As just about everyone knows by now, Hispanics are not only the largest ethnic minority group in the U.S., they are also the fastest-growing. Yet study after study–from the Institute of Medicine’s 2003 Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care to the Agency for Healthcare Research and Quality (AHRQ)’s annual National Healthcare Disparities Reports–has shown that Hispanics’ access to health care, as well as the quality of care they receive, is severely lacking in comparison with that of the Caucasian majority population.

Gloria Ceballos, MS, RN, CNAA, BCGloria Ceballos, MS, RN, CNAA, BC

Other studies, such as the Sullivan Commission on Diversity in the Healthcare Workforce’s 2004 Missing Persons: Minorities in the Health Professions, have strongly suggested that increasing the number of Hispanic nurses in the health care system can help make a profound difference in improving health outcomes for Hispanic patients and communities. In fact, culturally competent, bilingual Hispanic nurses are uniquely qualified to be more than just participants in the effort to close the gap of Hispanic health disparities–they are the ideal choice to lead these efforts.

But in order to have leadership, you must have leaders. The problem is that Hispanic nurses account for only about 2% of the nation’s RN population, which makes for a shallow pool of potential nurse leadership talent. And many Hispanic nurses who want to be leaders may lack the confidence and skills to do so and have few role models to emulate.

Creating new Hispanic nurse leaders is the goal behind the Institute for Hispanic Nursing Leadership, a leadership development workshop that is a collaborative effort between the National Association of Hispanic Nurses (NAHN) and the American Organization of Nurse Executives (AONE). Now in its second year, the workshop is offered free to NAHN members as a special half-day session at the association’s annual conference. The first Institute, held last summer at the 2006 NAHN conference in Phoenix, attracted 40 to 50 attendees, says Gloria Ceballos, MS, RN, CNAA, BC, a former chief nursing officer at Kettering Medical Center in Kettering, Ohio who is now pursuing her doctorate.

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Ceballos teamed up with NAHN’s 2004-2006 national president, Rudy Valenzuela, FSP, MSN, RN, FNP-C, to create the Institute after several NAHN members requested information about how to develop their leadership skills.

“Most of NAHN’s members are working at the staff nurse level,” Ceballos explains. “So what we wanted to show them was how they can progress on the nursing leadership ladder. [America] not only needs great Hispanic nurse clinicians, we also need leaders to develop the structure by which nurses can understand the diversity in their patient populations and have a closer relationship with those communities to promote the prevention of disease or to help the patients through their illnesses.”

Ceballos was also a member of AONE’s Diversity Council. “[NAHN] had never done a leadership development program and several members were asking , I saw the opportunity to [capitalize on the expertise of] both organizations and bring them together to see what we could do.”

The response to last year’s Institute was so positive that the second installment will be held this July 17 at NAHN’s 32nd Annual Conference in City of Industry, California. Its theme will be “Leaders and Leadership: Are You the Leaders You Want to Become?” and it will focus on topics such as knowing your leadership style, preparing to become a leader and influencing change. Nursing leaders scheduled to speak at the session include NAHN past presidents Antonia Villarruel, PhD, RN, FAAN, and Carmen Portillo, PhD, RN, FAAN, along with Fortuna “Tuni” Borrego, MSN, RN, president of NAHN’s Broward County (Florida) chapter, and Angelica Millan, MSN, RN, NP, president of the Los Angeles chapter.

“Think About Your Leadership Potential”

By popular demand, the 2007 Institute will feature an expanded format. Feedback from last year’s attendees indicated that they wanted more time, more speakers and, especially, more Hispanic speakers, says Valenzuela, who is now president of Camillus College, a nursing school in Paramount, California.

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“I think most of the nurses who [attended the Institute] were there because they wanted to be there and they wanted to make an impact,” he adds. “I encourage nurses to think about their leadership potential and to grab a hold of it and go with their heart so they can improve their lives, they can improve their careers and, most importantly, so they can improve the health of their communities.”

One of the speakers at last year’s Institute was Maria Warda, PhD, RN, who until June 2007 was dean and professor at Georgia Southwestern State University. She is now director of the nursing program at the University of Tampa in Florida. The 2006 workshop, she says, covered topics such as strategies for success, dealing with discrimination, staying focused and planning educational and career mobility.

Many of the participants were young Hispanic nurses who had either recently started graduate school or were considering it. For the most part, they were searching for role models who could serve as inspiration, Warda says.

“There are a lot of barriers for minorities in America, and certainly for minorities in nursing,” she notes, “because there are so very few of us. There are so few role models in either the service arena or, especially, in the academic arena who can understand the unique strengths and the unique barriers.”

The need for Hispanic nurse leaders is enormous, Warda continues. “We need to recruit more Hispanics into the nursing profession, and beyond that we need to help them continue their educational journey, so we can have future leaders who are also Hispanic. Those few that I know who are deans of nursing or in leadership positions are aging. We are close to retiring and we don’t have the new generation coming in to take our places and to mentor others.”

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Leaders Get Involved

Valenzuela believes nurses who wish to become leaders must first get involved–both in their workplaces and in their communities. “Nurses need to come out of their shell and become involved in issues that interest them,” he says. “Attend meetings, speak to doctors, administrators and other nurses about how the quality [of care] can be improved.”
He also advises nurses to become advocates and speak up about issues that are important to them, such as making more culturally sensitive care available to Hispanic patients. “We’re never going to make any progress toward improving the health of the community if we don’t speak up for it,” Valenzuela maintains. “[Hispanic nurses] need to be vocal about what is important to them and to their patients.”

Rudy Valenzuela, FSP, MSN, RN, FNP-CRudy Valenzuela, FSP, MSN, RN, FNP-C

Tuni Borrego, who is director of nursing for a med/surg and telemetry unit at Memorial Hospital West in Pembroke Pines, Fla., says getting involved helps nurses see an organization’s big picture rather than just their own area of interest. And that’s an important perspective for future leaders to gain.

“Learn how decisions are made, how changes come about and why they come about,” she recommends. “You need to know the ‘whys’ of things before you can understand the ‘hows.’”

Borrego took her first step into leadership by becoming a charge nurse just a few years after beginning her nursing career. “A lot of the other nurses were afraid to do charge or didn’t want the extra responsibility,” she says.

Warda advises Hispanic nurses interested in becoming leaders to first prepare themselves educationally. “No one is going to promote you just because you are Hispanic or intelligent,” she argues. “You have to have a strong education. Pursue graduate education, go as far as you can.”

She also stresses the importance of developing a strong support network of people who are accomplished leaders in the areas you want to pursue. In other words, mentors–and they don’t necessarily have to be Hispanic. Look for a mentor who is committed to diversity and wants to help. “There’s not enough of us [Hispanic nurse leaders] to go around,” Warda points out.

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Getting involved also means joining professional organizations, taking advantage of opportunities and being willing to take risks, such as moving to another city or state to pursue career advancement, even if it means being farther away from family and friends.

From a clinical standpoint, Borrego advises new nursing graduates to avoid working in a specialized area right out of school. Many new nurses go straight into specialties like home health, emergency nursing or labor and delivery, where their patient population and/or the conditions they treat are limited.

“If you get your foundation in med/surg first, you can pretty much work your way up and do anything,” she says. “Take at least six months to a year to get your feet on the ground. Get to know the med/surg population and from there you can go anywhere.”

Moving Into Leadership

Another topic that will be covered at this year’s Institute for Hispanic Nursing Leadership is understanding the roles and responsibilities within an organization. Borrego says it’s important to understand this so you know what’s expected of you when you’re given a task. That, in turn, helps you become a better leader. “You can’t really do things if you don’t know what’s expected of someone in that role,” she explains.

Fortuna Fortuna “Tuni” Borrego, MSN, RN

Warda, whose various career roles over the years have included being a military nurse, clinical nurse specialist and hospital administration executive, used the GI Bill to obtain a master’s in nursing in the late 1970s. Because there were so few nurses with master’s degrees in those days, “that gave me the opportunity to move into a leadership position in nursing.”

She later became interested in pursuing a PhD when her immediate supervisor at the hospital at which she worked enrolled in a doctoral program. This provided a role model for Warda to emulate. “I had never thought of doing that before,” she says. “Because I knew somebody else who was doing it, I decided to apply and I was accepted into the doctoral program at the University of California, San Francisco.”

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A Lifetime’s Work

By her second or third year in the program, Warda knew she wanted to go into academia, so she took a teaching job at San Francisco State University to develop her skills as an educator. Because she had extensive leadership experience, including several years in hospital administration, it was a natural transition when she was offered a job as assistant dean at the University of California, San Francisco.

After three years in that position, Warda was presented with still another opportunity to move up the leadership ladder. “My supervisor, who had been my academic advisor when I was a doctoral student at UCSF, just one day walked into my office and said, ‘I believe you will make an outstanding dean one day and you should consider pursuing that career path.’” That led her to apply for the dean’s position at Georgia Southwestern State.

As Warda’s career journey makes clear, learning to be a Hispanic nursing leader is a continuous, lifelong process. Leadership development workshops like the NAHN/AONE Institute are great, she says, because they energize and motivate participants and give them the confidence they need to work toward becoming leaders. “But unless that is followed up by having a network of mentors who are close to you and can work with you on an ongoing basis,” she emphasizes, “it will be an injection of enthusiasm that will only last so long.”

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