Enhancing Diversity in the Nursing Workforce

• According to a Brookings Institution analysis of 2020 U.S. Census Bureau data, more than 40% of the U.S. population now identify as people of color. With projections pointing to minority populations becoming the majority by 2045, professional nurses must demonstrate a sensitivity to and understanding of a variety of cultures to provide high quality care across settings.
   
• According to a 2020 survey conducted by the National Council of State Boards of Nursing (NCSBN) and The Forum of State Nursing Workforce Centers, nurses from minority backgrounds represent 19.4% of the registered nurse (RN) workforce. Considering racial backgrounds, the RN population is comprised of 80.6% White/Caucasian; 6.7% African American; 7.2% Asian; 0.5% American Indian/Alaskan Native; 0.4 Native Hawaiian/Pacific Islander; 2.1% two or more races; and 2.5% other nurses. In addition, 5.6% of the RN workforce report their ethnicity as Hispanic.
   
• The NCSBN survey also found that men now account for 9.4% of the RN workforce, which represents a 0.3% increase since 2017, When looking at specific nursing roles, the highest representation by men was in nurse anesthetist positions (41%).
   
• According to the 2008 National Sample Survey of Registered Nurses conducted by the U.S. Health Resources and Services Administration, RNs from minority backgrounds are more likely than their white counterparts to pursue baccalaureate and higher degrees in nursing. Data show that while 48.4% of white nurses complete nursing degrees beyond the associate degree level, the number is significantly higher or equivalent for minority nurses, including African American (52.5%), Hispanic (51.5%), and Asian (75.6%) nurses. RNs from minority backgrounds clearly recognize the need to pursue higher levels of nursing education beyond the entry-level.
   
• According to AACN's report on 2021-2022 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, nursing students from minority backgrounds represented 40.8% of students in entry-level baccalaureate programs, 38.9% of master’s students, 35.5% of students in research-focused doctoral programs, and 38.9% of Doctor of Nursing Practice (DNP) students. In terms of gender breakdown, men comprised 12.6% of students in baccalaureate programs, 11.7% of master’s students, 11.2% of research-focused doctoral students, and 14.1% of DNP students. Though nursing schools have made strides in recruiting and graduating nurses that reflect the patient population, more must be done before equal representation is realized.
   
• The need to attract diverse nursing students is paralleled by the need to recruit more faculty from minority populations. Few nurses from racial/ethnic minority groups with advanced nursing degrees pursue faculty careers. According to 2021 data from AACN’s annual survey, only 19.2% of full-time nursing school faculty come from minority backgrounds, and only 7.4% are male.

• All national nursing organizations, the federal Bureau of Health Workforce hospital associations, nursing philanthropies, and other stakeholders within the health care community agree that recruitment of underrepresented groups into nursing is a priority for the nursing profession in the U.S.
   
• AACN serves on the National Commission to Address Racism in Nursing, a coalition of nursing organizations focused on understanding the impact of systemic racism on nurses of color. Led by the American Nurses Association, National Black Nurses Association, National Coalition of Ethnic Minority Nurse Associations, and National Association of Hispanic Nurses, the commission is developing an action-oriented approach to addressing racism in education, practice, policy, and research. To amplify its work, the commission released a series of action reports in June 2022 to generate greater awareness about the impact of racism in nursing and society, including a report titled How Does Racism in Nursing Show Up in the Education Space?
   
• Besides adding new clinicians to the RN workforce, a diverse nursing workforce will be better equipped to serve a diverse patient population. According to a 2013 report by the National Advisory Council on Nurse Education and Practice (NACNEP), a diverse nursing workforce is essential for progress towards achieving health equity in the United States. NACNEP also found that nurses who are members of underrepresented minority (URM) groups or disadvantaged populations are more likely to advocate for services and programs in their communities. When nurses are members of the populations they serve, they are better able to improve communication and trust among URM groups. They may also be more likely to work in resource-poor communities facing a shortage of healthcare professionals, which can improve access to healthcare.
   
• Racial and ethnic minorities are more likely to return to and serve their underrepresented communities, bridge the cultural and linguistic gaps in patient education, and provide a broad and diverse cultural prospective to all conversations within nursing (Adams & Price-Lea, 2004). The positive impact of increasing nursing workforce diversity reverberates across education, research, and clinical areas.
   
• According to the National Center for Health Statistics, a lack of diversity in the healthcare workforce is one factor that has contributed to poorer health and higher mortality rates among URM groups. Some patients feel more comfortable when their healthcare providers share their ethnicity, race, and language. Improving nursing diversity strengthens the trust between patients and nurses, which can lead to patients more strongly adhering to nurses’ recommendations.
   
• We also need to think of the importance of diversity in leadership, A 2020 Nursing Forum article on the barriers to career advancement highlighted the benefits of URM nurses’ ascending to executive roles in senior leadership. Specifically, representation at the executive level can give URM nurses the ability to influence the overall structure of the healthcare environment to reduce health disparities and improve patient outcomes.
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• A growing body of research links diversity to enhanced healthcare delivery and financial outcomes. Research published in the August 2019 Journal of the National Medical Association found that a more diverse healthcare workforce was linked to improved patient care quality and cost savings.
   
• A groundbreaking report, titled Missing Persons: Minorities in the Health Professions, which was released by the Sullivan Commission on Diversity in the Healthcare Workforce in September 2004 stated: “The fact that the nation’s health professions have not kept pace with changing demographics may be an even greater cause of disparities in health access and outcomes than the persistent lack of health insurance for tens of millions of Americans. Today’s physicians, nurses, and dentists have too little resemblance to the diverse populations they serve, leaving many Americans feeling excluded by a system that seems distant and uncaring.”

A lack of minority nurse educators may send a signal to potential students that nursing does not value diversity or offer career ladder opportunities to advance through the profession. Students looking for academic role models to encourage and enrich their learning may be frustrated in their attempts to find mentors and a community of support. Academic leaders are working to address this need by identifying minority faculty recruitment strategies, encouraging minority leadership development, and advocating for programs that remove barriers to faculty careers.

AACN has taken the following steps to enhance diversity in the student pipeline and workforce:

• With funding from Johnson & Johnson, AACN launched the Building a Culture of Belonging in Academic Nursing in January 2022 to assist nursing schools in creating more inclusive learning environments. This work entails scaling up the use of AACN’s Leading Across Multidimensional Perspectives^© (LAMP) Culture and Climate Survey via a new digital platform to help schools better assess the experiences of diverse students, faculty, and staff. This initiative will help AACN identify practices that facilitate student success and enhance the sense of belongingness among individuals from underrepresented groups.
   
• In keeping with AACN’s strategic goal to serve as a “resolute leader for diversity, equity, and inclusion in nursing,” the association provides a variety of programs and services to help member schools thrive in their efforts to advance DEI.  This programming includes an annual Diversity Symposium which brings thought leaders together with academic nursing leaders to share insights and advancement strategies; an information-rich Diversity, Equity, and Inclusion Faculty Tool Kit; and a quarterly Diversity Digest highlighting school-sponsored DEI initiatives, AACN resources, and new funding opportunities.
   
• In July 2021, AACN launched Diversity, Equity, and Inclusion Leadership Network (DEILN) to supports the efforts of nursing schools to identify effective strategies for advancing inclusive excellence in academic nursing. Members explore an array of priority issues, including enhancing diversity in student and faculty populations, addressing the social determinants of health, ending structural racism, and advancing health equity. DEILN offers opportunities for members nationwide to share evidence-based practices, pose questions, disseminate information about available resources, and learn from each other.
   
• In February 2021, AACN released a video titled 10 Ways Academic Nursing is Addressing Systemic Racism as part of its Gallery of Leadership series. Featuring deans and directors from member schools of nursing, this video compilation highlights specific ways academic nursing leaders are moving to redesign systems and foster more inclusive learning environments.  The Gallery features individual videos from 50 schools focuses on addressing this critical issue.
   
• In January 2021, AACN hosted the inaugural Diversity Leadership Institute, which is designed to prepare academic nursing leaders with the skills needed to advance initiatives that foster DEI. Under the direction of subject matter experts, participants enhance their leadership capacity and apply current diversity research to develop DEI initiatives tailored to their own institution’s needs. Click here to explore the work of AACN’s Diversity Leadership Institute Fellows.
   
• In December 2020, AACN issued a new white paper titled Promising Practices in Holistic Admissions Review: Implementation in Academic Nursing, which outlines how recruitment and admissions practices can be adapted to ensure that prospective students are considered on a broad range of factors reflecting an applicant’s academic readiness, contribution to the incoming class, past work and life experiences, and potential for success.
   
• Since 2016, AACN has provided technical assistance program to nursing schools receiving funding through the Nursing Workforce Diversity (NWD) program offered by the Health Resources and Services Administration. This federal funding is awarded to schools looking to provide staff training related to Holistic Admissions Review. AACN’s assistance includes an assessment of admissions practices, an on-site Holistic Admissions Review workshop, student recruitment and retention strategies, and models for building a successful mentoring program.
    
• Since February 2018, AACN has partnered with the National Institute of Health to administer a mini-grants program to support the All of Us Research Program. This NIH initiative is working to extend precision medicine to all diseases by building a national research cohort of one million or more participants reflecting the diversity of the U.S. population. With a focus on schools serving communities that have been historically underrepresented in biomedical research (UBR), funding awarded through this program will be used to increase awareness of the program and the importance of participation of UBR members. To date, more than $400,000 in grant funding has been disbursed to 48 AACN member schools through this initiative.
   
• In March 2017, AACN’s members voted to adopt the Position Statement on Diversity, Inclusion, and Equity in Academic Nursing. In this statement, AACN recognizes diversity, inclusion, and equity as critical to nursing education and fundamental to developing a nursing workforce able to provide high quality, culturally appropriate, and congruent health care in partnership with individuals, families, communities, and populations. The position further states that AACN is committed to preparing a community of scholars, clinicians, educators, and leaders who fully value the importance of diversity, inclusion, and equity to promote the health of the nation and the world.
   
• AACN collaborates with a variety of national nursing organizations to advocate for more federal funding for Nursing Workforce Development Programs, including funding for Nursing Workforce Diversity Grants. This program provides funding for projects to increase nursing education opportunities for individuals from disadvantaged backgrounds, including racial and ethnic minorities underrepresented among nurses.
   
• In 2013, AACN and the Robert Wood Johnson Foundation (RWJF) initiated the Doctoral Advancement in Nursing (DAN) Project to enhance the number of minority nurses completing PhD and DNP degrees. DAN’s expert committee developed a white paper featuring successful student recruitment and retention strategies that can be used by schools of nursing; comprehensive approaches to leadership and scholarship development for students; suggestions for model doctoral curriculum; and more. Though the DAN Project is no longer active, the resources created through this program, including a self-assessment for doctoral study and faculty and student tool kits are still accessible online.
   
• In January 2010, AACN published a set of competencies and an online faculty tool kit at the culmination of a national initiative funded by The California Endowment titled Preparing a Culturally Competent Master’s and Doctorally-Prepared Nursing Workforce. Working with an expert advisory group, AACN identified a set of expectations for nurses completing graduate programs and created faculty resources needed to develop nursing expertise in cultural competency. This work complemented a similar project for undergraduate programs which resulted in the publication of Cultural Competency in Baccalaureate Nursing Education and the posting of an online faculty toolkit.
   
• In 2008, the Robert Wood Johnson Foundation joined with AACN to launch the RWJF New Careers in Nursing (NCIN) Scholarship Program to help alleviate the nation’s nursing shortage by expanding the pipeline of students from minority backgrounds in accelerated nursing programs. Scholarships in the amount of $10,000 each were awarded to more than 3,000 nurses in entry-level baccalaureate and master’s programs through NCIN. Preference was given to students from groups underrepresented in nursing or from disadvantaged backgrounds. The NCIN program was sunset in 2017.
   
• AACN and the Johnson & Johnson Campaign for Nursing’s Future launched the Minority Nurse Faculty Scholars Program in 2007, which was modeled after a successful AACN collaboration with the California Endowment. In addition to $18,000 in scholarship funding, the program featured mentorship and leadership development components to assure successful completion of graduate studies and preparation for a faculty role. By the time the program closed in 2019, 63 scholars received funding through this program with many graduates now holding in teaching and leadership roles at schools nationwide.