Nursing is a profession that can truly move with the person, wherever they choose to put down roots. The job prospects are solid for nurses with employers seeking minority nurses everywhere from small towns to urban centers. Because there is so much opportunity, deciding which nursing specialty and geographical area to live and work can take some soul searching.
While many older nurses are still hanging on to their positions and postponing retirement due to the economy, the job prospects for nurses in the future holds promise.
“There’s certainly evidence to show that currently hospitals and other facilities are not hiring at the pace that they were, simply because people are not retiring or leaving their employment the way that they were, and that has to do with the economy,” says Katie Brewer, a policy analyst for the American Nurses Association in Silver Spring, Maryland, discussing the region in and around the Washington, D.C., area. “It’s hard to trend and analyze data; but from hiring employment data, anecdotally we know that there has been a general slowdown in hiring.”
The nursing job market may be less robust in recent years due to the recession, but Brewer is optimistic about the near future of nursing jobs. “That [slowdown] will change in the next few years as people reach retirement age. They may have been close, but when the economy tanked, they weren’t close enough in order to justify retiring. But in the next few years as the economy recovers and people’s financial situations begin to improve, we’ll see a bottom fall-out in terms of the amount of people that retire and the amount of people that can afford to go to part-time work or leave their job. So there will be another influx of needs in the nursing field.”
One area in particular that Brewer says is on the cusp of major growth is geriatric nursing.
“There’s definitely evidence that there’s a great need in geriatric nursing. We’re on the cusp of almost a 20 million person increase in the age population of 65 and older,” Brewer says. “We’re going to have a tremendous need for nurses that can take care of older adults as well as some of the conditions that those people generally have, such as osteoarthritis, diabetes, heart conditions, and cognitive impairment. So that’s where the biggest growth in specialty needs will be. There’s no question of that. It’s definitely a nationwide need.”
“Because a lot of nursing students are trying to specialize now, it has really placed a void for nurses at the bedside,” says Linda Faye Hughlett, R.N., M.S.N., C.N.M., a certified nurse midwife for the Vanderbilt Nurse Midwives Practice in Nashville, Tennessee. “I see a great need for new nurses [at the bedside] because a lot of new nurses are coming out of school, inexperienced, and not wanting to deal with the challenges that many face on a medical-surgical unit. Also, the appeal of making more money as an advanced practice nurse (APN) is adding to this void. So they have no plan or desire to stay at the bedside and do that kind of grunt work.”
Hector M. Benitez, R.N., B.S.N., M.S.H.A., Care Management Operations Integration Director at WellPoint, in Lebanon, Tennessee, agrees. “I think that minority nurses are really needed at the bedside in medical-surgical situations where they’re on the floor,” he says. “It’s imperative that we have nurses at that level, particularly because that’s when patients are the most vulnerable. They’re lost and confused—especially if they don’t know the language.”
Medical-surgical nursing is an area where minorities, especially those with language skills, can make a huge impact on patient care.
“I’ve seen situations where the nurse comes in to assist a patient and they cannot communicate because of the language barrier,” Benitez says. “The nurse will explain what they’re doing and I always find it kind of comical because if you don’t understand what they’re saying to you most patients just smile and nod their head ‘yes.’ That gives the indication that it’s okay, although they have no clue of what was just said to them, and then the nurse proceeds to do whatever it is they need to do.”
For Felecia B. Green, R.N.C., B.S.N., O.B., nurse manager in the high-risk O.B. unit at Texas Health Presbyterian Hospital in Dallas, Texas, a specialty that comes to mind with significant growth is the nursing informatics field. “The era of a paperless health care delivery system lends itself to a greater demand for nurses to be proficient and versatile in computer technology. Minority nurses are needed in this arena to help navigate and influence the changes that are occurring in health care documentation.”
Finally, Brewer predicts that there will be a need for advanced practice registered nurses in the field as the health care landscape continues to change. “These are nurses that have advanced practice education training and can do things like prescribe medication, prescribe home care, and provide more independent medical and health care services to patients,” Brewer says. “And as more people are getting into the health care system with the affordable care act being fully realized, there’s going to be a huge need for providers in that sense. So advanced practice registered nurses can meet that need.”
As more patients enter the health care system because of widening access to care, the increase in minority patients will require good culturally competent care. And minority nurses are needed across all specialties to meet those growing needs. “It is beneficial to the patients and their families to witness minority nurses thriving in areas that were historically all white,” Green says. “Minority nurses can be advocates to assist in the cultural differences—whether beliefs or rituals—that many ethnic individuals may have. Minority nurses are a window into the future for the younger patients, and may influence perceptions that this career is within their grasp.”
Nurses aim to deliver the best patient care no matter the city or town they practice in—whether it’s a rural hospital or a thriving metropolis. But there are regional differences when it comes to job opportunities, average salaries, and the quality of living.
Quiz: Rural vs. Urban—Which area is right for you? Have you ever thought of working as a nurse in a rural area of the country? Perhaps you grew up in a rural town and want to give back. Or, would the fast-paced environment of a downtown hospital be a better fit for your career and personal goals? Take this quiz to see which area may be the best fit for you. 1. I feel that I can do my best work in ______. A: Facilities where I can take my time with each patient B: Facilities where I get to care for many patients at the same time 2. I would be willing to live in a sparsely populated area if there were incentives such as student loan repayment. A: True B: False 3. I enjoy taking a strong leadership role in my patients’ care where I have more authority to act as a primary care nurse. A: True B: False 4. Which do you value more: A: Lower cost of living B: Cultural diversity Answer Key: Mostly A’s–Small Town USA If you answered mostly A’s, you’re likely open to a nursing career in a rural setting. Visit the National Rural Health Association’s website at www.ruralhealthweb.org for more information. Mostly B’s–Faster-Paced City If you answered mostly B’s, urban cities or larger suburban areas are likely a better fit for your ideal quality of life. Be prepared for a tighter job market, as there will be more competition in larger communities.
Benitez and Alan Morgan, chief executive officer of the National Rural Health Association based in Washington, D.C., both agree that the Southeast region of the country needs more nurses.
“In my experience, there’s a lot of opportunity in the South. But for some reason, I’ve seen nurses who’ve completed school here and the first thing they do is move away,” Benitez says. “But looking around, our salaries have always been fairly competitive with other regions. It’s also been my experience that the cost of living is a bit easier to manage with a nursing salary [in the South] as opposed to moving somewhere in California or up North where your living expenses are going to be really expensive, in relationship to your salary.”
Morgan adds that Southeastern states, such as Mississippi, Louisiana, Alabama, and Tennessee are experiencing nursing workforce shortages. “The Southeast would be where we’re seeing the major need for additional health care and practitioners to be,” Morgan says.
Rosario Medina-Shepherd, Ph.D., A.R.N.P., B.C.R.N., assistant professor of nursing at the Christine E. Lynn College of Nursing at Florida Atlantic University in Boca Raton, Florida, and Vice President of the National Association of Hispanic Nurses agrees that minority nurses are needed in the South. She adds that “minority nurses are presently needed in the higher populated minority areas, including New York, Florida, and states in the West. This is rapidly changing to include areas such as North Carolina that were once not thought to be affected.”
No matter which area of the country you choose to work in, Brewer advises nurses to look for health care organizations that have obtained magnet status.
“Hospitals and other facilities that have magnet designation are definitely the places where nurses want to work because those are the places that are committed to nursing leadership and nursing excellence. And so when people are looking around for jobs, one of the first things that they should ask their potential employer is if they have magnet status or if they are working to become a magnet facility,” Brewer says.
There are many pros and cons to working in both rural and urban health care settings. Many nurses are drawn to rural areas because of programs that recruit them and offer student loan repayment arrangements. Other nurses prefer the hustle and bustle of the city.
“I started my career in an urban environment and quickly adjusted to the multidisciplinary team approach to patient care,” Green says. “It allowed for readily available resources, ongoing training, and utilization of evidence-based practices.”
On the other hand, rural nurses are often considered primary care givers—often working with a greater degree of independence and without much support from physicians due to shortages.
Rosario Medina-Shepherd, Ph.D., A.R.N.P., B.C.R.N., professor of nursing, Lynn University; Vice President, National Association of Hispanic Nurses
Hughlett suggests nurses considering practicing in a rural area ask questions and understand the work environment and how it differs from a heavily populated setting. “They need to know what resources are available for them. These resources can be a very integral component of their survival as well as job satisfaction,” Hughlett says. “If you are an APN, before you sign a work contract, ask who your consulting physician will be as well as the details surrounding that relationship. APNs in rural areas are often left out there by themselves to care for mass amount of patients without feeling support from the medical community.”
Green says nurses considering practicing in a rural area should also consider a number of factors impacting the move. “Nurses should ask themselves whether they are comfortable, proficient, and confident to practice outside of the safety net of having an entire team available for emergent situations,” Green says. “Are they willing to stabilize, prioritize, and give the appropriate intervention until a higher level of care is available? Do they want total autonomy—from admission to discharge?”
While there may be some unique challenges to working in rural areas, Morgan says job prospects are plentiful.
“The current job market for nurses in rural areas is outstanding,” he says. “That’s great news for rural nursing, not such great news for rural America, typically because there is such a significant workforce shortage now in rural areas.”
Morgan also notes some of the perks to rural nursing. “The two selling points for practicing in rural areas: one would be quality of life,” he says. “Living in a small town—it’s a wonderful place to raise a family, and there’s a tremendous sense of community that you have in small towns across the United States. Another benefit is that you’re working in small organizations—small rural hospitals, full health clinics, and small community health centers. When you’re in a small organization, there is a greater opportunity for leadership positions and for innovation in health care delivery.”
Others, like Trang Nguyen, R.N., B.S.N., a nurse manager at Texas Health Presbyterian Hospital in Dallas, Texas, believe minority nurses are especially needed in urban areas. “I see such a diverse population where I am now and have really developed an appreciation for diversity,” she says. “You learn how to care for different people and really tailor your care for them. As a minority, I find myself taking a step back and making sure that I am tending to culturally sensitive aspects for all patient populations.”
Salary Data for Registered Nurses (RN)
RN hourly rate by state or province Texas: $20.38–$35.60 California: $23.83–$50.51 Florida: $19.58–$33.86 Illinois: $19.60–$35.04 Ohio: $19.29–$31.51 Pennsylvania: $19.95–$35.89 New York: $20.08–$39.65 Source: Payscale.com; United States; updated: September 22, 2011; individuals reporting: 44,836
RN national hourly rate by years of experience Less than one year: $15.93–$29.38 1–4 years: $19.16–$31.79 5–9 years: $21.19–$36.86 10–19 years: $22.47–$39.90 20 years or more $23.03–$43.11 Source: Payscale.com; United States; updated: September 22, 2011; individuals reporting: 44,858
RN hourly rate by skill/specialty Medicine/Surgery: $19.69–$36.16 Acute Care: $19.94–$37.09 Intensive Care Unit (ICU): $20.21–$38.85 Geriatrics: $19.26–$34.08 Pediatrics $18.53–$35.74 Labor & Delivery, Birthing: $19.17–$36.82 Emergency/ER: $18.72–$37.23 Source: Payscale.com; United States; updated: September 22, 2011; individuals reporting: 40,004
RN hourly rate by degree/major subject Bachelor of Science (B.S.N.): $21.09–$40.90 Associate Degree in Nursing: $20.35–$36.77 CPR: $24.39–$30.18 Associate of Science in Nursing (A.A.S.): $21.23–$31.06 Diploma, Nursing: $20.53–$37.50 Master of Science, Nursing (M.S.N.): $22.67–39.25 Source: Payscale.com; United States; updated: November, 30 2011; individuals reporting: 15,555
Editor’s Note: This article is adapted from a version previously published as a chapter in the anthology Transforming Nursing Education: The Culturally Inclusive Environment (S.D. Bosher and M.D. Pharris, Eds., Springer Publishing Company, New York, N.Y., 2008).
Dance, Professor, Dance
Professor, you don’t know me but I am sure that you have seen me around. Who am I? What do I look like? Well, that’s not important right now. I am truly amazed by all of your certifications and nursing degrees. I see you each day as I sit and listen attentively to you speak. Boldly I begin to think, That may be me some day, A prolific nurse educator with diverse knowledge, flair and no-nonsense ways.
Professor, you don’t know me but I am sure that you have seen me around. Who am I? What do I look like? Well, that’s not important right now. At first it seems that you wanted me here, but as time passed it became crystal clear. Today when I approach you I feel instantly rejected. I start to think, No, this can’t be true of all of you.
Professor, you don’t know me but I am sure that you have seen me around. Who am I? What do I look like? Well, that’s not important right now. I sit in your class day to day and we have even stood side by side. I make no excuse for my silky caramel complexion, long black wavy hair or even my urban style. The grades I earn speak for themselves and my nursing skills are always above the rest. It’s true I know that what you see in me is not your vision of the trailblazing nurse of the 21st century.
Professor, you don’t know me but I am sure that you have seen me around. Who am I? What do I look like? Well, that’s not important right now. Please remember that I see you as a disseminator of nursing knowledge. Unfortunately, what you cannot see is that you truly are the mentor and I the mentee. Together we dance invisibly.
Professor, you don’t know me but I am sure that you have seen me around. Who am I? What do I look like? Well, that’s not important right now. I too represent the future and plan to become the new Nightingale, Peplau, Roy or the prolific Wykle. Now please don’t be ashamed that you overlooked my talent, worth and skill. Do not look back at the past. Look ahead to change your perspective this academic year. Once again I will sit in your class listening to you teach. Professor, let’s not again begin our mentor-mentee dance invisibly.
—Lorrie R. Davis-Dick, MSN, RN, BC
Projections from the Health Resources and Services Administration (HRSA)’s most recent National Sample Survey of Registered Nurses suggest that by the year 2020, over one million new RNs will be needed to support the demand for nursing care in the United States alone. In addition, with many of the current generation of nursing educators nearing retirement age, there will also be a great need for a large pool of nursing faculty from diverse specialties and backgrounds to connect to the growing student nurse population.
Unfortunately, the number of African American students in entry-level baccalaureate nursing programs who are dropping out of nursing school without obtaining their degrees is disproportionately high. This attrition contributes to the poor representation of African Americans in the nursing workforce and in graduate nursing programs. In its 2002 Annual State of the Schools report, the American Association of Colleges of Nursing (AACN) suggests that racial/ethnic minority representation remains solid in entry-level BSN programs. Yet the question remains whether African American students, who represent 11.2% of enrollment, will successfully remain in their nursing program and complete the requirements for graduation.
The continued shortage of African American registered nurses is worrisome. According to the 2004 National Sample Survey of Registered Nurses, blacks represent only 4.2% of RNs in the United States, even though they account for 12.2% of the U.S. population as a whole. This disappointing figure seems to indicate that current strategies for recruiting and retaining African American nursing students have failed and that there is an urgent need for a national initiative aimed at increasing not only short-term but long-term recruitment and retention of this student population.
Lack of diversity is also evident among the ranks of nursing educators. Statistics from AACN show that African Americans represent only 8.7% of nursing faculty and 6.8% of nursing deans. In turn, this lack of diversity on both the faculty and student sides of the classroom negatively impacts the recruitment of minorities into the profession of nursing.
Research studies suggest that African Americans do not pursue nursing, or fail to complete nursing programs, for a variety of reasons: role stereotypes, economic barriers, lack of direction from early authority figures, misconceptions about nursing careers, and increased opportunities in other fields.1 Another frequently cited factor is lack of mentors. Buchanan (1999) suggests that the attrition rate for African American nursing students has increased and that failure to retain black students is associated with the lack of mentoring relationships with persons they feel comfortable with and can relate to, learn from and emulate.2
The Power of Mentoring
Other recent studies have revealed the power of positive mentoring relationships to improve minority nursing student retention.3 One researcher found that students who learn from experienced nurse mentors have enhanced reflective abilities in the learning process.4 According to Scott (2005), mentoring is relevant for both the nursing student and the experienced nurse. Mentoring helps students successfully navigate the complex world of nursing and also helps faculty to become better teachers.5 The literature also suggests that mentoring can be made more flexible and fluid through the use of technology, in particular the Internet, for communication and exchange of information.6
Gray and Smith (2000) looked at mentorship from the students’ perspective. They interviewed student nurses over a three-year period, focusing on the students’ opinions of what makes a good mentor versus a poor mentor. The students said that a good mentor was “enthusiastic, friendly, approachable, patient, understanding, and had a great sense of humor.”7
Still other studies indicate that there is an apparent lack of understanding about the concept of mentoring and its implications for nurses acting as mentors. Mentoring is often confused with or used interchangeably with tutoring. Tutoring is only one aspect of mentoring and is not necessarily expected to occur in every mentor-mentee relationship. A nursing tutor is someone who primarily assists in helping a student perform well on essays, term papers, tests and/or improving nursing skills.7
On the other hand, mentors, as defined by the English National Board for Nursing, are “appropriately qualified and experienced first-level practitioners, who by example and facilitation guide, assist and support students in learning new skills, adopting new behaviors and acquiring new attitudes. . .Mentors are there to assist, befriend, guide, advise and counsel students.”8 It is important that mentors and mentees understand the difference between the role of a mentor and that of a tutor. Otherwise, nursing students may have a negative experience with mentoring if they were expecting a private tutor.
Atkins and Williams (1995) explored individual nurses’ perceptions and experiences of mentoring undergraduate nursing students.9 The study focused on identifying critical features within the mentor-mentee relationship from the mentors’ perspectives. It also examined ways in which mentoring affected the mentors’ working lives and their other professional roles and responsibilities.
The study’s findings suggest that mentors require formal preparation for their role, and that the activity of role modeling needs to be addressed in this preparation. Other findings include:
The time for mentoring needs to be included within the mentor’s working day.
The role of the mentor is complex and requires high levels of commitment.
Organized peer support groups may be valuable for mentors.
When done correctly, a good mentoring experience is holistic. It involves the whole person; it touches both the mind and the heart. Beyond the formality of the mentoring relationship, the vulnerable spirit of the nursing student must be nurtured.
At the heart of mentoring is the interpersonal relationship between mentor and mentee. The foundation of this relationship is the connection that they share. Here are five recommendations for developing a strong and effective mentor-mentee relationship:
Mentoring requires dedication from the mentor and a commitment to participate in the mentoring relationship throughout the academic year—and even beyond it. Mentors and mentees may find that the process of mentorship extends far beyond the suggested time frame of the individualized mentoring program. The mentor-mentee relationship may last for several years, or even a lifetime. There is no price tag that can be placed on such an invaluable relationship.
A significant part of the mentoring relationship is based on the honesty and truth that the mentor and mentee share with one another, and it is critical that both participants recognize this. For example, if a nurse mentor tells the mentee that his/her senior year in nursing will be a breeze and no obstacles will get in his/her path, the mentor may unknowingly instill false hope. It would be more appropriate to support the student by saying that the senior year will be filled with challenges, but that the student should see them as positive, rather than negative, issues in their academic career.
The next critical component of holistic mentoring is mutual respect. Mentors and mentees must treat one another as equals in this relationship. Mentors who belittle their mentee or have low expectations for him/her will lose the vision of the mentoring process.
Mentors should reflect a positive and caring attitude towards their mentee at all times. A positive attitude is contagious and so are negative behaviors. For many African American students, mentors may be one of the few lights shining in a dark place. Mentors should keep in mind that nursing students are under a tremendous amount of stress and pressure to do well in their courses.
The last component of the holistic mentoring relationship is appreciation of the mentor and mentee as whole persons. A mentee should recognize and appreciate that their nurse mentor may also be a graduate student, parent and/or nurse manager. In turn, the mentor should recognize and appreciate that the mentee may also participate in student nurse organizations, volunteer at a local hospital on weekends and/or work as a student research assistant.
Mentoring for the Future
There is no denying that the process of mentorship is complex. However, if both mentor and mentee consistently follow these guidelines, they will establish a mutually beneficial relationship that can have a lasting impact not just on individual mentees but on the future of African Americans in the nursing profession. If we are able to increase the retention rate of black nursing students through mentoring, there will be more baccalaureate-prepared African American registered nurses to care for the nation’s expanding and rapidly diversifying population. The hope is that these African American BSN graduates will then go on to obtain an advanced degree under the umbrella of nursing so that they can increase the supply of black nursing faculty and clinicians available to mentor future generations.
As a successful African American RN, nurse educator (I am a clinical assistant professor of nursing at my alma mater, North Carolina A&T State University), member of Sigma Theta Tau International and a recipient of the gift of mentorship during my own career journey, I feel that I have an obligation to reach out to future African American registered nurses. We are all familiar with the African proverb, “It takes a village to raise a child.” I encourage nurses and schools of nursing throughout the nation to create a village of holistic mentoring to help African American students achieve their goal of becoming registered nurses of the 21st century.
Through my own experiences, I have learned that what African American nursing students need and deserve is to be connected to an African American nurse mentor in their community who can spend a relatively small but rewarding amount of time empowering a student nurse. By providing the necessary co-curricular activities and support, such as structured mentoring programs that leave a lasting imprint in the academic travels of black nursing students, we can ensure a bright future for African Americans in nursing. Remember that diversity in nursing is not a dream—it is an achievable goal that is essential to the future health of our nation.
Washington, D., Erickson, J.I. and Ditomassi, M. (2004). “Mentoring the Minority Nurse Leader of Tomorrow.” Nursing Administration Quarterly, Vol. 28, No. 3, pp. 165-169.
Buchanan, B.W. (1999). “A Mentoring Pyramid for African American Nursing Students.” ABNF Journal, Vol. 10, No. 3, pp. 68-70.
Nugent, K.E., Childs, G., Jones, R. and Cook, P. (2004). “A Mentorship Model for the Retention of Minority Students.” Nursing Outlook, Vol. 52, No. 2, pp. 89-94.
Burnard, P. (1987). “Towards an Epistemological Basis for Experiential Learning in Nurse Education.” Journal of Advanced Nursing, Vol. 12, No. 2, pp. 189-193.
Knouse, S.B. and Webb, S.C. (2001). “Mentors, Mentor Substitutes, or Virtual Mentors: Alternative Mentoring Approaches for the Military.” Managing Diversity in the Military: Research Perspectives from the Defense Equal Opportunity Management Institute, Dansby, M.R., Stewart, J.B. and Webb, S.C. (Eds.), Transaction Publishers, New Brunswick, N.J., pp. 145-162.
Gray, M.A. and Smith, L.N. (2000). “The Qualities of an Effective Mentor from the Student Nurse’s Perspective: Findings from a Longitudinal Qualitative Study.” Journal of Advanced Nursing, Vol. 32, No. 6, pp. 1542-1549.
Suen, L.K. and Chow, F.L. (2001). “Students’ Perceptions of the Effectiveness of Mentors in an Undergraduate Nursing Programme in Hong Kong.” Journal of Advanced Nursing, Vol. 36, No. 4, pp. 505-511.
Atkins, S. and Williams, A. (1995). “Registered Nurses’ Experiences of Mentoring Undergraduate Nursing Students.” Journal of Advanced Nursing, Vol. 21, No. 5, pp. 1006-1015.
The nursing profession is and has been experiencing what is often described as an unendurable shortage of clinical nurses. Organizations are having difficulty recruiting new nurses and retaining current staff.1 The U.S. Bureau of Labor Statistics predicts the demand for registered nurses to grow from two million to 3.2 million between 2008 and 2018, a 60% increase. Ideally, a sufficient number of new graduates will fill the demand; however, according to Benjamin Isgur, Assistant Director of Price Waterhouse Cooper’s Health and Research Institute, the projections aren’t great. Of the 320,000 who applied to nursing school in 2008, only 78,000 graduated and 23% are currently working as nurses.2 After graduation, about 30,000 nurses stay in the field, but 50% leave their first job after two years. Compounding this staffing problem is the increasing age of the nursing population and their anticipated retirement.
Without a sufficient number of nurses, patient care and safety may become compromised, while nurses themselves may be overwhelmed, distressed, and dissatisfied. High patient-to-nurse ratios have been shown to lead to frustration and job burnout, which is linked to higher turnover. 3 An inadequately staffed nursing force has been found to play a negative role in patient outcomes. In contrast, studies have demonstrated that hospitals with low nurse turnover “have the lowest rates of risk-adjusted mortality and severity-adjusted length of stay.”3 In 2007, the Agency for Healthcare Research and Quality (AHRQ) conducted a met-analysis that found “the shortage of registered nurses, in combination with an increased workload, poses a potential threat to the quality of care…Increases in registered nurse staffing was associated with a reduction in hospital-related mortality and failure to rescue as well as reduced length of stays.”4
Nurses of all specialties and institutional roles, and those in administrative and leadership positions in particular, must examine the contributing factors of the current nursing shortage to familiarize themselves with the situation and determine what should be implemented to influence strategies for improvement. The objectives of this evaluation are to express the severity and implications of the nursing shortage, determine current contributing factors, and examine possible solutions, i.e., successful recruitment and retention strategies.
Reviewing the facts
Through review of literature it is easy to see that the nursing shortage is not confined to the United States but is a widespread issue. Canadian nurses, for example, are challenged by the same workforce dilemmas and report being overworked, stressed, and generally ill.5 All over the world, nurses are an integral part of the health care system and make up a significantly large portion of the health care provider population. In the United States, the largest group of nurses is expected to retire by the year 2020, pushing health care facilities’ resources beyond their limits.6 Blakeley and Ribeiro suggest that reasons contributing to a nurse’s early retirement include desire to decrease their workload, freedom and flexibility of schedules, and that senior nurses do not feel valued by their companies.7
Just over a decade ago, in 2000, the estimated pool of registered nurses in the United States was 1.89 million, while the demand was two million—a deficit of only 110,000, or 6%. Yet the gap continues to widen. In 2008, there were approximately 2.6 million working RNs, but it is predicted that by 2020 the shortage will be approximately 808,400 nurses, or 29%.8 The already fragile health care infrastructure is at risk of becoming completely handicapped by ineffective recruitment and retention, lack of nurse educators, and a growing elderly population requiring care.
In addition to the problems faced by seasoned nurses, job dissatisfaction, disappointment, and disillusionment with the nursing practice contribute to new nurses quitting. 9 With regard to disillusionment, it is simply not enough to view nursing exclusively in terms of personal commitment; it requires a “wide-range knowledge of illness, medication and appropriate treatment, comprehensive managerial skills, and emotional strength and sensibility.”10 It is important to portray an accurate and positive employment brand in any discipline, but this is particularly true for the profession of nursing.11 If individuals are expected to become dedicated and productive members of the nursing work force, job satisfaction must play a key role. Developing a retention committee to address high-ranking issues such as improving job satisfaction, approval, and expectations by providing some rewards and recognitions may be an example of positive employee branding.
Next in the series of considerations is a correlation between job satisfaction and autonomy. When nurses perceive they have little or no control within the work setting, they become frustrated and unhappy, and the desire to leave increases.1 Like any employee, nurses want to feel valued, to be recognized for their work, and enjoy the other professional benefits, such as flexible schedules. The top three areas considered by nurses in their decision to stay at their current job, according to Palumbo, McIntosh, Rambur, and Naud, are recognition and respect, a voice in discussion and decisions, and performance evaluation. Compensation ranks fourth, while the recruitment of older nurses falls last on a list of 10.
Dissatisfaction with one’s profession can also be detrimental to one’s personal health. In nursing, this is a notable dilemma. Nurses are consistently found to be among the most overworked, stressed, and sick workers, with more than 8% of the workforce absent each week due to illness.5 It is not so surprising, then, that nurses who report being unhappy in their work environment are also less motivated to perform their duties, experience more absenteeism, and tend to leave their jobs in favor of better career opportunities.
Fortunately, researchers are looking into potential solutions for the nursing shortage as they examine its causes. Their findings offer hope for maintaining and improving a healthy work environment that facilitates safe, quality health care and promotes a desirable professional avenue.
One recent job satisfaction study attempted to determine what entices and retains nurses and other human services employees. Respondents reported valuing, among other things, entrepreneurial opportunities and jobs that facilitate work-life balance. These findings suggest that focusing on an environment that nurtures advancement and autonomy may attract new younger nurses, while shorter shifts, job sharing, and work schedule flexibility would help retain veteran nurses.12 Other studies found comparable results.
Palumbo, McIntosh, Rambur, and Naud sought to examine what both nurses and their health care employers valued in the workplace. They found nurses appreciated recognition and respect. Employers’ focus seemed to center around employee health and safety, while recognition and respect ranked lower.
According to Coshow, Davis, and Wolosin, who examined decrements in registered nurse satisfaction mid-career, organizations may benefit from channeling their efforts on retaining nurses by investing in areas that result in higher job satisfaction, such as staffing, fulfillment, benefits, and pay.3 This is vitally important given their application of the Social Exchange Theory. The theory suggests that when “the benefits of maintaining an existing employment relationship are outweighed by its costs, employees will tend to seek out a more rewarding situation.” High turnover is expensive as well, with replacement costing 1.2 to 1.3 times the annual RN salary.13 As previously noted, job satisfaction is related to turnover intent, and a perceived stressful work situation, job tension, and emotional exhaustion increase its likelihood.14
Thus far two main strategies have been used to address the discrepancy between the supply and demand in nursing: first, increased nursing program enrollment, and second, the importation of nurses from other countries. However, the latter treads on controversial grounds, given the dire situations other countries’ nursing pools also share. Thus far, the strategy to increase nursing student enrollment enough to improve the shortage has failed. According to the American Association of Colleges of Nursing, U.S. nursing schools would have to increase the number of graduates by 90% to fill the gap.4
As researchers examine what motivates nurses to remain in their current work environments, they have determined the following: perceived autonomy, workload, recognition, scheduling, managements’ leadership skills, home duties, and peer relationships in the workplace all impact a nurse’s decision to stay. Concentrating on factors that affect nurse job satisfaction and promote retention can only be positive.15 Perceived autonomy, workload, recognition, and related issues deserve focused attention, as they have been found by numerous studies to be important to nurses’ job satisfaction.
Often hindering progress, however, is the gap that exists between what is being done by health care administration and what the clinical staff perceives is being done. What is highest on the clinical staff’s list and what is on the administration’s still seem to vary, despite research efforts. Most corporations’ goals are recruitment and retention, and their approach is to empower their staff to facilitate this within the organization.
A generational divide?
To facilitate improvements in nurse staffing, now and in the future, health care organizations must focus on recruitment, maintenance, and retention. A recommendation derived from a research study by Nogueras suggests policies also need to be developed to increase the recruitment and retention of young adults into the nursing profession.16 The nursing profession should be recognized as a profession that possesses high levels of pertinent scientific and technical knowledge as well as a personable aspect.10 This may appeal to younger people, or perhaps a more diverse applicant pool as well. Finally, it is imperative for nurse leaders to create and sustain an environment where employees are connected to their organization, with a focus on retention as well as recruitment. Other suggestions include examination of the hiring processes, maintaining public relations initiatives, and ensuring employee contributions as part of the recruitment of new nursing staff.11
Nurses report higher job satisfaction if they perceive they are part of a team and feel a sense of belonging, though age is another variable in retention and job satisfaction.3 Senior nurses were less satisfied across all dimensions measured. Researchers suggest organizations focus on aspects that yield higher satisfaction in older nurses such as pay, staffing, and benefits. Multiple studies focus on the retention of veteran nurses, who evidence supports prefer shorter shifts, part-time hours, and assessment of less acute patient populations.7 Younger employees were found to prefer more vacations and flexible scheduling, especially during summer holidays. Klug’s study concluded both older and younger nurses could benefit from programs and policies that support improvements in retention.17 Nurses at any age who perceive their work is appropriately recognized and rewarded tend to show more job satisfaction.7
Predicting the future
Truly, health care is facing losing a huge cohort of nurses in a small time frame very soon. Research has shown that a significant number of nurses intend to leave their current position for a new job or retire early, and in nursing schools, many of those enrolled abandon their studies. Yet, proactive maneuvers could curb the tide, such as designing work environments desirable to older nurses, developing more stringent screening tools for nursing school applicants and more supportive educational programs, and identifying ways to make becoming a nurse educator more desirable. Portraying the nurse educator as a more attractive career choice may lead to increased student enrollment and program development as well.
The retirement of the baby boomer nurses will be difficult to absorb; however, if changes are made based on evidence that supports the retention of older nurses, there is a possibility to ease that burden. But, of course, the profession will need to account for their absence eventually. Health care organizations need to focus on areas such as reward and recognition, which in turn yield high job satisfaction for, and retention of, nurses. Ideally this investment will lead to a positive employment brand that not only entices new applicants, but also affirms the commitment made by nurses of all ages.
1. Zurmehly, J. (2008). “The Relationship of Educational Preparation, Autonomy, and Critical Thinking to Nursing Job Satisfaction.” Journal of Continuing Education in Nursing, 39(10), 453–460.
2. Isgur, B. (Panelist). (2008, July/ August). Conference of Statebased Nursing Workforce Centers Explores Retention Issues and Solutions. Sixth National Conference of Workforce Leaders. “Effective Retention Throughout the Career Continuum.” Retrieved from www.NursingWorld.org.
3. Coshow, S., Davis, P., and Wolosin, R. (2009). “The ‘Big Dip’: Decrements in RN Satisfaction at Mid-Career.” Nursing Economic$. 27(1), 15–18.
4. American Association of Colleges of Nursing. (2009, September, 28). “Nursing Shortage Fact Sheet” (9-09.DOC). USA: AACN.
5. Cummings, G., Olson, K., Hayduk, L., Bakker, D., Fitch, M., Green, E., Butler, L., and Conlon, M. (2008). “The Relationship Between Nursing Leadership and Nurses’ Job Satisfaction in Canadian Oncology Work Environments.” Journal of Nursing Management, 16(5), 508–518.
6. Palumbo, M., McIntosh, B., Rambur, B., and Naud, S. (2009). “Retaining an Aging Nurse Workforce: Perceptions of Human Resource Practices.” Nursing Economic$, 27(4), 221–232.
7. Blakeley, J., and Ribeiro, V. (2008). “Early Retirement Among Registered Nurses: Contributing Factors.” Journal of Nursing Management, 16(1), 29–37.
8. Lavoie-Tremblay, M., O’brien-Pallas, L., Gélinas, C., Desforges, N., and Marchionni, C. (2008). “Addressing the Turnover Issue Among New Nurses from a Generational Viewpoint.” Journal of Nursing Management, 16(6), 724–733.
9. Gindel, C., and Hagerstrom, G. (2009). “Nurses Nurturing Nurses: Outcomes and Lessons Learned.” MEDSURG Nursing, 18(3), 183.
10. Sturgeon, D. (2008). “Skills for Caring: Valuing Knowledge of Applied Science in Nursing.” British Journal of Nursing(BJN), 17(5), 322–325.
11. Mitchell, S. (2008). “Your Employment Brand: Is it Working for or Against You?” Nursing Economic$, 26(2), 128–129.
12. Haley-Lock, A. (2008). “Happy Doing Good? How Workers’ Career Orientations and Job Satisfaction Relate in Grassroots Human Services.” Journal of Community Practice, 16(2), 143–163.
13. Kovner, Brewer, Greene, and Fairchild. (2009). “Changing Work Needs of New RNs: Literature Review.” The Online Journal of Issues in Nursing, 15(1).
14. O’Brien-Pallas, L., Duffield, C., and Hayes, L. (2006). “Do We Really Understand How to Retain Nurses?” Journal of Nursing Management, 14, 262–270.
15. Davis, B., Ward, C., Woodall, M., Shultz, S., and Davis, H. (2007). “Comparison of Job Satisfaction Between Experienced Medical-Surgical Nurses and Experienced Critical Care Nurses.” MEDSURG Nursing, 16(5), 311–316.
16. Nogueras, D. (2006). “Occupational Commitment, Education, and Experience as a Predictor of Intent to Leave the Nursing Profession.” Nursing Economic$, 24(2), 86–93.
17. Klug, S. (2009). “Recruit, Respect, and Retain: The Impact of Baby Boomer Nurses on Hospital Workforce Strategy—A Case Study.” Creative Nursing, 15(2), 70–74.
As nursing schools across the country continue to work aggressively to increase the diversity of their student populations, minority nurses remain less represented in doctoral degree programs than at the bachelor’s and master’s levels. But progress has been made over the last decade, and today universities are continuing to look at ways to not only recruit more nurses of color into doctoral programs but also ensure that they graduate.
According to data from the American Association of Colleges of Nursing (AACN), minority doctoral enrollments are up across the board among all ethnicities. Of the 3,362 nurses enrolled in research-focused PhD programs in 2006, for instance, 670–almost 20%–were nurses of color. That’s almost double the number from just five years earlier, when minority enrollment in those programs totaled 359 (about 14%). Ten years ago, minorities comprised just 11.6% of research-focused doctoral nursing students.
Graduation rates are up, too, AACN reports. Seventy-four minority nurses graduated from doctoral programs in 2006, comprising about 17% of all doctoral nursing graduates, compared with only 47 minority graduates (about 10% of the total) five years ago.
But many nurse educators believe universities need to do more to increase doctoral program enrollment and graduation rates among all students in general, and to continue to increase the representation of minorities.
“I think we still have a ways to go in getting more nurses interested in pursuing doctoral education,” says May Wykle, PhD, RN, FAAN, FGSA, dean of Case Western Reserve University’s Frances Payne Bolton School of Nursing in Cleveland, Ohio.
The need for more doctorally prepared nurses is critical for addressing the nursing faculty shortage. “It’s a big problem,” says Marjorie Isenberg, DNSc, RN, FAAN, professor and dean of the University of Arizona College of Nursing in Tucson. “The average age of a faculty professor is 55, so we have a large cohort of faculty who are preparing to retire.”
This has implications not just for nursing schools but for health care as a whole. If universities can’t recruit enough nursing faculty, they can’t expand their enrollments and programs to meet the nation’s need for more nurses. And nursing schools especially need more minority faculty members to foster a diverse student body.
More Options, Closer Access
Of course, doctoral degrees enable nurses to do more than just teach. More doctorally prepared minority nurses are also needed to conduct research and work in the field, especially in areas relating to the elimination of racial and ethnic health disparities. Wykle says nursing schools need to make sure that potential minority doctoral students know about other, newer options besides the traditional PhD degree, such as clinical doctoral programs for nurse practitioners (Doctor of Nursing Practice degrees).
The ability to work in the community with a doctorate is an important factor that is leading more American Indian and Alaska Native nurses to pursue terminal degrees. One reason Native nurses have been particularly underrepresented in doctoral programs is that many wanted to work in their communities and help their people in more tangible ways than they could through a faculty or research position at a university, says Sue Henly, PhD, RN, professor and project director of the American Indian/Alaska Native MS to PhD Nursing Science Bridge program at the University of Minnesota School of Nursing in Minneapolis.
“When pursuing a doctorate, Native students are doing something that’s less familiar to their families and communities,” she explains. “There’s less certainty about how it will pay off and fit in with their lives. What will come afterwards? They’re really trailblazers.”
Universities are also working on making young nursing students more aware of doctoral education opportunities. At the University of Arizona College of Nursing, faculty and diversity directors identify younger students who have an interest in research and teaching and then encourage them to move toward pursuing advanced degrees sooner rather than later. The university is one of a growing number of nursing schools that now offer BSN-to-doctoral programs, which are designed to put students on the path to the doctorate earlier in their careers than ever before.
“We have this tradition in nursing in which students earn a degree and go out and practice, and then they get another degree and practice again, and then they come back and get their doctoral degree,” Isenberg explains.
But by that time, nurses are in their 40s. They’re often married with children and they may be caring for aging parents. “Then life becomes very complicated,” Isenberg says. “We’re not talking about a 20-year-old who can lay all those things aside and concentrate on [getting a PhD].”
Schools that hope to recruit more minority doctoral students also need to look at making their programs more convenient for students to get to. Picking up and moving one’s family to another city or state to pursue a rigorous course of study is difficult at best. It’s particularly challenging for students from Hispanic, American Indian and other cultures, where the family context is so important, Isenberg says.
To address this issue, the University of Arizona College of Nursing launched a full-time online doctoral program four years ago. The distance-learning program has been well received by students, because they no longer have to leave their families behind to go to class.
“We noticed that some of our students were driving 200 or more miles to go to school,” Isenberg says.
Students and faculty meet face-to-face before the semester begins, and everyone has a camera on their computer to make communicating online more personal. The students get to know each other well: Each cohort has about 10 people, who move through the doctoral program together. “They become a very tight-knit group,” Isenberg adds.
Meeting Financial Needs
Because doctoral education is expensive, nursing schools also must make sure their programs are financially accessible to students of all backgrounds. Financial aid, including stipends as well as assistance with tuition, is critical for doctoral students, Wykle says. “If students don’t have enough scholarships, and they have to work [while trying to pursue their degree], that can be deadly.”
In recent years, the federal government has created more funding opportunities to assist nurses in obtaining advanced degrees. For instance, the Health Resources and Services Administration (HRSA)’s Nurse Faculty Loan Program (NFLP), created by Congress to address the nursing shortage, provides loans to nursing students enrolled full time in master’s or doctoral programs. If the student becomes a full-time nursing faculty member after graduating, the program forgives up to 85% of the loan.
The Graduate Assistance in Areas of National Need (GAANN) program, offered through the U.S. Department of Education, provides grants to academic institutions that enable the schools to offer fellowships for doctoral students in fields considered areas of national need, such as nursing. The Yale University School of Nursing in New Haven, Conn., is among the schools where GAANN fellowships are available. The school launched a new PhD program last fall to replace its Doctor of Nursing Science (DNSc) degree and received the three-year federal grant to support the recruitment and training of doctoral students to counter the nursing faculty shortage.
The school uses the grant funding to provide tuition and a stipend for four students based on financial need. In the first two years of the program, students work closely with faculty to gain graduate research experience. In the third or fourth years, they are mentored as they get experience teaching master’s-level classes. The students also receive support through the university’s Center for Graduate Teaching, which helps them with such practical issues as how to handle difficult students and how to write exams.
“When people graduate from here, they should be pretty set to go into an academic position,” says Marjorie Funk, PhD, RN, FAAN, FAHA, director of the PhD program.
Attention Helps Retention
Having a diverse and culturally sensitive faculty is also an important factor in the recruitment and retention of minority doctoral students. And faculty members must be trained in how to mentor students. “The faculty needs to be able to understand what you do to advise students,” Wykle says. “It goes beyond establishing office hours and returning phone calls.”
Individualized attention from faculty is a key to student retention in the doctoral program at Hampton University School of Nursing in Hampton, Va., the first historically black nursing school to establish a PhD program. Students have access to faculty members’ home phone numbers as well as work numbers and email, and the cohorts are kept fairly small–about 10 people–so everyone gets to know each other well. Classes are offered online and students are encouraged to post their own Web pages on the program’s network. Telephone conferences and computer cameras allow students and faculty to talk to and see one another. And an annual three-day to one-week residency brings faculty and students together for education and socialization.
Far more students apply than the PhD program can accommodate, says Pamela Hammond, PhD, RN, FAAN, professor and director of the program. Ten students so far have graduated, and five more are expected to graduate in the next year. The program receives numerous calls from employers interested in hiring its graduates for faculty and research positions, Hammond adds. “People are looking at our students because they know the program is rigorous and that our students do very well.”
Unfortunately, says Wykle, attitudes still prevail in some parts of the academic world that expanding minority enrollment in doctoral programs will mean letting standards slip. Not only is this completely untrue, she argues, but even students who are accepted on a provisional basis can succeed if they receive assessment of their study and writing skills, a welcoming attitude and enough support so that they have the tools and resources they need. “Schools have to go the extra mile to offer support services,” she emphasizes.
Bridging the Distance
Still another initiative that is not only boosting the number of minority nurses enrolled in doctoral programs but also ensuring that these students receive the cultural, academic and financial support they need to cross the finish line is Bridges to the Doctoral Degree, sponsored by the National Institutes of Health.
Bridges programs, such as the American Indian/Alaska Native MS to PhD Nursing Science Bridge program at the University of Minnesota, pair one or more universities that offer Master of Science as their highest degree with a university that has a doctoral program. The partner schools work together to help minority students successfully bridge the transition between the two programs. Other nursing schools whose doctoral programs are participating in Bridges to the Doctoral Degree include the University of Illinois at Chicago College of Nursing and Rutgers, The State University of New Jersey College of Nursing.
In the last six years, 17 Native nurses have been set on the path toward PhDs through the bridge program at the University of Minnesota, whose partner schools are the University of North Dakota and the University of Oklahoma. That’s a significant number considering that there were only a dozen American Indian/Alaska Native nurses in the country with a PhD when the program started. Of the 17, five have attained their master’s degrees, three have transitioned to the PhD program and one has advanced to candidacy.
While earning their master’s degrees, students in the bridge program receive financial support through paid research assistantships. This also helps them gain hands-on experience while serving as a valuable resource to faculty members. Students learn library research skills, data management and how to compile and critique research literature.
Once they enter the doctoral program at the University of Minnesota, the students receive financial assistance in the form of a research or teaching assistantship for the first year, which includes tuition. They are then encouraged and supported to apply for competitive fellowships through the university.
Recently, the University of North Dakota and the University of Oklahoma both decided to start their own doctoral programs, Henly reports. As a result, the bridge program at the University of Minnesota will end in July 2007. But the addition of the two new programs at the former partner schools will continue to increase Native nurses’ access to doctoral education. And with its history of providing culturally sensitive support, the American Indian/Alaska Native MS to PhD Nursing Science Bridge program leaves a legacy that serves as a successful model.
The program relied on American Indian academic consultants, who guided the faculty and served as role models for students. It also worked closely with Native elders, medicine people and spiritual guides to provide a welcoming environment. A highlight of the program was a project retreat every two years, in which faculty and students gathered with tribal elders and spiritual leaders to learn about and experience Indian culture.
“The program has been a bridge from good intentions to action in supporting Indian students in doctoral education,” Henly says.
Ever Upward: Minority Enrollment and Graduation Rates Continue to Rise
Enrollment in Nursing Doctoral Programs, 2006
No. of students
% of total
American Indian/Alaska Native
Asian/Native Hawaiian/Pacific Islander
Doctor of Nursing Practice:
No. of students
% of total
American Indian/Alaska Native
Asian/Native Hawaiian/Pacific Islander
Graduations in Nursing Doctoral Programs, 2006
No. of students
% of total
American Indian/Alaska Native
Asian/Native Hawaiian/Pacific Islander
Doctor of Nursing Practice:
No. of students
% of total
American Indian/Alaska Native
Asian/Native Hawaiian/Pacific Islander
Source: American Association of Colleges of Nursing
Louis W. Sullivan, M.D. founding dean of Morehouse School of Medicine
“Role models are important!” says Louis W. Sullivan, M.D. founding dean of Morehouse School of Medicine and former U.S. Secretary of Health and Human Services. “Too many minority young people have never interacted with any minority health professionals. [This type of interaction] tells the youngster-even if silently or indirectly-that they can be successful, too.
Sullivan urges all minority health care practitioners to become role models for minority youth in their communities by providing information, guidance, and support.
“Minority health professionals can answer questions with greater credibility for these youngsters. We need minority physicians, dentists, nurses and [other health care providers] to play such a role. We need local involvement; this is one of those local activities that can mean so much. It makes it real, rather than abstract, for a youngster to have [a role model] right in the room or right in the community as opposed to on television.”
Shortage of Minority Health Professionals
Role models for future minority health care practitioners is extremely important in a time when African Americans, Hispanics and American Indians combined make up more than 25% of the U.S. population but represent less than nine percent of nurses, six percent of physicians, five percent of dentists, and similar low percentages of other health professions.
In certain regions, the disproportion is worse. For example, in Georgia, the Hispanic population has surged to four percent, but only 0.8% of the state’s nurses are Hispanic.
The American Council on Education reports that fewer than 8,000 minority men and women earned master’s degrees in health professions in 2001 (the most current year data was collected). That’s only 18% of all the health professions master’s degrees awarded that year.
And the shortage may be getting worse-fewer minority students are enrolling in health care education programs. For example, in 2002, of more than 8,000 medical students in the state of New York, there were only 265 minority first-year students. This was 5.4% fewer than in 2001; it was also a ten-year low. “Deans and university officials are saying that they have none or only one new black or Hipanic student in their classrooms for the first time in decades,” Sullivan reports.
“We know that the lack of minority health professionals is adversely affecting critical racial and ethnic health disparities,” Sullivan adds. African Americans, Hispanics, and American Indians and Alaskan Natives on average receive less prenatal care, lower vaccination rates, less cancer screening, and worse control of diabetes and hypertension. In general, non-majority Americans receive less effective health care and are more likely to report poor or fair, rather than good or excellent, health. For many, life expectancy is cut short.
Sullivan Commission Takes to The Road
Louis Sullivan is not accepting deteriorating health outcomes with resignation. Supported by Kellogg Foundation funding, he has organized the Sullivan Commission on Diversity in the Healthcare Workforce in order to create solutions. “This is a problem that can be solved,” he affirms.
Since the fall of 2003, the Commission has held field hearings in Atlanta, Denver, New York, Chicago, Los Angeles and Houston, and a town hall meeting in Boston. At each hearing and meeting, the Commission has collected data and testimony from health experts, community advocates, business leaders and local governmental officials.
In New York, U.S. Representative Charles B. Rangel stated, “Increasing diversity in medicine, dentistry and nursing is one of the key strategies to reduce the alarming health disparities facing our nation. In the last decade, we have seen hardly any increase in the number of minority health professionals despite the growing ethnic diversity of our population. The work of this Commission will provide Congress a needed roadmap on how to solve this health care problem facing our nation’s citizens, including the poor and millions of minorities.”
In Chicago, U.S. Representative Jesse L. Jackson, Jr. stated, “Racial minorities–especially blacks, Hispanics and American Indians–are over-represented when it comes to disease and illness, but underrepresented in the healing professions. Both dimensions-health and healing-must change for the better soon. Increasing diversity in the healing professions is one way to bring about that change. The Sullivan Commission is pointing the way to close these gaps in the health care professions.”
Rupert Evans, president of the American Hospital Association’s Institute for Diversity in Health Management, testified, according to Associated Press reports, that minorities seek out medical care more frequently with providers of the same race. He said that in order to solve the racial disparity issue, the country needs providers that are culturally similar to and sensitive to patients. “It’s all tied together,” Evans concluded. “You can’t have one without the other.”
Take Action Now
“Now is the time to confront the crisis in the nation’s health care system and utilize the tool of diversity in crafting solutions,” Sullivan declares. “Barriers that are blocking the aspirations of minority students to become health professionals must be removed.”
The Commission emphasizes that all children deserve quality education from kindergarten on up. “We must strengthen educational preparation so that young people don’t have to leap over a chasm to gain entry to health care careers,” Sullivan says.
The Commission calls for better coordination at each level of school-from kindergarten through junior high, high school, college and graduate programs-so each level doesn’t stand alone “like a silo in a field,” as Sullivan puts it.The transition from two-year to four-year institutions of higher education is especially critical. At the hearings in Denver and again in Houston, the Commission heard that many minority youth enter higher education through community colleges. The Commission believes colleges and universities should smooth the way for these transfer students, with coordinated curricula, guaranteed transfer of credits, and even guaranteed admission to four-year programs for successful two-year students.
Another major recommendation is improved financial aid for students in health care programs, with more scholarships and low-interest loans, rather than unsubsidized loans. The prospect of heavy student debt distorts career choices, Sullivan explains. “It’s hard to explain to a young person from a low-income family that with the professional credential they would be earning enough to pay off the loan. That kind of debt can be a barrier. And financial barriers affect majority as well as minority youngsters.
“We have to find easier ways for youngsters to finance their health professions education than we have now,” Sullivan warns. “Our current system is very threatening for a youngster coming from a low-income background.”
For college graduates seeking careers as physician assistants, pharmacists, and other professions requiring graduate education, the Commission recommends short, “brush-up” programs to improve their preparation for professional school. “Students who have the intellectual capacity but find a weakness or deficiency in some area” would thereby be better prepared for admission to, and success in, graduate programs.
The Commission’s hearings also highlighted the often-overlooked fact that many minority people are already working in other jobs when they decide to pursue their dream of a health care career. “This represents a new career shift for them,” Sullivan explains, and the Commission calls for “strategies to help identify and assist those people in the transition to a second career.”
Cultural Competence for a Diverse America
“Years ago, when we talked about minority populations we were talking primarily about the African-American population,” Sullivan relates. “But today the Hispanic population has increased significantly; it is now larger than the African-American population. We also have Vietnamese, Hmong, Cambodian, Eastern European and so many other groups. The concept of diversity now implies a lot more specific cultural backgrounds that those in the health professions have to be aware of and adapt to.
“We need to meet these people more than half way, Sullivan says. “Even if you have a highly competent, technically and scientifically trained group of health professionals with the best facilities, it doesn’t help [patients] if there is no communication. If there is a communication barrier, then all that excellence is frustrated.
“The ideal that we envision in the Commission,” Sullivan adds, “is a health professions community sufficiently multicultural in orientation and understanding so that they know how to communicate with someone from a different background. They can communicate in such a way that patients are comfortable and develop trust. Then you’ll have patient compliance, whether it’s taking medicine, coming in for a follow-up visit, or any of a whole host of things.” Ultimately, patient compliance leads to better health outcomes.
Similarly, institutions of health care education can create environments that are more “user-friendly,” Sullivan suggests, so that “minority students have an experience that is affirming, rather than hostile or indifferent.”
All health care workers should take on these changes, Sullivan believes. “The health issues of minorities are not going to be addressed solely by minorities,” he says, “nor should they be, from an idealistic point of view. We need everyone involved, because, frankly, this is a problem and a challenge for all of us.
“As we find solutions, not only will there be improvements within the minority community in terms of improved access to health care careers, improved health care and improved health status, but also there will be advances in community development, social stability, and economic development. All of these things are intertwined.”
Sullivan gives credit to neighborhood institutions like the Boys’ Club and Girls’ Club that help young people develop self-esteem and become successful. “Youngsters have to view themselves as capable of achieving something,” he points out. “The more confidence they have, the more willing and able they are to take risks” such as pursuing demanding professional careers in health care.
His own Morehouse School of Medicine invites grade school children to a “Saturday Academy” on campus, collaborates with the Explorer Scouts, and even awards a scholarship to Boys’ and Girls’ Club members.
“Advocating for the necessary changes, including greater availability of financial resources, will be essential,” Sullivan concludes. He invites everyone in the health care field to make their views known.
“Individuals who are decision makers in federal government, state governments, the business community and the philanthropic community will have to be convinced that this is a worthwhile investment. The case has to be made that our society will get important and significant returns on this investment.
“Ultimately, there has to be a broad societal understanding of this problem and a belief that by investing the time, effort, and resources, this is a problem that can be solved.”
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