Recruitment and Retention of Hispanic Nurses: Challenges and

1
Recruitment and Retention of Hispanic Nurses
Challenges and Opportunities

• Sara Torres, RN, Ph.D., FAAN, Professor and Dean,
  School of Nursing
• University of Medicine and Dentistry of New
  Jersey (UMDNJ)
• Newark, New Jersey
• Past President, National Association of Hispanic
  Nurses

2
Presentation Overview

• Changing demographics/changing times
  Implications for the nursing profession
• Recruitment and retention research data
• Model program components
• Recommendations/strategies for the future

3
Demographic Changes Affecting Nursing
Education/Service Delivery

• Increasing diversity
• Aging population

4
US Population by Race/Ethnicity
5
Projection of the Resident Population by
Race/Ethnicity (Years 2001 to 2050)
Day, J.C. (1996). Population projection for the
United States by age, sex, race, and Hispanic
origin 1995-2050.
6
Percent Distribution of Hispanicsby Group 2000
Current Population Survey, March 2000, PGP-4
7
Aging Population Data
Aging Population
National Center for Health Statistics, 1993.
Hyattsville, MD Public Health Service, 1994. US
Bureau of the Census, Historical Statistics of
the US, Colonial Times to 1970, Washington, DC,
1975.
8
Aging Hispanic Population Data

• Percentage of U.S. population consisting of
  Hispanics aged 65 or older
• 2000 5.0
• 2050 16.4
• http//www.aoa.gov/prof/statistics/minority_aging/
  facts_minority_aging.asp

9
Statistical Comparisons (Total Population/Hispanic
Population)

• Projected National Growth in the Traditional
  College-age Population, 2000-2015
• Total Percent () Increase 16.2
• Projected Hispanic Student Increase () 56.4
• (second only to Asian/Pacific Islander 63.8
  increase)
• Campbell, P.R.Population Projections for States
  by Age, Sex, Race, and Hispanic Origin1995 to
  2025,
• PPL-47Washington, D.C. U.S. Government Printing
  Office, 1996).

10
Statistical Comparisons (continued)

• Total estimated of RNs 2,696,540
• Total estimated of Hispanic RNs 54,861
• Hispanics comprise more than 12 of the U.S.
  population, but only 2 of RNs
• http//bhpr.hrsa.gov/healthworkforce/reports/rnsu
  rvey/rnss1.htm

11
Nursing Education Enrollment Statistics

• Most Hispanic nurses hold associate degrees in
  nursing (ADNs)

12
Nursing Education Graduate Data

• of all students receiving baccalaurate
  degrees/RN (Fall 2002)
• Generic degree 23,436
• RN 9,720
• of Hispanic students receiving baccalaureate
  degrees/RN (Fall 2002)
• Generic degree 1,318
• RN 378
• American Association of Colleges in Nursing.
  Enrollment and Graduations In Baccalaureate and
  Graduate Programs in Nursing 2002-2003.

13
Nursing Education Masters Degree Graduate Data

• of all students receiving masters degrees
  (Fall 2002)
• 33,708
• of Hispanic students receiving masters degrees
  (Fall 2002)
• 1,349
• American Association of Colleges in Nursing.
  Enrollment and Graduations In Baccalaureate and
  Graduate Programs in Nursing 2002-2003

14
Nursing Education Doctoral Program Enrollee Data

• of all students graduating from doctoral degree
  programs in 2002 472
• of Hispanic students graduating from doctoral
  degree programs in 2002 6
• American Association of Colleges in Nursing.
  Enrollment and Graduations In Baccalaureate and
  Graduate Programs in Nursing 2002-2003

15
Percentage of RNs with BSN or Higher by
Racial/Ethnic Group
16
U.S. Nursing Shortage Facts

• Increasing demand for nurses projected to create
  nearly 1,000,000 new jobs (FTE) between 2000 and
  2020
• Decreasing number of new nurses means that the
  number of nurses available to fill these jobs
  will remain flat through 2020

17
Impact of U.S. Nursing Shortage

• According to the U.S. Department of Health and
  Human Services (HHS), a nursing shortage
• Increases the number of hospital admissions for
  the chronically ill
• Increases the number of the chronically ill
  admitted to long term care facilities

18
U.S. Nursing Shortage Facts (continued)

• Average age of an RN in the U.S. workforce was 43
  in 2000 and rising
• http//bhpr.hrsa.gov/dn/dn.htm
• 40 percent of RNs in the workforce will be older
  than age 50 by 2010
• http//www.gao.gov

19
U.S. Nursing Shortage Facts (continued)

• Failure to retain nurses contributes to avoidable
  patient deaths
• http//www.nursing.upenn.edu/news/detail.asp?t2
  id23
• More than 40 percent of hospital nurses report
  being dissatisfied with their jobs
• http//www.healthaffairs.org

20
U.S. Nursing Shortage Facts (continued)

• 1 out of 5 nurses currently in the patient care
  field is considering leaving within the field
  within 5 years (does not include those eligible
  for retirement)
• http//www.aft.org/fnhp/publications/index.html

21
U.S. Nursing Shortage Facts (continued)

• Qualified applicants to nursing programs are
  being turned away because of inadequate
  university resources, including a shortage of
  nursing faculty
• http//www.aacn.nche.edu

22
Barriers to Educational Pursuits

• Villarruel et al. study
• Methodology Focus groups conducted with Hispanic
  nurses at 6 sites nationwide
• San Jose, San Francisco, El Paso, San Antonio,
  New York City, and Springfield, Mass.
• Villarruel, A.M. et al. (2001) J Nurs Education
  40(6) 245-251.

23
Barriers (continued)

• Identified Barriers
• Financial
• Single parents/major wage earners need to work
  full time because of lack of sufficient financial
  aid

24
Barriers (continued)

• Institutional
• Unsupportive faculty
• Perceived discrimination by faculty and peers
• Lack of advisement
• Isolation, separateness

25
Barriers (continued)

• Institutional (continued)
• Isolation, separateness
• Scarcity of mentors, advocates, role models
• Lack of scheduling and program flexibility

26
Barriers (continued)

• Hispanic culture and family
• Prescribed gender roles result in limited family
  support for nursing education
• Conflict between role of family caregiver and
  pursuit of education
• Responsibilities as 1st and 2nd generation
  children (translators, etc.)

27
Barriers (continued)

• Hispanic culture and family (continued)
• Familys limited understanding of benefits of
  higher education
• Language
• Accents, ESL difficulties seen as negative
  reflection of intelligence

28
Bridges to Educational Achievement

• Institutional
• Availability of financial aid
• Flexible programs (weekend, evening classes)
• Accessible, safe locations of classrooms and
  worksites

29
Bridges (continued)

• Institutional
• Availability of supportive faculty, peers,
  colleagues,
• Access to formal and informal mentors
• Clinical experiences in Hispanic communities

30
Bridges (continued)

• Commitment of minority and majority faculty is
  critical to student success
• Supportive faculty characteristics
• Availability to students, respect for students
  expertise, ability to communicate support

31
Bridges (continued)

• Family
• Viewed as major support, not barrier, by some
  students
• Serve as role models and mentors
• Professional aspirations
• Source of greater job mobility, security, and
  social status

32
Bridges (continued)

• Personal factors
• Successful pursuit of degree bolstered confidence
  in their own abilities
• Negative experiences sharpened their resolve and
  better prepared them for adversity

33
University of New Mexico Program

• HRSA-funded, community-based, recruitment-,
  retention-, and graduation-focused program in
  northern and central New Mexico
• (College of Nursing at University of New Mexico)

34
University of New Mexico Program

• Located in large Hispanic population centers
• Focused on developing Hispanic student community
• Identified students
• Nurtured culture-based sense of community

35
University of New Mexico Program

• Involved local agencies in educational process,
  community partnerships
• Led to curriculum changes
• Intercultural communication courses
• E-mail usage
• Video-, computer-assisted instruction

36
University of New Mexico Program

• Featured creation of cooperative, collaborative
  relationships among University-wide subdivisions
  (community colleges)
• Community college/community-based agency/hospital
  relationships led to agreements that provided
  financial assistance and work schedule
  flexibility

37
University of New Mexico Program

• Provided ongoing social support
• Hispanic site coordinators served as friends,
  advocates, stakeholders, gatekeepers, and mentors
• Guided students in more culturally acceptable
  situations, e.g. clusters, dyads
• Made introductions, students would follow up si,
  se puede

38
Helpful Components From Other Programs

• Advising/mentoring components
• Full-time faculty liaison
• Acts as academic advisor, advocate, performance
  monitor
• Provides support when graduate school/personal
  lives conflict
• Peers serve as advisors
• Alumni serve as mentors

39
Program Components (continued)

• Workshops, other study aids
• GRE/reading comprehension workshops, Natl
  Council Licensure Exam preparation, application
  assistance
• Interventions small-group, tutorial, test-taking
  strategies, research database/Web assistance
  (Technology Orientation)
• Quarterly advising meetings involving all
  constituencies

40
Program Components (continued)

• Community involvement
• Local NPs invite students to professional
  practice programs
• Financial support
• Scholarships, stipends, grant application
  assistance
• Outcomes assessment
• Annual evaluation

41
UMDNJ Program

• 13.3 of New Jersey population is Hispanic
• Between 1990 and 2000, Hispanic population grew
  by 48.4
• Of the 67,407 licensed RNs in New Jersey, only 1
  are Hispanic
• Recent graduation statistics indicate s are on
  the rise (5 Hispanic)
• U.S. Bureau of the Census.(2000). Current
  Population Survey. Washington, D.C.
• Forums Institute for Public Policy.(2001). The
  Nursing Workforce ShortageImpacts on Health and
  Medical Care in New Jersey. Princeton, NJ.

42
UMDNJ Program

• Developing relationship with Marion P. Thomas
  Charter School
• (elementary and middle school)
• Participating in UMDNJs Urban Scholars Program
• (high school)

43
UMDNJ Program

• Working with current students, alumni, members of
  state chapters of Hispanic Students Association
  to develop recruitment strategies
• Developing academic support, career advisement,
  mentoring programs
• Mentors chosen from these constituencies, as well
  as from advanced practice nurses practicing in
  affiliated clinical agencies

44
Recommendations/Strategies

• Educate Hispanic communities regarding nursing as
  a career
• Dispel the myth it is a womens profession
• Promote the image of nursing as a rewarding
  career

45
Enhance Recruitment and Retention of Hispanic
Students

• Increase the overall number and percentage of
  baccalaureate prepared minority nurses in the
  basic nurse workforce. At least two-thirds should
  hold baccalaureates of higher degrees by the year
  2010
• Increase the number of minority faculty in
  nursing programs over the number reported by the
  American Association of Colleges of Nurses for
  1997-98
• Bureau of Health Professions Division of Nursing
  (2000). A National Agenda for Nursing Workforce
  Racial/Ethnic diversity. National Advisory
  Council on Nurse Education and Practice.

46
Recruitment and Retention (continued)

• Fund short term programs for high school students
  to be mentored to a nursing career
• Partner with professional associations, e.g.
  NAHN, to encourage RNs to continue their
  education
• Seek private and public support for scholarships
  for Latino nursing students

47
Recruitment and Retention (continued)

• Improve the evaluation of and accountability for
  the outcomes of programs that are funded to
  increase diversity in nursing
• Establish collaborative partnerships among health
  professions education groups to participate in
  the identification of indicators for the academic
  and practice success of minority students .
• Bureau of Health Professions Division of Nursing
  (2000). A National Agenda for Nursing Workforce
  Racial/Ethnic diversity. National Advisory
  Council on Nurse Education and Practice.

48
Recruitment and Retention (continued)

• Educate school counselors on the opportunities of
  Nursing as a career
• Bureau of Health Professions Division of Nursing
  (2000). A National Agenda for Nursing Workforce
  Racial/Ethnic diversity. National Advisory
  Council on Nurse Education and Practice.
• .

49
Require Curriculum Revisions in Schools of Nursing

• Higher Education accreditation organizations must
  require cultural competence training for all of
  their students, staff and faculty
• Organize clinical experiences that include caring
  for Latino clients and families that may be
  monolingual
• .

50
Curriculum Revisions (continued)

• Teach Latino cultural values, i.e Respeto,
  familism, personalism, etc
• Include Electives in Spanish for healthcare
  professionals (Language requirements for College
  students must be addressed)
• .

51
Promote Hispanic Nurse Leadership Development

• Increase the number of minority nurses in
  policy/leadership positions in health care
  administration, academia, and research
• Bureau of Health Professions Division of Nursing
  (2000). A National Agenda for Nursing Workforce
  Racial/Ethnic diversity. National Advisory
  Council on Nurse Education and Practice.
• .

52
Leadership Development (continued)

• Reduce social isolation of minority nurse leaders
  by increasing opportunities for professional
  development activities that focus on the
  development of support systems
• Increase the use of mentors for students and
  those nurses that are young in their careers
• Bureau of Health Professions Division of Nursing
  (2000). A National Agenda for Nursing Workforce
  Racial/Ethnic diversity. National Advisory
  Council on Nurse Education and Practice.
• .

53
Develop Diverse Practice Environments

• Create and maintain workplace environments and
  employee support programs that promote and
  document recruitment, retention and advancement
  of minority nurses
• Bureau of Health Professions Division of Nursing
  (2000). A National Agenda for Nursing Workforce
  Racial/Ethnic diversity. National Advisory
  Council on Nurse Education and Practice.

54
Prepare All Nurses to Provide Culturally
Competent Care

• Establish cultural competence standards in
  education and practice
• Document the effects and benefits of a culturally
  diverse and competent nursing workforce involving
  access to care, outcomes of care, and cost
• Bureau of Health Professions Division of Nursing
  (2000). A National Agenda for Nursing Workforce
  Racial/Ethnic Diversity. National Advisory
  Council on Nurse Education and Practice.