From the moment Sheldon D. Fields, PhD, RN, FNP-BC, AACRN, FNAP, FAANP, joined the Association of Nurses in AIDS Care (ANAC), he felt right at home. As a nurse who also happens to be African American, male and gay, Fields knew immediately on that day in 1996 that the association not only spoke to his clinical passions—treating patients with HIV and full-blown AIDS—but welcomed his personal diversities as well.

“I felt like I belonged,” says the University of Rochester (N.Y.) associate professor of nursing, who is now co-chair of ANAC’s Diversity Specialty Committee. “I didn’t have to apologize for who I am and the type of work that I want to do. It’s an extremely welcoming group. It’s like family.”

Whether you’re a minority nurse who’s also looking for a specialty nursing association that will make you feel like one of the family, or an association leader trying to increase the racial, ethnic, cultural and gender diversity of your membership, you can learn a lot from the outreach efforts of ANAC and other associations that have made diversity one of their top priorities. What are they doing successfully to attract more nurses from underrepresented populations and make sure they feel welcome enough to stay?

Preliminary research for this article revealed that many associations have taken few steps beyond acknowledging the need for diversity programs and putting it on their future to-do list. In all fairness, this is partly due to the fact that minority nurses are severely underrepresented in the nursing profession in general, and particularly in nursing specialty areas. Obviously, you can’t reach out to people who aren’t there.

But specialty associations that understand the urgency of meeting the health care needs of a nation whose population demographics are changing rapidly also see that increasing the diversity of their membership base creates benefits for everyone. For the association, bringing in new members from diverse backgrounds who can contribute a variety of cultural and lifestyle perspectives helps expand the specialty’s clinical knowledge base and enriches the dialogue about providing culturally competent care. And for minority nurses, joining a supportive specialty association provides opportunities for professional development, encouragement and networking with other nurses who share their clinical interests.

“It’s always important to have support from your colleagues,” says Bridget Howard, CNM, MSN, chair of the American College of Nurse-Midwives (ACNM)’s Midwives of Color Committee. “But when you’re interacting with people who share your ethnicity, or are on the same cultural page as you, it’s sometimes easier to take criticism and direction. More important, you’re getting support from others who have walked in your shoes.”

Top-Down Commitment

Just how do specialty nursing associations define diversity? The association leaders we interviewed cite a broad spectrum of characteristics that make for a varied specialty and workforce. Besides skin color and ethnic or cultural roots, these characteristics can include gender, age, disability, sexual orientation and even educational background or subspecialty choice. In other words, any nurse who expands an association’s look, experience and perspective brings diversity to the organization.

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Creating a big enough tent to accommodate a more inclusive membership starts with a top-to-bottom commitment to making diversity and cultural competence high priorities and integrating those priorities into the association’s mission statements, strategic plans, policies and programs. But associations like ACNM, ANAC and others have taken this one step further by creating formal diversity committees and advisory panels charged with formulating effective outreach strategies to invite nurses from underrepresented populations into the specialty, keep them tethered to the association and develop them into leaders in both areas. They’ve focused their collective attention on strategies and tactics such as:

  • Offering scholarships, fellowships and continuing education opportunities to help minority candidates advance professionally.
  • Providing mentors to support potential and new members as they navigate nursing school and the association.
  • Establishing special interest and focus groups within the association to spotlight multicultural issues.
  • Creating online communities and Web forums to facilitate networking and idea exchanges.
  • Offering workshops, community service projects and other events to interest potential new members in the association.

For example, because HIV and AIDS disproportionately affect minority populations, particularly African Americans and Hispanics, ANAC identified diversity as a major focus early on. Besides embracing cultural competence and the core values that support it, the association is committed, from its board of directors downward, to meeting the needs of a racially and ethnically diverse membership.

That promise plays out in a number of ways, such as $1,000 scholarships awarded annually to young nursing students interested in HIV/AIDS-related careers. By endowing the fund, ANAC has shown that it’s paying more than just lip service to diversifying its membership base. It’s also getting a jump on other associations by recruiting the next generation of nurses before they have a chance to be lured away by other specialties.

“If we’re not hooking people at the LPN and RN level, we’re missing the boat,” Fields says. “By the time they get to a master’s or PhD program, they’re already committed to a specialty. So we need to focus our resources on attracting younger people to both our specialty and our organization.”

Championing Diversity

Scholarship programs are a good first step, but they’re certainly not the only tool specialty associations are using to bring more minority nurses into the fold. From annual conferences to virtual conference rooms, some associations are pursuing their diversity missions through a variety of national and local outreach efforts.

Denise DeLollo, RN, BS, OCNOncology Nursing Society (ONS) Diversity Champion Denise DeLollo, RN, BS, OCN

With potential members likely to connect closer to home first, association chapters throughout the country are using a variety of ground tactics—e.g., workshops, community service projects, networking and job-shadowing opportunities—to attract the attention of new people. Whether they’re hosting events that raise awareness of the specialty, bringing interested nurses to their meetings or promoting projects for facilitating culturally competent care, chapter leaders are translating national diversity directives into successful local initiatives.

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Chapters of the Oncology Nursing Society (ONS), for instance, have collaborated with groups like the National Black Nurses Association and the Intercultural Cancer Council to parlay ONS educational grants into special projects tailored to specific underserved communities. Such initiatives not only help attract new members but also demonstrate the association’s overall commitment to diversity in cancer care.

In addition, ONS has created a cadre of national ambassadors, called Diversity Champions, who take personal responsibility for furthering outreach efforts among oncology nursing colleagues in their own cities. Their mission is to actively promote ONS’ programs and core values while also encouraging the pursuit of culturally competent cancer care initiatives at the local level. But their primary goal is to foster a welcoming environment to cancer nurses of all colors, genders, cultures and lifestyles and to encourage their continued professional growth through participation in the society.

“It’s like going to church for the first time and not knowing anyone,” says Diversity Champion Denise DeLollo, RN, BS, OCN, a community outreach nurse for St. Peter’s Hospital Cancer Care Center in Albany, N.Y. “Your very first impression [of how welcoming the organization seems to be] is going to stay with you. We want [our new] members to stay.”

Once locally recruited minority nurses become national members of a specialty association, they can apply for leadership positions, join committees and attend national meetings and conferences to advance their professional development. Opportunities for leadership training and roles come in a wide variety of shapes and sizes, such as access to grants, special projects, teaching opportunities in the U.S. and work prospects abroad.

Although nurses represent only one faction of the National Rural Health Association (NRHA)’s 18,000 members, they have multiple opportunities to network and grow. With eight annual conferences at their disposal—including one devoted to rural minority and multicultural health—nurses can easily earn their continuing education credits while interacting with experts from across the nation. They also can expand their leadership capabilities through a newly established leadership development program called Rural Health Fellows. Admission to the fellowship program is competitive, but those who are selected annually for training are on a track toward becoming future NRHA leaders.

Similarly, with 30 special interest groups (SIGs) representing various oncology topics, including transcultural nursing, it’s easy for new members to find their niche in ONS. As part of the association’s Diversity Virtual Community (DVC), the SIGs, along with online membership forums and virtual chapters, are accessible through an expansive Web site designed as a central source for ONS’s multiple diversity programs.

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The society also has focus groups, less structured than the SIGs, that provide other minority ONS members, such as gay, lesbian, bisexual and transgender (GLBT) nurses, with opportunities to address their own specific issues. Although the GLBT focus group’s current leader, Judy DeGroot, MSN, RN, AOCN, didn’t even know that such a group existed when she first joined ONS in the early 1990s, today the Colorado Springs-based Genentech nurse educator calls the group “home.” The biggest benefits, she says, are the camaraderie of being with fellow GLBT nurses and together educating others about cancer in the GLBT community.

DeGroot and her colleagues hope the education session they will be presenting at ONS’ upcoming 2009 national congress will help other nurses understand some of the legal, insurance and other challenges that both GLBT practitioners and patients experience. But they also want to raise the focus group’s visibility among potential members who may not know just how supportive ONS is of its GLBT members. As an out lesbian, DeGroot believes she brings important diversity to ONS’ Nominating Committee, of which she is a board-appointed member.

“The most powerful thing about coming out is that the more people know who we are, the more they understand that we’re just like everybody else,” she says. “Our organization is a melting pot, not just in terms of ethnic background and gender, but also sexual history. ONS is very supportive. It not only cares about us as members but as a population, especially in terms of health care.”

Reaching Out through Mentorship

In associations that have made diversity a priority, mentors play an important role in helping nursing students discover the specialty, get through graduation and transition into membership.

ONS, for instance, relies extensively on mentoring programs—including an Ethnic Minority Mentoring Program—to facilitate personal development. It utilizes a dynamic database linked to its Web site to match experienced oncology nurses who have specific resources and skills with students or new graduates who are still building their knowledge and expertise. The beauty of conducting the programs online is that mentors and mentees can connect with each other regardless of their geographic location.

Likewise, mentors are a significant part of the ACNM’s minority outreach efforts. Because networking and education are two primary goals of the association’s Midwives of Color Committee, the committee’s leaders place a high premium on showing new members around their specialty and the workings of the association.

When she first joined ACNM in 1980, Marsha E. Jackson, CNM, MSN, FACNM, co-director of BirthCare & Women’s Health in Alexandria, Va., benefited from the guidance of other minority nurse-midwives who helped her amass the skills she’d eventually need to assume a leadership role in the association. They not only encouraged her but also helped her navigate the College and learn how to get her agenda items before the board. As the co-director of a nurse-midwifery practice that specializes in at-home and out-of-hospital births, Jackson wanted to make sure that ACNM was invested in practitioners like her. “I became the squeaky wheel because I felt it was important that the College support us [home birth midwives] in what we do,” she says.

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Over time, Jackson parlayed her leadership skills into various advocacy positions within the organization. As chairperson of ACNM’s Home Birth Committee, for instance, she not only helped raise awareness of the issues facing midwives who perform deliveries outside the hospital but was also instrumental in spearheading two national studies concerning home births. Currently, she serves as a trustee of the ACNM Foundation, the association’s philanthropic arm. It recently provided funds to support a Smithsonian exhibit celebrating African American “granny midwives,” the profession’s pioneering practitioners.

Today Jackson extends the same guidance and support to the next generation of minority nurse-midwives. Besides keeping in touch with newcomers and tracking their progress, she encourages them to “make the best use of their gifts” by participating in leadership seminars underwritten by the ACNM Foundation, and by applying for the annual Midwives of Color Watson Scholarship. Thanks to grassroots fundraising by the Midwives of Color Committee, along with a generous gift from Watson Pharmaceuticals, the foundation has been able to award 10 annual $1,000-$3,000 scholarships to date. As someone who relied on financial aid to earn her own master’s in midwifery from Georgetown University, Jackson sees this scholarship as essential in diversifying a workforce already caring for a large proportion of underserved vulnerable patients, primarily women of color.

Besides offering financial support, Jackson and other Midwives of Color Committee members have made personal contact an important part of promoting their specialty and association to potential minority members. When her husband, a professor at Howard University, suggested that a student call Jackson to discuss what to do with her nursing degree, she took the young woman under her wing. After job-shadowing Jackson and learning more about the profession, the student not only decided to become a nurse-midwife but last year gave birth to her first child at home.

“There are many stereotypes about midwifery that simply don’t apply,” Jackson says. “Once people find out what we really do, they get interested. That helps us grow.”

Making Progress

How successful have these specialty association’s diversity efforts been? Slowly but surely, association leaders are reporting changes in their membership demographics. Even though the numbers are still relatively small, these organizations are making at least some progress in increasing the representation of minority nurses in their ranks.

For instance, between 2002 and 2009, ONS’s ethnic minority membership rose from 10% to 13%, while the representation of men in the society rose from 3% to 4%. ANAC has achieved even more dramatic results: Today nurses from traditionally underrepresented populations comprise about 25% of the total membership, up from 18% a decade ago.

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Still, the numbers tell only part of the story. Although midwives of color still account for only about one-tenth of the 2,000 or so attendees at ACNM’s annual assembly, they’re no longer meeting in each other’s hotel rooms as they did when Jackson first joined. They’re now much more visible and recognized within the association, hosting organized events in exhibit halls, providing continuing education sessions, mentoring young midwives and students, and preparing members for leadership roles, all through formalized funded programs. “We have a ways to go,” says Jackson, “but this gives us a running start.”

What advice do specialty associations with successful diversity programs have for other associations that hope to achieve similar results? First, form a diversity task force and survey your membership to see where you may be missing the mark. Second, make sure the commitment to ethnic, cultural, gender and other diversity comes from the top, is part of the strategic plan and is woven through every policy and program. Third, back up your diversity initiatives with manpower and money. Fourth, offer continuing education credits and other educational opportunities, then use your Web site to link people with programs. And fifth, assess your progress with surveys and other benchmarks.

They also offer this advice for minority nurses who are thinking of joining a particular specialty association but are wondering what kind of welcome they’d receive. First, review the association’s Web site and printed materials to see if there’s a commitment to diversity and if that commitment is prominently displayed. Make sure that the group’s officers and staff members reflect a mix of races, cultures and genders. Check to see whether the association offers any programs for minority members, and whether those programs will offer you sufficient opportunities, particularly for networking, mentoring and continuing education.

Finally, whether you’re a newly recruited minority member or an association trying to put out a new or improved welcome mat, stay committed to the diversity cause. Don’t be so overwhelmed by the challenges of altering the landscape that you think it can’t be done.

“Many minority nurses [who join specialty associations] say, ‘This is just too overwhelming. We’re such a small number. There’s no way we’re going to raise money or get our colleagues to understand what’s in our hearts,’” says ACNM’s Howard. “But I say, ‘Don’t give up.’ Small numbers can do big things!”

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