Problem: The nation is increasingly diverse, but the nursing profession remains predominantly White. Programs are in place to increase diversity, but researchers haven’t built up a base of evidence to prove their effectiveness to policy- and other decision-makers.
Background: After earning her baccalaureate degree in nursing at a historically black college in Greensboro, N.C., Margo Brooks Carthon, PhD, enrolled in a master’s program in nursing at the University of Pittsburgh. “It was hard not to miss that there were not a lot of underrepresented minorities in nursing,” she recalls.
The troubling realization has stayed with her ever since and has informed her work as a nurse educator and health services researcher who is focused on reducing health disparities. One way to do that is to diversify the profession. Racial, ethnic and linguistic “concordance” between providers and patients can improve the quality of care, she says.
The Institute of Medicine (IOM) came to the same conclusion in at least two reports in the last decade—The Future of Nursing: Leading Health, Advancing Change and Unequal Treatment: Addressing Racial and Ethnic Disparities in Health Care. A more diverse nursing workforce fosters better interaction and communication with minority patients, can increase access to care and improve adherence to treatment plans, Brooks Carthon explains.
The need for a diverse nursing workforce will become even more critical as the U.S. population becomes increasingly diverse. Indeed, minority groups are poised to reach majority status in three decades, according to the U.S. Census Bureau. But the nursing workforce is still more than 80 percent White, according to a 2008 study conducted by the Health Resources and Services Administration.
Barriers to building more diversity, however, remain high. Underrepresented minorities have less access to adequate educational preparation in math and science; often face higher financial hurdles than Whites; and are less exposed to nursing as a potential career option, Brooks Carthon says.
But she is working to help underrepresented minorities in nursing—and the health care system as a whole—break down those barriers. An assistant professor of nursing at the University of Pennsylvania, Brooks Carthon has studied the historical and social determinants of health inequities and the link between of nursing, health care quality and minority outcomes such as patient satisfaction and mortality.
Solution: Currently, Brooks Carthon is researching the effectiveness of college and university “pipeline” programs designed to recruit and retain students from underrepresented minority backgrounds. Her research is funded by the Robert Wood Johnson Foundation (RWJF) New Connections program, which works to develop and retain a diverse, well-trained leadership and workforce in health and health care to meet the needs of all Americans.
Pipeline programs have proliferated in recent decades, thanks to support from government and other entities, and to university administrators who recognize the need for greater diversity. The health reform law of 2010, for example, set aside funds for nearly 50 schools to support initiatives to recruit and retain underrepresented students in baccalaureate nursing programs.
In response, schools are creating programs that provide underrepresented minority nursing students with everything from financial help to mentoring and peer-networking services, tutoring and academic support, and exposure to clinical and research opportunities.
The problem is that there is little research into these programs. As a result, administrators, policy-makers and program leaders cannot make informed decisions about what elements of pipeline programs are most successful and most cost-effective.
“I’m interested in quality improvement initiatives that work, and we have to figure out what works,” she says.
Brooks Carthon hopes to do just that through her New Connections project, which will provide a base of evidence that can be used to help policy-makers, school administrators and other stakeholders determine the best way to design pipeline programs. For her project, she is conducting an electronic survey of 80 to 100 programs, some funded by a Health Resources and Services Administration workforce diversity program and some not, to evaluate structures and implementation and develop a common set of program measures. The research will be completed in 2013.
“The results of this research will help improve implementation efforts, provide important feedback to programs of nursing and national stakeholders, and assist in identifying aspects of nursing pipeline interventions that work best,” Brooks Carthon asserts.
The results aren’t in yet, but she expects that there won’t be a simple answer to what she sees as a complex question. “Success is multifactorial,” she says. “It has a lot to do with institutional characteristics, the climate and environment of the nursing school itself and its resources, and the human resources that are used to promote recruitment and retention.”
One thing is clear, though. Brooks Carthon does expect to have a data set that is large enough to produce results that are “generalizable” so other nursing schools can use them to develop and implement pipeline programs with proven measures of success. “We have to prove these programs are effective, and we’ll be able to do that better when this project is complete.”
RWJF Perspective: The Robert Wood Johnson Foundation has a deep and long-lasting commitment to narrowing health disparities. One way to do that, the Foundation believes, is to diversify the health care workforce.
The RWJF New Connections program is just one of the many programs supported by the Foundation that are designed to achieve that end. Other programs include the Harold Amos Medical Faculty Development program; Project L/EARN; New Careers in Nursing; the Summer Medical and Dental Program; the RWJF Center for Health Policy at Meharry Medical College; the RWJF Center for Health Policy at the University of New Mexico; and the RWJF Nursing and Health Policy Collaborative at the University of New Mexico.
The Foundation also supports The Future of Nursing: Campaign for Action, an initiative to advance comprehensive health care change. It envisions a health care system where all Americans have access to high-quality, patient-centered care, with nurses contributing to the full extent of their capabilities. A commitment to a more diverse nursing workforce underpins its work.