nursing workforce diversity updates and anticipated trends

Shanita D. Williams, PhD, MPH, APRNChief, Nursing Education and Practice Branch

Division of Nursing and Public Health Bureau of Health Workforce

Health Resources and Services AdministrationSWilliams3@hrsa.gov

Division of Nursing and Public Health: Nursing Workforce Diversity Updates and Anticipated Trends

AACN Spring 2016 Conference

Workshop: Building the Case for Diversity and Inclusive Learning

March 18, 2016 and March 23, 2016

BHW Priorities Spotlight: Preparing a Diverse Workforce

Programmatic Overview Legislative Authority: Nursing Workforce Diversity (NWD) Program

Why Diversity? Why NWD? NWD vs U.S. Population Demographics Benefits/Strengths of Diverse and Culturally Aware Workforce

Evidence-based Strategies to Increase Nursing Diversity in U.S. Population NWD Program Initiatives and Investments

Spotlight: Urban Universities for HEALTH Study: Holistic Review and Admissions in Nursing

Discussion and Questions

Presentation Outline:

2

Bureau of Health Workforce Mission

Improve the health of underserved and

vulnerable populations by strengthening the health workforce and

connecting skilled professionals to

communities in need.

Collaboration

Accountability

Innovation

HRSA MissionImproving health and health equity through access to quality services, a skilled health workforce and innovative programs.

BHW Programs Snapshot

In FY 2015, BHW awarded over $1 billion to more than 8,500 organizations and individuals through more than 40 workforce programs.

Collectively, our programs increase the nation’s access to quality health care by developing, distributing, and retaining a competent health workforce.

Workforce Supply

Priorities

Program Design

Academic & Community Partnerships

Interprofessional Practice & TrainingRapid Cycle QI/Data Driven

Research and Resources

Bureau of Health Workforce

Preparing a Diverse

Workforce

Improving Workforce

Distribution

Transforming Health Care

Delivery

5

Legislative Authority: Title VIII, Section 821 of the Public Health Service Act (42 U.S.C. 296m), as amended by Section 5404 of the Patient Protection and Affordable Care Act (P.L. 111-148). Annual Appropriations: $14.5 million/year1st Year of Appropriations/Awards: 1987

Nursing Workforce Diversity (NWD) Program:Goal: increasing nursing education opportunities for individuals from disadvantaged backgrounds (including racial and ethnic minorities underrepresented among registered nurses) Student scholarships, stipends, pre-entry preparation, advanced education

preparation, accelerated nursing degrees, and retention activitiesFY 2015:

11 - new awards - $3,488,008; 31 - continuing awards - $10,442,5261 - Interagency Agreement w/NIH National Institute on Minority Health and Health Disparities (NIMHD) - $150,000

Title VIII—Nursing Workforce Diversity

6

Frequent Question:“Why do we need a dedicated funding stream for Nursing Workforce Diversity? Hasn’t workforce diversity been integrated into all funding priorities?”

Why Nursing Workforce Diversity Matters…

Why Nursing Diversity Matters?Nursing Diversity: Increases cultural competence Improves patient satisfaction Improves patient-provider communication Increases access to care

Vulnerable populationsUnderrepresented minorities more likely to practice

in underserved areas Economic advantages

Good business practice

10

Participant Criteria NWD

Nursing Workforce Diversity (NWD) Program Disadvantaged Backgrounds1. Educational or Economic disadvantage2. Racial or ethnic minority

underrepresented among registered nurses

Demographic Profile*^ NWD National~WhiteBlackAsianHispanic/Latino

35.6% 83.2%23.4% 5.4% 2.9% 5.8%22.8% 3.6%

FemaleMale

76.3% 91.0%17.2% 9.0%

Disadvantaged BackgroundRural

73.4% 16.8%27.9% 16.0%

*Demographic Data from National Center for Health Workforce Analysis: NWD Program Annual Report CY 2013 -2014-unpublished^National Council of State Boards of Nursing (NCSBN) and Forum of State Nursing Workforce Centers (2013)~Registered Nurses

Constant Question:“What racial/ethnic minority recruitment and retention models implemented in undergraduate nursing programs have been successful in recruiting, retaining, and graduating students form schools of nursing”?

Nursing Workforce Diversity: Evidence-based Strategies That Work

Successful Strategies that Achieve Health Professions Student Diversity

Successful models include various combinations of evidence-based strategies: Academic support Professional and peer mentoring Student financial support Community partnerships Holistic Review and Admissions

What Works to Achieve Diversity: Insights from HRSA Grantees

Academic and peer support Before admission and during academic progression

Professional and peer mentoring Establishing mentoring networks Language partnerships

Visible minority faculty Financial support

Uninterrupted Social support Active Community partnerships

Nursing Workforce Diversity: Current and Future Directions

Social Determinants FrameworkSocial determinants are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life

World Health Organization

Five social ‘class’ determinants of student success and achievement:1. Challenged home intellectual environments2. Single parenthood3. Irregular parental work schedules4. Inadequate health car access5. Exposure to environmental lead

Economic Policy Institute (2015)

Social Determinants as a Nursing Workforce Diversity Strategy Move beyond individual-level strategies rooted in

deficit-based models and assumptions Multi-level and systems approaches

systems (college, university, and community-level) Partnerships

public and private sectors (beyond nursing)industry and other disciplines

Collective activity vs. Individual nursing school effort

From Social Determinants to Holistic Review and Admissions

Holistic Review and Admissions Admitting and graduating the best “nurses” vs the best

“students” Matching a student background/experiences to the

College/University mission, vision, and values Using diversity of admission criteria not exclusive of

quantitative metrics: GPA, GRE

Requires institutional leadership involvement starting at the top

HRSA’s Holistic Review and Admissions Investments2013: Urban Universities for HEALTH $265,000 HRSA Grant Survey of Admissions in the Health Professions examined how universities are admitting students into health professions programs, with a particular focus on “holistic review” as a strategy to increase diversity and cultural competence in the health professions, with the larger aim of improving access to care and achieving health equity

2015: Urban Universities for HEALTH $150,000 HRSA Grant Disseminating Evidence on Admissions project aim is to improve the understanding and use of evidence-based university admissions practices that lead to a more diverse and culturally competent nursing workforce

Shanita D. Williams, PhD, MPH, APRNChief, Nursing Education and Practice Branch

Division of Nursing and Public Health Bureau of Health Workforce

Health Resources and Services AdministrationSWilliams3@hrsa.gov

Division of Nursing and Public Health: Nursing Workforce Diversity Updates and Anticipated Trends

AACN Spring 2016 Conference

Workshop: Building the Case for Diversity and Inclusive Learning

March 18, 2016 and March 23, 2016