A Developing Proposal for Policies to Diversify the Nursing Workforce

Catherine L. GillissSeptember 24, 2010

American Assembly for Men in Nursing

Adapted from a manuscript now under review…

• “Recruiting and Retaining a Diverse Workforce in Nursing: From Evidence to Best Practices to Policy”

• Co-authors: Dorothy L. Powell, EdD, RN, FAAN, and Brigit Carter, PhD, RN, Duke University School of Nursing

• With special thanks to Judy Seidenstein, Director for Diversity and Equity Programs, Duke University Office of Institutional Equity

The faces of today and tomorrow…

Snapshot of Nursing in 2009Source: 2008 National RN Sample Survey, DHHS, HRSA, 2010

• 3,063,163 licensed RNs in US (up 5.3% from 2004)

• 84% actively employed; 63% employed FT

• 853 employed RNs/100,000 US population

• 34% BS prepared (up 3%); 46% ADN prepared

• Mean age = 47 yrs (45% are over 50 yrs)

• 16.8% non-white (up from 12.3% in 2000)

• Between 2005-2008, 22.5% of basic program grads were non-white (up from 12% 20 yrs ago)

Gender Profile

• Overall, women outnumber men in nursing, 15:1 (or 6.7%).

• Among those entering nursing since 1990, the ratio shifts to 10:1 (or 10%).

Distribution of registered nurses and the U.S. population by racial/ethnic background, 2008

Why does this matter?

• Assumption of a common, social good

• Assumption of greater cultural competence within a diverse work force

• Assumption that greater diversity could reduce health care bias and disparities

• Assumption of a greater commitment to service in underserved communities, under represented in the health professions

What’s the evidence?Source: HRSA (2006). The rationale for diversity in the health professions: a review of the evidence. Wash, DC: USGPO. (hrsa.gov/bhpr/workforce/diversity.pdf)

• Service Patterns: That health professionals from racial and ethnic minority and socially disadvantaged backgrounds are more likely to serve racial and ethnic minority and socially disadvantaged populations, improving access and health outcomes.

• Concordance: That increasing the number of racial and ethnic minority health professionals provides greater opportunity to see someone of your own racial/ethnic group and improves communication quality, comfort, trust, partnership and decision-making.

• Trust in Health Care: That greater diversity within the health care workforce will increase trust in the delivery system and increase likelihood of using the system.

• Professional Advocacy: That health professionals from racial and ethnic minority and socioeconomically disadvantaged backgrounds will be more likely to advocate for policies and programs aimed at improving care to those in need – increasing access and quality and, ultimately, health care outcomes.

One way to think about about bias…Adapted from: Scott Page (2007). The Difference: How the Power of Diversity Creates Better Groups, Firms, Schools, and Societies. Princeton: Princeton University Press.

• Everyone has biases; we call them preferences.

• We have fundamental preferences or preferences about outcomes. These represent our values.

• We have instrumental preferences, or preferences about how we get what we want. These represent preferences about our actions to accomplish outcomes.

• When we think our instrumental outcomes are better than those of others, we limit available options to accomplish our outcomes.

Best Practices: Develop a Pipeline

• Start earlier than you expect – career decisions are forming in middle school.

• Develop Magnet Health Professions Schools.

• Offer summer programs during college.

• Strengthen performance and resilience while in college.

• Improve funding options.

• Improve networks.

• Improve academic preparation.

• Create bridge programs.

Best Practices: Focus on Admissions

• Examine the relationship between admission requirements and program success.

• Develop alternative profiles for qualification.

• Develop admission requirements that value future potential in addition to past achievements.

• Yield those who are admitted – by providing the needed supports to ensure success.

Best Practices: Retention

• Invest in a supporting infrastructure.

• Financial aid

• Program flexibility

• Networks

• Academic supports

• Aspirational supports

Best Practices: Utilization

• Appoint persons from diverse backgrounds to key leadership and decision-making positions.

• Make diversity visible.

• Seek advice from diverse sources and use it.

Developing OpportunitiesSources: Affordable Care Act [PL111-148] and Health Care Education and Reconciliation Act of 2010 [PL 11-152]

• State Workforce Development Grants (section 5102): Competitive grant program that will fund innovative approaches to increase the numbers of skilled health care workers and create career pathways.

• Nursing Student Loan Program (section 5202): Expands loans amounts available.

• Nurse Education, Practice and Retention Grants (section 5309): Awards grants to nursing education and training programs to improve nurse retention.

• Loan Repayment and Scholarship Program/Nurse Faculty Loan Program (sections 5310-11): Expands debt reduction opportunities for those who enter teaching careers in nursing.

Download this information from the web…

http://dpc.senate.gov/healthcarereformbill/healthbill96.pdf

More developing opportunities…

• Workforce Diversity Grants (section 5404): Expands allowable uses of nursing diversity grants to include bridge programs, degree completion, advanced degrees, pre-entry prep and retention.

• Allied Health Loan Repayment and Retention (section 5205): Will focus on HPSA and MSSAs.

• National Health Service Corp (section 5207): Increases the authorization for appropriations for FY 2010-2015.

• Cultural Competence (section 5307): For cultural competency curriculum development, implementation and testing.

• Grants to Promote the Community Health Workforce (section 5313): Supports the development of community workers for medically underserved areas.

Download this information from the web…

http://dpc.senate.gov/healthcarereformbill/healthbill96.pdf

And even more…

• Centers of Excellence (section 5401):Develops a minority applicant pool and other supports for retention; funding expanded.

• Health Professions Training for Diversity (section 5402): Provides scholarships for disadvantaged students who commit to working in medically underserved areas as primary care providers and expands loan repayment opportunities for faculty.

• Demonstration Projects to Address Health Professions Workforce Needs (section 5507): Targets TANF recipients to support their entry into health careers in areas where shortages are anticipated.

Download this information from the web…

http://dpc.senate.gov/healthcarereformbill/healthbill96.pdf

One unfolding example…

• Duke University School of Nursing’s Making a Difference in Nursing Program.

• HRSA funded to Dorothy L. Powell.

• Modeled after the U MD, BC campus Meyerhoff Scholars program, designed to promote the entry to African American students into the STEM fields.

• Three elements:

1. Summer Socialization Program;

2. Connectivity leading to application and admission; and

3. Retention and support for program success and completion.

What work remains?

• The fundamental question of evidence has not been answered.

• We have an anecdotally based literature that offers direction to how the education system might improve.

• We have not tested the hypotheses about whether increasing diversity, collectively will, ultimately, influence access to care or ameliorate health disparities.

• Important health services questions remain unaddressed regarding program development, cultural competence and racial/ethnic concordance.

Thought for the day…

You must be the change you wish to see in the world.

- Mahatma Gandhi