Racially and ethnically diverse populations have grown in the US. The US Census Bureau finds that approximately 37% of the population is made up of minority groups. Nurses currently make up the largest group of health care professionals in the US, and the need for culturally diverse nurses in the workplace has been identified by many nursing leaders. The demand for culturally competent care has brought attention to the need for culturally diverse nurses. Several studies have identified that failure to provide culturally competent care can influence health outcomes. A 2009 study published in Health Affairs found that increasing minority representation in the health care workforce could have a positive effect on curbing the health care disparities found in minority populations.
The need for culturally competent health care highlights the need for a diverse nursing workforce, particularly since patients tend to migrate towards providers that share their ethnic background. Minority nurses and possibly advanced practice nurses are in a position to help these often underserved minority communities receive care that will increase their likelihood of compliance with medical treatment and increased health literacy.
Additionally, implementation of the Affordable Care Act will allow for the expansion of health insurance to historically underserved populations. This expansion will require an increase in the number of health care professionals available to care for these populations.
Of the almost 3 million registered nurses in the US, approximately 133,000 are black and 55,000 are Hispanic. A 2013 study published in Journal of Transcultural Nursing reveals that minority students account for about 27% of the students in undergraduate schools of nursing. The low number of minority students represented in the undergraduate nursing school enrollment numbers highlights the difficulty noted by graduate schools when it comes to attracting and enrolling minority registered nurses.
Federal initiatives like the Promoting Postbaccalaureate Opportunities for Hispanic Americans program authorized under Title V of the Higher Education Act of 1965 are designed to expand postbaccalaureate opportunities and academic offerings for universities that are educating the majority of postsecondary Hispanic students. According to a 2010 brief published by Excelencia in Education, there were 176 emerging Hispanic-Serving Institutions (HSIs) in 2007. Federal law requires that in order to receive a designation as a HSI, an institution must have at least 25% Hispanic undergraduate enrollment. Emerging HSIs are those with Hispanic enrollment within the range of 12% to 24% and have the potential to become HSIs over the next few years. The HSI designation allows an institution to qualify for grants and other modes of funding. A 2010 study published in Journal of Latinos and Education found that, behind funding, the most important issue facing the presidents of HSIs was the lack of academic preparedness of the students.
Challenges are faced by Hispanic nurses desiring to pursue advanced nursing degrees. Like undergraduate enrollment, the number of registered nurses with baccalaureate degrees applying for advanced practice nursing tracts is low. There are four HSI institutions that offer nurse anesthesia in these fine programs: University of Miami, Kaiser Permanente / California State University, Inter-American University of Puerto Rico, and the University of Puerto Rico. A relatively large Hispanic applicant cohort of prospective students submit to these diverse nurse anesthesia programs along with other urban located institutions within the US. A barrier that some underrepresented students encounter is the lack of academic preparedness and/or lackluster graduate exam scores. This lack of academic preparedness equals fewer applicants who are adequately prepared for undergraduate and graduate education. In the event that a student is successful in an undergraduate program, lack of preparedness could lead to the preparation of a graduate application packet that is not representative of the candidate’s true potential.
Optimization of the nurse anesthesia program application packet can mean the difference between acceptance and rejection. The graduate application for nurse anesthesia school normally contains many components. The application is the first glimpse of the candidate presented to the admission committee. One crucial component of the process is the essay. The essay should contain information that the candidate wants to express describing his or her participation in leadership and extracurricular activities. Admission committee members take note of well-rounded candidates. Candidates should include evidence of involvement in professional nursing organizations and hospital committees. These types of activities highlight the candidate’s desire for professional development. The essay should be edited for grammar, spelling, and content before the packet is submitted to ensure that the candidate appreciates attention to detail.
The construction of a comprehensive application will most likely yield an interview, but the interview process can be intimidating. Most admission committees attempt to evaluate the student’s preparedness for the rigors of the program. The types of questions revolve around principles of physiology, pathophysiology, and pharmacology. Candidates who recognize their deficiency in interviewing should seek out opportunities to practice these techniques. Career centers may offer opportunities to hone interviewing skills.
Prospective students tend to focus on securing a seat in a nurse anesthesia program, but it is unclear how many actually consider the rigorous nature of the program. The amount of preparation that goes into the admission to a nurse anesthesia program is only minimized by the challenges of the didactic and clinical experiences for a new student. These challenges should be considered in conjunction with other stressors that can include financial obligations, reduction of income, and family responsibilities.
How to Strengthen your Application and Secure an Interview
According to the American Association of Nurse Anesthetists (AANA)’s 2012 demographics of nurse anesthetists in the United States and Puerto Rico, as an aggregate number, there is less than 10% of underrepresented minority nurse anesthetists from the 44,000 advanced practice nurses practicing in hospitals, surgery and endoscopy centers, and dental and pain management offices. Less than 3%, 3.2%, and 0.5% are from Hispanic, African American, and American Indian groups, respectively. To learn more about becoming a certified registered nurse anesthetist (CRNA), visit www.aana.com/ceandeducation/becomeacrna. Here, students will find information about the requirements of becoming a CRNA as well as a list of accredited nurse anesthesia programs, frequently asked questions, and a list of related published articles. It is imperative that prospective applicants into a nurse anesthesia program peruse not only the nurse anesthesia program of interest website, but also our national nurse anesthesia association website.
It is vitally important that underrepresented minority nurses learn more about the history of nurse anesthesia and national implications of advocacy. The book Watchful Care by Marianne Bankert is a great resource. It will expand your knowledge about nurse anesthetists and prepare you adequately for the interview, if the admission committee members ask any questions about this well-read topic. The top candidates definitely shine during the interview if they have read this material.
Another way to strengthen your application is to include your shadowing experience with a CRNA in the operating room. You should contact the CRNA and ask to meet him or her in the operating room on an agreed time. Be prepared to witness the CRNA prepare the room by checking the anesthesia machine and related equipment as well as prepare medications for the planned anesthetic prior to a patient’s arrival in the operating room. In addition, you will witness the CRNA interview the patient extensively about his or her medical and surgical history, review and secure the anesthesia consent, and perform an oral exam to assess a Mallampati score (I – IV) to anticipate an easy or difficult intubation prior to entering the operating room. During the shadowing experience, ask plenty of questions about what type of anesthetic is being administered (such as general, regional, or sedation), fluid management, positioning considerations, and more.
Along with learning the history of nurse anesthesia, as a critical care nurse with a baccalaureate degree, you should study and schedule the critical care registered nurse (CCRN) exam offered by the American Academy of Critical Care Nurses (AACN). Information regarding this exam can be found on the AACN website (www.aacn.org). This test demonstrates aptitude in critical care nursing and professional commitment towards excellence. A significant number of nurse anesthesia programs require applicants to earn critical care experience and sit for and pass the CCRN exam prior to actual submission of the essay for a nurse anesthesia program.
Another viable option for underrepresented minority nurses to improve the application process, handle the stressful interview, comply with the rigor of a nurse anesthesia program, excel for clinical preparedness, and learn about doctoral programs in nurse anesthesia programs is to register and attend Diversity CRNA Information Sessions & Airway Simulation Labs scheduled in 2014. This event, sponsored by the Diversity in Nurse Anesthesia Program (www.diversitycrna.org), offers an opportunity to those interested in nurse anesthesia education to fully engage oneself and learn comprehensive information about the process, network, and participate in a hands-on simulation experience in the lab. You will also have the opportunity and access to meet four nurse anesthesia program directors, AANA senior leadership, minority CRNAs, and nurse anesthesia students from across the country. As a result, you will have the ability to include details about your experience in your eventual essay and articulate it during your interview.
An additional application requirement of some anesthesia programs is the Graduate Record Examination (GRE). It is incumbent of any prospective applicant to visit the GRE website (http://www.ets.org/gre) to learn about the comprehensive information about the scores and the actual make-up of the exam (verbal reasoning, quantitative reasoning, and analytical writing).
So, now it is up to you. Will you peruse through the suggested websites to broaden your knowledge base about proper preparation for entry into nurse anesthesia? Do you want to be a competitive applicant for a nurse anesthesia program? Do you want to be academically and clinically prepared for such a program? If you answered yes to these questions, be proactive in your educational goals to advance your professional development in a nurse anesthesia program. You can do it!
Wallena Gould, CRNA, EdD, is the founder and chair of the Diversity in Nurse Anesthesia Mentorship Program (www.diversitycrna.org) and chief nurse anesthetist at Mainline Endoscopy Centers.
Martina Steed is a CRNA and Associate professor and Assistant director in the Department of Nurse Anesthesia at Webster University in St Louis, Missouri. She is also a small business owner and PhD candidate in the College of Health Sciences at Walden University.
Do you work at one of the more than 400 Magnet-recognized hospitals around the world? It has been said that minority nurses who work at these recognized facilities have the benefit of flourishing in a positive environment with employers who value their skills and career goals.
However, the results of Minority Nurse’s 2014 best companies survey suggest that nurses value other qualities far more than Magnet status when it comes to selecting an ideal employer. The survey, which was conducted late last year, asked nurses how important certain qualities (such as salary, benefits, and flexibility of hours) were to them when considering an employer. The results revealed that Magnet status ranked near the bottom of the list, only ranking ahead of one category: workplace size.
For some health professionals, the question of whether or not Magnet status is important can’t be fully answered until they know more about the designation, and that includes those nurses who work at Magnet-designated facilities, says Kristin Baird, RN, a hospital consultant.
“In some programs, people talk about ‘Magnet’ but people don’t understand it,” she says. In turn, they may be less likely to advocate for it or share its benefits with their colleagues. If a facility has already achieved the designation by the time a nurse is hired, then the nurse who didn’t go through the certification process may have a harder time understanding its importance and impact, especially when speaking with fellow nurses, Baird argues.
“If it’s just part of who [their hospital] is and people stop talking about it, and they don’t embrace what it means, they’re not going to be promoting it,” she says.
However, many nurses who work at Magnet hospitals and who do understand the program believe that it is a very important ideal. “Having Magnet status heightened our visibility in the community and state for being a leader for health care,” says Cabiria Lizarraga, RN, manager of telemetry at Sharp Grossmont Hospital in San Diego, California. Sharp Grossmont Hospital first received Magnet status in 2007.
Other hospitals likely receive positive coverage in their communities as well, Lizarraga adds. In fact, according to the American Nurses Credentialing Center (ANCC), 15 of the 18 medical centers on the 2013 US News Best Hospitals in America Honor Roll and all 10 of the US News Best Children’s Hospital Honor Roll for the same year are recognized by the ANCC as Magnet-recognized organizations.
“It’s very important to have because it shows we are committed. When people see we are a Magnet facility, they know the employer is committed to nursing excellence,” says Lizarraga.
Patients who are seeking hospitals may also look for the Magnet designation as an objective benchmark to help them choose where they’ll do business, says Nick Angelis, CRNA, MSN, a nurse anesthetist in Pensacola, Florida. Angelis has worked at Magnet and non-Magnet hospitals throughout his career.
Understanding the Magnet Designation
According to the ANCC, which is the Magnet credentialing organization, there are three goals for the program:
• Promote quality in a setting that supports professional practice;
• Identify excellence in the delivery of nursing services to patients/residents; and
• Disseminate best practices in nursing services.
The process to achieve Magnet status is identified by the ANCC as the “Journey to Magnet Excellence.” Facilities have to show that they have strong nurse leaders who are able to guide teams, develop professionally, take the lead in research efforts, and can show good empirical outcomes and the impact of those results. The certification lasts for four years, after which time the facility can re-apply.
Angelis, who has served on several committees on hospitals seeking Magnet status, says it is an expensive and time-consuming process, but it’s a good way for hospitals to prove that they value nurses. “A Magnet designation can be a hint that a hospital has a culture that respects the contributions its nurses make,” he explains.
Enhanced Recruiting
“Nurses want to work for an organization that really strives to empower them, one that has opportunities in place for them to do research or advance their degrees,” says Lizarraga. Facilities that have Magnet status can attract some of the best nurses available, she adds. “It is used as a recruiting tool because nurses would know about Magnet nursing excellence.”
Angelis says that if a hospital has low morale among nurses, achieving Magnet status can provide positive motivation. “It’s an opportunity for the hospital to change their culture,” he says. “Facilities that empower their nurses can improve morale, and that can help with job recruiting and retention.”
Some Nurses Left Behind?
Having an environment that encourages professional development among nurses is a positive, but there is a concern among some professionals, particularly those who don’t have advanced degrees, about where they fit in under a Magnet facility, explains Lizarraga.
Will the jobs be there for LPNs and for associate degree and diploma nurses? “There is some concern about whether or not they’d be able to practice in an acute care hospital or Magnet facility,” says Lizarraga. It may be understandable why many Minority Nurse survey respondents viewed Magnet status as only “somewhat important.”
But that issue is bigger than Magnet certification, Lizarraga argues. In 2011, the Institute of Medicine released a report recommending that the proportion of nurses with baccalaureate degrees be increased to 80% by 2020. This recommendation affects all nurses, not just those at Magnet hospitals, she adds.
However, many nurses who have more advanced degrees obviously have an advantage, states Baird. “It’s not to say there’s not a place for LPNs, but if you’re a Magnet hospital you’re looking at advancing nursing as a profession and making sure you’re finding nurses who want to be at the peak of the profession,” she explains.
Find the Best Match
So what’s a nurse to do? According to Baird, nurses of all education levels should first identify their career goals and factors that are personally important, such as career growth potential, flexibility options, and income. Then, identify an employer that seems to offer the best environment.
“I’m a big advocate of hiring for fit and choosing a job for fit,” says Baird. “Identify your core values, then find an organization that’s in alignment with those values.”
If you plan to obtain an advanced degree or would like the opportunity to go into research or academia, working at a Magnet facility may be able to provide you with more opportunities than a non-Magnet facility, she says.
However, if a potential employer is not a Magnet facility, but has other benefits that may be important to you—such as more flexible scheduling or a generous tuition reimbursement program—that could be the way to go, says Baird. Whether nurses work at Magnet hospitals or not, identifying employers aligned with their values puts them in the best position possible to benefit their patients and their careers.
Margarette Burnette is a freelance writer based in Georgia.
By providing health education and wellness promotion in religious communities of color, minority nurses of all faiths can make a powerful difference in eliminating health disparities.
Not that long ago, nurses who answered a calling to promote physical and spiritual health in their places of worship were known as parish nurses or congregational health nurses. But in today’s unprecedentedly multicultural America, where many of the faithful are just as likely to attend a Muslim mosque or Hindu temple as a church or synagogue, this specialty area of nursing has acquired a new, more all-embracing name: faith community nursing.
“When what we do was first recognized by the American Nurses Association [ANA] as a specialty practice in the late 1990s, it was under the title ‘parish nursing,’” says Nancy Rago Durbin, RN, MS, FCN, interim director for faith community nursing for the Health Ministries Association (HMA), a professional association for faith community nurses (FCNs). But by 2005, when Durbin was part of a team working with ANA to update the specialty’s Scope and Standards of Practice, the limitations of that name had become glaringly obvious.
“One of the ANA leaders said: ‘Do you have to be Christian to claim this specialty?’” recalls Durbin, who is also director of Advocate Parish Nurse Ministry and the Parish Nurse Support Network for Advocate Health Care in the Chicago area. “When I said, ‘No, this is by no means an exclusive specialty, any nurse from any faith is welcome to practice,’ she said: ‘Well, your name doesn’t seem to include that.’ And she was right!”
Of course, the term “parish nurse” is still alive and well. It’s widely used to denote FCNs who work to improve health in specifically Christian settings. But professional organizations like HMA and the International Parish Nurse Resource Center (IPNRC), a ministry of the Church Health Center, now recognize that church-based nursing is one thread in a much bigger tapestry that encompasses many different faith traditions. In fact, the Church Health Center, despite its name, teaches FCN training courses to nurses of all faiths all over the world.
When and how did traditional parish nursing evolve into this broader, more culturally inclusive specialty? “I’ve always known it to be all-inclusive,” says Maureen Daniels, RN, MN, FCN, an IPNRC faith community nurse specialist. “I think it’s just the organic nature of it that’s helped it grow into more of these other faith settings. One of the things that’s so beneficial about this model is that it’s meant to be adapted to the community and to where the needs are.”
Different Faiths, Same Roles
No matter whether the faith they practice is Baptist, Buddhist, or Baha’i, minority nurses need to be involved in addressing the health and wellness concerns of their own faith communities. Even though most FCNs do this work on a volunteer basis while also holding regular nursing jobs, they can make a tremendous difference in improving health outcomes and reducing health disparities in communities of color—especially those that are economically disadvantaged and/or medically underserved.
“[Places of worship] can be a very important resource for promoting health, because they reach so many people on a regular basis,” explains Ann Littleton, a congregational health advocate at Sacred Heart Catholic Church in Greenville, Mississippi, which serves a predominantly African American congregation plus a smaller Hispanic congregation. “At our church, we probably have more people from the community gathered together in one place every weekend than anywhere else. We can pass out information about cancer, heart disease, stroke, and diabetes just like we pass out the Sunday bulletin.”
The roles FCNs perform are remarkably similar from faith to faith. The Canadian Association for Parish Nursing Ministry organizes those functions into this easy-to-remember acronym:
H – Health advisor
E – Educator on health issues
A – Advocate and resource person
L – Liaison to faith and community resources
T – Teacher of volunteers and developer of support groups
H – Healer of body, mind, spirit, and community
For example, Ameena Hassan, RN, a Muslim nurse who works in the ICU at Las Colinas Medical Center in Irving, Texas, has been providing faith community nursing services at her mosque, the Islamic Center of Irving, since 2009. It’s a large mosque, serving approximately 500 families in the Dallas area.
“We do health education classes here every month,” says Hassan, coordinator of the mosque’s Health Advisory Committee. “We do blood pressure screenings and cholesterol screenings. We do mammograms every year, usually in April. During flu season, we do flu shots.”
The mosque also holds an annual health fair. At last year’s event—attended by almost 200 community members—local physicians, nurses, and dentists provided 100 cholesterol and diabetes screenings, 33 bone density screenings, 67 dental exams, and 42 vision exams. In addition, they gave 90 attendees nutrition advice and distributed 100 bicycle safety helmets to children.
At New Horizon Church International in Jackson, Mississippi, “cardiovascular disease is the number one health problem among my congregation, so we do lots of CVD screenings, education, and referrals,” says Ella Garner Jackson, RN, CHN, leader of the church’s Health and Wellness Ministry. Jackson and her team also provide a full calendar of other disease prevention programs, including exercise classes, kidney disease screenings, and HIV/AIDS education. On the advocacy front, the ministry helps increase access to health care for low-income church members by connecting them with community resources that provide affordable prescriptions.
Because Mississippi has some of the highest levels of poverty and African American health disparities in the nation—including disproportionately high morbidity and mortality rates from cancer, diabetes, and other chronic diseases—Jackson is especially focused on the FCN’s volunteer training role. In 2005, Jackson, who is also a cardiac case manager at Mississippi Baptist Medical Center, founded the Abundant Living Community Organization (ALCO), a nonprofit organization that has taught nearly 160 nurses and non-nurse volunteers to lead health ministries in African American churches throughout the state.
Same Roles, Different Needs
How faith community nurses carry out these roles is driven by the unique needs of the communities in which they serve. In some faith settings, for instance, FCNs must tailor their health promotion activities to accommodate specific religious requirements.
“In Islam, we don’t mix men and women together in the mosque,” says Hassan. “If we’re doing something like screenings or flu shots, we have to have it in two separate places for men and women. And the women’s space has to be covered, because they don’t want to [expose their bodies] in front of others.”
But in many minority faith communities, the biggest challenges for FCNs are more likely to revolve around cultural and socioeconomic needs than belief-based ones.
“Here in the Chicago metro area, Advocate’s parish nursing program includes two Latino congregations and two African American congregations,” says Durbin. “Our nurses who work with those communities are very focused on the needs of people who are disenfranchised, undocumented, and struggling with access to care. Some of our nurses are dealing with the problem of food deserts, and they’re trying to work with the communities to create sustainable vegetable gardens and increase access to quality foods.”
Littleton, a retired English teacher who became a church health advocate after taking the ALCO training in 2010, emphasizes that “in our Hispanic health ministry, we don’t ask about immigration status. If anybody comes to us in need of our services or a referral, we try to make them feel as comfortable with us as possible. It’s important for them to feel that we’re not going to pry into their status; we’re just providing health services that they need.”
One of the most empowering ways minority FCNs can lead their faith communities down the path to healthier living is by breaking down cultural barriers that exacerbate health inequities and impede access to care.
“In some African American communities, there is still enormous distrust of the health care system,” Durbin notes. “A black faith community nurse can become the entry point for many people to develop that trusting relationship. Someone may say, ‘I went to the public health clinic down the street and they were mean to me. So I’m not going back.’ And the nurse will say, ‘Well, how about if I go with you? Because that’s where you need to be to get your meds refilled.’ Then the nurse can physically take that person back to the clinic and help them [build a better relationship with those providers].”
Durbin also notes, “In our Latino communities, men’s health is a big issue. Many of the guys have traditional machismo cultural values, so they don’t take care of their health. And traditionally, it’s the women and the older men who are the churchgoers, but not the younger guys. Latino faith community nurses who know the culture can figure out creative ways to engage that core group of men, such as providing them with health information through the people who love these men and who do go to church.”
Enlisting the aid of lay community health promoters can also help FCNs connect with hard-to-reach populations. Daniels cites the example of a group of parish nurses in Portland, Oregon, who are partnering with local promotores to extend their health ministry outreach deeper into the Hispanic community. “Because the promotores had such good relationships with the people, and people trusted them so much, they were able to get many more community members to come to health events the nurses had organized than the nurses would have gotten by themselves,” she says.
Bridging Cultural Differences
Even if a nurse doesn’t share the same religious, ethnic, or cultural background as the faith community he or she works with, collaborating with leaders within the community can be an effective way to bridge those gaps. For example, the Faith Community Health Ministry (FCHM) program at Carolinas HealthCare System in Charlotte, North Carolina, uses a model that makes it possible for the hospital system to meet the needs of virtually any belief community.
“We form partnerships with faith communities through either a faith community nurse or a faith community health promoter,” explains Sheila Robinson, BSN, RN, the program’s health ministry coordinator for Mecklenburg County. “My role is to help each one of those individual communities promote health and wellness within their own particular faith. I provide the clinical guidance and oversight to the nurses and the health promoters.”
This approach enables Robinson, an African American Christian nurse, to work with such diverse faith communities as the Hindu Center of Charlotte, a temple that serves about 2,000 families. Her health promoter partner is Chidaabha Vyas, vice president of the Hindu Center’s executive committee. When they first teamed up in 2012, one of their key projects was to survey the temple’s members about their most important health concerns and then develop programs targeted to those needs.
“Heart disease, allergies, and weight loss were some of the top concerns the community identified for us,” Vyas says. “Diabetes is a very big concern. And it’s not specifically the Hindu community that’s so affected by this disease,” she points out. “It’s [Asian] Indian people in general. Diabetes is more of a concern for us as a race, I would say.”
Being able to work side by side with a community liaison like Vyas makes it easier for both Robinson and Carolinas HealthCare System to serve the local Hindu community in culturally sensitive ways. “When we formed the partnership, I told Chidaabha, ‘I’m of Christian faith, so you will have to help me to be able to meet the needs at the Hindu Center,’” Robinson says. One cultural lesson she learned early on is that some members of this community may be uncomfortable with the idea of placing a terminally ill family member in hospice care.
“Again, this is more of an Indian cultural issue than a religious one,” Vyas stresses. “Some of us do not believe in speeding up the process of death. We believe death will come when it will come. Having a connection between our temple and the hospital system through the FCHM program is very helpful, because we can let them know that when an Indian family is resisting hospice it’s because there is a real cultural dynamic going on.”
A Higher Power
Praying isn’t enough to make America’s health disparities crisis go away. But by educating, advocating, and integrating spirituality with health in all the diverse settings where people gather together to pray, faith community nurses have the power to bring about real change.
“Because of our partnership with Sheila and the FCHM, something is happening at the Hindu Center now that was never happening before,” Vyas reports. “It has helped us develop a culture that prioritizes health. Before, health was thought of as more of an individual responsibility. But now, we’re beginning to develop a connection with our members based on the idea that ‘you are responsible for your own health, but the temple is here to help you be responsible for your health.’”
Jackson adds: “My pastor has told me, ‘I know that you’ve saved some lives in this congregation. I know that I am a healthier person myself because of all the education you’ve provided in the church.’ I can look out into the pews and show you people who were not going to the doctor, who weren’t taking their medicine, and who are now routinely seeing a physician. That’s at the heart of what a faith community nurse can do.”
Depending on where they work and their specialties, nurses can earn a range of salaries. Salaries continue to appear to vary by ethnic background as well, but overall, nurses reported in the second annual Minority Nurse salary survey making more this year than they did last year—and more than they did five years ago.
Although nurses reported making higher salaries this year than they reported last year, there are wage gaps by ethnicity that remain to be closed.
In 2013, nurses reported making a median salary of $67,000; this year, they reported earning a bit more, a median $68,000. Still, African American nurses earned a median $60,200 and Hispanic nurses received a median $60,000, while white nurses took home a median $72,000.
To gather all this data, Minority Nurse and Springer Publishing e-mailed a link to an online survey that asked respondents about their jobs, educational backgrounds, and more to better understand their roles as nurses and to determine their current and past salaries.
Some 4,850 nurses from all over the United States responded to the survey questions. The respondents also hailed from a number of specialties, including nurses working in critical care, as certified nurse educators, and in pediatrics, as well as nurses employed at public hospitals, private hospitals, and at colleges or universities.
Some stark differences, though, were noticeable when survey data were broken down by ethnicity. For instance, nurses belonging to different ethnic groups working at similar institutions reported earning different amounts of money. African American nurses working at a public hospital reported earning a median $65,000, as did Asian nurses. Hispanic nurses reported making less, taking home a median $60,000. White nurses, though, said they earned $79,500.
Additionally, nurses belonging to different ethnic groups with similar educational backgrounds also reported salary differences. African American nurses with a bachelor’s degree reported making a median $62,000—similar to the median $60,000 reported by Hispanic nurses—though higher than the median $50,000 received by Asian nurses, but lower than the median $70,000 that white nurses said they made.
At the master’s degree level, the picture is a little different. Asian nurses with master’s degrees commanded the highest salary, a median $80,000, followed by African American nurses, who received a median $76,000. Hispanic nurses, meanwhile, earned a median $74,940, and white nurses with a master’s degree reported making a median $73,000.
Overall, respondents reported earning a higher salary this year than they took home last year and a bit more than they reported earning five years ago. For example, nurses working primarily in patient care reported earning $60,000 this year, $55,000 last year, and $47,000 five years ago, and advanced practice nurses reported making $89,000 this year, $84,000 last year, and $78,000 five years ago.
Though there are still wage gaps to be bridged, nurses reported earning more now than they did just a few years ago.
Highlights
17.6% of respondents have a PhD or other doctoral-level degree
33.3% work at a college or university
56.2% have been at their current job for five years or longer
65.8% received a raise within the last year
53.5% left their prior job to pursue a better opportunity
41.1% do not expect a raise this year
48.9% are looking to leave their current job in coming years
Romeatrius Moss, RN, MSN, APHN-BC, DNP, doesn’t mince words when she advises other nurses about advancing their careers. “If you aren’t geared and ready and have everything in your toolbox, you are going to be left behind,” says Moss, the executive director of the Mississippi Gulf Coast Black Nurse Association. “Getting an advanced degree is extremely important. It pushes our profession forward.”
As more minority nurses advance, they are positioned to assume leadership roles and increase the diversity of nurse leaders, all of which reflects the patient population.
Moss’s outlook mirrors one that is hotly debated in nursing. The Institute of Medicine (IOM) garnered attention with its 2010 report, The Future of Nursing: Leading Change, Advancing Health, which calls for a highly educated nursing workforce to keep pace with the changing demands of both the health care environment and the patients who are served. An 80% goal of nurses with BSN degrees and a doubling of nurses with doctorates are imperative for the nursing community, the report stated.
“It’s good for the professions, but equally good and equally more important for the people who are coming into the health care system who deserve an educated workforce,” says Jane Kirschling, PhD, RN, FAAN, president of the American Association of Colleges of Nursing (AACN). “The bottom line is about patient safety and providing health care that is high quality, efficient, and cost effective.”
In light of the study and others like it, nurses—who build careers on change—are debating the best and most reasonable ways to achieve career satisfaction and advancement. A nursing career includes different options, and one work day is never like another. To achieve maximum career success and optimize your salary potential, learn to embrace the changing atmosphere, says Janice Phillips, PhD, MS, RN, FAAN, director of government and regulatory affairs at Commission on Graduates of Foreign Nursing Schools International, an authenticity credentialing service of foreign-educated nurses.
Advancing Your Education
The 2010 IOM report brings the issue of higher nursing degrees into sharp focus, causing some nurses to reevaluate their goals and some hospitals to implement new minimum requirements for employment. “Whether it is an associate’s, bachelor’s, or master’s-prepared nurse, the reality is that nursing requires lifelong learning,” says Kirschling.
Nurses have choices about how to advance, but a degree appeals to many organizations. “A minimum of a bachelor’s in nursing will open doors when you are competing for a job, and it shows a level of commitment,” says Marie-Elena Barry, a senior practice and policy analyst at the American Nurses Association. And even Kirschling says that an associate’s degree is often considered a point of entry into nursing now, not the final point.
Nurses are taking notice. Results from the Health Resources and Services Administration’s (HRSA) “2008 National Sample Survey of Registered Nurses” showed that half of registered nurses hold a bachelor’s degree or higher, and just over a third hold an associate’s. The rest have a diploma in nursing. Most nurses initially receive an associate’s degree, but about a third start out with a BSN. And for those who eventually earn higher degrees, the study showed approximately half of nurses with master’s degrees work in hospitals while the rest work in academia or in an ambulatory care setting.
According to a May 2012 occupational employment and wages report by the Bureau of Labor Statistics, an RN can expect to earn a mean annual wage of $67,930. Furthermore, the 2008 HRSA study revealed that RNs with graduate degrees earned an average of at least $20,000 more than RNs with other levels of education. Nurses who graduate with a degree also get into the workforce faster. Data from an August 2013 survey by the AACN revealed that nursing graduates of BSN or master’s programs are much more likely to have a job offer at graduation than graduates in other fields.
And while the higher salary is great, nurses are finding they need a bachelor’s to even get a job. The AACN study showed that 43.7% of hospitals and other health care settings require the degree and that 78.6% of employers prefer to see the BSN on a resume even if they don’t require it.
When you consider how to advance both your professional goals and your personal goals, keep in mind how each job will help you get to where you want to be. “Lots of nurses get a degree and go to work and don’t think about career development and learning how to grow your career,” says Barry. As a new nurse, you must ask yourself whether you are gaining valuable experience that you can put on a resume. And if you have been in nursing for years and are considering a move to academia, you should consider whether a teaching position will offer you needed benefits and retirement.
A Balancing Act
Working and going to school isn’t easy, and adding other obligations, like family, often makes the task overwhelming. But as the demand for nurses with a bachelor’s degree increases, schools are making it easier by offering accessible classes and accelerated degree programs. And Moss advises nurses not to be discouraged by the commitment. “This is a train,” she says. “Jump in when you can.”
In the meantime, anything you can do to make yourself more valuable to an organization will help increase your salary, and often a new degree raises your pay as well. “Provide evidence of how you made a difference,” advises Phillips.
Kirschling suggests talking with your employer about wanting to build on your skill set or your desire to continue your education. “Employers want to retain nurses and create career mobility within the organization,” she adds.
Keep Your Options Open
“People believe the continuing mantra that nurses need to work in traditional venues like hospitals and doctors’ offices,” says Carmen Kosicek, RN, MSN, author of Nurses, Jobs, and Money: A Guide to Advancing Your Nursing Career and Salary. But the pay for those positions doesn’t always match the financial outlay needed to practice there, she continues.
Instead, Kosicek advises nurses, especially those just graduating from nursing school, to look for other opportunities that offer both professional experience and gainful employment. “It’s not all about the money,” says Kosicek, “but they all have bills.”
According to Kosicek, many graduates are not hired for 4 to 18 months, and many of them are competing for med/surg jobs to gain broad experience. She suggests considering other options where you will use all your skills. A position as a school nurse, for example, where you handle hundreds of varied and often complex cases is an excellent way to use your skills and learn new ones. When you apply for a new grad residency program, you are already starting above the rest of the pack, she says.
If you are unsure what your next move should be, Kirschling recommends checking out www.discovernursing.com to explore opportunities.
Approach Your Career as a Business
When you view your career as a business, you give yourself permission to look impersonally at your experience and your credentials. And you treat any potential job offer, salary increase, or career move with the same consideration as you would a major life change.
Just as you would negotiate the price of a house you are buying, you also must learn to negotiate salary offers, argues Kosicek. “It’s not always about your base pay of dollars,” she says. “You can negotiate other ways of compensation.” For example, you can ask for more vacation days, a higher match of your 401(k) plan, or tuition reimbursement for classes.
“No one is teaching that,” says Kosicek, but it is a valuable skill because it will get you closer to your goals. Negotiating shows you are confident and know your worth. “It is a totally different language,” she adds.
Act Like a Leader
Even if you haven’t reached your ultimate career goal, you can act like you have. “You can’t do a BSN [program] and expect to be a manager,” says Barry. “There are lots of little steps.”
Be a leader in your nursing community and make your presence known. One way to help increase your salary potential is to get involved within your state or with national organizations, says Barry. Don’t just become a member. Begin to make a difference by giving your input, showing up at events and meeting others, or volunteering on your state board of nursing, advises Barry. “It increases your ability to network and puts your face out there.”
Don’t overlook the importance of your workplace as well. Barry recommends getting involved with unit-based activities. Join a shared governance committee or work on a quality improvement project. Then give thoughtful input and work hard for the team.
Be More than Just Another Resume
Your resume might be your only shot at a job you want, so make it perfect. Just as nurses need negotiating skills to get ahead, they need a resume that is detailed and exact because it could mean the difference between the slush pile and a job offer.
“Nurses are not going to get in with traditional nursing resumes or traditional interviewing skills,” says Kosicek. “They have to show they are business wise.”
Barry agrees. Your experience, commitment, and education all combine into one package to an employer, but they have to be able to see it. You can do your part with a detailed resume that lists your education and any current classes along with your qualifications.
Become a recognizable name through your professional and appropriate exposure on social media and your networking efforts that bring you in touch with various health care professionals, suggests Barry.
Other Benefits
Of course, taking on a new degree doesn’t work for everyone. You have to consider the financial return on your investment, so you aren’t trading more education for insurmountable debt.
Chart the financial impact of furthering your education. If you want a degree but can’t imagine how you will pay for it, become a sleuth for scholarships or take an alternative path. If your company doesn’t reimburse for tuition, see if your professional organization membership gives you access to scholarships or grants. Can you take one class at a time to chip away at the degree?
A less tangible benefit of continuing your learning is confidence. “It gets you excited and keeps you informed and learning outside your unit,” says Barry. “Certification is important. It shows your commitment to your profession. It also shows your professional role modeling.” When you are learning and advancing by taking classes, even if it’s one at a time, you are demonstrating to your employer that you are actively engaged in your profession, she says.
Phillips knows firsthand the benefits of doing the unexpected. She recently left a faculty job at Rush University and the comforts of family and friends for her current job in a new city. Although the prospect gave her nervous butterflies, Phillips says the job fit perfectly with her career plan, filling a gap in policy experience that Phillips wanted to have. “Sometimes you just have to do it,” she says. “I didn’t want to sit around and not take some risk. Most people who have a well-rounded professional life have taken some risk.”
Have a Plan
Your career will stagnate if you don’t have a solid and ambitious plan to follow. Decide where you want to go and write a plan of action to get there. Put yourself in position to get where you want to be. Do you respect a nurse in a leadership position? Notice how she acts and ask about her volunteer work or about any organizations of which she is a member. “Part of the learning process is going through and collecting along the way,” says Barry. “As you are getting a degree, you are exposed to all those other areas.”
Even if you are not looking for a job, keep accurate records of your career successes, advises Phillips. “We don’t document our outcomes,” she says, so when the time comes to tell potential employees about them, it’s hard to remember the details. Keep a file—“call it a happy file,” suggests Phillips—where you record accurate outcomes and contributions from your job successes. Pay particular attention to relevant numbers and dates, so you can retrieve them when necessary. “Nurses have to be prepared,” she says. “You never know when an opportunity will present itself.”
Does an Advanced Degree Equal Respect?
Like it or not, an advanced degree is the first step toward a leadership position. “It’s very important for nurses to get a nursing degree,” says Barry. For nursing as a profession to advance with respect, getting a degree—particularly a BSN—will also bring more nurses into position to take over as future leaders. “Nursing education has a lot to do with where you go,” says Barry.
Starting with a BSN is the most important goal because it keeps you competitive, argues Barry. But as Kosicek points out, you will have to find your place in the market and actively seek out nursing roles that both pay your bills and satisfy your professional goals. Sometimes, a career move is your chance to advance professionally and personally and will lead to greater rewards, but you have to be willing to take the leap.
“The risk is that we have to be open and willing to leave our comfort zone to experience all nursing has to offer,” says Phillips. “And it’s scary. But I don’t believe anyone should be burned out. You need to find a new perspective.”
Just as each nurse is unique, so is each successful career path, says Phillips. “I’ve been a nurse for 37 years, and I am just as excited today as the day I graduated because I see the possibilities,” she says. “At the end of the day, how do you want to feel about what you want to do and what makes you proud of your profession?”
Julia Quinn-Szcesuil is a freelance writer based in Bolton, Massachusetts.
