Recruitment and Retention of Hispanic Nurses: Challenges and Opportunities

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 Origin:1995 to 2025, PPL-47;Washington, 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/rnsurvey/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: Master’s Degree Graduate Data # of all students receiving master’s degrees (Fall 2002) • 33,708 # of Hispanic students receiving master’s 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?t=2&id=23 • 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) • Family’s 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, Nat’l 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 Shortage:Impacts 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 UMDNJ’s 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 women’s 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) .