Since becoming a nurse in 1991, Rose Khalifa, RN, has devoted her career to reaching out to culturally diverse communities, including the large Arab American population in southeast Michigan. She is a respected authority on transcultural nursing and has been honored for developing such innovations as the nation’s first Arabic-language prenatal care program.

But when colleagues approached Khalifa, a native of Lebanon, for information about Arab American nurses, she came up short. There simply was no organization that collected data on this particular group of minority nurses or served as a central network for Arab American nurses across the United States.

AANA President Rose Khalifa, RNAANA President Rose Khalifa, RN

Finally, one day three years ago, Khalifa became fed up. She and four other Arab American nurses were at a photo shoot for an article about nursing for an Arab American magazine. When the reporter asked them basic demographic questions–How many Arab American nurses are there? In what parts of the country do they work?, etc.–none of the nurses could answer.

“It was the straw that broke the camel’s back,” Khalifa recalls. “Even within our own communities we didn’t have the answers to questions posed to us from the community-at-large. We needed to have a central hub where we could collect data.”

Khalifa and her colleagues realized it was time to start a national organization that would bring the Arab American nurse population together and serve as a centralized source for information, resources and networking. They immediately went online to register the group’s name for incorporation.

Today the American Arab Nurses Association (AANA) serves not only as a voice for nurses of Arab descent but also as a force to address the national nursing shortage and promote awareness of cultural diversity in post-9/11 America. “We want to play a role in building cultural bridges in the profession,” says Khalifa, the association’s president.

Khalifa, a transcultural nurse consultant for Oakwood Healthcare System in Dearborn, Mich., reached out to colleagues at universities and a variety of health care organizations to launch the association. During its first year after incorporating, the nonprofit group focused on recruiting leaders, attaining tax-exempt status, defining goals and seeking early funding commitments.

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Although still in its infancy, the association has already gained international attention, launched an annual scholarship program and held its first professional development conference. And more expansion is on tap for 2006 as the AANA plans its first national convention.

Filling Information Gaps

Based in Dearborn, the AANA’s initial activities are focused mainly on the southeast Michigan region. According to the Arab American Institute, Michigan is home to an estimated 490,000 Arab Americans–the highest concentration of this ethnic population in any U.S. state. As the AANA grows, says Khalifa, it wants to establish volunteer chapters in other areas of the country.

At the American Arab Nurses Association's first professional development conference last May. AANA leaders and conference speakers--including transcultural nursing pioneer Dr. Madeleine Leininger (front row, fourth from left--pose for the camera.At the American Arab Nurses Association’s first professional development conference last May. AANA leaders and conference speakers–including transcultural nursing pioneer Dr. Madeleine Leininger (front row, fourth from left–pose for the camera.

The Arab American Institute estimates that at least 3.5 million Americans are of Arab descent. Several waves of immigrants from more than 20 Arabic-speaking countries have settled in the United States since the 1880s. More than 80% of these immigrants are U.S. citizens. Arab Americans live in all 50 states, but the majority are concentrated in just 10 states and one-third live in either Michigan, California or New York.

The AANA has already made progress in gathering information. In its second year, the group conducted a survey of 50 Arab American nurses in Michigan. The nurses were asked about their work environments, focusing particularly on whether they encountered any ethnic bias in their jobs and whether the atmosphere of their workplaces had changed since September 11.

The survey found no alarming evidence of widespread discrimination, Khalifa reports. Any instances of bias appeared to be isolated and the nurses reported little change in their work environments in the aftermath of 9/11. In fact, many respondents had high praise for their places of employment.

“We were pleased that our concerns were put to rest,” Khalifa says. “The survey results show that these nurses must have built some strong relationships. It really spoke highly of the communities they work with.”

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The association has also been working with state health officials to begin collecting data on the number of Arab American nurses working in Michigan. Starting this year, Michigan nurses can now identify themselves as Arab Americans on the paperwork they file with the state to renew their licenses. Previously the form asked nurses to identify their ethnicity by checking one of several categories, but the list did not include Arab/Middle Eastern.

Jeanette Klemczak, MSN, RN, chief nurse executive for the Michigan Department of Community Health, worked with AANA to make the change on the renewal forms, and she is a member of the association’s board. Nurses renew their licenses in Michigan every two years, so half of the state’s RNs will apply for renewal in 2006. That will allow state officials to get a good estimate of the percentage of Arab Americans in the nursing workforce by the end of this renewal cycle. Answering the ethnic heritage question on the renewal forms is voluntary and nurses who choose to answer remain anonymous. The state compiles the information to get total figures and does not keep racial or ethnic information on individuals, Klemczak says.

As chief nurse executive, a position created by Gov. Jennifer Granholm, Klemczak’s role is to address the need for nurses in Michigan in light of the national nursing shortage. An important part of that mission is developing recruitment and retention efforts to ensure that the nursing workforce matches the state’s diverse population. Collecting demographic information on nurses’ racial and ethnic backgrounds helps nursing leaders like Klemczak know where they need to focus their efforts. This year, for the first time ever, they will get a clearer idea of how well represented Arab Americans are in the state’s nursing ranks.

Klemczak says she has been impressed with the AANA’s leadership and was “delighted” to join the board. “The association brings to the table an ability to reach out to this community,” she adds. “It’s a new group, but the leaders are so energetic.”

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Spreading Cultural Awareness

Recently, the AANA has been directing much of that energy toward working with other state nursing groups as part of the Coalition of Michigan Organizations of Nursing. The coalition develops positions on key health care issues and makes recommendations to the state. Thanks to AANA’s involvement, it also serves as a resource where universities and health care providers can get information about Arab American cultural traditions and how they affect this population’s health care needs.

For instance, many Arab American women prefer to see only female doctors and nurses for treatment. Awareness of this cultural preference is important because some of these women would rather get no treatment at all than be treated by a male practitioner.

Understanding this culture’s religious beliefs and practices is critical, too, particularly when dealing with end-of-life issues. Health care providers need to understand the role of the extended family and the spiritual implications of such things as the withdrawal of life support, so that they can communicate with patients and families about these issues in a culturally sensitive way. “It’s not just the message that’s important. It’s the delivery and timing,” Khalifa explains.

The AANA also has a speakers bureau and can refer these experts to health care professionals who need information on best practices.

Another of the association’s top priority goals is addressing the national nursing shortage. The group wants to work with other ethnic minority nursing associations to recruit and retain culturally diverse nurses. As part of its efforts to encourage more people to become nursing students, AANA recently established an annual scholarship program, offering five $1,000 scholarships for 2005-2006. (See “Investing in the Future of Nursing.”) In keeping with the association’s vision of being an inclusive organization, all the scholarships except one are open to students of any ethnicity.

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Allegiance Home Health Care, Inc., based in Sterling Heights, Mich., provided the seed money for the scholarship fund and was also one of the sponsors of the association’s 2005 conference. The company’s CEO, Marvin Al-Khafaji, is vice president of the AANA. “I wanted to be the first to provide scholarship money,” he says. “I wanted to make a statement.”

Al-Khafaji started his company three and a half years ago after previously working in the technology field. He is passionate about the AANA’s mission to recruit more ethnic minorities into nursing, including Arab Americans. Michigan is one of the most diverse melting pots in the country, and Al-Khafaji sees on a daily basis the business case for having a diverse nursing staff to provide culturally competent care. His firm has a multilingual staff proficient in 10 languages, including Arabic, Spanish, Polish, Russian, Urdu, Farsi and more.

“We want to be a company that represents the real world,” he says.

Building Bridges

The American Arab Nurses Association now has 120 members–a number that will rapidly increase if attendance at the group’s first conference last May is any indication. The event drew more than 400 people–one of the largest crowds ever for an inaugural conference.

Held in Livonia, Mich., the conference, titled “Building Cultural Bridges in Health Care,” explored issues such as the value of cultural competency in clinical practice, variances in cross-cultural communication, cultural diversity in the health care workplace and health care beliefs and practices in Arab American, African American and Hispanic cultures. It featured presentations from an impressive array of nursing and health care leaders, including keynote speaker Dr. Madeleine Leininger, the pioneer of transcultural nursing theory and practice and founder of the Transcultural Nursing Society. The conference also brought together prominent minority nursing leaders, such as Rudy Valenzuela, MSN, RN, FNP, president of the National Association of Hispanic Nurses, and Jonnie Hamilton, MS, RN, CPNP, CNA, chair of the Michigan State Board of Nursing.

Although most of the attendees were from Michigan, 20 came from other states, demonstrating interest on a national level. The association is now planning a national convention to be held in 2007.

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Meanwhile, the AANA is inspiring nursing professionals beyond the nation’s borders. Nurses in Jordan have expressed interest in starting a similar group there. And many nurses in the Middle East have contacted the American association, asking for information about working in the United States. “We are getting inquiries from across the globe,” Khalifa says.

Investing in the Future of Nursing

The American Arab Nurses Association’s annual AANA Scholarship program provides financial assistance to nursing students and practicing nurses at a variety of educational and career levels. The association offers five $1,000 scholarships per year, each one targeted to a specific category of student:
• A freshman student seeking a nursing degree;
• An RN seeking a bachelor’s degree in nursing;
• A minority freshman, sophomore, junior or senior student seeking a degree in nursing;
• An RN seeking a master’s degree in nursing; and
• A degreed freshman, sophomore, junior or senior student pursuing nursing as a second degree.
Students do not necessarily have to be Arab American to be eligible for these awards. For more information about the scholarship program, visit the association’s Web site,

On a Mission

The mission of the American Arab Nurses Association (AANA) is to:
• Encourage and support the recruitment of student nurses.
• Serve as a vehicle for the promotion of nurses generally and Arab American nurses specifically throughout the United States and abroad.
• Promote the image of American Arab nurses in the profession and to patients.
• Work to advance the knowledge and career status of nurses.
• Collaborate with health care and similar organizations to further these goals locally and nationally.
• Educate health care providers about cultural practices that impact the health care of the Arab American community.



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