A Developing Proposal for Policies to Diversify the Nursing Workforce
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Transcript of A Developing Proposal for Policies to Diversify the Nursing Workforce
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