A Healthcare Reform Mandate Building a More Educated, Diverse Professional Nursing Workforce

Healthcare reform presents new challenges and opportunities for the nursing profession, in both academic and practice settings. The Institute of Medicine (IOM) recently released its report, “The Future of Nursing: Leading Change, Advancing Health,” which included among its recommendations raising the education level of the nursing workforce.

The IOM recommends doubling the number of nurses with doctorates, and increasing the baccalaureate-prepared RN population to 80{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} from its present level of 50{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} by 2020.

The mandate for healthcare reform comes at a time of shifting population demographics.  According to the U.S. Census Bureau, Latinos now account for nearly 10{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the Massachusetts population.  Furthermore, the increase in the Latino population alone accounted for more than 60{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the state’s total growth between 2000 and 2009. Currently, nearly 21{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the Hampden County population is Latino.

Nursing’s leaders recognize a strong connection between a culturally diverse nursing workforce and the ability to provide quality, culturally competent healthcare to an increasingly diverse population. Unfortunately, national enrollment in baccalaureate nursing-education programs is not keeping up with the changes in population demographics. The American Assoc. of Colleges of Nursing’s 2011 annual report notes that Latinos account for just 6.8{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of total baccalaureate enrollments. While these numbers reflect improvement over previous years, diversity of the RN workforce remains far less than that of the general U.S. population, and Latino RNs remain the most underrepresented minority group.

A main route to upward mobility and equality of opportunity for minorities in the healthcare industry is equity of access and success in achieving the baccalaureate nursing degree. A report by the National Academy of Sciences, “In the Nation’s Compelling Interest,” states that, “to a great extent, efforts to diversify health professions … have been hampered by gross inequalities in educational opportunity for students of different racial and ethnic groups.” A number of studies have shown that inadequate academic preparation and financial barriers are very significant for Latino nursing students. In addition, lack of cultural sensitivity in the curriculum, lack of access to ethnic nursing organizations, and lack of adequate mentors are also critical factors.

Here, taken from the higher-education literature as well as interviews with Latina nursing students, are recommendations for practitioners and policy makers working in the field of higher education and, in particular, baccalaureate nursing-education programs.

• Establish seminars conducted by college financial-aid officers for low-income Latino families and students to provide them with information on how to finance a college education, including eligibility for Pell grants and assistance with the grant application process;

• Provide specific information to first-generation Latino students in secondary-education settings about how to set realistic goals for college, including what colleges and what careers to consider;

• Develop outreach programs with high schools in which student-affairs officers and college-student ambassadors help familiarize Latino high-school students and families with the various aspects of the college experience, with the added benefit of creating linkages between high-school and college students;

• Create credit-bearing college-transition programs that could be offered in 12th grade or during the summer before college to get Latino students ready for college-level work;

• Establish core groups of student advocates whose purpose it is to reach out to Latino students and help them connect with available resources on campus;

• Adopt proactive academic-advising systems that reach out to Latino students rather than waiting for a student to ask for help, and have bilingual staff available in academic-advising and resource centers;

• Establish connections with Latino nurses in the practice environment and with the local chapter of the National Assoc. of Hispanic Nurses for the purpose of developing a cadre of career mentors and professional role models to work with Latino nursing students;

• Create programs in which nursing graduate students advise and mentor undergraduate Latino students on earning credit toward their graduate degree;

• Provide professional-development programs that help nursing faculty examine their own attitudes regarding teaching diverse students and assist them in creating relevant cultural-competence curricula, including simulation and immersion experiences that validate students from diverse backgrounds;

• Place students in cohorts that follow the same course and clinical schedules throughout the nursing curriculum to facilitate the establishment of strong Latino nursing-student peer and study groups; and

• Establish student-faculty ratios for sophomore-level nursing courses that optimize the faculty-student interactions and individualized attention which Latino students consider important for their success.

• Create policies to build capacity at institutions that serve low-income minority and first-generation students. This will ensure opportunity for the fastest-growing segments of student bodies, with particular attention to smaller, less-selective, private institutions that primarily serve local populations;

• Target public subsidies (e.g. under Title VIII federal funding for nursing-workforce development) to steer the composition of the future nursing workforce toward more BSN graduates by expanding baccalaureate and graduate education programs that produce nurses for positions in professional practice, education, and research;

• Build institutional and departmental budgets that consider the particular needs of first-generation and minority students, such as academic and student support services that help those with the greatest need. For example, initiate or expand existing mentorship programs in order to provide this resource to more students and expand the availability of tutors to accommodate the schedules of those who commute, work, or have family responsibilities;

• Establish policies that facilitate transfer from two-year programs, including robust credit-transfer agreements, flexible scheduling of academic and support services, dual-enrollment programs, centrally located registration and financial-aid offices, and diversity among faculty and staff with backgrounds similar to students’ own; and

• Designate Health Resources and Services Administration funding for projects that create agreements between two- and four-year colleges to establish programs that bring Latinos currently working in healthcare as unlicensed assistive personnel into community colleges and on to baccalaureate programs for their BSN degrees, with a portion of the funding available as scholarships or stipends for students.

The ultimate objective is to have Latinos equitably represented in the nursing workforce and to be prepared for graduate-level education. This necessitates a broad worldview in which nurse educators and policy makers see the significance of their roles in promoting Latino nursing student retention and persistence to the baccalaureate degree. v

Cheryl A. Sheils, is a registered nurse and associate professor of Nursing at Elms College; sheilsc@elms.edu