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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.

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Recruitment and Retention of Hispanic Nurses: Challenges and Opportunities

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Recruitment and retention of hispanic nurses challenges and opportunities l.jpg

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


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Presentation Overview

  • Changing demographics/changing times: Implications for the nursing profession

  • Recruitment and retention research data

  • Model program components

  • Recommendations/strategies for the future


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Demographic Changes Affecting Nursing Education/Service Delivery

  • Increasing diversity

  • Aging population


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US Population by Race/Ethnicity


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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.


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Percent Distribution of Hispanicsby Group: 2000

Current Population Survey, March 2000, PGP-4


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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.


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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


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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).


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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


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Nursing Education: Enrollment Statistics

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


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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.


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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


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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


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Percentage of RNs with BSN or Higher by Racial/Ethnic Group


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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


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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


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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


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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


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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


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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


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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.


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Barriers (continued)

Identified Barriers

  • Financial

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


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Barriers (continued)

  • Institutional

    • Unsupportive faculty

    • Perceived discrimination by faculty and peers

    • Lack of advisement

    • Isolation, separateness


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Barriers (continued)

  • Institutional (continued)

    • Isolation, separateness

    • Scarcity of mentors, advocates, role models

    • Lack of scheduling and program flexibility


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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.)


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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


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Bridges to Educational Achievement

  • Institutional

    • Availability of financial aid

    • Flexible programs (weekend, evening classes)

    • Accessible, safe locations of classrooms and worksites


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Bridges (continued)

  • Institutional

    • Availability of supportive faculty, peers, colleagues,

    • Access to formal and informal mentors

    • Clinical experiences in Hispanic communities


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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


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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


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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


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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)


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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


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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


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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


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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”


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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


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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


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Program Components (continued)

Community involvement

  • Local NPs invite students to professional practice programs

    Financial support

  • Scholarships, stipends, grant application assistance

    Outcomes assessment

  • Annual evaluation


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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.


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UMDNJ Program

  • Developing relationship with Marion P. Thomas Charter School

    (elementary and middle school)

  • Participating in UMDNJ’s Urban Scholars Program

    (high school)


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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


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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


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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.


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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


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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.


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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.

    .


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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

    .


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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)

    .


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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.

    .


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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.

    .


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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.


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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.


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