“Diverse nurses can shape the future and write the script that is not yet writeen.” Vernice Ferguson, MA, RN, FAAN

It was the era of the Civil Rights Movement, a time when history was being made across America. In 1954, the Supreme Court’s Brown vs. Board of Education decision mandated the racial integration of the nation’s public schools. In 1963, Dr. Martin Luther King led the March on Washington. And on May 2, 1965, the National Student Nurses’ Association (NSNA) made civil rights history in the nursing profession by launching the Breakthrough to Nursing Project (BTN).

At a time when people of color were even more severely underrepresented in nursing education and practice than they are today, the goals behind the formation of BTN were bold and clear: To recruit more racial and ethnic minorities into nursing and to increase nursing educators’ awareness and sensitivity to minority students’ needs. Over the years, the BTN Project’s scope has expanded to address the needs of men, people with disabilities and other traditionally unrepresented populations in nursing and to advocate for improving the quality of nursing care for diverse populations.

At its 53rd Annual Convention, held this past spring in Salt Lake City, NSNA proudly commemorated the 40th anniversary of Breakthrough to Nursing, which is still going strong today. One of the convention’s highlights was a panel discussion exploring the landmark program’s past, present and future. Pointing out that most of the students in the audience weren’t even born when BTN first began, moderator Thomas Smith, MS, RN, senior vice president of Nursing and Patient Care Services at Mount Sinai Hospital, commented: “BTN was a bold step forward. Today we are here to celebrate and reflect.”
As part of this process of reflection, panelist Mary Ann Tuft, past executive director of NSNA, provided a look back at the historical conditions that had created the need for a program like BTN. In the 1960s, she explained, the nation was experiencing a severe nursing shortage, especially in the inner cities. This resulted in a huge need for more minority RNs. But African Americans and other racial/ethnic minorities were seriously underrepresented in RN training programs, largely because they had traditionally been steered instead toward LPN and nurses’ aide programs.

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In BTN’s early years, Tuft continued, NSNA members worked aggressively to help change this situation. The student nurses, nearly all of whom were volunteers, put in countless hours peer recruiting minority high school students into nursing and raising minority teenagers’ awareness of nursing careers. The National Urban League and other organizations helped provide the fledgling project with guidance and funding during the ‘60s. By the 1970s, BTN had achieved so much initial success that the federal government provided NSNA with $1 million in grant funding to expand the program.

While BTN’s efforts in its formative years did much to help increase minorities’ access to nursing education, minority nursing students still faced considerable challenges in those days, Tuft noted. Some of the biggest obstacles were difficulties in getting admitted to nursing programs, nursing school promotional materials that didn’t reflect diversity, lack of financial resources, lack of role models and lack of acceptance from white students. But even though considerable progress has been made in these areas since then, Tuft said, “we still have a long way to go.”

Diversity: The Final Frontier

This message–that Breakthrough to Nursing cannot sit back and rest on its laurels–was echoed by panelist G. Rumay Alexander, EdD, MSN, RN, director of Multicultural Affairs at the University of North Carolina at Chapel Hill School of Nursing, who spoke on the current state of diversity in the profession. She argued that not much has really changed in the 40 years since BTN was established: “Nursing faculty are still unprepared to deal with diversity, and enrollments of minority nursing students are still very small. Space is not the final frontier–this is. How can we enlarge the circle so that more people can be included?”

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“Nursing faculty are still unprepared to deal with diversity.” G. Rumay Alexander, EdD, MSN, RN

Pointing out that “diversity is about much more than just race,” Alexander cited research showing that “differentness” of any kind–e.g., race, gender, lifestyle, disability, age–is still not embraced in nursing schools. “This is a huge issue,” she emphasized. “Students who are perceived as ‘different’ do not receive the support and acceptance they need to succeed in nursing school, such as mentoring and faculty role models. Admissions committee standards must be challenged and made less subjective. There are still too many nursing schools where diversity is just window dressing.”


This issue of differentness is a problem not just in nursing education but also in the practice environment, Alexander continued. “I have minority colleagues who have two different resumes,” she explained. “One resume has nothing in it that indicates race or difference. The other resume is the one they send when the ad specifies ‘minorities are encouraged to apply.’ It’s the resume that says who they really are and what they look like. It’s sad that people have to do this.”

Alexander, who is African American, related a harrowing personal example of having to hide her own racial identity. When she and her family recently tried to sell their house, the Realtor advised them to remove all evidence that black people lived there, or else the house wouldn’t sell. “We had to pack up all our family pictures and hide them in a box behind the washing machine,” she said. “When minority nurses have to have two resumes, they are metaphorically ‘hiding their pictures.’ It is time for us to stop having to put our cultural identity away in a box.”

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Carry It Forward

Where does the Breakthrough to Nursing Project go from here? That’s up to you, the final panelist, Vernice Ferguson, MA, RN, FAAN, told the audience of more than 3,000 student nurses at the convention.

“I am so proud of [the NSNA] and its history with this project,” said Ferguson, who is senior fellow emeritus at the University of Pennsylvania in Philadelphia. “At a time when other associations, such as the National League for Nursing and the American Nurses Association, were not addressing the issue of diversity, NSNA was. Today, you are the future, the ones who will provide the leadership to carry this forward.”

She then challenged the students to think seriously about how they could make a difference in addressing six critical multicultural health issues “where diverse nurses can shape the future and write the script that is not yet written.” These issues are:

  1. End-of-life care.
  2. Elder care.
  3. Providing culturally competent nursing care. “There is a huge wave of new immigrants coming to the U.S.,” Ferguson commented. “As nurses, we must make them feel welcome and well cared for.”
  4. Eliminating racial and ethnic health disparities.
  5. Providing leadership in health promotion and disease prevention. (“This is nurses’ work and we haven’t done it yet.”)
  6. Developing team approaches to providing better quality health care.

“With the formation of BTN, student nurses showed the world that you were concerned about an issue no one else in nursing was looking at,” Ferguson reminded the current generation of NSNA members. “Now you can continue to trailblaze in these six areas. Ask yourself: What will you bring to the table [as a nurse]? What will you do to help eliminate health disparities?”

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For more information about the Breakthrough to Nursing Project’s 40th anniversary, visit the National Student Nurses’ Association Web site, http://www.nsna.org/.

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