“To begin, we must acknowledge that from 1916 until 1964, ANA purposefully, systemically and systematically excluded Black nurses…”
The American Nurses Association (ANA) is taking a meaningful first step to acknowledge its own past actions that have negatively impacted nurses of color and perpetuated systemic racism. With the release of a formal racial reckoning statement on July 12, ANA is beginning a multi-phase journey of reconciliation, forgiveness, and healing. The Journey of Racial Reconciliation is the name for ANA’s racial reckoning journey as it seeks to address past racial harms from as far back as the formation of the association in 1896.
From the ANA statement:
“Similar to the concerns raised by Black nurses, in 1974, led by Dr. Ildaura Murillo- Rhode, a group of 12 Hispanic nurses who were also members of ANA came together to consider establishing a Hispanic Nurses Caucus within ANA because ‘ANA was not being responsive to the needs of Hispanic nurses.'”
“We know that ANA’s work to reckon with our historical and institutional racist actions and inactions is long overdue. Racism is an assault on the human spirit, and we want to be accountable for our part in perpetuating it. We have certainly failed many nurses of color and ethnic-minority nursing organizations, undoubtedly damaging our relationship with them and in so doing, diluting the richness of the nursing profession. We ask forgiveness from nurses of color as a first step to mend what is broken,” said ANA CEO Loressa Cole, DNP, MBA, RN, NEA-BC, FAAN.
“ANA recognizes that issues of racism persist today and continue to harm nurses of color. Findings from the Commission’s 2021 national survey on racism in nursing (n = 5,600) noted that racist acts are principally perpetrated by colleagues and those in positions of power. Over half of nurses surveyed (63%) said they had personally experienced an act of racism in the workplace with the transgressors being either a peer (66%) or a manager or supervisor (60%). Fifty-six percent of respondents also noted that racism in the workplace has negatively impacted their professional well-being.”
On June 11, 2022, the ANA Membership Assembly, ANA’s highest governing body, took historic action to begin a journey of racial reckoning by unanimously adopting the ANA Racial Reckoning Statement. Please read the entire statement and stay connected with ANA on its journey.
“In 1975, the world was a very different place,” Carmen Portillo, PhD, RN, FAAN, immediate past president of the National Association of Hispanic Nurses, told NAHN members at the opening ceremony of the association’s 25th Annual Conference last summer. “The war in Vietnam finally ended; the International Women’s Year Conference adopted a 10-year plan to improve the status of women. Congress repealed the Taft-Hartley Act, giving nurses the right to collective bargaining. In 1975, the world held 4 billion people—but no personal computers and no cell phones. The world had not yet heard about AIDS.”
Back then, the world was also a dramatically different place for Hispanic nurses. There were very few nurses of Hispanic origin in the nursing work force—even though the nation’s Hispanic population was growing rapidly. With very few exceptions—most notably, Ildaura Murillo-Rohde, PhD, RN, FAAN—there were virtually no Hispanic nurses working in academic settings, doing research on Hispanic health issues or advising federal policy-makers about the health care needs of Hispanic people.
What’s more, back in 1975 there was no national organization serving the professional and leadership development needs of Hispanic nurses. There was no unified voice to speak up in advocacy for the unique cultural concerns of Hispanic nurses and the communities they served.
“I began to realize that something had to be done about this,” recalls Murillo-Rohde, dean emeritus and professor emeritus at SUNY Brooklyn. “I saw that I was the only Hispanic nurse who was going to Washington to work with the federal government, review research and education grants, etc. There was nobody else. I looked behind me and thought: ‘Where are my people?’”
Ildaura Murillo-Rohde, PhD, RN, FAAN
This determination to “do something” to increase the representation of Latinos in the nursing profession led Murillo-Rohde to create the organization known today as the National Association of Hispanic Nurses. Last year, NAHN proudly celebrated its 25th birthday as the nation’s voice for Hispanic nurses and Hispanic health. With more than 30 local chapters across the United States and in Puerto Rico, NAHN currently represents the interests of more than 40,000 Hispanic nurses coast to coast.
Today, at the start of the 21st century and the new millennium, America’s Hispanic population is growing faster than the U.S. population as a whole, creating a huge and urgent demand for more Hispanic nurses who can meet this underserved ethnic group’s need for culturally and linguistically competent care. In light of this, NAHN’s original mission statement seems even more relevant today than it was a quarter century ago:
• To serve the nursing and health care delivery needs of the Hispanic community and the professional needs of Hispanic nurses; • To work toward improvement of the quality of health and nursing care for Hispanic consumers; and • To provide equal access to educational, professional and economic opportunities for Hispanic nurses.
Like the National Black Nurses Association, NAHN began as an ad hoc minority nurse committee within the American Nurses Association that eventually broke away to go solo. “We felt that we really didn’t have a place within ANA,” explains NAHN’s 1984-1988 President, Henrietta Villaescusa, RN, FAAN. “We had special issues and problems that we felt were unique to Hispanic nurses and were not being addressed. We needed to be accepted as part of the nursing profession; we needed people to understand that Hispanic patients had special cultural needs.”
Adds Mary Lou de Leon Siantz, PhD, RN, FAAN, a founding member of NAHN who is now the association’s current president, “In 1975, many of us were feeling isolated. There were so few Hispanic nurses in the country—and, especially, very, very few in academia. There was little available in terms of mentorship and networking with other Hispanic nurses. Back then, it was a time when ‘minority’ wasn’t a buzzword and the isolation was very acute.”
Following the 1975 ANA annual conference, a group of about 15 nurses, led by Murillo-Rohde, received approval to form a completely new association devoted exclusively to serving the needs of Hispanic nurses. Originally called the National Association of Spanish-Speaking/Spanish-Surnamed Nurses, the fledgling association met in New York City in space donated by the New York State Nurses Association. In 1979, the group was renamed the National Association of Hispanic Nurses and is now headquartered in Washington, D.C.
As the association’s first president (serving from 1977 to 1980), Murillo-Rohde continued to be the driving force behind NAHN in its early years, even using her own money to fund the organization’s growth. “That was because there was no money to do anything,” she says. “For the first four years, I was the chief cook and bottle washer for NAHN. I promoted the association, I put out the newsletter, I did everything.”
Triumphs and Challenges
The National Association of Hispanic Nurses today is a very different organization than it was in its infancy and toddler days. Since the formation of the group’s first local chapter in New York in 1983, the aggressive development of a network of NAHN chapters throughout the country has fueled steady membership growth. It has also provided opportunities for many other Hispanic nurses to serve in leadership roles in the association. “It has been the chapters, working with the communities and the nurses, that have shaped the growth of NAHN,” Murillo-Rohde asserts.
While the association has evolved tremendously since 1975, Antonia Villarruel, PhD, RN, FAAN, the group’s 1996-1998 president, believes NAHN’s fundamental goals have not changed. “We continue to be advocates for Hispanic communities and Hispanic nurses,” she says. “We believe Hispanic nurses can provide unique leadership in the nursing profession, because of our bilingual, bicultural skills. I think we have become more savvy and more powerful as our membership has grown and we continue to attract Hispanic nurse leaders.”
Identifying barriers to quality education for Hispanic nursing students and working toward recruitment and retention of Hispanic students in nursing education continue to be high-priority goals on NAHN’s agenda. Says Portillo, “Given that Hispanic high school students have such a high drop-out rate, we are already at a disadvantage. Those who do make it into nursing school often do not have the appropriate tools to be successful academically. They may drop out or will not pursue higher educational degrees. The majority of our nurses are prepared at the associate-degree level.”
While NAHN’s membership outreach has helped make inroads in increasing the number of Hispanic nurses in the RN population, “the recruitment and retention challenges have been constant as well as the growth,” Villarruel feels. “I think it’s a crime that Hispanic nurses still account for only 1.6% of the nurse work force. People will play games with the numbers and say there’s been an increase, but the fact is, the number of Hispanic nurses has not grown proportionately to meet the health needs of our people.”
In the National Spotlight
Ask the association’s founders and leaders what NAHN accomplishments they’re most proud of after 25 years and you get many different answers. For Founder Emeritus Murillo-Rohde, it is NAHN’s success in encouraging Hispanic nurses to move beyond associate-level education and earn advanced degrees.
“High school counselors would try to railroad Hispanic students into the AD nursing programs,” she explains. “I’m proud of the fact that we’ve been able to push more of our nurses on to earn doctoral degrees. We now have a number of Hispanic doctoral nurses who are very good at research and have been recognized worldwide for their studies. For example, Mary Lou de Leon Siantz has done work with Mexican migrant families that was truly ground-breaking.”
Portillo is excited about the fact that “in the last 10 years, NAHN has really risen to a different level—one of national recognition as well as local recognition. There has been great enthusiasm from people who see the need for this organization—including nursing schools, private industry and community health organizations—because they see our members as the connection to the Hispanic community they need to serve.”
Much of this national recognition is due to NAHN’s efforts to bring more Hispanic nurses to the federal health care policy-making table, an achievement Villarruel is particularly proud of. “We now have Hispanic nurse representation on important government boards, such as the Division of Nursing and the National Institute of Nursing Research,” she points out. “I think we’ve been instrumental in moving the agenda for [Hispanic] nursing forward, and in that sense, moving our community forward.”
The association regularly submits the names of Hispanic nurse leaders when positions open up on health policy committees, according to NAHN Vice President Rose Gonzalez, RN, MPS, who chaired the group’s Policy Committee for the last four years. “For instance, Carmen Portillo was appointed to serve on the NINR’s national advisory committee,” she says. “Prior to that, Mary Lou de Leon Siantz served on that committee. Patricia Montoya [RN, MPA], commissioner of the Administration on Children, Youth and Families, is a long-time NAHN member. We sent a letter of recommendation on her behalf for that position, along with the ANA.”
Mary Lou de Leon Siantz, PhD, RN, FAAN
For Siantz, the association’s most worthwhile accomplishment is the creation of a vital and growing national network of Hispanic nurses, eliminating the isolation that existed in the past. “Hispanic nurses need to communicate with each other,” she emphasizes. “Through our networks, Hispanic nurses have their hands on the pulse of the Hispanic community. This enables us to give national, regional and community leaders the message that they need to work with us, because we know about Hispanic people’s health needs more than anybody else does.”
Building Future Leaders
By the year 2050, Hispanics are projected to become the nation’s largest minority group, comprising nearly a quarter of the U.S. population. Will the nursing profession be able to provide enough Hispanic nurses to meet this exploding need for culturally sensitive care? With this challenge at the top of its agenda, the National Association of Hispanic Nurses plans to be a very busy organization as it gears up for its next 25 years.
“We have done a lot but we need to do more,” Murillo-Rohde believes. “We want to continue to increase our membership. As I travel, I still hear Hispanic nurses saying, ‘I didn’t know that we had [an organization like NAHN].’”
Siantz would like to see NAHN representing 100,000 Hispanic nurses in the United States and Puerto Rico by the year 2025. “One thing we’ll be focusing on during my presidency is expanding the student portion of our membership. As the association grows, I’d also like to see us have the capacity to reach out and mentor Hispanic boys and girls who are interested in health care careers.”
But the ultimate goal, NAHN’s president emphasizes, is to continue Murillo-Rohde’s legacy of not just increasing the number of Hispanic nurses but also developing more Hispanic nurse leaders. “NAHN has established a venue for developing Hispanic nursing leadership that simply didn’t exist 25 years ago,” Siantz says. “One of our key strengths is the ability to mentor—in government, academic and community settings. I want NAHN to continue that mentorship with the new students who are coming in. We now have the wherewithal to help Hispanic nurses develop their careers in whatever direction they want.”
How Much Do You Know About Hispanic Nurses?
Test your knowledge with this quiz:
1. How many Hispanic nurses are currently practicing as RNs in the United States?
2. Today more than 10% of the total U.S. population is Hispanic and that figure is expected to rise to at least 22% by 2050. What percentage of the current RN population is Hispanic?
3. True or False: Hispanic nurses are older on average than other RNs.
4. Where in the U.S. would you find the greatest number of Hispanic nurses?
5. True or False: Hispanic nurses are more likely to enter their nursing careers through associate degree programs than nurses of other ethnic/racial backgrounds.
6. What percentage of Hispanic nurses hold advanced degrees (master’s or doctoral level)? How does this compare with nurses from other ethnic/racial backgrounds?
Answers to Hispanic Nurses Quiz
1. As of March 1996*, approximately 40,600 of the 2,559,000 individuals with current licenses to practice as registered nurses in the U.S. were of Hispanic background.
2. Although Hispanics account for more than 10% of our nation’s population, less than 2% of the RN population is Hispanic. You do the math.
3. False. The average age of Hispanic nurses is 41.1 years, compared to 44.3 years for the RN population as a whole.
4. Seventy-five percent of the Hispanic nurse population is located in the western and southern regions of the U.S.—specifically, 38% in the West and 37% in the South.
5. True. As of March 1996, about 53% of Hispanic nurses entered the profession through associate degree programs, compared to about 37% of the RN population as a whole.
6. About 7% of Hispanic nurses hold master’s or doctoral degrees, compared to about 10% of Caucasian nurses and 12% of African-American nurses.
Did you know that abolitionist leaders Harriet Tubman and Sojourner Truth both worked as nurses during the Civil War? Can you name the first black nurse to join the American Red Cross Nursing Service? (Answer: Frances Reed Elliott Davis, in 1918.) Were you aware that Dr. Phoebe Dauz Williams was the first Filipino-American nurse to become a Fellow of the American Academy of Nursing (FAAN)? Or that the National Association of Hispanic Nurses (NAHN) was founded in 1975 by Ildaura Murillo-Rohde, RN, PhD, FAAN?
Minority nurses in the United States have a rich and proud history dating back to at least the mid 1800s, yet most people have little knowledge of these courageous nurses’ exceptional accomplishments and the barriers they overcame to achieve their rightful place in the nursing profession. But Marie O. Pitts Mosley, RN, EdD, PNP, is planning to change all that. The noted nursing scholar and historian is currently at work on a landmark book that will celebrate the history and leadership of nurses of color in America.
Tentatively titled Despite All Odds, the book will feature personal stories, biographies and photographs of minority nurses that will document, in Mosley’s words, “our oral histories of courage, hope, perseverance, faith and fortitude.” She envisions a wide international audience for this long-overdue book, including elementary and high schools, nursing schools, other university programs, historians, nurses and the general public.
Mosley, an associate professor at Hunter-Bellevue School of Nursing in New York, says this first-of-its-kind history is intended to “recognize all [minority nurses] who overcame great obstacles. . .who have a song to sing, a story to tell or a vision for all people of the Earth. This book is a celebration of your strength,” she adds. “It pays tribute to you and is dedicated to all nurses of color.”
Would you like to be part of this exciting project? If you are a minority nurse with “a song to sing, a story to tell,” or a photograph to share, Dr. Mosley would like to hear from you so that your experience can be included in Despite All Odds. For more information about how to submit material for the book, contact her at 2541 Seventh Avenue, Apt. 8K, New York, NY 10039, (212) 926-1647, email [email protected].
Last summer I enjoyed the honor and great privilege of presenting a poster session with my former colleague Anderson Torres, PhD, LCSW-R, at the 34th Annual Conference of the National Association of Hispanic Nurses (NAHN). The conference was held in San Antonio, Texas—a city known for good Southwestern food, intoxicating Mariachi and Tex-Mex music and warm, engaging Texan hospitality.
NAHN, founded by Dr. Ildaura Murillo-Rohde in 1975, is a professional nursing association committed to improving the health of Hispanic patients and communities and to increasing educational, professional and economic opportunities for Hispanic nurses. Although he is a social worker, not a nurse, Anderson was one of the core group members who helped in revitalizing and expanding our local NAHN chapter here in New York City.
The subject of our poster presentation was the correlation between diabetes and Alzheimer’s disease in the Hispanic community. Alzheimer’s is a topic close to Anderson’s heart, since his abuela (grandmother) suffered from this heartbreaking condition. The Alzheimer’s Association defines it as an irreversible, progressive disease that slowly destroys memory, reasoning skills and, eventually, the ability to carry out the simplest tasks of daily living. Our presentation focused on the effects of diabetes and Alzheimer’s disease among Hispanics and on the role diabetes plays in increasing the risk of dementia in this vulnerable populations. We also presented culturally competent, patient-centered strategies that our Hispanic community can implement in real-life settings to promote healthy behavior change and encourage patients to take control of their health.
Before I describe our presentation in detail, let me explain that for nearly 40 years I have served as a home care nurse with the Visiting Nurse Service of New York (VNSNY), which was founded by Lillian D. Wald in 1893. We VNSNY nurses collaborate with teammates in other disciplines, such as medicine and social work, to offer home health services—ranging from infant care and acute care to long-term rehabilitation and hospice care—to a highly diverse patient population throughout New York City and two suburban counties.
About a quarter of VNSNY patients are non-English-speaking, including the many Spanish-speaking patients that I care for in the Washington Heights neighborhood of Northern Manhattan. To offer a broader perspective, I am one of about 4,500 Hispanic nurses in a city estimated to have more than 2.5 million Hispanic residents. Working for VNSNY makes me a member of the largest group of Spanish-speaking Hispanic health care providers in our metropolitan area. For the record, VNSNY defines Hispanics as persons who come from Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish cultures. The term “Latino” encompasses people from Brazilian, Asian and African cultures as well.
In 2008, VNSNY was honored with the NAHN New York City Chapter’s first-ever Institutional Award, recognizing our agency for its efforts to “raise awareness of and address health care disparities and increase diversity in nursing” and for being a true champion and outspoken advocate for Hispanic communities in New York City.
Culture and Alzheimer’s
Anderson began his portion of our presentation by noting that the number of U.S. residents aged 65 or older is projected to increase to 12.5 million by 2050, while those aged 85 or older are expected to number 2.6 million at mid century. As the average age rises, the risk of contracting Alzheimer’s disease rises concomitantly. Furthermore, Anderson pointed out, the Alzheimer’s Association reports that the number of Hispanics/Latinos in the U.S. with Alzheimer’s disease and related dementias could increase by more than sixfold by mid century—to as many as 1.3 million.
“The lack of Alzheimer’s resource information in the Spanish language has become a serious barrier to meeting diagnostic and cultural needs and obtaining appropriate services for Hispanic patients suffering from this disease in New York City,” said Anderson, who co-founded the Latino Alzheimer’s Coalition of New York, Inc. (LAC-NY) to address issues related to access, information, advocacy and research.
“Alzheimer’s disease exerts a direct impact on the emotions and behaviors of both diagnosed individuals and their [family] caregivers,” Anderson continued, adding that Alzheimer’s disease is a shared family experience that can have a devastating effect on Hispanic patients’ extended family systems. He noted that studies of Alzheimer’s caregivers have identified increased depression, anxiety, use of psychotropic medications and a negative impact on their work and social lives.
While research is only beginning to uncover the impact of Alzheimer’s disease among Hispanics, the Alzheimer’s Association suggests that this population may be at greater risk for dementia than other ethnic or racial groups, Anderson said. In 2005 the association reported that cardiovascular risk factors such as diabetes and hypertension—which contribute to higher rates of cognitive decline with aging—are also more prevalent among Hispanics.
Patients with Alzheimer’s disease deteriorate and debilitate, requiring supervision and controlled environments to help them remain safe. “Many Hispanic families include working adults who are unable to provide Alzheimer’s patients with the level of care needed in a traditional home setting,” Anderson said. “In spite of their cultural viewpoint that nursing homes are uncaring environments [and that it is the family’s responsibility to care for elders], more Hispanic families find themselves facing the difficult choice of whether to institutionalize their parents in nursing homes.
Therefore, he added, nursing home facilities need to address the needs of Hispanic residents with Alzheimer’s disease and develop a model for providing culturally sensitive living environments and culturally and linguistically competent care. Anderson noted that knowledge and understanding of Hispanic cultural concepts, such as traditional perceptions of illness and intervention, is the key to providing a culturally sensitive approach to care delivery. In addition, health care providers who serve these patients must be trained in cultural nuances, cultural competency, symptom reduction, caregiver receptiveness, engagement in outreach programs and psycho-educational services.
Anderson concluded by presenting a successful best-practice model he developed, which focuses on providing empowerment and improving the quality of life for Hispanic Alzheimer’s patients and their families. His model combines culturally relevant videos and Spanish-language content with a multidisciplinary approach to care delivery that brings together teams of la familia (family), physicians, nurses, social workers, caregivers and informal networks.
As a supplement to this model, Anderson provides cultural competence training to health care providers who serve Hispanic/Latino patients living with Alzheimer’s disease and its clinical co-morbidities, including diabetes. He will soon begin working with the American Diabetes Association as the New York City chair for the ADA’s Por Tu Familia (For your Family) initiative, which will target boroughs with a high percentage of Hispanics/Latinos with diabetes.
The Alzheimer’s/Diabetes Connection
Hispanics also suffer one of the highest rates of diabetes in the United States. In New York City, the prevalence of diabetes among Hispanics is more than 50% higher than average. According to the findings of a recent study conducted by the National Institute on Aging (NIA) under the auspices of the National Institutes of Health’s Intramural Research Program, diabetes can impair a patient’s cognitive health. The study demonstrated that poorly controlled diabetes with high cortisol production causes high levels of stress.
Furthermore, the Alzheimer’s Association has published findings that support the correlation between diabetes, hypertension, obesity and Alzheimer’s disease. When we look at the Hispanic/Latino community, we find a high incidence of these conditions along with high rates of cardiovascular disease. This all contributes to a high risk factor for Alzheimer’s in the Hispanic population.
My portion of our poster presentation was intended to raise awareness of these research findings—and of the importance of controlling diabetes. As a New Yorker whose family emigrated from the mountains of Puerto Rico, I sometimes share with patients that my own mother and father died very young, and that their diet played a role in their heart disease and diabetes.
We VNSNY nurses help diabetes patients with every aspect of managing their disease, so that they can feel better and reduce the risks of long-term health consequences. One patient education tool we have found helpful is our agency’s Diabetes and Meal Planning Guide, which teaches diabetics to incorporate healthy lifestyle modifications, like meal planning and portion control, to help control their blood sugar.
One of my VNSNY colleagues, clinical nurse specialist and diabetes educator Margery Kirsch, MS, RN, CDE, describes the history of our agency’s success in using this tool. “It all started with [the late] Elaine Edelstein, MSN, RN, CDE, who was the VNSNY’s first diabetes clinical nurse specialist,” she explains. “Recognizing the need for a specialized nutrition teaching tool for Spanish-speaking patients in the five boroughs of New York City, in 1996 Elaine developed a guide that showed pictures of correctly portioned, commonly eaten foods, labeling them in both English and Spanish.
“Initially, the tool consisted of food-portion pictures on 4” x 6” laminated cards, attached to a key ring. This format, called Meals on Cards, proved very popular with staff and patients alike,” Margery goes on to say. “Two years later, Elaine expanded the format to a full-size 8 x 11-inch spiral bound book that also included the Food Pyramid and [sample low-calorie meal plans]. This book, which is still one of the most widely used teaching tools at VNSNY, received the prestigious Nutrition Education Award from the American Association of Diabetes Educators. We fondly remember Elaine, who passed away in 2005. Her patient teaching guide makes a fitting memorial to her meaningful work to improve the lives of patients with diabetes.”
Editor’s Note:Anderson Torres, PhD, LCSW-R, director of health initiatives at Bon Secours New York Health System, also contributed to this article.
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