Breaking Barriers, Expanding Diversity, and Finding Success
Despite being a rapidly expanding field, the nursing profession is still working to increase diversity. Learn how minority nurses can overcome barriers and find out what’s being done to improve diversity in both nursing education and the workplace.
Cultural, racial, and ethnic demographics in the United States continue to change, with minorities projected to become the majority by 2043, according to the U.S. Census Bureau. Yet the nursing industry is still trying to reflect the changing face of its increasingly diverse patient population. The following guide offers strategies for breaking down some of the most common barriers for minority nurses, reviews how diversity enhances the quality of patient care, and discusses the efforts being made to bring greater diversity to nursing education and the healthcare industry. If you’re a minority in the nursing field, learn how you can better serve your community and help improve the nursing profession overall.
Breaking Barriers as a Minority in Nursing
Across the nursing field, there are still biases that hinder minority nurses and students, both in the classroom and the hospital. Identifying these barriers—and establishing strategies to overcome them—is a critical step to helping nurses and nursing students succeed. Below are several strategies on how to overcome some of the biggest barriers that minority nurses may face both inside and outside the classroom.
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Surviving Nursing School
Being first generation Mexican American and a college attendee, my family struggled financially and was not very familiar with the different financial assistance programs that were available, such as filling out the FAFSA®, etc., so finding financial support was difficult.
Lack of mentoring opportunities Strategies for Success Although a formal mentoring program may not be available at the local hospital or nursing school, students can look farther afield for opportunities. Great mentors can be found in a variety of places, including businesses, associations such as the National Black Nurses Association, and community groups.
Financial aid/difficulty understanding the financial aid system Strategies for Success Get financial counseling Work with a financial aid counselor at the school to walk through the financial aid process, including filling out and submitting the FAFSA®, finding and securing federal financial aid, and where to find scholarships and grants. Attend community college. Many students, including minorities, use community college as a cheaper alternative to complete their core course requirements before transferring to a four-year BSN program.
Feelings of isolation Strategies for Success Join a student-based diversity organization Outside of the nursing school, many universities offer diverse student groups that allow students from any college to join. Join a local chapter of a national minority association. Most national minority associations, such as the National Association of Hispanic Nurses, have chapters throughout the country and encourage student membership. Form your own group If there are other minorities in your nursing program, create a support group to bring everyone together. Members can study together and assist one another throughout nursing school and beyond.
Overcoming Obstacles in the Workplace
Lack of voice in the workplace Strategies for Success The key is to stay visible and remain persistent. Minority nurses should participate in task forces, join committees, and take advantage of opportunities to contribute to reports, studies or other projects.
Language barriers Strategies for Success Minority nurses, especially recent immigrants, often find that language can be a barrier. Nurses can take ESL (English as a Second Language) classes to become well versed in English. They can also choose to work in hospitals or facilities that serve diverse communities, where they can use their multilingual skills to better connect and communicate with patients, making language less of a barrier and more of an asset.
Being bilingual has been my greatest asset
A Closer Look at the Nursing Field
Race/Ethnicity by Enrollment at Nursing Programs, 2014
Hispanic or Latino
Asian/Native Hawaiian/Or Other Pacific Islander
American Indian/Alaskan Native
Two or More Races
Source: American Association of Colleges of Nursing, 2014
Degree Attainment of Minorities, 2010-2014
Enhancing Diversity in Nursing
Although the RN workforce is more diverse than it was just ten years ago, the majority – 75 percent – is still white, which means the United States still has a ways to go before its healthcare workforce reflects its diverse population. Fortunately, efforts to increase diversity are underway within the healthcare system and via state, federal, and nonprofit programs.
These initiatives typically fall into a few major categories: organizational support, programmatic, funding, and marketing. Below is a list of the different types of diversity initiatives that have been implemented to help improve diversity within the nursing workforce.
Dedicated departments and positions to serve underrepresented populations
Making the inclusion of minority nurses a goal in an organization’s strategic plan
Cultural competency training for staff members
Partnerships with minority associations or community groups
Below is an overview of specific examples of programs and partnerships aimed at improving diversity in the nursing workplace
Nursing Workforce Development Programs
Established under Title VIII of the Public Health Service Act and administered through the U.S. Department of Health and Human Services’ Human Resources and Services Administration (HRSA), these programs focus on nursing recruitment and retention. Nursing Workforce Diversity grants are a major component of the program, aimed at recruiting and retaining students from minority backgrounds into nursing. Funds are used in myriad ways, from nursing program stipends to scholarship programs, and retention activities to education preparation programs. In the 2013-2014 year, Nursing Workforce Diversity grants supported the education of nearly 17,000 students.
Multicultural Nurses Mayo Employee Resource Group (MNMERG)
Established by the Mayo Clinic in Rochester, Minnesota, MNMERG is a recruitment and retention program for minority nurses. It offers a variety of services, including networking opportunities, mentoring relationships, community partnerships, and professional development activities.
Clinical Leadership Collaborative for Diversity in Nursing (CLCDN)
Established in 2007, the CLCDN program is a mentoring and scholarship program for minority students sponsored by PartnersHealthCare in Massachusetts. Applicants come directly from the nursing program at the University of Massachusetts Boston.
The Cleveland Clinic in Ohio has created a series of different diversity councils at each of its family health centers and community hospitals. Led by employees, these councils develop and implement strategies and activities designed to improve cultural competence, diversity, and employee engagement.
Doctoral Advancement in Nursing Project
The Robert Wood Foundation and American Association of Colleges of Nursing (AACN) partnered to create the DAN project to increase the number of nurses from minority backgrounds completing PhD and Doctor of Nursing Practice (DNP) degrees.
RWJF New Careers in Nursing Scholarship Program
The Robert Wood Foundation and American Association of Colleges of Nursing again partnered to launch a minority-focused scholarship program to increase the number of minority students in accelerated nursing programs. More than 3,500 students have received scholarships to bachelor’s and master’s degree nursing programs since the program’s launch in 2008.
Increasing Diversity in College Nursing Programs
In an effort to attract more minority students, many nursing schools have developed a range of strategic initiatives to boost diversity in their programs. Examples of such efforts include the following:
Adding cultural competency to the curriculum
Hiring minority faculty members
Developing flexible course offerings through online and distance education
Launching minority student learning centers and campus resources
Starting satellite campuses in minority communities
Hiring recruitment and retention staff
Creating mentor programs
Implementing community-based training
Enhancing academic support services such as student advisement, ESL & language support, testing accommodations, and tutors
Below is a more detailed look at ways nursing schools are working to reach minority nursing students.
Improving the recruitment pipeline Nursing schools have started to develop strategic marketing campaigns to reach minority students. For example, the University of Delaware was recently awarded a federal grant to develop a comprehensive recruitment model for underrepresented minority students.
Partnering with community colleges Nursing schools are also starting to establish partnerships with local community colleges, offering support to help two-year students transition to four-year BSN nursing programs.
Connecting with the K-12 educational system Recruiting minority students starts early, even as early as middle and high school. Indiana University, for example, works with the local school system in Bloomington to bring high school students from economically disadvantaged areas into the university’s nursing school.
Developing culture-specific programs In order to attract and retain students, some schools have created a variety of training programs for minority nurses. For example, Chamberlain College in Illinois launched Chamberlain Care, a coordinated workshop with the National American Arab Nurses Association; Kentucky’s Frontier Nursing University developed a distance education program specifically for African American and Hispanic nursing students.
Providing specialized academic support Some minority students may need ESL support or additional developmental coursework to prepare them for the rigors of a four-year nursing program. In New York, Nassau Community College developed a grant-funded program, PREPS (Preparation Retention Education for Professional Success), that offers academic tutoring and assistance to minority nursing students.
Updating curriculum Cultural competency is an important component of providing quality nursing care, and schools are starting to integrate cultural training into their curricula. For example, Ottawa University in Kansas offers a course in nursing and cultural diversity to teach students about the impact cultural diversity has on healthcare behaviors and beliefs, and how that translates to patient care.
Creating diversity programs Many schools are pursuing projects to enhance nursing diversity in their programs, which subsequently leads to diversity in the workforce. For example, Oregon Health & Science University has created HealthE STEPS with a grant from the Health Resources and Services Administration. The program allows the school to offer scholarships and stipends to minority students, increase academic and social support, and provide community outreach services to minority populations.
Offering mentoring relationships Mentoring is a critical factor in attracting and retaining new minority students. In Ohio, Mount Carmel College of Nursing created Learning Trails, a mentoring program that offers one-on-one mentoring and regular consultation opportunities.
Providing flexible scheduling Students from low-income or underserved populations may have to work, so many nursing schools have launched educational programs tailored to the need of working students, including distance education programs and night and weekend programs. For example, Maryland’s Mount St. Mary’s launched a night and weekend for ADN students, and San Francisco State University created a satellite nursing program at Cañada College, located near San Francisco in a Latino community.
According to projections from the U.S. Census Bureau, the non-white population will be the majority by 2043, and will steadily increase thereafter, with minorities accounting for 57 percent of the country’s population by the year 2060. Those figures are significant because, according to the U.S. Agency for Healthcare and Research Quality, minority populations continue to experience disparities in the healthcare system, including access to quality healthcare, access to proper health education, and poor patient-provider communication.
Introducing more diversity to nursing, then, is becoming an increasingly vital tool to address disparities and, most importantly, improve patient care. Nurses interact with patients daily, so as the nation’s demographics change, the need to have patient care providers who are in tune with this increasingly diverse population is a pressing concern.
Interview with Roxana Vazquez
Roxana Vazquez, a Mexican American who currently works as a Certified Breast Cancer Nurse at Cancer Treatment Centers of America, shares her thoughts and experience on being a minority within the field of nursing.
What were the biggest challenges you experienced as a minority while in nursing school?
My alma matter, Chamberlain College of Nursing, was very diverse. Therefore I do not feel I faced many challenges as a minority. However, the biggest challenge I did face (and I’m sure many others did as well) was finances. Being first generation Mexican American and a college attendee, my family struggled financially and was not very familiar with the different financial assistance programs that were available, such as filling out the FAFSA®, etc., so finding financial support was difficult.
How did you overcome those challenges as a student?
To overcome the financial challenges of school, I took the initiative myself to become informed and apply for grants, loans and scholarships. I also worked part-time at a hospital while in nursing school. I was lucky to have a very understanding manager who worked around my school schedule. Also, my parents fully supported me and provided assistance as much as possible.
What do you think is the most difficult thing about being an ethnic minority in the nursing field?
The most difficult thing to me about being a minority in the nursing field is seeing people of my same culture struggle to receive the appropriate health care needed at the appropriate time; whether it is due to finances, language barrier, education or a combination of all three. Seeing patients at their worst is very difficult, especially when knowing that certain illnesses can be prevented.
How do you address that concern - and others - in the workplace?
My goal is to educate co-workers and others about a patient’s background and culture to the best of my knowledge. Nurses are very empathetic; therefore, we treat all patients with respect and value them. We do our best to help our patients, regardless of their background.
Do you feel there are certain benefits to being a minority in nursing? If so, what are those benefits?
[Being bilingual brings] comfort to patients when they see someone that looks like them and speaks like them.
There are many great benefits of being a minority in nursing. First off, being bilingual has been my greatest asset. It has many advantages, such as assisting physicians to communicate with patients, and also bringing comfort to patients when they see someone that looks like them and speaks like them. In many cultures, such as in Latin America, people tend to use different holistic approaches that US physicians may not be aware of and/or forget to ask about, which can have a huge impact in the care of a patient. Being of Mexican descent, I know this is very common and it is something all nurses should always keep in mind to ask in their assessment.
Did you receive unique support or resources from your school - and now, from your employer - as a minority in nursing? (For instance, did your school offer mentorship opportunities for minority nursing students?)
I am aware of an Hispanic student nurses association available to students which offer support groups, scholarships, monthly meetings, etc. Currently, I and another nurse are working on reaching out to the Hispanic community to provide cancer awareness through our employer, Cancer Treatment Centers of America at Midwestern Regional Medical Center.
What advice would you give an aspiring nurse who is an ethnic minority?
My advice to aspiring nurses of an ethnic background is to embrace your ethnicity. The number of minorities in nursing is still very low, especially for Latinos. There are many opportunities in the nursing field if you are bilingual. The most amazing feeling is knowing that patients appreciate being understood and helped.
An assortment of financial support, including scholarships, fellowships and grants, are available to prospective nursing students from minority backgrounds. Below is a small sample of what’s currently available.
Sponsoring Organization: Asian American/Pacific Islander Nurses Association
Description: The AAPINA sponsors an annual $1,000 scholarship for members who are enrolled in either an undergraduate or graduate nursing program, have been members of the AAPINA for two years, and meet academic and leadership qualifications.
Sponsoring Organization: Alaska Native Health Consortium
Description: The ANTHC offers 10 educational scholarships to Alaska Native and American Indian students who are enrolled in a formal training or educational program, are interested in working in a healthcare field, and are permanent Alaska residents.
Description: The IHS sponsors three scholarship programs (Preparatory, Pre-Graduate, and Health Professions) for qualified Alaska Native and American Indian students and healthcare professionals, in exchange for a two-year service commitment in an Indian health program.
Sponsoring Organization: American Association of Colleges of Nursing and Johnson & Johnson
Description: The Minority Nurse Faculty Scholars program provides scholarships to fund the graduate education of minority nursing students who intend to become nursing faculty members after graduating from a full-time clinical master’s degree program or doctoral nursing program.
Sponsoring Organization: National American Arab Nurses Association
Description: The NAANA sponsors an annual scholarship program for applicants of Arab heritage who are members of the NAANA and are enrolled in a nursing program at the associate, bachelor’s, master’s or RN-BSN level.
Sponsoring Organization: National Black Nurses Association
Description: The National Black Nurses Association offers a variety of scholarship programs, such as the Nursing Spectrum Scholarship and Ruth E. Miller Scholarship, to NBNA members who are enrolled in a nursing program (e.g. LPN, associate, bachelor’s) and have at least one year of school remaining.
Sponsoring Organization: Philippine Nurses Association of America
Description: The PNAA offers an annual scholarship to members who are graduate nursing students pursuing a post-master’s or doctorate degree and who meet academic requirements.
Student Training Opportunities
In addition to scholarships, minority nursing students can also take advantage of specialized training programs. Below is a sample list of minority-focused training programs available from hospitals, government agencies, national associations, and universities.
Aurora Minority Nursing Student Scholars Program
The Milwaukee-based Aurora Health Care offers a scholar program for ethnic minority nurses, which includes loan forgiveness payments, mentoring relationships in the nurse’s clinical area of practice, leadership development opportunities, and externship positions for students still in school. Applications are submitted through Aurora Health.
The National Black Nurses Association offers a seminar through its Founders Leadership Institute that is open to any association member. The intensive, four-hour session is conducted at the annual NBNA conference, and features healthcare leaders from around the country.
Indian Health Service externships are designed to provide nursing students with pre-professional clinical training opportunities in an Urban Indian clinic, IHS clinic or tribal clinical program. Externships last between 30 and 120 workdays during the non-academic year; participants either earn a salary or are provided with tuition payments and a stipend. Applications can be submitted on USAJobs.gov.
The Mount Sinai International Exchange Program for Minority Students, sponsored by the Mount Sinai (New York) School of Medicine, is a 12-week program that supports the work of nursing students and recent nursing graduates to perform mentored research in other countries. Interns receive paid travel, healthcare coverage, and a monthly stipend during the program. Applications are submitted directly to the Mount Sinai program.
The American Nurses Association and Substance Abuse and Mental Health Service Administration (SAMSHA) offer fellowship opportunities to foster the development of African American, Asian American, Hispanic American, Pacific Islander and American Indian nurses. Open to students with a master’s degree in mental health or psychiatric nursing who are pursuing a doctoral degree, the program provides stipends, tuition payments, research workshops, and career guidance.
The School of Nursing at Rutgers University in New Jersey sponsors a 10-month mentored leadership program for minority nurses who hold a bachelor’s degree in nursing and at least two years of full-time professional experience. The program includes a mentoring component, research projects and end-of-program presentations. Prospective candidates submit an application packet that can be found on the program website.
The Mayo Clinic in Arizona offers an unpaid externship program to nursing students to help them gain clinical experience working with diverse patient populations. Participants work three, 12-hour shifts each week during the eight-week summer program, and can gain clinical exposure to different areas of medicine, including intensive care, emergency medicine, medical-surgical care, and blood and marrow transplant. Candidates must be enrolled in an accredited nursing program and have a satisfactory academic record. Applications are submitted via the Mayo Clinic website.
Massachusetts General Hospital sponsors a six-week paid fellowship for minority nursing students who are entering their final year of a Bachelor of Science in Nursing Program. Fellows are assigned a minority nurse preceptor and are able to work in an area of interest they select. Interested candidates can contact Massachusetts General Hospital for more information.
National Organizations and Associations
There are several professional minority nursing associations and organizations. From offering scholarships to public policy advocacy efforts, these groups are dedicated to supporting prospective and current nurses.
A national organization with local chapters, the American Assembly for Men in Nursing advocates for men to join the nursing profession and supports this effort through scholarships, an annual conference, a member newsletter, and a job board to connect members to employment opportunities.
The Asian American/Pacific Islander Nurses Association, Inc. is a global organization that serves Asian American and Pacific Islander nurses through a variety of means, including scholarships and fellowships, health policy advocacy, networking events, a newsletter, and a members-only forum.
The Association of Black Nursing Faculty, Inc. is a membership-based organization for nurses who teach at institutions of higher education. It offers a platform for communication, assists members with professional development and continuing education activities, advocates on behalf of its members, and encourages networking and retention in the workplace.
The National Alaska Native American Indian Nurses Association is a membership organization that supports the needs of American Indian and Alaska Native nurses. It works to reduce barriers to nursing education and create employment opportunities, advocates on behalf of AI/NA nurses, and recruits AI/NA individuals into nursing education programs.
The National American Arab Nursing Association is a professional, membership-based organization that advocates for quality healthcare for the American Arab community, works to educate the healthcare workforce about American Arab cultural practices, and provides scholarship opportunities and employment resources to its members.
Founded in 1974, the NAHN works to promote quality healthcare services in the Hispanic community and to increase the number of Hispanic students in nursing programs. With chapters throughout the U.S., NAHN offers a peer-reviewed publication and supports students with scholarship programs.
Founded in 1971, the National Black Nurses Association now has approximately 150,000 members across 91 chapters and is a central networking hub for African American nurses. It offers continuing education programs for nurses, provides scholarships, hosts a national conference, and advocates on behalf of African American nurses and allied health professionals.
A national nonprofit organization, the NCEMNA consists of the five major ethnic nursing associations. In addition to advocating on behalf of ethnic and minority nurses, the NCEMNA also hosts conferences, provides scholarships, and offers networking opportunities to nurses for each association.
The Philippine Nurses Association of America is a membership organization that represents more than 10,000 Filipino American nurses through four regional chapters across the country; it offers a range of support services including educational programs, scholarships, networking events, and subscription to its journal.
American Nurses Association The American Nurses Association (ANA) is the country’s largest professional membership organization for registered nurses, with a comprehensive network of state nurse associations, chapters and affiliates. The ANA advocates on behalf of nurses, sponsors professional certifications, holds conferences and networking events, provides a career center, and publishes several members-only publications.
Discover Nursing DiscoverNursing.com is part of Johnson & Johnson’s Campaign for Nursing’s Future. The site is an informational hub for aspiring nurses and current professionals, offering career advice, profiles of nursing specialties, and a scholarship and school database.
Diversity in Nurse Anesthesia Nursing Program The Diversity in Nurse Anesthesia Nursing Program is an all-volunteer organization with a goal of reaching and mentoring underserved, minority populations who are pursuing a career in nurse anesthesia. The DNAP program offers a range of services, such as information sessions, luncheon programs and workshops, and sponsors student attendance at conferences.
DiversityNursing.com Launched in 2007, DiversityNursing.com works to improve diversity in the student nurse and employee populations. Users can access a job board, post resumes, review nursing employer profiles, connect with other nurses through a forum and blog, and apply for scholarships and educational funding.
MinorityNurse.com MinorityNurse.com is a career resource website that focuses on serving minority nurses and diversifying the healthcare workplace. Users can find jobs, sign up for job alerts, and access the site’s blog and magazine.
National Hispanic Health Foundation The National Hispanic Health Foundation is a nonprofit organization created by the National Hispanic Medical Association in 1994. Among its many efforts is the goal of providing leadership and development opportunities for Hispanic health researchers to provide better care to Hispanic populations. The foundation offers a range of scholarships to health students, including the National Hispanic Health Professional Scholarship.
The Provider’s Guide to Quality & Culture This website provides information about how to offer culturally competent patient care services to diverse populations. It offers advice on patient-provider interactions, includes insights into health disparities, and provides additional resources about individual cultural groups.
Sigma Theta Tau International Sigma Theta Tau International is an invitation, membership-based nursing organization that currently has more than 135,000 active members in 85 countries. The organization provides a wealth of resources to members, including networking events, conferences, scholarships, and continuing education programs. During the past decade, STTI has been focused on promoting diversity both within its own organization and in the nursing profession, and has launched multiple initiatives to support that effort.
Think Cultural Health Think Cultural Health is a project sponsored by the Office of Minority Health and offers resources to advocate for and promote cultural competency in healthcare. The site includes information about continuing education programs, as well as tools to help nurses provide quality care.
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