse-patient relationship
is similarly critical to the development
of the faculty-student relationship. In
order to achieve success, an increase
in funding must be allocated and available
to prospective student to allow them to
attend baccalaureate and higher degree
nursing programs and to Schools of Nursing
to develop, initiate, and evaluate programs
specifically addressing the needs of Hispanic
and other minority students. The Hispanic
population will continue to grow nationally;
it is crucial that Hispanic professional
nurses are available to address their
concern and meet their overall health
care needs.
Increasing Diversity
in the Nursing Workforce: The Hispanic
Challenge
Racial and ethnic minority populations
are surging in the United States, among
these, Hispanics. As this growth continues,
the change in demographics will create
a challenge in meeting the health care
needs of these populations (Buerhaus &
Auerbach, 1999; Soroff, Rich, Rubin, Strickland,
& Plotnick, 2002). As minority health
care needs rise, so must the availability
of services. To best care for a diverse
patient populace, an increase in minority
health care providers is crucial. Growth
in the diversity of health care professionals
must parallel that of the nation in order
to avoid a crisis in the health care delivery
system.
There is a severe overall nursing shortage
which in time will magnify the under representation
of minorities in the nursing workforce.
Some fundamental reasons for the shortage
are the rise in age of nurses and their
impending retirement, the increase in
pace at which nurses are leaving the profession,
and the slow growth rate of nurses entering
the profession. According to the March
2000 National Sample Survey of Registered
Nurses the average age of the RN population
is 45.2 years (HRSA, 2001). In the last
two decades there has been a 41% decline
in working RNs under the age of 30. In
the same time period, the decline in the
U.S. workforce under the age of 30 was
only 1% (Buerhaus, Staiger, & Auerback,
2001). Buerhaus et al. (2001) maintain
that by 2010 almost 40% of RNs will be
over the age of 50. As these aging nurses
retire, the profession will see an even
more devastating decline in the workforce.
The amount of nurses leaving the field
compounds the shortage issue. According
to Sochalski (2002) there were 81,000
nurses not working in 2000 that were under
44 years of age. More satisfying jobs
in other fields, with better compensation
and hours, were most common reasons for
leaving (Sochalski, 2002). The number
of new RNs not working in nursing is also
of concern. Between 1996 and 2000, the
number of new male RNs not working increased
from 4.6% to 7.5%, while females displayed
a smaller jump from 2.7% to 4.1% (Sochalski,
2002). It can only be assumed that this
trend will continue if retention strategies
and barriers are not investigated. The
nursing profession is not growing at an
adequate pace to replace those nurses
retiring and leaving the profession. Although
the number of licensed nurses in the U.S.
increased by 5.4% between 1996 and 2000,
this is down from the 14.2% increase seen
between 1992 and 1996 (HRSA, 2001). A
survey conducted by The American Association
of Colleges of Nursing revealed a 17%
decline in enrollment in schools of nursing
from 1995 to 2001 (AACN, 2002). The data
suggest recruitment of nurses and nursing
students must be a priority, to prevent
future health care demands from exceeding
the supply of providers. Projections for
2020 leave the nation with a shortage
of over 800,000 nurses, which is an estimated
29% below estimated requirements (HRSA,
2002). Minority populations are growing
at a record pace. The fastest growing
minority group in the United States is
Hispanics. They comprise 13% of the nation's
population and this figure is projected
to climb to 17% by the year 2020 (U.S.
Census Bureau, 2002). At 13%, Hispanics
are now the largest minority group in
the U.S. What is alarming is the fact
that as the most populace minority group
in the nation, Hispanics are the second
most underrepresented group in the nursing
workforce (HRSA, 2001). Although the number
of Hispanic nurses rose from 1.6% of the
total workforce in 1996 to 2% in 2000,
this is not substantial enough to close
the gap between the growth of the Hispanic
population and that of Hispanic nurses
in the workforce (HRSA, 2001).
Over 1.4 million Hispanics are enrolled
in post-secondary education; they comprise
9.3% of all college students in the U.S.
In comparison 78.3% of students are White
and 14.1% are Black (U.S. Census Bureau,
2002). In nursing programs, enrollment
of Hispanics is even more dismal. According
to a 2000-2001 survey conducted by the
American Association of Colleges of Nursing,
Hispanics made up 4.9% of baccalaureate
enrollment and 3.9% of graduate enrollment
in nursing programs (Staiger, Auerbach,
& Buerhaus, 2001). The profession
needs to identify why more Hispanics are
not pursuing nursing as a career. It is
then imperative to address the implementation
of recruitment and retention programs
specifically designed for the Hispanic
student. Professional organizations, schools
of nursing, and health care organizations
together must commit to increasing Hispanics
in nursing. This is a crucial step toward
lessening the gap between cultural backgrounds
of nurses and patients. It is not true
that only minority nurses can provide
culturally competent health care to the
same minority population. However, studies
of nurses and nursing students' attitudes
towards diverse patient populations have
shown there is a deficit in knowledge
and confidence when it comes to caring
for diverse groups (Bond, Kardong-Edgren,
& Jones, 2001). The National Advisory
Council on Nurse Education and Practice
2000 report stresses the need for a diverse
nursing workforce. It states that while
the number of minority nurses is small,
they play a of care that address the unique
needs of racial/ethnic minority populations"
(NACNEP, 2000). Heller (2002) also asserts
it is known that minority health care
providers contribute significantly to
caring for poor and uninsured patients,
and for those in their own minority group.
In order to promote more Hispanics to
pursue nursing as a career, schools must
be sensitive to the academic and cultural
needs of the students. Recruitment of
minorities into nursing programs has been
an enduring challenge (Dowell, 1996).
Poor academic preparation, lack of social
support, lack of financial resources,
poor English skills, and lack of knowledge
about college are among some of the barriers
perspective students face (Dowell, 1996;
Soroff et al., 2002). If at all possible
it is best to address these issues early
in their education. To accomplish this
recruitment must start at the high school
level (AACN, 2001; Soroff et al., 2002).
Schools of nursing must take initiative
and develop relationships with high schools
to connect with students and spark interest
in nursing. Hispanic students can be targeted
specifically and advised by Hispanic nurses
and faculty members. Advisement should
go beyond the student and reach out to
parents and families as well (Soroff et
al., 2002). The students¹ cultural needs
must be considered during recruitment
and strategies for minorities must be
more personal and family-oriented (Williams,
2001). Bilingual brochures and media advertisements
are appropriate to get information in
circulation. However, offering information
sessions at schools of nursing, or directly
in Hispanic communities allows prospective
students and their families to interact
with Hispanic students, nurses, and faculty.
This allows prospective students to identify
with role models of similar backgrounds
(Evans, 2003; Soroff et al., 2002). In
any recruitment effort, the value of growth
in the Hispanic student body and in the
Hispanic nurse population must be emphasized.
Implementing a recruitment program is
the first step, but efforts are futile
if a retention program doesn't exist to
follow students through to success. Once
enrolled, there's a new set of obstacles
that Hispanic nursing students face. If
they weren't adequately prepared, in their
secondary education program, they struggle
more in science courses, and may have
poor study and time management skills.
Other barriers to retention include the
inability to pay for tuition, feelings
of isolation, lack of faculty contact/support,
and perceived discrimination (Soroff et
al., 2002; Villarruel, Canales, &
Torres, 2001; Williams, 2001). These barriers
contribute to the display of low confidence
and self-esteem seen in minority students,
which further hinders performance (Williams,
2001).
The rising cost of tuition and changing
financial aid rules are making the inability
to pay a common problem among minorities
(Williams, 2001). An adequate financial
aid package is important to both recruiting
and retaining minority students. A strong
commitment from governmental agencies,
professional organizations, and school
administrators is vital to help lobby
for and generate appropriate funds. Once
relieved of financial stress, students
can focus more on academics, however other
barriers remain to be overcome.
Feelings of isolation integrated with
feelings of neglect by faculty contribute
to minority students' failure in nursing
school (Goba, 2001). Minority students
feel faculty members are unsupportive
and do not provide adequate advisement
(Villarruel et al., 2001). Nursing faculty
need to provide a nurturing environment
to all students, but especially to minorities
who are already feeling isolated. Building
self-esteem through support and advocacy
improves minority students' success rates
(Campbell & Davis, 1996; Villarruel
et al., 2001). A study by Shelton (2003)
revealed students were more likely to
complete a nursing program when they perceived
greater faculty support than other students.
In their study on mentor/student relationships,
Campbell and Campbell (1997) found students
with a mentor had higher grade point averages
and a lower drop out rate than those without
a mentor. Given this, a minority faculty/student
mentor program should be in place to increase
retention and success rates in nursing
schools. Hispanic faculty can serve as
role models, and exemplify competence
and success. When positive interactions
with minority faculty were experienced,
students reported feeling accepted, encouraged,
motivated, and having increased confidence
to succeed as nurses (Campbell & Davis,
1996; Soroff et al., 2002). One obstacle
to implementing a faculty/ student mentor
program for Hispanic students is the shortage
of Hispanic faculty (Dowell, 1996). When
minority faculty members are not available
majority faculty can advocate for minority
students. If a majority faculty member
is committed to helping a minority student
who is accepting of the relationship,
the faculty member can be just as effective
in promoting confidence and success (Campbell
& Campbell, 1997).
The key to success is to have faculty
members committed to and accepting of
students' cultural as well as academic
needs, especially during their first year
of school (Wood & Chwedyk, 2001).
A successful mentor is knowledgeable,
encouraging, caring, acts as a role model
and counselor, and is a good teacher (Pinkerton,
2003). Another attribute of a successful
mentor is to be proactive. Mentors should
be involved enough to recognize and help
students in need instead of waiting for
them to fail (Shelton, 2003). Clearly
mentors must be chosen carefully; preferably
faculty members would volunteer for the
role. Benefits to the mentor would hopefully
include a sense of pride, empowerment,
and overall personal satisfaction.
The faculty/student mentor relationship
increases feelings of acceptance and bolsters
success in minority students (Campbell
& Davis, 1996; Shelton; Soroff et
al., 2002). But, isolation and failure
can also be attributed to students experiencing
perceived discrimination (Villarruel et
al., 2001). In a study conducted by Villarruel,
Canales and Torres (2001), perceived discrimination
from faculty and peers was a common theme
for Hispanic students in schools of nursing.
This caused students pain and anger, and
made building relationships with faculty
members impossible. This is detrimental
given the aforementioned correlation between
student success and faculty support. When
experiencing discrimination from peers,
students felt isolated and alienated from
the school (Villarruel et al., 2001).
All students should feel they are of value
and that they are an important and respected
part of the nursing student body. Discrimination,
regardless of the source, engenders low
self-worth and a poor self-image, which
is linked to failure in school (Griffiths
& Tagliareni, 1999). Schools of nursing
must address theses attitudes of cultural
bias and insensitivity to achieve higher
retention rates of minority students.
The academic environment should have a
"zero tolerance" policy for
such behavior.
It is also necessary to consider the
implications of the nursing faculty shortage.
Results from a study by the Southern Regional
Education Board revealed there were 432
vacant nursing faculty positions and 343
resignations in 2000-2001 in the 16 SREB
states (SREB, 2002b). A national survey
by the American Association of Colleges
of Nursing predicts, between the years
2004 and 2012, approximately 250 doctoral
level nurse educators will be eligible
for retirement annually (AACN, 2003).
The shortage of faculty will strain nursing
school enrollment and magnify the nursing
shortage even further. Of the 491 institutions
surveyed by SREB, 86 reported falling
short of faculty for their undergraduate
and graduate nursing programs (SREB, 2002b).
Attracting more graduate prepared nurses
into the educational arena must be a priority
of schools of nursing. Unfortunately,
only 10% of nurses hold a graduate degree
(NACNEP, 2001). This number is insufficient
to replace retiring faculty and fill current
vacant positions. In order to keep the
faculty pipeline full, the profession
must promote graduate education, especially
at the doctoral level to prevent further
exacerbation of the faculty shortage.
The SREB survey reported that only 34%
of nurse educators held a doctoral degree
in nursing or a related field (SREB, 2002a).
It is of particular importance to achieve
greater representation of Hispanics among
nursing faculty. The American Association
of Colleges of Nursing reported that for
the academic year 2000-2001, Hispanics
comprised only 1.2% of the total full-time
nursing faculty (Staiger et al., 2001).
This deficit in Hispanic faculty will
severely impact recruitment and retention
efforts of Hispanic students (Dowell,
1996; AACN, 2001). It is important to
provide mentors and role models to Hispanic
nursing students. More Hispanic students
must be encouraged to earn a graduate
degree to address the deficit in faculty
representation. According to the March
2000 National Sample Survey of Registered
Nurses, only 8.4% of Hispanic nurses hold
a graduate degree in nursing (HRSA, 2001).
Current enrollment doesn't look promising,
as Hispanics only comprise 3.9% of graduate
enrollment in nursing programs (Staiger,
Auerbach, & Buerhaus, 2001). The profession
needs a continuous supply of faculty members
as mentors to guide the future generations
of Hispanic nurses.
There are many other reasons, academic,
social, and psychological, that contribute
to the lack of Hispanics in the nursing
profession. Ongoing studies are needed
to point the nursing profession in the
right direction so that more aggressive
and relevant recruitment and retention
strategies can be implemented relevant
to the Hispanic nursing workforce. More
importantly, there needs to be a financial
commitment to recruit, retain, and support
Hispanic nursing students while in school.
Together with this, there has to be accountability
for the utilization of these funds that
should be earmarked for minority students
and faculty, to increase the number of
nurses available to serve the health care
needs of the growing Hispanic population.
The issues are critical; they deserve
more attention and research to address
the demands of a more diverse nursing
workforce, and the health care needs of
our Hispanic population.
More information on racial and ethnic
diversity in the nursing workforce is
available at ftp://ftp.hrsa.gov//bhpr/nursing/divreport/DivFull.pdf
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