Diversity In Nursing Is An Elusive Goal

April 8, 2009
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County results from the 2008 Michigan Center for Nursing annual survey put a microscope on the lack of diversity in local ranks of registered nurses.

West Michigan's four largest counties lag behind the statewide proportions of registered nurses belonging to ethnic and racial minorities. Instead, black and Hispanic nurses in Kalamazoo, Kent, Muskegon and Ottawa counties are more likely to be licensed practical nurses, jobs that require less education and, consequently, pay less.

The survey questions are posed to nurses renewing their licenses, which they must do every two years. The 2008 questionnaire went to 37,054 registered nurses and 7,520 licensed practical nurses. The results focus on nurses currently with jobs in nursing.

Statewide, the survey showed that 88 of active RNs renewing licenses last year were white; 6 percent were African-American; 2 percent, Native American; and 4 percent, Asian. Among LPNs, 83 percent were white; 13 percent were African-American; 2 percent, Native American; and 2 percent, Asian. Two percent of both RNs and LPNs were Hispanic.

Ottawa County's nursing force is the least diverse of West Michigan's largest counties: 98 percent of RNs and 97 percent of LPNs are white. And in a county that the U.S. Census Bureau estimated is 8 percent Hispanic, just 1 percent LPNs and 0.5 percent of RNs identified themselves as Hispanic, Latino or Spanish.

In Kalamazoo County, which has the highest proportion of minority nurses of the four counties, nearly 6 percent of RNs are of color, and more than half of them are black. Among LPNs, more than 13 percent are of color: 8.8 percent are black and 5.8 percent are Hispanic.

In Kent County, 95 percent of RNs and 90.6 percent of LPNs are white.

"We certainly recognize that we do not represent the populace that we care for," said Julie Coon, chair of the Alliance for Health's West Michigan Nursing Advisory Council. "That has been an issue for us for some time now."

As director of the School of Nursing at Ferris State University, Coon points to the effect of the college admissions process. The nursing shortage is attracting record numbers of applications, she said, but, despite modest growth in capacity, the state's programs are unable to handle the crowd. That's made admission to nursing school highly competitive, at times shutting out good students — and potentially good nurses — who present with solid but less than top high school grade point averages and ACT scores, she said.

Cash-strapped urban school districts, which often have a high rate of minority enrollment, can be challenged to provide the advanced math and science classes that prepare students for such a competitive college admissions process.

"We have become so competitive in the way we admit students to nursing," Coon said. "If a program sorts by highest GPA, that automatically disadvantages many students who might be successful in the program, but they don't get the chance."

Several months ago, Coon sorted through 135 applications for 50 slots in FSU's fall 2009 nursing class. Unlike colleges that focus exclusively on grades and test scores, FSU requires a minimum 2.7 GPA, then accepts candidates based on the date their applications were received.

"It's almost 3 to 1 for every seat," she said. "If everybody sorts by GPA or ACT or whatever, if you have three or four students for every seat, think about the people you are eliminating. I just don't know how you'd get diversity when you do that."

The recession is another hurdle, added Floyd Wilson, executive vice president of human resources at Metro Health.

"The challenge is probably compounded because, right now, even though there's a nursing shortage, there is an employment shortage across Michigan," he said.

Hospitals are interested in having a diverse staff for good patient care, said Wilson, who is on the board of directors of the Grand Rapids African American Health Institute.

"People are more at ease and comfortable when they see people like themselves that are going to deliver their health care," he said. "People vote with their feet. If they feel safe, secure and happy, they'll patronize your organization."

Metro Health recruits across the state and even across the nation, Wilson said. But the pipeline of minority nursing graduates ready for the workplace is a trickle, he said.

"I don't think it would be that difficult to get down into the grade schools, the junior highs, the high schools, that all kids could be motivated to look at those careers. I really believe it's not for a lack of talent. I think it's a lack of knowledge. If you show me, now I know. If you give me an opportunity, I can do it."

Initiatives are under way in Grand Rapids and Kent City to introduce health career concepts at the high school level and even into grade schools.

Judy DeBruyn, a registered nurse who is Spectrum Health's school-health partnerships program coordinator, is working with Grand Rapids Public Schools to turn Central High School into a Center of Innovation for health, science and technology. While planning is still under way, dual enrollment, mentorships and "a summer experience" are all under consideration, DeBruyn said. The CHS program is open to all GRPS students who will be ninth- and 10th-graders in the fall, not just minorities. But 78 percent of GRPS students belong to a minority group.

"Some may go to higher learning, some may want to do a certification or more of a technical job, some may go into the business aspect," DeBruyn said. "I know there has been talk in the community of creating a pipeline from pre-K for the health profession."

State law prohibits Michigan public universities from recruiting minorities. Coon said she bypassed the chance to apply for a Robert Wood Johnson Foundation grant because it would have required participation from certain minority groups, and that would violate FSU's state-law-compliant admissions policy.

"The notion of not being able to use ethnicity or minority status as part of admissions decisions here makes it a little harder," added Grand Valley State University Kirkhof School of Nursing Dean Cynthia McCurren, who came from the University of Louisville in Kentucky in 2007.

She said GVSU and four other West Michigan nursing schools are participating in a small grant to help them winnow ideas for attracting and retaining minority students.

"You almost have to reach down at least to the middle-school level and start making opportunities available for people early on, so they understand the prerequisite work they need through middle school and high school, the study habits they need to develop to make them better prepared to be successful," she added.

Kimberly Slaikeu, director of nursing practice and development at Saint Mary's Health Care, spent seven years teaching nursing at GVSU and at Marquette University in Milwaukee.

"I believe recruitment needs to start earlier in the school-age years, to make sure their curriculum is set up so they are prepared for the college courses they are going to need to take," she said.

Given high school drop-out rates, academic underachievement and secondary schools that lack curriculum resources, the pool of minority students interested in nursing school is small, Slaikeu said. She pointed out that research shows that minority students score lower on standardized tests such as the ACT.

"What are other ways we can evaluate skill sets? It's going to take lot of thinking outside of the box."

She also advocated for mentorship programs, adding that she relied on several mentors as she worked through her undergraduate, graduate and doctoral degrees.

"It's gets difficult," Slaikeu said. "Throughout my whole college career, I was one or two, or the only minority; that gets kind of draining when you don't have anyone who looks like you. If I didn't have mentors along the way, it would have made a huge difference in how I navigated the system."

Coon said she thinks the laws of supply and demand are working against the goal of increased diversity in the nursing ranks.

"The bottom line is, we're not desperate enough," Coon said. "We are so bombarded with so many people wanting to come into our programs. … It's difficult when we have this huge backlog of people just waiting to get in.

"To me, the trick is to see what we can do to give students some kind of advantage so they can get to that point. We're the gatekeepers of the profession. We have to get more diverse student populations."

Registered Nurses By County And Statewide



Kalamazoo
Kent
Muskegon
Ottawa
State


Hispanic
1.4%
1.4%
1.2%
0.5%
2%


White

94.2%
95.6%
96.7%
98.5%
88%


Black

3.1%
1.3%
1.2%
0%
6%

Native
American

1%
0.8%
2.1%
0%
2%


Asian

0.5%
1.5%
0.5%
0.5%
4%

Licensed Practical Nurses By County And Statewide



Kalamazoo
Kent
Muskegon
Ottawa
State


Hispanic
5.8%
1.2%
2.5%
1%
2%


White
86.9%
90.6%
95.8%
97%
83%


Black
8.8%
7.2%
2.5%
0%
2%

Native
American
1.5%
.6%
0%
1%
2%


Asian
.7%
.8%
.8%
1%
2%

Source: Michigan Center for Nursing Survey of Nurses 2008

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