Polly Bednash, Executive Director American Association of Colleges of Nursing To Institute of Medicine Committee on Institutional and Policy-Level Strategies for Increasing the Diversity of the U.S. Health Care Workforce (February 5, 2003) On behalf of the American Association of Colleges of Nursing (AACN), I would like to thank the Institute of Medicine for focusing on an issue of great concern to all stakeholders within the health professions: Increasing the diversity of the U.S. health care workforce. Nursing leaders understand the connection between a culturally diverse nursing workforce and the ability to provide quality patient care. Though nursing has made great strides in recruiting and graduating nurses that closely mirror the patient population, we realize that more must be done before adequate representation becomes a reality. I welcome this opportunity to share with you some success stories from nursing and to work with the Committee to identify viable strategies and recommendations. Why Diversity Matters Despite their relatively small numbers, minority nurses are leaders in the development of models of care that address the unique needs of diverse populations. According to an April 2000 report prepared by the National Advisory Council on Nurse Education and Practice (NACNEP), a culturally diverse nursing workforce is essential to meeting the health care needs of the nation. Not only are minority populations increasing substantially, but they also have higher rates of certain diseases, lower rates of successful treatment, and in some cases, shorter life expectancies than the majority population. Although a number of factors contribute to racial and ethnic disparities in health, inadequate access to quality and appropriate care is one of the more significant. Accordingly, NACNEP calls for increasing the number of minority nurses as a major strategy in reducing the health disparities that exist among the nation's population. AACN, in a 1999 position statement on Nursing's Agenda for the 21st Century, echoed many of NACNEP's statements and strongly urged schools of nursing to use effective and creative recruitment strategies to achieve cultural diversity. The AACN task force that produced this statement found broad consensus among educators that the nursing workforce should be representative of the patient population and that nurses must strive for a higher level of cultural competence. Nursing schools have embraced these concepts and are moving to create culturally sensitive, supportive learning environments for students from all backgrounds. Strategies to Increase Diversity In December 2001, AACN released an Issue Bulletin on Effective Strategies for Increasing Diversity in Nursing Programs which described successful methods for diversifying the nursing student population that can be duplicated at schools across the country. AACN found that many institutions use a combination of traditional marketing methods, targeted outreach campaigns, and strategic planning to encourage diversity and eliminate barriers. For example: Using funding provided through a Workforce Diversity Grant, Montana State University has partnered with six American Indian tribes to increase interest in nursing careers. To date, the program has enrolled 40 new students in the baccalaureate nursing program and identified an additional 758 tribal members with an interest in health careers. Savvy college recruiters, like those at Indiana University, are working to develop a pool of future nursing students from diverse backgrounds by reaching out to middle and high school students from underserved communities. The University of Texas Health Sciences Center at Houston has updated brochures, retooled promotional messages, and used images of diverse groups of nurses to appeal directly to underrepresented groups. Through a HRSA-funded grant, the University of Missouri-Kansas City launched a coordinated outreach campaign which has boosted minority representation to 36% in its baccalaureate program. At the University of Nebraska Medical Center, where minority student admissions increased by 43% last year, administrators are reaching out with recruitment materials translated into other languages besides English. Mentoring is a key element in attracting new student populations, and schools such as Mount Carmel College of Nursing in Ohio provide one-to-one attention and counseling to assist minority students throughout their entire college experience. And finally, partnerships and collaborations are forming nationwide between schools of nursing and practice settings wishing to diversify the workforce, address the RN shortage, and broaden minority faculty representation. These efforts to diversify the nursing student population are working. Though minority representation within the nursing workforce is only 12.3% according to the latest National Sample Survey of Registered Nurses, minority students currently enrolled in baccalaureate nursing programs make up 21.5% of the student population. In fact, minority representation in baccalaureate nursing programs has risen steadily over the past 10 years from 17.1% in 1990 to 21.5% in 2002. Diversity in the Nursing Faculty Population The need to attract diverse nursing students is paralleled by the need to recruit more faculty from minority populations. Though data indicate that minority nurses are more likely to pursue advanced education than their white counterparts, few minority nurses with advanced degrees become nursing faculty. According to AACN data, minorities represent only 8.7% of nursing school faculty and 6.8% of nursing school deans. A lack of minority nurse educators may send a signal to potential students that nursing does not value diversity or offer career ladder opportunities to advance through the profession. Students looking for academic role models to encourage and enrich their learning may be frustrated in their attempts to find mentors and a community of support. AACN is committed to working with academic leaders to identify faculty recruitment strategies, encourage minority leadership development, and advocate for programs that remove barriers to faculty careers. Efforts to increase the minority nursing faculty population must focus on expanding enrollment at the baccalaureate level. Data from the National Sample Survey of Registered Nurses show that students who receive their basic nursing education at the baccalaureate level are much more likely to pursue advanced education than nurses prepared at the diploma or associate degree level. According to the latest available data, 53.2% of nurses with advanced degrees received a baccalaureate degree as their first level of nursing education. In contrast, only 25.4% of nurses with advanced degrees began their education at the diploma level and only 17.4% at the associate degree level. The Nursing Shortage: A Call to Action Despite the growth of minority representation in nursing programs and recruitment efforts at the institution level, more must be done to diversify the nursing workforce and meet the growing demand for nursing care. The need to attract minority groups into nursing and expand the capacity of baccalaureate nursing programs is gaining in importance given the Bureau of Labor Statistics' projected need for one million new and replacement nurses by 2010. Besides enhancing patient care, diversifying the nursing workforce will also serve to address the nursing shortage by bringing new recruits into the field. Leading nurse collaborations including the Tri-Council for Nursing and the Call to the Profession, a coalition of more than 60 national nursing organizations, have identified minority populations as a rich source for new nursing students. Recent nursing shortage reports, including those produced by the American Hospital Association, the Robert Wood Johnson Foundation, the Joint Commission on Accreditation of Healthcare Organizations, and the Association of Academic Health Centers, all point to minority recruitment as a necessary step to addressing the unfolding crisis. AACN's Recommendations In conclusion, AACN believes that health care providers and the nursing profession should reflect and value the diversity of the populations and communities they serve. At the policy level, we recommend that stakeholders: Provide incentives and funds to schools of nursing to recruit faculty from diverse populations, increase scholarship funding for minority students pursuing advanced education, promote faculty careers to underrepresented groups, and engage minority faculty in the recruitment of students from their respective communities. Remove the financial barriers that prevent minority students from pursuing a nursing education, support mentoring programs and targeted outreach programs launched by baccalaureate and higher degree schools of nursing, increase funding for Diversity Workforce Grants which are available through Title VIII of the Public Health Act, and raise the cultural competency level of all nurse educators and clinicians. Support community-based collaborations among educators, human services organizations, businesses, practice settings, and a wide range of stakeholders interested in enhancing cultural diversity in the health professions and providing needed services to the community. Thank you for the opportunity to share AACN's perspective and address the Committee this morning. Top | Government Affairs | AACN Home Copyright © 2004 by the American Association of Colleges of Nursing. All rights reserved.