Of the 2.2 million nurses in the United States, the vast majority still conforms to the traditional white/female nurse profile. Only 4%-5% of nurses are male, 4% are African American, 3.4% are Asian/Pacific islander, 1.6% are Hispanic and 0.5% are Native American/Alaskan Native.1
With the exception of male nurses, whose numbers are on the increase, these percentages have essentially not changed in 10 years, despite ongoing changes in the makeup of the U.S. population. For example, the growth of the Hispanic population is now outpacing that of the nation as a whole. And yet, according to the most recent National Sample Survey of Registered Nurses by the U.S. Department of Health and Human Services’ Division of Nursing, Caucasians still account for approximately 90% of the total number of registered nurses in the U.S., even though they comprise only about 72% of the total population.
It seems to me that at least three issues are raised as a result of these figures. First, although there has been a steady change in the racial and ethnic makeup of the greater U.S. population, the nursing profession does not reflect this change. The underrepresentation of minorities in nursing and schools of nursing can be attributed to a variety of factors, including the high dropout rate of minority students at the high school level.2 Additionally, a minority student’s acceptance into a nursing school does not guarantee his or her successful completion of the program.
Secondly, these statistics raise the issue of cultural competency—both within the profession and in nursing education. Providing culturally competent care is the key to ensuring that underserved minority populations receive quality health services. Yet most nursing schools continue to design their curricula around the needs of the majority, leaving out the unique needs of the other 28% of the population. Perhaps nursing schools would be better able to recruit and retain students if they would offer a curriculum that would teach students to take care of people from all ethnic backgrounds.
Towards a Multicultural Curriculum
Embracing multicultural education is a shift from the norm of educating from a Eurocentric perspective, but by doing so, the opportunities for people of different cultures to learn about each other and themselves increase. A multicultural perspective means accepting that a variety of cultures exist and understanding that each one may have its own different traits, beliefs and traditions.
Although there are exceptions, basic nursing education generally does not include information relevant to minority populations. For example, in many instances hair care for African Americans, and also some Hispanics, is different than hair care for whites. Yet this issue is rarely discussed in nursing schools. It is addressed in teaching about personal hygiene, but instruction is generally based on the needs of the white population. This approach leaves nurses underprepared to provide care to minority patients whose hair texture may be different. Unfortunately, what often happens is that the nurse may not provide any hair care at all—a good example of how a lack of cultural competency affects the quality of patient care.
A second example is the dietary instruction that student nurses receive. Sometimes the foods included in the teaching plan may not be the same foods that a minority patient consumes at home. Therefore, the instruction is ineffective because the patient’s cultural food traditions have not been taken into consideration.
A third issue, based on my own experience as the only Latina student in my nursing program, is the way students of color may be perceived and treated within the educational experience—by faculty, administration and peers. In researching my doctoral study, “Understanding the Experiences in Nursing School: A Latina Perspective,” Latina students described to me such incidents as a faculty member telling a student: “Spanish students do not pass my course.” Another student told of being asked by a fellow student if she was “hiding a knife or a gun” in the brace on her leg, because “you Puerto Ricans are always shooting people.”
In another incident, a Latina student who felt she had received an unfairly low grade on a paper took her case to the school’s director of nursing, who asked, “Is Spanish your primary language?” The student replied, “No. What does that have to do with it?” The director’s response was: “I wish you had said ‘yes,’ because that would explain the problems you are having.”
Being continually bombarded with cultural insensitivity and negative stereotypes can be detrimental to a minority student’s success in school. Non-inclusion can also be a contributing factor to a student’s failure to complete his or her nursing studies. Students of color need to receive positive messages and images to enhance and support their learning experiences. A nurturing educational experience is beneficial to all students, not just those who are white.
Whatever their race or ethnicity, students need to feel they are a respected part of the educational experience, and they need to be trained to offer culturally competent care to a diversity of patients. If educators don’t provide all nursing students with an opportunity to develop a multicultural perspective—i.e., to view nursing and patients from a broader perspective than just a Eurocentric one—then we have shortchanged them in their education.
1. U.S. Department of Health and Human Services, Bureau of Health Professions, Division of Nursing (1996). National Sample Survey of Registered Nurses.
2. Nieto, S. (1996). Affirming Diversity: The Sociopolitical Context of Multicultural Education (2nd edition).