“As nurses, we’re expected to provide quality health care to people from a variety of cultural and socioeconomic backgrounds. Without diversity among our ranks, it’s almost impossible to do that.”
That’s how May Wykle, RN, PhD, FAAN, explains her decision to make diversity the focus of her term as the 24th president of Sigma Theta Tau International (STTI), the Honor Society of Nursing.
The society, whose mission is to provide leadership and scholarship in nursing practice, education and research in order to enhance the health of all people and improve nursing care worldwide, has 120,000 active members in 90 countries. Yet, like the nursing profession itself, STTI remains predominately white and female. When Wykle, who is African American, began her two-year term as president in 2001, its membership was 96% female and 93% white.
“Since we are the international honor society of the profession, we should take the lead in defining diversity and making a commitment to achieving it,” asserts Wykle, a distinguished scholar, researcher and geriatric health specialist who is currently dean and Florence Cellar Professor of Nursing at Case Western Reserve University’s Frances Payne Bolton School of Nursing in Cleveland. “The diversity in nursing should mirror that of the general population. My definition of diversity is a broad one that includes cultural diversity, but also diversity of gender, backgrounds, resources and talents.”
To achieve these goals, the honor society has launched an ambitious initiative designed to increase and celebrate all forms of diversity within its membership ranks and in the nursing profession as a whole. The push began last year with the creation of a Diversity Task Force, whose responsibilities included drafting the organization’s official position statement on the subject, “Community Through Diversity: A Diversity Statement for Sigma Theta Tau International.”
In stating STTI’s overall motivation in pursuing diversity, the position paper notes that “diversity creates an opportunity to support a mosaic of cultural distinctiveness and nursing excellence through inclusivity, personal and professional development and the stimulation to think in different ways.”
Diversity at the Top
Sigma Theta Tau’s commitment to “the value and active engagement of diversity in achieving the society’s vision” encompasses 10 points, beginning with encouraging dialogue at the both the individual and chapter levels. The society’s more than 400 local chapters and their members are charged with finding ways to enhance diversity, such as developing educational programs that promote diversity, cultural competence and community building.
The initiative also stresses the importance of reflecting diversity in the society’s leadership by seeking officers and committee members from culturally diverse backgrounds. This “starting at the top” approach is vital to any organization’s efforts to build diversity, according to STTI Vice President Carol Picard, RN, PhD.
“You diversify an organization from the top to the bottom and horizontally,” explains Picard, associate director of the Graduate Program in Nursing at MGH Institute of Health Professions in Boston. “Having a diverse leadership makes a difference in [attracting more minority nurses and men] into the organization and in how we present Sigma Theta Tau to the world.”
This year, in addition to Wykle, the organization’s board of directors includes one other African-American woman and three men, including one European. And for the first time, the organization has elected a man, Daniel Pesut, RN, PhD, CS, FAAN, to the position of president-elect. Pesut has been involved in Sigma Theta Tau since his 1976 induction as a nursing student.
“For STTI, diversity is a means to building a community,” he says. “We want a diverse membership so that we can attract the best of the creative minds and backgrounds to build a stronger community within the organization.”
Pesut, who is professor and chair of the Department of Environments for Health at the Indiana University School of Nursing in Indianapolis, feels that attracting more minority and male nurses into the organization can best be accomplished on a one-on-one basis backed by national media coverage.
“We need more coverage of the different kinds of things that men are doing in nursing,” he adds. “The reason I am a nurse is that it gives me creativity and flexibility in career roles. You can be a consultant, you can practice, you can teach. You can do a variety of things with the same fundamental education.”
Going Local
While the honor society’s national leaders are spearheading the diversity initiative, much of the responsibility for actually changing the demographics of the organization will rest with its local chapters. At the chapter level, diversity doesn’t just mean attracting more male and minority members, but also providing education programs on cultural competence to help all local nurses better meet the needs of the diverse patient bases they serve.
Many STTI chapters have found success in attracting more nurses from underrepresented populations into their membership by jointly sponsoring educational and networking events with other local and regional nursing organizations.
“In Boston, our chapter has partnered with the New England Black Nurses Association to hold a luncheon with a guest speaker,” says Picard. “From those types of events, nurses learn about us and we can establish relationships with [minority] nurses who might be interested in joining Sigma Theta Tau. In turn, these new members take our message back to their nursing colleagues.
“I hope to see more such partnerships engaged in dialogues at the local level,” she adds. “That will give us the broadest impact across the world.”
The honor society will learn more about how well its chapters are implementing the diversity plan at the local level when chapter annual reports are submitted in July.
Encouraging Diversity Today–and Tomorrow
Attracting more men and nurses of color into its current membership is just one aspect of Sigma Theta Tau’s diversity goals. The honor society is also exploring ways to increase the racial, cultural and gender diversity of the nursing profession in the future. One local chapter, for example, is sponsoring a Girl Scout troop.
“We have to talk about the importance of nursing [careers] in the early grades,” Wykle explains. “Nursing has always been held in the highest esteem among racial and ethnic minority groups. We need to build on that.”
One barrier she hopes to challenge is the career advice many minority students interested in nursing careers receive from guidance counselors. “So many of them are counseled to go into two-year [nursing] programs,” she says. “These programs are fine, but students need to be encouraged to keep going and earn a higher degree.”
Wykle believes the low number of associate-degree and diploma students who choose to continue their nursing education at four-year universities can be blamed on the misconception that “a nurse is a nurse is a nurse.” Disproving that myth by demonstrating the career advantages a BSN degree brings would play a key role in drawing more minorities into nursing leadership roles, she adds.
“Once we have attracted a diverse group of students into nursing programs, we want to make sure they have access to faculty and practicing nurses who can provide mentorship and other types of support that help retain minority students,” the STTI president continues. “It’s one thing to bring in people [from diverse backgrounds], but we also have to ensure that they’ll stay in the profession.”
Still another key item on the Honor Society of Nursing’s diversity agenda is to address the disparities in health outcomes and quality of care between Caucasian populations and persons of color. As Wykle puts it, “We want it to be an even playing field.”
To meet this challenge, Sigma Theta Tau hopes to influence the nursing research community so that more members of underrepresented minority groups will be included in research studies.
“To change [health care] practice, you have to have the evidence,” Wykle points out. “Nursing needs research not only to discover improvements in patient care but also to contribute to the growth of the profession. STTI envisions research being conducted not just by nurse scientists with PhDs, but by nurses at all levels who value research and want to solve clinical problems. If nurses don’t do the research, who will?”
Diversity on a Global Scale
Because Sigma Theta Tau is an international society, efforts to promoting diversity within its membership must take a global approach. The organization has chapters in Canada, Brazil, The Netherlands, Hong Kong, Korea, Pakistan and several other countries. This can sometimes cause STTI’s leaders to reexamine membership policies that work well in North America but may not be effective in other parts of the world.
The society’s traditional chapter model is one such structure currently under examination. In the past, STTI chapters have always been affiliated with a university. Now, several nurses in Africa have expressed an interest in forming a Pan-Africa chapter. The nurses involved are national leaders in the profession and members of an association that meets regularly but is not affiliated with a university.
“They came forward to the eligibility committee and said, ‘this is how we connect [professionally] and we would like our association to be the way we bring Sigma Theta Tau to our nurses,’” Picard explains. “So we’re working with them to establish a new chapter model that will fit their needs.”
Being able to interact with international nurses from a diverse range of countries and cultures is a big draw for STTI members, according to Richard Smith, RN, MSN, who has held various local and national positions in Sigma Theta Tau and now serves on its national Public Relations Committee. “You have the opportunity to work very closely with people throughout the world who are working toward a common goal of promoting professional aspects of nursing, whether it’s research or another objective,” he says. “You benefit from gaining their [international] insights and perspectives.”
To Be Continued
Wykle knows that all of her goals won’t be accomplished before her term as president expires next spring. She’s hoping, however, that her two years at the helm have laid the foundation for Sigma Theta Tau International to not only increase its own racial, ethnic and gender diversity but also change the way nursing care is delivered to people of color.
“I think this initiative will eventually impact nursing significantly,” she explains. “Having an international honor organization step up and call for more diversity in nursing is going to improve the image of the profession. It’s going to attract a more diverse group of people into nursing and also attract more young people. We can’t do all of this in two years, but we can have people become more aware of the differences in care [available to white versus minority populations] and work toward a goal of erasing those disparities. We can help people understand that nursing is a wonderful, open profession.”
Becoming a Member
The opportunity to help increase the racial, cultural and gender diversity of one of nursing’s most respected professional organizations isn’t the only reason why nurses of color and male nurses should think about joining Sigma Theta Tau International. Membership in this prestigious international honor society, whose name is synonymous with excellence, leadership and scholarship in nursing, offers many benefits that can help advance your career and foster the achievement of your personal goals, whether your interest lies in clinical practice, education or research.
A 10-Point Plan for Diversity Sigma Theta Tau International’s “Community Through Diversity” initiative encompasses these 10 principles and practices, which the honor society is encouraging at both the chapter and individual member levels throughout the organization: 1. Encourage ongoing dialogue and learning in the area of the richness of diversity and its contributions to building community. 2. Develop and value the organization’s definition, policies and procedures related to diversity. 3. Support and encourage chapters to reflect the richness and diversity of their local and global communities. 4. Encourage chapters and members to find ways to enhance diversity and build community. 5. Stimulate dialogue to learn about cultural criteria for excellence, educational distinction, and ways and means to honor achievements in nursing practice, education, research and community leadership. 6. Respect the richness and diversity of traditions and heritage as the society creates and designs future plans and programs. 7. Seek diversity in nominations and appointments to committees, task forces and key policy and leadership positions. 8. Build a culturally diverse cadre of leaders, officers, board members and staff. 9. Create and use advisory groups to inform and advise the leaders of the organization regarding diversity as a means to create and support a global community of nurse leaders. 10. Develop and promote educational programs that inform and educate members on issues of diversity, cultural competence and community building.
Adding STTI membership to a resume or vita sets a nurse apart as someone who is interested in playing a leadership role in the profession, says Richard Smith, RN, MSN, who serves on the society’s national Public Relations Committee. “The organization stands behind research and supports evidence-based practices,” he explains. “STTI’s emphasis on scholarship and professionalism is its most outstanding feature.”
Smith, an assistant professor at the University of Arkansas for Medical Sciences College of Nursing in Little Rock, notes that his involvement with STTI has benefited him in every stage of his career: as a student, a clinical nurse and now as a faculty member.
“Sigma Theta Tau has opportunities for you no matter what your particular career focus is–whether you’re a clinician who works in a hospital or even a self-employed nurse entrepreneur,” he states. “There’s a heavy emphasis on research, which is necessary for good evidence-based practices. If you’re a faculty member, you want to prepare your students with the latest information for achieving better patient outcomes. Sigma Theta Tau is a good vehicle for that.”
Currently, more than 60% of the organization’s active members are clinicians, 23% are administrators or supervisors and 17% are educators or researchers. Sixty percent of STTI members hold advanced degrees.
How does the honor society recruit new members? Most of them are invited to join while still in nursing school. Undergraduate students must have completed at least half of the nursing curriculum, have a GPA of 3.0 on a 4.0 scale, rank in the upper 35 percentile of their class and meet the society’s expectation of academic integrity. Graduate students must have completed 25% of their curriculum and have a GPA of at least 3.5.
“Student members have access to the same benefits [of STTI membership] that are available to nurses who have been working in the field for many years,” says Smith. “Plus, students have the added advantage of being able to develop a mentor relationship with more experienced STTI members. For graduate students, it’s an opportunity to be involved with faculty as a peer member of the same organization, not just as a student.”
Membership in Sigma Theta Tau isn’t just open to students–practicing nurses are often invited to join as well. They must be RNs, be legally recognized to practice in their country, hold at least a baccalaureate degree in nursing and have demonstrated achievement in the profession.
For these nurses, there is less emphasis on the grade point average they may have earned years ago, emphasizes STTI Vice President Carol Picard, RN, PhD. “We’re looking for people who are community leaders. I can remember having someone come to me and say, ‘my GPA was only 2.9 but I’d like to join.’ This person happened to be running the HIV action committee for a large city,” Picard says, adding that the nurse’s professional accomplishments and contributions to health care outweighed her lack of a 3.0 average.
Even though membership in STTI is invitational, Daniel Pesut, RN, PhD, CS, FAAN, who next year will become the honor society’s first male president, encourages qualified nurses to be proactive about becoming involved in the organization, rather than waiting for an invitation to join. “Visit our Web site and find a chapter near you,” he recommends. “If someone is actively making a contribution to the nursing profession, he or she can certainly seek membership by getting connected with the local chapter.”
For more information, contact:
Sigma Theta Tau International
550 West North Street
Indianapolis, IN 46202
(888) 634-7575
Fax (317) 634-8188
www.nursingsociety.org
“In 1975, the world was a very different place,” Carmen Portillo, PhD, RN, FAAN, immediate past president of the National Association of Hispanic Nurses, told NAHN members at the opening ceremony of the association’s 25th Annual Conference last summer. “The war in Vietnam finally ended; the International Women’s Year Conference adopted a 10-year plan to improve the status of women. Congress repealed the Taft-Hartley Act, giving nurses the right to collective bargaining. In 1975, the world held 4 billion people—but no personal computers and no cell phones. The world had not yet heard about AIDS.”
Back then, the world was also a dramatically different place for Hispanic nurses. There were very few nurses of Hispanic origin in the nursing work force—even though the nation’s Hispanic population was growing rapidly. With very few exceptions—most notably, Ildaura Murillo-Rohde, PhD, RN, FAAN—there were virtually no Hispanic nurses working in academic settings, doing research on Hispanic health issues or advising federal policy-makers about the health care needs of Hispanic people.
What’s more, back in 1975 there was no national organization serving the professional and leadership development needs of Hispanic nurses. There was no unified voice to speak up in advocacy for the unique cultural concerns of Hispanic nurses and the communities they served.
“I began to realize that something had to be done about this,” recalls Murillo-Rohde, dean emeritus and professor emeritus at SUNY Brooklyn. “I saw that I was the only Hispanic nurse who was going to Washington to work with the federal government, review research and education grants, etc. There was nobody else. I looked behind me and thought: ‘Where are my people?’”
Ildaura Murillo-Rohde, PhD, RN, FAAN
This determination to “do something” to increase the representation of Latinos in the nursing profession led Murillo-Rohde to create the organization known today as the National Association of Hispanic Nurses. Last year, NAHN proudly celebrated its 25th birthday as the nation’s voice for Hispanic nurses and Hispanic health. With more than 30 local chapters across the United States and in Puerto Rico, NAHN currently represents the interests of more than 40,000 Hispanic nurses coast to coast.
Today, at the start of the 21st century and the new millennium, America’s Hispanic population is growing faster than the U.S. population as a whole, creating a huge and urgent demand for more Hispanic nurses who can meet this underserved ethnic group’s need for culturally and linguistically competent care. In light of this, NAHN’s original mission statement seems even more relevant today than it was a quarter century ago:
• To serve the nursing and health care delivery needs of the Hispanic community and the professional needs of Hispanic nurses; • To work toward improvement of the quality of health and nursing care for Hispanic consumers; and • To provide equal access to educational, professional and economic opportunities for Hispanic nurses.
Flying Solo
Like the National Black Nurses Association, NAHN began as an ad hoc minority nurse committee within the American Nurses Association that eventually broke away to go solo. “We felt that we really didn’t have a place within ANA,” explains NAHN’s 1984-1988 President, Henrietta Villaescusa, RN, FAAN. “We had special issues and problems that we felt were unique to Hispanic nurses and were not being addressed. We needed to be accepted as part of the nursing profession; we needed people to understand that Hispanic patients had special cultural needs.”
Adds Mary Lou de Leon Siantz, PhD, RN, FAAN, a founding member of NAHN who is now the association’s current president, “In 1975, many of us were feeling isolated. There were so few Hispanic nurses in the country—and, especially, very, very few in academia. There was little available in terms of mentorship and networking with other Hispanic nurses. Back then, it was a time when ‘minority’ wasn’t a buzzword and the isolation was very acute.”
Following the 1975 ANA annual conference, a group of about 15 nurses, led by Murillo-Rohde, received approval to form a completely new association devoted exclusively to serving the needs of Hispanic nurses. Originally called the National Association of Spanish-Speaking/Spanish-Surnamed Nurses, the fledgling association met in New York City in space donated by the New York State Nurses Association. In 1979, the group was renamed the National Association of Hispanic Nurses and is now headquartered in Washington, D.C.
As the association’s first president (serving from 1977 to 1980), Murillo-Rohde continued to be the driving force behind NAHN in its early years, even using her own money to fund the organization’s growth. “That was because there was no money to do anything,” she says. “For the first four years, I was the chief cook and bottle washer for NAHN. I promoted the association, I put out the newsletter, I did everything.”
Triumphs and Challenges
The National Association of Hispanic Nurses today is a very different organization than it was in its infancy and toddler days. Since the formation of the group’s first local chapter in New York in 1983, the aggressive development of a network of NAHN chapters throughout the country has fueled steady membership growth. It has also provided opportunities for many other Hispanic nurses to serve in leadership roles in the association. “It has been the chapters, working with the communities and the nurses, that have shaped the growth of NAHN,” Murillo-Rohde asserts.
While the association has evolved tremendously since 1975, Antonia Villarruel, PhD, RN, FAAN, the group’s 1996-1998 president, believes NAHN’s fundamental goals have not changed. “We continue to be advocates for Hispanic communities and Hispanic nurses,” she says. “We believe Hispanic nurses can provide unique leadership in the nursing profession, because of our bilingual, bicultural skills. I think we have become more savvy and more powerful as our membership has grown and we continue to attract Hispanic nurse leaders.”
Identifying barriers to quality education for Hispanic nursing students and working toward recruitment and retention of Hispanic students in nursing education continue to be high-priority goals on NAHN’s agenda. Says Portillo, “Given that Hispanic high school students have such a high drop-out rate, we are already at a disadvantage. Those who do make it into nursing school often do not have the appropriate tools to be successful academically. They may drop out or will not pursue higher educational degrees. The majority of our nurses are prepared at the associate-degree level.”
While NAHN’s membership outreach has helped make inroads in increasing the number of Hispanic nurses in the RN population, “the recruitment and retention challenges have been constant as well as the growth,” Villarruel feels. “I think it’s a crime that Hispanic nurses still account for only 1.6% of the nurse work force. People will play games with the numbers and say there’s been an increase, but the fact is, the number of Hispanic nurses has not grown proportionately to meet the health needs of our people.”
In the National Spotlight
Ask the association’s founders and leaders what NAHN accomplishments they’re most proud of after 25 years and you get many different answers. For Founder Emeritus Murillo-Rohde, it is NAHN’s success in encouraging Hispanic nurses to move beyond associate-level education and earn advanced degrees.
“High school counselors would try to railroad Hispanic students into the AD nursing programs,” she explains. “I’m proud of the fact that we’ve been able to push more of our nurses on to earn doctoral degrees. We now have a number of Hispanic doctoral nurses who are very good at research and have been recognized worldwide for their studies. For example, Mary Lou de Leon Siantz has done work with Mexican migrant families that was truly ground-breaking.”
Portillo is excited about the fact that “in the last 10 years, NAHN has really risen to a different level—one of national recognition as well as local recognition. There has been great enthusiasm from people who see the need for this organization—including nursing schools, private industry and community health organizations—because they see our members as the connection to the Hispanic community they need to serve.”
Much of this national recognition is due to NAHN’s efforts to bring more Hispanic nurses to the federal health care policy-making table, an achievement Villarruel is particularly proud of. “We now have Hispanic nurse representation on important government boards, such as the Division of Nursing and the National Institute of Nursing Research,” she points out. “I think we’ve been instrumental in moving the agenda for [Hispanic] nursing forward, and in that sense, moving our community forward.”
The association regularly submits the names of Hispanic nurse leaders when positions open up on health policy committees, according to NAHN Vice President Rose Gonzalez, RN, MPS, who chaired the group’s Policy Committee for the last four years. “For instance, Carmen Portillo was appointed to serve on the NINR’s national advisory committee,” she says. “Prior to that, Mary Lou de Leon Siantz served on that committee. Patricia Montoya [RN, MPA], commissioner of the Administration on Children, Youth and Families, is a long-time NAHN member. We sent a letter of recommendation on her behalf for that position, along with the ANA.”
Mary Lou de Leon Siantz, PhD, RN, FAAN
For Siantz, the association’s most worthwhile accomplishment is the creation of a vital and growing national network of Hispanic nurses, eliminating the isolation that existed in the past. “Hispanic nurses need to communicate with each other,” she emphasizes. “Through our networks, Hispanic nurses have their hands on the pulse of the Hispanic community. This enables us to give national, regional and community leaders the message that they need to work with us, because we know about Hispanic people’s health needs more than anybody else does.”
Building Future Leaders
By the year 2050, Hispanics are projected to become the nation’s largest minority group, comprising nearly a quarter of the U.S. population. Will the nursing profession be able to provide enough Hispanic nurses to meet this exploding need for culturally sensitive care? With this challenge at the top of its agenda, the National Association of Hispanic Nurses plans to be a very busy organization as it gears up for its next 25 years.
“We have done a lot but we need to do more,” Murillo-Rohde believes. “We want to continue to increase our membership. As I travel, I still hear Hispanic nurses saying, ‘I didn’t know that we had [an organization like NAHN].’”
Siantz would like to see NAHN representing 100,000 Hispanic nurses in the United States and Puerto Rico by the year 2025. “One thing we’ll be focusing on during my presidency is expanding the student portion of our membership. As the association grows, I’d also like to see us have the capacity to reach out and mentor Hispanic boys and girls who are interested in health care careers.”
But the ultimate goal, NAHN’s president emphasizes, is to continue Murillo-Rohde’s legacy of not just increasing the number of Hispanic nurses but also developing more Hispanic nurse leaders. “NAHN has established a venue for developing Hispanic nursing leadership that simply didn’t exist 25 years ago,” Siantz says. “One of our key strengths is the ability to mentor—in government, academic and community settings. I want NAHN to continue that mentorship with the new students who are coming in. We now have the wherewithal to help Hispanic nurses develop their careers in whatever direction they want.”
How Much Do You Know About Hispanic Nurses?
Test your knowledge with this quiz:
1. How many Hispanic nurses are currently practicing as RNs in the United States?
2. Today more than 10% of the total U.S. population is Hispanic and that figure is expected to rise to at least 22% by 2050. What percentage of the current RN population is Hispanic?
3. True or False: Hispanic nurses are older on average than other RNs.
4. Where in the U.S. would you find the greatest number of Hispanic nurses?
5. True or False: Hispanic nurses are more likely to enter their nursing careers through associate degree programs than nurses of other ethnic/racial backgrounds.
6. What percentage of Hispanic nurses hold advanced degrees (master’s or doctoral level)? How does this compare with nurses from other ethnic/racial backgrounds?
Answers to Hispanic Nurses Quiz
1. As of March 1996*, approximately 40,600 of the 2,559,000 individuals with current licenses to practice as registered nurses in the U.S. were of Hispanic background.
2. Although Hispanics account for more than 10% of our nation’s population, less than 2% of the RN population is Hispanic. You do the math.
3. False. The average age of Hispanic nurses is 41.1 years, compared to 44.3 years for the RN population as a whole.
4. Seventy-five percent of the Hispanic nurse population is located in the western and southern regions of the U.S.—specifically, 38% in the West and 37% in the South.
5. True. As of March 1996, about 53% of Hispanic nurses entered the profession through associate degree programs, compared to about 37% of the RN population as a whole.
6. About 7% of Hispanic nurses hold master’s or doctoral degrees, compared to about 10% of Caucasian nurses and 12% of African-American nurses.
Although there are still relatively few minority nurses who have been inducted into the American Nurses Association (ANA)’s prestigious Hall of Fame, their number slowly and steadily continues to grow. The most recent minority nurse leader to be honored for a lifetime of exceptional contributions to advancing the profession of nursing is trailblazing educator, researcher, author and advocate Hattie M. Bessent, EdD, MSN, RN, FAAN. The ANA proudly presented Dr. Bessent with its Hall of Fame Award at the association’s 2008 Biennial House of Delegates meeting, held this past summer in Washington, D.C.
“As an African American woman, Dr. Bessent is responsible for breaking down many cultural, educational and professional barriers,” says ANA president Rebecca M. Patton, MSN, RN, CNOR. “As an educator, her work has impacted generations of nurses. As a health care professional, her strength and leadership has inspired women from all walks of life. Dr. Bessent serves as a role model to all nurses and ANA is grateful for her life-long dedication to nursing.”
Dr. Bessent, whose specialty is psychiatric nursing, is one of those extraordinary nursing leaders who truly deserve the title Living Legend. During her long and distinguished career, she has published landmark research studies and designed programs that have made an impact in reducing health disparities and improving the health of minority communities. A prolific author, Dr. Bessent has published three books as well as many journal articles and monographs. She has held numerous fellowships and consultancies and has advised virtually every U.S. president since Eisenhower on mental health issues.
Dr. Bessent is perhaps best known for her pioneering efforts not only to increase the representation of minorities in the nursing profession but to help them develop into leaders. For more than 15 years, she spearheaded the ANA’s Ethnic Minority Fellowship Program (now known as the SAMHSA/ANA Minority Fellowship Program), a national initiative dedicated to developing a cadre of minority nurse leaders in the fields of mental health and substance abuse nursing. Dr. Bessent also launched, and continues to direct, Project LEAD (Leadership Enhancement and Development), which prepares minority nursing faculty to assume leadership positions in academia.
Other minority nurses in the ANA Hall of Fame include Dr. M. Elizabeth Carnegie, Dr. Luther P. Christman, Mary Eliza Mahoney, Estelle Massey Osborne, Mabel Keaton Staupers and Susie Walking Bear Yellowtail. The complete list of Hall of Fame inductees is available at www.nursingworld.org (click on “About ANA,” then “Where We Come From,” then “Hall of Fame”).
The year was 2002. Gathered together in a small Asian diner in Hawaii, the board of the Asian American/Pacific Islander Nurses Association (AAPINA) was discussing whether or not their young organization had enough membership support to hold a national conference. Who would attend and why? What would be the criteria for determining whether the event was a success?
Back then, the board, consisting of 14 members, didn’t have answers to these questions. But today AAPINA has held four successful national conferences in different cities across the country and is preparing to hold its fifth annual conference, “Achieving Health Parity for Asians and Pacific Islanders through Practice, Research and Education,” on May 22-24 in Las Vegas.
The national conferences have given AAPINA members the opportunity to come together in one place to network, gain support and mentorship, and discuss issues facing Asian/Pacific Islander (API) nurses. This in-person camaraderie is important, because many members have little interaction with other API nurses in their day-to-day working lives.
“I didn’t feel like I had a political voice in any other nursing organization,” says SeonAe Yeo, PhD, RNC, FAAN, associate professor at University of North Carolina at Chapel Hill School of Nursing and immediate past president of AAPINA. “I felt that it was critical to bring our voice to the nursing profession.”
The idea of holding a national conference was implemented during Yeo’s presidency. “Prior to that, the association mainly communicated with its members through newsletters,” she explains. “Now that we have an annual conference, members get to see each other at least once a year. That’s one reason why membership grew during my tenure to about 200 members. When I began my presidency in 2001, we had less than 20. And it continues to grow.”
According to its mission statement, AAPINA has four main objectives:
• To identify and support the health care needs of API people in the United States and globally;
• To implement strategies to act on issues and public policies affecting the health of APIs;
• To collaborate with other interdisciplinary health and professional organizations; and
• To identify and support professional and nursing concerns of API nurses in the U.S. and globally through active networking and empowerment.
“We try to appeal to nurses working in different areas of the profession, including clinical, research and administration, and we’ll continue to do that,” says Yeo. “But what I’ve found is that this type of organization is particularly attractive to many international Asian graduate students [studying in America]. If you look at any major nursing school in the nation, about half of the graduate students are from various countries in Asia. These students are typically isolated. I’ve also found that many API nurse clinicians working in hospitals in staff or administrative roles are more isolated in their work environments and feel the glass ceiling effect more.”
Yeo notes that these nurses often have impressive titles and have earned graduate-level degrees and certifications, yet cannot advance to higher levels in hospital settings. “AAPINA provides them with a way to start thinking in terms of asking why they can’t get on a career path the way [majority nurses] are doing,” she says. “We’re [helping them address] the language barriers and cultural isolation that API nurses face. We also provide connections to other Asian and Pacific Islander nurses.”
Laying the Foundation
Compared to some other minority nursing associations, such as the National Black Nurses Association and the National Association of Hispanic Nurses, which have been in existence for more than 30 years, AAPINA is a relatively young organization. It was founded in 1991.
“That year, several of us [founding members] were attending a conference for ethnic minority nurses. This was the first time I had ever seen a group of Asian American nurses together in one place,” says Kem Louie, PhD, RN, CS, FAAN, associate professor at William Paterson University Department of Nursing in Wayne, N.J., and a past president of AAPINA. “We were all very concerned about [diversity in the nursing profession and creating more leadership opportunities for] minority nurses. So before we left the conference, I suggested that we stay connected, not realizing that this would be the impetus for forming AAPINA.”
AAPINA began with a group of 14 members who were committed to being advocates for Asian American and Pacific Islander nurses. These founding members represented a variety of geographic areas, from Hawaii to the East Coast. The fledgling association established bylaws and set out to bring the diverse voices of API nurses to the forefront of professional nursing issues.
Louie points out that one of the reasons why an association like AAPINA didn’t form earlier is because the API population is very diverse, encompassing many different ethnic subgroups. But even though, for example, the health care needs of Native Hawaiians are different from those of immigrants from Southeast Asia, “we are trying to [address the health concerns of the overall API population] and health disparities in particular,” she says.
Adds another AAPINA founding member, Mi Ja Kim, PhD, RN, FAAN, professor and dean emerita of the University of Illinois at Chicago College of Nursing, “Since we serve such a diverse population, language barriers can be a problem. English isn’t always [patients’] primary language.”
Over the years, AAPINA has been involved in several initiatives that have made a major difference in increasing national awareness of API health disparities and advancing health policy agendas that benefit the API population. In the late 1990s, under Louie’s leadership, the association worked with a coalition of other groups, such as the Asian and Pacific Islander American Health Forum, to get President Bill Clinton to establish a White House Initiative on improving the health status of API communities. Prior to this, the API population had been falsely stereotyped as a “model minority group” with few health problems. Therefore, they were rarely included in federal minority health programs or government-funded health disparities research studies.
There had already been many federal initiatives aimed at improving the quality of life for underserved African American, Hispanic and Native American communities, Louie explains. “It was quite exciting to be part of this movement that was saying, ‘Look, Asian Americans and Pacific Islanders would like some recognition that we, too, face great health disparities [and that we need more federal resources directed toward this problem’]. As president of AAPINA, I was invited to be a part of these important discussions.” President Clinton signed the executive order authorizing the API Initiative in June 1999.
Two years later Louie, representing AAPINA, published a landmark white paper on the health status of Asian Americans and Pacific Islanders in the journal Nursing Outlook. “The white paper was a review of API health disparities, what we need to do to remove them and recommendations for research,” she says.
Louie’s article noted, for example, that “Asian Americans and Pacific Islanders exceed other groups in health disparities in the areas of tuberculosis and hepatitis B, whereas cancer and cardiovascular diseases are leading causes of death within the Asian American and Pacific Islander populations.”
Sharing a Common Vision
In much the same way that AAPINA was established from a common bond among like-minded API nursing professionals, the National Coalition of Ethnic Minority Nurse Associations (NCEMNA) grew from discussions among leaders of several prominent minority nursing organizations. These dialogues revealed that the individual associations all shared a common goal—advocating for equal opportunity in nursing and better health care for communities of color.
“We decided to work together as a single unified force instead of each association separately competing for funding when we have such common missions and goals,” says Louie, who holds the position of secretary on NCEMNA’s board of directors.
NCEMNA, incorporated in 1998, serves as the umbrella organization for five associations: AAPINA, the National Alaska Native American Indian Nurses Association (NANAINA), the National Association of Hispanic Nurses (NAHN), the National Black Nurses Association (NBNA) and the Philippine Nurses Association of America (PNAA). Collectively, NCEMNA gives voice to 350,000 minority nurses and to the lived health experience of a constituency marginalized from mainstream health delivery systems.
Being part of the NCEMNA collaborative has enabled AAPINA to receive federal funding that an association of its size would have difficulty obtaining on its own. Each year, through a grant from the National Institute of General Medical Sciences (NIGMS), a different NCEMNA member association receives funding to support its annual conference. AAPINA is the 2008 recipient.
“The grant has helped in getting keynote speakers and panels for the conference,” says Jillian Inouye, PhD, APRN-BC, AAPINA’s newly elected president. “[On a broader level], it is stimulating research and development of minority nurse scientists.” NCEMNA is also using the $2.4 million NIGMS grant to fund the Nurse Scientist Stimulation Program, a five-year initiative to increase the number of minority nurse researchers who can investigate the causes of health disparities and develop culturally appropriate interventions.
“When we incorporated all the minority nurse associations through NCEMNA, it gave AAPINA a lot of energy and financial support to become more organized,” continues Inouye, who is a professor and graduate chair at the University of Hawaii at Manoa School of Nursing and Dental Hygiene. “Kem Louie was the association’s driving force throughout the early years. Now, [thanks to our involvement in the coalition], more people have become interested in AAPINA. We have more members, we’ve gotten our Web site up, we’ve started to hold conferences. And through NCEMNA’s Aetna Foundation grant, we’re able to offer scholarship opportunities to pre-doctoral or even master’s students. That has really helped draw more people to our organization.”
The annual Aetna/NCEMNA Scholars Program is another NCEMNA project designed to introduce nurses of color to careers as nurse scientists and socialize them into the research agenda to eliminate health disparities. Each year, the program provides financial and mentoring support to 10 nursing students—two from each of the coalition’s five member associations.
Mentoring is also an important part of AAPINA’s mission to support and empower Asian and Pacific Islander nurses and students.
“I’ve served as a mentor through AAPINA as well as through NCEMNA,” says AAPINA president-elect Oisaeng Hong, PhD, RN, associate professor, Department of Community Health Systems and director of the Occupational Health Program at the University of California San Francisco School of Nursing. “Our mentees are mostly doctoral students who are matched with a mentor based on areas of interest, research topic and target population. We spend one to two years together, but we don’t have to be in the same city. Communication happens through phone calls and email. We get face-to-face time during our annual conferences.”
Onward and Upward
With membership on the rise and the success of the national conferences firmly established, AAPINA’s leaders are setting goals to ensure the association’s future growth and sustainability while continuing to increase its value as a resource for Asian and Pacific Islander nursing professionals.
“One of our most important objectives at the moment is to expand our efforts in growing our membership and to reach more API nurses,” says Hong. “It’s hard work because we have no hired staff.”
Inouye says that implementing a strategic plan is one of her goals during her presidency. “I also plan to update our mission statement and Web site,” she adds. “Now that we have some funds, we’re able to hire an attorney for the first time to update our bylaws. I’d also like to expand our board of directors and [create more opportunities for our members to get involved as leaders in the association]. Currently, we only have an executive board, which includes the president, president-elect, secretary, treasurer, past president and the chairs of the membership and newsletter committees. So I’d like to create a board aside from that to help manage AAPINA. It’s a slow process, but it’s working.”
The strategic plan will also focus on establishing local AAPINA chapters in various parts of the country. “We currently have a student chapter in San Francisco and one that’s starting in Chicago. These are things that will be fleshed out as we develop the plan,” says Inouye.
Of course, AAPINA will continue to promote the expertise of Asian American and Pacific Islander nurses as culturally competent advocates who can play a crucial role in improving the health of API populations. “The health care issues that we [APIs] face are similar to those of other ethnic minority groups,” says Inouye. “These include diabetes and obesity. It may not seem that obesity is a problem for APIs, but their BMIs are increasing, which puts them at risk for cardiovascular disease and cancer. Our Native Hawaiian population is at risk for every kind of disease. They have very poor health outcomes.”
The association keeps its members abreast of key API health issues through its newsletter, Web site and workshops at the national conference. In 2005, AAPINA was one of several nursing associations that received grant funding from the national Nurse Competence in Aging (NCA) program to disseminate information to its members about the health care needs of minority elders. As a result, AAPINA was able to add a new section to its Web site focusing exclusively on gerontology/geriatrics issues and resources.
These successes are only the beginning of what AAPINA will continue to achieve through its dedicated and determined leadership. “In the future, I would like to have more [API] scholars and clinicians united in voice so that we can promote the AAPINA organization and our mission,” says Kim.
For more information about the Asian American/Pacific Islander Nurses Association, visit www.aapina.org.
As the youngest and first Asian American president of AARP (formerly the American Association of Retired Persons), Jennie Chin Hansen, RN, MS, FAAN, embodies the changing face of this important advocacy organization and its 40 million members, one-third of whom are baby boomers.
Hansen, who is 59, was elected to her two-year term as AARP’s president in May 2008, bringing with her a wealth of expertise in health care and aging issues. According to her official AARP bio, she teaches nursing at San Francisco State University, holds an appointment as senior fellow at the University of California San Francisco’s Center for the Health Professions and is a past president of the American Society on Aging.
Hansen also spent nearly 25 years as executive director of On Lok, Inc., a not-for-profit family of organizations providing community-based health care and other social services for seniors in culturally diverse California communities. On Lok was the prototype for PACE (Program of All-Inclusive Care for the Elderly), which was signed into federal law in 1997, making this Medicare/Medicaid program available in all 50 states.
“I think I am probably the first nurse in this position [of AARP president] in 25 years,” Hansen says. “It is a tremendous honor and a tremendous responsibility.”
Hansen grew up in Boston, the daughter of parents who were immigrants from China. “Being very bicultural—my first language was Chinese—I bring [to AARP] a mindset that is able to [understand and work well] in a diverse, complex community,” she says. “There are many ways to look at life and living. I think [having a multicultural background] allows you that perspective, because you realize that you are always moving in multiple communities.”
In an extensive interview with Minority Nurse in early March, Hansen discussed several health care-related AARP initiatives and her goals for her presidency. Here are some highlights of that conversation.
Q: During the course of your nursing career, you went from community nursing to rural nursing to being a nurse advocate. How have these roles helped you in your current position at AARP?
I think one of the things you learn [in community nursing] is that when you are [working] outside of an institution, such as a hospital, people look at health and well-being a little differently. I think I am quite grounded in understanding the professional knowledge that we bring but also how people want and use information to maintain their well-being or to address their illness. That approach applies in rural health as well.
Growing up in a Chinatown community, I learned that you need to understand core values and help people view what is important in their lives. When you do that, it really informs how you help do community building or do advocacy. It is not something that is [done] top down. It is really about what matters to people at the living edge, as I call it. So you need to bring [everything] together in ways that make sense from a policy perspective, but it also has to make sense to people whose lives are directly affected by policy.
Q: What led you to AARP and your current position?
When I was president of the American Society on Aging, one of our board members was the [then] director of AARP’s Andrus Foundation, so we were colleagues. He was interested in recruiting members for [the foundation’s] board who would bring a different point of view that would help both the foundation and AARP itself begin to think more broadly.
I was actually brought in as an independent member of the board [in 2000] to add to the mix of what the core board offered. From that, I became part of the AARP affiliated family and was then invited to apply for a position on a larger AARP board.
Q: When you became AARP’s new president last year, you highlighted three core themes: the roles medications play in older people’s health; fall prevention; and encouraging important conversations about such issues as end-of-life preferences. Why those three themes?
It relates back to AARP’s current Divided We Fail joint initiative (www.DividedWeFail.org), which focuses on bringing the country together [to develop bipartisan solutions] for ensuring affordable, quality health care for all Americans, and also long-term economic security. This [initiative is a partnership between] the business community, the labor community and AARP, along with other independent organizations.
Since I am a nurse, I am focusing a little bit more on the health side, but [my approach also involves] showing how [health care] ties in to economic security, both for individual people and the country. We need to make these issues tangible and not political, bringing it down to specifics that regular people can do something about, regardless of [which political party is in power]. These are three themes that I think people can relate to.
People over 45 years old take, on average, at least four medications apiece. Medications are an important part of our daily lives. When we do not take them correctly, it costs money and it creates [health care] quality problems. The theme of medication is an important one to me. If people go into the hospital and then go home and do not take their medication correctly, they end up back in the hospital.
The second point was about falls. One in three people over the age of 65 will likely fall in a given year. This is the biggest cause of injury for older people. Half of the people [in this age bracket] who break a bone will die within the following year.
Half the falls that happen to older people happen in their own homes. This is an example of how we can use evidence-based practice [to create practical solutions]. The evidence from the Centers for Disease Control and Prevention tells us that there are simple things people can do to prevent falls from happening: make sure there are better light bulbs, that there are not slippery rugs in place, that electric wires are not crossing areas where people walk. They can also learn to do some exercises that strengthen trunk balance and prevent falls.
These are well-known strategies that involve little or no cost. So this is an area where we can use proven research and apply the [data] in our daily lives to enhance the quality and safety of living and save money.
The third theme is about how much money both individuals and the country spend on the last year of life for people. Oftentimes it doesn’t produce the quality or value that people really wanted. We spend more money on health care during the last six months of life than we do in our entire lifetime. Is that really the best use of our precious resources?
We need to focus more on having conversations [with loved ones about end-of-life care planning] because we all know how much angst occurs when a loved one goes into the hospital. Often family members have not had those conversations about the important changes that happen as we age. We need to bring our families together and have some of these conversations at a time that is not an emergency, because only in America do people think death is an option.
Q: How much support has there been for the Divided We Fail platform and how has it manifested itself?
Our core partners include the Business Roundtable, the National Federation of Independent Business and the Service Employees International Union. In addition to the big players, we have more than 100 independent groups that have joined in to pledge their support as well. On the legislative side, nearly 360 members of the last Congress have signed the pledge or written a letter of support on [the initiative’s] behalf.
[This year] we will host more than 50 events in nearly every state to educate the public about the contemporary issues of what is going on in health care reform and economic security. Part of this will be done through the globalization of town hall meetings, especially during this first Congressional recess, so that constituents and their lawmakers can really connect and discuss [these issues] directly. We will collectively present to the lawmakers the 1.6 million pledges that have been signed by people across the country, asking for this above-partisanship focus by our policymakers.
There are three particular policy areas we will focus on:
The first is access to health insurance coverage. We will try to build on the existing employer-based system while also thinking about other ways to provide coverage for people who are currently not insured. We all have a personal responsibility to make sure we have some good choices and participate in coming under the health care umbrella.
Second, we are looking at improving health care affordability, value and outcomes. Part of this includes a focus on preventive care programs, which again emphasizes the personal opportunity and responsibility people have.
Also, we need to address how poorly advanced our health care system is in the area of technology. We are focusing collectively on that to make sure the electronic highway system of communication will be built to help improve the quality of care and decrease health care costs.
We also need to make sure that the system rewards evidence-based care—in other words, not just [doing something] because somebody thinks it’s the best way, but [because it’s based on proven clinical evidence].
We need to make sure that care is coordinated. Older people who have multiple chronic diseases see anywhere from 10 to 14 doctors a year. We want to make sure that more effort is put into place to ensure that one doctor doesn’t inadvertently prescribe something that [will cause a negative interaction] because [they don’t know that] another doctor is treating that person with a different medication. Coordination of care is so important to make sure we are aligned together for good outcomes.
The third area is increasing quality and efficiency and making sure that we think about it from a patient-centered standpoint, so that the patient is not shunted around from place to place and the delivery of care is smoother and well-coordinated on behalf of that individual
[We also need to] compare the effectiveness of different treatments. Sometimes medication may be more effective than surgery. This kind of research really needs to be done and promoted and used. Divided We Fail [calls for] increasing comparative effectiveness in all parts of the health care system and making sure that the public [can access and understand] this information.
We do know there is a lot of money in the health care system—over $700 billion every year, according to the Congressional Budget Office—that is not being used well. Beyond the need for new money, there is money in the system already that can be better used on behalf of coverage and on behalf of quality.
Q: Another joint initiative AARP is involved in, along with the AARP Foundation and the Robert Wood Johnson Foundation, is the Center to Champion Nursing in America (www.championnursing.org), which is addressing the nursing shortage as well as the shortage of nursing faculty. Last month the Center, in collaboration with the Health Resources and Services Administration (HRSA) Division of Nursing and the Department of Labor (DOL), convened a national Nursing Education Capacity Summit, which brought together teams from nearly all 50 states to discuss solutions to the nursing shortage. What came out of that summit?
What we are doing is aligning all the efforts [across the country, including sharing] of some of the best practices that have been implemented in some of the states. We have states that have signed up to [share information] at the ground level about what some of the best practices are and facilitate the forming of coalitions to bring that about [on a national level].
We are bringing together [representatives from DOL and business], because [they are stakeholders too; we have to] make sure we have a nursing workforce. And we are also bringing in other foundations [that are concerned with aging issues] to try to make sure that not only are we [increasing the number of] nurses in general but also addressing a particular need for nurses to know about [the health care needs of older people] and the complexity of those needs, such as having multiple chronic diseases. This follows on the heels of the [2008] Institute of Medicine report Retooling for an Aging America: Building the Health Care Workforce.
This initiative is also helping to support [health care-related provisions in] the
current economic stimulus bill to make sure that not only is the government
funding nursing education but also education for all [the many] health professionals that are going to be needed for elder care in the future.
So the summit helped bring all of these efforts together to say that this is a national problem and we need advocacy, practice and new ways to think about the care of older people in America.
Q: What are the goals of the Center to Champion Nursing in America?
One of its objectives is to help support the infrastructure for increasing the number of nursing faculty. Without more faculty, thousands of people get turned away [from nursing schools, because there are not enough nursing educators to teach them].
The second goal is the whole aspect of retaining nurses. This especially speaks to people who are middle-aged nurses. Are there ways in which we can help in retention of existing, practicing nurses?
Number three is the ability to advance nurses further into leadership roles, so that they can help represent our profession throughout larger organizations and foundations [that can help shape health policymaking]. We are the largest health care workforce in America. There are nearly 3 million nurses in America right now [compared to] about 750,000 physicians. The contribution and voice [of nurses] to help shape where health care is going to be in the future is an important part of having nurse leaders embedded in the country.
Q: Even though there are 3 million nurses, people of color are very underrepresented in the RN workforce. In your personal opinion as a minority nurse, what can be done to attract more minorities into nursing?
I think having nurses of color as faculty , but there also has to be a focus on providing [more] educational opportunities for [future minority] nurses, such as [bridge programs] that align community college programs with baccalaureate programs. Many students who are immigrants or people of color might find it easier to start with a community-college level of access, so we need to ensure that there is an open pipeline that can lead them to more advanced nursing credentialing, such as bachelor’s and master’s degrees. Some people may find that starting with a BSN program is prohibitive economically. So it may well be that [putting more emphasis on] community colleges as a beginning venue, especially in large urban areas, might be one opportunity to increase the pool of [minority] nurses.
Given [America’s] diversity and the known health care disparities, it is so important to have a workforce that reflects the population.
Q: President Obama’s Health Summit is happening this week. The president is proposing a $634 billion down payment on health care reform. What are your thoughts about what is happening at that summit right now?
One great thing is that all the input and constructive thinking is open and on the table, so we know we agree to these core principles and that there are many ways to approach this. The openness to different ideas that may be delivered is extremely promising. We are recognizing that the need for health care reform is a problem for the whole country, not for one party or another, not for one sector or another. I think if we are able to hold that [inclusive, non-partisan] tone, some give and take will occur. The bottom line is that we have to protect the country’s economic security, and that is so tied to health care security. We have to spend the money, invest in it, but spend it well.
The fact that insurance companies and businesses, as well as advocacy groups [are all coming together and] saying we are committed to change is a very different space to be in than we had back in 1993-94, which was the last attempt at health care reform.
Q: Is there anything else you’d like to add?
This is such an important opportunity for minority nurses and students to become active in thinking not only about the clinical care we give and the research that is in our field, but about the economics, politics and policy issues. It is a time when we need to raise our own bar in understanding both how we fit into the picture and how we can lead the country.
