“Hospital employees are disproportionately female and Caucasian. Attracting a more diverse workforce is a hospital business imperative.”
–American Hospital Association Commission on Workforce for Hospitals and Health Systems, April 2002

America is suffering from an acute shortage of nurses–but by now, this should not be news to anyone. We have all heard the dire predictions and sobering statistics about fewer young people choosing nursing as a career and an aging current RN population that is rapidly nearing retirement age. According to a recent survey by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), there are currently 126,00 nursing positions open across the nation, and 45 states report that they are experiencing a shortage at this time.

Where are these new nurses going to come from? We can’t sit around and wait for people to decide to become interested in the health care professions. The time to avert this potential crisis is NOW.

In addition, the nursing workforce as it exists today does not adequately represent the demographics and growing diversity of the U.S. population. According to the 2000 Census, one out of every four Americans is non-white, yet our nation’s RN population continues to be overwhelmingly Caucasian. What’s more, men make up less than 6% of the 2.7 million nurses nationwide. This statistic clearly demonstrates the lack of equal representation in nursing between males and females, since the ratio for the overall population is approximately 50/50.

One of the most logical places to look for the new nurses we urgently need is among people who are currently underrepresented in the nursing profession. In April 2002, the American Hospital Association (AHA) Commission on Workforce for Hospitals and Health Systems published a study, In Our Hands, that included this strategic recommendation: “Work aggressively to develop a workforce pool that represents the full spectrum of your community’s population, including men and women, all racial and ethnic minorities, and immigrants.”

Laura Easton, RN, MSN, chief operations officer at Caldwell Memorial Hospital, a 110-bed semi-rural hospital in Lenoir, N.C., serves on the diversity board of the American Organization of Nurse Executives and also sat as a commissioner on the AHA Commission on Workforce. Hearing all of the gloomy predictions, Ms. Easton led a team of three other nursing vice presidents representing small to medium-sized rural and semi-rural hospitals in North Carolina in writing a grant proposal to The Duke Endowment requesting funding to support a major Workforce Diversity Initiative.

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As a result, last summer the Endowment awarded a grant of approximately $941,388, which will be distributed amongst all four hospitals over a three-year period. In addition to Caldwell Memorial, the other three hospitals involved in the project are Rowan Regional Medical Center in Salisbury, Wayne Memorial Hospital in Goldsboro and Heritage Hospital in Tarboro.

In July 2003, the North Carolina Board of Nursing reported the following statistics for Caldwell County and the five surrounding counties regarding the racial, ethnic and gender distribution of the nursing workforce. Out of a total of 4,272 nurses:

• Only 313 were men

• 70 were African-American women

• None were African-American men

• 12 were Hispanic women

• 2 were Hispanic men.

In looking at our four hospitals, it was clear to the grant-writing team that the nursing workforce was not diversified and that persons from underrepresented groups needed to be brought into the field to help fill the ranks. Our Workforce Diversity Initiative is a concentrated effort to interest these underrepresented people in health care careers. But while people of color and men are the primary focus, we also want to gain the interest of candidates from all populations who haven’t considered the nursing profession as a career option, as well as older workers who are ready for a career change.

Getting the Message Out

Since launching the Workforce Diversity Initiative, our four-hospital partnership has been working aggressively to plan and implement a variety of programs for achieving our diversity recruiting goals, as well as expanding some programs that were already underway. The Duke Endowment grant supports the appointment of a diversity coordinator at each facility (I am the coordinator for Caldwell Memorial, appointed by Laura Easton), diversity needs assessments, diversity training for staff, public awareness campaigns, and outreach programs for high school and college students, to name but a few of the projects

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In October 2003, a diversity consulting firm, Gardenswartz & Rowe, conducted diversity needs assessment surveys at all four hospitals to determine each facility’s strengths and weaknesses. A “Train the Trainer” program will be taught in January 2004 so that each hospital can prepare its staff for the pending workplace changes that will occur with the hiring of new employees from more diverse backgrounds and help them better understand and serve their respective communities.

The public awareness campaign began in June 2003. We felt that the public in general needed to be informed and educated about the nursing and health care fields to entice people in their communities to consider this profession as a career option. Our campaign was launched with the cooperation and support of Johnson & Johnson’s national “Discover Nursing” program (www.discovernursing.com) and The North Carolina Center for Nursing’s “Nursing: The Power to Make a Difference” program (www.nurseNC.org), both of which provided us with diversity recruiting posters and brochures to distribute to our target audiences. We strategically placed these materials in a variety of locations, including:

• Local schools, colleges and community colleges

• Community centers

• Parks and recreation centers

• Barber shops, beauty shops and nail salons

• Employment offices

• Day care centers

• Health departments

• Social services departments

• Community businesses.

We also placed ads and articles about out diversity program in local newspapers, making sure they ran in different sections where a wide variety of people would see them, such as the sports, financial and home pages. Radio interviews presented as public interest announcements were another media strategy we used. In addition, each hospital sponsored a billboard depicting male and female nurses of diverse ethnicities and encouraging viewers to consider nursing as a career.

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Because simply distributing literature without follow-up isn’t enough, the diversity coordinators have gone out into the community and made presentations about health care careers. For example, we have met with religious leaders who then allowed us to talk with their congregations. We have also given presentations in such varied settings as public and private community organization meetings, classrooms, teachers’ meetings, private clubs, community centers and youth scouting programs, such as the Medical Explorers program.

Anywhere we felt we were able to reach an audience of potential candidates, or those who may need to support those candidates’ career decisions, became a target of our information campaign. Family members also must be educated about nursing careers, as they are the ones who will encourage or discourage these potential future nurses.

Diversity Recruiting Goes to School

Schools and colleges at all levels are naturally an area in which our Workforce Diversity Initiative is strongly focusing is efforts. It’s important to inform not just students but also guidance counselors, teachers and career development counselors about the nursing shortage and the fact that nursing is a viable career option for people of all genders and races. To give local high schools students an opportunity to experience the real face of health care, we have established a summer “Camp Med” program, in which teens in grades 9-12 visit the partner hospitals to shadow health care workers and learn firsthand about the full range of career options in the field.

We have worked to promote the positive image of nursing and to dispel the negative stereotypes that exist for both males and females. In our presentations and promotional materials, we strive to show that nursing is not exclusively a feminine line of work and that there is a lot of career flexibility in nursing with above-average pay. For female students, it’s important to convey the message that nurses are not “handmaidens” but skilled clinicians who work in a technical and caring environment shoulder-to-shoulder with other professionals.

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To help students visualize these positive aspects, we have created PowerPoint presentations that portray exciting images of nurses performing action-filled duties–e.g., flight nursing and ER nursing–and working with the medical technology of today. We also emphasize the benefits of the nursing and health care professions, such as:

• Ability to work anywhere in the world

• Many different positions and job settings to choose from

• Educational opportunities from associate’s degrees to doctorates

• The powerful impact that nurses and health care workers can have on patients and families

• An autonomous, licensed profession that you can take with you.

We have also developed programs to support and assist students once they have made the decision to pursue education in nursing or health care. The “Adopt-A-Student” initiative gives individuals, churches, businesses and service organizations an opportunity to financially support people in their community who are seeking health care careers. In addition, we are partnering with local organizations that can provide students with services such as free day care, as well as working with the College Foundation of North Carolina, which has provided assistance to help students find and apply for scholarships.

There is a pool of nurses from our hospitals who have volunteered some tutoring time to students who need that little bit of extra help to get through a certain class. Local nursing instructors let us know who is in need of this assistance. We want to graduate these students and not see them fail from needing a few more points. You may recall people from your own student days that you knew in your heart would be a good nurse but due to some circumstance didn’t make enough points to pass a particular class.

Covering All the Bases

In addition to targeting the younger generation, our project is also investigating ways to bring back nurses who have left the profession for various reasons, such as childbirth or retirement. We are not excluding any group of people in this campaign. After all, the big picture is to bolster the numbers of qualified health care personnel and create a diverse workforce that will better mirror the community, enabling our hospitals to better serve our patients.

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Our diversity programs are as wide as they are deep and long. We are not staying focused on one area or population but are covering all the bases that we can get to. We are also working with The North Carolina Center for Nursing, which is compiling a list of all the different organizations that are working on similar projects. They will then send out this information so that we all can network and become stronger in our efforts across the state, rather than each facility trying to solve the nursing shortage individually.

One of our eventual goals is to hold a symposium to which all hospitals will be invited. Those who have been working on diversity projects will share information on how their respective campaigns were developed so that others can learn from them and not have to reinvent the wheel. The idea is to share this effort, work together in our state and promote the idea across the nation.

Creating nursing workforce diversity initiatives is not difficult, but it is time- consuming. We can’t afford to get too far behind in the effort to avert this crisis. Why does it seem that we always wait for a problem to become critical before action is taken? Let’s start today for tomorrow. You never know where that next nursing candidate may come from.

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